Cardiovascular Therapy and Prevention, 2016, 15(6)

Aim. To analyze, how is, under the framework of the Pilot Project, organized and being conducted the improvement of work of the known departments in exact medical institutions (MI) of RF for rehabilitation of cardiovascular diseases (CVD) patients at the three steps under the current “Order of medical care and medical rehabilitation”, and how do the scientifically proven and types and methods of cardiorehabilitation (CR) being implemented, and to try to elaborate on an exact algorithm for patients course.

Material and methods. Into the Pilot Project, 17 MI included, from 13 entities of RF. For the analysis of effectiveness of organizational models of CR in MI the unified charts were developed making to assess the equality to the Order of the rehabilitation care provided to patients with CVD, of multidisciplinary team involved in care, the staff list and MI equipment.

Specific charts included the units assessing the efficacy of work on three stages of CR: I stage — in resuscitation and intensive care unit or specialized cardiology department, II — in in-patient department, III — in polyclinics. The article presents data from CR analysis of Jan 2013 to Dec 2015.

Results. The CR was organized at the stage I in 10 MI, stage II in 10 MI and stage III in 7 MI. By the year 2015, almost in all MI the multidisciplinary teams were shaped, including cardiologist, cardiorehabilitologist, exercise specialist, clinical psychologist, physiotherapist; the rooms for exercise were equipped, as the halls for education of patients. The start of rehabilitation process from ICU made it to decrease the remaining of patient on the bedside for 0,7 days in average (2013-2015) and for 1 day in cardiovascular department. About 67% myocardial infarction patients in average were transferred to the stage II of CR. In all MI there were educational Schools organized, and the explanatory talks with the relatives were done as well. By now, the project is on its way.

Conclusion. The analysis of three-staged CR system for myocardial infarction patients according to current laws, showed significant improvement of rehabilitational activeness of the newly created multidisciplinary teams at all stages of CR, increase of the number of methods of CR and better fulfillment of those, as demonstrated the safety of proposed principals of physical rehabilitation according to the Russian clinical guidelines “Myocardial infarction with ST elevation: rehabilitation and secondary prevention” under the framework of the organizational model of CR.

Key words: cardiovascular rehabilitation, acute myocardial infarction, organization, exercise treatment, rehabilitation stages.

Cardiovascular Therapy and Prevention, 2016; 15(6): 4–12

http://dx.doi.org/10.15829/1728-8800-2016-6-4-12

Aim. To study the clinical course and outcomes of myocardial infarction (MI) in diabetes mellitus patients (DM) and non-diabetic, underwent percutaneous coronary intervention (PCI).

Material and methods. Totally, 99 MI patients included, that underwent PCI with stenting. Patients were selected to 2 groups by absence or presence of DM: group 1 (n=49) — DM type 2; group 2 (n=50) — non-diabetic and glucose intolerance. We studied the baseline clinical and demographic, as laboratory and instrumental characteristics of patients, specifics of in-patient

stage of treatment and outcomes in 1 year after discharge.

Results. There was predominance of women in DM2 group and developing MI. It was found, that DM patients adhered the preclinical treatment of ischemic heart disease in 47% cases and about 20% DM patients did not take glucose lowering medications. In patients from group 1 the arterial hypertension was diagnosed significantly more commonly in comparatively lower values of the left ventricle ejection fraction. More commonly than the other complication of MI, the acute heart failure developed (14%). By the end of the 1 year, DM patients nonsignificantly more commonly had recurrent hospitalizations for all

cardiovascular causes, as the cases with fatal outcomes.

Conclusion. The course of MI in DM has its specifics as comparatively lower values of myocardium contractility, significant lesion of coronary vessels, high number of acute period of MI complications with indefinite influence on the one-year prognosis.

Key words: myocardial infarction, diabetes mellitus, percutaneous coronary interventions, prognosis.

Cardiovascular Therapy and Prevention, 2016; 15(6): 13–18

http://dx.doi.org/10.15829/1728-8800-2016-6-13-18

Aim. To evaluate the effectiveness of fixed combination of perindopril arginine and amlodipine besilate (Prestans®, Les Laboratoires Servier) in optimal treatment scheme selection of arterial hypertension (AH) in patients with chronic heart failure (CHF) having the signs of chronic kidney disease (CKD).

Material and methods. Totally, 118 patients studied, with essential AH, with CHF. In 53 (44,9%) of those, thre were signs of CKD. The latter presented with a decreased glomerular filtration rate (GFR) and increased cystatin C in the blood plasma (1,4±0,3 mg/L). As the treatment, they were prescribed the fixed combination of perindopril arginine and amlodipine besilate — 5/5, 5/10, 10/10 mg. The assessment of treatment was done in 2 months follow-up.

Results. During treatment there was significant decrease of office systolic and diastolic blood pressure (BP). Target BP was reached in 82,6% cases. The mean daily values of systolic and diastolic BP load became lower. During the treatment, there was improvement of clinical condition by functional class of CHF. The score by CAS decreased from 6,2±1,1 to 4,2±1,3 (р<0,01) and exercise tolerance increased: sixminute walking test distance from 160,4±14,5 to 307,14±13,1 m (р<0,01). Also, the level of cystatin C decreased in plasma, and GFR increased, witnessing the improvement of functional capacity of kidneys as a result of treatment.

Conclusion. The fixed combination of perindopril arginine and amlodipine besilate can be successfully applied into treatment of AH and CHF patients with the signs of CKD.

Key words: chronic heart failure, chronic kidney disease, arterial hypertension.

Cardiovascular Therapy and Prevention, 2016; 15(6): 19–23

http://dx.doi.org/10.15829/1728-8800-2016-6-19-23

Aim. To compare efficacy of bisoprolol and nebivolol treatment in ventricular arrhythmias patients (VA) and arterial hypertension (AH) and/or ischemic heart disease (IHD) taken its influence on regulatoryadaptive state (RAS).

Material and methods. Totally, 60 patients participated with VA of Lown I-IV grades, Bigger II-III grades, at the background of AH II-III stage and/or IHD, who were randomized to 2 groups of treatment: bisoprolol 6,5±1,8 mg daily or nebivolol 6,5±2,1 mg daily. As combination therapy, lisinopril was used 12,3±4,0 mg daily and 13,7±4,5 mg/daily, acetylsalicylic acid 92,3±18,8 mg/daily and 92,9±18,2 mg/daily, atorvastatin 16,3±4,8 mg/daily and 16,5±4,7 mg daily together with bisprolol or nebivolol, respectively. At baseline and in 6 months of therapy we performed: quantitative RAS assessment via the test of cardio-respiratory synchronicity, echocardiography, triplex scanning of brachocephalic arteries, tredmill, six minute walking test, 24-hour blood pressure monitoring and ECG monitoring, self-assessed life quality.

Results. Both regimens of combination therapy comparably same improved structural and functional state of the heart, decreased blood pressure, effectively suppressed ventricular arrhythmia. However, only nebvolol positively influenced RAS, better improved exercise tolerance and improved life quality.

Conclusion. In VA patients with AH of II-III stages and/or IHD, usage of nebivolol, comparing to bisoprolol, as combination therapy, might be more preferrable due to positive influence on RAS.

Key words: regulatory-adaptive state, ventricular cardiac arrhythmias, bisoprolol, nebivolol.

Cardiovascular Therapy and Prevention, 2016; 15(6): 24–30

http://dx.doi.org/10.15829/1728-8800-2016-6-24-30

Aim. To assess the factors associated with combination cardio protection therapy intake in patients with atherosclerotic lesion of lower extremities.

Material and methods. Totally, 436 patients studied: 372 (82,3%) males and 64 (14,7%) females at the age 45-81 (mediana 63) year old with obliteration atherosclerosis of lower extremities >50%. Patients were investigated under the framework of the registry in Kemerovo cardiological center in 2009-2013 y. The study included a dynamic follow-up of vascular surgeon and cardiologist, instrumental and laboratory investigation. Depending on the regularity of cardioprotection therapy, two groups were shaped: group 1 (n=226) taking full combination cardioprotection therapy: antiplatelets, inhibitors of angiotensin-converting enzyme or angiotensin receptor blockers and statins, group 2 (n=210) did not take at least one of the listed drug groups.

Results. The intake of combination cardioprotection therapy was associated with higher prevalence of arterial hypertension (95,1%), myocardial infarction (46,5%), coronary bypass and percutaneous coronary intervention (21,1% and 32,3%, resp.), as interventions on extracranial arteries (12,8%). Patients from this group had angina presentation more often and the diagnosed coronary heart disease — 68,1% and 83,2%, resp. Almost 60% of patients with adequately prescribed treatment were followed-up by cardiologist. In laboratory data of this group there was lower level of total cholesterol. Patients had significantly larger left ventricle and lower ejection fraction.

Conclusion. The factors associated with optimal medication treatment were ischemic heart disease (p<0,001), cardiologist follow-up (p<0,001), decrease of total cholesterol (p=0,02). To increase the effectiveness of secondary prevention in obliteration atherosclerosis of lower extremities it is worthy to apply novel organizational approaches during outpatient period, particularly, dispensary follow-up in cardiologist practice.

Key words: obliteration diseases of lower extremities arteries, atherosclerosis.

Cardiovascular Therapy and Prevention, 2016; 15(6): 31–38

http://dx.doi.org/10.15829/1728-8800-2016-6-31-38

Aim. The research on medical technologies for optimization of complication prevention and of post-surgery management of patients with coronary heart disease (CHD) with ejection fraction (EF) of the left ventricle (LV) <40% in surgical revascularization of the heart.

Material and methods. In the controlled, randomized study of 103 CHD patients with severe systolic dysfunction of the LV, the effectiveness of aortic coronary bypass surgery was studied. All patients underwent clinical investigations, where the severity of patient’s condition was assessed, as the risks of surgery by EuroSCORE, severity of heart failure signs by the clinical condition scale, echocardiography, clinical and chemistry lab. Aldosterone levels were studied with immune enzyme assay, brain natriuretic peptide — with immune enzyme assay, redox potential (NAD/NADP) with the Sigma-Aldrich system, procollagen III of N-end peptide — with the test-system USCN, Statistics was done on the software Statistica 8.0.

Results. The inclusion to pre-operation preparing of patients of a drug with positive inotropic properties and decreasing the level of systemic inflammation syndrome, dosage of 2 ampules intravenously during 3 days before operation and with following 7-day post-surgery, in CHD patients with significant LV dysfunction influences positively the symptoms of chronic heart failure, initiates the deremodeling of the heart — significantly decreases the end-systolic size and increases EF LV, reduces pulmonary hypertension, significantly decreases the duration of artificial ventilation, timing of inotropic support, duration of stay in ICU. It is shown that the level of brain natriuretic peptide (NT-proBNP) in plasma does negatively correlate with EF LV (r=-0,69, p<0,01) and redox-potential NAD/NADP (r=-0,89; p=0,0001). At the background of Adenotsin® treatment there is significant decrease of NT-proBNP level by the 7th day after operation by 55%, the level of renin decreases, of aldosterone and procollagen type III in blood, that confirms the positive prognosis of treatment. There are no negative events in the drug course of implication for the studied category of patients.

Conclusion. The data obtained makes it to recommend Adenotsin® for presurgery medication and postsurgery therapy in cardiovascular diseases.

Key words: postinfarction cardiosclerosis, brain natriuretic peptide, aldosterone, myocardium remodeling, Adenotsin®.

Cardiovascular Therapy and Prevention, 2016; 15(6): 39–45

http://dx.doi.org/10.15829/1728-8800-2016-6-39-45

Aim. To assess the relation of obstructive sleep apnea syndrome (OSAS) by the data of Berlin questionnaire and risk of fatal cardiovascular events.

Material and methods. Totally, 275 persons studied (115 males, 160 females) age 25-64 y. o., with unknown cardiovascular complications, underwent structured interview. The risk of sleep-disordered breathing was assessed by Berlin questionnaire, cardiovascular risk — by SCORE. Anthropometric parameters were studied, as lipid profile, fasting glucose, uric acid, creatinine, C-reactive protein, adiponectin, leptin.

Results. The increased OSAS risk according to Berlin questionnaire was found in 7,3% of the studies. Most (90,0%) common was concomitance of the components of OSAS such as snoring/stops of respiration and cardiometabolic disorders. Males more frequently complained on snoring/ stops of breathing — 21,7% vs 6,3% (p=0,001), that determined higher general risk of OSAS among them comparing to women — 11,3% vs 4,4% (p=0,03). For males (1,7%) and females (3,1%) the complaints on daytime sleepiness were less common. Among those 40 y. o. and older the increased risk of OSAS was found in 9,8%, comparing to 1,2% younger than 40 y. o. (p=0,01). In higher OSAS risk there was higher total cholesterol — 6,10±0,18 vs 5,53±0,09 mM/L (p=0,05) and low density lipoproteides — 4,17±0,19 vs 3,59±0,08 mM/L (p=0,02); they were more often overweight — body mass index 31,73±1,19 vs 27,71±0,38 kg/m² (p=0,001), and had higher systolic pressure — 134,89±4,96 vs 126,72±1,18 mmHg. (p=0,04) and diastolic pressure — 84,26±2,69 vs 78,55±0,80 mmHg (p=0,03). Respondents with higher risk of OSAS regardless the gender, did not differ by SCORE. While determine the specific combinations of OSAS components, there was no independent significance of snoring/respiration pauses and daytime sleepiness in the total cardiovascular risk by SCORE.

Conclusion. In the Russian population, higher OSAS risk is associated with the signs of metabolic syndrome. Berlin questionnaire does not reveal the subgroups of those who have OSAS risk together with cardiovascular risk.

Key words: sleep-disordered breathing, obstructive sleep apnea, Berlin questionnaire, cardiovascular risk, metabolic syndrome.

Cardiovascular Therapy and Prevention, 2016; 15(6): 46–52

http://dx.doi.org/10.15829/1728-8800-2016-6-46-52

Aim. To assess the relation of polymorphism of the genes APOC3, PON1, AGT, AGTR1 and psychovegetative disorders in young, relatively healthy persons.

Material and methods. Totally, 75 healthy volunteers included, white race, aged 20-25 y. o. Psychovegetative status was assessed with tests for panic attacks revealing, anxiety level assessment, as with the questionnaire for vegetovascular dystony. The inclusion criteria was organic pathology of cardiovascular and central nervous system. Genes polymorphism was identified with the method of pyrosequencing of desoxyribonucleic acid with the genetic analysis equipment “PyroMark Q24”.

Results. The presence of vegetovascular dystony, panic attacks and increased level of anxiety was mostly associated with the presence of T polymorphism -482 C>T gene APOC3, allele М polymorphism L55M А>Т gene PON1 and allele А — polymorphism А1666С А>С gene AGTR1.

Conclusion. There is relation of genes polymorphism playing role in lipids metabolism and arterial pressure regulation, with psychovegetative status of the young, relatively healthy persons.

Key words: genetic polymorhpism, panic attacks, vegetative dystony.

Cardiovascular Therapy and Prevention, 2016; 15(6): 53–57

http://dx.doi.org/10.15829/1728-8800-2016-6-53-57

Aim. To study the nosological structure and mortality dynamics of adult population from cardiovascular diseases (CVD) by nosological and agerelated regards.

Material and methods. The study uses the data from Rosstat on the population in general, mortality in yearly age groups according to the causes of death based on the Brief list of fatal outcomes of Rosstat. During analysis the nosological structure of fatal cases from CVD in 2006 and 2014 was assessed, part of the each of cases of death defined in the total number of adults died and in mortality values from CVD in 5-year age groups.

Results. The significant decrease of mortality from CVD was found, related to the improvement of organization and of quality of medical care. Simultaneously conducted analysis of structure and parameters of mortality witness the problems of comparison of mortality from different causes of from combination of causes.

Conclusion. There is necessity in review of clinical and anatomic criteria of cardiological diagnostics.

Key words: cardiovascular diseases, mortality, nosological structure.

Cardiovascular Therapy and Prevention, 2016; 15(6): 58–65

http://dx.doi.org/10.15829/1728-8800-2016-6-58-65

The review presents with the literary data on the prevalence of risk factors (RF) of cardiovascular diseases among inhabitants of rural areas comparing to citizens from the point of view explaining the mortality gradients between rural and city inhabitants in many countries in the world. It is shown that gradients of RF prevalence among rural inhabitants and citizens are oppositely directed and might change with time. In Russia in general the profile of RF among rural inhabitants is less benign comparing to citizens, that may explain mortality gradient. This issue demands further investigation.

Key words: risk factors, cardiovascular diseases, rural inhabitants, gradients.

Cardiovascular Therapy and Prevention, 2016; 15(6): 66–71

http://dx.doi.org/10.15829/1728-8800-2016-6-66-71

Recently, there is a lot being done for optimization of care in pulmonary embolism (PE), however there is no significant decline in mortality and its structure within this pathology. Epidemiological data on PE remain unknown due to difficulties in diagnostics, however the data has been collected, witness for the low levels of diagnostics of this pathology, but not rareness of its development. Based on the Regulation of the Ministry of Health from 29.12.2012 № 1706 (ed. from 13.02.2013) in the regions, there are schemes for routing of patients with one or another nosology, that are the administratively proven order of direction with a detailed explication of all movements related to medical care. Hence, the routing of an exact patient is a process of an optimal route of scheduled events for quality medical care with minimal time and financial expenses. Under framework of 3-level system of medical care, the order for PE patients is not yet established. However, it is known that in this category of patients an on-time verification of PE and start of adequate treatment do determine prognosis. Therefore, the optimal organization of routing for patients with suspected PE does determine a course of disease and might, in many cases, prevent fatal outcome. This article focuses on the optimal routing of patients with suspected PE.

Key words: pulmonary embolism, routing, levels of medical care, emergency crew.

Cardiovascular Therapy and Prevention, 2016; 15(6): 72–77

http://dx.doi.org/10.15829/1728-8800-2016-6-72-77

The cumulative impact of the so called “reversible” risk factors into development of chronic heart failure (CHF) is significant even with no significant myocardium injury. According to current view, mechanism of the complex multiorgan involvement does define the high level of mortality among patients with acute decompensation, demanding of the necessity of holistic approach to prevention and treatment of CHF. Taken that the main expenses on treatment of a one taken patient with CHF are

mostly on in-patient management, decrease of hospitalization rates does have two reasons. It makes to improve not just a stability of the disease, but wil improve life quality of severe condition patients significantly decreasing the expenses on their management.

Key words: chronic heart failure, acute decompensated chronic heart failure, hospitalization, pathogenesis, prognosis.

Cardiovascular Therapy and Prevention, 2016; 15(6): 78–82

http://dx.doi.org/10.15829/1728-8800-2016-6-78-82

Arterial hypertension (AH) is a serious medical and social problem due to its complications leading to disability. Recently, there is a lot of attention paid to markers evaluation for cardiovascular pathology — endothelial dysfunction, arteries elasticity decline, increased pulse wave velocity (vascular wall stiffness) and studying of an influence of various antihypertension treatments. Current article focuses on the modern influences on remodeling of vessel wall in AH and opportunities of its pharmacological correction with angiotensine converting enzyme inhibitors, calcium channel blockers and beta-blockers as monotherapy and combination.

Key words: arterial hypertension, vessel wall stiffness, inhibitors of angiotensine converting enzyme, calcium antagonists, beta-blockers, combination antihypertension treatment.

Cardiovascular Therapy and Prevention, 2016; 15(6): 83–88

http://dx.doi.org/10.15829/1728-8800-2016-6-83-88