The study was aimed at determining heart pathology features in young and middle-aged patients with metabolic syndrome (MS). Ln total, 88 people aged 35-55 years, with various MS components, were examined. Seventeen patients had three MS components (Group 1), 42-4 components (Group 2), and 29-5 components (Group 3). Left ventricular (LV) electrical myocardial instability and autonomous dysfunction were observed in 16 %, cardiac arrhythmias - in 28 %, and ischemia -in 22 %. Metabolic disturbance severity directly correlated with the number of MS components. LV structure changes manifested in myocardial hypertrophy and increased myocardial mass (65 %), diastolic dysfunction (45 %), and systolic dysfunction (10 %). Therefore, young and middle-aged patients with various MS components demonstrated LV electrical myocardial instability, heart rate variability disorders, ischemic, structural and functional LV myocardial disturbances. These changes were more manifested in patients with more MS components.

 

To investigate the prevalence of renal dysfunction and disorders in I-Ш Stage primary arterial hypertension, AH (WHO classification, 1997), complicated with AH crises, 563patients (189 men and 374 women aged 25-66 years) were examined. Control group included 619patients (207men and 412 women aged 31-66years) with non-crise Stage I-ШАН. Instrumental examination included renoradiography, static and dynamic renal scintigraphy, ultrasound and computed renal and suprarenal tomography, excretory urography, and selective renal artery angiography, if necessary. Glomerular filtration rate was assessed by endogenous creatinine clearance, and microproteinuria - by urinary excretion of albumin and beta-2-microglobulin. Aldosterone and cyclic nucleotide excretion, plasma renin activity were measured by radio-immune methods. Renal dysfunction and disorders were diagnosed in two-thirds of the patients with crise-characterized primary AH. Chronic mono- and bilateral inflammation and nephrosclerosis were the most prevalent disorders, followed by renal artery stenosis, disturbed renogram secretory phase, decreased functional parenchyma volume and terminal nephrosclerosis, accompanied by increased plasma renin activity. Nitro- and hydroextretory renal functions were not directly linked to AH crise development. Patients with frequent AH crises differed from participants with rare AH crises by such parameters as urinary white and red blood cell excretion, absorptive and excretory renal function.

In 125 thrombolysedpatients with acute myocardial infarction (AMI), baseline dQTc parameters and their dynamics in treadmill test were assessed. The data analyzed with comparison to the number of affected coronary arteries, AMI complications, ventricular arrhythmias (Class 2+ by B. Lown). Maximal dQTc was observed inpatients with complicated AMI and one- or two-vessel coronary pathology. Maximal dQTc increase was registered in participants with non-complicated AMI and one-vessel coronary pathology. There was a direct correlation between dQTc increase, reperfusion syndrome, and ventricular arrhythmias.

Bioelectrical heart function (BEHF) was assessed in 224 women with various morphological variants of euthyroid nodules (ETN). In control group (n=42), BEHF was studied by standard ECG analysis. In all ETN variants, heart rate and ECG wave amplitude were significantly reduced, and ECG wave and interval duration were significantly increased. In 92, 9 % of the cases, cardiac arrhythmias, blockades, repolarization disturbances were observed; combined disturbance rate was as high as 40, 5 %. BEHF disturbances night be explained by mild peripheral hypothyrosis, as TTG level in ETN (3, 1 mkIE/l) was close to upper norm limit.

The study was aimed at identifying clinical diagnostics role of Chlamydia pneumoniae antibodies (ATCP), IgA, G, M, and acute phase proteins in acute coronary syndrome (ACS). In 91 hospitalized ACS patients, aged 35-70 years (mean age 54, 74+0, 89 years), serum levels of specific ATCP IgM, IgA, IgG, C-reactive protein (CRP), and fibrinogen (F) were measured at Days 1, 14, and 27. The participants were divided into two groups: with or without ST segment elevation (ACS ST 1 and ACS STO, respectively). Specific ATCP titers were measured by immuno-enzyme method (test systems SeroCP™IgG, IgA, IgM EIISA, Savyon, Israel). In ACS ST 1 group, ATCP IgM titers, CRP (5, 6 mg/l) and F (4, 7 mg/l) levels were increased, ACS clinical course was more severe, with myocardial infarction (MI) development in 100 % patients; complications were more common. In ACS STO group, no signs of active CP infection were observed; CRP (2, 5 mg/l) and F (3, 7 g/l) level increase was less prominent; MI developed in 50 %. ATCP, CRP, and F level measurement in ACS facilitated differential diagnostics, as well as complication and outcome prognosis.

In this 24-week study, spirapril antihypertensive effect and organo-protection was assessed inpatients with metabolic syndrome (MS) and arterial hypertension (AH). Parameters of 24-hour blood pressure (BP) monitoring (systolic and diastolic BP - 24 hours, daytime, nighttime) and pulse BP were significantly higher in MS patients than in AH individuals. Seventy-five per cent of MS patients had pathological circadian BP profile, with non-dippers' prevalence. In the same group, more advanced target organ pathology was observed (left ventricular hypertrophy, increased vascular stiffness, microalbuminuria). Spirapril therapy was associated with target BP level achievement, circadian BP profile normalization, target organ pathology regression, and was potentially linked to insulin resistance reduction. Therefore, spirapril can be recommended for MS treatment, as well as for preventing target organ damage in MS and AH.

Effectiveness and safety of Class IС antiarrhythmic agent, propafenone (Propanorm, PRO. MED. CS Praha a.s., Czech Republic), was studied inpatients with persistent atrial fibrillation (PAF) after sinus rhythm conversion, during long-term ant-recurrent treatment. The study included 30 men and women; mean age 57, 97± 1, 2 years. PAF was caused by essential arterial hypertension, or its combination with stable coronary heart disease. To treat PAF paroxysms, propanorm was administered in the loading dose of 600 mg, continued by anti-recurrent therapy (450 mg/d for 12 months). All participants also received ACE inhibitor lisinopril (Dapril, PRO. MED. CS Praha a.s., Czech Republic). During anti-recurrent propanorm therapy (450 mg/d), no recurrent AF paroxysms were registered in 63, 3 % of the patients; paroxysm frequency reduced in 23, 3 %; paroxysms remained frequent in 13, 3 %. No adverse events were registered. Twelve-month propanorm and dapril treatment was associated with significant improvements in intracardiac hemodynamics and chronic heart failure functional class, as early as by Month 6.

The authors compared platelet hemostasis effects for two angiotensin receptor blockers, valsartan and eprosartan, in patients with arterial hypertension (AH) and metabolic syndrome (MS). For 16 weeks, 34 patients received valsartan, and 32 - eprosartan. Plasma and platelet lipid peroxidation products, blood and platelet antioxidant potential, platelet hemostasis parameters were investigated. Data were analyzed using Student t statistics. Valsartan therapy in AH and MS patients reduced peroxidation syndrome and optimized primary hemostasis. To reduce body weight in such patients, valsartan should be combined with non-pharmaceutical methods.

In population to the Siberian sample of men the prevalence of hyperhomocysteinemia (HHC) in winter-spring and in autumn seasons of year for the first time is studied, search of theoretically expected associations with CHD and with major factors of its risk is lead. It is executed a screening examination of representative sample of 243 men of 45-69 years with use of the standardized epidemiological and biochemical methods. The prevalence of HHC during the winter-spring period of year has made 43 %, during an autumn season of year has made 52 %. Statistically significant distinctions in the prevalence of HHC between seasons of year it is not revealed. It is not revealed correlation communications between a level of homocysteine blood and presence CHD. Positive correlation of homocysteinemia with the years, with a level of products of lipid peroxidation in IDI, and also its negative correlation with α-tocopherol level in LDL and with an index of weight of a body.

The authors compare unstable angina clinical course, short- and long-term prognosis in working-age male and female residents of Tomsk City. Short- and long-term prognosis is better in female patients with unstable angina than in their male peers. Factors associated with unstable angina incidence include diabetes mellitus in women and previous myocardial infarction in men.

The review is devoted to individual antiaggregant sensitivity issue. According to numerous studies' data, acetylsalicylic acid is ineffective in 5 % of the patients. It might be explained by target molecule (COG-1) gene polymorphism. This phenomenon has important clinical implications, as aspirin-resistant patients have significantly higher risk of thrombotic complications. Another widely used antiaggregant, clopidogrel, is ineffective in more than 15 % of the patients. Clopidogrel effectiveness depends on hepatic iso-enzyme CYP3A activity and ADP receptor gene variant. Many studies demonstrated that clopidogrel resistance worsens prognosis in coronary heart disease patients. Even new antiaggregants, Ilb-IIIa receptor inhibitors, are ineffective in 20 % of the cases, due to glycoprotein receptor gene polymorphism. Therefore, to identify optimal antiaggregant therapy regimen, individual approach is needed, including genetic and pharmacogenetic tests.