Aim. To assess the role of endothelial dysfunction and circadian blood pressure profile disturbances in the development of cerebrovascular insufficiency among patients with metabolic syndrome (MS). 

Material and methods. The study included 53 MS patients (8 men and 44 women; mean age 51,6+5,5 years), who underwent brain single-photon emission computed tomography, neuro-psychological assessment, 24-hour blood pressure monitoring (BPM), and brachial artery Doppler ultrasound, in order to assess endothelial function. The control group (12 healthy volunteers) was comparable by age and sex with the main group. 

Results. MS patients had significantly lower parameters of cognitive function and regional cerebral blood flow (rCBF), compared to controls. At the same, in all patients, a standard neurological examination did not identify any local symptoms. There was a strong association between endothelial function, 24-hour BPM, rCBF, and cognitive status parameters. 

Conclusion. In MS patients, one of the pathogenetic mechanisms of cognitive dysfunction is a reduction in rCBF, which is linked to endothelial dysfunction and circadian BP profile disturbances.

Aim. To investigate morphological and volumetric parameters of left and right heart and large arteries in young individuals with stable normal blood pressure (StNBP) and unstable BP (UnStBP). 

Material and methods. We examined 76 students aged 19–24 (mean age 19,9±0,9 years). All participants were divided into Group 1 (28 people with StNBP) and Group 2 (48 people with UnStBP). Both groups underwent echocardiography and duplex ultrasound of large arteries. 

Results. Young individuals with UnStBP, compared to their peers with StNBP, demonstrated higher linear and volume atrial and ventricular sizes, as well as higher left and right ventricular stroke volumes. All morphological and functional changes were more pronounced for the right ventriculum. Participants with UnStBP were characterised by a 25% increase in minute volume, primarily due to increased circulating volume. In individuals with Stage 1 arterial hypertension, left and right ventricular remodelling and hemodynamic disturbances were more pronounced, and minute volume was reduced (by 36%, compared to people with StNBP), with reduced inotropic reserve and increased chronotropic reserve. In UnStBP, blood flow was redistributed and increased in the brachiocephalic region, mostly due to increased circulating volume and decreased blood flow volume in femoral arteries. 

Conclusion. The pathogenesis of BP elevation in young people involves the increase in circulating volume, brachiocephalic blood flow, and cardiac preload. In parallel to the BP elevation, morphological and functional grounds for heart failure are developing.

Aim. To assess the association between Type D personality and the severity of subclinical peripheral atherosclerosis in patients with chronic pulmonary disease. 

Material and methods. In total, 134 patients with chronic pulmonary disease (104 men and 30 women; mean age 58,9±0,5 years, range 44–78 years), who participated in the rehabilitation programme at the Topaz Rehabilitation Centre, were examined. All participants underwent spirometry, 6-minute walk test, and clinical and biochemical blood assays. Type D personality was diagnosed using the DS-14 instrument. Colour duplex ultrasound of carotid arteries and leg arteries was used for the assessment of intima-media thickness and ankle-brachial index (ABI). All patients were divided into two groups: with pathologic ABI (<0,90 or >1,40; n=28) and with normal ABI (0,9–1,40; n=106). 

Results. Both groups were similar by the spirometry results and 6-minute walk test distance (481±16 and 502±8 m, respectively; p=0,217). The DS-14 levels of negative affect were similarly high in both groups (11,8±0,8 and 10,4±0,5; p=0,209); however, in patients with pathologic ABI, the levels of social inhibition were significantly higher (12,4±0,8) than in patients with normal ABI (9,9±0,6; p=0,033). The prevalence of Type D personality was significantly higher (67,9%) in patients with pathologic ABI, compared to their peers with normal ABI (36,8%; p<0,0001). In multilevel logistic regression analyses, only age, Type D personality, and blood leukocyte count were independent predictors of pathologic ABI. 

Conclusion. In the examined patients with chronic pulmonary disease, 21% had subclinical peripheral atherosclerosis. Patients with pathologic ABI were older and had higher blood levels of total cholesterol, triglycerides, and leukocytes, higher levels of intima-media thickness and social inhibition, and a higher prevalence of Type D personality. The assessment of psychological distress predisposition and its correction could play in important role in the cardiovascular prevention among patients with chronic pulmonary disease.

Aim. To study the association between body mass index (BMI) and cardiovascular (CV) death risk in an open population ofTumenCity, using prospective data of the 12-year follow-up. 

Material and methods. In 1996, a cardiologic screening of a representative Tumen City sample (25–64 years) was performed, using standard methods and achieving a response rate of 80,4% (n=1608). Over 12 years of the prospective follow-up, 85 CV deaths in men (10,69%) and 33 CV deaths in women (4,06%) were registered. Using Cox regression models, the parameters of absolute and relative risk (AR, RR) were assessed. Survival assessment was performed using the Kaplan-Meier method. 

Results. In men, RR of CV death was significantly higher for the top quintile of body mass index, BMI (

According to WHO, arterial hypertension (AH) determines the structure of morbidity, mortality, and disability of adult populations. However, the origins of AH stem from the childhood, as the development period of regulatory mechanisms and structural disorders. 

Aim. To assess the blood atherogenic potential among children living in ecologically unsafe regions and to investigate the role of metabolic disorders in the AH development. 

Material and methods. In total, health status was assessed in 1500 children from ecologically unsafe regions of theMoldovaRepublic. All Moldovan regions were divided into 3 categories: moderate xenobiotic pollution; heavy xenobiotic pollution; and a control zone. Morbidity assessment was based on standard methods and unified diagnostic criteria. In addition, physical development, blood pressure, autonomic haemostasis, metabolic status, and atherogenic index were assessed. 

Results. AH was diagnosed in 3,1% of the examined children, and its prevalence was higher in more polluted regions. Among children and adolescents from ecologically unsafe regions, a relatively high prevalence of metabolic syndrome, reduced antioxidant protection, and pronounced hypothalamic dysfunction suggested an important role of xenobiotics in the AH development during childhood. Metabolic syndrome was characterised by a significant increase in the levels of lipids and low-density lipoproteins, as well as by elevated levels of total cholesterol and triglycerides. Atherogenic index was doubled in children from ecologically unsafe regions, compared to their peers from the control group. In all children with AH, dyslipidemia was observed. Compared to healthy children, atherogenic index was 2,4 and 1,7 times higher in hypertensive children with overweight or normal body weight, respectively. 

Conclusion. Assessment of blood atherogenic potential in children from ecologically unsafe regions could be used for the prediction of AH development and progression.

Background: Atrial septal defect (ASD) can be closed safely by transcatheter closure with an Amplatzer septal occluder (ASO) with cardiac computed tomography (CT) being used to image and evaluate the ASD. The purpose of this study was to evaluate the characteristics of Secundum ASD by CT and to determine whether cardiac CT is an alternative to balloon sizing. 

Methods and Results: Forty-four ASD cases were evaluated by cardiac CT. we measured the defect diameters and lengths of the rims. The patients were divided into two groups: not using a balloon sizing technique (group 1), and using a balloon sizing technique (group 2). Most ASD cases showed ellipsoid defects with 19,6±6,5 cm for the longest diameter and 15,5±5,3 for the shortest. Except for two patients, they had sufficient posterior-inferior rims. We observed that the ratios of the device size to the longest diameter and the ratios of the occluder area to the defect area measured on CT were significantly smaller in group 1 than those in group 2 (1,1±0,1 vs 1,3±0,2 and 1,6±0,3 vs 2,2±0,9). 

Conclusions: Cardiac CT is useful for evaluating ASDs for transcatheter closure with an ASO. It can allow the operator to select a smaller size device than when using a stretched balloon sizing technique.

Aim. The issue of safety and effectiveness of endovascular correction of atrial septal defects (ASD) in children aged 0–3 years remains controversial, due to a range of technical challenges and inadequate knowledge on the right atrium remodeling consequences in children across age groups. We analysed the in-hospital, 30-day, and long-term (12 months) outcomes of transcatheter correction of secundum ASD and occluder implantation in 89 children. 

Material and methods. All patients were divided into two groups: Group 1 (n=49) – younger children (mean age 1,7±0,6 years) who were operated before the age of 3; and Group 2 (n=40) – older children (mean age 6,2±3,2 years), who underwent the surgery after the age of 3. In both groups, no in-hospital or long-term (12 months) adverse effects, such as death, occluder migration, or the need for open surgery, were registered. 

Results. By Day 30 after the surgery, both groups demonstrated a consistent, significant reduction in mean size of right atrium, which persisted for the next 12  months (p<0,05). 

Conclusion. In children aged 0–3 years, endovascular correction of ASD is safe and effective. It is also beneficial in terms of right atrium remodelling effects, both in younger children (mean age 1,7±0,6 years) and in older children (mean age 6,2±3,2 years).

Aim. To assess the clinical value of cystatin C for the prediction of the in-hospital complication risk among patients with coronary heart disease (CHD) who underwent coronary artery bypass graft surgery (CABG). 

Material and methods. The perioperative period data were analysed for 583 patients who underwent CABG in March-November 2011. Before the surgery, all patients underwent colour duplex ultrasound of peripheral arteries. One day before CABG and at Day 7 after the surgery, serum levels of creatinine and glomerular filtration rate (GFR; MDRD formula) were assessed. In 150 participants, cystatin C concentration was measured one day before the surgery and at Day 7 after CABG. The incidence of in-hospital adverse outcomes of CABG, such as myocardial infarction, stroke, acute renal failure, and repeat mediastinotomy, was evaluated. In all participants, the risk levels by the EuroSCORE scale were measured. 

Results. Pre- and post-surgery levels of serum creatinine and GFR did not differ significantly between the low, intermediate, and high EuroSCORE risk groups. Moreover, pre- and post-CABG levels of serum creatinine and GFR were similar in patients with favourable and adverse outcomes. However, the concentration of cystatin C, both before and after CABG, was significantly higher in patients with adverse outcomes, compared to participants with favourable outcomes. 

Conclusion. These findings suggest that cystatin C could be used as a universal prognostic marker of cardiovascular complications and renal dysfunction in post-CABG patients.

Aim. To study the changes in antioxidant status and glucose-insulin homeostasis among atorvastatin-treated patients with metabolic syndrome and to investigate the potential of coenzyme Q10 for the correction of these changes. 

Material and methods. The study included 44 patients with metabolic syndrome (MS). For one year, the first group (n=21) received atorvastatin, while the second group (n=23) received atorvastatin and coenzyme Q10. The examination included the assessment of lipid and carbohydrate metabolism, lipid peroxidation system, and antioxidant status parameters. 

Results. Atorvastatin suppressed antioxidant system and increased insulin resistance in patients with MS. The combination of atorvastatin and coenzyme Q10 increased antioxidant defence levels, prevented a statinnduced increase in lipid peroxidation, and did not affect carbohydrate metabolism parameters in MS patients. 

Conclusion. The combination of atorvastatin and coenzyme Q10 demonstrated lipid-lowering effects, optimised lipid peroxidation processes, increased antioxidant defence levels, and minimised negative statininduced effects on glucose and insulin metabolism in MS patients.

Aim. To assess the dynamics of skin microcirculation (MC) in response to medications with different mechanisms of hypotensive action in patients with arterial hypertension (AH). 

Material and methods. In patients with Stage 2–3 AH, MC was assessed by laser Doppler flowmetry at baseline and after a single administration of corinfar (n=38), capoten (n=37), and concor (n=37). 

Results. In patients with a clear hypotensive effect of the examined medications, the dynamics of skin MC parameters was similar. The reorganisation of peripheral hemodynamics was characterised by dysbalanced and insufficiently effective regulatory processes and restricted reserves of capillary blood flow. The increase in tissue perfusion was due to the increased pulse filling of MC vessels. 

Conclusion. Similar dynamics of MC parameters in response to the administration of medications with different hypotensive mechanisms suggests that an acute drop in peripheral vascular resistance leads to an urgent adaptive reaction aimed at the maintenance of adequate capillary-tissue metabolism.

This paper compares the results of multiple studies on antihypertensive diuretics
and various clinical parameters in patients with arterial hypertension, including
vascular stiffness, end-points, hypotensive effects, organ protection, potassium
levels, and metabolic effects.

Aim. To assess the therapeutic potential of ivabradine, as a part of complex treatment regime, for the correction of the target organ pathology in patients with chronic heart failure (CHF) of ischemic aetiology. 

Material and methods. In total, 90 patients with Functional Class II–III CHF and stable angina were examined. All participants were divided into three groups, by the type of 6-month antiischemic therapy: Group 1 received perindopril and ivabradine; Group 2 was administered perindopril, bisoprolol, and ivabradine; and Group 3 received perindopril and bisoprolol. At baseline and after 6 months of the treatment, the following renal and arterial parameters were assessed: glomerular filtration rate (GFR; MDRD formula); pulse wave velocity (PWV measured for elastic-type vessels on the right and left side: R-PVW and L-PVW); cardiac-ankle-vascular index (CAVI1); carotid-femoral PWV (PWVcf); aortic PWV (PWV) and carotid PWV (C-PWV); and radial and carotid augmentation index (R-AI and C-AI). In addition, blood levels of the following biomarkers were measured: N-terminal pro B-type natriuretic peptide (NT-proBNP); and key markers of renal and arterial extracellular collagen matrix: tissue inhibitor of matrix metalloproteinase 1 (TIMP-1) and C-terminal telopeptide of collagen 1 (CTP-1). 

Results. After 6 months of a complex ivabradine-including therapy, a significant positive dynamics was observed for the levels of GFR, TIMP-1 and CTP-1 (extracellural collagen matrix markers), and NT-proBNP (a myocardial stress marker). The improvement in arterial wall structure and function was manifested in both reduced stiffness (decreased CAVI1 and PWVcf) and increased elasticity and distensibility (decreased PWV and C-PWV). The improvement in arterial elasticity and distensibility was significantly greater in patients receiving the three-medication therapy. 

Conclusion. The findings on the ivabradine therapy, as a part of complex treatment regime in patients with ischemic CHF, demonstrated nephro- and vasoprotective effects of ivabradine.

Aim. To study erythropoietic activity and safety of methoxy polyethylene glycol epoetin beta (MEB) and its effects on haemoglobin (Hb), erythropoietin, ferritin, NT-proBNP, cytokines, and chronic heart failure (CHF) symptoms and signs. 

Material and methods. In total, 84 patients with Functional Class (FC) II–IV (NYHA) CHF and anaemia were examined (mean age 59,7±1,6 years; 54 men and 30 women). Anaemia criteria were Hb levels <120 g/l in men and <110 g/l in women. CHF was due to coronary heart disease, CHD (post-infarction cardiosclerosis; n=40); to CHD in combination with Type 2 diabetes mellitus, DM-2 (n=10), and arterial hypertension, AH (n=14); and to the combination of CHD, AH, and DM-2 (n=10). Left ventricular ejection fraction (LVEF) in CHF patients with FC II, III, and IV was

The paper focuses on the problem of intravascular thrombosis and the methods of its treatment. The data on haemostasis pathophysiology, which underlie the occurrence of acute ischemic events in humans, are presented, together with the data on the action mechanisms of fibrinolytic medications. The focus is on tenecteplase, as a modified agent which is more effective than the native tissue plasminogen activator or its closest derivatives.

Aim. To compare the dynamic effects of atorvastatin doses 20 mg and 40 mg on lipid profile, insulin resistance markers, adipokines, prothrombotic, and proinflammatory status in myocardial infarction (MI) patients during the hospitalisation period. 

Material and methods. The study included 42 patients with ST segment elevation MI. Group 1 (n=21) received atorvastatin in the dose of 40 mg/day; Group 2 (n=21) was administered atorvastatin in the dose of 20 mg/day. At Day 1 and Day 12 after admission, the parameters of lipid profile (total cholesterol and its fractions, atherogenic index, free fatty acids, and triglycerides), carbohydrate metabolism (glucose, insulin, and C-peptide), insulin resistance (HOMA index), proinflammatory status (C-reactive protein and interleukin-6), prothrombotic status (plasminogen activator inhibitor-1), and adipokines (leptin, resistin, and adiponectin) were measured. 

Results. Dose-dependent effects of atorvastatin were already demonstrated in the early hospitalisation period: the 40 mg dose was more effective in terms of lipid profile improvement, while the 20 mg dose was more effective for insulin resistance correction. The increase in atorvastatin dose up to 40 mg was associated with a reduction in pancreatic insulin-producing function. The effects on inflammation and thrombogenesis markers were less dose-dependent. A lower dose of atorvastatin (20 mg) normalized adipokine levels (increased leptin concentration and increased protective effects of resistin), which could be regarded as a beneficial prognostic factor. 

Conclusion. The selection of atorvastatin dose in MI patients should take into account the adipokine status and the dynamics of biochemical markers of insulin resistance.

This literature review focuses on the treatment of patients with arterial hypertension (AH) and obesity, from the point of view of personalised medicine (PM). One of the PM approaches is the use of biochemical markers which reflect normal and pathologic processes in the human body, as well as the presence of a disease or the response to a treatment. In patients with AH and obesity, antihypertensive medications should also affect the levels of biomarkers. This requirement is met by perindopril, an angiotensin-converting enzyme (ACE) inhibitor with high tissue specificity. Pathogenetic therapy with perindopril provides an opportunity to target the biomarkers of adipokine activity, endothelial dysfunction, inflammation, and other processes.

The paper emphases the need for dual antihypertensive therapy and describes its
benefits, such as synergetic hypotensive action and other beneficial effects. One of
the pathogenetically justified variants of combination therapy – a third-generation
dihydropyridine calcium channel antagonist and an angiotensin-converting enzyme
inhibitor – is discussed in more detail.