Aim. To assess the effects of a complex treatment programme including the “free load choice” cycling training (FLC–CT) on exercise capacity and large artery hemodynamics in elderly in-patients with arterial hypertension (AH). Material and methods. The study included 81 patients with Stage II (39,5%) or Stage III (60,5%) AH (mean age 75,6±0,7 years). In total, 50 patients received pharmacotherapy plus FLC–CT. After the treatment, exercise capacity, hemodynamics in common carotid artery (CCA), brachial artery (BA), and femoral artery (FA) (duplex ultrasound), and endothelial function (compression test) were assessed. Results. In elderly AH patients, the treatment programme including FLC–CT was more effective than pharmacotherapy in terms of exercise capacity improvement, assessed by veloergometry. An increase in 6-minute walk test distance was observed for the FLC–CT group only. Patients not receiving FLC–CT demonstrated decreased cerebral blood flow in all hemodynamic phases, without an increase in FA blood flow volume. FLC–CT was associated with increased leg blood flow in the rapid phase, without any substantial changes in cerebral blood flow volume. Endothelial reaction in compression test was substantially decreased at baseline and did not change substantially in both treatment groups. Conclusion. Adding FLC–CT to the complex treatment of elderly AH patients improves leg hemodynamics and more effectively increases exercise capacity than pharmaceutical treatment only.

The paper analyses the role of lipid and carbohydrate metabolism disturbances in the development of metabolic syndrome (MS), based on the prevalence of MS among 554 individuals with varying body weight. Among participants with normal body weight and overweight individuals, dyslipidemia was registered in 85–88%. Among patients with Stage I–II obesity, the most prevalent MS component was arterial hypertension (75–80%). Hyperglycemia, the diagnostic criterion of MS, was less prevalent than hyperinsulinemia or insulin resistance, which complicated early MS diagnostics. Overall, participants with normal body weight or overweight individuals demonstrated higher prevalence of lipid vs. carbohydrate metabolism disturbances. Further research is needed to clarify the pathogenetic role of dyslipidemia in MS development.

The study included 21 patients (mean age 35,86±10,01 years) with hypertrophic cardiomyopathy (HCMP) diagnosed according to the WHO criteria. All patients underwent in-hospital complex clinical and functional assessment, electrocardiography (QT dispersion, Sokolow-Lyon index, and Cornell voltage index analysis), Holter ECG monitoring (time and spectral parameter analysis), and echocardiography (EchoCG). Based on the interventricular septum thickness (IVST), all patients were divided into two groups: Group I with IVST <20 mm (n=13) and Group II with IVST >20 mm (n=8). Group II was characterised by left ventricular diastolic dysfunction, with a tendency towards the development of its restrictive variant. In addition, Group II patients demonstrated autonomic disbalance, sympathetic hyperactivity, and disturbed circadian patterns of heart rate.

Aim. To assess the use of isosorbide-5-mononitrate in clinical practice and evaluate its benefits in antianginal therapy of stable angina pectoris, based on pharmaco-economic analysis data. Material and methods. The authors analysed 902 medical histories of in-patients treated in a cardiology department in 2004-2006. The reports on pharmaceutical support of federal and regional cardiovascular therapy programs, as well as the three-year data on organic nitrate (ON) sales, were also analysed. For standardization purposes, the results were presented as defined daily dose (DDD), in accordance with the Anatomical Therapeutic Chemical (ATC) Classification. A prospective survey of 259 patients was performed, in order to assess their quality of life (QoL) with a psychometric visual analogous scale. In addition, the cost-effectiveness and cost-utility analyses were performed. Results. Overall, the use of ON was relatively low; mean in-hospital levels were 4,57±0,13 DDD/100 bed-days, while out-patient levels were almost 1,5 times lower (3,12±0,19 DDD/1000 patients per year). There was a positive tendency towards the increased use of ON with improved pharmacokinetic profile, such as standard and prolonged-action isosorbide-5-mononitrates (ISMN). The use of ISMN was also associated with a more pronounced QoL improvement. The pharmaco-economic analysis demonstrated the economic benefits of ISMN use in clinical practice. The use of standard isosorbide dinitrate forms for stable angina treatment is not justified both clinically and economically.

Our previous studies have demonstrated the importance of early diagnostics and treatment of pathological cardiac transformations in young athletes. The present pilot clinical study is focused on cardioprotective effects of 2-ethyl-6-methyl-3-oxy-pyridine succinate (“Mexicor”, EcoPharmInvest) in young athletes with stress cardiomyopathy. It was demonstrated that Mexicor is at least as effective as creatine phosphate, a “gold standard” medication in sports medicine, for correction of hemodynamic, autonomic, or metabolic disturbances, as well as exercise capacity improvement. The results obtained enable us to increase the range of metabolic medications used in sports cardiology.

In experimental studies using radioactive isotopes in chicken, it has been clearly demonstrated that paecilomycosis diagnostics, based on the detection of mycotic spherules in the blood, is a valid and clinically feasible method. For the first time, paecilomycotic atypical myocarditis (PAM) in children was described. This disease is characterised by anemic and pain syndromes: pain is localized in the arms, and then involves chest, abdominal area, and spinal areas. Modern analgetic agents – movalis, sirdalud, clopheline, and nimesil – are not effective in children with PAM and pain syndrome. The complex treatment included a homeopathic medication Latrodectus mactans C6, as well as diflucan, polyoxydonium, antibiotics, and ferrum lek. The use of Latrodectus mactans C6 was associated with the pain syndrome regression. In 5 animal species, the authors demonstrated that Latrodectus mactans C6 did not have any adverse or toxic effects. The statistical significance of the results was confirmed by p values of ≤0,01–0,05 in the Student test.

Transoesophageal (TE) assess in stress echocardiography (EchoCG) enables us to overcome the principal limitation of the method – poor visualization quality in patients with “non-diagnostic windows”. Currently, physical stress is regarded as the safest method for inducing possible myocardial ischemia, with an equivalent increase in both myocardial contractility and heart rate. A combination of TE EchoCG and veloergometry (VEM) appears to be an optimal, inexpensive method of visualization-based diagnostics of coronary heart disease (CHD). At the same time, the potential of this method is limited by its emetogenicity. The study of diagnostic accuracy of TE stress EchoCG in combination with VEM, performed according to the STARD statement, demonstrated high sensitivity (91%) and specificity (92%) of this method. Gradual changes in ejection fraction facilitated the assessment of left ventricular inotropic reserve, which was minimal in patients with severe coronary artery stenosis. The endoscope position did not affect forced breathing, and the discomfort was similar to that during routine fibrogastros-copy, due to the use of low Ondansetron doses and limited load phase of the test.

Aim. To assess the quality of life (QoL) and its gender specifics among Ingushetia Republic patients with coronary heart disease (CHD) and effort angina. Material and methods. The study included 520 patients with CHD and Functional Class II–III effort angina – 300 men (mean age 54±0,4 years) and 230 women (mean age 55,7±0,5 years). QoL was assessed with the EQ-5D questionnaire (European Quality of Life Instrument), including 5 areas: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Results. Approximately 40% of the participants reported mobility problems, while self-care problems were reported by 15% only. Disturbed usual activities were registered in 40%, and chest pain or discomfort, as typical symptoms of effort angina, were reported by 60%. Anxiety/depression symptoms were also reported by 60% of the participants. In total, approximately 10% of the patients had severely affected QoL, while 40% did not report any difficulties with usual activities or mobility. Mobility problems, chest discomfort, and anxiety/depression were more prevalent in women. The prevalence of self-care and usual activities problems was similar in both genders. Conclusion. In every second CHD patient with effort angina, QoL was affected, due to restricted usual activities, disturbed mobility, or chest discomfort, accompanied by anxiety/depression symptoms. Self-rated health deteriorated in every second patient.

Increasing incidence of arterial hypertension (AH) justifies the need for more effective AH treatment and prevention. Pharmaceutical therapy remains the basis of AH management. The most modern and effective variant of pharmaceutical AH management is combination treatment, as confirmed by the data from multiple clinical trials. Antihypertensive agents could be combined with metabolic medications, in particular, ubiquinone – coenzyme Q₁₀ (Kudesan). This agent optimises electron transport in the cytochrome chain, improves tissue energy balance, and demonstrates antioxidant activity. Moreover, several studies have shown antihypertensive effects of this medication. In addition, coenzyme Q₁₀ is virtually free from adverse effects. The available evidence supports the clinical use of coenzyme Q₁₀ (Kudesan) for AH treatment.

The paper is focused on salt intake reduction and the subsequent cardiovascular risk reduction. The results of international, multi-centre randomised prospective clinical studies are analysed, summarizing the evidence obtained in the second half of the 20th century and the early 21st century. It has been demonstrated that decreased salt intake results in blood pressure reduction among both healthy people and patients with arterial hypertension. It is also associated with cardiovascular risk reduction and lower levels of all-cause and cardiovascular mortality. The potential risk of adverse effects is relatively small and should not prevent salt intake reduction. The evidence-based recommendations on salt intake are presented.