Similarto most developed countries, cardiovascular disease (CVD)is a leading cause of mortality in Russia. The levels of CVD mortality in working-age Russian men and women are the highest in Europe and characterised by marked fluctuations. Up to 60% of fatal CVD cases could be explained by the population levels of cardiovascular risk factors. Presently, however, no data are available to demonstrate the varied prevalence of these risk factors inRussia. The information on the actual health status and cardiovascularrisk factor levels in the Russian population could be obtained only in epidemiological studies. Therefore, the Russian Ministry of Health and Social Development initiated the study “Cardiovascular Disease Epidemiology in Russian Regions”. This study involves 12 Russian regions which differ by their climatic, geographic, economic, and demographic characteristics. This analysis presents the official levels of CVD mortality in respective Russian regions and the associations between mortality and regional per capita income. A marked inter-regional heterogeneity in fatal CVD levels, as well as a significant regional gradient in CVD mortality by income, demonstrates the urgent need for the wide implementation of risk factor monitoring across the Russian regions.

Aim. To analyse the treatment characteristics and specifics in patients with acute coronary syndrome (ACS) and anaemia, based on the data from the Russian ACS registry (RECORD). Material and methods. The recruitment of the patients (November 2007 – February 2008) was performed, using the independent Russian ACS register RECORD. Results. The study included 796 patients (mean age 64,7±12,1 years; 57,2% men). ACS with ST segment elevation (ST ACS) was registered in 246 patients (30,1%), while ACS without ST segment elevation (non-ST ACS) was observed in 550 patients (69,9%). Anaemia at admission was registered in 228 participants (29,0%). The anaemia group had a higher proportion of elderly patients – those with diabetes mellitus, heart failure in anamnesis and at admission, and high risk by the GRACE scale. These patients were less often hospitalised in “invasive” hospitals. In hospital, anaemic patients less often received clopidogrel and underwent reperfusion in ST ACS or invasive procedures in non-ST ACS. Low baseline levels of haemoglobin (<110 g/l) independently predicted the risk of in-hospital death (odds ratio 4,6; 95% confidence interval 1,9–11,2; p=0,001). Anaemic patients had significantly higher risk of in-hospital death, compared to their non-anaemic peers (10% vs. 5,2%; p=0,012). In the group of anaemic patients with non-ST ACS, the risk of adverse outcomes (death or new myocardial infarction during hospitalisation) was significantly lower in those who underwent percutaneous coronary intervention (PCI) (4,1% vs. 18,2%; p=0,04) or PCI and coronary artery bypass graft surgery (3,6% vs. 17,6%; p=0,013). However, in non-anaemic patients, no such difference was observed: 5,8% vs. 4,2% (p=0,6) and 5,6% vs. 4,1% (p=0,6), respectively. Conclusion. First, in RECORD Registry participants, haemoglobin levels ><110 g/l independently predicted the risk of in-hospital death. Second, anaemic patients were characterised by a higher number of risk factors, lower rates of invasive procedures, and a significantly higher risk of in-hospital death. Third, in patients with non-ST ACS and anaemia, the absence of coronary interventions was linked to a significantly higher risk of death or new MI during hospitalisation. Russ J Cardiol 2012, 5 (97): 12-16 Key words: acute coronary syndrome, registry, anaemia><110 g/l) independently predicted the risk of in-hospital death (odds ratio 4,6; 95% confidence interval 1,9–11,2; p=0,001). Anaemic patients had significantly higher risk of in-hospital death, compared to their non-anaemic peers (10% vs. 5,2%; p=0,012). In the group of anaemic patients with non-ST ACS, the risk of adverse outcomes (death or new myocardial infarction during hospitalisation) was significantly lower in those who underwent percutaneous coronary intervention (PCI) (4,1% vs. 18,2%; p=0,04) or PCI and coronary artery bypass graft surgery (3,6% vs. 17,6%; p=0,013). However, in non-anaemic patients, no such difference was observed: 5,8% vs. 4,2% (p=0,6) and 5,6% vs. 4,1% (p=0,6), respectively. Conclusion. First, in RECORD Registry participants, haemoglobin levels < 110 g/l independently predicted the risk of in-hospital death. Second, anaemic patients were characterised by a higher number of risk factors, lower rates of invasive procedures, and a significantly higher risk of in-hospital death. Third, in patients with non-ST ACS and anaemia, the absence of coronary interventions was linked to a significantly higher risk of death or new MI during hospitalisation.

 

Aim. To assess the results of endovascular revascularisation in patients with acute myocardial infarction (AMI) and ST segment elevation (STEMI), in regard to the presence of Type 2 diabetes mellitus (DM-2), in the real-world clinical settings. Material and methods. The study included 423 STEMI patients, with or without concomitant DM-2. In the DM-2 group (n=77, 18,20%), percutaneous coronary intervention (PCI) was performed in 35 individuals (45,5%); in participants without DM-2, the respective figure was 54,91% (n=190). The follow-up period lasted for one year. The adverse long-term prognosis included repeated non-fatal MI and/or stroke, cardiac death, unstable angina, and decompensated heart failure (combined end-point). Results. In patients who underwent PCI, the presence of DM-2 did not affect substantially (p>0,05) the incidence of adverse clinical outcomes: it reached 28,57% (n=10) in participants with STEMI and DM-2 and 30,53% (n=58) in STEMI patients without DM-2. However, among individuals who did not undergo PCI, DM-2 was associated with increased incidence of the combined end-point: 52,38% (n=22) among those with STEMI and DM-2 vs. 42,95% (n=67) among those with STEMI only. Repeated interventions due to stent thrombosis (n=2; 5,71%) or stent restenosis (n=4; 11,43%) were non-significantly more frequent among patients with DM-2, compared to the non-diabetic patients (1,05% (n=2) and 3,68% (n=7), respectively). Therefore, PCI in STEMI patients with DM-2 substantially improved the long-term prognosis, halving the incidence of the combined end-point. By contrast, this incidence was reduced only by 1,5 among patients who did not undergo PCI. To summarise, the presence of DM-2 is associated with adverse long-term prognosis only in STEMI patients who do not undergo PCI. Conclusion. The presence of DM-2 significantly aggravates long-term prognosis in AMI patients who do not undergo PCI.

 

 

Aim. To assess the dynamics of myocardial contractility, geometry, and diastolic function in patients with acute myocardial infarction (AMI) after endovascular intervention vs. thrombolysis. Material and methods. In total, 60 patients (mean age 48,9±2 years) with AMI and ST segment elevation (STEMI) were examined within the first 6 hours from the AMI onset. All participants were divided into three groups: Group I – 22 patients with primary stenting; Group II – 22 patients with the stenting within 24 hours after successful thrombolysis; and Group III – 16 patients with effective thrombolysis and no endovascular intervention. At Day 1 and 7, all participants underwent Doppler echocardiography with the assessment of left ventricular (LV) diastolic function, LV size and volume parameters, total and segmental myocardial contractility (biplane Simpson’s method). Results. According to the comparative analysis results, LV volume parameters did not deteriorate substantially only in Group I. By Day 7, Group III demonstrated a restrictive type of LV diastolic dysfunction, persistent reduction of ejection fraction, and more pronounced disturbances of local LV contractility, compared to Groups I and II. Conclusion. In STEMI patients, primary stenting of the infarct-related artery more effectively prevents early pathological LV remodelling, compared to successful thrombolysis or post-thrombolysis endovascular intervention.

 

Aim. To investigate the parameters of systolic function in patients with acute Q-wave myocardial infarction (AMI), comparing the results of two-dimensional echocardiography (2D EchoCG), three-dimensional real-time EchoCG (3D EchoCG), and computed tomography (CT) as a verification method. To study the parameters of dyssynchrony, which develops due to mechanic myocardial heterogeneity in AMI patients. Material and methods. In total, 82 patients (61 men and 21 women; mean age 52±21 years) were examined within the first 6 days of AMI. The comparison group, comparable by age and sex, included 65 individuals without clinically manifested cardiovascular pathology. All participants underwent standard examinations, electrocardiography (ECG), 24-hour ECG monitoring, EchoCG, angiography, and CT. Mechanic dyssynchrony was assessed by dispersion of the time to the minimal volume of 16 segments (strain dyssynchrony index, SDI). Results. The difference for end-diastolic volume (EDV; 2D vs. 3D EchoCG and 2D EchoCG vs. CT) was statistically significant (respective p-values 0,014 and <0,005). Ejection fraction (EF) and local contractility index (LCI) were significantly different for 2D vs. 3D EchoCG (p=0,0002 and ><0,005, respectively). EF values were similar for 3D EchoCG and CT (p=0,3). SDI values in AMI patients were significantly higher than in the comparison group participants (6,8±2,7% vs. 2,9±1,6%; p><0,001). In patients with anterior AMI, the SDI differences were observed for one vs. two-vessel (p>< 0,005). Ejection fraction (EF) and local contractility index (LCI) were significantly different for 2D vs. 3D EchoCG (p=0,0002 and <0,005, respectively). EF values were similar for 3D EchoCG and CT (p=0,3). SDI values in AMI patients were significantly higher than in the comparison group participants (6,8±2,7% vs. 2,9±1,6%; p><0,001). In patients with anterior AMI, the SDI differences were observed for one vs. two-vessel (p><0,005 , respectively). EF values were similar for 3D EchoCG and CT (p=0,3). SDI values in AMI patients were significantly higher than in the comparison group participants (6,8±2,7% vs. 2,9±1,6%; p<0,001). In patients with anterior AMI, the SDI differences were observed for one vs. two-vessel (p>< 0,001). In patients with anterior AMI, the SDI differences were observed for one vs. two-vessel (p<0,05) and one vs. three-vessel pathology (p<0,005), but not for two vs. three-vessel pathology. Patients with inferior AMI did not demonstrate any marked differences in SDI values. Among patients with SDI >< 0,005), but not for two vs. three-vessel pathology. Patients with inferior AMI did not demonstrate any marked differences in SDI values. Among patients with SDI >5,1, the incidence of clinical complications (pulmonary oedema, ventricular fibrillation, high-grade atrioventricular block) was higher by 55% (p<0,05; r=0,35). SDI was also associated with high-grade ventricular arrhythmias (p><0,005; r=0,48). Conclusion. Three-dimensional visualization provides an opportunity to assess systolic function parameters more accurately. SDI values were linked to the number of affected coronary vessels. The significance of the observed differences was related to AMI localization. SDI could be regarded as a determinant of both mechanical myocardial heterogeneity and the risk of clinical and arrhythmic complications in AMI.><0,05; r=0,35). SDI was also associated with high-grade ventricular arrhythmias (p<0,005; r=0,48). Conclusion. Three-dimensional visualization provides an opportunity to assess systolic function parameters more accurately. SDI values were linked to the number of affected coronary vessels. The significance of the observed differences was related to AMI localization. SDI could be regarded as a determinant of both mechanical myocardial heterogeneity and the risk of clinical and arrhythmic complications in AMI.>< 0,005; r=0,48). Conclusion. Three-dimensional visualization provides an opportunity to assess systolic function parameters more accurately. SDI values were linked to the number of affected coronary vessels. The significance of the observed differences was related to AMI localization. SDI could be regarded as a determinant of both mechanical myocardial heterogeneity and the risk of clinical and arrhythmic complications in AMI.

 

Aim. To investigate clinical and morphological features of gastro-duodenal ulcers and erosions associated with unstable angina (UA) and to study the role of the disturbances of gastric secretion, microcirculation, and haemostasis in their development Material and methods. The study included 82 UA patients with gastro-duodenal ulcers or erosions confirmed by the clinical findings and endoscopy results. Parameters of gastric secretion, gastro-duodenal tissue blood flow, systemic microcirculation, and haemostasis were assessed with the methods adapted to the pathology of interest. Results. Acute erosions were found in 73,2% of UA patients, acute ulcers in 11,0%, and recurrent ulcers in 15,8%. Clinical manifestations of acute erosions typically included various dyspeptic symptoms, or, less often, diffuse epigastric pain during the first treatment days. For acute ulcers, moderate abdominal pain syndrome was often less intense than the gradually receding and disappearing symptoms of gastric dyspepsia. Recurrent ulcers were characterised by the combination of moderate abdominal pain, often without a typical circadian rhythm, and dyspeptic symptoms, typically persisting throughout the first two weeks of treatment. The symptoms of minor gastro-duodenal haemorrhage were registered in 33,3% of UA patients with acute ulcers, 11,8% of the participants with acute erosions, and 7,7% of the individuals with recurrent ulcers. The development of gastro-duodenal erosions and ulcers in UA patients was associated with increased acidic and peptic gastric secretion, reduced production of protective mucus, and disturbed blood flow in gastro-duodenal tissues, which could be regarded as a manifestation of Stage 1–2 haemorrhagic syndrome. Conclusion. Gastro-duodenal erosions and ulcers in UA patients have some morphological, clinical, and pathogenetic features which should be taken into account in order to facilitate the early diagnostics and adequate choice of pharmacological therapy.

Aim. To analyse the long-term trends in the acute coronary syndrome (ACS) outcomes; to identify the predictors of ACS clinical course and outcomes using a discrimination model. Material and methods. From 1993 to 2011, over 31000 patients with suspected ACS, including 8686 patients with acute myocardial infarction (AMI), were hospitalised to the Acute Cardiac Care Unit of the Voronezh City Clinical Hospital of Emergency Medical Care No. 10. The present analysis includes 565 patients (311 men, 55%). Results. Over 18 years of the follow-up, no significant increasing or decreasing trend in in-hospital mortality was observed. In all hospitalised patients, the mean level of in-hospital mortality was 3,91% per year; in ACS patients, it was 13,65%. The outcome predictors included age, degree of myocardial damage, Killip class, the degree of ST segment deviation, ST segment depression, and corrected QT interval dispersion. A discrimination model was created, which identified the groups with poor, ambiguous, and good prognosis. Overall, the classification matrix was accurate in 96,4% of the patients. Conclusion. The long-term trend in the levels of in-hospital mortality among ACS patients failed to demonstrate any marked reduction. The proposed discrimination model accurately predicted the clinical course and outcomes of ACS.

Aim. To identify the optimal therapeutic strategy in Functional Class (FC) I–II chronic heart failure (CHF), in accordance with the effects of different drug classes on the regulatory and adaptive status (RAS). Material and methods. The study included 200 patients with FC I–II CHF, who were randomised into two groups. The first group included 104 patients (mean age 52,8±1,9 years) who received metoprolol succinate extended-release in the mean daily dose of 87,7±7,6 mg. The second group included 96 patients (mean age 55,0±1,4 years) receiving quinapril in the mean daily dose of 21,0±5,5 mg. At baseline and 6 months later, 24-hour blood pressure monitoring, the cardio-respiratory synchronism test, treadmill test with the VO2 max assessment, echocardiography, and the measurement of the plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were performed. Results. Both medications improved the parameters of left ventricular (LV) diastolic function. However, only quinapril effectively improved LV structure, geometry, and systolic function. Only in the quinapril group, exercise capacity and stress test VO2 max increased, while the reduction in NT-proBNP levels, together with the improvement in RAS parameters, was more pronounced. Conclusion. Compared to metoprolol succinate, quinapril demonstrated more pronounced positive effects on cardiac structure and function, as well as on RAS parameters, in patients with FC I–II CHF.

Aim. To analyse the markers of sudden cardiac death (SCD) in patients with stable angina and arterial hypertension (AH), in regard to the progression of left ventricular hypertrophy (LVH). Material and methods. In total, 90 patients with Functional Class II–III stable angina, AH, and LVH were examined. The following parameters were assessed: left ventricular myocardial mass index (LVMMI), left ventricular ejection fraction (LVEF), heart rate variability (HRV) parameters (SDNN, HRVi, CBBP); mean 24-hour HR levels, QT and QTc intervals, QT dispersion (QTds), ectopic ventricular activity; mean 24-hour blood pressure (BP) levels; levels of serum markers of myocardial collagenolysis and N-terminal pro-brain natriuretic peptide (NT-proBNP). Results. In all participants, LVEF was preserved, without significant difference between the tertiles. The increase in LVMMI was linked to a significant increase in the total number of ventricular extrasystoles (VE) over 24 hours (p<0,001) and the mean number of paired (p><0,008) and polytopic (p>< 0,011) VE per patient; reduced HRV, based on the SDNN dynamics (p=0,004); increased mean 24-hour pulse BP (p=0,003); elevated levels of tissue inhibitors of matrix metalloproteinase-1 (p=0,017) and NT-proBNP; and decreased levels of procollagen type I C-terminal telopeptide (p=0,011). Conclusion. In patients with stable angina, AH, and preserved LVEF, the LVH progression is associated with an increased number of SCD markers: increased ventricular ectopic activity, reduced HRV, increased mean 24-hour BP, and elevated levels of NT-proBNP and serum markers of myocardial fibrosis, which confirms the increase in the risk of SCD in parallel to the increase in the LVMMI.

 

Aim. To assess the life prognosis in patients with chronic heart failure (CHF) – male residents of St. Petersburg – according to the Seattle Heart Failure Model (SHFM) and compare it to the observed survival. Material and methods. A retrospective survival analysis was performed in 135 patients with Functional Class (FC) II–IV CHF of ischemic aetiology. At baseline, anamnestic, clinical, functional, and instrumental data were collected. Observed five-year all-cause mortality was compared to that predicted by SHFM. Statistical analyses were performed in SPSS 15.0. Results. Over the five years of the follow-up (60 months), 67% of the participants (n=88) survived. Observed one-, two-, and five-year survival in FC II CHF patients was 95%, 92%, and 74%, respectively. In FC III CHF patients, the respective figures were 92%, 85%, and 61%. Predicted one-, two-, and five-year survival, according to the mean risk estimates by SHFM, was 98%, 95%, and 89% for FC II CHF individuals, and 96%, 92%, and 80%, respectively, for the FC III CHF participants. Therefore, for the first five years of the follow-up, the SHFM predictions exceeded the observed survival by 3–15% and 4–19% in CHF patients with FC II and FC III, respectively (p1,2<0,05). There was a statistically significant association between the observed survival and smoking, concomitant chronic obstructive pulmonary disease, and hypertension duration before the CHF manifestation. Conclusion. The SHFM markedly overestimated the observed survival in male patients with systolic CHF – St. Petersburg residents. Therefore, in this population, this instrument cannot be recommended for the CHF prognosis assessment. There is a need to develop a survival model for Russian patients with CHF, which would incorporate additional determinants of adverse prognosis.>< 0,05). There was a statistically significant association between the observed survival and smoking, concomitant chronic obstructive pulmonary disease, and hypertension duration before the CHF manifestation. Conclusion. The SHFM markedly overestimated the observed survival in male patients with systolic CHF – St. Petersburg residents. Therefore, in this population, this instrument cannot be recommended for the CHF prognosis assessment. There is a need to develop a survival model for Russian patients with CHF, which would incorporate additional determinants of adverse prognosis.

 

Aim. To identify the reasons for the patients’ refusal to undergo a planned coronary artery bypass graft (CABG) surgery, after being put on the “waiting list” for the intervention. Material and methods. From January 2010 to March 2011, 1,057 patients (100%) were put on the CABG “waiting list” of the Research Institute of Complex Cardiovascular Problems, Kemerovo. Due to various reasons, 74 individuals refused to undergo the surgery (7%). The reasons for refusal were identified during a telephone interview of 65 patients; for 51 (4,8%), the refusal was confirmed. The final analysis included 51 patients – the main group, who refused the intervention due to various reasons. Clinical and anamnestic parameters of these patients were compared to those of the control group (51 consecutive patients hospitalised for the planned CABG). For both groups, the primary medical documentation was used to determine the waiting period between establishing the need for CABG and the planned hospitalisation, as well as to record the results of coronary artery angiography (CAG). In addition, we analysed the results of echocardiography (EchoCG; left ventricular ejection fraction, LVEF) and the levels of creatinine, urea, potassium, sodium, glucose, haemoglobin, white and red blood cells, and erythrocyte sedimentation rate, measured before CAG. Results. The most prevalent refusal reasons were fear of the intervention (35,3%) and good self-perceived health (33,3%). The third most common reason was no explanation of the intervention importance to the patient by the doctor (9,8%). In the control group, the hospitalisation for planned CABG significantly more often took place within one month after CAG, compared to the main group (n=17 and 6, respectively; p<0,01). By contrast, in the main group, hospitalisation for CABG was significantly more often planned for the sixth month after CAG, compared to the control group (n=12 and 4, respectively; p=0,02). According to the multivariate analysis results, waiting for the intervention for longer than one month was associated with an increased likelihood of refusal. Conclusion. The prevalence of CABG refusal among “waiting list” patients was 4,8%. The main reasons for refusal included no symptoms of coronary heart disease progression, fear of intervention, and no explanation of the intervention necessity. The key additional factor associated with refusal was the waiting time over one month. Russ J Cardiol 2012, 5 (97): 63-69 Key words: coronary heart disease, coronary artery bypass graft surgery, waiting list order.><0,01). By contrast, in the main group, hospitalisation for CABG was significantly more often planned for the sixth month after CAG, compared to the control group (n=12 and 4, respectively; p=0,02). According to the multivariate analysis results, waiting for the intervention for longer than one month was associated with an increased likelihood of refusal. Conclusion. The prevalence of CABG refusal among “waiting list” patients was 4,8%. The main reasons for refusal included no symptoms of coronary heart disease progression, fear of intervention, and no explanation of the intervention necessity. The key additional factor associated with refusal was the waiting time over one month.

 

Aim. The sleep apnoea syndrome (SAS) is a widely prevalent but under-studied condition which might aggravate the clinical course of various diseases. This study aimed to assess the influence of SAS on the clinical course of coronary heart disease (CHD) and quality of life (QoL) of CHD patients. Material and methods. The study included 186 patients with various CHD forms and 24 controls with angiographically confirmed absence of CHD. The patients were divided into groups of effort angina, post-infarction cardiosclerosis without chronic heart failure (CHF), and with Functional Class (FC) II–III CHF (NYHA classification). All participants underwent cardiorespiratory monitoring and QoL assessment (WHOQOL-BREF and SAQL questionnaires). Based on the SAS severity, two subgroups with low (0–10 per hour) and high (11–30 per hour) index of apnoeahypopnoea (AHI) were defined. Results. SAS affected the clinical course and QoL to the greatest extent in patients with CHF. Among effort angina patients, this effect was weaker, while no negative impact of SAS was registered in patients with post-infarction cardiosclerosis without CHF. Conclusion. The management of CHD patients should incorporate the screening for possible SAS and target SAS, if present, as one of the factors aggravating the clinical course of the main pathology.

 

Aim. To assess the effects of antihypertensive therapy on the dynamics of cardiometabolic risk factors among pregnant women with chronic arterial hypertension (AH) in the second trimester. Material and methods. In total, 37 pregnant women with chronic AH were examined. The clinical and anamnestic data were analysed, and the levels of office blood pressure, body mass index, blood lipids, systemic inflammation markers (C-reactive protein, fibrinogen), and glucose were measured. Subclinical pathology of target organs was assessed via the measurement of left ventricular myocardial mass index (echocardiography), glomerular filtration rate, and microalbuminuria. Results. Slow-release nifedipine therapy improved the parameters of lipid metabolism and target organ status. Metoprolol therapy was linked to an improvement in cardiovascular and renal structure and function. However, metildopa treatment was associated with some increase in glucose levels and a significant elevation in total cholesterol levels. Conclusion. The complex assessment of cardiometabolic risk factors and target organ status is particularly important for a differential choice of antihypertensive therapy in pregnant women.

Aim. To perform a clinical and epidemiological survey of women with coronary heart disease (CHD) from different age groups, in comparison with healthy people without CHD. Material and methods. We examined 122 women of childbearing or menopausal age (20–69 years), including 102 patients with clinical and epidemiological evidence of CHD. The control group included 20 healthy women. In all participants, the levels of the following hormones were measured: estradiol (E), progesterone (P), testosterone (T), cortisol (C), and estradiol: testosterone ratio (E: T). Results. Hormonal homeostasis disturbances, typical for each age group, were identified. The levels of sex hormones could be regarded as additional risk factors of CHD in women of childbearing age and menopausal women. Conclusion. In the age of 30–39 years, decreased E and P levels are combined with elevated T. Among 40–49-year-old women, E decreases and T increases, without any marked P dynamics. In age groups of 50–59 and 60–69 years, P levels are substantially decreased, without significant changes in E and T levels.

Aim. To assess and compare the effects of perindopril/indapamide (Noliprel) and low-intensity laser therapy (LILT) on central hemodynamic parameters in elderly patients with chronic heart failure (CHF). Material and methods. In total, 160 CHF patients, aged 60–96 years, were randomised into four groups. Group 1, “Noliprel” (n=26), received Noliprel and other medications; Group 2, “LILT” (n=54), received LILT and other medications (not Noliprel); Group 3, “Noliprel + LILT” (n=27), was administered complex treatment with LILT and Noliprel; and Group 4, a comparison group (n=53), received pharmacological therapy only. At baseline and 20 days after the start of the treatment, central hemodynamic parameters were assessed, using Doppler echocardiography method. Results. At baseline, our participants typically had normal systolic function, in combination with diastolic dysfunction and increased heart chamber size. By the end of the treatment phase, reverse cardiac remodelling was observed in Noliprelreceiving patients. In the “LILT” group, myocardial function improvement was not accompanied by marked morphological changes. The combination of Noliprel and LILT had a complementary beneficial effect on intracardiac hemodynamics, particularly in Functional Class III CHF. Conclusion. In elderly CHF patients, including Noliprel and LILT into the complex CHF treatment demonstrated a larger positive effect on central hemodynamics, compared to the standard treatment.

Background. Previous studies showed that nicorandil can reduce coronary events in patients with coronary artery disease. However, it is unclear whether oral nicorandil treatment may reduce mortality following acute myocardial infarction (AMI). Methods and Results. We examined the impact of oral nicorandil treatment on cardiovascular events in 1846 AMI patients who were hospitalized within 24 h after AMI onset, treated with emergency percutaneous coronary intervention (PCI), and discharged alive. Patients were divided into those with (Group N, n = 535) and without (Group C, n = 1311) oral nicorandil treatment at discharge. No significant differences in age, gender, body mass index, prevalence of coronary risk factors, or history of myocardial infarction existed between the two groups; however, higher incidences of multi-vessel disease, and a lower rate of successful PCI were observed in Group N. During the median follow-up of 709 (340–1088) days, allcause mortality rate was 43% lower in Group N compared with Group C (2.4% vs. 4.2%, stratified log-rank test: p = 0.0358). Multivariate Cox regression analysis revealed that nicorandil treatment was associated with all-cause death after discharge (Hazard ratio 0.495, 95% CI: 0.254–0.966, p = 0.0393), but not for other cardiovascular events such as re-infarction, admission for heart failure, stroke and arrhythmia. Conclusions. The results suggest that oral administration of nicorandil is associated with reduced incidence of death in the setting of secondary prevention after AMI.

Theassessmentofbloodpressurevariability(BPV)basedontheofficeBPmeasurements (“visit-to-visit” BPV) has recently gained more attention. A retrospective meta-analysis demonstrated that in the cohorts of patients after stroke or transient ischemic attack (n≥2450), this parameter strongly and independently from mean BP levels predicted the risk of stroke. In the ASCOT-BPLA study, the “visit-to-visit” variability of systolic BP was a strong predictor of stroke and coronary events, as confirmed by the results of the multivariate regression analyses adjusting for conventional risk factors. Throughout the follow-up period, BPV values were significantly lower in the amlodipine/perindopril group, compared to the atenolol/diuretic group, which was associated with a reduced risk of cardiovascular complications. BPV appears a promising new target for antihypertensive therapy. Statistically significant BPV reduction denotes the stability of the treatment effects and other beneficial pharmacodynamic effects. The most extensive evidence base exists for the combination of amlodipine and perindopril.

The importance of the optimal choice of antihypertensive treatment strategy is currently widely recognised. The evidence obtained over the last five years justifies the revision of the traditional approach towards the tactics of mono- and combination antihypertensive therapy. It is essential to ensure that the patient-centred tactics of mono- and combination therapy choice is based on the detailed analysis of the clinical status.