The myocardial function has been studied in 30 patients in the acute phase of acute coronary syndrome, ACS (19 and 11 individuals with and without ST segment elevation, respectively). Electrocardiography and tetrapolar integral rheography were performed at Days 1-2, 5-6, and 15-20. It was demonstrated that ACS with ST elevation was associated with reduced myocardial functional reserve and activation of adaptive mechanisms supporting adequate blood flow. ACS without ST elevation, due to the less severe myocardial injury, was characterised by the activation of cardiac compensatory mechanisms preventing heart failure progression. Extracardiac compensatory mechanisms were involved to a lesser extent.

The activity of sympatho-adrenal system was investigated in 103 patients with post-infarction cardiosclerosis (mean age 59 years, mean body mass index – 27 kg/m2 ), with night sleep apnoea syndrome of varying severity. Morning blood pressure (BP) level, mean nighttime heart rate (HR), and urinary concentrations of vanilylamygdalic acid and total metanephrines were measured. In patients with high index of apnoea-hypopnoea, BP and HR levels were higher, as well as the night excretion of catecholamine metabolites. It could be concluded that increased apnoea-hypopnoea index and reduced blood oxygenation are linked to increased sympatho-adrenal activity

The study aimed to assess renal function and anaemia prevalence and severity in patients with chronic heart failure (CHF) of various functional classes (FC). In total, 115 patients (76 women, 39 men; mean age 60,4±1,2 years) with NYHA FC I-IV CHF were examined. Renal filtration was assessed by glomerular filtration rate, GFR (Cockroft-Gault formula) and creatinine clearance (Reberg-Tareev method). Circadian GFR rhythm was analysed. Renal excretion was assessed by N-acetyl-beta-Dhexosaminidase (NAH) activity in morning urine sample. Microalbuminuria (MAU) prevalence and severity, as well as anaemia prevalence, were also analysed. Renal dysfunction in CHF depended on FC and manifested in disturbed circadian GFR rhythm, reduced GFR, progressing MAU, and impaired renal excretion. Urinal NAG combined with inadequate GRF reduction was an early marker of renal dysfunction. The most severe renal dysfunction, including disturbed circadian GFR rhythm, were observed in patients with high CHF FC and significantly decreased hemoglobin and hematocrit levels. There was no independent association between renal function and hemoglobin level. NAH, as an early marker of renal excretory dysfunction, was observed even in CHF FC I-II, before glomerular dysfunction manifested itself. Anaemia was associated with CHF FC.

The aim of this study was to identify the optimal, characterised by minimal risk of cardiovascular events (CVE), levels of renin-angiotensin-aldosterone system (RAAS) components in patients with arterial hypertension (AH). In total, 454 patients with high-risk AH were examined (age 18-65 years; 92 men, 362 women). Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were assessed by radio-immune method, adrenalin and noradrenalin concentration in 24-hour urine sample – by fluorometric method, left ventricular myocardial structure and function – by echocardiography, renal function – by glomerular filtration rate (Reberg method) and 123 I-Hippuran renography. Target levels of RAAS components were defined as follows: PRA=0,22-3,0 ng/ml/h, if PAC: PRA=5-23 and PAC=0,18- 0,83 nmol/l (5-23 ng/dl). In patients with high CVE risk, the target levels of PRA=0,22-1,0 ng/ml/h and PAC: PRA=5-23 would minimize the risk of stroke, myocardial infarction, and target organ damage.

To analyze ambulatory and clinical tactics in target blood pressure (BP) achievement, 60 ambulatory medical cards and 60 hospital medical histories of patients with arterial hypertension (AH) were analyzed. Target BP levels were registered in 60% of ambulatory patients. Despite the fact that 93,3% of the patients needed more aggressive antihypertensive treatment, only in 37%, such an attempt (increasing the dose and/or administering combined therapy) had been done. The mean number of medications had decreased during the control year. Thiazide diuretics (TD) and calcium antagonists (CA) were rarely administered. By the end of the control year, target BP levels were achieved in 15% only. Therapy change frequency in those achieving and not achieving target BP levels varied from 0 to 14 (on average, 3,8), mostly due to “incorrect” prescriptions. Target BP level achievers received ACE inhibitors and TD more often. The main reason for hospitalization was uncontrolled AH (67,5%) due to irregular regimen of pharmaceutical therapy (64,9%). During the hospitalization, target BP levels were achieved in 97,5%, at Day 9 on average. After admission, most patients received combined three-component therapy, including TD and CA. The АВС/VEN-analysis demonstrated low prevalence of effective medication administration and a three-fold increase in the second-choice medication use. The results obtained confirm the potential for target BP level achievement in high and very high-risk AH patients, and demonstrated real-world mistakes in ambulatory management of AH.

In total, 104 elderly patients with arterial hypertension (AH) and 20 healthy controls were examined. Thirty-four individuals had essential AH (EAH), and 70 – isolated systolic AH (ISAH). Statistically significant increase in blood pressure (BP) variability, reduction in night-time diastolic BP (DBP) combined with high systolic BP (SBP) level, and an increase in temporal index and night-time BP drop were maximal in ISAH patients. Disturbed systolic and diastolic left ventricular function was associated with transitory myocardial ischemia (79,7%) and silent night-time ischemia (SNI). SNI was characterised by higher SBP levels, and ISAH – by decreased night-time DBP. In elderly AH patients, cerebral perfusion was reduced, and in ISAH, adaptive and compensatory potential of cerebral vessels was also decreased.

A female patient T., 67 years, had a 30-year anamnesis of heart failure, HF (NYHA Functional Class III) with normal left ventricular ejection fraction and Stage II arterial hypertension. After thyroidectomy in 1987, the patient received L-thyroxin. The patient also received long-term standard antihypertensive therapy and HF treatment. Due to ineffective therapy and increased dyspnoea, radionuclide ventriculography was performed, suggesting restrictive cardiomyopathy. Intracoronary injection of autologous bone marrow stem cells was performed. Four months later, an improvement in clinical status (NYHA FC I) was associated with improved diastolic function at ventriculography. Immunological analysis confirmed a virus infection.

A clinical observation of amiodarone thyrotoxicosis in a patient with hypertrophic cardiomyopathy is presented.

Arterial hypotension, including orthostatic hypotension, is associated with cardiovascular morbidity and mortality risk in elderly patients. However, the prognostic role of orthostatic hypotension in chronic heart failure (CHF) is under-studied. This study aimed at comparing torasemide and furosemide effects on 24-hour blood pressure (BP) profile, BP level in orthostatic test, and brain natriuretic peptide (BNUP) level dynamics in patients with functional class (FC) III-IV CHF. The study included 40 patients with stable FC III-IV CHF and left ventricular ejection fraction (LVEF) <40% (Simpson); 90≤systolic BP≤140 mm Hg. Dynamics of clinical status, 6-minute walk test results, BNUP and aldosterone levels, quality of life (QoL), 24-hour BP monitoring (BPM), and active orthostatic test (OT) results was also assessed. All participants were randomised into two groups: one group (n=20) received torasemide (TG), and another group (n=20) was administered furosemide (FG). In patients with lower BP levels during 24-hour BPM and OT, higher levels of BNUP were registered. Lower BP levels affected the titration of the doses recommended for CHF treatment. In both groups, reduced CHF FC, decreased blood BNUP levels, and increased distance in a 6-minute walk test were observed. However, TG demonstrated higher BP levels and smaller BP drop in OT, which allowed using higher doses of beta-adrenoblockers (BAB) and increased QoL significantly. In patients with severe systolic CHF and substantial BP drop in OT, BNUP levels were higher. Switching from furosemide to torasemide helped to reduce orthostatic reaction, to optimise circadian BP profile, and to increase BAB doses in patients with Stable FC III-IV CHF.

The study aimed at mexicor effectiveness assessment in patients with bradyarrhythmias. Among 19 individuals with bradyarrhythmias, 9 patients (main group) received standard therapy plus intravenous mexicor (300 mg/d), and 10 participants were administered standard therapy only (control group). Mexicor effects on subjective clinical status and physical stress tolerance, sinus node automatism (transoesophageal electrophysiological examination, 24-hour ECG monitoring) and central hemodynamics (echocardiography) were assessed in comparison with respective parameters in the control group. The patients receiving mexicor demonstrated improved functional activity of sinus node, reduced number of supraventricular and ventricular extrasystoles, and improved left ventricular pump function. Including mexicor in the complex therapy of bradyarrhythmia patients also improved their clinical status and physical stress tolerance: the number of subjective complaints decreased, and the distance in the 6-minute walk test increased. Mexicor as a part of complex bradyarrhythmia therapy improved the effectiveness of standard treatment, assessed by various parameters.

In total, 60 45-70-year-old patients with Functional Class II-III chronic heart failure (CHF) after a myocardial infarction, compensated or sub-compensated Type 2 diabetes mellitus (DM-2), and autonomous cardiac neuropathy were examined. The basis therapy included enalapril, bisoprolol, aspirin, and simvastatin. Anti-diabetic treatment included gliclazide and/or metformin. Group I (n=30) additionally received mildronate (1 g/d). The study lasted for 16 weeks and focused on the dynamics of heart rate variability, quality of life, systolic and diastolic cardiac function, carbohydrate and lipid metabolism parameters. In DM-2 patients with autonomous cardiac neuropathy, a cardioprotective agent mildronate, as a part of complex CHF therapy, improved cardiac autonomous function, quality of life, carbohydrate and lipid metabolism, demonstrated anti-ischemic effect, and reduced CHF clinical manifestations.