Source: http://roscardio.ru/ru/current-issue-ctp/
Timestamp: 2019-04-21 02:32:41+00:00

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Maslennikova G. Ya., Oganov R. G.
$1,000, per person per year) there is a low (less than 10% probability of premature deaths) from NCDs and high, 80+ years, rates of LE. Reducing the probability of premature deaths from NCDs leads to the preservation of human capital, increasing of government revenues and, consequently, possibility to provide for maintaining of public health, development and use of effective technologies for the prevention and control of NCDs.
Key words: life expectancy, noncommunicable diseases, healthy lifestyle, prevention of socially significant diseases, healthy longevity, human capital.
Maslennikova G. Ya. ORCID: 0000-0003-1447-2490, Oganov R. G. ORCID: 0000-0003-0875-0773.
Aim. To determine the feasibility of complex approach for the determination of individual tolerance to physical activity based on functional and biochemical markers, in order to choose an effective program of physical rehabilitation for patients with non-ST elevation acute coronary syndrome (NSTEACS) after percutaneous coronary intervention (PCI).
to physical activity were carried out. Individual tolerance to physical activity was assessed by the results of a loading test and biochemical markers characterizing metabolic processes during aerobic exercise. A loading test was performed on the Marquette-Hellige 2000 treadmill biochemical markers, patients were recommended to controlled walking or prescribed a short course of exercises with an intensity of 60% of the threshold power.
Results. At the end of the short cycle of the exercise program, a significant increase of the minute oxygen consumption (MOC) was observed in 72,5%. In 15,5% of the remaining patients the increase of MOC was insignificant, and in 12% MOC remained at the initial level. The analysis of biochemical markers in the dynamics of these patients showed consistently elevated values. The level of urea and creatinine increased by 16,7% compared with baseline afterload parameters. The level of creatine phosphokinase decreased by 16-24% of the afterload data. Myoglobin level was 106,2±8,4 μg/l vs baseline 90,2±6,2 μg/l. In addition, the total duration of exercise programs in these patients was less than stated.
Conclusion. Thus, focusing on the initial level of the MOC in determining of load is not always possible to obtain the expected increase in physical performance. In this case, the assessment of biochemical blood changes allows to determine signs of overstrain under the influence of physical exertion, which makes it possible to correct the level of load. Key words: physical exercises, tolerance to physical activity, biochemical markers.
Lyamina N. P. ORCID: 0000-0001-6939-3234, Karpova E. S. ORCID: 0000-0003-0869-2307.
Tatarintseva Z. G., Kosmacheva E. D., Porkhanov V. A., Kruchinova S. V.
(CAG) and determination of the relationship between the value of LVEF and the coronary substrate.
generator from patients admitted to the hospital with ACS and intact sinus rhythm (SR) for the period of time from November 20, 2015 to November 20, 2017 (120). We analyzed the ECHO-CG parameters, the coronary substrate — according to the CAG.
percentage of cases (p=0,0007) occurs significant hemodynamic stenosis of coronary arteries, in contrast to the group of patients with ACS + SR with LVEF ≤40%. In patients with EF >40% and ACS + SR we determined a significantly more frequent (p<0,001) stenosis.
that occur on the background of AF, which is important for correct prediction of the course of the disease. The maintenance of the ACS register will provide information on the real clinical course of the disease, as well as improve the effectiveness of treatment in real clinical practice.
Key words: acute coronary syndrome, atrial fibrillation, coronary angiography, echocardiography, register.
Tatarintseva Z. G. ORCID: 0000-0002-3868-8061, Kosmacheva E. D. ORCID: 0000-0001-5690-2482, Porkhanov V. A. ORCID: 0000-0003-2732-2133, Kruchinova S. V. ORCID: 0000-0002-7538-0437.
Noruzbaeva A. M., Kurmanbekova B. T., Osmankulova G. E.
Aim. To reveal latent disorders of carbohydrate metabolism (CHM) in conjunction with neurohormonal status in hospitalized patients with chronic heart failure (CHF) of ischemic etiology.
determined by enzyme immunoassay. Insulin resistance (IR) is assessed using the HOMA-IR index.
Results. Among 174 hospitalized patients with NYHA class II-IV CHF of ischemic etiology disorders of CHM was detected in 52,3% of patients: 33,9% of those had impaired glucose tolerance (IGT), 1,7% — impaired fasting glucose (IFG), 16,7% — newly diagnosed type 2 diabetes mellitus (DM), in 47,7% of the patients disorders of CHM was not found. In all patients with CHF, along with elevated levels of brain natriuretic peptide and aldosterone, insulin levels were also increased. IR elevated with the increase in the severity of disorders of CHM (in the group without disorders of CHM — 10,78 (8,9-12,2), IGT — 14,6 (11,2-18,2), newly diagnosed type 2 DM — 18,6 (15,19-26,7). Also the concentration of aldosterone was higher in the group with DM, compared with the ITG group (p2-3<0,01).
Conclusion. The presence and progression of IR in patients with CHF of ischemic etiology in conjunction with neurohormonal status emphasizes the importance of timely detection of latent CHM disorders with its future management.
Key words: chronic heart failure, insulin resistance, prediabetes, type 2 diabetes, coronary artery disease.
Acknowledgements. Thanks to M. T. Duyshenalieva, M. M. Turgunov for collection of material, N. S. Satieva for carrying out enzyme immunoassay with determination of insulin, aldosterone and Nt-proBNP.
Noruzbaeva A. M. ORCID: 0000-0001-6511-8534, Kurmanbekova B. T. ORCID: 0000-0002-8685-8387, Osmankulova G. E. ORCID: 000-0002-7486-8289.
Aim. To study the prognostic value of Left Ventricular Mass (LVM) with asymptomatic aortic stenosis (AS) in a long-term outpatient study, as well as the effect of the LVM on major cardiovascular events (CVe).
Material and methods. Cox regression analysis was used to evaluate the effect of an echocardiographically detected increased LVM on the frequency of major cardiovascular diseases: a serious cardiovascular event; events related to the aortic valve — combined aortic valve replacement, congestive heart failure due to AS, and ischemic cardiovascular events — nonfatal myocardial infarction, non-hemorrhagic stroke, coronary revascularization, hospitalization due to unstable angina.
The study included 165 patients with average age of 67 years; 39,6% of women had asymptomatic form of mild and moderate AS. Patients were selected with asymptomatic, mainly moderate AS, without diabetes, cardiovascular or renal pathologies. Patients were observed for 4 years.
Results. At the beginning of the study, the LVM index was 45,9±14,9 g/m2, and the peak velocity in the aorta was 3,9±0,54 m/s. During the observation, 58 major CVE were indentified. In Cox regression analysis, 1 standard deviation (15 g/m2) above the initial level of the LVM index determines the predicted increase in risk by 12% for major CVE, 28% for ischemic CVE, 34% for cardiovascular mortality and 23% for all cause mortality and hospitalization for heart failure (all p<0,01). A higher LVM index was consistently associated with CVE risk increase from 13% to 61% (all p<0,01) regardless of age, gender, body mass index, LV ejection fraction, concentricity and presence of concomitant hypertension.
Conclusion. A higher LVM index is independently associated with increased cardiovascular morbidity and mortality with progression of AS.
Key words: aortic valve stenosis, echocardiography, hypertrophy, left ventricle, mortality, prognosis.
Ryazanov A. S. ORCID: 0000-0003-2823-7774, Makarovskaya M. V. ORCID: 0000-002-2313-2159, Kapitonov K. I. ORCID: 0000-0002-2750-0852, Kudryavtsev A. A. ORCID: 0000-0001-8294-5136.
Aim. To develop mathematical models for predicting the risk of gangrene of the lower limb and the algorithm for selecting of treatment strategies for vascular surgeons and angiologists.
support system by a decision-making algorithm.
Results. It was shown that, compared with traditional treatment tactics, using of presented algorithm can increase the speed of positive results achieving by 3,4 times (68,3%), reduce the risk of lower limb gangrene development by 2,8 times (61,6%) and reduce the risk of limb amputation by 4,1 times (68,1%).
Conclusion. The obtained mathematical models should be used in the medical practice of vascular surgeons and angiologists, both in the form of software for smartphones and tablet computers, and as part of decision support systems, including telemedicine systems.
Key words: critical lower limb ischemia, gangrene, fuzzy mathematical models, an algorithm for selecting of treatment strategies.
Bykov A. V. ORCID: 0000-0001-6015-0412, Korenevsky N. A. ORCID: 0000-0003-2048-0956, Parkhomenko S. A. ORCID: 0000-0002-2221-2026, Khripina I. I. ORCID: 0000-0001-6586-7973.
Aim. To study the relationship of polymorphism of APOC3, PON1, AGT, AGTR1 genes and Vascular control parameters (blood pressure — BP and heart rate — HR) when performing an orthostatic test in young individuals.
Material and methods. The study involved 75 relatively healthy Caucasian volunteers aged 20-25 years. The exclusion criterion was the presence of cardiovascular and central nervous pathologies. Vascular control was assessed by conducting an active orthostatic test. Identification of gene polymorphism was carried out by the method of deoxyribonucleic acid pyrosequencing.
associated with a less high systolic blood pressure (SBP) at the first minute of orthostasis, as well as a less significant increase in DBP. Persons whose genotype contains the T allele of the L55M A>T polymorphism of the PON1 gene had a lower SBD and PP in the prone position. The presence in the genotype of the T allele of the -482 C>T polymorphism of the APOC3 gene is associated with lower rates of DBP in the prone position and SBP on the first minute after the rise. Also these individuals showed a more pronounced heart rate increase after the rise.
Conclusion. There is a significant relationship between the studied polymorphic variants of the APOC3, PON1, AGT, AGTR1 genes and vascular control parameters in the context of orthostasis. It may be a predictor of early development of arterial hypertension.
Key words: genetic polymorphism, orthostatic test, young persons.
Conflicts of Interest : nothing to declare.
Elkina A. Yu. ORCID: 0000-0002-3036-9613, Akimova N. S. ORCID: 0000-0002-5935-2655, Schwartz, Yu. G. ORCID: 0000-0002-5205-7311, Martynovich T. V. ORCID: 0000-0002-3939-6343, Fedotov E. A. ORCID: 0000-0003-3563-5535.
Aim. To evaluate the prevalence of prehypertension and its interrelations with other cardiovascular risk factors in Krasnoyarsk Region population.
performed in IBM SPSS v. 22. Differences in prehypertension prevalence were assessed for statistical significance using the Pearson’s chisquared test. The influence of sociodemographic factors and laboratory parameters was evaluated using logistic regression with the gradual elimination of insignificant factors. Statistical significance was taken into account at p<0,05.
Results. We determined that 29,1% of Krasnoyarsk Region population had prehypertension. It was more prevalent in males compared to females (32,5% vs 27,2% respectively), in younger people compared to older (41,6% in 25-34 vs 16,5% in 55-64), and in urban population compared to rural (30,7% vs 24,7% respectively). Prehypertension prevalence in the Krasnoyarsk Region was lower compared with the average country statistics (35,0%) due to the greater prevalence of arterial hypertension. The significant predictors of prehypertension were higher education, obesity and hypertriglyceridemia.
Conclusion. The prevalence of prehypertension in Krasnoyarsk Region was 29,1%; it is lower than the average data over Russia because of a higher percentage of people with arterial hypertension and a lower percentage of optimal blood pressure in Krasnoyarsk Region population. The percentage of prehypertension decreased with age. Higher education, obesity and hypertriglyceridemia increased the risk of prehypertension.
Key words: prehypertension, hypertension, arterial hypertension, prevalence, epidemiology, ESSE-RF.
Grinshteyn Yu. I. ORCID: 0000-0002-4621-1618, Shabalin V. V. ORCID: 0000-0001-8002-2362, Ruf R. R. ORCID: 0000-0003-1753-6816, Shtrikh A. Yu. ORCID: 0000-0002-2065-8585, Balanova Yu. A. ORCID: 0000-0001-8011-2798.
Aim. To assess the incidence of unfavorable in-hospital outcomes (fatal and non-fatal complications) following coronary artery bypass grafting (CABG), depending on the age of the patient and the presence of comorbidities.
Material and methods. In the period from 2011 to 2012 we included in the study 680 patients for elective CABG (single-site, register, prospective study). Combined clinical endpoint (CCE) included the presence of myocardial infarction (MI), multiple organ dysfunction syndrome (MODS), heart failure (HF), new atrial fibrillation (AF) after CABG, repeat mediastinotomy (of one or more complications) and/or deaths.
in the early postoperative period. The highest number of CCEs was registered in the group of patients with combined surgical interventions.
Conclusion. Factors associated with the probable development of unfavorable nosocomial outcomes either fatal or non-fatal following is the age of patients 61 years and older, concomitant CABG, and the extracorporeal circulation.
Key words: comorbidities, coronary artery bypass grafting, unfavorable in-hospital outcomes.
Funding. This work was supported by program of basic scientific research of SB RAS.
Barbarash O. L. ORCID: 0000-0002-4642-3610, Zhidkova I. I. ORCID: 0000-0002-4819-5965, Shibanova I. A. ORCID: 0000-0001-8418-8140, Ivanov S. V. ORCID: 0000-0002-9070-5527, Sumin A. N. ORCID: 0000-0002-0963-4793, Samorodskaya I. V. ORCID: 0000-0001-9320-1503, Barbarash L. S. ORCID: 0000-0001-6981-9661.
COMORBIDITY, MULTIMORBIDITY, DUAL DIAGNOSIS — SYNONYMS OR DIFFERENT TERMS?
The authors express their opinion on the problem of the terminology of the combined pathology in modern clinical practice. The terms “comorbidity”, “multimorbidity”, “dual diagnosis” are considered in terms of conceptual differences. The issues of diagnostics, classification and modern clinical recommendations for patients with combined pathology are also discussed. Given the variety of terminology and the ambiguity of the semantic component in the discussion of the problem of comorbidity/multimorbidity, it seems justified for the medical community to come a common consensus in terms of terminology, classification and diagnosis. It will help to avoid mistakes and disagreements between physicians of various specialties.
Key words: comorbidity, multimorbidity, dual diagnosis, terminology, classification.
Drapkina O. M. ORCID: 0000-0002-4453-8430, Shutov A. M. ORCID: 0000-0002-1213-8600, Efremova E. V. ORCID: 0000-0002-7579-4824.
Nizov A. A., Suchkova E. I., Dashkevich O. V., Trunina T. P.
Aim. To study the structure of cardiovascular comorbidities, the quality of outpatient management and the structure of concomitant pathology in patients with cardiovascular continuum. To compare the obtained results with the results of the pilot stage of the REKVAZA register study (Outpatient Polyclinic Register of Cardiovascular Diseases in the Ryazan Region), conducted in 2012 using similar selection criteria. To evaluate the results of preventive measures for this patient population.
Material and methods. We carried out one-stage retrospective analysis of 1 thousand outpatient cards of cardiovascular patients in Ryazan, who visited a general practitioner in 2016.
that is 13,6% more than in 2012. Over the past 4 years, the number of people receiving statins increased from 35,9% to 50,6%, but the proportion of patients who achieved total cholesterol levels <5,0 mmol/l decreased from 51,1% to 31,6%. The frequency of prescription of antiplatelet agents and anticoagulants in the total cohort of the surveyed patients decreased from 64,8% to 40,6%.
Conclusion. Comorbidity levels among cardiovascular patients are high and it increases with age; the most common are various combinations of cardiovascular diseases. Antihypertensive, antiplatelet and lipid-lowering therapy does not fully comply with current clinical guidelines. Insignificant positive changes in the management of patients were noted: compared to 2012, the number of people receiving antihypertensive therapy and the number of patients taking statins increased, but there were no positive changes in case management.
Key words: cardiovascular diseases, comorbidity, outpatient practice, registries, chronic kidney disease, disorders of carbohydrate metabolism.
Nizov A. A. ORCID 0000-0001-9511-2547, Suchkova E. I. ORCID 0000-0002-7997-0338, Dashkevich O. V. ORCID 0000-0002-6383-5078, Trunina T. P. ORCID 0000-0002-2946-201X.
The article is a lecture on modern recommendations of the European Society of Cardiology and the American Heart Association for the diagnosis of syncopal conditions. The article presents the latest information from the 2018 review concerning the definition of syncope, its classification, diagnostics and risk stratification, patient management tactics. The article will be useful both to students, residents, postgraduates of medical universities, and practicing doctors.
Key words: syncope, cerebral hypoperfusion, orthostatic hypotension, tilt-test.
Conflicts of Interest: clinical studies of Astra Zeneka, Novartis, Janssen; Lecturer — Takeda 2013-2017, Servier 2016, Recordati 2013-2017, Sanofi 2018 — present.
Dzhioeva O. N. ORCID: 0000-0002-5384-3795, Reznik E. V. ORCID: 0000-0001-7479-418X, Nikitin I. G. ORCID: 0000-0003-1699-0881.
Volkova N. I., Davidenko I. Yu.
Arterial hypertension (AH) is observed in almost every third of adult, and in 15% of cases it can be secondary. Endocrine hypertension as a cause of symptomatic hypertension (SAH) takes the second place after renovascular etiology. Thus, screening of endocrine SAH should be performed on almost every patient with AH. The general practitioner first meets a patient with elevated blood pressure levels, and his aim is to suspect SAH just-in-time, be able to provide its primary diagnostics, interpret the results and know the cases when patient with AH should be referred to a narrowly focused specialist. The article presents modern approaches to screening of endocrine hypertension causes, which allow not only to normalize blood pressure, but also to avoid complications.
Key words: arterial hypertension syndrome, endocrine arterial hypertension, screening of endocrine pathology, general practitioner.
Volkova N. I. ORCID:0000-0003-4874-7835, Davidenko I. Yu. ORCID: 0000-0002-8690-681X.
anticoagulant drugs required for reperfusion. Knowledge of current guidelines should help reduce ischemia time and cases of unjustified refusal to effective interventions.
Key words: myocardial infarction, ST-segment elevation, pharmacoinvasive approach, thrombolytic therapy, tenecteplase.
Glezer M. G. ORCID 0000-0002-0995-1924, Astashkin E. I. ORCID 0000-0002-3559-9071.

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