The impact of visual functions on athletes’ results and methods of their improvements

Regardless of the sport, maintaining and improvement of visual functions in athletes act an important role in achieving personal records.In this article, the interrelationships between sports results and the state of visual functions were determined, as well as devices and methods were analyzed, thanks to which it is possible to improve functions of the visual analyzer

Improving outpatient care in chronic heart failure

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region

The influence of Losartanum and Amlodipinum fixed combination use on cardiovascular complications risk factors seasonal variability in patients with arterial hypertension

Rationale: The influence of drugs on adaptation to high temperatures and seasonal variability of cardiovascular disease factors is one of the most important issues of treatment raised during re-cent heat waves. The safety of calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) use during heat waves is quite controversial. Aim: To assess the seasonal variability of hemodynamic parameters, vessel wall stiffness, lipid, carbohydrate and electrolyte metabolism in patients with arterial hypertension (AH) and to as-sess safety and effectiveness of fixed combination of Losartanum and Amlodipinum (Lortenza® KRKA) use according to one-year follow-up results. Materials and methods. The study included 26 patients with stage 1 and 2 AH aged from 42 to 81 years. Office blood pressure measurement, electrocardiography, volumetric sphygmography (pulse-wave velocity, cardio-ankle vascular index), serum chemistry, blood osmolarity tests were performed. Visual Analog Scale (VAS), Heat Questionnaries and self-control diaries were also assessed. The baseline visit took place in spring of 2016, the first visit - in May-June 2016, the second - during the heat wave, the third - in September-October 2016, the fourth - in January-February 2017, and the fifth - in April-May 2017. Results. The treatment resulted in systolic and diastolic blood pressure decrease (р=0.000) to target value which persisted during the follow-up period. According to the self-control diaries 81% of patients did really control BP. During the heat wave only 58% of patients succeeded in BP control, in autumn - 63%, in winter and spring - 81% and 86%, respectively. By the third visit the heart rate decreased on -6.0 (-11.1; -2.8) beats per minute, p=0.007. The decrease in pulse-wave velocity from 15.2±3.4 m/s to 13.6±2.7 m/s, p=0.01 and CAVI on -2.1 (-2.9; -0.65), p=0.01 was observed on the third visit. Decrease in uric acid level (

Prognostic value of subclinical atherosclerosis in patients with a SCORE risk <5%: data from a 10-year follow-up

Aim. To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs) &lt;5% based on a 10-year follow-up.Material and methods. The study included 379 patients with SCORE risk of CVEs &lt;5% (82 men, 297 women). In 2009, all patients underwent clinical examination, carotid artery (CA) ultrasound with the detection of plaques, total CA occlusion, intima-media thickness (IMT) of the common carotid artery (CCA). The plaque number was determined as the total number of all plaques in 6 following segments: both CCAs, both CCA bifurcations and both internal carotid arteries. The total stenosis was calculated as the sum of stenoses in 6 CA segments in %. In 2019, a telephone survey of patients was conducted with a questionnaire assessing the following CVEs: all-cause death, cardiovascular death, myocardial infarction (MI), stroke, myocardial revascularization, cardiovascular hospitalizations, and composite endpoint.Results. The initial patients’ age ranged from 35 to 67 years (51,1±7,5 years). Plaques from 20% to 50% were detected in 303 participants (79,94%). Over the past 10 years, there have been 5 cardiovascular deaths (1,3%), 7 MIs (1,8%), 5 cases of unstable angina (1,3%), 12 cases of myocardial revascularization (3,2%), 15 strokes (4,0%), 51 cardiovascular hospitalizations (13,5%). The proportion of patients with registered endpoints (CVE+) was 22,4% (n=85). The groups of patients with and without CVEs differed in the level of systolic blood pressure (BP) and blood triglycerides, and did not differ in the level of diastolic BP, lipid profile, glucose, heart rate, smoking status, sex, and age. In the CVE+ group, there were higher values of CCA IMT (0,65 (0,64; 0,70) mm vs 0,62 (0,62; 0,66) mm, p&lt;0,05), total CA stenosis (102,5 (88,1; 120,8)% vs 80 (72,5; 88,1)%, p=0,01), and the CA plaque amount (4,0 (2,8; 3,9) vs 3,0 (2,6; 3,1), p=0,01), respectively. Total CA stenosis was an independent predictor of CVEs when adjusted for sex, age, systolic and diastolic BP (β=0,149; p&lt;0,05), but not for lipid profile. A ROC-analysis revealed a cut-off point for total CA stenosis of 82,5% (AUC=0,598, 95% confidence interval 0,5243-0,673, p&lt;0,05).Conclusion. The total CA stenosis has shown itself to be an independent predictor of CVEs in patients with a SCORE risk &lt;5%

Кардиомиопатия и множественный артериальный тромбоз у пациента с тахиформой фибрилляции предсердий, перенесшего COVID-19 тяжелого течения

We present a case of cardiomyopathy with a reduced left ventricular ejection fraction of up to 18%, multivessel arterial thrombosis in a patient who had undergone severe COVID-19 3.5 months earlier. The cardiopathy was initially considered as an outcome of SARSCoV2-induced myocarditis, but MRI with delayed gadolinium contrast revealed no fibrosis or evidence of active myocarditis. A detailed collection of the medical history showed that the duration of tachyform atrial fibrillation exceeded the 4 months indicated in the medical records. Oligosymptomatic manifestation of arrhythmia occurred 8 months earlier, the patient did not consult a physician due to epidemic conditions. Coronary angiography revealed subtotal stenosis of the anterior descending artery. Most probably, the cardiopathy was arrhythmogenic and ischemic. After achieving normosystole and coronary stenting, the left ventricular ejection fraction was 25-27%. At the first hospitalization 4 months ago, left atrial auricular thrombus was detected. After COVID-19 the patient received inadequately low dose of apixaban 5 mg per day. Three weeks after COVID-19, the patient was diagnosed with infarction of the right kidney, wall thrombosis in the abdominal aorta, thrombosis of the superficial femoral, deep femoral, popliteal, anterior tibial arteries on the left, right popliteal artery; thrombotic complications could have developed both in situ and as a result of cardioembolism. Administration of dabigatran 300 mg per day and aspirin helped to dissolve the thrombus in the left atrial auricle, improve the course of intermittent claudication, and avoid recurrent thrombotic complications. COVID-19 could contribute to the progression of atherosclerosis, more malignant course of atrial fibrillation, development of thrombosis, but coronavirus infection is not the only cause of severe disease in a patient. СOVID-19 can not only be the cause of direct lesions of the heart and vessels, but also have an indirect negative effect - to delay the detection of cardiac pathology and be the cause of its hypodiagnosis under the mask of “postcovid”.Представлен случай кардиомиопатии со снижением фракции выброса левого желудочка до 18%, многососудистым артериальным тромбозом у пациента, перенесшего COVID-19 тяжелого течения 3,5 мес. назад. Изначально кардиопатия расценивалась как исход миокардита, вызванного SARS-CoV2, однако МРТ с отсроченным контрастированием гадолинием не выявила ни фиброза, ни признаков активного миокардита. Подробный сбор анамнеза показал, что давность тахиформы фибрилляции предсердий превышает 4 мес., указанные в медицинской документации. Малосимптомная манифестация аритмии произошла на 8 мес. раньше, пациент не обращался к врачу в связи с эпидобстановкой. По данным коронароангиографии был выявлен субтотальный стеноз передней нисходящей артерии. Наиболее вероятно, кардиопатия носит аритмогенный и ишемический характер. После достижения нормосистолии и коронарного стентирования фракция выброса левого желудочка составила 25–27%. При первой госпитализации 4 мес. назад выявлен тромб ушка левого предсердия. После COVID-19 пациент получал неадекватно низкую дозу апиксабана 5 мг в сутки. Через 3 нед. после COVID-19 у пациента был выявлен инфаркт правой почки, пристеночные тромбы в брюшной аорте, тромбоз поверхностной бедренной, глубокой бедренной, подколенной, передней большеберцовой артерий слева, подколенной артерии справа; тромботические осложнения могли развиться как in situ, так и быть следствием кардиоэмболии. Назначение дабигатрана 300 мг в сутки и аспирина позволило добиться растворения тромба в ушке левого предсердия, улучшения течения перемежающейся хромоты, избежать повторных тромботических осложнений. COVID-19 мог способствовать прогрессированию атеросклероза, более злокачественному течению фибрилляции предсердий, развитию тромбозов, однако коронавирусная инфекция не является единственной причиной тяжелого заболевания у пациента. СOVID-19 не только может быть причиной прямого поражения сердца и сосудов, но и оказывать косвенное негативное влияние – отдалять выявление кардиальной патологии и быть причиной ее гиподиагностики под маской «постковида»

What “new” factors should be considered when assessing cardiovascular risk?

One of the causes of high mortality from cardiovascular diseases is the lack of effective measures for the primary and secondary prevention of cardiovascular complications (CCO), due to the difficulty of timely identification risk factors (RF) and individuals with a high individual risk of CCO. This is especially true for patients from low/mean risk. This group is heterogeneous. Often, clinical manifestations of atherosclerosis occur for the first time without “classical” RF. Possible factors that increase the risk of developing cardiovascular diseases and CCO, are: heart rate, increased formation of advanced glycation endproducts, disorders of bone mineral metabolism, thyroid function, low adherence to therapy, psychosocial factors and climatic features. This review is devoted to the analysis of the evidence base of the influence of these “new” CCO RF and the individual patient prognosis

THE POSSIBLE INFLUENCE OF BISPHOSPHONATE THERAPY AND ITS COMBINATION WITH STATINS ON PARAMETERS OF AORTIC STIFFNESS IN WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS

The study shows that addition of statins to osteoporotic therapy in postmenopausal women with different cardiovascular risk beside desired hypolipidemic effect and reduction of arterial stiffness also elevates BMD at femoral neck by 4,9% from the baseline (p<0.05). Bisphosphonates therapy in postmenopausal women gives additional reduction of central systolic arterial pressure of 4.1 mm Hg with the tendency to improvement in the arterial stiffness. The dynamics of aortal stiffness was correlated with changers in intensity of bone remodeling (for N-terminal propeptides of type I procollagen (P1NP) p =0.47, p=0.019; for carboxyl-terminal telopeptide of collagen type I (CITP1) p=0.40, p=0.05) as well as systolic blood pressure (r=0.52, p=0.008). Conclusions. Bisphosphonate therapy and its combination with statins may influence the on parameters of blood pressure and aortic stiffness in women with postmenopausal osteoporosis