ОСОБЕННОСТИ ТЕЧЕНИЯ И ПРИВЕРЖЕННОСТЬ ЛЕЧЕНИЮ ПРИ РАЗЛИЧНЫХ ВАРИАНТАХ СТАБИЛЬНОЙ СТЕНОКАРДИИ В СОЧЕТАНИИ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ У ЖИТЕЛЕЙ г. НОВОСИБИРСКА

The purpose. To study clinical and angiographic status, N-terminal pro-brain natriuretic peptide (Nt-proBNP) level and treatment adherence in stable angina associated with hypertension patients (pts).Materials and methods. 151 pts (men) divided into 3 groups were investigated. The 1st group was consisted of 43 men with uncomplicated angina without significant lesions of coronary artery. The 2nd group included 47 men with angina with history of coronary revascularization (percutaneous coronary intervention). The 3rd group included 61 men with angina after previous cardiovascular event (myocardial infarction or stroke).Results. There were less number of current smokers in uncomplicated stable angina group. 3rd group pts took more alcohol drinks before cardiovascular events. Biochemical blood status were compared in three groups. Structure-functional heart parameters were more disturbed in pts with previous cardiovascular events. Coronary arteries were more lesion in complicated angina pts too. Nt-proBNP levels were significantly higher in patients undergoing cardiovascular events. Factors determining in stable angina associated with hypertension were extent of coronary artery lesion, left-atrium, and left-ventricular size, left-ventricular hypertrophy, and ejection fraction. The relationship between Nt-proBNP levels and left ventricular remodelling as well as between Nt-proBNP levels and extent of coronary arteries lesions were revealed. Adherence to treatment was higher in patients underwent percutaneous coronary intervention.Цель. Целью исследования явилось изучение факторов риска, клинико-ангиографической картины, уровня N-концевого фрагмента предшественника мозгового натрийуретического пептида и приверженности лечению при различных клинических вариантах стабильной стенокардии.Материалы и методы. Обследован 151 мужчина со стабильной стенокардией. Больные были разделены на три группы: 1-ю группу составили 43 пациента с неосложненным течением стенокардии с гемодинамически незначимыми стенозами коронарных артерий, 2-ю – 47 пациентов со стабильной стенокардией, подвергшихся чрескожному коронарному вмешательству и 3-ю – 61 пациент со стабильной стенокардией с перенесенным кардиоваскулярным событием (инфаркт миокарда, мозговой инсульт) независимо от характера поражения коронарных артерий.Результаты. Выявлено достоверно меньшее число курящих больных в группе неосложненного течения стенокардии, а больные, перенесшие кардиоваскулярное событие, употребляли в прошлом большее количество алкоголя. Структурно-функциональное состояние миокарда в большей степени изменено у больных стенокардией с наличием кардиоваскулярных событий, у них же имелось более значимое поражение коронарных артерий. Уровень N-концевого фрагмента мозгового натрийуретического пептида был достоверно выше у больных, перенесших инфаркт миокарда, его значения коррелировали со степенью ремоделирования левого желудочка и выраженностью стеноза коронарных артерий. Приверженность лечению оказалась выше у больных, подвергшихся чрескожному коронарному вмешательству

MicroRNA level in patients with stable coronary artery disease with borderline coronary artery stenosis

Aim. To assess the level of microRNA (miR) -21, -22, -126, -221 in patients with coronary artery disease (CAD) with borderline coronary artery stenosis depending on comorbidities and sex.Material and methods. We examined 37 patients with class 1-3 stable CAD aged 49-59 years with borderline (40-70%) coronary artery stenosis. The relative level of miRNA was determined using real-time polymerase chain reaction. Statistical analysis was performed using the non-parametric Mann-Whitney U-test. P<0,05 were considered statistically significant. Results. The miR-221 level was higher in the group of patients with stable CAD with borderline coronary artery stenosis with a metabolically unhealthy obesity (MUO) phenotype, but without diabetes (p=0,042). The level of miR-22 and miR-126 was higher in the group of patients with stable CAD phenotype with borderline stenosis and diabetes (p=0,007 and p=0,034, respectively). The analysis of miR levels in stable CAD patients depending on sex, without taking into account the phenotype, found that miR-21 and miR-221 values were higher in men (p=0,021 and p=0,014, respectively). The study of the sex characteristics of miR content in relation to different phenotypes revealed an increase of miR22 levels in men with MUO and diabetes (p=0,048) and an increase of miR-126 levels in women with concomitant diabetes in the comparison both with patients without MUO and diabetes (p=0,018), as well as with MUO and without diabetes (p=0,007). Conclusion. The study of the miRNA level in patients with CAD with borderline coronary artery stenosis is of great interest and reflects a promising direction in diagnosis based on comorbid pathology. Keywords: miRNA, obesity phenotypes, coronary artery disease, borderline coronary artery stenosis. Relationships and Activities: none. 1Novosibirsk State Medical University, Novosibirsk; 2Federal Research Center of Fundamental and Translational Medicine, Novosibirsk; 3E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia.><0,05 were considered statistically significant.Results. The miR-221 level was higher in the group of patients with stable CAD with borderline coronary artery stenosis with a metabolically unhealthy obesity (MUO) phenotype, but without diabetes (p=0,042). The level of miR-22 and miR-126 was higher in the group of patients with stable CAD phenotype with borderline stenosis and diabetes (p=0,007 and p=0,034, respectively). The analysis of miR levels in stable CAD patients depending on sex, without taking into account the phenotype, found that miR-21 and miR-221 values were higher in men (p=0,021 and p=0,014, respectively). The study of the sex characteristics of miR content in relation to different phenotypes revealed an increase of miR22 levels in men with MUO and diabetes (p=0,048) and an increase of miR-126 levels in women with concomitant diabetes in the comparison both with patients without MUO and diabetes (p=0,018), as well as with MUO and without diabetes (p=0,007).Conclusion. The study of the miRNA level in patients with CAD with borderline coronary artery stenosis is of great interest and reflects a promising direction in diagnosis based on comorbid pathology

Atrial fibrillation and arterial hypertension in hypothyroid pathology

A special role in the formation of atrial fibrillation in patients with arterial hypertension is played by diseases of the thyroid gland. In any form of hypothyroidism, vascular tone increases, hypervolemia is formed, which leads to changes in blood pressure, myocardial dystrophy and the development of AF. The development and progression of AF affects the lack of thyroid hormones: TH suppresses aldosterone synthesis and stimulates the secretion of atrial and cerebral natriuretic peptide. Therefore, hypothyroidism develops hyperaldosteronism and decreases the content of natriuretic hormone in the blood, which leads to hypervolemia. Atrophic processes in cardiomyocytes are exacerbated by intracellular potassium deficiency, which is caused by hyper aldosteronism characteristic of all types of hypothyroidism. TG plays the role of physiological antagonists of antidiuretic hormone, and their deficiency leads to increased water reabsorption and increases the likelihood of the formation of a volume-dependent form of hypertension, the effect on the endothelium of the cell, releasing vasoactive substances and reducing the sensitivity of adrenoreceptors to the action of catecholamines. In hypothyroidism, almost all soft tissues, including the vascular wall, accumulate in an excessive amount of glycosaminoglycans, which binds sodium ions and water, which leads to swelling of the vascular wall, reduction of nitric oxide production and narrowing of the lumen of arteries and veins. Hyperproduction of thyroliberin, which leads to a decrease in dopaminergic activity of the brain. In addition, hypothyroidism causes thickening of the basement membrane of capillaries and the diffusion of oxygen through their wall is disturbed. The effect of hypothyroidism and drugs used in its treatment on AF is ambiguous. The authors disagree about the course of AF and the frequency of relapse, the risk of complications of AF. All this indicates the need to continue research in this direction.В статье изложен обзор литературы, отражающий преставления о значении гипотиреоидной патологии в развитии фибрилляции предсердий. особую роль в формирование фибрилляции предсердий у больных артериальной гипертонией играют заболевания щитовидной железы. При любой форме гипотиреоза повышается сосудистый тонус, формируется гиперволемия, что приводит к изменению уровня артериального давления, дистрофии миокарда и развитию фибрилляции предсердий. На развитие и прогрессирование ФП влияет недостаток гормонов щитовидной железы: тиреоидные гормоны подавляют синтез альдостерона и стимулируют секрецию предсердного и церебрального натрийуретического пептида. Поэтому при гипотиреозе развивается гиперальдостеронизм и снижается содержание в крови натрийуретического гормона, что приводит к гиперволемии. Атрофические процессы в кардиомиоцитах усугубляются внутриклеточным дефицитом калия, который обусловлен гиперальдостеронизмом, характерным для всех видов гипотиреоза. ТГ выполняют роль физиологических антагонистов антидиуретического гормона,а их дефицит приводит к усилению реабсорбции воды и повышает вероятность формирования объемзависимой формы АГ, влиянию на эндотелий клетки, высвобождающий вазоактивные вещества и уменьшения чувствительности адренорецепторов к действию катехоламинов. При гипотиреозе почти во всех мягких тканях, включая сосудистую стенку, накапливаются в избыточном количестве гликозаминогликаны, который связывает ионы натрия и воду, это приводит к отеку сосудистой стенки, снижению продукции оксида азота и сужению просвета артерий и вен. Гиперпродукция тиреолиберина, которая приводит к снижению дофаминергической активности головного мозга. кроме того, при гипотиреозе происходит утолщение базальной мембраны капилляров и нарушается диффузия кислорода через их стенку. Влияние гипотиреоза и препаратов, используемых при его лечении, на ФП неоднозначно. авторы расходятся во мнении относительно течения ФП частоты развития рецидивов, риска возникновения осложнений ФП. Все это указывает на необходимость продолжения исследований в данном направлении

Measurement of the 1s-2s energy interval in muonium

The 1s-2s interval has been measured in the muonium ({$\mu^+e^-$}) atom by Doppler-free two-photon laser spectroscopy. The frequency separation of the states was determined to be 2 455 528 941.0(9.8)~MHz in good agreement with quantum electrodynamics. The muon-electron mass ratio can be extracted and is found to be 206.768 38(17). The result may be interpreted as measurement of the muon-electron charge ratio as $-1- 1.1(2.1)\cdot 10^{-9}$

Metabolic disturbances and endothelial function in elderly patients with systolic and diastolic chronic heart failure

Aim. To study the associations between metabolic disturbances, cytokine levels, brain natriuretic peptide (BNP), and endothelial function markers in elderly patients with various types of chronic heart failure (CHF).Material and methods. The study included 127 men aged 60-75 years (mean age 67,4±0,3 years), divided into two groups. Group I consisted of 77 patients with restrictive diastolic CHF (dCHF). Group II included 50 patients with systolic CHF (sCHF). The control group (CG) consisted of 30 healthy volunteers. The levels of pro- and anti-inflammatory cytokines, N-terminal fragment of pro-brain natriuretic peptide (Nt-proBNP), and NO were measured.Results. Metabolic disturbances of varying severity were observed in all elderly patients with CHF. In both dCHF and sCHF, endothelial dysfunction was present, which manifested in high levels of microalbuminuria, C-reactive protein, interleukin ip, and tumor necrosis factor-alpha (TNF-а). Cytokine system activation differed in dCHF and sCHF.Conclusion. High levels of TNF-alpha and Nt-proBNP in elderly patients with both types of CHF pointed to a marked left ventricular dysfunction. In sCHF group, significantly higher levels of TNF-alpha, Nt-proBNP, and uric acid were an evidence of more severe clinical course and adverse prognosis of CHF

Current aspects of stable ischemic heart disease. ISСHEMIA study: breakthrough or constant optimism in approaches to treatment. Myocardial ischemia in non-obstructive coronary arteries (INOCA)

Approaches to stable coronary artery disease (CАD) treatment have been subject to debate for a long time. One of the first and fundamental studies in stable coronary artery disease patients treatment is the COURAGE study, which showed the advantage of rational drug therapy in comparison with percutaneous intervention in such patients. However, CAD high prevalence with medical and social significance cause the need for future development of relationship between conservative and invasive approaches in the problem of this disease treatment. It was particularly the focus of recently completed multicentre ISCHEMIA trail. The aim of review is to analyze the available data on the management of stable coronary artery disease patients based on the ISCHEMIA study data. Results. In the largest multicenter randomized clinical trial ISCHEMIA, the primary outcome (cardiovascular death, myocardial infarction, cardiac arrest with effective resuscitation, hospitalization due to heart failure) rate was 13.3% in the routine invasive strategy group and 15.5% in the conservative strategy group (p = 0.34). The main secondary outcome rate also does not differ between groups significantly. Quality of life in the non-invasive group was higher only in those patients who had angina at baseline. Study subanalysis demonstrated that left coronary artery borderline stenosis accompanied by a poor prognosis, and an invasive strategy improves angina symptoms. Also, low density lipoprotein cholesterol target values achievement predictors were determined. In addition, women, participated in ISCHEMIA study had more frequent angina episodes, regardless less extensive coronary artery damage, and less severe ischemia manifestations than men. Among stable CAD accompanied moderate to severe ischemia and severe chronic kidney disease patients, no evidence initial invasive strategy, compared initial conservative strategy, in relation of death or non-fatal myocardial infarction risk reduction was found. Conclusion: ISCHEMIA trial data demonstrated necessity more carefully stable coronary artery disease patients selection for invasive treatment, taking into account angina pectoris severity and modern antianginal therapy possibilities

COMPARISON OF ENALAPRIL AND PERINDOPRIL IN PATIENTS WITH ARTERIAL HYPERTENSION AND LEFT VENTRICLE SYSTOLIC DYSFUNCTION

Aim. To compare efficacy of enalapril and perindopril in patients with arterial hypertension (HT) and left ventricle systolic dysfunction.Material and methods. Patients (n=51) with HT and left ventricle systolic dysfunction (ejection fraction<45%) were included in the prospective open randomized comparative study. Patients were randomized into 2 groups of therapy with enalapril 10-20 mg BID (n=25) or with perindopril 4-8 mg OD (n=26). Hydrochlorothiazide (12,5-25 mg OD) was added in case of ineffective therapy. Routine clinical examination, ambulatory blood pressure (BP) monitoring, an electrocardiogram, an echocardiography were performed in all patients.Results. The 24-hour and night antihypertensive effect of enalapril was more prominent than this of perindopril. Target BP level was reached in 21 patients (84%) of enalapril group and in 20 patients (76,9%) of perindopril group. 8 (30,8%) patients of perindopril group did not reach night target BP level vs 3 (12%) patients of enalapril group. Similar improvement of the left ventricle systolic function was observed in both groups.Conclusion. Enalapril and perindopril demonstrated comparable antihypertensive and cardioprotective effect

THE IMPROVEMENT OF LIPID-LOWERING THERAPY EFFECTIVENESS IN PATIENTS WITH HIGH CARDIOVASCULAR RISK AND CONCOMITANT LIVER DISEASE (RESULTS OF ADDITIONAL ANALYSIS OF THE RAKURS STUDY)

Aim. To evaluate the differences between a group of patients treated with ursodeoxycholic acid (UDCA) during the study period and a group of patients not treated with UDCA by pseudo-randomization using Propensity Score Matching.Material and methods. 262 patients aged 60.1±8.9 years, taking statins for the secondary prevention of cardiovascular complications were included into a 6-month observational cohort study. The UDCA intake was recommended to all the patients due to the presence of liver and/or bile duct diseases. One part of the patients strictly followed medical recommendations and used UDCA, while the other part of the patients wasn’t taking UDCA. This allowed comparing the effect of UDCA in these groups.Results. Propensity Score Matching method allowed forming two groups of patients of 52 people each with similar main clinical and demographic characteristics. A more significant decrease in the levels of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) (up to 4.0 mmol/L and 1.92 mmol/L, respectively; p&lt;0.001) after 6 months was found in patients treated with lipid-lowering therapy in combination with UDCA as compared with patients without UDCA (up to 4.52 mmol/L and 2.6 mmol/L, respectively; p&lt;0.05). No ALT, AST, CPK, LDH activity deterioration and no bilirubin serum level increase was found. Due to statin treatment the target levels of LDL-C by the end of the study were achieved in 31% of the patients of UDCA-group. Target levels of LDL-C were not achieved in any of the patients of the group without UDCA (p&lt;0.001). There was demonstrated a high adherence to UDCA therapy.Conclusion. Combined therapy with statins and UDCA is effective and safe in patients with high cardiovascular risk and concomitant liver disease. Co-administration of statins with UDCA is promising in the treatment of hyperlipidemia in patients with low tolerance to statins. However, additional controlled studies are required.</p