Features of changes of cardiogemodynamics and some myocardial structural-functional parameters in patients with a combined current of essential hypertension

Синтропія, як характерна ознака більшості хронічних захворювань внутрішніх органів, певною мірою стосується есенціальної гіпертензії (ЕГ) та пептичної виразки (ПВ) дванадцятипалої кишки (ДПК), а їх поєднання може змінювати клінічні прояви і мати обтяжуючий вплив на перебіг кожного із захворювань

Daily monitoring of arterial pressure as a method of early diagnosis of arterial hypertension in young patients

Thus, it can be concluded that daily monitoring of blood pressure is a highly sensitive method that allows diagnosing arterial hypertension in young patients in the early stages. It should be noted that the majority of patients with arterial hypertension had pathological daily profiles, which indicates an unfavorable prognosis and it needs for more careful management of such patients. It seems that we should change our traditional practice to diagnose and manage BP according to office measurements and more broadly use 24-h ABPM, particularly in young patients, to optimize BP control

Quercetin reduces the transcriptional activity of NF-kB in stable coronary artery disease

The aim of this study was to determine the effect of quercetin on the indicators of chronic systemic inflammation (CSI) in stable coronary artery disease (CAD). Methods: This study included 85 patients with CAD, stable angina pectoris, functional class (FC) II, and heart failure (=F) 0-y. Each patient was prescribed beta-blockers, statins, and aspirin. In addition, a total of 30 patients, forming the study group received quercetin at a daily dose of 120 mg for two months, while the remaining 55 patients made up the control group. The levels of cytokines, such as tumor necrosis factor (TNF-a), interleukin-1b (IL-1b), and interleukin-10 (IL-10) in serum and the expression of the inhibitor of kappa B a (IkBa) gene in blood mononuclear cells, were determined

Justification of increasing the blood flow velocity in the arteries of the thyroid gland in autoimmune thyroiditis as a reflection of endothelial changes due to inflammatory status

Abstract: Objective: The aim of the research was to determine the dependence of the blood flow velocity in the thyroid arteries in patients with autoimmune thyroiditis (AIT) on the presence of atherosclerotic carotid disease and the level of systemic blood pressure. Method: The research involved 20 patients with AIT in euthyroid state, 30 patients AIT in euthyroid state with stable coronary heart disease (CHD), 30 patients with stable CHD and 30 healthy individuals. Participants of the research were examined using ultrasound of carotid arteries and inferior thyroid arteries. Parameters of blood flow velocity were compared with the level of systemic blood pressure. Results: In AIT peak systolic velocity and resistance index in the inferior thyroid arteries were sig- nificantly higher than in healthy individuals and patients with CHD (p<0.05). In patients with CHD velocity parameters in carotid arteries were high, unlike in the healthy individuals and patients with AIT (p<0.05). In patients with AIT without CHD the atherosclerotic changes of carotid arteries were not found. Increased systemic blood pressure was noticed in all patients with CHD without significant differences between groups

Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Phase transformations in Pt/Fe bilayers during post annealing probed by resistometry

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Effect of quercetin on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease

The aim: The aim of our research was to study the effect of quercetin on parameters of central hemodynamics and myocardial ischemia in patients with stable coronary heart disease (CHD). Material and methods: The research involved 85 patients with CHD: stable angina pectoris, FC II, and 30 healthy individuals made up the control group. After 1.5 months of stabilizing therapy (β-blockers, statins, aspirin) patients with CHD were randomized into 2 groups — the research group (30 people) and the comparison group (55 people). Quercetin at a dose of 120 mg per os daily was added to standard treatment of the patients of the research group (with CHD), patients of the comparison group continued receiving the same treatment. The day before randomization and 2 months after prescribing differentiation therapy to the patients, echocardiography (echo) and 24 hour Holter ECG monitoring were made. Results: Clinical evaluation of echocardiography revealed that diastolic dysfunction of the left ventricle (LV) had been found in 100% of patients studied: in 97.6% — in the form of violation of relaxation (type I), in 2.4% of patients — in the form of pseudonormalization (type II). The 24 hour Holter ECG monitoring revealed episodes of myocardial ischemia (10.7+2.7 episodes a day), premature atrial contractions (PACs) and premature ventricular contractions (PVCs) in patients with stable CHD. After a two-month term of therapy in patients of both research and comparison groups left ventricular systolic function in terms of ejection fraction (EF) of LV significantly improved (by 4.5% and 3.2% respectively). LV diastolic function improved in both groups in terms of the ratio of the phases of the transmitral flow E/A, also IVRT significance decreased (p<0.05). DT value dropped significantly influenced by quercetin, in the comparison group it didn`t change. According to the 24 hour Holter ECG monitoring, the total time and number of episodes of ST segment depression decreased with dominative results in quercetin group. PVC number was significantly reduced only by influence of therapy with quercetin (р=0.0022). Conclusions: The data have shown cardioprotective properties of quercetin in conditions of CHD

Comparative characteristics of the endothelial functional indices in the patients with chronic obstructive pulmonary disease in the presence of comorbidity

Вивчались показники функції ендотелію у хворих на хронічне обструктивне захворювання легень (ХОЗЛ) в умовах коморбідності з ішемічною хворобою серця (ІХС) та метаболічним синдромом (МС). Встанов¬лено, що наявність коморбідної ІХС, а особливо в поєднанні з МС, супроводжується більш значним погіршен¬ням показників функціонального стану ендотелію. Свідченням тому є відповідні зміни як вазоконстрикторів (ЕТ-1) та вазодилататорів (метаболітів оксиду азота), так і показників морфометрії плечової артерії; Изучались показатели функции эндотелия у больных хронической обструктивной болезнью лег¬ких (ХОБЛ) в условиях коморбидности с ишемической болезнью сердца (ИБС) и метаболическим синдро¬мом (МС). Установлено, что наличие коморбидной ИБС, а особенно в сочетании с МС, сопровождается более значительным ухудшением показателей функционального состояния эндотелия. Свидетельством тому стали соответствующие изменения как вазоконстрикторов (эндотелина-1) и вазодилататоров (метаболитов оксида азота), так и показателей морфометрии плечевой артерии; Еstimation of endothelial function’s indices in the patients with chronic obstructive pulmonary disease (COPD) at conditions of comorbidity with coronary artery disease (CAD) and metabolic syndrome (MS) has been carried out. 45 outpatients with COPD of the second stage (male-30, female-15, mean age – 61,3±5,4) were examined. There were 15 patients with comorbid CAD (the 2nd group), 15-with comorbid CAD and MS (the 3nd group) among them. The 1st group included 15 patients with the isolated COPD. The patients’ status was medicamentous compensation. All the groups were of the same sex and age. The control group consisted of 10 practically healthy individuals of the same sex and age. It has been established that significant increase of endothelin-1(ET-1) occurs not only in patients of the 2nd and the 3rd group in comparison with the 1st group (accordingly, 1,41 times and 1,88 times as much as among the 1st group, р<0,001), but also in case of comparison of the 3rd and the 2 nd groups (1,33 times, р<0,001). Clear regularity also was observed during the analysis of content of the stable metabolites of nitrogen oxide (NOХ). Their concentration, on the contrary, was decreased in the patients of the 2nd and the 3rd groups in comparison with the 1st (accordingly, 1,43 times and 1,79 times as little as among the patients of the 1st group, р<0,001). Decrease of this index in the patients of the 3rd group (20,1±1,7 μmol/l) in comparison with the 2nd group (25,1±1,3 μmol/l) was also significant (р<0,05), but less than statistical difference of the preceding index. We have established the significant increase of the diameter of the right brachial artery (DRBA) only in the patients of the 2nd and the 3rd groups in comparison with the 1st (accordingly, 1,24 times and 1,31 times as much as among the patients of the 1st group, р<0,001). As for the comparison of this index between the 2nd and the 3rd groups, it is necessary to note that there is just an insignificant tendency to increase in case of combination of CAD and MS with COPD (the 2nd group – 5,2±0,2 mm; the 3rd group – 5,5±0,2 mm). The same result (but to the side of decrease) was obtained during the analysis of endothelium-dependent vasodilatation (EDVD) (the difference was significant only between the 2nd and the 1st, the 3rd and the 1st groups, р<0,001). As for endothelium-independent vasodilatation (EIVD), we have revealed not only significant differences between the 2nd and the 1st groups (р<0,001), the 3rd and the 1st groups (р<0,001) but also significant decrease of this index (1,30 times) in the patients of the 3rd group in comparison with the 2nd group (р<0,05). Such a decrease of the two last-mentioned indices can be connected with diminishing of smooth muscles cells’ sensitivity to nitrovasodilators (that can be observed in case of hypoxia, signs of the heart failure, metabolic imbalance) and with intensification of the vasoconstrictor factors. Difference of initial blood velocity in the patients with comorbid pathology was more significant (the 2nd group – 0,55±0,007 м/с, the 3rd group – 0,51±0,005 m/sec., (р<0,001), not to mention the more significant decrease of these indices in comparison with the 1st group. Analysis of hyperemia (percentage of increase of the blood velocity) has shown a significant decrease of this index in the patients of the 2nd group in comparison with the 1st (р<0,01), and especially in the patients of the 3rd group in comparison with the 1st (р<0,001). In our opinion, this result and the preceding data are the confirmation of the negative influence of comorbid pathology upon the functional state of endothelium. At the same time, its significant difference between patients of the 2nd and the 3rd groups wasn’t established in spite of decrease of this index in case of comorbidity of COPD with CAD and MS. Thus, the presence of comorbid CAD and, peculiarly, CAD combined with MS in the patients with COPD is accompanied by more significant worsening of the indices of the functional state of endothelium. The changes of both vasoconstrictors (ET-1), vasodilators (NOX) and indices of brachial artery’s morphometry are the evidence for it

Chronic obstructive pulmonary disease and ischemic heart disease: the problems of comorbidity

В статті представлений аналіз сучасних літературних даних стосовно коморбідності хронічно¬го обструктивного захворювання легень (ХОЗЛ) та ішемічної хвороби серця (ІХС), надзвичайно актуальної проблеми сьогодення. Визначено та показано, що коморбідність ХОЗЛ з кардіоваскулярною патологією за¬лишається найбільш важливою, вона відображає єдність кардіореспіраторної системи і є сумарним інте¬гральним фактором негативного прогнозу. Доведено, що ці два захворювання на сьогодні розглядаються як «кримінальні партнери». В статті встановлено, що наявність ХОЗЛ можна розглядати як незалежний чинник ризику ІХС поряд з віком, палінням, рівнем холестерину, підвищенням систолічного артеріального тиску. В широкому об’ємі висвітлено, що значну увагу слід приділяти активному виявленню клінічної симптоматики ІХС, безбольової ішемії для своєчасної діагностики захворювання та призначення антиангінальної терапії. Зазначено, що у хворих на ХОЗЛ розвиток ІХС погіршує легеневу гемодинаміку, альвеолярний газообмін та його перебіг. Проаналізовані групи ризику поєднаної патології, знання яких надасть можливість попередити прогресування кожного із захворювань, покращити віддалений прогноз, якість життя хворих; В статье представлен анализ современных литературных данных коморбидности хроничес¬кой обструктивной болезни легких (ХОБЛ) и ишемической болезни сердца (ИБС) – чрезвычайно актуальной проблемы современности. Установлено, что коморбидность ХОБЛ с кардиоваскулярной патологией оста¬ется наиболее важной, она отображает единство кардиореспираторной системы и является суммарным интегральным фактором негативного прогноза. Показано, что эти заболевания рассматриваются как «криминальные партнеры». В статье установлено, что ХОБЛ можно рассматривать как независимый фактор риска ИБС наряду с курением, уровнем холестерина, повышением систолического артериального давления. Значительное внимание следует уделять активному выявлению клинической симптоматики ИБС, безболевой ишемии для своевременной диагностики заболевания и назначения антиангинальной терапии. Установлено, что у больных ХОБЛ развитие ИБС ухудшает легочную гемодинамику, альвеолярный газообмен и его течение. Проанализированы группы риска сочетанной патологии, знание которых даст возможность предупредить прогрессирование каждого из заболеваний, улучшить отдаленный прогноз, качество жизни больных; The epidemiological research conducted in different parts of the world for many years have showed that diseases of respiratory organs have a great percentage, the morbidity remains on the high level and has no tendency to the reduction. Chronic obstructive pulmonary disease (COPD) remains one of the main problems of the public health service in the world. Every year this pathology becomes the reason for 2,75 million deaths. COPD will have taken the 3rd place among the reasons for death by 2030. Only 25% cases of COPD is diagnosed in time even in European countries and it is the reason for early patients’ disability. Increase of spreading of the broncho-pulmonary and cardiovascular pathology, aging of population cause the prognosis for the increase of the patients with comorbidity in future. Many experts claim that COPD must be considered only as the polymorbid state and that it is often manifested on the background of the ischemic heart disease (IHD), arterial hypertension, metabolic disorders, diabetes mellitus, infiltrative diseases, tumors of the lungs, primary pulmonary hypertension etc. Comorbidity of COPD with the cardiovascular pathology remains the most important one. It reflects the unity of the cardiorespiratory system becoming a summary integral factor of a negative prognosis: COPD and cardiovascular diseases are considered as “criminal partners” nowadays. Anatomic-functional connections “lungs-heart” are so closely interwoven that changes in one organ cause changes in the other inevitably. Even the first exacerbation of COPD or patient’s hospitalization is accompanied by the reaction of the heart. It has been proved in a number of works that the presence of COPD can be considered as an independent risk-factor of IHD together with age, smoking, the cholesterol level, elevation of systolic blood pressure. According to multicenter research the frequency of IHD in patients with COPD is 7-13%, and COPD is diagnosed in 26-35% patients with IHD. Spreading of IHD grows with the increase of severity of the broncho-pulmonary pathology reaching 60% and rises significantly with age. It is IHD that is the cause of lethality of the patients with COPD of mild and moderate severity. IHD is revealed in the third part of cases among hospitalized patients with exacerbation of COPD, i.e. death occurs most often not as the result of a respiratory disease but for cardiovascular reasons; it is confirmed by literature information. The synchronous course of COPD and IHD is accompanied by the syndrome of “mutual burdening” which causes the earlier disability and the death of the patients. The changes of rheological properties of the blood, increase of hemostatic and decrease of fibrinolytic blood potential are its main mechanisms. It promotes the disorder of pulmonary and myocardial microcirculation, ventilating, hemodynamic (and later also tissue) hypoxia, forming of pulmonary hypertension which intensifies myocardial ischemia of the both ventricles and leads to the coronary and pulmonary insufficiency. It is necessary to mention that IHD in patients with COPD has the course without apparent clinical symptoms in most cases; it is characterized by modification of the typical anginous attack and severe arrhythmias. In turn, systolic blood pressure and the degree of dyspnea by MRC-test increase significantly in patients with COPD and the combined pathology, also a short distance covered by patients during 6 minutes (in comparison with the same indices of the patients without the accompanied IHD) is registered, pulmonary hemodynamics, alveolar gas exchange become worse. One should keep in mind the possibility of latent and small-symptom course of COPD; it must be taken into account during follow-up of the patients with IHD. The community of the pathogenesis of COPD and atherosclerosis which is a basis of IHD is determined by a problem of the oxidant stress, inflammation, development of the endothelial dysfunction. The signs of right ventricular hypertrophy, the increase of its sizes are marked mainly in the patients with COPD while also the sizes, thickness of the left ventricle increase and its pumping function decrease in the combined pathology (COPD+IHD). The issue of the follow-up of the patients with the mentioned comorbid pathology is complicated. An appropriate combined prescription of medicaments and an adequately planned rehabilitation program for these patients will help not only to prevent progression of each from the diseases but also to improve a long-term forecast and life quality