Aim — to compare the features of diastolic dysfunction (DD) with preserved left ventricular (LV) ejection fraction (EF) in patients with diabetes mellitus type 2 (DM2) with arterial hypertension (AH) and in patients with essential hypertension (EH) without diabetes.Material and methods. The study involved 87 patients with DD with preserved LV EF: 53 patients with DM2 with AH and 34 patients EH without diabetes. Transthoracic echocardiography was performed by ultrasonic imaging system iE33 xMATRIX («Philips», USA). DD was determined in a complex: type on the basis of the ratio parameters of pulsed-wave (E/A) and tissue (e/a) Doppler; and severity on the Е/e values and pulmonary capillary wedge pressure (PCWP). Myocardial contractile function was assessed by traditional LVEF by Simpson and more exactly, in details on the basis of the longitudinal, radial and circular deformation of the LV myocardium by speckle-tracking echocardiography (using the program Q-lab 3.0 Advanced Ultrasound Quantification software).Results. The groups were comparable in clinical characteristics. The average level of HbA1c in patients with DM2 was 8.2±1.7%. The average LV EF by Simpson in the EH group was 59.9±8.1, in DM2 — 58.3±6.7 (p=0.228). There were more severe disorders of LV Diastolic function in DM2 patients: the values of E/e (p=0.000) and PCWP (p=0.001) were significantly higher in diabetic patients (14,1±5,5 and 15,3±4,7 mm Hg) than in EH (9.7±2.3 and 11.9±1.3 mm Hg). Although that the LV EF (by traditional echocardiographic method of Simpson) was preserved in both groups , the LV global longitudinal strain (12.4±3.0) was significantly lower in DM2 (p=0.005), than patients with EH (16.6±2.0) by speckle-tracking echocardiography.Conclusion. Severity of LV DD are harder in Patients with diabetes and hypertension, than in patients with EH with the similarity of clinical manifestations and data of traditional echocardiographic methods. There were found initial disorders of LV longitudinal myocardial fibers contraction by speckle-tracking echocardiography in patients with DM and preserved LV EF. The combination of impairment of systolic and diastolic function in diabetes is inseparable. Early development of combined systolic and diastolic dysfunction in DM2 is associated with a poor prognosis: a higher risk of early development of atrial fibrillation, ventricular arrhythmias and progressive heart failure.

Aim. To evaluate the association of serum resistin with morphological and functional indices of hypertrophic myocardium in patients with type 2 diabetes and chronic heart failure (CHF) with preserved left ventricular ejection fraction.Material and methods. Patients (n=60; 12 men and 48 women) with type 2 diabetes and ischemic heart disease and CHF class II-III (NYHA) were included into the study. Clinical, laboratory and instrumental examinations, as well as determination of serum resistin were performed in all patients.Results. Positive correlation was found between serum resistin level and left ventricle end-diastolic pressure (LV EDP; r=0.43; p=0.02) in patients with concentric left ventricular hypertrophy (LVH). Negative correlation was found between serum resistin level and LV EDP (r=-0.61; p=0.000) in patients with eccentric LVH. A number of supraventricular extrasystoles positively correlated with the serum resistin level (r=0.34; p=0.033) in patients with concentric LVH.Conclusion. The role of "physiological" levels of resistin in the formation of cardiovascular indicators of the hypertrophic myocardium as well as possible prognostic significance of different levels of resistin for optimization of therapy are shown in patients with type 2 diabetes with CHF.

Intracranial cerebral blood flow and cerebral perfusion reserve were examined in 50 patients with diabetes mellitus type I. The results were compared to the control group. There were changes in the intracranial cerebral blood flow and the decrease in cerebral perfusion reserve in patients with diabetes mellitus type I. The degree of the changes was correlated with the disease duration, compensation of carbohydrate metabolism, presence and degree of retino-and nephropathy.

It is known that hypoglycemia is associated with an increased risk of cardiovascular adverse events including death. ACE-inhibitors, when taken with antidiabetic drugs, can cause hypoglycemic episodes by improving insulin sensitivity. This clinical case illustrates the necessity to monitor plasma glucose in the early phase of the treatment by the ACE-inhibitors in diabetic patients.

The clinical application of thiazolidinediones has an almost 12 year history. The correction of carbohydrate metabolism achieved by the treatment with hiazolidinediones is associated with the reduction of many risk factors of coronary heart disease and the improvement of prognosis for the patients presenting with type 2 diabetes mellitus. The possible mechanisms underlying complications encountered in the clinical practice in connection with the use of thiazolidinediones are discussed.

The clinical application of thiazolidinediones has an almost 12 year history. The correction of carbohydrate metabolism achieved by the treatment with hiazolidinediones is associated with the reduction of many risk factors of coronary heart disease and the improvement of prognosis for the patients presenting with type 2 diabetes mellitus. The possible mechanisms underlying complications encountered in the clinical practice in connection with the use of thiazolidinediones are discussed.

Diabetes mellitus type 2 (DM2) is an independent predictor of development of heart failure (HF). Spiroergometry is a method for studying blood gas exchange parameters, commonly used for specification of HF. The purpose: 1. To study features of gas exchange at patients with DM2 without cardiovascular diseases in comparison with healthy control. 2. To estimate efficiency of metoprolol for correction of metabolic disturbances in patients with DM2. Materials and methods: 12 patients with DM2, aged 48,4±8, without history of cardiovascular diseases and 15 control subjects, aged 43,6±8 underwent cardio-pulmonary exercise test on treadmill, according to Bruce protocol. Exercise energy, VO2 peak, MET, VE max, VCO2 production were observed. Results: Patients with DM2 had a reduced exercise duration (p2 production and MET (p2 production (p2 consumption in patients with DM2 is decreased to the same levels as in persons without DM2, who have IHD and HF. 2. Changes in oxygen-transport in persons with DM2 may serve as a marker of negative influence of the disease on cardiovascular system status. 3. Metoprolol improves parameters of cardio-respiratory system in patients with DM2.

Diabetes mellitus type 2 (DM2) - is an independent predictor of development of heart failure (HF). Spiroergometry - is a method for studying blood gas exchange parameters, commonly used for specification of HF. The purpose: 1. To study features of gas exchange at patients with DM2 without cardiovascular diseases in comparison with healthy control. 2. To estimate efficiency of metoprolol for correction of metabolic disturbances in patients with DM2. Materials and methods: 12 patients with DM2, aged 48,4±8, without history of cardiovascular diseases and 15 control subjects, aged 43,6±8 underwent cardio-pulmonary exercise test on treadmill, according to Bruce protocol. Exercise energy, VO2 peak, MET, VE max, VCO2 production were observed. Results: Patients with DM2 had a reduced exercise duration (p

Цель. Оценка безопасности применения карведилола с точки зрения его воздействия на количество и выраженность гипогликемических эпизодов у больных СД 2 с сердечной недостаточностью, получающих терапию АПФ-ингибиторами. Материалы и методы. Группа обследованных пациентов состояла из 13 больных сахарным диабетом 2 типа с сердечной недостаточностью, обусловленной наличием ишемической болезни сердца. Каждое из обследований включало в себя следующие исследования. Эхокардиография, оценка диастолической дисфункции миокарда, контроль артериального давления, непрерывный мониторинг глюкозы, определение уровня гликированного гемоглобина. Результаты. При первом, втором и третьем обследовании не отмечалось статистически достоверных различий уровней систолического и диастолического артериального давления. Средние показатели гликемии натощак и через 2 часа после еды у больных СД 2 с сердечной недостаточностью до, во время и после лечения карведилолом не изменились. Эпизоды тяжелой гипогликемии (

Aim. To evaluate an influence of carvedilol on risk of hypoglycemia in patients with diabetes type 2 (D2) and chronic heart failure (CHF) treated with angiotensin converting enzyme (ACE) inhibitors. Material and methods . 13 patients (10 men, 3 women; aged 59,8±6,7 y.o.) with D2 and CHF caused by ischemic heart disease were included in the study. Before inclusion all patients were treated with ACE inhibitors and various beta-blockers (atenolol, metoprolol, bisoprolol). These beta-blockers were changed for carvedilol. Heart ultrasonography, blood pressure control, glycemia monitoring, HbA1c level determination were performed before, during and after carvedilol therapy. Results. Carvedilol reduces frequency and duration of hypoglycaemia episodes. There were not episodes of severe hypoglycaemia during carvedilol therapy. Conclusion. Carvedilol reduces risk of hypoglycemia when it is used in combination with ACE inhiditors in diabetic patients with CHF.

Цель. Комплексное исследование хронической сосудистой мозговой патологии у больных СД 2 типа на основе МРТ визуализации головного мозга, оценки когнитивных нарушений и роли современных метаболических, иммуновоспалительных и структурных маркеров атеросклероза, особенностей течения АГ, позволяющих выявить наиболее ранние стадии и механизмы развития сосудистого неблагополучия. Материалы и методы. Обследован 91 пациент с СД 2 типа и 20 лиц контрольной группы, сопоставимых по возрасту, полу, без документированных сердечно-сосудистых заболеваний и СД. Локализация, характер и выраженность очаговых и диффузных изменений мозгового вещества оценивались при помощи МРТ. Оценка состояния кровотока по экстракраниальным сегментам сонных артерий проводилась по стандартной ультразвуковой методике. Нейропсихологическое тестирование осуществлялось нейропсихологом с использованием стандартных тестов. Результаты. Полученные результаты свидетельствуют (с учетом нормативов по каждому тесту), что у обследованных больных преобладали умеренные когнитивные нарушения. Полученные данные согласуются с результатами исследований других авторов, которые относят АГ и СД к важнейшим факторам риска сосудистых когнитивных нарушений и деменции. Распространенность структурных маркеров по данным МРТ у больных СД 2 типа по сравнению с контрольной группой была достоверно больше. У больных СД 2 типа нами установлена зависимость выраженности лейкоареоза и длительности артериальной гипертонии. Выводы. Развитие когнитивных нарушений у больных СД 2 типа ассоциировано с выраженностью инсулинорезистентности, длительностью СД 2 типа, уровнем САД, общего и ночного. По данным МРТ у больных СД 2 типа в 66% случаев выявлялся периваскулярный энцефалолизис, в 49% ? очаговые изменения белого вещества и в 31% ? лейкоареоз. Периваскулярный энцефалолизис ассоциирован с длительностью АГ, гипертонической ангиопатией сетчатки, уровнем среднего ночного САД, что определяет вклад артериальной гипертонии, характерной для СД 2 типа, в формирование этого нарушения.