Aim. To evaluate effects of various protocols of cardiac shock wave therapy (CSWT) on quality of life and exercise tolerance in patients with stable angina against the background of optimal medication therapy (OMT). Material and methods . Overall 53 patients (37 men, 16 women) were included in the study. The mean age of examined patients was 67,3 ±8,1 years. Inclusion criteria: CCS class I-IV angina pectoris, stable therapy for at least 1 month before inclusion in the study and a stable course of coronary artery disease for more than 3 months (no cardiovascular events) before inclusion in the study. Patients were divided into 2 groups. The Group 1 (n=37) received OMT+CSWT standard-modified protocol, Group 2 (n=16) received OMT+CSWT rapid-modified protocol. Electrocardiography, echocardiography, treadmill test, and Seattle quality of life questionnaire (SAQ) were performed at inclusion and 6 months follow up. Results. Both CSWT with rapid-modified protocol and standard-modified protocol significantly reduced the number of short-acting nitrates from 2 (2; 7) to 1 (0; 2) (p=0,04) and from 2 (0; 6) to 0 (0; 2) (p ≤0,001) at 6 months, respectively, as well as the number of angina attacks per week (from 4 (2; 7) to 1 (1; 1) (p=0,007) and 6 (2; 20) to 1 (0; 5) (p ≤0,001). Treadmill test total exercise duration was significantly increased from 393 (326; 574) to 561 (411; 650) seconds (p=0,007) and 365+140,4 to 411,5±156,1 seconds (p=0,01), respectively. Time to 1 mm ST segment depression was also significantly increased from 399,8+169 to 460+182 seconds (p ≤0,05) and from 303,1+179 to 389,9+203 seconds (p=0,001), respectively. Conclusion. In our study, CSWT with rapid-modified protocol improved quality of life and exercise tolerance in patients with stable angina similar to the standard-modified protocol. Rapid-modified protocol of CSWT reduced total duration of the treatment.

Echocardiography is a useful tool for risk stratification and prognosis assessment after myocardial infarction. It was shown, that for prediction related data acquisition, it is possible to apply multiple echocardiographic parameters, such as the volumes and ejection fraction of the left ventricle, wall motion index, left atrium volume, and existence of atrial regurgitation. Development of the method of tissue Doppler and “speckle-tracking” led to invention of novel prediction parameters, as deformation, deformation velocity, dissynchrony of the left ventricle. Method of contrast echocardiography makes it to evaluate myocardial perfusion and safety of microvascularity, gives valuable data on myocardial viability, which is closely related to prognosis. Stress echocardiography makes it to assess myocardial ischemia and find viable myocardium, and the Doppler of coronary arteries — to evaluate coronary flow reserve. Finally, 3D echo makes possible the gathering of optimal data on the volumes, functioning and sphericity of the left ventricle, which are significant parameters of long term prognosis.

Aim. To assess the influence of retinol-binding protein synthetized by adipose tissue, on clinical course and prognosis of arterial hypertension (AH). Material and methods.  Totally, 168 patients included, with AH of 1-3 grade. Study protocol included general clinical investigation (at inclusion, in 1, 4 and 9 months) with analysis of complaints, anamnesis, physical examination, additional laboratory and instrumental methods. In 78 patients among the included, the level of retinolbinding protein RBP4 was measured in blood serum. Results . Increased level of RBP4 correlated significantly with the age, body mass index, duration of AH, raised level of uric acid, pulse wave velocity signs, endogenic nitrite. Only in the group with raised RBP4 there was stroke anamnesis noted, and obesity of III grade. Dynamics of the level of RBP4 during 9 months treatment, depending on cardiometabolic risk, showed some specifics: at inclusion, in the group with high cardiometabolic risk there was significantly increased RBP4 comparing to the groups of patients with low and moderate cardiometabolic risk. Conclusion . Increased level of retinol-binding protein is associated with higher cardiometabolic risk and adverse prognosis.

Aim. In the study we evaluated the influence of antihypertension therapy on 24-hour central BP and parameters of aorta stiffness in hypertensive patients with obesity. Material and methods. Totally, we included 80 patients with AH and obesity, at the age 35-55 y.o. All patients underwent clinical, laboratory and instrumental assessment, including office, home and 24-hour measurement of BP. All patients were randomized to 3 groups: 30 patients received fixed combination of trandolapril/ verapamil in daily dosage 2/180 mg, 25 — free combination of bisoprolol/indapamid 5-10/1,5 mg per day, 25 patients were taking fixed combination of perindopril/ amlodipine 5-10/5-10 mg per day. Follow-up period, in average, was 32 weeks. Results. All combinations studied significantly reduced central BP, but combination of bisoprolol/amlodipine was least effective. Only on perindopril/amlodipine there was significant reducing of aortal augmentation index (Δ% -4,1±8,7), that might be related to influence of the drug on HR. Analysis of daily dynamics of BP amplification of pulse BP, index of subendocardial blood circulation efficacy, pulse wave velocity, showed significant correlations between these parameters and HR. Thus, only prescription of pulse-reducing combinations of trandolapril/verapamil and bisoprolol/indapamid was followed by significant reduce of pulse wave velocity in aorta in patients with AH and obesity (Δ m/s -0,4±1,1; -0,4±0,7, resp.). Conclusion. Different influence of the studied combinations of antihypertension drugs on HR might be definitive for the improvement of aortic wall in AH patients and obesity.

The article deals with the results of 6-month perindopril therapy in patients with arterial hypertension. The study was aimed to assess the safety of perindopril and its effect on daily blood pressure profile, structure and function of left and right heart, NT-proBNP levels.

The level of serum brain natriuretic peptide (BNP) was measured in 236 patients with acute coronary syndrome. Some of them presented with mitochondrial dysfunction. None showed diagnostically significant BNP levels within 12 hours after admittance, but patients with unstable angina and BNP level below 80 pg/ml had the lowest risk of serious cardiovascular diseases. Marked mitochondrial dysfunction was associated with maximum BNP levels 12 hr and 14 days after hospitalization and mild dysfunction with minimal BNP concentration.

Aim. To compare the effectiveness of the combination therapy with ivabradine and β-adrenoblockers (β-AB) and the dose-titration β-AB therapy. Material and methods. This multi-centre, open, controlled study included 1104 patients with functional Class (FC) II-III stable angina (SA), sinus rhythm, and heart rate (HR) ≥60 bpm, who received regular β-AB therapy in submaximal doses. The participants were divided into the standard therapy group (β-AB therapy with the dose titration to the maximal tolerated dose; 228 patients (20,7%)) and the ivabradine therapy group (876 patients (79,3%)) Results. Both groups were comparable by main demographical and clinical characteristics. Adding ivabradine to the β-AB therapy resulted in a more pronounced HR reduction at Week 16, compared to the standard therapy group (61±6 vs. 63±8 bpm; p=0,001). By the end of the study, the percentage of the patients with FC I SA was significantly higher in the ivabradine group than in the standard therapy group (37,1% vs. 28%; p=0,017). The average number of angina attacks between Weeks 8 and 16 was significantly lower in the ivabradine group than in the standard therapy group – 4 (2;10) vs. 6 (2;15), respectively (p=0,015). In the standard therapy group, the incidence of adverse events, such as dyspnoea, hypotension, and fatigue, was significantly higher than in the ivabradine group – 18,4% vs. 9,4%, respectively (p<0,001). Conclusion. In SA patients, the combination therapy with β-AB and ivabradine demonstrated good tolerability, safety, and high antianginal effectiveness, which resulted in a more pronounced clinical improvement, compared to the dose-titration β-AB therapy.

The functional state of a thiol disulfide link of the antioxidant system was evaluated in 322 patients with brucellosis (160 and 162 with its acute and chronic forms, respectively), including the patients with that involving the cardiovascular systems (120 and 92 with acute and chronic forms, respectively). Examination of the blood antioxidant system indicated that in brucellosis patients, cardiovascular involvement was accompanied by a reduction in SH groups and thiol disulfide coefficient and by an increase in the content of SS groups, which indicates the predominance of the oxidant system over antioxidant one. At the same time, the functional insufficiency of the blood antioxidant system was more evident in patients with acute brucellosis.

Aim. To assess influence of combined antihypertensive (captopril or metoprolol) and antidepressant (thianeptin or sertralin) therapy on clinical status, blood pressure (BP) and myocardial function in patients with arterial hypertension (HT) and affective disorders (AD). Material and methods. 1 06 patients with HT were involved in the study. 64 patients (60,4%) had concomitant AD. All patients were divided into 3 groups. 46 patients with HT and AD were included in the 1 -st group. They received metoprolol or captopril in combination with tianeptine or sertaline. The 2-nd group included 1 8 patients with HT and AD who received only antihypertensive therapy. The 3-rd group consisted of 42 patients with HT without AD. They also received only antihypertensive therapy. Results. After 6 month therapy patients of the 1 -st and the 3-rd groups had more significant clinical improvement and BP reduction (according to 24-hour BP monitoring) as well as more farourable structural and functional changes of left ventricular in comparison with patients of the 2-nd group. Conclusion. In patients with HT and concomitant AD combined antihypertensive and antidepressant therapy result in favourable clinical changes, effectively reduce BP, improve left ventricular structure and function.

Inhibitor of synthesis of tumor necrosis factor-α, pentoxifylline, in combined therapy of the chronic heart failure O.P. Dudarenko, E.L. Shkol'nik, K.G. Kulikov, M.K. Serova, Yu.A. Vasyuk Department of clinical functional diagnostics, Moscow State Medical Stomatological University Aim. To study effects of pentoxifylline in combination with basic therapy on functional status, intracardiac hemodynamics, neurohormones and proin-flammatory cytokines levels in patients with chronic heart failure (CHF) complicated ischemic heart disease (IHD). Material and methods. 55 patients with CHF complicated IHD (83,6% men and 16,4% women) were involved in the study. Duration CHF was 2,4 years in average. Class I of CHF (NYHA) was registered in 5 patients (9,1 %), class II in 33 patients (60,0 %), class III in 16 patients (29,1 %), class IV in 1 patient (1,8 %). Dynamics of life quality, severity of clinical status, functional reserve, intracardiac hemodynamics, neurohormones and proinflammatory cytokines levels was assessed during 9 months of therapy. Results. Pentoxifylline, added to standard therapy of CHF, resulted in improvement of life quality, intracardiac hemodynamics and clinical status of the patients with CHF of I-II class (NYHA). Besides reduction in proinflammatory cytokine (tumor necrosis factor-α, interleukin-6) and neuronhormone levels was found in patients with CHF of I-II class. Conclusion. Pentoxifylline can be useful in combined therapy of CHF.

Aim. To determine the potential of tissue Dopplerography (TDG) for early diagnosis of functional myocardial disorders in patients with arterial hypertension (HT). Material and methods. 66 patients with HT were examined. Clinical examination, 24-hour ambulatory blood pressure monitoring, two-dimensionaland Doppler-echocardiography of transmitral blood flow, TDG of mitral annulus, determination of blood level of brain natriuretic peptide (BNP) were performed. Results. Regional disturbances of diastolic myocardial function are detected in patients with HT and normal transmitral blood flow. These disturbances are more expressed in left ventricle (LV) remodeling. The LV remodeling is also connected with disorders of the longitudinal myocardial contractile systolic function of the inferior wall. These disorders are more expressed in patients with HT and chronic heart failure (CHF). The average ratio of peak rates of the early transmitral blood flow and the diastolic myocardial movement (E/Ea), as well as the average level of BNP confirmed the moderate increase in end-diastolic pressure in LV. Conclusion. Regional disorders of diastolic myocardial function in patients with HT are detected before structural changes of LV even in normal transmitral blood flow. The LV remodeling is related to the disorders of diastolic and regional systolic myocardial function, which are accompanied with increase in BNP level. At the same time increased BNP level is especially related with increased E/Ea ratio, which is more earlier predictor of CHF in hypertensive patients.