В статье проанализированы частота встречаемости и особенности течения амилоидоза сердца в пожилом и старческом возрасте. Представлены морфология и патогенез амилоидной кардиомиопатии. Проанализированы особенности клинической картины поражения сердца и аорты при системных и локальных вариантах амилоидоза. Отражена полиморбидность пожилых пациентов, затрудняющая диагностику амилоидоза сердца и приводящая к запаздыванию лечения. Оценены методы диагностики амилоидоза сердца. Представлены современные представления о лечении различных вариантов амилоидоза.

Background . The percentage of short-term and long-term consequences of chemoradiation therapy and their detection increases with the increase in the survival cancer patient rate. Currently, enalapril, carvedilol, and low-dose statins are recognized as drugs that prevent cardiotoxicity from chemoradiation therapy. The work aimed to study the cardioprotective treatment tolerability in patients with lymphomas receiving chemotherapeutic treatment with the inclusion of anthracycline antibiotics. Materials and methods . We examined 47 patients with Hodgkin’s and non-Hodgkin’s lymphomas, who received treatment with chemotherapeutic agents, including anthracycline antibiotics (doxorubicin and epirubicin). Study inclusion criteria were anthracycline antibiotic use in specific treatment regimens for the underlying lymphoproliferative disease and signed informed consent. At the start of treatment and after the first cycles of chemotherapy, the indicators of electrocardiography, echocardiography, and blood pressure measurements at home with constant monitoring were assessed. And then, the general condition of the patients, the tolerability of the main and preventive treatments, and adherence to therapy were studied during the preventive treatment with carvedilol and/or enalapril. Results . Drug titration was difficult because of poor tolerability, asthenia increase, and low blood pressure, and in some cases, it led to self-withdrawal of drugs. The heart rate during preventive treatment decreased in both groups of patients, but it was statistically insignificant and did not reach the target values. This result was due to the rapid decrease in systolic blood pressure, which prevented the titration of enalapril and carvedilol to the target dosages. Conclusion . Adherence to preventive therapy throughout chemotherapy remained low. When assessing the tolerability of enalapril and carvedilol at the initial stages of titration, there were difficulties because of the rapid decrease in blood pressure before reaching the target heart rate values.

Юрий Александрович Васюк1, Валерий Валерьевич Несветов1*, Евгений Леонидович Школьник1, Леонид Донович Школьник2, Геннадий Валентинович Варлан2, Геннадий Ефимович Гендлин3, Елена Ивановна Емелина3 1 Московский государственный медико-стоматологический университет им. А.И. Евдокимова Россия, 127473, Москва, ул. Делегатская, 20/1 2 Городская клиническая больница им. братьев Бахрушиных. Россия, 107014, Москва, ул. Стромынка, 7 3 Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Россия, 117997, Москва, ул. Островитянова, д. 1

The paper describes an original procedure for a comprehensive study of the cardiovascular system in patients with terminal chronic renal failure on continuous ambulatory peritoneal dialysis. It gives the data of examination using this procedure in 50 patients (30 women and 20 men) on peritoneal dialysis at the Moscow City Nephrology Center. The main result of using this procedure is that a group of patients at the highest cardiovascular risk, who have a poor late prognosis and need a continuous follow-up by a cardiologist, can be identified.

The measurement of the concentration of brain natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) has currently enjoyed wide application in the diagnosis of chronic heart failure (CHF); however, the use of these markers for the diagnosis of CHF with preserved left ventricular (LV) systolic function has been inadequately studied. The purpose of the investigation was to study the level of NT-proBNP at peak exercise in patients with CHF and preserved LV systolic function as compared with changes in NT-proBNP concentrations during exercise in healthy individuals. The serum concentration of NT-proBNP was determined in 22 patients with CHF and preserved LV systolic function and in 15 subjects without CHF at rest and peak treadmill exercise testing by the standard Bruce protocol. In the CHF group, the increment in NT-proBNP at peak exercise (d NT-proBNP) was 3.2 times greater than that in the control group (p = 0.02) and the percentage increase in NT-proBNP (d NT-proBNP/NT-proBNP at rest 100%) was 3.4 times higher than that in the controls (p = 0.02). In the patients with CHF, the ratio of d NT-proBNP to exercise duration was 5.4 times greater than that in the subjects without CHF (p = 0.003) and that of percentage increase in NT-proBNP to exercise duration was 7 times higher than that in the controls (p = 0.004). The absolute and percentage increments in NT = proBNP correlated with exercise duration (p = 0.009 and p = 0.035, respectively); the percentage increase in NT-proBNP also correlated with ejection fraction (p = 0.016).