Objectives : to analyze the results of echocardiography 1 year after STEMI in patients undergoing pharmaco-invasive reperfusion using various thrombolytic drugs. Materials and Methods : 240 patients with STEMI after pharmaco-invasive reperfusion were included in an open-label prospective cohort study. Depending on the thrombolytic agent used, the patients were divided into 4 groups: in the 1st (n = 73) — lysis was performed with alteplase; in the 2nd (n = 40) — tenecteplase; in the 3rd (n = 95) — forteplase; in the 4th (n = 32) — streptokinase. Depending on the fibrin-specificity of the thrombolytic, all patients were presented with 2 groups: the group of fibrin-specific thrombolytics (FST, n = 208) and the group of fibrin-nonspecific streptokinase (FNST, n = 32). Echocardiography was assessed 1 year after reperfusion. Results : after 1 year, there was a slight violation of the global LV systolic function, while the EF between the groups did not differ (p = 0.420). A higher EF was recorded in the FST group compared with FNST (49.8 ± 7.4 % versus 47.4 ± 6.8 %; p = 0.048). After 1 year, violations and local LV contractility persisted in each of the four groups (p = 0.161). At the same time, lower WMSI were recorded in the FST group compared to FNST (1.19 [1.06; 1.38] versus 1.25 [1.175; 1.5]; p = 0.029). In the FST group, significantly lower iEDV were recorded (p = 0.048), and iESV (p = 0.022) and LA size (p = 0.007) compared with FNST. In dynamics, 1 year after reperfusion in the FST group, there was a significant increase in EF by 5.5 % (p = 0.000) and a decrease in LV WMSI by 5 % (p = 0.000) compared with the FNST group. Conclusions : pharmaco-invasive treatment of STEMI with the use of thrombolytic drugs after 1 year of follow-up is characterized by comparable echocardiography parameters. After 1 year of follow-up, patients undergoing pharmaco-invasive treatment with fibrin-specific drugs had significantly higher EF, as well as lower WMSI, iEDV, iESV, and LA size compared to fibrin-nonspecific streptokinase.

Purpose : the Assessing of the relationship of the daily diet of dialysis patients with chronic kidney disease with a change in the levels of myostatin and protein kinase-β in order to determine the areas of potential impact on the development of protein-energy deficiency. Materials and methods : тhe study included 80 patients with chronic kidney disease 5D. All patients underwent laboratory tests and the average daily diet was estimated from 3-day nutrition diaries. MSTN and AKT levels were determined in the blood by ELISA. Results : in the study, the prevalence of PEW was 90%. We have proposed a catabolic muscle tissue index (CMTI), which takes into account the complex effect of the relationship between MSTN and AKT on the development of PEW. The daily calorie and protein in patients were less than recommended. The interconnections of dietary features and markers of catabolism of muscle tissue were determined, which is an area of potential interest in the prevention and progression of PEW and requires further study. Conclusions : correction of the diet of dialysis patients is important for nutritional deficiency and control the catabolic way of the myostatin.

THE AIM: to identify risk factors of cardiovascular calcification and to determine relationship between severity of valvular and vascular calcification in patients with S5d CKD. PATIENTS AND METHODS: The study involved 83 patients of two outpatient hemodialysis centers. In all patients studied medical history, anthropometric and laboratory data. We analyzed results of instrumental methods, including heart echocardiography and abdominal plain film in the lateral projection. RESULTS: Positive correlation between severity of heart valve calcification as assessed by echocardiography, and degree of aortic calcification according to survey abdominal radiography (r = 0,301, p = 0,006). Revealed malnutrition and inflammation importance in extraossal calcification development. At lower total protein (χ=8,97, р=0,003), lower level of albumin (χ=13,9, р<0,01) and increasing of pulse blood pressure (χ=5,9, р=0,01) cardiovascular calcification formation possibility increased. calcification risk increase occurs not only with pulse pressure increase, but also in hypertension development (χ=10,6, р=0,005). CONCLUSION: Thus, the severity of valvular calcification associated with aorta calcification, role of malnutrition, inflammation and calcium-phosphorus homeostasis disorders in extraossal calcification development is established.

THE AIM: to identify risk factors of cardiovascular calcification and to determine relationship between severity of valvular and vascular calcification in patients with S5d CKD. PATIENTS AND METHODS: The study involved 83 patients of two outpatient hemodialysis centers. In all patients studied medical history, anthropometric and laboratory data. We analyzed results of instrumental methods, including heart echocardiography and abdominal plain film in the lateral projection. RESULTS: Positive correlation between severity of heart valve calcification as assessed by echocardiography, and degree of aortic calcification according to survey abdominal radiography (r = 0,301, p = 0,006). Revealed malnutrition and inflammation importance in extraossal calcification development. At lower total protein (χ 2 =8,97, р=0,003), lower level of albumin (χ 2 =13,9, р 2 =5,9, р=0,01) cardiovascular calcification formation possibility increased. calcification risk increase occurs not only with pulse pressure increase, but also in hypertension development (χ 2 =10,6, р=0,005). CONCLUSION: Thus, the severity of valvular calcification associated with aorta calcification, role of malnutrition, inflammation and calcium-phosphorus homeostasis disorders in extraossal calcification development is established.

THE AIM: to assess interactions between risk factors as well as arterial sclerotic bed lesion features and GFR decrease in patients with CHD in long term period after myocardial revascularization. PATIENTS AND METHODS. The study included 90 patients with CHD and indications for myocardial revascularization. All patients performed coronary angiography with subsequent surgical myocardial revascularization method definition. Traditional cardiovascular and renal risk factors (GFR) were analyzed in view of coronary angiography. 5,8 ± 0,05 years after blood flow recovery 52 patients were observed, some patients with GFR decrease were revealed. RESULTS. Significant effect of effort angina class III, left ventricular hypertrophy, left coronary artery (LCA) arterial sclerotic disease and also number of clinically significant and subtotal coronary artery stenosis on GFR decrease probability in long term after myocardial revascularization was established. Effort angina class III significantly increased the risk of GFR decrease by 38.2%, LVH - by 74.3%, atherosclerosis - by 40%. Table of calculated GFR aggravation risk stratification according to clinically significant and subtotal CA stenosis is presented. CONCLUSION. GFR factor before myocardial revascularization in patients with CHD is important risk factor of kidneys dysfunction progress in long term period.

Among patients with chronic kidney disease who receive renal replacement therapy by chronic hemodialysis, cardiovascular disease is the leading cause of morbidity and mortality. Vascular calcification is highly correlated with cardiovascular diseases and is often found in patients with chronic kidney disease. The aim of the study was to determine the relationship between the severity of calcification of the aortic valve calcifications and sizes. City rengenografiya abdominal aortic calcification can detect at first to fourth lumbar vertebra. When the total evaluation of segments has been found that the calcification of the abdominal aorta is associated with the risk of cardiovascular disease in patients on dialysis.When performing echocardiography assessed the degree of calcification of the mitral and aortic valves according to a semiquantitative scale assessment of the calcification of heart structures. Next, calculate the volume of each valve calcifications. Calcification of the aorta showed an association with the degree of calcification of the aortic valve and the amount of calcification in patients receiving renal replacement therapy of chronic hemodialysis.

Цель работы – выявить особенности краткосрочной и среднесрочной вариабельности АД у больных артериальной гипертензией (АГ) в пожилом возрасте и оценить прогностическую значимость выраженности колебаний АД для развития почечной дисфункции. Обследованы 64 пациента с АГ: основная группа – 33 пациента с началом АГ в возрасте старше 60 лет, контрольная группа – 31 пациент с неосложненной АГ и началом заболевания в возрасте до 60 лет. Оценивали вариабельность дневного, ночного и суточного систолического и диастолического АД по результатам суточного мониторинга АД, а также внутривизитную (краткосрочную) вариабельность АД и вариабельность АД семи последовательных дней (среднесрочную). Изучали взаимосвязь между параметрами вариабельности АД и характеристиками хронической болезни почек (ХБП). Установлено, что у больных АГ пожилого возраста краткосрочная и среднесрочная вариабельность АД повышена. У пациентов с АГ пожилого возраста с развитием хронической болезни почек ассоциировано повышение среднесрочной вариабельности систолического АД. При превышении среднесрочной вариабельности САД уровня 9,7 мм рт.ст. риск развития ХБП повышается с диагностической чувствительностью 77,1 % и диагностической специфичностью 80,8 %.

The main cause of death among patients with chronic kidney disease receiving renal replacement therapy chronic hemodialysis is cardiovascular disease. Regular changes in the volume of fluid in dialysis patients cause changes in preload and afterload on the myocardium, which further leads to structural and functional changes of the heart. Changes may occur myocardial concentric remodeling, concentric and eccentric hypertrophy of the left ventricular myocardium. Importance of changes in myocardial geometry belongs disorders of mineral metabolism, including participants such as FGF-23 and alpha-Klotho. Identify links FGF-23 and hypertrophy of the subject of many studies, and studies on this morphogenetic protein and a cofactor in the development of various types of restructuring infarction significantly smaller, allowing us to examine this relationship and to conclude that FGF-23 and alpha-Klotho They are factors reconstruction of left ventricular myocardium.

Статья посвящена изучению влияния If-ингибитор ивабрадина на систолическую и диастолическую функции левого желудочка (ЛЖ) сердца у 32 больных хронической сердечной недостаточностью (ХСН) ишемического генеза II–III функционального класса. Ивабрадин дополнительно назначали к длительной терапии ингибиторами ангиотензинпревращающего фермента и антиагрегантами. Через 6 месяцев наблюдения у пациентов фракция выброса ЛЖ возросла на 14,1 %. При этом продольная сократимость мышечных волокон ЛЖ также усиливалась. В результате терапии, основанной на ивабрадине, у пациентов отношение раннего диастолического наполнения ЛЖ кровью к позднему наполнению E/A возросло на 9,3 %, время изоволюметрического расслабления укорачивалось на 12,1 %, что свидетельствовало о повышении эффективности диастолического расслабления миокарда ЛЖ. На фоне терапии ивабрадином у пациентов наблюдалось снижение конечно-диастолического давления в ЛЖ, что приводило к снижению трат кислорода на напряжение стенки. Установленные факты подтверждают возможность применения ивабрадина в комплексной терапии ХСН ишемического генеза.

Статья посвящена изучению влияния изменений структурно-функциональных показателей магистральных сосудов на прогрессирование хронической сердечной недостаточности (ХСН). В клиническое исследование было включено 78 пациентов с диагнозом ишемическая болезнь сердца и хронической сердечной недостаточностью II–IV ФК. Сосудистое ремоделирование у больных оценивали по толщине интимы и медии в сонных артериях, скорости пульсовой волны на каротидно-радиальном и каротидно-феморальном сегментах, растяжимости аорты. При исследовании сосудодвигательной функции плечевой артерии определяли эндотелийнезависимую и эндотелийзависимую вазодилатацию. У больных ХСН ишемического генеза происходит последовательное изменение реологических свойств сосудов: ограничение податливости и растяжимости, повышение жесткости. У больных ХСН эндотелийзависимая и эндотелийнезависимая вазодилатация снижена. Структурно-функциональные изменения усугубляются по мере повышения ФК ХСН. Прогрессирование ХСН сопряжено со снижением амплитуды эндотелийзависимой вазодилатации, повышением толщины интимо-медиального комплекса сонных артерий и ограничением растяжимости аорты.

This article is devoted to studying the effects of changing сytokines status, immunoregulation of apoptosis and fibrosis in the progression of chronic heart failure (CHF) ischemic genesis. In the clinical study was included 78 patients diagnosed with coronary heart disease and CHF II-IV FC. In patients with CHF found improved concentration in blood of proinflammatory factors of tumor necrosis factor-alpha (TNF-α) and interleukin-6. Interleukin-1 in blood was lowered from its concentration growth antagonist raIL-1β. Growth of proinflammatory cytokines and anti-inflammatory cytokine has limited the increase – interferon-γ. Increasing concentrations of soluble receptors type 1 to TNF not restrained the proinflammatory cytokines. Improvement of the transforming growth factor-β1 has contributed to the development of fibrosis in the wall of the heart and vessels. With increased FC CHF increase in blood concentration was proinflammatory proinflammatory TNF-α and the transforming growth factor-β1.

The Chair of Internal Medicine №2 was founded in 1919 on the base of St. Nickolas Hospital in Rostov-on-Don. The founder of the Chair was professor A.I. Ignatovsky who emigrated from Russia the same year. The next chief of the chair was professor E.M. Kastanayan who made a great contribution in scientific studies of internal medicine. At different periods the chair was leaded by S.S. Mindlin, I.A. Grabenko, B.I. Vorobiev. At present time the chief of the chair is professor A.A. Kastanayan. The scientific studies of the department are dedicated to the diagnose and treatment of cardiovascular diseases.

To assess the to assess the safety of goal blood pressure (GBP) destination and the influence on left ventricular (LV) remodeling and cerebral vascular reactivity (CVR) 30 patients with arterial hypertension (AH) and calcific aortic valve (CAV) were prescribed perindopril (8 mg) based therapy for 3 months. LV geometry, diastolic function (DF), LV-aorta pressure gradient, AV density and CVR parameters were measured by ultrasound methods before and after treatment. After the treatment the reversal of LV remodeling and improvement of LVDF were noted. Decrease in LV-aorta pressure gradient and AV ultrasonic density was not significant. Destination of GBP on P based therapy, was accompanied by improvement of CVR in majority of patients, except for 2 patients with significant stenosis (Gmax ≥ 36 mm Hg and AV ultrasound density ≥ 18 units). Conclusions. In majority of patients with CAV antihypertensive therapy based on P promotes achievement of goal BP and reversal of LV remodeling without deterioration of cerebral blood flow, for acception of patients with significant AV stenosis.