рецепторов АII(АРА) – не менее эффективны для профилактики ССЗ у больных хронической сердечной недостаточностью (ХСН)за счет снижения избыточной активности РААС. В ходе больших рандомизированных клинических исследованийнакапливаются данные по эффективности блокады синтеза альдостерона для профилактики ХСН. Цель исследования: изучить эффективность коррекции артериальной жесткости, нейрогормональных нарушений при ХСНпосредством комбинированной блокады АТ

Установлено, что повышенная экспрессия биомаркеров, отражающих состояние коллагенового матрикса сердечнососудистой системы, сопряжена с повышенным риском прогрессирования сердечной недостаточности и высокой смертностью. Цель: оценить диагностическую значимость биомаркера поражения коллагенового матрикса – тканевого ингибитора металлопротеиназ1 (ТIMP1) у больных с ишемическим и/или постинфарктным ремоделированием миокарда при манифестной хронической сердечной недостаточности (ХСН). Анализироваласьдиагностическая значимость и прогноз развития неблагоприятных сердечнососудистых событий при 6месячном проспективном наблюдении у пациентов с ХСН II, III, IV ФК по NYHA, рандомизированных в 3 группы: в 1югруппу (n=18) вошли пациенты с симптомами ХСН II ФК с сохраненной фракцией выброса левого желудочка (ФВЛЖ) >45%, во 2ю (n=23) – с ХСН III ФК со сниженной ФВ ЛЖ, в 3ю группу (n=11) включены пациенты с наиболее тяжелой ХСН IV ФК с ФВ<32,5%. Средний возраст обследованных составил 60,6±0,92 лет. Уровень TIMP1 вкрови определялся твердофазным иммуноферментным методом. У пациентов 1й группы с клиническими симптомами умеренной сердечной недостаточности (СН) уровень TIMP1 в крови колебался в диапазоне 181–375,9нг/мл (Ме=278,45 нг/мл); у больных 2й группы с выраженным ишемическим и постинфарктным ремоделированием миокарда с низкой ФВ ЛЖ (<35%) и ХСН III ФК определялись явно повышенные сывороточные уровниTIMP1 в пределах 376,6–897,8 нг/мл (Ме=637,2 нг/мл); у пациентов 3й группы с наиболее тяжелым течениемХСН IV ФК при низкой ФВ ЛЖ TIMP1 колебался в пределах 903,6–1687,9 нг/мл (Ме=1295,8 нг/мл). У двух пациентов 2 и 3й групп, умерших вследствие прогрессирования СН, TIMP1 в крови составил 1289,9 и 1687 нг/мл соответственно. У больных ишемической болезнью сердца (ИБС) с повышенным риском развития ишемическогои/или постинфарктного ремоделирования сердца при манифестации ХСН определение уровня биомаркера состояния коллагенового матрикса TIMP1 может расцениваться как новый независимый прогностический маркеришемической дисфункции миокарда, фиброза ЛЖ при ХСН.

This three-week open uncontrolled study included 34 men (mean age 53.14+-1.19 yr) with coronary heart disease (CHD) and insulin resistance (HOMA >2. 77); it was designed to estimate effect of amlodipine on transcapillary oxygen metabolism (TCOM). Multivascular stenosing coronary atherosclerosis was managed by aortocoronary bypass surgery. Traditional methods applied in specialized cardiological clinics were supplemented by TCOM measurement using a PA-2 polarograph (Czech Rep.). Polarography revealed deterioration of TCOM parameters including permeability of hemocapillaries, adaptive reserves of the microcirculatory bed, and oxygen supply to the tissues. Amlodipine therapy demonstrated high antianginal potency of this drug and its ability to improve TCOM

Follow-up (10 years) results of 72 CAD patients (mean age 54,8±5,9) after coronary bypass grafting are given in the article. We assessed influence of arterial hypertension, smoking, overweight and dyslipidaemia on mortality and development rate of unfavourable cardiovascular events. The most unfavourable influence on the prognosis of CAD patients after coronary bypass grafting exerted smoking which increased mortality cases by 6 times and high level of high density cholesterol (g3.5 mmol/l).

The aim of research was comparison of prognostic importance of various indexs non-homogeneousness of processes repolari-zations of heart ventricles registered in acute and subacute periods of myocardial infarction (MI). The retrospective analysis of med-ical histories has allowed to determine dynamics of dispersion of intervals Q-T, Q-Ta and R-Tm in groups of patients with fa-vourable (n = 125) and lethal (n = 250) outcome. The best prognostic importance concerning fatal cardial events have indexs cor-rected on frequency of cardiac rhythm. Most important and independent predictor of intrahospital cardial deaths of the patients with MI is a dispersion of the corrected interval R-Tm, exceeding 80 мс1/2 in the first 6 hours after hospitalization.

A three-year follow-up of patients with coronary heart disease (CHD) and type II diabetes after coronary artery bypass grafting, shows that the following pathologic conditions are significantly more frequent: arterial hypertension, visceral obesity, marked disturbances of blood lipid spectrum, an increases CHD duration, and an increased rate of myocardial reinfarction and revascularizations. The study shows that the presence of diabetes mellitus in CHD patients undergoing coronary artery bypass grafting, is associated with pronounced disturbances in blood lipid spectrum, and is an important risk factor of coronary event progression.

The purpose of the study was to evaluate the influence of atenolol, a selective, beta1-adrenoblocker, on the quality of life (QL) of patients with old myocardial infarction (MI). The subjects of this 12-month open uncontrolled study were 40 male patients aged 29 to 59 years (mean age 46.8 +/- 1.19) suffering from functional class II-III stable exertional angina, which occurred 6 months after their first large-focal MI. QL was evaluated before and during the course of therapy (after 1, 3, 6, and 12 months) using EORTC QLQ CORE 30, short version of MMPI test, and Spielberg State-Trait Anxiety inventory. The patients received atenolol in effective doses selected on an individual basis (mean day dose was 67.9 +/- 4.2 mg) within one year; the study revealed increase of QL falling in all the categories of EORTC QLQ CORE 30, decrease of reactive and personal anxiety, as well as positive changes in averaged MMPI profile, which reflected lowering of anxiety and depression level in the actual psyche status.

Thirty males with prior myocardial infarction concurrent with arterial hypertension (AH) were examined to study the antihypertensive and antiischemic effects of the AT1-receptor blocker irbesartran. Group 1 comprised 12 (40%) patients with mild AH; Group 2 included 18 (60%) with moderate AH. In Group 2, the standard therapy with irbesartan in a single dose of 150 mg in the morning was supplemented by the beta1-adrenoblocker atenolol in the average daily dose of 31.25 mg. In Group 1 patients there were decreases in systolic blood pressure (SBP) by 28% and diastolic blood pressure (DBA) by 19% while in Group 2 receiving combined therapy with atenolol, SBP lowered on the average of 38.3 mm Hg of the baseline values and DBA became normal in 66.7% of the patients (p < 0.00). Thus, irbesartan provides good antihypertensive and antiischemic effects in patients with grade 1 AH; the combined therapy enhances the efficiency of treatment by 92% in patients with moderate AH.

The antiishemic efficiency of course monotherapy with trimethazidine and its impact on myocardial perfusion were studied in patients with postinfarct dysfunction of the left ventricle (LV), which was associated with moderate heart failure (HF). This prospective controlled clinical study included 47 patients who had experienced myocardial infarction. The patients had also angina pectoris on exertion and NYHA Functional Classes (FC) II-III HF. The patients were randomized into 2 groups: Group 1 comprised patients with more than 50-W exercise tolerance (ET), FC II angina, and FC II HF; Group 2 consisted of those with 50-W or less ET, FC II-III angina, and FC II-III HF. Four-week course therapy with trimethazidine in a dose of 60 mg/day was found to exert a pronounced antiischemic effect in patients with reversible LV ischemia associated with HF. The tolerance of the drug during its 4-week course therapy was good and the drug caused no adverse reactions.