Objective: to assess the value of tissue Doppler (TD) imaging in predicting the clinical course of patients with hypertrophic cardiomyopathy (HCM). Materials and Methods: clinical and demographic data were analyzed in 212 subjects with HCM (141 males and 107 females, mean-age 45 yo). Median follow-up was 3,2 years (0,7-12,5 years). Patients were stratified into two groups: with present or absent adverse outcomes. Results: over the follow-up period, 7 fatal cases were registered due to SCD, and 4 successfully resuscitated subjects who experienced SCD received implantable pacemaker, 6 patients developed a stroke, cardiovascular death (1 patient) or hospitalization due to worsening of heart failure symptoms developed 7 patients. A statistically significant factor associated with adverse outcomes in cohort examined was возраст (OR 0,94; 95% CI 0,90 -0,98; p<0,001); LV outflow tract gradient (OR 1,04; 95% CI 1,01 -1,04; p<0,001); LAV/BSA (ОР 1,06; 95% CI 1,02 - 1,10; p<0,004) и E/Em lat (OR 1,37; 95% CI 1,12-1,67; p<0,002. Conclusions: there has been shown in our study that ratio E/ Em lat was the most significant prognosis factor: increasing of E/ Em by 1 CU followed by 37% increasing of relative risk of adverse effect appearance.

Objective: to evaluate the prognostic significance Baevsky-index (BI), during the bicycle exercise test, in comparison with the data of coronary angiography (CAG) in patients with chronic ischemic heart disease. Material and methods: the study involved 116 patients with chronic ischemic heart disease (men - 84.5%) of them with angina pectoris functional class 2 - 47 (40.5%), functional class 3 - 69 (59.5 %) patients. The average age of the subjects = 56,99±9,29 years. From the 116 surveyed 62 (53.4%) patients had a history of myocardial infarction. More than 80% of the patients in the subsequent CAG were performed. Depending on the values of the BI patients were divided into 4 groups: 1gr. - 37 (31.9%) patients with BI <2.6; 2gr. - 31 (26.7%) patients with BI = 2.6-2.9; 3gr. - 40 (34.5%) of persons with BI = 3.0-3.5 and 4gr. - 8 (6.9%) patients with BI > 3.5. Results: more than 85% of the patients were characterized by the presence of excess weight, and in 4gr. - 100% of patients. Also in 4gr. patients, lipid profile, in comparison with those in groups 1-3, were slightly lower and atherogenic index (AI) - was the smallest. Analysis of the echocardiographic parameters, in addition to the relative left ventricular dilatation, testified about reducing the contractile function of the heart muscle, and a more severe diastolic dysfunction in patients 4gr. According bicycle exercise tests, it was found that patients 4gr. characterized by the lowest level of maximal oxygen consumption (MOC 4gr. = 3,46 ± 0,94 MET, that is 22.9%, 16.6% and 12.6% was lower than in groups 1-3, respectively), and with the growth of values BI noted decline in the index of Duke. According to the CAG, the average score on the SYNTAX score reaches a maximum value in people 4gr. Correlation analysis found an inverse relationship between the BI and the index of Duke (p>0,05). At the same time, by comparing the value of BI and CAG data, in particular the amount of vascular lesions, direct correlation was observed (p<0.05). Conclusion: Baevsky index has a direct correlation with the quantitative coronary lesion vessels and can be recommended as a predictor of more severe coronary lesions in patients with chronic ischemic heart disease in the outpatient practice.

In this review data of clinical investifation of serelaxin were briefly outlined. In these trials administration of serelaxin just after admission in the hospitals was acoompanied by middle-term improvement of survival of patients with acute heart failure.

In spite of the fact that clinical measurement of blood pressure which meets methodical requirements is still a basis for diagnostics of arterial hypertension and assessment of treatment efficiency, it is widely recognized that proper diagnostics and management of patients with arterial hypertension are impossible based only on the measurements of blood pressure which are carried out by doctor. The out-patient methods of blood pressure monitoring - daily monitoring (ABPM) and measurement of blood pressure at home (home blood pressure monitoring (HBPM)) - enable to overcome restrictions of clinical measurement of blood pressure. The combined use of clinical and out-patient measurement of blood pressure significantly expands understanding of Blood Pressure phenotype at the stage of diagnostics and assessment of treatment efficiency, especially at discordance of their results. Only by means of these methods it is possible to detect white-coat hypertension and masked hypertension. The existing out-patient methods of blood pressure monitoring, its description, comparison, advantages and disadvantages, its places in modern recommendations and clinical practice guidelines as requirements to technique are provided in this article.

Objective: to study the parameters of central aortic blood pressure and main arteries stiffness in patients with coronary artery disease (CAD) depending on the prevalence of atherosclerotic lesions. Material and methods: the study involved 90 patients with a diagnosis of unstable angina class II B (E. Braunwald et al., 1989) the control group consisted of 27 healthy people. The method of applanation tonometry using the apparatus of SphygmoCor («AtCor Medical», Australia) studied the performance stiffness: pulse wave velocity (PWV) and augmentation index (AIx). Coronary angiography was performed at the facility Allura CV-20 (Philips, The Netherlands), the state of the carotid arteries was studied by duplex ultrasonography, evaluation of involvement of femoral arteries was based on ankle-brachial index <0.9, in case of doubt, underwent ultrasound duplex scanning. In the main group, patients were divided into 3 subgroups: subgroup A defined patients with isolated coronary lesion; subgroup B was presented by patients who diagnosed combined lesion: coronary arteries with carotid arteries or coronary arteries with femoral arteries; subgroup C was presented with multifocal atherosclerosis patients who had atherosclerosis lesion in three vascular beds: the carotid, coronary and femoral arteries. Results: values PWV (11,2±1,5 m/s), and AIx (19,8±5,0%) in patients with CAD were, respectively, 1.5 (p<0.001) and 2.4 (p<0.001) times higher than in healthy persons. During the intragroup analysis in all three subgroups PWV was accelerated, with maximum values in the subgroup C (13,3±1,5 m/s), which significantly exceeds the value of this index in the subgroup A (10,1±0,6, p<0.01) and B (11,0±0,9, p<0.05). The value of augmentation index AIx was also highest in the subgroup C 26,8±6,4%, relative to the subgroup A (13,7±2,9%, p<0.001) and subgroup B (18,9±4,3%, p<0, 01). Conclusion: the obtained results allow to recommend studied parameters of vascular stiffness as surrogate markers to assess the prevalence and progression of atherosclerosis, as well as efficacy of pharmacological interventions.

The phylogenetic theory of general pathology postulates an inversion of the concept about the role of arterial blood pressure (AP) in physiology and pathology. Activation of the synthesis of the renin → angiotensin-II (AG-II) system components by nephron and increase in aldosterone secretion are not aimed at elevating AP., but at maintaining the volume of extracellular medium, part of the Third Word Ocean where all cells still live as millions of years ago. Phylogenetically early internal organs cannot regulate the effects of phylogenetically late AP., a physical factor of metabolism. AP is not increased by kidneys, but by the vasomotor center that attempts to reanimate nephronal function, the biological function of endoecology and biological reaction of excretion by increasing AP in proximal and, subsequently, hydrodynamic pressure in the distal region of arterial bed. In addition to the major role in the realization of the biological function of locomotion, AP is a physical factor involved in compensation of impaired functions of homeostasis, trophology, endoecology and adaptation. Levels of metabolism regulation have developed during phylogenesis. Biochemical reactions are specifically regulated at the autocrine level. In paracrine-regulated cell communities of distal arterial bed, metabolism is regulated by millions of local peristaltic pumps by compensating the biological reactions of endothelium-dependent vasodilation, microcirculation, effects of humoral messengers and hormones. In vivo metabolism is regulated nonspecifically from the vasomotor center level by a physical factor (AP) by sympathetic activation of the heart; AP in proximal and distal regions of arterial bed overcomes peripheral resistance and «squeezes through» the arterioles where microcirculation is impaired. AG-II acts as a vasoconstrictor only in the distal arterial bed. In essential (metabolic) arterial hypertension, paracrine cell communities of nephrons and kidneys are involved in realization of pathologic compensation in the second turn and often “suffer being innocent” , similar to other “target” organs”, such as brain, lungs and heart.

Retracted 11.11.2019

To reduce the overall cardiovascular risk it is advisable to use a combination of drugs - the poly-pill that will increase the effectiveness of therapy and patient compliance. The company «Gedeon Richter» has created a polypill - the Ekvamer medication, which in addition to amlodipine and lisinopril includes rosuvastatin - one of the most powerful and safe statins to date that will provide hosting and primary and secondary prevention of cardiovascular diseases and their complications.