REVIEW
The paper reviews the pathophysiological links between ischemic stroke and sleep-disordered breathing. We discuss well-known mechanisms, such as intermittent hypoxemia, disturbed sleep structure and fluctuations in intrathoracic pressure, autonomic imbalance, oxidative stress, as well as genetic factors and the role of glymphatic system. The impact of sleep-disordered breathing on the development of various subtypes of stroke (according to the TOAST classification) and the so-called “wake-up stroke” is presented.
Objective. Literature review aimed to study the effectiveness of psychotherapeutic, psychopharmacological and psychosocial interventions in the prevention and treatment of cardiovascular disease (CVD).
Design and methods. The search of scientific and medical publications was updated using the English language electronic search system PubMed and the domestic platform elibrary.ru with a focus on systematic reviews, metaanalyses, and randomized controlled trials.
Results. An overwhelming number of papers report positive effects of psychocorrective interventions on regression of psychological syndromes, stress, as well as on cardiometabolic parameters (including hyperlipidemia, cardiovascular remodeling) and CVD/events. In addition, we analyzed foreign and domestic experience in organizing psychological and psychotherapeutic care for patients, based on integrative and multidisciplinary approach.
Conclusions. The available evidence supports the effectiveness of some psychocorrective interventions in patients with CVD. The integration of psychosocial and psychopharmacological interventions into treatment approaches (multiprofessional approach) is a promising area of primary and secondary cardiovascular prevention.
ORIGINAL ARTICLE
Objective. To assess the arterial stiffness, peripheral and central aortic blood pressure (PBP and CBP), and to determinate their relationships with indicators of structural changes of the affected aorta in patients with hypertension (HTN) and abdominal aortic aneurysms (AAA).
Design and methods. We examined 75 patients with HTN and AAA and 75 controls with HTN without AAA. Groups matched by age and gender. A PBP was measured by OMRON (Japan). Noninvasive measurements of CBP, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (cfPWV) were assessed by SphygmoCor (AtCorMedical, Australia).
Results. There was no difference in cfPWV between patients with AAA and control group (10,3 (2,2) vs 9,7 (2,1) m/s; р = 0,102). Age, systolic PBP, and aortic diameter were independent predictors of cfPVV in patients with AAA (β = 0,271, р = 0,029; β = 0,272, р = 0,030 и β = –0,361, р = 0,004, respectively). Patients with large aortic diameter of AAA (> 60 mm) had decreased cfPWV compared with control group (8,8 (1,5) vs 9,7 (2,1) m/s; р < 0,05), patients with AAA diameter less than 60 mm, on the contrary, had increased cfPVV compared with the controls (11,8 (1,7) vs 9,7 (2,1) m/s; р < 0,001). Patients with AAA and patients of control group did not differ in systolic and pulse PBP (138,6 (16,4) vs 138,1 (13,6) mm Hg; р = 0,831 and 58,6 (11,8) vs 59,6 (10,2) mm Hg; р = 0,569, respectively). AIx and AP were higher in patients with AAA versus patients without AAA (27,6 (8,2) vs 21,3 (7,9)%; р < 0,001 and 17,3 (6,8) vs 13,9 (5,4) mm Hg; р = 0,001, respectively). Systolic and pulse CBP were higher in patients with AAA than in patients of control group (130,0 (16,4) vs 124,9 (13,9) mm Hg; р = 0,046 and 49,5 (11,7) vs 45,7 (9,9) mm Hg; р = 0,031, respectively).
Conclusions. In patients with AAA cfPWV decreased with the expansion of the maximum aortic diameter. CfPWV is not suitable for accurate arterial stiffness assessment in patients with HTN and AAA due to the apparent confounding effect of aneurysm on the biomechanical properties of the aorta. Local assessment of the elastic properties of the aorta such as computed tomography angiography and magnetic resonance imaging is required for arterial stiffness evaluation in patients with AAA. Parameters of the reflected pulse wave such as AP and AIx are increased in patients with AAA. This might contribute to the increase in central aortic BP and target organ damage in patients with HTN combined with AAA.
Combination of hypertension (HTN) and hyperhomocysteinemia > 10 mсmol/l is frequently called H-type hypertension. It is associated with an increased risk of vascular events including stroke.
Objective. To estimate the frequency and clinical and laboratory correlates of combination of hyperhomocysteinemia and HTN in a cohort of patients with atherosclerosis of brachiocephalic arteries (BCA).
Design and methods. We recruited out-patients with confirmed atherosclerosis of BCA based on the ultrasound duplex scans. History were registered. Complete blood count, biochemical analysis (lipids, creatinine, homocysteine and C-reactive protein) and urine analysis were performed.
Results. Data from 93 patients were analyzed. The frequency of combination of hyperhomocysteinemia and HTN among patients with atherosclerosis of BCA was 95%. The level of homocysteine was higher in males than in females (p = 0,001). Correlation analysis showed a direct weak association between the level of homocysteinemia and the number of white blood cells, red blood cells, monocytes, level of creatinine in the blood and microalbuminuria (p < 0,05). Linear regression analysis showed that male gender along with microalbuminuria were independent predictors of the homocysteine level in these patients.
Conclusions. A combination of hyperhomocysteinemia and HTN is common among patients with the atherosclerosis of BCA. Stroke prevention measures in patients with HTN and atherosclerosis of BCA should include assessment of homocysteine level and prescription of B vitamins if needed.
Objective. To study the relationship between the thickness of epicardial adipose tissue (EAT) and indicators of the structural and functional heart characteristics and cardiovascular risk in hypertensive patients with nonalcoholic fatty liver disease (NAFLD).
Design and methods. A comparative cross-sectional study was conducted involved 120 patients, aged 45 to 65 years, with hypertension (HTN) of I–II stages, degrees 1–2, with NAFLD (Fatty Liver Index (FLI > 60)) and without NAFLD. A clinical examination was carried out: history, physical examination, measurement of “office” blood pressure and heart rate, anthropometric parameters (height, weight, body mass index). The indicators of carbohydrate and lipid metabolism, chronic low-intensity inflammation (C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α)) were determined, insulin resistance indices were calculated. The structural and functional state of the liver and heart was assessed by ultrasound, and the thickness of the EAT was determined. The SCORE scale was used to assess the 10-year fatal risk.
Results. Indicators characterizing chronic low-intensity systemic inflammation (CRP, TNF-α) and insulin resistance (HOMA-IR metabolic index (MI), triglycerides (TG) / high-density lipoproteins (HDL)) were higher in patients with HTN and NAFLD than in patients with isolated HTN. Echocardiography showed that patients with comorbid pathology had greater EAT thickness (p < 0,001) and more profound left ventricular myocardial hypertrophy (thickness of the left ventricular posterior wall (LVPW) (p = 0,019), interventricular septum (IVS) (p = 0,012), left ventricular myocardial mass (LVMM) (p = 0,029)). In the group of patients with HTN and NAFLD, the correlation analysis showed direct moderate-strong relationships between EAT thickness and TPWLV (r = 0,345, p < 0,001), IVS (r = 0,344, p < 0,001), LVMM (r = 0,372, p < 0,001), index LVMM (r = 0,221, p = 0,015), FLI (r = 0,722, p < 0,001), TNF-α (r = 0,495, p < 0,001), HOMA-IR (r = 0,38, p < 0,001), MI (r = 0,374, p < 0.001), TG/HDL (r = 0,354, p < 0,001), CRP (r = 0,30, p = 0,002), TG (r = 0,305, p = 0,001), very low density lipoprotein cholesterol (r = 0,306, p = 0,001) and medium strength inverse relationship with HDL (r = 0,30, p = 0,008). A multiple regression analysis was performed to assess the relationship between EAT thickness and the severity of chronic systemic inflammation and insulin resistance in patients with HTN and NAFLD: with an increase in TNF-α by 1 pg/ml and TG/HDL by 1, an increase in EAT thickness by 0,15 and 0,68 mm, respectively, should be expected. An increase in EAT thickness by 1 mm was accompanied by an increase in LVMM by 12,8 g. Logistic regression analysis showed a direct relation between EAT thickness and the probability of cardiovascular 10-year risk increase by 5,0% or more.
Conclusions. This study showed that in patients with HTN and NAFLD, the EAT thickness was significantly higher, which strongly correlates with indicators of left ventricular hypertrophy, the severity of liver steatosis (FLI), chronic low-intensity systemic inflammation, and insulin resistance. With an increase in TNF-α and TG/HDL, an increase in the EAT thickness should be expected. EAT thickness was significantly associated with an increase in LVMM and increased chance of high and very high risk of cardiovascular complications in patients with HTN and NAFLD.
Objective. To identify the features of the left heart structure and function in patients with hypertension (HTN) and new onset paroxysmal atrial fibrillation (AF).
Design and methods. We included HTN patients with left ventricular hypertrophy and valid 24-hour Holter monitoring carried out over the last month. Patients without AF paroxysms (age from 37 to 82 years, 38,4% men) were divided into two groups: the 1st group included 32 patients under 55 years of age, the 2nd group comprised 63 patients 55 years of age and older. Thirty-eight patients with AF paroxysms were included in the 3rd group (age from 56 to 74 years, men 28,9%). The parameters of the left heart structure and function, including the global longitudinal strain of the left ventricle and the left atrium strain in the reservoir and contraction phases, were assessed by echocardiography.
Results. The average age of patients in the groups was 44,7 46,4 48,2 vs 61,9 63,7 65,4 vs 63,4 64,8 66,2 years (p < 0,001), and the average duration of HTN was 3,2 4,35,6 vs 6,9 7,99,1 vs 5,7 6,98,1 years (p < 0,001), respectively. The moderate and severe left ventricular hypertrophy and the diastolic dysfunction were found significantly less frequently in the 1st group than in other groups (5,0 12,528,1% vs 43,3 55,667,8% vs 36,8 52,668,5%, p < 0,001 and 5,2 18,832,3% vs 51,6 63,575,4% vs 53,6 68,483,2%, p < 0,001). In 1st group, the left atrial reservoir strain was higher than in the 2nd group, and in the 2nd group it was higher than in the 3rd group (24,7 26,3 28,0 vs 21,5 22,7 23,9 vs 17,8 19,2 20,5, p < 0,001). The left atrial contraction strain did not differ in the 1st and 2nd groups and it was higher than in the 3rd group (13,8 14,9 16,0 and 12,9 13,6 14,2 vs 9,6 10,3 11,1, p < 0,001). The multivariate logistic regression analysis showed that the left atrial strain in the contraction phase is a predictor of AF occurrence in HTN patients over 55 years old depends on. The chances of AF detecting in these patients increase by 3,122 9,21127,171 times (p < 0,001), if the left atrial strain in the contraction phase is below 13%.
Conclusions. The left atrial strain in HTN patients with paroxysmal AF are significantly lower than in patients without cardiac arrhythmias independently of age and the left ventricular state. The left atrial contraction strain ≤ 13% is a predictor of the detection of AF paroxysms during 24-hour Holter monitoring in HTN patients aged 55 years and older.
Background. The development of myocardial infarction (MI) is associated with the lipid and hemostatic disorders, which are not fully investigated in patients with senile asthenia syndrome (SAS).
Objective. To analyze changes in the lipidogram and hemostasis system in elderly patients with MI, hypertension (HTN), depending on the severity of SAS.
Design and methods. Indicators of lipid metabolism and hemostasis system were studied in patients aged 60–74 years with MI, grade 1–2 HTN (n = 80); 60–74 years with MI, grade 1–2 HTN with senile preasthenia (SP); 60–74 years with MI, grade 1–2 HTN and SAS in the period from 2 to 4 days after MI onset. The diagnosis of MI without ST segment elevation was established based on the criteria of the European Society of Cardiology, HTN was diagnosed in accordance with the “National Recommendations of the All-Russian Scientific Society of Cardiology”, SAS — according to the criteria of L.P. Fried. The study of lipid metabolism indicators performed on the analyzer “KoneLab 300” and “PersonalLab”, hemostasis systems — with the use of reagents “Technology Standard”.
Results. In elderly patients with MI, HTN and SP, the level of triglycerides is significantly higher compared to those without senile asthenia (1,8 ± 0,04 vs. 1,4 ± 0,03 mmol/l), low-density lipoproteins (4,2 ± 0,07 vs. 3,6 ± 0,05 mmol/l), antithrombin III activity (105,8 ± 2,2 vs. 97,4 ± 2,3%), plasminogen activator inhibitor (291,5 ± 3,8 vs. 275,2 ± 3,6 ng/ml). With the progression of senile transformation into SAS, these changes in patients 60–74 years old with MI, HTN are aggravated, and especially changes in apoliprotein-A1, leptin, very low density lipoproteins, fibrinogen, plasminogen activator inhibitor, in globulin-dependent fibrinolysis, which indicates a negative effect of SAS on lipidogram and hemostasis indicators.
Conclusions. The changes in lipidogram and hemostasis indicators should be taken into account in the management of elderly patients with MI, HTN and SAS symptoms, they should be also considered as predictors of the MI outcomes.
Objective. Evaluation of the effectiveness and safety of antihypertensive therapy with a fixed dose combination of amlodipine/indapamide in patients with hypertension (HTN) and chronic obstructive pulmonary disease (COPD).
Design and methods. We conducted a non-randomized, open, single-center study, which included 74 comorbid patients (62 men, 12 women) with stage I–II HTN, grade 1–2 HTN, moderate cardiovascular risk and COPD (GOLD I–III). We also assessed respiratory function, the parameters of the microcirculatory bed, vascular stiffness, level of tumor necrosis factor α (TNF-α). For HTN, after the examination all patients were prescribed a fixed combination of amlodipine and indapamide (Arifam, Les Laboratoires Servier, France). The observation period was 6 months.
Results. The study was completed by 58 patients who achieved blood pressure (BP values of 132,7 + 4,8 mm Hg), 54% patients took the initial dose of amlodipine/indapamide was 5/1,5 mg and in 46% patients, the dose of the drug was increased to 10/1,5 mg. After 6 months of treatment, a statistically significant increase in forced expiratory volume in 1st second (FEV1) was detected (p < 0,05), decrease in the average linear velocity along the maximum velocity curve (p < 0,05), Purcelo peripheral resistance index (p < 0,05), pulse wave propagation velocity in the elastic arteries, which was increased at the beginning of the study (p < 0,05), TNF-α (p < 0,05).
Conclusions. The administration of a fixed combination of amlodipine/indapamide in patients with COPD and HTN leads to the achievement of target BP levels, reduction of vascular stiffness, reduction in TNF-α level, improvement of microcirculatory blood flow. The combination is safe and well-tolerated.
CLINICAL CASE
The article discusses the problems of bicuspid aortic valve and associated valvulo-aortopathy, including the principles of separate classifications, mechanisms and risk factors of aortic dilatation formation, indications for surgical treatment and type of surgery. A clinical case of the patient with L-R variant of the 1st type of this defect is presented. The valvular pathology she was diagnosed at the age of 24 and aortic valve replacement operation was performed at the age of 34 due to its severe insufficiency. Before the operation, the diameter of the ascending aorta was 4,8 cm, and after 7 years, control echocardiography showed pronounced dilatation of the ascending aorta with signs of dissection. This confirms the opinion about different mechanisms of the formation of this defect and related aortopathy and proves that the latter is caused not only by hemodynamic factors, as it progresses significantly after isolated aortic valve replacement, requiring repeated surgical intervention. An important predictor of aortic diameter growth is pronounced aortic insufficiency at baseline, and the risk factors are hypertension and smoking in past.
ISSN 2411-8524 (Online)
