The existing diagnostic approaches to coronary artery disease in systemic hypertension are discussed, and the clinical case demonstrates the imperfection of the common algorithm, in particular, in asymptomatic patients. 

Background. The article reviews the main clinical trials on the management of acute coronary syndrome (ACS) and approaches to the intracoronary thrombi. The results of the Russian study are also presented. Percutaneous coronary intervention (PCI) is the most effective revascularization method, nowadays has become the preferable therapeutic method in ACS. However, reestablishing blood low in epicardial artery with balloon angioplasty and stenting can be complicated by microvascular damage, primarily due to distal embolization. Preventive procedures could help to preserve the microvascular circulation and improve the results of the intervention.

Objective. To assess the impact of bolus infusion of IIb/IIIa receptor inhibitor (Eptiibatide) on the microcirculation in PCI.

Methods. Seventy one patients with ACS underwent primary PCI and traditional intravenous or intracoronary bolus of of IIb/IIIa receptor inhibitor was performed. The TIMI grade low, corrected TIMI frame count, myocardial blush and ST segment resolution were measured after coronary low restoration, after Eptiibatide bolus administration and after coronary stenting.

Результаты. Представлены результаты обследования 71 больного ОКС, у которых сравнивалось интракоронарное и внутривенное введение болюсной дозы эптифибатида (Интегрилина) при выполнении ЧКВ. Выводы. Селективное, интракоронарное введение болюсной дозы ингибитора рецепторов IIb/IIIa эптифибатида является безопасным, позволяет достичь максимальной концентрации препарата в зоне коронарного тромбоза и способствует дезагрегации свежего тромба и предотвращает развитие дистальной эмболии с поражением микроциркуляторного русла при выполнении ЧКВ больным ОКС.

Abstract

The article reviews the problem of sleep-disordered breathing starting with the historical issues on the irst literally descriptions and clinical reports of sleep apnea cases, moving to the data from population studies and giving the overview of the modern diagnostic and treatment approaches to sleep apnea.

The articles reviews the main approaches to the choice of the antihypertensive drug in cardiovascular comorbidities based on the data from the worldwide guidelines by the Joint National Committee of the USA, European Society of Cardiology / European Society of Hypertension, American Society of Hypertension /International Society of Hypertension.

Objective. To study the indices of local arterial stiffness in correlation with structure-functional parameters of cardiovascular remodeling in healthy individuals and in hypertensive patients.

Design and methods. We carried out a cross-sectional population study in workers of an industrial enterprise. Altogether 213 people were enrolled, including 106 patients with arterial hypertension stage I–II and 107 healthy individuals. We assessed the stage and the grade of hypertension together with the additional categories of cardiovascular risk in accordance with national guidelines. All patients underwent echocardiography, ultrasound of the carotid arteries with simultaneous evaluation of arterial stiffness. Results. Hypertensive patients demonstrated a signiicant association between arterial stiffness indices and intima-media thickness (91 %) and echocardiographic parameters of the left heart volume.

Conclusion. The indices of arterial stiffness may serve as markers of effective management of risk factors in individuals with normal blood pressure and those of drug therapy in hypertensive patients.

Objective. To study erythrocyte glutathione system, its reduction potential compared to oxidative stress indicators and systemic inlammation in patients with acute coronary syndrome (ACS).

Design and methods. Based on the concept of prooxidant and antioxidant redox signaling erythron functions, parameters of oxidative stress, inlammation, metabolism and redox erythrocyte glutathione status in 47 patients with myocardial infarction with ST segment elevation (STEMI) on the electrocardiogram and 71 patients with unstable angina (UA) were studied and compared.

Results. A severe disruption of prooxidant-antioxidant balance and systemic inlammatory response in patients with UA with a decrease in superoxide dismutase activity in both groups of patients was established. The opposite changes in the concentrations of total glutathione and reduced glutathione in erythrocytes were obtained: an increase in STEMI and reduction in UA together with the low glutathione reductase activity in the first case. A signiicant shift of erythrocytes redox potential in the oxidized side on 15,4 mV in patients with UA and higher glutathione peroxidase activity were revealed.

Conclusions. Against the background of pronounced impairments in a prooxidant-antioxidant balance and manifestations of a systemic inlammatory response, patients with UA (in contrast to patients with STEMI) showed decreased concentrations of total and reduced glutathione and the ratio of reduced to oxidized glutathione. This causes a shift in the erythrocyte glutathione redox potential to the oxidized side and an increase in the activity of glutathione peroxidase, the key prognostic factor in ACS. The changes in the erythrocyte glutathione system in ACS relect the processes of erythron adaptation in maintaining systemic redox signaling, due to protein deglutathionylation, and preventing further hemorheologic complications.

Objective. To analyze myocardial blood low and metabolism in patients with high gradation nonischemic ventricular arrhythmia (VA).

Design and methods. Sixteen patients (9 males, 7 females, average age — 44 ± 99м 6,5 years) were enrolled. One-photon emission computer tomography with Tc-tetraphosmine at rest and at the physical training (veloergometry) were performed for myocardial perfusion examination. Estimation of fatty acids metabolism in myocardium was performed by positron-emission tomography (PET) with С-natrium butyrate. Control groups included age- and sex-matched 10 patients with coronary artery disease (CAD) and VA and 10 99м healthy volunteers.

Results. At rest diffused equal distribution of Tc-tetraphosmine was revealed in 93,75 % patients. Reversible diffused stress-induced defects were found at exercise training test, but the changes were not signiicant. There were no changes in myocardial metabolism and no changes in the rate of fatty acids metabolism. Thus, diffused changes of metabolism and perfusion of left ventricle were found in the most patients with VA. Whereas there were no changes in healthy volunteers, and we found reduced extraction and velocity of fatty acids utilization in areas of left ventricle with stress-induced changes of perfusion in the group with CAD and VA.

 Conclusions. PET is an effective method to conirm nonischemic character of VA, and in most cases of VA it is helpful to ind diffused changes of metabolism and perfusion of left ventricle. These might be important when a treatment approach is to be chosen.

Objective. To develop evidence-based technology for creation or selection of quality indices of health care in hypertensive patients aiming at clinical result — achievement of the goal blood pressure (BP).

Design and methods. To identify the major causes of non-achievement of the goal BP we used the method of systems analysis of clinical incidents — ishbone diagram. To construct the diagram system review of literature (E-library, PubMed) including the results of own previous investigations was performed.

Results. The following major causes of target BP non-achievement were identiied: doctor-related — inadequate therapy, patient-related — low adherence, healthcare system-related — low medical care availability. The following indices were proposed to control the mentioned issues: «BP measurement», «Two antihypertensive drugs administration», «Target BP recorded», «Target BP not recorded and two antihypertensive drugs not administered». Principal stages of performance measures creation were proposed.

Conclusions. Clear deinition of clinical therapeutic result together with the system analysis methods allow the development of the evidence-based measures healthcare quality assessment.

The problems of hypotensive conditions in mainly elderly patients are considered in the article. Factors of transient hypotension pathogenesis relevant to essential hypertension are presented. The role of comorbid somatic and infectious pathology as a potential predictor of essential hypertension current change with the development of the adverse hemodynamic orthostatic responses is highlighted. The article presents the clinical example of spontaneous hypertension involution in a patient with concomitant septicemia, parasitosis, oncology.

Objective. To review the main issues of the pathogenesis, clinical presentation, diagnostics and treatment approaches of aorta coarctation that is a segmental narrowing of thoracic aorta below left subclavian artery (usually at the level of the isthmus).

 Methods. We present a clinical case of a young male patient with drug-resistant hypertension. Secondary cause was suspected, and aorta coarctation was conirmed by computer scan.

Conclusion. We emphasize few eatures of the case: the diagnostics of the congenital heart malformation in adulthood, normal constitution and leg muscle development, high physical load tolerance, the absence of intercostalarteries pulsation.