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The high prognostic significance of the concentration of the N-terminal - pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations., Aim: to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers., Materials and Methods: The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm)., Results: NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p.

Aim: To evaluate the effect of decompensated HF with preserved or slightly impaired EF on the risk of cardiovascular complications during a 5‑year follow-up., Materials and Methods: 33 patients with arterial hypertension and HF with preserved or slightly impaired EF (NT-proBNP ≥125 pg/ml, mean, 500.1±590.32 pg/ml and EF ≥40 %, mean, 57.0±10.29 %) were observed for 5 years. EchoCG, markers of immune inflammation and hormonal changes (endothelin, tumor necrosis factor (TNF), interleukin-6 (IL-6), aldosterone, renin) were evaluated at baseline. The endpoint was development of acute fatal and non-fatal cardiovascular events (CVEs). The one-way regression analysis was used to identify predictors of the risk for CVEs. The ROC analysis was used to determine "threshold levels" of significant predictors for this risk., Results: During the 5‑year follow-up period, CVEs developed in 13 (39.4 %) patients. The CVE predictors included baseline increases in creatinine and IL-6, NT-proBNP and a greater decrease in EF (р.

Accumulation and release of atrial and brain natriuretic peptides (ANP and BNP) in right atrial cardiac muscle cells has been investigated in rats after 60 minutes and 60 days after the reperfusion start. The total ischemia was simulated by the method of V. G. Korpachev. Immunocytochemical localization of peptides in cardiomyocytes was performed in ultrathin sections using polyclonal antibodies. The intensity of accumulation/excretion of ANP and BNP were analyzed by the method of counting the number of granules (A- and B-types) with immunoreactive labels in 38 x 38 mkm2 visual fields in transmission electron microscope Morgagni 268D (FEI). The results were assessed using Mann-Whitney U-test (p < 0.05). After 60 minutes and 60 days post-reperfusion period, we detected an increase in the synthesis and release of ANP and BNP. The reaction of BNP was more pronounced than ANP. This is due to the fact that ANP is the main hormone of the natriuretic peptide system involved in the regulation of blood pressure in normal conditions, while BNP is the principal regulator of pressure in cardiovascular pathology.

Aim: To estimate cardiac chamber sizes and epicardial fat (EF) thickness in patients with chronic heart failure (CHF) and metabolic syndrome (MS)., Materials and Methods: The investigation enrolled 77 patients with CHF. The diagnosis of the latter was made on the basis of clinical symptoms and verified measuring N-terminal pro-brain natriuretic peptide levels in all the patients. A study group (SG) included 39 patients with CHF and MS. A control group comprised 38 CHF patients without MS. Clinical and biochemical blood tests and electrocardiography were performed in all the patients. Cardiac chamber sizes, myocardial wall thickness, and EF were estimated from echocardiographic findings. Fatty liver index (FLI) and nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) were calculated in all the patients., Results: All the patients had clinical signs and symptoms of CHF. There were 25 (32%) men among the 77 patients. The mean age was 63.9±10.3 years. The patients with CHF and MS showed pronounced myocardial remodeling, which was manifested as significantly higher increases in the sizes of cardiac chambers and in the thickness of their walls and as larger EF thickness (EFT) and larger myocardial mass. In SG, EFT was 3.39±1.82 mm (p=0.00001). This group exhibited correlations between EFT and FLI (r=0.52; p=0.004), glycated hemoglobin levels (r=0.41; p=0.016), E peak (r=-0.25; p=0.005), E/A ratio (r=0.25; p=0.041), left ventricular (LV) end-systolic size (r=0.25; p=0.035), LV myocardial mass (r=0.29; p=0.038), NFS (r=0.29; p=0.002), and body mass index (r=0.29; p=0.003)., Conclusion: The found correlations between EFT and the clinical and metabolic parameters of CHD and cardiovascular diseases allow EFT to be regarded as a new marker of risk for MS and cardiovascular diseases.

To determine the pathogenic role of insulin resistance in the formation of involutive sarcopenia and chronic heart failure (CHF) were examined 88 elderly patients with arterial hypertension (AH) and 32 elderly patients without cardiovascular disease by methods of carbohydrate metabolism and the level of brain natriuretic peptide precursor evaluation, muscle mass and strength measuring, echocardiography, 6 minute walking test. It was found that in the group of hypertensive patients with low mass and muscle strength significantly increased indices of insulin resistance and more expressed signs of the left ventricle myocardial dysfunction and functional class of heart failure, probably as a result of disorders of energy homeostasis, resulting from the deterioration of glucose into the muscle cells of the heart and skeletal muscles.

The intensity of accumulation and release of brain natriuretic peptide (BNP) in right atrial cardiac muscle cells was investigated in rats after 5 and 60 min from the reperfusion start. Total ischemia was simulated by cardiovascular bundle compression according to V. G. Korpachev. Immunocytochemical identification of BNP in atrial myocyte granules was investigated in ultrathin cuts. We applied polyclonal antibodies to BNP. The calculation of granules (A- and B-types) with BNP was carried out in (38 x 38 μm) visual fields in transmission electronic microscope. The results were assessed using Mann-Whitney U-test (p < 0.05). After 5 min from the reperfusion start, the amount of the granules with BNP did not change compared to intact animals rate. On the 60th min of the post-reperfusion period was shown active accumulation and release of BNP; the amount of A-type granules increased by 134%, B-type granules increased by 210 % in comparison with intacy level. The results showed stimulating effect of ischemic and reperfusion factors on the processes of the brain natriuretic peptide synthesis and secretion in the early post-reperfusion period.

Aim: To study the specific features of an immune response and the role of infectious pathogens in the occurrence, development, and maintenance of ventricular ectopic activity in patients without signs of organic disease of the cardiovascular system (CVS)., Subjects and Methods: The investigation enrolled 91 patients (27 men and 64 women with a mean age of 36.5 +/- 11.5 years) with premature ventricular contractions (PVC) without signs of organic CVS pathology. A control group comprised 31 healthy volunteers. In addition to standard physical examination, a study of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cellular and humoral immune parameters was performed and the serological and molecular genetic markers of infections were determined in all the patients., Results: The persons with PVC, as compared to the control group, were recorded to have a higher NT-proBNP level (49.2 pg/ml versus 25.4 pg/ml; p = 0.001) accompanied by an increase in both the total number of PVC and the number of coupled PVC and the episodes of ventricular tachycardia. They were also found to have elevated CD3(+)HLA-DR+ (2.4% versus 1.56%) and CD3(+)CD95+ (27.6% versus 18.8%) counts (p = 0.001). In patients with a C-reactive protein level of more than 2 mg/l, the total number of PVC was larger than that in the other patients (p = 0.065). The patients with PVC did not show a statistically significant difference from the controls in the levels of antiviral and antibacterial antibodies. The people with PVC displayed a number of relationships between the infectious pathogen antibody titers and the ECG Holter monitoring and echocardiography readings., Conclusion: In the patients with PVC without signs of organic CVS pathology, the parameters of an immune response were not different from those obtained in the control group, which was likely to be associated with the involvement of the immune system in the development and maintenance of ventricular arrhythmias.

In article, analysis has been carried out on the influence of recanalization of chronic total occlusion of left anterior descending artery on the course of heart failure in elderly patients who had damage to a single artery and viable myocardium. Recanalization of chronic occlusion of left anterior descending artery together with conservative therapy in elderly patients improves the clinical course of heart failure. A more significant improvement seen in patients with chronic occlusion of left anterior descending artery without history of myocardial infarction.

For the purpose of estimation of peculiarities of interrelation between endothelial dysfunction (ED) and myocardial dysfunction (MD) in elderly persons due to arterial hypertension (AH) 66 patients of elderly age with AH of II stage and 26 persons of similar age without cardiovascular diseases were examined. It is established, that development AH is accompanied by formation of a concentric hypertrophy and concentric remodelling of myocardium, diastolic and systolodiastolic myocardial dysfunction, its expressiveness is interfaced to severity of endothelial dysfunction. Progressing of ED is accompanied by infringements of lipids' metabolism, increasing of their peroxidation activity and decreasing in efficiency of anti-oxidation protection.

The system of cardiac natriuretic peptides (NP) is a very important factor opposing the effects of the rennin-angiotensin-aldosterone system (RAAS), sympathoadrenal system and vasopressin to reduce blood pressure. In the present study, we analyzed the release of atrial and brain natriuretic peptides in the myocytes of the right atrium in rats by the quantitative morphometric method using double immunocytochemical labeling of atrial granules comprising NP in vasorenal hypertension induced by the renal artery ligation. The decrease in the total amount of secretory granules in atrium myocytes by 18% was detected on the 30th day after the operation. The number of the A-type granules was reduced by 53%, and the number of B-type granules was increased by 64% in comparison with the intact animals. Our data indicate activation of NP secretion in vasorenal hypertension. The results suggest that high arterial pressure might be explained by reduced expression of NP receptors in this pathology.

STUDY AIM - assessment of dynamics of markers of inflammation (CRP, Il-6, Il-10, TNFa, CD40L, fibrinogen) and N - N in acute coronary syndrome (ACS) as well as analysis of effect of various methods of treatment on level of these parameters. Patient aged 30 - 70 years were included in the study: 52 patients with ACS with ST-segment elevation (STEACS) and 61 - without ST-segment elevation (NSTEACS). Initial level of markers of inflammation (Il-6, CRP) in STEACS was lower than in NSTEACS. Initial level of antiinflammatory Il-10 was significantly higher in patients in the STEACS group (72.6 +/- 39.1 and 6.6+4.2 pg/ml, < 0.01). At admission the highest values of N - N were noted in the group of NSTEACS (761.5 pg/ml compared with 451.1 pg/ml in STEACS, =0.04). During period of hospitalization elevation of N - N occurred in the group of STEACS while its lowering occurred in the group of NSTEACS. In STEACS patients with early restored coronary blood flow dysfunction of the myocardium was less pronounced (lower level of N - N ). In patients with NSTEACS during period of hospitalization levels of CRP, Il-6 fibrinogen lowered. In invasively treated patients with NSTEACS levels of CRP and fibrinogen lowered to a greater extent than in conservatively treated.