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A 36-year-old man presented to the clinic with frequent headaches and a brief episode of fainting. He said that he had experienced headache for a few months and occasionally had found his arterial pressure to be elevated at 180/120 mm Hg. He sometimes felt feverish and shivering all over, which was

Cell death is an important feature of the development of multicellular organisms, a critical factor in the occurrence of cardiovascular diseases. Understanding the mechanisms that control cell death is crucial to determine its role in the development of the pathological process. However, the most well-known types of cell death cannot fully explain the pathophysiology of heart disease. Understanding how cardiomyocytes die and why their regeneration is limited is an important area of research. Ferroptosis is an iron-dependent cell death that differs from apoptosis, necrosis, autophagy, and other forms of cell death in terms of morphology, metabolism, and protein expression. Ferroptotic cell death is characterized by the accumulation of reactive oxygen species resulting from lipid peroxidation and subsequent oxidative stress, which can be prevented by iron chelates (eg, deferoxamine) and small lipophilic antioxidants (eg, ferrostatin, liproхstatin). In recent years, many studies have been carried out on ferroptosis in the context of the development of atherosclerosis, myocardial infarction, heart failure, and other diseases. In addition to cardiovascular diseases, the review also presents data on the role of ferroptosis in the development of other socially significant diseases, such as COVID-19, chronic obstructive pulmonary disease. With the study of ferroptosis, it turned out that ferroptosis participates in the development of bacterial infection associated with the persistence in the host body of Pseudomonas aeruginosa. The review summarizes the recent advances in the study of ferroptosis, characterizing this type of cell death as a novel therapeutic target.

The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM. The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus, obesity, dyslipidemia, etc.), chronic kidney disease and the risk of developing hepatocellular cancer were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of ursodeoxycholic acid to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.Национальный мультидисциплинарный Консенсус подготовлен при участии Национальной медицинской Ассоциации по изучению сочетанных заболеваний (НАСЗ), Российского общества по изучению печени (РОПИП), Российской Ассоциации эндокринологов (РАЭ), Российской Ассоциации геронтологов и гериатров (РАГГ), Национального общества профилактической кардиологии, Профессионального фонда содействия развитию медицины ПРОФМЕДФОРУМ. Цель мультидисциплинарного консенсуса в подробном анализе течения неалкогольной жировой болезни печени (НАЖБП) и основных ассоциированных с ней состояний. Дано определение НАЖБП, описаны ее распространенность, методы диагностики таких составляющих, как стеатоз, воспаление и фиброз. Проанализирована связь НАЖБП с рядом кардиометаболических заболеваний (артериальной гипертонией, атеросклерозом, тромботическими осложнениями, сахарным диабетом 2-го типа, ожирением, дислипидемией и др.), хронической болезнью почек и риском развития гепатоцеллюлярного рака. Представлен обзор немедикаментозных методов лечения НАЖБП и современных возможностей фармакотерапии. Рассмотрены возможности новых молекул в лечении НАЖБП: агонистов ядерных рецепторов, антагонистов провоспалительных молекул и т.п. Описаны положительные свойства и недостатки применяемых в настоящее время препаратов (витамин Е, тиазолидиндионы и др.). Особое внимание уделено мультитаргетной молекуле урсодезоксихолевой кислоты в комплексном лечении НАЖБП как мультифакторного заболевания. Рассмотрены ее противовоспалительные, антиоксидантные и цитопротективные свойства, способность через модуляцию аутофагии уменьшать стеатоз независимый фактор риска развития сердечно-сосудистой патологии, уменьшать воспаление и печеночный фиброз. Продемонстрированы способности урсодезоксихолевой кислоты влиять на гомеостаз глюкозы и липидов, оказывать антиканцерогенное действие. В Консенсусе выработаны положения для практикующих врачей по оптимизации диагностики и лечения НАЖБП и связанных с ней общими патогенетическими звеньями кардиометаболических заболеваний.

One of the trends in modern cardiology is the study of the matrix metalloproteinase (MMP) system. Currently, an increase in plasma concentrations of some MMPs and their tissue inhibitors is considered as one of the earliest biochemical markers of myocardial fibrosis in various diseases of the cardiovascular system. Discusses the importance of MMP in the development of atrial fibrillation (AF).To study the effect of the MMP system on the development of AF in obese patients.The study included 105 patients with a body mass index of more than 30 kg/m2. Depending on the presence of AF, the patients were divided into 2 groups. The criterion for inclusion of patients in group 1 was the presence of documented AF paroxysm in 55 obese patients. The comparison group (group 2) consisted of 50 obese patients without heart rhythm disorders. When patients were included in the study, in order to assess the severity of visceral obesity, all patients underwent a general clinical examination, echocardiography. To determine the activity of the MMP system, venous blood was taken from patients.Significantly higher values of MMP-9 were detected in patients with obesity and paroxysmal AF 315.753.4 ng/ml than in patients with obesity without heart rhythm disorders 220.954.7 ng/ml (p=0.002); the values of tissue inhibitor of metalloproteinase 1 were 185.342.2 and 119.242.6 ng/ml, respectively (p=0.007). In patients with obesity and paroxysmal AF, a correlation of moderate strength between the level of MMP-9 and the volume of left atrium and a direct dependence of moderate strength between the ratio of waist volume to height and the plasma values of MMP-9 was revealed. The MMP-9 index (AUC 0.92) had a high diagnostic value for determining the probability of having a paroxysmal form of AF in obese patients. With an increase in the level of MMP-9 more than 295 ng/ml, it is possible to predict the presence of paroxysmal AF in obese patients with a sensitivity of 74.5% and a specificity of 94%.In patients with obesity and paroxysmal AF, a significant increase in the parameters of the MMP system (MMP-9 and tissue inhibitor of metalloproteinase 1) was revealed when compared with obese patients without heart rhythm disorders (p0.05). With an increase in MMP-9 of more than 285 ng/ml in obese patients, the appearance of AF with a sensitivity of 74.5% and a specificity of 94% can be predicted.Обоснование. Одним из трендов современной кардиологии является изучение системы матриксных металлопротеиназ (ММП). В настоящее время повышение плазменных концентраций некоторых ММП и их тканевых ингибиторов рассматривают как один из наиболее ранних биохимических маркеров фиброза миокарда при разных заболеваниях сердечно-сосудистой системы. Обсуждается значение ММП в развитии фибрилляции предсердий (ФП). Цель. Изучить влияние системы ММП на развитие ФП у больных с ожирением. Материалы и методы. В исследование включены 105 пациентов с индексом массы тела более 30 кг/м2. В зависимости от наличия ФП больные разделены на 2 группы. Критерием включения пациентов в 1-ю группу было наличие у 55 больных с ожирением документированного пароксизма ФП. Группу сравнения (2-я группа) составили 50 пациентов с ожирением без нарушений сердечного ритма. При включении пациентов в исследование с целью оценки выраженности висцерального ожирения всем больным проводились общее клиническое обследование, эхокардиография. Для определения активности системы ММП пациентам выполнялся забор венозной крови. Результаты. Достоверно более высокие значения ММП 9-го типа (ММП-9) выявлены у пациентов с ожирением и пароксизмальной формой ФП 315,753,4 нг/мл, чем у больных с ожирением без нарушений сердечного ритма 220,954,7 нг/мл (р=0,002); значения тканевого ингибитора металлопротеиназ 1-го типа составили 185,342,2 и 119,242,6 нг/мл соответственно (р=0,007). У больных с ожирением и пароксизмальной формой ФП выявлены корреляционная зависимость умеренной силы между уровнем ММП-9 и объемом левого предсердия и прямая зависимость умеренной силы между соотношением объема талии к росту и плазменными значениями ММП-9. Высокой диагностической ценностью для определения вероятности наличия пароксизмальной формы ФП у пациентов с ожирением обладал показатель ММП-9 (AUC 0,92). При увеличении уровня ММП-9 более 295 нг/мл можно с чувствительностью 74,5% и специфичностью 94% прогнозировать наличие пароксизмальной формы ФП у больных с ожирением. Заключение. У пациентов с ожирением и пароксизмальной формой ФП выявлено достоверное увеличение показателей системы ММП (ММП-9 и тканевого ингибитора металлопротеиназ 1-го типа) при сравнении с тучными больными без нарушений сердечного ритма (p0,05). При увеличении ММП-9 более 285 нг/мл у больных с ожирением можно прогнозировать появление ФП с чувствительностью 74,5% и специфичностью 94%.

The development of microcirculatory disorders is considered to be one of the earliest changes in the cardiovascular system with a combination of arterial hypertension (AH) and obesity. The rheological properties of blood play a significant role in the system of microcirculation. An important place in changing the rheological characteristics of blood is largely assigned to erythrocytes. Aggregation of erythrocytes is closely related to the magnitude of the surface-bound charge of their membranes or zeta potential of erythrocyte membranes. Purpose. To study the state of compound zeta potential of erythrocyte membranes in patients with hypertension and obesity. Material and methods. The study included 112 patients with AH and Index of Mass Corporal more than 30 kg/m2 (main group); the control group consisted of 25 people without AH and obesity. All patients of the main group received standard antihypertensive, lipid-lowering and hypoglycemic therapy to achieve the target levels of the indices under correction. Results. The level of compound zeta potential of erythrocyte membranes in patients with AH and obesity was significantly lower than in the control group and amounted to 1.57 ± 0.06 × 107 and 1.67 ± 0.03 × 107, respectively (p < 0.05). At the same time, in patients of the main group with an increase in AH, lower indices were noted. In patients with AH and obesity, a significant inverse correlation was found between the compound zeta potential of erythrocyte membranes and the degree of hypertension, which indicates a negative effect of hypertension on the rheological properties of blood at the microvasculature level. A correlation analysis was carried out to evaluate the association between Index of Mass Corporal and zeta potential of erythrocyte membranes in obese hypertensive patients. A negative direct correlation was revealed (r = 0.7, p < 0.05). Conclusion: a decrease in the total charge of erythrocytes can be considered as an early sign of microrheological disorders in patients with a controlled course of arterial hypertension and obesity.

Choriocarcinoma (CC) is a very rare and aggressive neoplasm. The characteristic feature of this disease is a rapid hematogenous spread, mainly to the lungs and brain, which largely defines clinical signs of the disease and complicates the diagnosis. Gastrointestinal metastases are rare, and of those, only few cases with gastric location have been reported. There are publications describing choriocarcinoma syndrome (CCS). As a rule, it presents in patients with an advanced disease and is characterized by hemorrhage from metastatic foci, leading to hemoptysis and gastrointestinal bleeding. CCS development is associated with poor prognosis and high mortality. This article describes a case of testicular CC with rare few gastric metastases, complicated by CCS.

Mineralocorticoid receptor antagonists have been successfully used for many years to treat patients with primary hyperaldosteronism, refractory arterial hypertension and chronic heart failure. The increased interest in this drug in recent years is due to new information about its antifibrotic and antiproliferative effects, both cardiac and extracardiac. The article also discusses the possibility of using spironolactone in patients with the new coronavirus infection SARS-CoV-2 (COVID-19).Антагонисты минералокортикоидных рецепторов в течение многих лет с успехом используются для лечения больных с первичным гиперальдостеронизмом, резистентной артериальной гипертензией и хронической сердечной недостаточностью. Возросший в последние годы интерес к этим препаратам обусловлен новыми сведениями об их антифибротическом и антипролиферативном эффектах, как сердечных, так и экстракардиальных. В статье также рассматривается возможность применения спиронолактона у пациентов с новой коронавирусной инфекцией SARS-CoV-2 (COVID-19).

The coronavirus pandemic showed not only an increase in levels of excess morbidity and mortality in the acute phase, but also persisting symptoms 4 weeks after the onset of the disease. A review of international studies on the prevalence and diversity of the manifestations of postcoid syndrome is presented. The data on such a manifestation of post-COVID syndrome as postural orthostatic tachycardia syndrome (POTS) are accumulating. Pathogenetic mechanisms, modern diagnostic criteria and research data on the prevalence of this syndrome are presented in the article. The Canadian Cardiovascular Society has proposed medications as a treatment for POTS, including the sinus node If channel inhibitor ivabradine. Data from several studies showing the effectiveness of this drug for POTS, including after suffering COVID-19, are presented in the article. Clinical data on the prevalence of tachycardia among patients admitted to the Sechenov University hospital are presented. About 18% of patients with hypertension and 21% of patients with normal blood pressure had a high heart rate. A clinical example of the use of ivabradine in a patient after a coronavirus infection is presented. Drug interactions and individual tolerance of ivabradine in patients after coronavirus infection are being discussed. The authors put forward the hypothesis about the further prospect of using ivabradine in the treatment of clinical manifestations of postcoid syndrome on the basis of literature data and their own experience.

At the end of 2020, a new term “post-COVID-19 syndrome” appeared in the medical community. The prevalence of this syndrome reaches more than 30% among patients who have had COVID-19, and its duration can vary from 12 weeks to 6 months. One of the most severe consequences of COVID- 19 is the defeat of the cardiovascular system, which has a variety of mechanisms: dysregulation of the renin-angiotensin-aldosterone system; pathological systemic inflammatory response; direct action of the virus on the myocardium with the development of myocarditis; respiratory failure with hypoxia, leading to damage to cardiomyocytes; microvascular damage due to hypoperfusion, increased vascular permeability, angiospasm and the direct damaging effect of the virus on the endothelium of the coronary arteries; thrombotic complications due to the procoagulant and prothrombogenic effect of systemic inflammation. One of the most promising directions in the treatment and prevention of damage to the cardiovascular system in patients with hypertension who have undergone COVID-19 is the appointment of antihypertensive drugs that have the most pronounced organoprotective properties together with statins. The single pill combination of lisinopril, amlodipine and rosuvastatin is an effective drug that allows achieving not only adequate hypotensive and lipid-lowering effects, but also due to its pronounced organoprotective properties, to expect a reduction in cardiovascular risk and complications in patients who have suffered a new coronavirus infection caused by the SARS-CoV-2 virus.

Obesity is a non-infectious pandemic. The visceral distribution of adipose tissue is a significant factor in the development of cardiovascular diseases and their complications. Along with the visceral abdominal depot in omentum and subcutaneous tissue, there are other ectopic adipose tissue depots: epicardial adipose tissue (EAT), perivascular adipose tissue (PVAT) and perirenal adipose tissue. This article presents a review of the physiological role and molecular basis of the PVAT and EAT function in healthy, as well as in pathological, conditions; the interaction of adipokines and cytokines, their contribution to the development and progression of cardiovascular diseases. The review discusses well-known facts and controversial issues in this field. Comprehensive investigation of the mechanisms of vascular and myocardial pathology in obese people, along with identification of biomarkers for early prediction of cardiovascular complications, would contribute to the development of targeted preventive measures and choice of therapeutic strategies, which is consistent with the contemporary concept of personalized medicine. We have analyzed domestic and foreign literature sources in eLIBRARY and PubMed scientific libraries for the period of 2001-2020.

The emergence of new research methods makes it possible to study the tissue, structural, cellular, and molecular causes of atrial fibrillation (AF). Recently, the role of interstitial telocyte cells in the pathogenesis of AF has been actively discussed. Telocytes are a special type of interstitial cells identified in many organs and tissues, including the heart. The roles of telocytes in the myocardium are diverse: they have pacemaker activity, and carry out structural and coordination communication between cells. The ability of these cells to change the speed of the electrical pulse in the atrial and ventricular myocardium has been proven. Telocytes form "atypical" connections with almost all types of cells in the human heart, which collects them in an integrated network. Using electron microscopy, it was found that interstitial cells have different types of connections in the network and can integrate "information" from the vascular and nervous systems, interstitial, immune system, stem cells, progenitor cells, and contractile cardiomyocytes. Currently, the results of studies have been obtained that prove both positive and negative effects of telocytes on the occurrence of various diseases of the cardiovascular system. The role of telocytes in AF arrhythmogenesis remains a subject of discussion. The unique properties of telocytes in providing intercellular contacts, transmitting genetic information, and their ability to regenerate heart tissue are undoubtedly the most promising areas of modern cardiology. There is evidence of both direct and indirect effects of telocytes on the electrophysiological properties of the myocardium. There is no doubt that the development of this area opens up new therapeutic targets for the prevention and treatment of AF.

Aim. To study changes in vascular wall stiffness in patients with obesity and paroxysmal atrial fibrillation (AF) during sinus rhythm retention.Material and methods. The study included 86 obese patients aged 38 to 72 years. Patients were divided into 2 groups: 42 patients with paroxysmal AF and obesity (Group I) and 44 patients with obesity and without rhythm disturbance (Group II). All patients were evaluated for the main parameters of arterial wall stiffness: the heart-ankle vascular index (CAVI) and the ankle-brachial index (ABI) in the right and left main arteries.Results. Body mass index (BMI) did not differ significantly between groups. The prevalence of visceral obesity in patients with paroxysmal AF was significantly higher than in patients without heart rhythm disorders. The study of vascular wall rigidity revealed a significant increase in the CAVI index in patients with paroxysmal AF compared with this in patients without cardiac arrhythmia. The average value of the CAVI index was 9.61±1.51 and 7.92±0.18, respectively (p=0.0003). In patients with obesity and paroxysmal AF, correlations were found between waist circumference to hip circumference (WC/HC) ratio and CAVI index (r=0.455, p=0.004); WC/height ratio and CAVI index (r=0.443, p=0.003); between WC and CAVI index (r=0.493, p=0.002). A positive direct relationship was found between CAVI index and the frequency of AF attacks during the year: r=0.782 (p=0.001).Conclusion. A significant increase in the CAVI index, indicating a change in vascular wall stiffness, was found in patients with obesity and paroxysmal AF when compared with overweight patients without heart rhythm disorders. The increase in the CAVI index was correlated with the increase in WC, the WC/HC ratio, and WC/height ratio. There was a significant direct relationship between the CAVI index and the frequency of arrhythmia attacks in patients with obesity and paroxysmal AF.

One of the trends in modern cardiology is the use of omega-3 polyunsaturated fatty acids ( ω -3 PUFA) in the prevention of heart rhythm disorders and the prevention of sudden cardiac death. In experimental studies, it was found that ω -3 PUFAs have a variety of pleiotropic effects: they reduce the formation of oxygen radicals, reduce reperfusion complications, reduce the level of thromboxane and platelet aggregation, and improve endothelial function. The ability of ω -3 PUFA to have an anti-inflammatory effect, which includes the inhibition of leukocyte chemotaxis, the expression of adhesion molecules, the formation of eicosanoids and biologically active substances with powerful anti-inflammatory properties. One of the most significant effects of ω -3 PUFA can be considered their anti-atherogenic effect. Antiarrhythmic properties of го -3 PUFA are associated with the effect on the ion channels of cardiomyocytes, they are able to activate "slow" calcium channels, increase the activity of Ca 2+ /Mg 2+ -ATPase and reduce the work of sodium channels. In animal experiments, it has been shown that in conditions of ischemia or adrenergic stimulation, ω -3 PUFA stabilizes the cardiomyocyte membrane, can increase the duration of the effective refractory period, and prevent the development of various heart rhythm disorders. Clinical studies have shown that the administration of ω -3 PUFA in addition to standard treatment reduces the risk of new cases of atrial fibrillation, ventricular arrhythmias and sudden cardiac death.

Background: Obesity and related cardiovascular diseases (CVDs) are important public health problems. The role of visceral ectopic fat remains contested. We studied the relationship between pericard...

Despite the current possibilities of using different classes of antihypertensive drugs that effectively reduce blood pressure and significantly improve the long-term prognosis of patients, the problem of uncontrolled arterial hypertension has not lost its importance and its solution in a particular clinical situation often remains very difficult. The term "uncontrolled arterial hypertension" can be used in all cases where arterial pressure has not been achieved. The true prevalence of uncontrolled arterial hypertension has not been established, and its study is hampered primarily by the fact that not all patients initially receive antihypertensive therapy that meets generally accepted standards. Currently, the tactics of management of patients with uncontrolled hypertension involves the use of combinations of antihypertensive drugs. Rational combinations, according to the new recommendations for the diagnosis and treatment of arterial hypertension in 2018, remain a combination of blockers of the renin-angiotensin-aldosterone system – angiotensin-converting enzyme inhibitors or receptor blockers to angiotensin with a calcium antagonist or diuretic, preferably in one tablet. With the ineffectiveness of dual therapy needs to be assigned to a third antihypertensive drug. Among the most modern antihypertensive drugs can be considered a triple fixed combination of lisinopril, amlodipine and indapamide. All the components included in the composition of the drug, has proved its high efficiency and safety. Uncontrolled arterial hypertension remains one of the most urgent problems of modern cardiology. Many aspects of it are far from unambiguously interpreted solutions and standards. Until the end, the mechanisms of the formation of uncontrolled course of hypertension remain unexplored, which, in turn, leads to a restriction of the use of drug and non-drug methods in the treatment of this pathology. Rational choice of antihypertensive therapy regimens can significantly improve the quality of treatment of this category of patients.

Aim. To identify predictors of progression of atrial fibrillation (AF) in patients with hypertension (HT), coronary heart disease (CHD) and chronic heart failure (CHF) with recurrent AF. Material and methods . The study included 31 2 patients with recurrent AF. The patients were divided into 3 groups according to a leading underlying condition: essential HT (n=1 36), CHD (n=11 2), and CHF with III-IV functional class by NYHA (n=64). The average follow-up duration was 60±3 months. Progression of AF was defined as development of long-standing persistent or permanent AF. Results. All three groups of patients with recurrent AF revealed progression of the arrhythmia from paroxysmal or persistent to a sustained permanent form during the 5-year prospective follow-up. The rate of AF progression in the patients with CHF was significantly higher and accounted for 59% as compared to 46% in the patients with hypertension (p=0.002) and 51% in the patients with CHD (p=0.008). AF progression in patients with HT correlated significantly with left ventricular (LV) hypertrophy (odds ratio [OR] 1.25; 95% confidence interval [95%CI] 1.03-1.52) and increased arterial wall stiffness (OR 2.3; 95%CI 1.95-2.65). The independent predictors of arrhythmia progression in patients with CHD were a history of myocardial infarction (OR 1.23; 95%CI 0.9-1.5), irreversible LV wall motion abnormalities (OR 1.41; 95%CI 1.1-1.7), and increased plasma level of N-terminal pro-A-type natriuretic peptide (Nt-proANP; OR 1.16; 95%CI 0.8-1.4). Reduction in LV ejection fraction below 40% (OR 0.84; 95%CI 0.7-0.89) and increased plasma N-terminal pro-B-type natriuretic peptide (Nt-proBNP; OR 2.3; 95%CI 1.93-2.67) were independent predictors of AF progression from persistent to permanent form in the patients with systolic heart failure. Conclusion. Progression of AF is related to the underlying cardiovascular disease. The early vascular aging syndrome and LV hypertrophy are the main factors of AF progression in patients with HT. Previous myocardial infarction with irreversible hypokinesia is associated with AF progression in patients with CHD. Reduced LV ejection fraction and increased plasma BNP predict AF progression in patients with CHF.

Due to the spectacular progress made in human genomic studies, molecular biology and genetics have become an essential part of modern medicine making it possible to early detect the risk factors and select the personalized treatment. The genetic studies have been widely used in the diagnosis and treatment of arrhythmias. Significant advances in the study of electrophysiological and genetic mechanisms of life-threatening arrhythmias have been achieved through studies of familial conditions with high risk of sudden cardiac death. However, the area of special interest for a practitioner is the identification of mutations associated with atrial fibrillation (AF). The novel methods enable us to study histological, structural, cellular and molecular causes of this arrhythmia. The two main directions of molecular genetic studies of AF are the identification of genetic mutations causing familial atrial fibrillation and the study of different genes polymorphism predisposing to arrhythmia in general population. Gene polymorphism screening helps both identify AF risk factors and predict its evolution from paroxysmal to chronic type. Emerging genetic studies provided explanation for the variable efficacy of antiarrhythmic drugs. It can be assumed that the clinical use of genetic methods will allow accurate and personalized selection of antiarrhythmics. Currently, therapeutic drug monitoring is widely recommended for a number of medications including cytostatics, aminoglycosides, anticonvulsants, and, by some researchers, antiarrhythmic and anticoagulant drugs. Medicine from the very beginning was intended to be personalized, but until recently it was a little more than a myth. The discovery of the human genome makes it possible to choose the most effective treatment with minimal adverse drug reactions for a particular patient.

Aim To study the influence of epicardial fat tissue (EFT) on atrial fibrillation (AF) occurrence in hypertensive patients. Materials and methods The study included 195 patients with hypertension aged from 38 to 72 years (mean age was 61.5±1.8 years). All patients were divided into two groups: group I included 95 hypertensive patients with paroxysmal AF; 100 patients with hypertension in sinus rhythm were enrolled into group II. Echocardiography was performed to evaluate the thickness of EFT in a parasternal long-axis view. The EFT volume was assessed with computed tomography (CT) scan. The plasma concentration of tissue inhibitor of metalloproteinase-1 (TIMP-1) and metalloproteinase-9 (MMP-9) was measured to evaluate the myocardial fibrosis process. Results There was no significant difference between the studied groups of patients in body mass index: 34.43±1.2 kg/m2 in group I vs 31.97±1.67 kg/m2 in the group II. Waist circumference was significantly higher in group I in comparison with the group II patients: 118.9±3.3 cm vs 110.2±1.4 cm, respectively (p=0.038). EFT thickness was significantly higher in patients with paroxysmal AF (11.6±0.8 mm) in comparison with the patients in sinus rhythm (8.6±0.4 mm) (p Conclusion Increased EFT thickness (more than 10 mm) and EFT volume (more than 6 ml) are predictors of AF onset in hypertensive patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The complex subject of the Department

Objective To study the changes in arterial stiffness in patients with obesity and paroxysmal atrial fibrillation (AF). Materials and methods The study included 82 obese patients. Forty-two of them (group I) had paroxysmal AF, their mean age was 60.9 ± 6.2 years. The control group (group II) included 40 obese patients in sinus rhythm with the mean age of 57.2 ± 6.5 years. We studied arterial stiffness using cardio-ankle vascular index (CAVI) measured by the VaSera device (VS-1000) in all the patients. Patients from group I were evaluated after 3 days of sinus rhythm restoration and maintenance. We also measured the anthropometric indicators which included body mass index, waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios. Results There were no significant differences in body mass index between 2 groups. The waist-to-hip ratio was significantly higher in patients with obesity and paroxysmal atrial fibrillation than in obese patients in sinus rhythm and was 1.37 ± 0.09 and 0.84 ± 0.06, respectively (p = 0.002). The mean value of CAVI was 9.61 ± 1.51 and 6.42 ± 0.18 in group I and group II respectively; this difference was significant (p = 0.001). There was a strong positive correlation between CAVI and waist-to-hip ratio in the group I patients (p = 0.02). The results show that vascular stiffness is significantly higher in obesity patients with paroxysmal form AF. Conclusion Positive correlations between increased arterial stiffness and anthropometric indicators confirm the role of visceral obesity in the development of AF.

Aim. To study the changes in the stiffness of the arterial wall, vasomotor function of the endothelium, and appearance of new cases of atrial fibrillation (AF) in patients with arterial hypertension with long-term treatment with lisinopril.Material and method. 66 hypertensive patients with cardiac sinus rhythm at the age of 48-64 years (mean age 58.4±4.2 years) were included into the study. They were randomized into 2 groups: patients of group 1 (n=35) were prescribed lisinopril or a combination of lisinopril with hydrochlorothiazide over the 5-year follow-up; patients of group 2 (control) did not receive angiotensin converting enzyme inhibitors or angiotensin II receptor blockers. The follow-up duration was from September 2010 until June 2016. It included telephone calls once every 3 months and annual clinical, instrumental and laboratory examination. The new-onset AF was identified by the 24-hour Holter ECG monitoring results and by patient symptom diaries.Results. New-onset AF was registered in 2 patients (6%) in the lisinopril group and in 4 patients (13%) from the control group (p=0.001) over the 5-year follow-up. Lisinopril significantly reduced AF incidence in hypertensive patients. The patients on lisinopril were found to have no significant changes in the left ventricular mass index and left atrial size according to echocardiography done after the 5-year follow-up whereas in the patients of control group both parameters increased significantly. Lisinopril contributed to the maintenance of endothelial vasodilator function and prevented increase in arterial wall stiffness.Conclusion. Long term lisinopril treatment was found to significantly reduce the AF incidence in hypertensive patients over the 5-year follow-up. Lisinopril demonstrated organoprotective properties throughout the cardiovascular disease continuum and can be recommended for primary prevention of arrhythmia in hypertensive patients.

An appreciable progress has recently been achieved in the study of the nature of atrial fibrillation (AF), from its early asymptomatic stages to irreversible arrhythmia. There are data on the risk factors of AF in the literature, but predictors of progressive arrhythmia remain to be elucidated. This study was aimed to identify predictors of AF progression in patients with congestive heart failure (CHF). Material and methods. The study involved 64 patients aged 59-82 (mean 69,4±3,9) followed up prospectively from September 2010 till June 2016 (observations of mean duration 60±3 mo included regular telephone interviews (each 3 mo) and annual general clinical examination with laboratory and instrumental studies. Continuous or persisting AF served as the criterion for progressive arrhythmia. Results. Cardiovascular complications and progressive arrhythmia were documented in 23 (36%) and 38 (59%) patients respectively during the 60±3 mo observation period. The multifactorial analysis revealed the significant influence of a decrease of left ventricular ejection function (EF) to below 40% and a rise in the plasma level of brain natriuretic peptide (Nt-proBNP) to more than 903 pg/ml on the risk of development of arrhythmia. Conclusion. Independent predictors of arrhythmia in patients with CHF and persistent AF are a decrease in left ventricular ejection function (EF) to below 40% (1,2, 95% CI 0,9-1,5) and a rise in the plasma Nt-proBNP level to more than 903 pg/ml (OR 1,3, 95% , CI+1,1-2,9). Such a rise predicts transition of arrhythmia into continuous form with sensitivity 92,1% and specificity 84,6%.

Objective To identify predictors of progression of atrial fibrillation (AF) in patients with hypertension, coronary heart disease (CHD) and chronic heart failure (CHF) with recurrent AF. Materials and methods The study included 312 patients with recurrent AF. The patients were divided into 3 groups according to the leading underlying condition: essential hypertension (n=136), CHD (n=112), and CHF (n=64). The average follow-up duration was 60±3 months. “Progression” of AF was defined as development of persistent or permanent AF. Results During the 5-year prospective follow-up in all the groups of patients with recurrent AF, progression of arrhythmia from paroxysmal or persistent to permanent form was noted. The rate of AF progression in patients with CHF was significantly higher, and its percentage was 59%. The progression percentage after 5 years was 46% (p=0.002) in patients with hypertension and 51% (p=0.008) in patients with CHD. AF progression in patients with hypertension correlated significantly with left ventricular hypertrophy (OR 1.25; 95% CI, 1.03 to 1.52) and increased vascular wall stiffness (OR 2.3; 95% CI, 1.95 to 2.65). Independent predictors of arrhythmia worsening in patients with CHD were history of myocardial infarction (OR 1.23; 95% CI, 0.9 to 1.5), irreversible left ventricular (LV) hypokinesis (OR 1.41; 95% CI, 1.1 to 1.7), and increased plasma N-terminal pro–A-type natriuretic peptide (NT-proANP) (OR 1.16; 95% CI, 0.8 to 1.4). Reduced LV ejection fraction (EF) (OR 0.84; 95% CI, 0.7 to 0.89) and increased plasma N-terminal pro–B-type natriuretic peptide (NT-proBNP) (NT-proBNP) (OR 2.3; 95% CI, 1.93 to 2.67) were independent predictors of AF progression from persistent to permanent form in patients with heart failure with reduced ejection fraction. Conclusions Progression of AF is related to the underlying cardiovascular disease. Early vascular aging syndrome and LV hypertrophy are the main factors of AF progression in patients with hypertension. Previous myocardial infarction with irreversible hypokinesis is associated with AF progression in patients with CHD. Reduced LVEF and increased plasma BNP predict AF progression in patients with CHF.

Aim . To study the effect of atorvastatin on the progression of the arrhythmia in hypertensive patients with paroxysmal atrial fibrillation (AF) in the longterm follow-up. Material and methods. Patients with paroxysmal AF (n=65) were included into the study. The patients were divided into two groups depending on the level of lipid metabolism: group I (n=33) received atorvastatin (10-40 mg/day), and control group II (n=32) did not take statins. The duration of follow-up was 4 years. The evolution of the AF clinical course was evaluated by the number of arrhythmia episodes for 3 months. Increase in the frequency of paroxysms of AF over the past 3 months, the appearance of the long-standing persistent AF or permanent AF considered as the arrhythmia progression. Results . The increase in rate and duration of AF episodes was found in 14 (42%) patients of group I and in 13 (41%) patients of group II. Progression of AF was observed with equal frequency in groups I and II. The average value of arrhythmia progression was 10.5% per year in patients of group I and 10.3% in group II. Significant differences between groups in the progression of AF were not found (p=0.2). Conclusion. Atorvastatin in hypertensive patients with paroxysmal AF did not lead to a change in rate and duration of arrhythmia paroxysms. The average value of paroxysmal AF progression was comparable regardless of atorvastatin use.

The modern medical literature practically does not contain clinical publications reporting studies of factors responsible for progression of atrial fibrillation (AF) in patients with coronary heart disease (CHD). It accounts for the importance of investigations into evolution of the clinical course of AF in such patients.Aim. To elucidate evolution of the clinical course of AF in patients with CHD in a long-term prospective study.Materials and methods. The study included. 112 patient aged 57-74 (mean 67.44±3.3) years with CHD and paroxysmal form of AF carried outfrom 2011 to 2015. Evolution of the clinical course of AF was evaluated based on the number of arrhythmic attacks during the last 3 months. The appearance ofprolonged persistent AF episodes or permanent AF was regarded as progression of arrhythmia.Results. During the 4 year study, 64 (57,2%) patients (group 1) did not experiencea rise in the frequency and duration of AF attacks. Progression of arrhythmia was documented in 48 (42,8%) of the 112 (100%) patients (group 2). These patients more frequently had the history of myocardial infarction and chronic heart failure than patients of group 1. The latter had the mean values of left ventricular (LV) ejection fraction 61,23±6,24%, i.e. significantly higher than 48,47±8,4% in group 2.47 and 28 % of the patients in group 2and 1 respectively suffered mitral regurgitation (p

Arterial hypertension (AH) occupies the first place among causes of atrial fibrillation (AF) in general population. AF in patients with AH substantially elevates risk of cardiovascular complications. Endothelial dysfunction (ED) in patients with AH at appearance of AF might have great prognostic value for stratification of risk of thromboembolic complications. We studied biochemical markers of ED in patients with AH and various forms of AF. Collagen binding activity of the von Willebrand factor (vWF) in patients with permanent AF was significantly higher than in patients without heart rhythm disturbances and did not depend on degree of AH. We revealed dependence of moderate strength between frequency of AF paroxysms during a year and collagen binding activity of vWF in patients with persistent AF. Blood plasma concentration of endothelin increased with increase of degree of AH both in patients with AF and in those without heart rhythm disturbances and did not depend on form of arrhythmia.

Recently progress has been made in the study of the natural history of atrial fibrillation (AF) from the stage without clinical manifestations, to the final stage, represent an irreversible arrhythmia associated with the development of serious cardiovascular complications. The progression of the arrhythmia worsens the clinical status of patients and prognosis. Slowing down progression of AF should be considered as a priority treatment of this cardiac arrhythmia.Aim. The study the predictors of AF progression in patients with arterial hypertension.Materials and methods. The study included 136 patients with essential hypertension and paroxysms of AF. Prospective observation of the patients was carried out from 2011 to 2015. The progression of the arrhythmia was considered: increased frequency of paroxysms of AF; the emergence of long-term persistent attacks or permanent form of arrhythmia.The results of our work allow to conclude that the predictors of progression of AF in patients with hypertension and preserved systolic left ventricular function are: endothelial dysfunction, increased vascular wall stiffness, left ventricle hypertrophy and increased size of the left atrium.

Supraventricular tachycardia (SVT) is one of the most common arrhythmias. The prevalence of SVT varies widely in different countries and is 2,25 per 1,000 people in the general population. SVT reduce the quality of life of patients, and in some cases can worsen the prognosis. In patients with cardiovascular disease, the risk of SVT increases. Therapy of SVT is selected depending on the stability of hemodynamic and the QRS width. Until now, the treatment of SVT remains an urgent issue of modern cardiology, since despite the high effectiveness of catheter ablation, antiarrhythmic therapy plays an important role.

Concept of deterioration of myocardial contractile function under long-term intake of antiarrhythmic drugs may be regarded as one of the myths of modern cardiology. Multiple references to negative influence of majority of antiarrhythmic drugs on myocardial inotropic function are speculative. Studies on estimation of influence of arrhythmia treatment strategy on myocardial contractile function are almost absent.Aim. To estimate dynamics of myocardial contractile function in patients with ischemic heart disease (IHD) and persistent atrial fibrillation (AF) compared among those treated with amiodarone 200 mg daily and with bisoprolol 5 mg daily.Material and methods. A total of 47 IHD patients with persistent AF were enrolled into the study. Sinus rhythm (SR) was restored during the first 24 hours of hospitalization in all the pa- tients. After SR restoration the patients were randomly allocated to two groups receiving either amiodarone 200 mg daily during 6 months for SR maintenance (group 1) or bisoprolol 5 mg daily for ventricular rate (VR) control (group 2). To estimate myocardial inotropic function all patients underwent steady-state radionuclide ventriculography (RVG) and echocardiography during the first 24 hours after SR restoration and 6 months later.Results. We revealed changes in left ventricle (LV) diastolic function, reduction of left atrium (LA) contribution to LV diastole and enlargement of LA anterior-posterior dimension during the first 24 hours after SR restoration in the patients of both groups.6-month SR maintenance in the first group of patients promoted significant decrease in isovolumic relaxation time (IVRT) from 103.4±1.01 ms to 96.4±1.1ms (р=0.02) and reduction of LA anterior-posterior dimension up to 36.1±3.8 mm (р=0.03). Target VR achievement in the second group of patients promoted restoration of LV diastolic function (decrease in IVRT from104.3±1.2 ms to 97.3±1.2 ms; р=0.03) but did not influence LA size (44.1±3.1 mm and 43.5±3.0 mm, respectively). Atrial inotropic function was only changed in the patients of group 1, the patients of group 2 did not reveal significant change in LA contribution to LV diastole.Conclusion. 6-month SR maintenance at amiodarone intake in IHD patients with persistent AF resulted in LA contraction, restoration of its contractility and improvement of LV diastolic parameters. Target VR for 6 months of bisoprolol intake led to LV diastolic function improvement, but did not influence LA dimension and contractile function.

Aim. To study the changes of plasma levels of NT-proBNP and NT-proANP in patients with persistent atrial fibrillation (AF) treated with various antiarrhythmic drugs.Material and methods. Patients with persistent AF (n=123) aged 39-83 years old were included into the study. The patients were divided into 2 groups: group 1 included patients with arterial hypertension (n=61), group 2 - patients with ischemic heart disease (IHD; n=62). After sinus rhythm restoration the patients were divided into 4 subgroups. Patients of 1A subgroup used propafenone to maintain sinus rhythm during the next 6 months, while patients of 2A subgroup used amiodarone. Patients of 1B and 2B subgroups used bisoprolol to control ventricular rate. Plasma natriuretic peptide levels were evaluated in all patients during the first 3 days after the sinus rhythm restoration and 6 months after.Results. Increased levels of NT-proBNP and NT-proANP in the first days after the sinus rhythm restoration were found in patients of both groups and were associated with the episode of AF. After 6 months of treatment the reduction of NT-proBNP and NT-proANP levels was found in patients of 1A subgroup (NT-proBNP: from 160.5±15.2 pg/ml to 130.1±12.2 pg/ml; NT-proANP: from 15.3±6.4 nmol/L to 11.5±5.3 nmol/L, pConclusion. Increased plasma levels of NT-proBNP and NT-proANP were found in the first days after the restoration of sinus rhythm in patients with persistent AF, and after 6 months of sinus rhythm maintenance these levels reduced significantly.

The paper highlights the use of telmisartan, one of the currently available angiotensin receptor blockers, for the treatment of patients with hypertension, metabolic syndrome, and those at high cardiovascular risk. Telmisartan treatment allows blood pressure control, provides organ protection at different stages of the cardiovascular continuum, and reduces the risk of cardiovascular diseases and death. The additional properties and pleiotropic activity of the drug determines its wide range of applications in cardiology.В обзоре освещены вопросы применения одного из современных блокаторов рецепторов ангиотензина телмисартана для лечения пациентов с артериальной гипертонией, метаболическим синдромом и с высоким риском развития сердечно-сосудистых осложнений. Лечение телмисартаном позволяет эффективно контролировать артериальное давление, обеспечивает органопротекцию на различных этапах сердечно-сосудистого континуума, снижает риск развития сердечно-сосудистых заболеваний и смерти от них. Наличие дополнительных свойств и плейотропной активности препарата определяет широкий спектр его применения в кардиологии.

Objective:To evaluate the progression of arrhythmia in patients with hypertension and paroxysmal AF treated with propafenone or bisoprolol in the long-term prospective study.Design and method:The study involved 62 patients with paroxysmal AF and essential hypertension aged from 45 to 63 years and fo

Блокаторы рецепторов ангиотензина (БРА) являются одним из основных классов лекарственных препаратов, применяемых в кардиологии. БРА II поколения – это бифункциональные лекарственные препараты, которые не только блокируют рецепторы ангиотензина 1-го типа, но и оказывают влияние на патогенетические механизмы нарушения обмена углеводов и липидов. Родоначальник II поколения БРА – телмисартан, первый и пока единственный из сартанов II поколения, разрешенный в настоящее время для лечения больных с сердечно-сосудистыми заболеваниями. Лечение телмисартаном пациентов с артериальной гипертензией позволяет эффективно контролировать артериальное давление с достижением его целевого уровня, обеспечивает органопротекцию на разных этапах сердечно-сосудистого континуума, снижает риск развития сердечно-сосудистых заболеваний и смерти от них. Наличие дополнительных свойств и плейотропной активности препарата определяет широкий спектр его применения в кардиологии.

Data on angiotensin II receptor blockers, one of the main drug classes used in cardiology , are presented. The advantages of this drugs class are highlighted with the focus on telmisartan. Additionally clinical example of successful telmisartan application in patients with hypertension, high risk of cardiovascular complications, and obesity is presented.

Influence of the combined antihypertensive therapy, including combination of ACE inhibitors and dihydropyridine calcium channel blocker (DCCB), on frequency of cardiovascular events is studied in many trails. Advantages of the combination of ACE inhibitor and DCCB which is one of the most rational are discussed. Both components are vasodilators and have synergistic mode of action in arterial hypertension. Combination of ACE inhibitor and DCCB allows neutralizing of antiregulatory mechanisms reducing drug efficacy. Results of clinical trails which promoted of the fixed combination of lisinopril (10 mg) and amlodipine (5 mg) are presented. Safety and organoprotective properties of this combination are also shown according to the trail results.

Aim. To study effects of sympathomimetic agents on electrocardiogram (ECG) indexes in patients with bronchial asthma (BA) in exacerbation stage complicated by respiratory insufficiency and sympathomimetic agents overdose.Material and methods. 40 patients with persistent BA of various severities with respiratory insufficiency and sympathomimetic agents overdose were investigated. ECG was performed and P wave, QRS, duration and dispersion of corrected QT interval (QTc) were analyzed.Results. Mean QTc dispersion correlated with asthma severity and was 76,8±5,9 ms1/2, 87,9±5,1 ms1/2, 87,8±3,1 ms1/2 in patients with mild, moderate and severe BA, respectively. Significant correlation between QTc dispersion and BA duration was found. QTc dispersion level was directly connected with duration of use of β-agonists and their overdose. Average QTc dispersion in patients who used more than 20 daily doses of inhaled β-agonists was 89,0±5,8 ms1/2.Conclusion. Increase in QTc dispersion directly depends on BA duration and severity. β-agonist overdose results in growth of QTc dispersion, which has arrhythmogenic potential.

Interest for the problem of inheritance of premature ventricular excitation syndrome (PVES) has grown significantly in the recent years due to an increase in the prevalence of paroxysmal supraventricular tachycardia and atrial fibrillation in the general population. Appearance of such cardiac arrhythmias in young people makes it necessary to include PVES in diagnostic search program. At the same time, the clinical picture of the disease may change with age and appearance of various cardiovascular pathology. A prospective study including 240 patients was undertaken to study the evolution of the clinical course of PVES. A 30-year observation showed that in 88% of PVES patients the number of forms and the degree of the severity of cardiac arrhythmias tended to grow. By the end of the study the prevalence of paroxysmal supraventricular tachycardia had decreased significantly, while the number of patients with atrial fibrillation had increased. Attacks of atrial fibrillation occurred in PVES at older age than paroxysmal tachycardia, and it was observed much more often in cases where PVES was combined with other heart diseases. Thus, the studies show that paroxysms of atrial fibrillation in PVES patients occur more often in the presence of different cardiovascular diseases, and that clinical manifestations of PVES are determined by the evolution of the associated diseases as well.

Comments on American College of Cardiology, American Heart Association and European Society of Cardiology Guidelines (2006) for the management of patients with atrial fibrillation.