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Aim. To study the relationship and predictive value of integral metabolic indices of obesity in the identification of ectopic obesity.Material and methods. The study included 326 patients (146 men and 180 women, mean age 61±9 years). Anthropometric data, degree of obesity, body mass index (BMI), waist circumference (WC), sagittal abdominal diameter (SAD), body obesity index (BAI), visceral obesity index (VAI), lipid accumulation index (LAP), triglycerides-glucose index (TyG) was assessed. Perivascular adipose tissue (PVAT) volume, pericardial adipose tissue (PAT) volume and thickness of perirenal fat tissue (PRF) were assessed with CT.Results. Patients were divided into groups: with isolated ectopic obesity (iEO) (n=17); with isolated abdominal obesity (iAO) (n=74); with EO variants: pericardial (PCO) (n=31), perivascular (PVO) (n=22) or perirenal (PRO) (n=33) with AO; with mixed ectopic obesity and AO (mEO+AO) (n=117), and patients without obesity (n=32). Significantly higher BMI, WC, SAD, and BAI indices were found in individuals with PCO+AO, PRO+AO and mEO+AO. The highest values of LAP were found in groups: PCO+AO, PVO+AO, PRO+AO. There was a correlation between ectopic fat depots and WC (r=0,62 for PAT, r=0,55 for PVAT and r=0,39 for PRF, p=0,01) and SAD (0,429, 0,329 and 0,435, respectively, p=0,01). Correlation was established between PAT, PRF and LAP (0,425 and 0,319, respectively, p=0,01). The highest AUC values>0,8 had models of WC and SAD in identification of PCO (0,801 and 0,801, respectively) and PRO (0,826 and 0,826, respectively). For PCO, the cut-off point of WC was 100,5 cm (specificity 72,9%, sensitivity 70,2%, p=0,000), SAD — 25 cm (specificity 73%, sensitivity 70,2%, p=0,000). For PRO, the cut-off of WC was 101 cm (specificity 71,4%, sensitivity 72,7%, p=0,000), SAD — 25 cm (specificity 71,4%, sensitivity 72,7%, p=0,000).Conclusion. Еctopic fat depots are related to the risk of metabolic disorders. Potential informative value of simple and accessible integral metabolic indices was established. WC>100,5 cm, SAD>25 cm may indicate to the presence of PCO; WC>101 cm, SAD>25 cm — to the presence of PRO.

Aim. To study the frequency and clinical characteristics of ectopic obesity in patients with different body weights and hypertension (HTN).Material and methods. The study included 326 patients (145 men and 181 women, mean age 63±8 years). Patients underwent chest and retroperitoneal space computed tomography with calculation of the volumes of perivascular adipose tissue (AT) (PVAT), pericardial AT (PAT) and perirenal fat thickness (PFT) using specialized software QCT Pro Tissue Composition Module (Mindways Software, USA). PAT volume ≥3,2 cm3, PVAT volume ≥0,4 cm3, PFT ≥1,91 cm were considered criteria for pericardial (PCO), perivascular (PVO) and perirenal (PRO) obesity.Results. When studying the prevalence of ectopic (EO) and abdominal (AO) obesity phenotypes, patients were divided into groups: 1) with isolated EO without AO (n=17), 2) with PCO and AO (n=31), 3) with PVO and AO (n=22), 4) with PRO and AO (n=33), 5) with mixed EO (PKO+PVO, or PKO+PRO, or PVO+PRO, or PKO+PVO+PRO) and AO, 6) with isolated AO without EO (n=74), 7) without obesity (n=32). Isolated EO was significantly more common in individuals with normal and overweight compared to patients with obesity: 8,9 and 12 vs 1,1% (p=0,001), respectively. The prevalence of the mixed EO+AO phenotype in obese patients was significantly higher than in patients with normal and overweight as follows: 41,7 vs 19,6 and 21,7% (p=0,001), respectively. In patients with HTN, PVO+AO was significantly more common compared to patients without HTN as follows: 12,8 vs 3% (p=0,001), respectively.Conclusion. The study results indicate the heterogeneity of the distribution of obesity phenotypes in people with different body mass index, which emphasizes the importance of taking into account all its variants, including EO, for timely and adequate cardiovascular risk assessment.

Aim. To study a rate of excessive pararenal fat tissue (PRFT) thickness and its relationship with anthropometric obesity indices.Material and methods. 372 patients (152 men and 220 women) were included in the study, the average age was 63.5±13.3 years. There were measured: height, weight, waist circumference (WC), hip circumference (HC), body mass index (BMI), WC/height ratio, sagittal abdominal diameter (SAD), body fat percentage (BFP), body surface area (BSA), body adiposity index (BAI) and visceral obesity index (VAI). All subjects underwent abdominal multispiral computed tomography. PRFT thickness was detected on a single slice at the level of the left renal vein.Results. 27% of the examined group had BMI

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.

Aim. To study the relationship between the volume of perivascular adipose tissue (PVAT) and the vascular wall lesion.Material and methods. The study included 318 patients without cardiovascular disease (mean age, 63,5±13,7 years). Hypertension was detected in 268 (84,3%) patients. All patients underwent assessment of anthropometric characteristics, lipid profile, arterial wall stiffness with the estimation of cardio-ankle vascular index, intima-media thickness, brachial artery endothelial vasomotor function. Chest computed tomography was performed with the estimation of the volumes of PVAT and pericardial adipose tissue (PAT).Results. The volume of PVAT, on average, was 0,3 [0,2; 0,4] cm3 . The VAT volume was significantly higher in obese individuals when compared with patients with normal body weight: 0,4 [0,3; 0,5] vs 0,25 [0,2; 0,4] cm3 (p=0,0007). The VAT volume was higher in individuals with an increased CAVI level when compared with patients with normal CAVI values: 0,4 [0,3; 0,5] vs 0,3 [0,25; 0,3] (p=0,02). A significant correlation was found between the VAT volume and body mass index (r=0,27, p

Objectives. (1) To evaluate the efficiency of work of the Department of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI); (2) to study of its work processes; and (3) to elaborate recommendations for their optimization.Material and methods. Using the principles of lean manufacturing and the original methodology of the Philips Co., the investigators made a comprehensive assessment of the work of the Tomography Department, Center for Radiation Diagnosis, Treatment and Rehabilitation, Ministry of Health of the Russian Federation, in December 2016 to February 2017, including: (1) a study of management reports; (2) oral interviews of employees; (3) a survey of employees, by using a specially designed questionnaire; (4) direct observation and subsequent description of work processes; and (5) assessment of patient satisfaction, by calculating the net promoter score. Based on the findings, the investigators calculated the throughput potential of CT and MRI, described the factors influencing the possibility of realizing this potential, developed recommendations to enhance the efficiency of work processes, and ranked the latter by the magnitude of the expected effect, by the complexity of implementation, and by material costs, followed by prioritization.Results. Assessment of the throughput potential has shown that CT and MRI examinations can be performed by 50.6% and 23.2% more, respectively. This can be achieved by additionally attracting patients, reducing equipment downtime, optimizing work processes, most of all at the stage of patient recording and registration, as well as at the stage of image interpretation and creation of a conclusion. The developed recommendations for optimizing work processes included measures of varying effectiveness and complexity, which could rank them according to three priority levels and identify long-term strategic initiatives.Conclusion. The comprehensive study of the efficiency of work of the Departments of CT and MRI made it possible to quantify the potential for increasing the throughput of CT and MRI, to consider in detail the stages of a medical service delivery process, to reveal areas for improving the process, and to form a set of recommendations for their optimization.

The review presents the important problem of resistant hypertension. Its real prevalence is unknown. According to population studies and metaanalyzes of clinical studies, the prevalence of this most severe form of hypertension reaches 12-15% in the general population and 15-18% in clinical cohorts. Over the past decades, an increase in its frequency among patients with hypertension has been noted. Based on the results of large-scale studies, risk factors are detected that allow to assess the risk for the resistance to antihypertensive drugs. Adherence to ongoing antihypertensive therapy is crucial to addressing the issue of hypertension resistance; there are acceptable ways to evaluate it in clinical practice. The review discusses the most common mistakes in the choice of therapy, which can cause resistance to antihypertensive treatment, namely irrational drug combinations, insufficient dosage of the drug, and the use of non-prolonged forms of drugs. The latest recommendations for the diagnosis and treatment of hypertension, including its resistant form, are analyzed. The review contains a rationale based on the results of randomized clinical trials, the choice antihypertensive strategy in this variant of arterial hypertension. The importance of fixed combination antihypertensive drugs, as well as thiazine-like diuretics and amlodipine is stressed. The results of studies demonstrate the rational for the use of antimineralcorticoid drugs, namely spironolactone, for this category of patients. The authors offer an updated algorithm for the diagnosis and treatment of resistant hypertension, based on the sections of the latest clinical recommendations on this problem.

Obesity is a progressing epidemic, the prevalence of which has doubled over the past 30 years. The distribution of adipose tissue is an important factor in predicting the risk of cardiovascular events. The most significant inflammatory activity is characteristic of epicardial adipose tissue (EAT), the role of which in the development of atrial fibrillation (AF) remains a subject of discussion.Aim. To study the effect of EAT size on the development of AF in hypertensive (HTN) patients.Material and methods. The study included 95 patients with HTN aged 38-72 years (mean age, 61,5±1,8 years), including 45 patients with paroxysmal AF (group I) and 50 patients in the comparison group (group II). In order to assess the severity of visceral obesity, all patients underwent a general examination and echocardiography. To determine the EAT volume, cardiac multislice computed tomography was performed.Results. Echocardiography revealed that the EAT thickness was significantly greater in hypertensive patients with paroxysmal AF than in the comparison group: 11,6±0,8 and 8,6±0,4 mm, respectively (p10 mm and volume >6 ml can serve as integral markers of the onset of paroxysmal AF.Conclusion. Integral markers of AF in hypertensive patients are an increase in the EAT thickness >10 mm (odds ratio, 4,1; 95% confidence interval, 1,1-5,6) and volume >6 ml (odds ratio 3,7; 95%, confidence interval 1,0-4,2).

In Russia, target blood pressure (BP) levels are achieved in only 14.4% of men and in 30.9% of women. The need for combination therapy of hypertension is as high as 70.7%. There are well-known benefits of combined antihypertensive therapy allowing for higher efficiency and better tolerability. One of the current combinations is a combination of an angiotensin-converting enzyme inhibitor and a calcium antagonist, which have pronounced protective activity and metabolic neutrality. Fixed-dose combinations have substantial advantages over free ones, contributing to improving patient compliance with the used treatment regimen. Dyslipidemia is present in 60.7% of the hypertensive patients. Nonetheless, only 9.7% of Russian patients with coronary heart disease take statins and control of lipid levels remains very poor. The review discusses whether the use of the triple combination lisinopril + amlodipine + rosuvastatin is reasonable from the standpoint of evidence-based medicine. There are literature data suggesting the high value of this fixed-dose combination in the context of organ protection and the reduced risk of cardiovascular events.