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Unlabelled: Empirical choice of antihypertensive therapy (AGT) for patients with complicated hypertensive disease (HD) encounters difficulties due to high variability of arterial pressure (AP) and inadequate response to intake of medicines. The objective methods for the choice of AGT methods are absent., Aim: To evaluate effectiveness ofthe choice of AGT taking account of AP profile calculated based on the analysis of results of 3 day AP monitoring in patients with complicated HDfor whom the empirical prescription of medicines does not give the desirable result., Materials and Methods: The study included 51 patients aged 56 +/- 19 yr with HD 18 +/- 13 yr in duration without adequate control of AP despite combined AGT AD was measured (BPLab, Nizhni Novgorod) every 30 min for 3 days, the AP profile was calculated by special FORM-based algorithm. Peak time and magnitude were calculated, the first and second derivatives of the process were determined, AGT was prescribed at the computed AD maximum points., Results: Systolic and diastolic AP decreased within 2 weeks after AGT The number of patients with enhancedAP in the daytime and at night and those with highly variable AP decreased from 33 to 11% (chi2 = 8.4, p < 0.005), from 61 to 33% (chi2 = 10.1, p < 0.005), from 51 to 26% (chi2 = 8.2, p<0.005) respectively. The number ofpatients with inadequate lowering of night-time AP and those with abnormally high fluctuations of AP decreased from 53 to 24% (chi2 = 9.3, p < 0.005) and from 31 to 15%, (p < 0.005) respectively. The frequency of intake of AGT drugs did not change., Conclusion: Approximation of real AP circadian profile fluctuations based on results of 3 day monitoring is a sensitive diagnostic tool facilitating the choice of rational AGT for patients with markedly altered circadian rhythms when empirical prescription of AGT does not ensure desired control ofAP

Aim: To study the prevalence of anxiety and depression by psychometric methods (the Hospital Anxiety and Depression Scale (HADS) in different regions of the Russian Federation (RF), which are characterized by various climatic, geographic, economic, and demographic indicators., Subjects and Methods: The investigation used the data of the multicenter epidemiological survey of cardiovascular diseases in different regions of the Russian Federation--the ESSE-RF study. The subjects of the study were representative samples from unorganized male and female populations aged 25-64 years from 10 RF regions. The survey included a total 16,877 people (6244 men and 10,623 women). All the examinees were interviewed using a standard questionnaire. An analysis involved their gender, age, education level, place and region of residence, and income and morbidity level. The HADS validated in Russia was used to rate the level of anxiety/depression., Results: The total prevalence of higher anxiety and depression averaged 46.3 and 25.6%, respectively. Respondents with clinical anxiety/depression constituted more than one third of those who had a higher level of these conditions. In the examined population, the moderate level of anxiety/depression was 7.5 ± 0.06 and 5.1 ± 0.04, respectively. The population of Volgograd, Samara, Saint Petersburg, and Tomsk had the similar values of the moderate level of anxiety/depression (p > 0.05). The lowest level of anxiety/ depression (p < 0.0001) was seen in the dwellers of Tyumen (5.9 ± 0.1 and 3.4 ± 0.1, respectively) and the highest in the Republic of North Ossetia-Alania (NOA) (8.4 ± 0.1 and 6.8 ± 0.1, respectively). These regions showed the lowest and highest prevalence of higher anxiety (22% in Tyumen and 59.8% in the Republic of NOA (p < 0.0001)., Conclusion: All the 10 selected RF regions differing in demographic, economic, climatic, and geographical parameters are characterized by a high level of anxiety that remains statistically significant after adjusting for gender and age, so are parameters, such as income and morbidity levels are present in only 4 of the 10 regions.

The objective of this study was to characterize dental status and oral mucosa blood flow in patients with chronic heart failure and amyloid deposits in oral mucosa. Histological and immunohistochemical analysis of 80 oral mucosa biopsies taken from patients aged 32-72 years with chronic heart failure I-IV NYHA functional class was carried out. It detected a systemic amyloidosis in 15.7% of cases; a local amyloid deposition in oral mucosa was found in 58.5% of cases. Amyloid deposition in oral mucosa was associated with severe chronic generalized periodontitis in more than a half of cases. Amyloid deposits in oral mucosa were revealed more often in patients with metabolic syndrome (63.5%). The article describes dental status and oral mucosa blood flow in patients with heart failure.

Study aim - to elucidate possibilities of the use of precision administration of mononuclear bone marrow cells (MBMC) for the treatment of myocardial ischemia and heart failure. "Intramyocardial Multiple Precision Administration of Mononuclear Bone Marrow Cells in the Treatment of Myocardial Ischemia" was a double blind randomized placebo controlled study in which we included patients more or equal 6 months after Q-wave myocardial infarction with systolic myocardial dysfunction (ejection fraction <35%), not requiring myocardial revascularization, receiving stable optimal medical therapy for more or equal 8 weeks, and with implanted cardioverter-defibrillator. Transplantation of MBMC was guided by fluoroscopy and tridimensional NOGA XP Cardiac Navigation System. For assessment of efficacy of the method we used surrogate end points: decrease of number of fixed perfusion defects according to SPECT data and improvement of regional myocardial contractility according to data of echocardiography. Results of dynamic observation of the first experience of MBMC administration are presented in this paper.

The present study was aimed to investigate neuroprotective effects of early and late ischemic preconditioning in the acute phase of ischemic brain damage in rats. It was found that a single five-minute ischemic episode of early ischemic preconditioning did not lead to significant neuroprotective effects in comparison with control group, while three five-minute ischemic episode early ischemic preconditioning accompanied by a significant increase in neurological deficit and growing damage rate in CA1 hippocampus neurons. In contrast, later ischemic preconditioning in form of single five-minute episode 24 hours before ischemia modeling, provided a significant neuroprotective effect, manifesting reduced neurological deficit and maintaining viability of CA1 hippocampus neurons.

The paper comparatively analyzes myocardial morphology in children and adults with hypertrophic cardiomyopathy. All the cases analyzed had its obstructive form and significant asymmetric left ventricular hypertrophy--hypertrophy of the ventricular septum (VS). When stratifying the risk of sudden death from the obstructive form of the disease in adults, the most important characteristics are shown to be less than 45 years of age, stromal enlargement in the right VS closer to the endocardium of the right ventricle; and in some cases this fact must be considered when choosing a management tactic.

Cerebral ischemia results in severe derangements of energy metabolism in the nervous tissue including activation of glycolytic pathway. Activity of cytosolic lactate dehydrogenase (LDH) in the specific brain structures remains unclear. The recent study was aimed at investigation into the LDH activity in the cytoplasm of both hippocampal and cortical neurons in Mongolian gerbils (Meriones unguiculatus) at different durations of reperfusion after global ischemia. Analysis showed that the activity of LDH in pyramidal neurons of various hippocampal areas and neurons of II, III and V cortical layers after 7-minute forebrain ischemia depended on both localization of the neurons and duration ofreperfusion. In general, the changes in postischemic cytosolic LDH activity include significant decrease in the LDH activity 2 days after reperfusion with varying degree of recovery on day 7 of reperfusion.

This article deals with peculiarities of development and clinical course of heart failure (HF) in diabetic patients, influence of diabetic cardiopathy on HF formation., role of genetic predictors of diabetes mellitus (DM) and HF formation, also the importance of treatment response predictors, the significance of a more "personalized" exposure in order to optimize treatment. The role of stationary and dynamic genomics was analyzed, especially molecular visualization that allows the earliest possible intervention. The article also includes examples of molecular visualization use in diagnosis of myocardial dysfunction, disease monitoring, and treatment efficacy assessment. Authors give an analysis of targeted treatment methods on the example of targeted delivery of medications to the target-organ (myocard). Discuss means of anti-ischemic myocardial protection, perspectives of metformin use in order to enhance efficacy of myocardial ischemic pre- and postconditioning mechanisms. Presented perspectives of study of molecular and genetic mechanisms involved in the pathogenesis of HF in diabetic patients, in particular, study of key biological features of stem cells, cell interactions, stem cell plasticity (in vitro direction of differentiation) and their paracrine function evaluation. Given information about identification of genes with partly altered expression due to chronic exposure of mesenchymal stem cells to the high concentration of glucose, and upon decreased ability of mesenchymal stem cells of proangiogenic factors with simultaneous increase of inflammatory markers production (IL8). In whole this article reviews modern state of HF in diabetic patients development mechanisms study with the use of molecular and genetic technologies, and of perspectives of development of this area.

In the first part of this review molecular mechanisms of ischemic tolerance emerging as a result ofpreconditioning of the brain are discussed. Data on inductors, sensors, transducers and effectors of early and delayed ischemic tolerance are presented.

The aim of this study was to determine the effect of ischemic postconditioning on hippocampal CA1 neuronal survival and cytoplasmic activity of lactate dehydrogenase (LDH) in the gerbil model of cerebral ischemia-reperfusion injury. Ischemia was induced by bilateral common carotid artery occlusion (for 7 min) in male Mongolian gerbils (Meriones unguiculatus). Ischemic postconditioning protocol comprised 3 cycles of 15 s reperfusion/15 s ischemia. After 48 h of reperfusion, CA1 neuronal death was detected by Nissl staining and the cytoplasmic LDH was demonstrated histochemically in CA1 area of the hippocampus with a quantitative cytophotometric assessment of the enzyme activity. The results have shown that 7 min ischemia resulted in a significant decrease in the number of viable neurons (up to 24%) in the CA1 area of hippocampus; in addition, it reduced the activity of LDH in these neurons (from 0.260 +/- 0.009 to 0.190 +/- 0.006 relative units). The application of ischemic postconditioning significantly increased the number of viable neurons (up to 52.9%, P < 0.01) in the CA1 area of hippocampus, and it was accompanied by an increase in the activity of LDH (0.240 +/- 0.008 relative units, P < 0.001).

Cryoballon ablation (CBA) for pulmonary vein (PV) isolation is a new method for catheter-based treatment of patients with atrial fibrillation (AF). The purpose of our work is to describe the CBA technique and to report its short-term results. Methods. CBA was performed in 12 patients (8 men; age 53.1+/-5.7 years) with highly symptomatic drug-refractory AF. Paroxysmal AF was present in 11 and persistent AF - in 1 patient. CBA procedure was carried out under general anesthesia with intubation in 6 and under light sedation in 6 patients. After transseptal access and direct PV angiography, 28 mm-cryoballoon was introduced into the left atrium, and more or equal 2 cryoapplications were delivered to each PV, once good PV occlusion was obtained. PV isolation was verified utilizing a circular mapping catheter. Arrhythmia recurrences were monitored every 3 months after ablation using 24-hour Holter, and additional ECG registrations. Holter monitoring was also performed in a case of symptoms. Results. Complete electrical PV isolation was achieved by only cryoballoon ablation in 11 patients, and additional cryocatheter touch-up ablation was required in left PVs in 1 patient. Total procedure time was 203.1+/-34.2 min, fluoroscopy time - 50.5+/-14.0 min. There were no complications. During a mean follow-up period of 136.8+/-59.8 days 9 (75%) patients were free from arrhythmia recurrence after a single procedure. Redo ablation was required in 1 patient, in whom electrical reconnection to all PVs was documented. Conclusion. CBA is a novel promising technique for treatment of patients with AF, and now is available in Russian Federation. The method standardizes and facilitates interventional AF treatment with acute isolation of 96% PVs. The short-term follow-up shows freedom from atrial tachyarrhythmias in 75% of patients.

In the 2nd part the authors describe in details the main aspects of protective effect of preconditioning of the brain: inhibition of programmed cell death, weakening of phenomenon of excitotoxicity, activation of endogenous antioxidant systems, anti-inflammatory effects, modulation of glial cell function, changes in regional blood flow and vascular reactivity. In addition, data analysis on the impact of preconditioning on brain neurogenesis, the state of the blood-brain barrier, ion homeostasis and metabolism of neurons is presented. Review emphasizes the role of microRNAs in mechanisms of ischemic tolerance of brain. Profound understanding of molecular mechanisms of increased tolerance of brain to ischemic and reperfusion injury requires the implementation of this phenomenon in clinical practice.

A search of transthyretin (TTP) gene mutations was conducted in patients with cardiomyopathies from St. Petersburg. Mutations H90N, V30M, G47A, and deletion (del9) of nucleotides GACTTCTCC in position 6776 from the start codon of the TTP gene (in position 98782 according to reference sequence AC079096 (NCBI) was found. The H90N mutation in the third exon of TTP gene was detected in a son of a cardiomyopathy patient and in his mother, which lacked any clinical manifestations. Mutations V30M and G47A in exon 2 of TTP gene were found in heterozygous and homozygous state, respectively, in one of the probands. Deletion (del9) was revealed in a patient with cardiomyopathy and in his two daughters from different marriages, who had no clinical manifestations of the disease. All the mutations revealed in this study were previously identified in other populations.

We examined 41 patients with ischemic heart disease (n=26) and dilated cardiomyopathy (DCM) (n=15). Control group comprised 15 practically healthy subjects. We found no substantial differences in the presence of CD34+CD133- and CD34+CD133-VEGFR-2+ cells in peripheral blood of patients with chronic heart failure (CHF) but noted lowering of level of CD34-CD133+VEGFR-2+ cells mainly in DCM group. Most significant factors determining lowering of number of circulating endothelial precursor cells (EPC) were age, level of low density lipoprotein cholesterol, and intima media thickness of common carotid arteries. We found lowering of colony forming ability of EPC in patients with CHF first of all in the group of patients with DCM. Abnormality of qualitative and quantitative composition of EPC can be considered as one of risk factors of endothelial dysfunction, pathological remodeling of cardiovascular system and CHF progression.

Aim: To estimate a diagnostic algorithm for anxiodepressive disorders (ADD) in coronary patients in general therapeutic practice., Material and Methods: A total of 163 coronary patients were examined using Seattle, Moriski and Green, Hospital questionnaires for anxiety and depression. Patients with clinical and subclinical anxiety and/or depression by Hospital testing responded to Hamilton anxiety and depression questionnaire. An analysis of clinical, anamnestic and socioeconomic parameters was made to create a multifactor model for ADD detection in coronary patients basing on the method of multiple logistic regression., Results: A model of ADD dependence Z = -3.446 x [presence or absence of anxiety and/or depression in the past]-2.451 x [presence or absence of stress for a year] - 2.452 x [drinking alcohol or rejection of alcohol] + 0.071 x [the disease perception in percent from Seattle angina questionnaire]. In certain combination of responses (presence or absence of parameters) and digital result in 7 combinations the patients can be diagnosed to have ADD., Conclusion: The diagnostic algorithm proposed helps ADD detection in coronary patients in general therapeutic practice without participation of psychotherapists and medical psychologists.

At the present time heart transplantation is considered to be the operation of choice in treatment of patients with terminal stage of chronic heart failure. Results of the first 5 heart transplantations made in the Federal Center of the heart, blood and endocrinology named after V. A. Almazov are assessed. There were no perioperational lethality and complications at the hospital stage. An analysis of the long-term results has shown effectiveness of heart transplantations in treatment of severe heart pathology.

Unlabelled: The purpose of this investigation is to evaluate the influence of purified highly-concentrated omega-3 polyunsaturated fatty acids (90% omega-3 polyunsaturated fatty acids 1 g/day) on the severe ventricular arrythmias in patients with stable coronary heart disease (CHD) without concomitant left ventricular contractivity impairment., Materials and Methods: 43 patients with stable CHD (26 male and 17 female, aged 66.2 +/- 8.3) with ejection fraction above 45% with unstable paroxysms of ventricular tachycardia detected at Holter ECG monitoring that received 1 g/day omega-3 polyunsaturated fatty acids during 1 month. 23 patients continued treatment for one month extra, while 20 stopped receiving after one month. ECG monitoring was repeated monthly., Results: In one month after started receiving 90% omega-3 polyunsaturated fatty acids the mean heart rate reduced by 2.4%, the number of single extrasystoles reduced by 20.1% (p=0.01), the number of paired extrasystoles reduced by 47% (p=0.0018) and the number of paroxysms reduced by 49% (p=0.0029). In 41.9% patients no paroxysms have been registered after one month. When continuously receiving omega-3 polyunsaturated fatty acids during the second month, the treatment efficiency increases, while the receiving been stopped after one month, the effect is reduced but remains., Conclusion: 1 g/day omega-3 polyunsaturated fatty acids application in patients with stable CHD without myocardium contraction dysfunction suffering from ventricular arrhythmias (4B grade after B.Lown) with no direct indications for implantable cardioverter defibrillator therapy results in significant reduction of arrhythmia.

This study was designed to identify major risk factors of PCTS and elucidate the possibility of early laboratory diagnosis of this syndrome for the choice of optimal therapeutic strategy. Retrospective analysis covered medical records of 500 patients who had experienced open heart surgery. Prospective studies included 60 patients of whom 50 had clinical manifestations of PCTS. Risk of its development depended on the severity of the underlying disease and increased after mechanical revascularization of myocardium. Urgency surgical intervention and greater extent of coronary shunting increased the probability of PCTS. Results of the measurement of serum procalcitonin by a highly sensitive method and of relative content of different protein fractions in serum and pleural/pericardial fluid suggest high informative value of these methods as diagnostic tools for PCTS. Preventive treatment with non-steriodal anti-inflammatory agents decreased the incidence of PCTS by 53%.

We assessed effect of therapy with HMG--CoA reductase inhibitor rosuvastatin on the number of circulating hemopoietic stem CD34+, CD133+ cells in peripheral blood of patients with systolic left ventricular dysfunction of ischemic genesis. Number of circulating hemopoietic stem CD34+, CD133+ cells in patients with chronic heart failure did not differ from their number in control group, however we revealed tendency to increase of number of endothelial CD34+, CD133+, VEGFR-2+ progenitor cells. We confirmed presence of relationship between quantity of circulating stem and progenitor cells and traditional risk factors of cardiovascular events: age, excessive body mass, arterial hypertension, and intima media thickness of common carotid arteries. Besides lipid lowering effect therapy with rosuvastatin was associated with lowering of C-reactive protein level and increase of number of circulating CD34+, CD133+ cells.

The stacking interactions of the clonidine aromatic ring with the aromatic rings of Phe or Tyr of alpha2-adrenoreceptor and Tyr aromatic ring of the pore of the tetradotoxin-resistant channel have been investigated. Ab initio quantum chemical calculations for a model system of two parallel aromatic rings were performed by GAMESS software with 6-31G** basis set in the framework of the Moller-Plesset second-order perturbation theory with full geometry optimization without any symmetry. It was shown that the parallel shifted conformation of two aromatic rings is energetically most favorable. The 2,6-chlorination of one of the benzene rings leads to the amplification of the stacking interaction, an increase in the relative shift of the rings and possible growth of both the hypotensive and analgetic functions of clonidine due to the increase in the binding energy. The 4-fluoridization of the clonidine benzene ring can amplify its analgetic function but practically excludes its hypotensive action.

Congestive heart failure with preserved or moderately lowered left ventricular pump function in some patients is caused by mitral regurgitation. Its consequences are left atrial dilation, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, disturbances of rhythm with elevated risk of sudden death. As efficacy of drug treatment and electroimpulse therapy is small surgery is the method of choice and one of alternatives - autotransplantation of the heart. Here we present a successful experience of application of this technique in a patient with moderately lowered left ventricular function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation, and pronounced manifestations of congestive heart failure.

Mechanisms of hypertrophy development in hypertrophic obstructive cardiomyopathy (HOCM) have not been enough investigated. In our study, there have been examined patients with severe HOCM at different ages, including children, and patients with essential arterial hypertension (EAH). There was found, that HOCM in children compared to adults was characterized by considerable interventricular septum (IVS) hypertrophy and it was accompanied by the acceleration of cardiomyocyte polyploidy. The average ploidy level of cardiomyocytes in children with HOCM was higher than analogous indices in adults. The average ploidy level of nuclei, the part of PCNA-positive nuclei and polyploidic nuclei of cardiomyocytes in aduls with HOCM were authentically higher than in patients with EAH. Activation of the nuclear antigen in stromal cells was detected only in patients with HOCM. Our findings provide evidence of an important role of cardiomyocyte polyploidy and activation of the proliferating cell nuclear antigen in development of the myocardial hypertrophy in patients with HOCM.

Relationship between disorders of endothelial function, proinflammatory activity of leucocytes and effects of therapy with simvastatin or its combination with ezetimibe was studied in 72 patients with ischemic heart disease subjected to coronary artery bypass grafting (CABG). Vascular endothelial function was assessed by ultrasound detection of brachial artery response to its compression, oxidant activity of leucocytes - by chemiluminescent microscopy, severity of coronary artery atherosclerosis - by invasive coronary angiography. Twenty two healthy individuals comprised control group. Endothelial function, activity of leucocytes, and lipid levels were evaluated before and in 12 months after CABG. Patients with multivessel involvement revealed more complex disorders of endothelial function and higher levels of leucocytes activity compared to patients with single-vessel disease. CABG resulted in disappearance of anginal attacks and negative stress echo test during 1-year observation in 80.6% of patients. Patients with recurrent angina after CABG had more severe endothelial and leucocytes disorders. Combined lipid lowering therapy (simvastatin plus ezetimibe) compared to simvastatin alone demonstrated higher efficacy in terms of achievement of target lipid levels, improvement of endothelial function and leucocytes disorders.

The authors consider modem views on tachyinduced cardiomyopathy, which occurs as a result of an increase in atrial or ventricular contraction rate. Data of experimental and clinical studies are presented. The issues of pathogenesis, the clinical significance, the questions of diagnostics, and possibilities of treatment of tachyinduced cardiomyopathy are reflected.

With the aim to detect genetic factors of risk of development of early myocardial infarction (MI) we studied 29 allele variants of 19 genes in 206 men who had survived MI in the age before 45 years and in 195 men of similar age without cardiovascular diseases. All subjects were inhabitants of North-West region of Russia. The following factors were associated with history of myocardial infarction: genotype RR191 of paraoxonase-1 (PON1) gene (RR 2.8 [95% CI: 1.24 - 6.30]), P1A2 allele of glycoprotein (GP) IIIa subunit of platelet fibrinogen receptor GPIIb/IIIa (RR 1.8 [95% CI: 1.11 - 2.93]), and Met145 allele of GPIbalpha platelet von Willebrand factor receptor gene. Genotype CC ( - 108) PON1 was associated with lowered risk of MI development (RR 0.6 [95% CI: 0.40 - 0.91]). During 7 years of follow-up 30 men from MI group died of recurrent acute coronary syndromes. In the group of those who died we noted increased prevalence of P1A2 GPIIIa allele compared with those who survived (p < 0.03). The results allow to suggest that contribute to development of MI in young men factors associated with elevation of functional state of platelets and levels of oxidized lipids in blood plasma.

Aim: To assess concentration of metalloproteinase (MMP) -9 and its inhibitor in blood serum of patients with defects of left cardiac chambers, associated with pressure or volume overload., Results: Elevation of MMP-9/TIMP-1 ratio at the account of MMP-9 was characteristic for patients with volume overload while elevation of blood serum level of TIMP-1 was characteristic for patients with pressure overload. MMP-9/TIMP-1 coefficient was directly related to left ventricular myocardial mass index and negatively related to myocardial contractile capacity. In patients with aortic stenosis elevation of TIMP-1 content was associated with lowering of global left ventricular contractility. Concentration of MMP-9 in blood serum and MMP-9/TIMP-1 ratio depended on etiology of valvular heart disease. Values of the given parameters were maximal in patients with mesenchymal dysplasia and sclerodegenerative calcinosis of the aortic valve., Conclusion: Serum levels of MMP-9 and TIMP-1, as well as MMP-9/TIMP-1 ratio reflect type and severity of hypertrophy of the myocardium and can be looked upon as markers of myocardial remodeling.

36 intervertebrate disks (IVD) were studied in spinal osteochondrosis concurrent with herniation. Expression of herpes simplex types 1 and 2 (HSV-1 and HSV-2) antigens, which was absent in IVD of the control group (autopsy cases without disk hernia). The similarity of herniation in osteochondrosis and cardiac mesenchymal dysplasia, a frequent concomitance of these processes and the presence of HSV-1 and HSV-2 antigens in the IVD cells and cardiac valves may indicate the same nature of these diseases.

The study revealed an increase in the serum levels of TGF-beta1 and the N-terminal peptide procollagen type III in patients with essential arterial hypertension (EAH), as well as an association between this increase and the duration of the disease, mean day arterial pressure profile, and left ventricular hypertrophy. An increased leukocyte functional activity is associated with disturbances in left ventricular diastolic function and an increase in TGF-beta1 serum concentration in EAH. The authors conclude that leukocytes participate in the development of myocardial hypertrophy and cardial fibrosis through the secretion of pro-inflammatory cytokines and peptide growth factors within the process of their activation.

The phenomenon of ischemic preconditioning consists in increase in myocardial tolerance to ischemia after short periods of ischemia and reperfusion of the myocardium (local preconditioning) or a distant organ (distant preconditioning). This study is dedicated to the role of oxygen free radicals (OFR) in the mechanisms of preconditioning; pharmacological inhibition of OFR with N-2-mercaptopropionylglycin, a synthetic anti-oxidant, was used. Mouse experiments demonstrated a reduction in the infarction-limiting effect of local preconditioning as a result of OFR inhibiting. This confirms the hypothesis according to which OFR play an important role in the mechanisms of launching and mediating the protective effect of local preconditioning. On the contrary, application of the same dose of N2-mercaptopropionylglycin does not lead to a significant weakening of the infarction-limiting effect of distant preconditioning caused by 20 min of ischemia and 15 min of reperfusion of the small intestine. Thus, it is unlikely that OFR participate in the realization of the effect of distant preconditioning caused by small intestinal ischemia. The authors discuss hypothetic molecular mechanisms of distant myocardial preconditioning.

Histologic and immunohistochemical studies (use of antibodies for viruses of herpes simplex type 1 and 2, desmin, vimentin, SMA as well as polymerase chain reaction to DNA of viruses of herpes simplex) were made on the material of the valves taken from 1326 patients with valvular heart disease, the ascending aorta of 30 patients with aneurysm, valves of 35 deceased patients without cardiovascular pathology. As a result, expression of viruses of herpes simplex type 1 and/or 2 was found in all cases with mesenchymal dysplasia and cystic medianecrosis in endotheliocytes, fibroblasts, smooth muscle cells of valves and aorta. This indicates the role of these viruses in the pathogenesis of these diseases and their common etiology.

Silver staining was used to estimate structural and functional conditions of cardiomyocyte and stromal cell nucleoli in myocardium from 3 patients with idiopathic restrictive cardiomyopathy (RCM). We revealed a prominent increase in the amount of myocardial stromal component cells. The area of nuclei, the area and amount of nucleoli in cells of myocardial stromal component much varied. In some cells of myocardial stromal component we found nuclei, whose area was comparable with that of cardiomyocyte nuclei. In all patients we revealed cardiomyocytes with extranucleolar distribution of argentophilic substance in the nuclei. These data suggest an important pathogenic role of structural rearrangments in the nuclei of cardiomyocytes and stromal component cells in providing specific cell phenotype of myocardium in patients with idiopathic RCM. Extranucleolar (atypical) distribution of argentophilic substance in the nucleus, referred to as "micronucleoli", point out certain disturbances of nucleolar functions in cardiomyocytes in patients with RCM.

Aim: To study myocardial remodeling (MR) in hypertensive patients with normal and excessive body mass, to analyse MR features depending on clinical and hemodynamic parameters., Material and Methods: Structural-functional conditions of the myocardium were studied with echocardiography, and determination of left ventricular remodeling (LVR) type was made in 734 untreated hypertensive patients aged 19-76 years., Results: Patients with essential hypertension (EH) stage I had mostly excentric left ventricular hypertrophy (LVH). The number of patients with concentric LVH increases with age, disease severity. This type of LVH occurs more frequently in males than in females. In females, LVH severity depends, primarily, on the degree of obesity. If EH combines with obesity, structural alterations of the myocardium are more prominent than in isolated pathology. In android obesity, LVH is more frequent., Conclusion: In EH, structural alterations of the heart and a LVR variant are determined, besides arterial pressure, by such factors as age and gender, duration of EH, obesity, its degree and kind.

Aim: To elucidate whether endothelium-dependent vasodilation (EDVD) is a method of early diagnosis of endothelial dysfunction or is a sign of established morphological changes in the vascular wall., Material and Methods: Endothelialfunction was studied in 44 males with essential hypertension (EH) (mean age 46.9 +/- 0.9 years), in 52 patients with coronary heart disease (CHD) (mean age 50.0 +/- 0.9 years) after mammary-coronary and aortocoronary bypass operation with use of radial artery (RA), and in 28 healthy males (mean age 44.2 +/- 1.2 years). Intraoperative RA biopsy results for patients with ischemic heart disease after coronary artery bypass grafting with RA as an arterial graft were analysed., Results: Patients with CHD showed thicker complex intima-media (TIM) of the common carotid arteries compared to control and hypertensive patients free of CHD clinical symptoms. This is associated with lowering of EDVD in RA and, therefore, suggests systemic occurrence of endothelial dysfunction. The histological study of RA has found hyperplasia of the internal vascular intima of 1.1 +/- 0.2 degree in 97% of CHD patients. Combination of CHD with hypertension showed thicker intima, higher index of intima thickness and RA narrowing percentage vs such parameters in CHD free of hypertension., Conclusion: Impaired EDVD in the test with reactive hyperemia is due to morphological changes in the radial artery, its intima. The degree of changes in endothelial vascular reactions in RA is closely related to severity of systemic atherosclerosis. In CHD, RA has a marked intimal hyperplasia which leads to vasospasticity and may result in development of stenosis in its use as a graft for myocardial revascularization. One of the basic factors influencing the degree of intimal hyperplasia of the radial artery is severity of arterial hypertension.

Aim: To examine effects of ischemic postconditioning on persistent ventricular fibrillation (VF) induced by reperfusion on the model of isolated rat heart., Material and Methods: Isolated by Langendorf hearts (n = 46) were ischemized for 30 min with following reperfusion. Hearts with persisting VF (n = 11) persisting to reperfusion minute 15 were randomized into two groups: control (n = 6)--reperfusion without interventions, study group on postconditioning (n = 5)--2 min global ischemia followed by reperfusion. Left ventricular pressure, heart rate, coronary blood flow were registered continuously., Results: VF converted to a regular rhythm in all the hearts exposed to postconditioning. Regular contractions were made by all the postconditioned hearts in the course of further reperfusion. None of the control hearts had normal rhythm in the end of the experiment. In the end of reperfusion pulse left ventricular pressure of the postconditioned hearts was lower than that in hearts without persistent VF., Conclusion: Ischemic postconditioining exerts an arrhythmic effect in relation to persistent reperfusion ventricular tachyarrhythmias. Postconditioning may serve a new strategy for myocardial protection.

Phenomenon of ischemic post-conditioning of the myocardium (attenuation of myocardial damage during reperfusion resulting from interruption of early reperfusion period by repetitive short episodes of ischemia) was discovered in 2003. This paper contains presentation of protective effects of ischemic post-conditioning during ischemia-reperfusion of the myocardium, data on antiarrhythmic effects of post-conditioning in relation to persistent tachyarrhythmias during reperfusion, analysis of possible mechanisms of infarct-limiting effect of post-conditioning, and perspectives of its clinical application.

Aim: To compare efficacy of long-acting nifedipin (cordipin-XL) and beta-blocker atenolol (tenormin) in hypertensive patients; to assess efficacy of antihypertensive treatment on functional activity of blood and endothelial cells, remodeling of the myocardium and vessels., Material and Methods: A total of 35 patients with essential hypertension stage II entered the trial. Eighteen of them received cordipin-XL, 17--tenormin., Results: Contrary to tenormin, cordipin-XL significantly improved blood rheology, reduced functional activity of leukocytes, concentration of Willebrand factor and intercellular adhesive molecules in blood plasm. Positive hemodynamic and non-hemodynamic effects of cordipin-XL were accompanied with reversion of left ventricular hypertrophy., Conclusion: Non-hemodynamic effects of cordipin-XL associated with improvement of endothelial function and blood rheological properties seem to have an independent role in prophylaxis of cardiovascular complications.

The presence and concentration of the inducible form of heat shock proteins (Hsp70) were determined in blood serum of patients with hypertension (HT), stage II, including 28 males with stage II HT, who did not receive any antihypertensive therapy, and 10 healthy subjects. A higher Hsp70 content was found in blood serum of in patients with stage II HT. Such Hsp70 concentration was related with ECG signs of left ventricular hypertrophy and with the rennin content in blood. The findings of endothelium-dependent vasodilation (EDVD) of the radial artery did not differ within the examined groups. Still EDVD was reliable lower in patients with atherosclerotic plagues in the common carotid arteries. A reduced EDVD in the radial artery was attributed to a higher EDVD content in blood serum, which did not depend on a prescription or on an arterial hypertension severity. The results are indicative of that a higher inducible Hsp70 concentration in blood serum could potentially be a marker of lesions to target organs in HT; equally it could be of a certain significance in the atherosclerotic pathogenesis.

Patients with hypertension are characterized by elevated platelet and erythrocytes aggregation and presence of relationship between rigidity of red blood cells and myocardial mass index. They also have increased number of leukocytes in peripheral blood, enhanced adhesive ability of neutrophils, increased representation of integrin receptors on lymphocytes and monocytes, and expression of Fas-receptors. These features evidence for augmented functional activity of leukocytes in hypertensive disease. Changes of rheological parameters of blood occur before impairment of vasomotor endothelial function. Augmentation of viscous properties of blood and functional activity of leukocytes aggravates hemodynamic disturbances in hypertension and can facilitate myocardial and vascular remodeling.

Morphological study of intraoperative biopsies of radial and internal mammary arteries taken from patients with ischemic heart disease during coronary bypass surgery revealed structural alterations of intima and media mostly in radial artery. These alterations depended on severity of arterial hypertension, presence of diabetes and extent of atherosclerosis. Hyperplasia of intima could be a basis for radial artery spasm and cause of graft stenoses and occlusions. Therefore protocols of pre and post operative care should take into consideration individual risk factors and morphological and functional features of an artery used for grafting.