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Aim. To compare heart rate variability parameters in patients after a coronavirus disease 2019 (COVID-19) with acute ST elevation myocardial infarction (STEMI) during the inhospital and post-hospital periods.Material and methods. A total of 140 patients with STEMI were divided into 2 groups: I — patients with STEMI who had COVID-19 (n=52) in the period of 1,5-6 months before acute coronary syndrome, II — comparison group (n=88), which included patients with STEMI without prior COVID-19. All patients underwent infarct-related artery stenting within the first 24 hours from the onset. Heart rate variability (HRV) parameters were determined for all patients on days 2-3 and days 9-11 and 6 months after the hospitalization for STEMI.Results. Patients in group I showed more pronounced changes in HRV indicators on days 2-3 of STEMI: RMSSD (root square of successive RR intervals) by 21% (p=0,026), variations (Var) (the difference between the minimum and maximum RR intervals) by 33% (p=0,013), VLF (total very low-frequency HRV) by 7% (p=0,009) were higher, and HF (highfrequency HRV) by 40% (p=0,003), pNN50% (ratio of the number of consecutive RR interval pairs differing by >50 ms to the total number of RR intervals) by 66% (p=0,038) were lower than in the control group, respectively. On days 9-11 of the disease in patients with a history of STEMI and COVID-19, in contrast to the control group, there was a more pronounced increase in the SDNN (standard deviation of RR intervals) by 46% (p=0,005), VLF by 42% (p=0,031), whereas in the control group there were an increase of only 22% (p=0,004) and 11% (p=0,022), respectively. The HF value in the main group increased by 25% (p=0,007), while in the control group it decreased by 19% (p=0,030). Six months after STEMI in the main group, the RMSSD decreased by 19% (p=0,009), Var by 16% (p=0,041), VLF by 30% (p=0,025), LF (low-frequency component HRV) by 11% (p=0,005), while the control group these parameters decreased by 20% (p=0,006), 21% (p=0,001), 9% (p=0,011), and 7% (p=0,016), respectively.Conclusion. In patients with STEMI and prior COVID-19, the initial HRV values differ from similar HRV parameters in patients with STEMI without prior COVID-19. In the hospital and post-hospital periods, the changes of HRV in patients with and without COVID-19 are multidirectional as follows: pronounced sympathetic hyperactivity predominates, and slower recovery of HRV in patients after COVID-19 predominates.

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p

Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p

Aim. To compare the effect of atorvastatin and rosuvastatin as part of complex therapy in patients with hypertension (HTN) with a high cardiovascular risk on the level of matrix metalloproteinases -1, -9 (MMP-1, MMP-9) and tissue inhibitors of metalloproteinases -1, -4 (TIMP-1, TIMP-4).Material and methods. The study included 140 hypertensive patients who received atorvastatin (Liprimar) 20 mg/day in addition to antihypertensive therapy for a year, which was later replaced by rosuvastatin (Rosucard) in the following doses: 10 mg/day (n=96), 20 mg/day (n=24), 40 mg/day (n=26). Patients underwent standard clinical and paraclinical investigations. In the blood serum of patients, the levels of MMP-1, MMP-9 and TIMP-1, TIMP-4 were determined.Results. Patients who used rosuvastatin at a dose of 40 mg/day had a more pronounced decrease in MMP-1 than those treated with rosuvastatin at a dose of 10 and 20 mg/day (p0,05). The content of TIMP-1 and TIMP-4 increased when taking rosuvastatin, while a more pronounced dose-dependent increase in TIMP-1 was observed with rosuvastatin 20 mg/day and 40 mg/day. In addition, the largest increase in TIMP-4 was observed when using rosuvastatin at a dose of 40 mg/day. Atorvastatin had no significant effect on MMP-1 and MMP-9, as well as TIMP-1 and TIMP-4.Conclusion. Long-term rosuvastatin therapy (10 mg/day, 20 mg/day, 40 mg/day) as part of the complex therapy of cardiovascular patients affects the metabolism of vascular wall elastin and collagen, reducing the level of MMP-1, MMP-9 and increasing the content of TIMP-1, TIMP-4 in the blood.

Aim. To conduct a comparative analysis of the effect of long-term pharmacotherapy (12 months) using a β-blocker (nebivolol) and its combination with eplerenone in patients after ST-segment elevation acute coronary syndrome (STE-ACS) with heart failure with mildly reduced ejection fraction (EF) (HFmrEF) on the structural and functional cardiac parameters.Material and methods. We examined 130 patients with STE-ACS and HFmrEF after successful myocardial revascularization by percutaneous coronary intervention. The mean age of patients was 53,6 [46;57] years. Ten patients withdrew from the study due to personal reasons. Subsequently, patients were randomly divided into 2 treatment groups as follows: 60 patients received nebivolol; 60 patients received nebivolol and eplerenone. Patients were examined at two stages: 1st day of the disease before PCI and 12 months later. All patients underwent a clinical examination, echocardiography, followed by assessment of left ventricular (LV) EF, LV end-diastolic volume index (EDVI), LV endsystolic volume index (ESVI), LV myocardial index (LVMI), LV wall motion score index (WMSI), the ratio of peak early diastolic flow over peak late diastolic flow (E/A), the ratio of early diastolic transmitral flow velocity to the mitral annular velocity (E/e´).Results. Twelve-month pharmacotherapy with nebivolol in patients after STE-ACS showed an increase in LVEF by 7,2% (p0,05). Twelve-month combined pharmacotherapy with nebivolol and eplerenone showed an increase in LVEF by 16,0% (p0,05). The E/A ratio increased significantly by 22,2% (

Aim. To study comorbidity, drug therapy and outcomes in patients with atrial fibrillation (AF) included in the outpatient and hospital RECVASA registries.Material and methods. Patients with AF (n=3169; age 70.9±10.7 years; 43.1% of men) in whom comorbidity, drug therapy, short-term and longterm outcomes (follow-up period from 2 to 6 years) were included in hospital registers RECVASA AF (Moscow, Kursk, Tula), as well as outpatient registers RECVASA (Ryazan) and RECVASA AF-Yaroslavl.Results. Outpatient registries (n=934), as compared to hospital registries (n=2235), had a higher average age of patients (73.4±10.9 vs 69.9±10.5; p80 bpm, systolic blood pressure 80 bpm (RR=1.50). Anticoagulant prescription in women was associated with a lower risk of ACVA (if adjusted for age: RR=0.54; p=0.04), in contrast to men (RR=1.11; p=0.79).Conclusion. The majority of patients with AF registries in 5 regions of Russia had a combination of three or more cardiovascular diseases (73.9%), as well as chronic non-cardiac diseases (68.8%). The frequency of proper cardiovascular pharmacotherapy was insufficient (68.6%), especially at the outpatient stage (55.6%). Over the observation period (2-6 years), the average mortality per year was 10.3%, but at the same time it differed significantly in the regions (from 3.7% in Moscow to 9.7-12.5% in Yaroslavl, Ryazan and Kursk). Cardiovascular causes of deaths occurred in 62%. A higher risk of death (1.5-2.7 times) was associated with a history of stroke and MI, diabetes mellitus, COPD, heart rate>80 bpm, systolic blood pressure

The article substantiates the feasibility of combination antihypertensive therapy in patients with arterial hypertension without target organ damage and high cardiovascular risk. The authors consider a clinical case of the use of amlodipine and losartan in a fixed-dose combination (Lozap AM) as part of complex therapy in a patient with arterial hypertension, dyslipidemia and obesity. The clinical case showed the ability of the drug to both achieve a steady level of target blood pressure and improve its daily profile by transferring the Night-peaker type to the Non-dipper type.

Aim. To evaluate an incidence of oral anticoagulants (OAC) administration during longterm follow-up period in patients with atrial fibrillation (AF) enrolled in outpatient and hospital RECVASA registries.Material and methods. 3169 patients with AF were enrolled in outpatient registries RECVASA (Ryazan), RECVASA AF-Yaroslavl and hospital registries RECVASA AF (Moscow, Kursk, Tula), age 70.9±10.7 years, 43.1% men. The incidence of OAC administration was evaluated in hospital and outpatient settings, including longterm follow-up period (2-6 years).Results. OAC were administrated only in 42.2% of cases (1335 from 3169 patients; age 69.1±10.4 years, 43% men), including warfarin (817 patients; 26%) and non-vitamin K antagonist oral anticoagulants (NOAC) – 518 (16%). Patients with permanent and persistant types of AF had lower incidence of OAC administration (43% and 40%) than in cases of paroxysmal type (47.6%, p0.05) contrary to the pronounced difference of thromboembolic risk in these groups (6.14±1.34 and 3.77±1.39; р

Prevention of cardiovascular complications, which often result in fatal events in the peri-operative period, is one of the most crucial issues of modern anesthesiology.The objective: to investigate the changes in arrhythmic activity and conduction disorders during anesthesia and in the peri-operative period in the patients undergoing open cholecystectomy under general anesthesia.Subjects and methods. 57 patients of 60.1 ± 3.8 years old were enrolled in the study; they all underwent planned open cholecystectomy under combined anesthesia with tracheal intubation and artificial pulmonary ventilation. Group 1 consisted of 28 patients suffering from coronary heart disease (CHD) in the form of exertional angina of functional classes of I and II; and Group 2 included 29 patients without CHD. The frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was analyzed by daily Holter ECG monitoring for certain time periods during anesthesia and the peri-operative period. Stages of the study: I – on the eve of the surgery (18 h); II – within 6 hours before the surgery; III – immediate preparation and induction of anesthesia (62.0 ± 6.7 min); IV – maintenance of anesthesia (57 ± 14 min); V – recovery from anesthesia (48 ± 11 min); VI – the 2nd day after surgery (18 h).Results. A significant increase in the frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was found out at the stages of induction, maintenance and recovery from anesthesia in patients with CHD and in patients without concurrent cardiovascular disorders. Increased frequency of episodes of group and polymorphic premature ventricular contractions was observed in patients with CHD at the stages of induction and recovery from anesthesia (by 242 and 225%). The highest increase in the frequency of polymorphic premature ventricular contractions was observed in patients with CHD during recovery from anesthesia (by 284%) and in those without cardiovascular pathology at the induction stage (by 461%); the increase in episodes of supraventricular tachycardia was maximum at the induction stage in the patients without cardiovascular pathology (by 291%).Conclusion: Open cholecystectomy in general anesthesia is associated with increased arrhythmic activity and higher conduction disturbances incidence at all stages of anesthesia in patients with coronary heart disease and those without concurrent cardiovascular disorders.

The International Society of Hypertension and the World Hypertension League initiated a blood pressure screening study called May Measurement Month 2019 (MMM19) to improve the detection of elevated blood pressure (BP) and to assess BP control in patients with hypertension (HTN).Aim. To assess adherence to treatment of the hypertensive population according to MMM19 campaign in Russia.Material and methods. During May 2019, 5394 people from 21 regions of Russia took part in the screening. Participation was voluntary and did not imply gender restrictions; all subjects were over 18 years of age. During the screening, BP was measured three times using electronic and mechanical sphygmomanometers, as well as a questionnaire on the diabetes, history of cardiovascular events, smoking, and alcohol consumption was filled. Information was also collected on the date of last BP check and the administration of statins, acetylsalicylic acid and antihypertensive drugs. Data on height and body weight was obtained from respondents.Results. The analysis included data from 5274 participants aged 18 to 96 years (men — 1834 (34,8%)). Median age was 25 years, quartiles — 20 and 49 years. According to MMM19 data, the proportion of HTN patients in the Russian population was 31,9%, and with the exception of participants under 25 years old — 51,5%. Patients with HTN over 25 years old take antihypertensive therapy in 73,6%; 38,6% are characterized by irregular drug intake. Only 11,8% of men and 17,2% of women reach the target blood pressure

Experts consensus of the Russian Cardiology Society (RSC)

Prevention of fatal complications in patients with high cardiovascular risk means achieving target blood cholesterol and its fraction in low-density lipoprotein levels, which level depends on the cardiovascular risk (CVR) degree and is determined by the guidelines of the European Cardiology Society (2016) and the Russian National Atherosclerosis Society (2017). When choosing statins for lipid-lowering therapy, one should be guided by the hepatic metabolism nature, hypolipidemic activity, and the pleiotropic profiles of the drug.

Am. To study in the RECVASA registers the availability of data about the international normalized ratio (INR) indicator and achievement of its target values in outpatient and hospital practice in patients with atrial fibrillation (AF) receiving anticoagulant therapy with warfarin.Material and methods. Data about the INR control and the frequency of achievement of its target values at the outpatient and hospital stages were analyzed in RECVASA (Ryazan) and RECVASA FP – Yaroslavl outpatient registries, as well as in the hospital registers RECVASA FP (Moscow, Kursk, Tula) in 817 patients (46.9% of men, age 68.5±9.6 years) with AF and the prescribed anticoagulant therapy with warfarin.Results. INR was determined in 689 (84.3%) of 817 patients. The values of INR were monitored during therapy with warfarin in RECVASA (Ryazan) and RECVASA FP –Yaroslavl outpatient registries in 73.7% and 77.7% of patients, respectively, and in RECVASA FP hospital registers: 95.8% (Moscow); 81.3% (Tula) and 93.5% (Kursk). The target level of INR (2.0-3.0) was achieved in a minority of patients with AF during treatment with warfarin: inRyazan – in 26.3% of cases;Yaroslavl – 38.3%;Kursk – 34.8%;Moscow – 39.5%; Tule – 26.3%. Control of INR in hospital registries during warfarin therapy in patients with AF significantly more often (p

The aim of the study was to evaluate the effect of omega-3 polyunsaturated fatty acids on the main metabolic rates of the arachydonic acid cycle in patients with acute myocardial infarction in the context of traditional complex therapy. Materials and methods of research. We conducted an open, randomized study of two groups of patients (n=59) with acute myocardial infarction (MI), which did not undergo angioplastic and thrombolysis: in the main group (n=26) traditional complex therapy (including double antiaggregant therapy) from the first day supplemented with Omega-3 triglycerides [EPA/DGA — 1.2/1-90%] 1g. per day. In the control group (n=33) only complex therapy was performed. The main components of the arachydonic acid cycle — thromboxane B2 (TxB2) and prostaglandin I2 (PgI2), as well as their analogues, thromboxane B3 (TxB3) and prostaglandin I3 (PgI3), resulting from the replacement of arachidonic acid by omega-3 PUFAs, were evaluated for all patients on the 1st, 7th, 14th days after the onset of MI in the blood plasma. Results of the study. On day 14, an increase in the level of prostaglandin I3 in the Omega-3 triglycerides [EPA/DGA — 1.2/1-90%] group was observed in 10 times, the level of thromboxane B3 was increased in 15.9 times, in the absence of significant differences between the groups in the thromboxane B2 and prostaglandin I2 level. A decrease in the ratios of PgI2 / PgI3 and TxB2 / TxB3 in the main group also was noted. Conclusion. Given the lower functional activity of thromboxane B3 and the decrease in the ratio of TxB2 / TxB3, against the background of Omega-3 triglycerides [EPA/DGA — 1.2/1-90%] therapy, one can judge the presence of an independent antiaggregant effect of omega-3-polyunsaturated fatty acids as a result of their use in patients with MI.

Study objective. To assess the peculiarities of hospitalization of patients with AF in combination with CHD in the departments of the general therapeutic profile of a multidisciplinary hospital, the frequency of complications of various forms of AF, to analyze anticoagulant (AC) and antiplatelet (AP) therapy in prehospital (PreH), hospital and post-hospital (PostH) stages of treatment based on the register. Material and methods. 502 patients were included in the prospective hospital registry RECVASA AF-Kursk, 480 of which with the diagnosis of AF in combination with ischemic heart disease were hospitalized in the therapeutical departments of Kursk Emergency Hospital during the period from 01.06.2013 to 31.05.2014. 2-3 years after the referral hospitalization, information about the drugs taken was collected after telephone or face-to-face contact with survived patients (n = 293), as well as their relatives, treating doctors. Results. The study included 261 women and 219 men, with an average age of 70.4 ± 10.3 years. The greatest number of patients with AF was treated in the departments of cardiology and therapy. In all departments, patients with a permanent AF prevailed, with the exception of cardiology, where the proportion of patients with persistent AF was the greatest. The share of stroke and MI was 39.4% and 29.8%, respectively. The cases of emergent hospitalizations recorded 56.8%, 28.6% of them — because of the AF. Among patients with different forms of AF, there were no differences in the frequency of emergent hospitalizations (p>0.05). The polyclinic directed 38% of patients, 41% of AF (p = 0.007). In all cases, the main cause of the hospitalization was cardiovascular disease (CVD). In patients with AF and IHD, prognostically significant AC therapy at the outpatient stage was assigned in 5.3%. By the time of discharge from hospital, the frequency of application of AC increased to 26.5% (p = 0.0001); Among patients with a permanent AF, AC are used significantly more often — in 30% of cases, in comparison with other forms of AF. At the PH stage, there remains a low share of AC (20%). At the same time in 20% of the PreH stage, 74.2% at the time of discharge and 64.5% of the cases at the PostH stage, instead of AC, AP were unreasonably prescribed. Conclusion. According to the prospective registry RECVASA AF-Kursk patients with AF in combination with IHD are hospitalized in the hospital, mainly because of CVD, half of them for emergent indications. Stroke and MI in this category of patients reaches a third of cases. There is a low frequency of prescribing ACat all stages of treatment (5.3% in PreH, 26.5% at discharge and 20.2% in PostH stages), unjustifiably replaced with AP therapy. At the hospital and PostH stages, significantly more frequent use of both AC and AP is observed in comparison with the PreH stage.

(IHD), stable angina of effort of functional class II (43 persons) – III (39 persons) (53.3±7.5 y.o., men - 71, women - 11), with concomitant arterial hypertension – in 21 patient. All patients received traditional anti-anginal disaggregation and hypolipidemic therapy. The therapy of patients of Group 1 was supplemented by meldonium (Mildronate®) at a dosage of 750 mg per day for 2 months. Patients of Group 2 continued to receive traditional therapy. After the period of wash-out (3 months) rotation of patients was done: meldonium was indicated to 750 mg/day for 2 months to a group of patients that previously didn’t receive meldonium previously.Materials and methods. Evaluation of physical tolerance by the cycle ergometer test; activity of free radical processes in the blood by the level of lipoperoxides degradation in blood – diene conjugate (DC), malondialdehyde (MDA). Results. Meldonium inclusion in the complex therapy was accompanied by increase of physical tolerance, reduction of DC and MDA levels in the blood, reduction of the frequency of angina attack and demand in sublingual nitrates. Conclusion. Application of Mildronate® in a composition of complex therapy of patients with stable angina allows increasing effectiveness of traditional anti-angina therapy.

Aim. To evaluate the pleiotropical and hypolipidepmic efficacy of generic rosuvastatin (Rosucard) comparing with atorvastatin in arterial hypertension patients (AH) with high and very high cardiovascular risk (CVR) during the long-term usage in outpatient circumstances. Material and methods. Totally, 114 patients studied (age 58,2±3,11 y. o.) with AH of II-III grades and with high or very high CVR by SCORE, taking antihypertension treatment with metoprolol, indapaminde, enalapril in effective dosages, who, during the previous 1 year of atorvastatin treatment (20 mg/day) did not reach the target level of cholesterol. Atorvastatin was replaced by rosuvastatin 10 mg/day for 1,5 year. If the mentioned dosage did not reach cholesterol and low-density lipoproteides (CLDL) to target levels by 6 weeks, dosage was increased to 20 mg/day, and then if again not achieved during next 6 weeks, to 40 mg/day.Results. Introduction of rosuvastatin to the complex treatment was followed by further decrease of atherogenic lipids: cholesterol by 24%, CLDL by 53% and was followed with the decrease of vessel wall stiffness — decreased CAVI by 12%, augmentation index by 17%, improvement of the vasodilation endothelium function by 24%.Conclusion. Rosucard has, together with hypolipidemic properties, the pleiotropic properties more prominent than in atorvastatin, that makes it to apply the drug in AH patients with high and very high CVR for prevention of cardiovascular complications in outpatient practice.

Aim. To evaluate the comparative efficacy of Rosivastatin (Rosart) and atorvastatin in patients with very high grade of cardiovascular risk (CVR), arterial hypertension (AH) and chronic ischemic heart disease (CHD) in outpatient practice.Material and methods. Totally, 2 groups studied, of patients with chronic CHD with AH (n=50) and isolated AH (n=50) with very high CVR by SCORE, had taken during 1 year the traditional antianginal, antihypertension therapy, and aspirin. Under the outpatient conditions, patients received atorvastatin 20 mg/day, that have not led to target lipid levels in blood. Atorvastatin was repaced by rosuvastatin (Rosart) 10 mg/day, for 1 year. In cases, when the dosage provided did not lead to cholesterol (Ch) decrease, and low density lipids cholesterol (LDL) to target levels for 6 weeks, Rosart dosage was increased to 20 mg/day: in 2% cases in CHD, in 8% in AH; in 8% cases Rosart dosage was increased to 40 mg/day for next 6 weeks.Results. Replacement of atorvastatin by rosuvastatin increased the efficacy of antihypertension treatment, decreased the need for sublingual nitroglycerin, decreased the rate of angina attacks, decreased the quantity of patients that did not reach target blood pressure (BP), decreased the rate of destabilizations of angina, rate of hospitalizations for cardiovascular events, number of hypertension crises and led, in most cases — with Rosart 10 mg/day, to achivement of target Ch and LDL levels, to decrease the vessel wall rigidity parameters, to increase the coefficient of endothelium dysfunction coefficient, that represents the rate of endothelium-dependent vasodilation, with absence of significant hepatotoxic and myopathic adverse events.Conclusion. The data obtained makes it to recommend the wider usage of Rosart in patients with very high CVR in outpatient practice.

A randomized study of the state of stiffness parameters arteries wall (CAVI — cardio-ankle vascular index), AI (augmentation index) PEP (duration of the voltage of the left ventricle) using «VaSera-1000» («Fukuda Denshi», Japan) in primary hypertension patients (80) not treated with systemic antihypertensive therapy. The effect of long-term (3 months) was be marketed. Losartan combined with Mexicor 300mg/day or mildronate 1000 mg/day for the specified parameters. It sets the initial reduction the properties of the arterial wall in patients with hypertension, in contrast to healthy individuals. Mexicor or mildronat accompanied by improvement east-cal properties of the arterial wall, reducing CAVI and AI in 3 months on 9.4% and 8.9%, 14.9% and 15.4%, respectively. In the control group-term change CAVI and AI no. Mexicor led to a more pronounced increase in PEP, than mildronate, respectively, on 23.7% and 18.9%. Losartan monotherapy results in a less pronounced decrease in the stiffness of the vessel wall.

Aim. To assess the effectiveness of Mildronate in the prevention of arrhythmias during the perioperative period of open cholecystectomy under intravenous multicomponent anesthesia.Material and methods. In total, 69 patients were divided into 3 groups: with concomitant coronary heart disease (CHD), with essential arterial hypertension (EAH), or without concomitant cardiovascular disease (CVD). Each group was divided into a control subgroup (total n=36) receiving conventional treatment and a main subgroup (total n=33) additionally receiving Mildronate (500 mg twice a day intravenously: 24 hour before the operation, during premedication, during early postanesthetic period, and for 2 days after the operation). Arrhythmic episodes were registered at Holter ECG monitoring for 4 days: 24 hours before the operation; 24 hours of the operation; and 48 hours after the operation. The monitoring period was divided into 6 intervals: 1 — preoperation; 2–6 hours before the operation; 3 — anesthesia start; 4 — anesthesia maintenance; 5 — anesthesia finish; and 6 — second day after the operation.Results. Cardiac arrhythmias were registered not only among patients with EAH and CHD, but also with patients without concomitant CVD.Conclusion. Mildronate therapy reduced the number of arrhythmic episodes at different stages of perioperative period, particularly in the anesthesia start, finish, and maintenance periods among patients with CHD and EAH, as well as among CVD-free patients.

Aim. To study the effects of mildronate, as a component of complex therapy, on left ventricular (LV) systolic and diastolic function and exercise capacity (EC) in myocardial infarction (MI) patients undergoing post-hospital rehabilitation. Material and methods. This open, randomized study included 2 groups (50 men in each group; mean age 53,8±2,7 years): the control group (CG) and the main group (MG), which suffered MI in 4 weeks prior to the study inclusion (70% with Q-wave MI and 30% with transmural MI), and had stable post-infarction angina, Functional Class (FC) II, and ejection fraction (EF) >35%. In both groups, pharmaceutical therapy included metoprolol (75-150 mg/d), isosorbide mononitrate (40 mg/d), aspirin (100 mg/d), clopidogrel (75 mg/d), atorvastatin (20-40 mg/d), and enalapril (2,5-5 mg/d). The MG patients additionally received mildronate (1,5 g/d) for 3 months. The follow-up period was 1 year. EC was assessed using veloergometry (VEM) and 6-minute walk test (6MWT). LV systolic and diastolic function was assessed with the use of Doppler echocardiography. The following parameters were calculated: EF, DTE, LV isovolumetric relaxation time (IVRT), and enddiastolic pressure (EDP). Two types of diastolic dysfunction (DD) were defined: Type I (E/A 0,220 ms) and Type II (E/A >1,5; DTE

The review discusses the benefits and various practical aspects of the new cardioprotector mildronate use in cardiology. The latest evidence on the mildronate role in complex therapy of patients with stable angina, or patients in the rehabilitation period after myocardial infarction, is summarised.

Anti-ischemic effects of high-dose cardiac cytoprotector Mexicor (0,014 g/kg/d, 0,019 g/kg/d) were examined in rabbits with experimental myocardial infarction. In addition, anti-ischemic activity of Mexicor (0,4 g/d) was assessed in patients with acute coronary syndrome (ACS). It has been demonstrated that Mexicor reduced the size of infarction area and decreased the ratio “necrosis area / ischemia area”, compared to the control animals. In ACS patients, Mexicor facilitated faster recovery of left ventricular diastolic function, and also decreased blood levels of NT-proBNP.

The study compared the effects of cardiocytoprotectors (mildronate, trimetazidine) on endothelial function, physical stress tolerability, and circadian blood pressure (BP) profile in patients with arterial hypertension (AH; n=60) and stable angina (n=82), receiving anti-anginal therapy (beta-adrenoblockers, nitrates) or antihypertensive therapy (enalapril). Adding cardiocytoprotectors to the complex therapy improved endothelium-dependent vasodilatation and circadian BP profile, as well as reduced endothelial dysfunction severity and intima-media thickness in AH patients. Mildronate was more effective in improving endothelial structure and function.

The study investigated the effects of cardiac cytoprotectors – mildronate and trimetazidine, combined with ACE therapy, on lipid peroxidation product levels, endothelial function, circadian blood pressure (BP) profile, left ventricular myocardium, and intracardiac hemodynamics in patients with arterial hypertension (AH). It was demonstrated that in AH patients, the combination of mildronate and enalapril facilitated lipid peroxidation reduction, endothelial function and circadian BP normalization, as well as improvement of left ventricular morphology and function. The combination of trimetazidine and enalapril did not improve the effectiveness of antihypertensive therapy.

The study investigated the effects of cardiocyte protectors, mexicor and mildronate, in combination with ACE inhibitors, on blood levels of lipid peroxidation products, vascular endothelial function, circadian profile of blood pressure, and left ventricular morphology and function in patients with arterial hypertension. The results obtained supported the importance of cytoprotectors mexicor and mildronate, combined with ACE inhibitors, in the complex management of arterial hypertension. Compared to mildronate, mexicor more effectively influenced blood levels of lipid peroxidation products, circadian blood pressure profile, and left ventricular diastolic myocardial function.

Aim. To study efficacy of cytoprotector mexicor in patients with unstable angina (UA), acute myocardial infarction (MI), hypertensive crises (HC) in combined therapy with conventional drugs. Material and methods. An open randomized study included 338 patients with acute forms of ischemic heart disease (IHD) and arterial hypertension running with crises. Combined therapy of 20 patients with UA, 90 patients with MI and 43 patients with HC (study groups) was supplemented with mexicor in a dose 6-9 mg/kg/day. The control matched patients (20, 86 and 79 patients, respectively) received conventional treatment alone. The effects of the treatments were assessed by ultrasound investigation of the heart in M-, B- and Doppler modes, by ECG and arterial pressure 24-h monitoring, by activity of lipid peroxidation (LPO). Results. Adjuvant therapy of urgent cardiological conditions with mexicor diminished oxidant stress, left ventricular dysfunction. In MI patients mexicor promoted reduction of the akinesia zones, recovery of disturbed segmentary contractility. In UA patients mexicor contributed to more pronounced decrease in the frequency, duration and severity of myocardial ischemia, enhanced stabilization of angina. In HC patients mexicor promoted earlier normalization of a 24-h AP profile and variability of cardiac rhythm, recurrence rate of HC decreased 2-fold. Conclusion. The addition of mexicor to conventional therapy of UA, MI, HC improves clinical course of these diseases, reduces oxidant stress, accelerates recovery of cardiac contractility and left ventricular diastolic function, normalization of central hemodynamics.