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Aim. To assess the secondary prevention in Russian patients with coronary artery disease in the long-term period after acute myocardial infarction, acute coronary syndrome (ACS), percutaneous coronary intervention and/or coronary artery bypass grafting, obtained in the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in comparison with the general population of the study.Material and methods. EUROASPIRE V is a cross-sectional study with 27 countries, including Russia, which involved patients with ACS or indications for myocardial revascularization. At participating centers, patients admitted to hospital due to ACS or for percutaneous coronary intervention or coronary artery bypass grafting were identified. After 6 months and

Aim. Analysis of psychosocial risk factors in coronary heart disease (CHD) patients among Russian centers of the EUROASPIRE IV study, comparing to overall study population.Material and methods. In the cross-sectional study, 24 European countries participated, including Russian Federation (3 centers). In the study, patients were included of the age 18-80 y.o., who, during the period ≥6 months to

Aim. To study clinical and economical rationales for cardiovascular risk evaluation at workplace (on example of the personnel of engineering research institute).Material and methods. Complex preventive screening with evaluation of arterial hypertension (HT) prevalence, cardiovascular risk level and requirement for risk factors correction is performed. Economical rationales for preventive screening (with estimation of the total costs, costs for one studied person and costs for revealing of one person needed in preventive actions) are also estimated.Results. Preventive screening in the organized collective found new HT cases (12,2%), high and very high cardiovascular risk (58,6%). The desire for risk factors correction is found in 13,0-59,0% of workers. The total costs for preventive screening of 468 persons were 174413 rubles in 3,5 months. Costs for examination of one worker were 561,7 rubles. Costs for detecting of one worker requiring preventive actions were from 635,6 to 3077,4 rublesConclusion. There are rationales for preventive screening of cardiovascular risk and desire to correct it at the workplace.

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.

Clinical effectiveness, safety, and the impact on left ventricular (LV) systolic and diastolic function were assessed for Propanorm® and Cordarone® in patients with atrial fibrillation (AF), arterial hypertension (AH), coronary heart disease (CHD), and chronic heart failure (CHF) with preserved ejection fraction (EF). In total, 218 patients were randomised, and 189 were included in the study (132 in the Propanorm® group, and 57 in the Cordarone® group). The follow-up period lasted for 12 months. Primary end-points included all-cause mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction or stroke, and hospitalisation due to decompensated CHF or recurrent AF. Secondary end-points included AF episode frequency, their duration, ventricular rate (VR) during AF paroxysms, blood pressure levels, dynamics of CHD and CHF functional class (FC), LV systolic and diastolic function, treatment safety and adverse effects in patients with CHF and preserved LV EF. At 12 months, Propanorm® effectiveness, in terms of AF paroxysm prevention, reached 61,4% and was similar to that for Cordarone®. In 31,8% of the patients from the Propanorm® group, the number of tachyarrhythmia episodes decreased by 82,4%, the total paroxysm duration was reduced by 86,6%, and VR during the paroxysm decreased by 16,1%. Improved LV diastolic filling resulted in the increased proportion of FC I CHF patients (by 50%), and reduced hospitalisation rates (by 72,9%) among the patients from the Propanorm® group. In patients with AH, CHD, and CHF with preserved LV EF, Propanorm® demonstrated a better safety profile, compared to Cordarone, since the respective adverse effect incidence was 1,5% vs. 45,6%.

The paper presents the results of 3 prospective, randomised, double-blind, placebo-controlled trials of patients with coronary heart disease (CHD) and peripheral artery disease (PAD). The aim was to compare veloergometry parameters and skeletal muscle strength in CAD patients, as well as exercise capacity dynamics in PAD patients, during long-term standard therapy with or without additional administration of mildronate (M). According to 3- and 12-month results for CAD patients, M groups demonstrated substantial increases in veloergometry exercise duration and maximal workload, as well as skeletal muscle strength, compared to placebo groups. In PAD patients, 24-week M therapy was associated with substantial increase in absolute claudication distance (ACD) during treadmill test, compared to placebo. Long-term M therapy was effective and safe. Positive effects on ACD were observed even one month after the end of M treatment.

Clinical effectiveness and safety of Propanorm® was studied in patients with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) with intact systolic left ventricular (LV) function, and atrial fibrillation (AF). Effectiveness and safety of Propanorm® was compared to those in Cordarone®. Out of 137 randomised patients, 110 were included in the study (59 in the Propanorm® group, 51 – in the Cordarone® group) and followed up for 12 months. Primary end-points included all-cause mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction and stroke. Secondary end-points included recurrent AF episodes, their duration, AF or decompensation-related hospitalisation rates, systolic and diastolic LF function dynamics during the treatment, and safety profile of Propanorm® and Cordarone® in CHF with intact systolic LF function. The treatment of the main pathology was associated with achieving target blood pressure (BP) levels in 67,3% of the patients, reduction in functional classes (FC) of angina (70%) and CHF (94,5%), and decrease in cardiac decompensation-related hospitalisation rates by 72,9%. After 6 and 12 months of the therapy, Propanorm® effectiveness was as high as 67,4% and 52,9%, respectively, being similar to that for Cordarone® (62,7% and 52,9%, respectively). In 33,9% of the patients, Propanorm® therapy was associated with a reduction in clinical AF symptoms, their duration, ventricular rate during AF paroxysm, and increased number of asymptomatic AF episodes by 30,9%. In cardiac patients, Propanorm® was safer than Cordarone®, with respective incidence of adverse effects of 0% vs. 31,6%. The study PROSTOR is being continued, and the present paper describes the results of 12-month therapy.

Aim. To develop, test and evaluate the workplace (wp) programme of multifactorial prevention of cardiovascular disease (CVD). Material and methods. In a technical research institute, with 523 employees, a complex programme of CVD prevention was introduced, including preventive examination, preventive intervention, and clinical effectiveness monitoring. Preventive examination included complex assessment of CVD and CVD risk factors (RFs) (response rate 89,5 %). Preventive intervention, developed with consideration of CVD prevention demand, was performed in the intervention group (IG). The control group (CG) was formed according to “case-control” principle. In clinical effectiveness analysis, the dynamics of blood pressure (BP), total cholesterol (TC), psycho-emotional RFs, and SCORE-calculated CVD risk was assessed. Results. Preventive examination demonstrated high prevalence of arterial hypertension (AH), metabolic and psycho-emotional RFs at wp, together with high interest in RF correction. Preventive intervention resulted in a significant reduction in systolic BP (SBP) — by 9 mm Hg, in diastolic BP (DBP) — by 9,7 mm Hg, in TC — by 0,7 mmol/l, and also in SCORE-calculated CVD risk — from 3,8 % to 3,0 %. Conclusion. Complex CVD prevention at wp was associated with substantial beneficial effects within first 12 months.

Aim. To study health-related quality of life (QoL), psychological status, and their associations with cardiovascular (CVD) risk factors (RFs) in education and science professionals, to specify the priorities of CVD prevention in organized collectives of intellectual workers.Material and methods. This preventive examination of two organized collectives of education and research workers assessed psycho-emotional status and health-related QoL. The examination was performed as a part of extended dispanserisation programme and included questionnaire survey, using such scales as HADS (anxiety and depression assessment), Reeder scale (stress assessment), and SF-36 (QoL).Results. The high prevalence of anxiety and depressive disorders pointed to increased CVD risk. Most traditional RFs positively correlated with depressive disorder severity. The two collectives examined were significantly different in terms of health-related QoL and some parameters of psycho-emotional stress. This could be partly explained by different workplace settings and social circumstances.Conclusion. In intellectual workers, CVD prevention should start with psycho-emotional and QoL correction, which could also improve the compliance to traditional RF correction.

Aim. To demonstrate the independence of cardio-ankle vascular index (CAVI) from blood pressure (BP) level, to investigate CAVI associations with various risk factors (RFs) of cardiovascular disease (CVD), to determine prognostic CAVI level.Material and methods. In total, 1563 individuals were examined: 447 healthy subjects, 855 patients with arterial hypertension (AH) and 261 patients with diabetes mellitus (DM). BP level, CAVI and brachio-ankle pulse wave velocity (PWV) were measured by volume sphygmography method (VaSera-1000, "Fukuda Denshi", Japan).Results. Volume sphygmography method demonstrated high reproducibility, with CAVI independence from BP level. CAVI was dependent on CVD RFs: age, AH, DM, family history of AH, overweight, waist circumference, and hypercholesterolemia. Vascular wall stiffness could integrate CVD RF influence on the organism, which is reflected by CAVI. Prognostic CAVI level was equal to 9.Conclusion. Volume sphygmography method, with CAVI assessment, could be used in the screening for people with high CVD risk.

One of the conditions for high-quality medical care, including medical prevention, is preliminary assessment of objective need for this type of medical service.Aim. То assess the need for medical prevention of cardiovascular risk factors (CVD RFs) in organized collectives of educational and research workers. То identifY preventive behavior models requiring different tactics for individual preventive programs.Material and methods. А survey was performed in two collectives of intellectual workers, to assess their need for CVD RF prevention and identify preventive behavior models as а basis for individual preventive programs.Results. Among the collectives exarnined, both CVD RF prevalence and unmet need for CVD RF coпection were high; the latter reached 70-80 % among all individuals with RFs.Conclusion. The indicators of preventive consulting need could Ье used for developing targeted preventive programs.

Aim. To study diagnostic value of transoesophageal electrocardiography (TE ECG) in verifying double physiology of atrio-ventricular (AV) node in differential diagnostics of supraventricular tachycardias (SVT), as well as in assessment of short and long-term treatment results in paroxysmal AV nodal reentrant tachycardia (PAVNRT).Material and methods. The study included 32 patients with PAVNRT diagnosis, verified by TE ECG. At Stage I, PAVNRT patients were clinically examined. Then intracardiac (IC) ECG and radioablation (RA) were performed at a Cardiosurgery department. At Stage II, all participants underwent TE ECG, to assess RA effectiveness 1 and 3 months later.Results. At Stage I, TE ECG demonstrated some specific features of AV node physiology. Their impact on treatment effectiveness and post-intervention clinical course was assessed at Stage II. PAVNRT in combination with impaired AV conductivity and increased effective refractory periods (EFP) of beta-pathway (>500 ms) were not contraindicative to RA of slow AV node pathways. Among these patients, AV conductivity was satisfactory, with no clinical symptoms or signs. During TE ECG, PAVNRT was difficult to diagnose in patients without double AV node conductivity and wide QRS tachycardia.Conclusion. The results obtained confirmed the importance of ТЕ ECG in PAVNRT diagnostics. RA is needed in patients with confirmed diagnosis and double AV node physiology. This method is important for identifying indications and counter-indications for intervention, for predicting complications and adverse events during RA.

Aim. To study blood pressure (BP) levels in various vascular basins, as well as to investigate the role of aorta and large artery elasticity (stiffness) in arterial hypertension (AH) development.Material and methods. In total, 447 normotensive people and 855 AH patients aged 17-90 years were examined. BP in upper and lower extremity basins and arterial stiffness for elastic and muscular type vessels were measured by volume sphygmography method (VaSera-1000, «Fukuda Denshi», Japan). In 218 participants, pulse wave (PW) contour analysis and central BP measurement were performed by applanation tonometry method (SphygmoCor, «AtCor Medical», Australia).Results. Age BP dynamics for upper and lower extremity basins was similar in normotensives and AH patients. In calf arteries, comparing to brachial artery (BA), BP was more dependent on aorta and large artery stiffness, reflecting damping function of the latter. In BA, BP was more dependent on reflected waves (pressure augmentation) and PW amplification. Measuring lower extremity BP gives a chance to diagnose aorta stiffness-related AH earlier than traditional В A measurement of В P. The latter diagnoses AH only when elastic vessel stiffness increases enough.Conclusion. Measuring BP in upper and lower extremity basins improves AH diagnostics and arteriosclerosis stage assessment.

Aim. To study effectiveness, safety, and dynamics of cognitive function in eprosartan therapy among arterial hypertension (AH) patients after stroke (S) or transient ischemic attack (TIA), comparing to standard antihypertensive therapy. Material and methods. The study included 60 AH patients, who underwent S or TIA. All participants wee randomized to two equal groups. Mean age in Group I was 62,2±7,8 years, in Group II – 59,8±6,7 years; AH duration - 9,5±3,5 and 9,8±3,2 years, respectively. For 3 months, Group I received eprosartan (600 mg/d), as monotherapy or combined with hydrochlorthiazide, if target blood pressure (BP) level was not achieved. Group II received standard antihypertensive therapy. At 4 visits, BP, heart rate, body mass index were measured; medication tolerability were assessed. At the baseline and at the end of the study, electrocardiography, echocardiography, 24-hour BP monitoring (BPM), psychological testing with Beck and MMSE questionnaires were performed. Results. In 2 patients (6,7%) from control Group II, recurrent TIA episodes were registered. In both groups, a significant positive dynamics of all manually measured BP parameters was observed. At the end of the study, BP positive dynamics was more manifested in eprosartan group. Moreover, in Group I, depression and cognitive dysfunction levels substantially decreased. Conclusion. Eprosartan is an effective antihypertensive agent for AH treatment, with cerebroprotective effects in S and TIA patients, that could be used as monotherapy or in combination with a diuretic.

Aim. To study risk factor (RF) structure and relative prevalence of pathological alterations (RPPA) in arterial hypertension (AH) patients from various age groups. Material and methods. Main group included 70 AH patients, control group – 47 individuals with normal blood pressure (BP). Mean age was 55.2±13.67 years and 53.7±13.45, respectively. In all participants, anamnestic, hemodynamic, anthropometric, and biochemical parameters were assessed. Both groups were divided into three age intervals: 55 years. At first, the parameters assessed were compared in each age interval. Then RPPA of these parameters was assessed in main and control groups. Results. Under age of 35, AH development was significantly influenced by family predisposition (FP) and abdominal obesity (AO); in 35-55 years, it was influenced by FP, AO and high level of total cholesterol (TCH); over 55 years, it was influenced by AO and high TCH level. All anthropometric, morphological, functional, and biochemical parameters studied had greater RPPA in main group than in control group, in patients under 35; in 35-55 year-olds, the tendency was similar, with insulin resistance index as an exception; after 55 years, the exceptions were pulse Conclusion. Among traditional cardiovascular event RF, only AO was a universal AH development RF for all age groups. At the same time, the study results should be regarded as preliminary.

Aim. The principal objective of this randomized, comparative, open clinical trial PRESTIGE was to determine the time of achieving optimal therapeutic dozes of ACE inhibitors. The secondary goal was to assess dynamics of chronic heart failure (CHF) functional classes (FC) during the treatment. Material and methods. The study involved 125 patients with Q-wave acute myocardial infarction (MI): 68 males, 57 females; mean age 67 years. All participants were randomized into perindopril or captropril groups (n=63 and 62, respectively). In dose titration, starting doses were 2 mg/d and 18.75 mg/d, respectively. Recommended daily doses were 4-8 mg once per day for perindopril, and 75-150 mg, three times per day, for captropril. Treatment and follow-up period lasted for 6 months. ACE inhibitor efficacy was assessed by measuring brain natriuretic peptide (BNUP) levels - at baseline, Weeks 8 and 24. Quality of life (QoL) was assessed by two methods: by “health line” and standard Minnesota University Questionnaire for heart failure patients. Incidence of death and hospitalization due to cardiovascular causes was also registered. Results. At Week 8, there was a significant reduction in BNUP level (to 296.5±16.7 pmmol/l; or by 25.4%; р=0.004) in perindorpil group, and to 342.7±13.8 pmmol/ml (by 19.1%; NS; р=0.06) in captopril group. At 6 months, QoL improved in perindopril group (reduced total QoL score, 23.8; р=0.047), and did not change comparing to Week 3, in captopril group (31.4). Conclusion. MI patients with left ventricular dysfunction, early administered ACE inhibitors, achieved target dose of perindopril faster than that of captopril. That was associated with improved clinical course (CHF FC, QoL) in perindopril group.

The paper focuses on the diagnostics, clinics, and treatment of functional heart diseases, which require high professionalism and interdisciplinary knowledge and skills from health professionals.

Aim. To perform a standardised preventive examination in organised collectives of intellectual workers (educational and research institutions), to assess the potential and feasibility of cardiovascular risk assessment unification, with the goal of developing preventive workplace (WP) programmes.Material and methods. A standardised preventive examination was performed in two organised collectives of intellectual workers (higher education institutions, 234 participants; technical research institute, 265 participants). According to the uniform protocol, questionnaire survey, anthropometry, and measurement of blood pressure (BP), cholesterol (CH) and blood glucose were performed.Results. Among middle-aged educational and research workers, the WP examination demonstrated high prevalence of increased BP, high levels of total cardiovascular risk and separate risk factors (RFs). Therefore, cardiovascular risk reduction in intellectual workers should be addressed not only by health professionals, but also by rational work organisation and health promotion at WP.Conclusion. The extended dispanserisation programme in educational and research workers should include simple methods of cardiovascular risk assessment (total risk and separate RFs). This would facilitate the creation of targeted preventive strategies for specific organised collectives of intellectual workers.

Aim. To assess the effectiveness of depressive disorder (DD) treatment with fluvoxamine in patients with various forms of atrial fibrillation (AF), as well as to investigate fluvoxamine effects on AF clinical course. Material and methods. Group I included 51 patients with various forms of AF and DD, receiving fluvoxamine (50 mg once a day) for 6 months. Group II included 49 patients with AF and non-treated DD (comparison group). All participants received standard antiarrythmic therapy. At 6 months, the incidence of AF attacks and transition from tachycardic to normocardic AF, blood levels of fibrinogen, and depression severity (CES-D questionnaire) were assessed. Results. Three AF patients were withdrawn from fluvoxamine therapy at Week 1, due to adverse effects. In the other Group I patients (n=48), fluvoxamine reduced DD severity by 2,8 points on average (p

Aim. To investigate the levels and prevalence of main risk factors (RFs) in patients with acute coronary syndrome (ACS), to evaluate the long-term effectiveness of secondary prevention and its agreement with Russian and international guidelines (2005-2006).Material and methods. A cross-sectional, retrospective analysis of medical histories was performed for 278 patients, hospitalized at the Moscow Regional Cardiology Centre (Zhukovsky) and State Research Centre for Preventive Medicine (Moscow) with myocardial infarction (MI). A subsequent questionnaire survey and examination of these patients provided the general information and the data on laboratory and instrumental test results, number of hospitalizations, work status dynamics, and current treatment.Results. Both in-hospital and long-term prevalence of RFs was high: for body mass index (BMI) ≥ 25 kg/m2 – 34,62%, for systolic blood pressure (SBP) ≥140 mm Hg – 26,28%, for smoking – 18,22%, for clinical symptoms of depression and anxiety – 19,23% and 23,42%, respectively. Heart rate (HR), blood lipids, and fasting blood glucose levels were higher than the respective target levels.Conclusion. The long-term RF prevalence in MI patients was high, with inadequate effectiveness of secondary preventive measures, and insufficient clinical implementation of existing international and local standards of CV prevention and therapy.

Aim. To study diagnostic value of transoesophageal electrocardiography (TE ECG) in verifying double physiology of atrio-ventricular (AV) node in differential diagnostics of supraventricular tachycardias (SVT), as well as in assessment of diagnostic specifics among patients with paroxysmal AV nodal reentrant tachycardia (PAVNRT).Material and methods. To diagnose SVT, 391 TE ECG procedures were performed; in 234 patients, PAVNRT diagnosis was confirmed. The present study included 49 PAVNRT patients: 34 (69,4%) women and 15 (30,6%) men; mean age 52,6±24,6 years; mean arrhythmia duration 11,6±8,9 years. TE ECG was performed according to a standard protocol; afterwards, intracardiac (IC) ECG and radioablation (RA) were performed at a Cardiosurgery department. Finally, the protocols of TE and IC ECG were compared.Results. TE ECG demonstrated some specific features of AV node physiology and higher sensitivity and specificity in PAVNRT diagnostics. However, TE ECG was inadequately effective in verifying double physiology of AV node in PAVNRT patients with “inseparable” AV conduction curve or with wide QRS tachycardia. Moreover, TE ECG potential was limited in differential diagnostics between PAVNRT and orthodrome AV tachycardia with involvement of left posterior additional branch. To identify specific SVT types, AV conductivity character, atrial activation sequence, and VA conductivity time in tachyarrhythmia should be analysed. Since all these criteria have low specificity, they should be considered in combination only.Conclusion. IC ECG remains the “gold standard” in diagnosing electrophysiological mechanisms of paroxysmal tachycardias. However, TE ECG data ply an important role in PAVNRT diagnostics. Specificity of the latter method influences indications and contraindications for intervention, as well as affects RA complication prognosis.

Aim. To study clinical effectiveness, safety, and effects on left ventricular (LV) systolic and diastolic function for Class IC and Class III antiarrhythmic medications — propafenone and amiodarone, respectively — in patients with chronic heart failure (CHF), intact ejection fraction (EF), and atrial fibrillation (AF). Material and methods. Out of 227 patients, 198 were followed for 12 months (mean age 54,4±2,1 years). For AF prevention, 138 and 60 participants received propafenone and amiodarone, respectively. The assessed parameters included AF episode incidence, their duration, LV systolic and diastolic function, and therapy safety (incidence of adverse effects, AE) in CHF with intact LV EF. Results. After 12 months of the treatment, propafenone and amiodarone effectiveness for AF prevention was similar — 61,4 % and 63,2 %, respectively. ImprovedLV diastolic filling was associated with increased numbers of Functional Class I CHF patients (+50 %) and reduced hospitalization rates (-72,9). In CHF patients with intact LV EF, propafenone demonstrated a better safety profile than amiodarone: AE incidence was 0,72 % vs. 31,8 %, respectively.Conclusion. In CHF patients with intact LV EF and paroxysmal and/or persistent AF, the Class IC antiarrhythmic medication propafenone demonstrated high antiarrhythmic effectiveness, safety, and beneficial effects onLV diastolic function.

Aim. To study clinical effectiveness and safety of propafenone and amiodarone in patients with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) with preserved left ventricular (LV) systolic function, and atrial fibrillation (AF). Material and methods. The study included 110 34-66-year-old patients from various Russian regions, with paroxysmal and/or persistent AF. To prevent AF episodes, the participants were administered propafenone (n=59) or amiodarone (n=51) for 12 months. Results. The treatment of the leading pathology resulted in achieving target blood pressure levels (in 67,3 % of the patients), as well as in reducing functional class of angina (70 %) and CHF (94,5 %). In its turn, this resulted in reduced incidence (-72,9 %) of hospitalisations due to CHF decompensation. After 12 months of the treatment, propafenone effectiveness was 54,2 % — similar to that for amiodarone (52,9 %). In 33,9 % of the patients taking propafenone, the number of AF episodes was reduced by 86,6 %, their total duration — by 70,1 %, ventricular rate during the paroxysm — by 43,1 %, while the number of asymptomatic episodes increased by 30,9 %. Propafenone was also safer than amiodarone: the respective incidence of adverse effects was 0 % vs. 31,6 %. Conclusion. Propafenone, a Class IC antiarrythmic medication, was characterised by high antiarrythmic effectiveness and safety, and could also be combined with beta-adrenoblockers in CHF patients with preserved LV systolic function, AH, CHD, and paroxysmal and/or persistent AF.