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V.M. Kovalenko, Е.G. Nesukay, O.O. Danylenko, E.Yu. TitovStructural and functional state of the left ventricle, intraventricular dyssynchrony and exercise tolerance in patients after Q-wave myocardial infarction.

National Scientific Center “M.D. Strazhesko Institute of Cardiology NAMS of Ukraine”, Kyiv, Ukraine
The aim – to explore the relationship of structural and functional state of the left ventricle (LV), its geometry and intraventricular dyssynchrony with exercise tolerance (ET) in patients after Q-wave acute myocardial infarction (Q-AMI). Material and methods. The study involved 58 patients (96 % male) with post-infarction cardiosclerosis (after Q-wave myocardial infarction), average age (56.0±1.2) years. Group I included 40 patients who were examined at 10–12 days and at 6 months after Q-AMI. Group II included 48 patients after Q-AMI, who performed exercise stress test (EST). Group III included 31 patients with post-infarction cardiosclerosis from group I to assess possibility of making submaximal EST 6 months after Q-AMI. All patients underwent echocardiography and speckle tracking echocardiography (STE). Results. In 6 months after Q-AMI the value of global longitudinal systolic strain (GLS) was increased in 23 patients of group I by 9 %, LV ejection fraction (LVEF) was increased by 4 % and wall motion score index (WMSI) was decreased by 5.6 % in comparison with those parameters at 10–12 days after Q-AMI. In group II direct correlation between the
level of oxygen consumption (VO2 max) during EST and LVEF, GLS, global circumferential systolic strain at rest, as well as an inverse correlation between VO2 max and WMSI (r=–0.56; Р<0.001) and index post-systolic shortening (IPSS) (r=–0.34; Р=0.043) were established. The odds ratio (OR) to perform submaximal test in patients of group III increased along with GLS (OR 1.89; confidence interval (CI) 1.17–3.05; Р=0.010), LVEF (OR 1.22; CI 1.02–1.46; Р=0.034) and lower WMSI (OR 0.04; CI 0.004–0.44; Р=0.008) at 10–12 days after Q-AMI. It was found that in group III the value of GLS ≤ –10 % at the 10–12 days of Q-AMI allows to predict ability to perform submaximal test 6 months after Q-AMI with sensitivity of 88 % and specificity of 67 %. Conclusions. In patients after Q-AMI increasing GLS is associated with improving global and segmental LV systolic
function. Aerobic activity in patients with post-infarction cardiosclerosis is associated with LVEF, longitudinal and circumferential components of the myocardial strain, as well as amount of myocardial injury and intraventricular dyssynchrony. Early assessment of GLS in Q-AMI patients is important for predicting exercise tolerance.

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A.S. Gavrish, S.I. Dorofeeva, V.A. KrichkevychRegional peculiarities of myocardium microcirculation in chronic ischemic heart disease.

National Scientific Center “M.D. Strazhesko Institute of Cardiology NAMS of Ukraine”, Kyiv, Ukraine
The morphological and functional alteration of microcirculation was studied in myocardial biopsies, performed in patients with ischemic heart disease without diabetes mellitus and myocardial infarction. The degree of stenosis of the coronary arteries was 80–90 % in proximal segment. The specimens of myocardial tissue were received from the ischemic area and outside zones. The research was carried out with use of semi-thin cut and studies with microscopic and morphometric methods. It was discovered that adaptation and pathological changes іn microvessels were widespread and played role in the limitation of coronary reserve, presenting a structural basis for coronary X syndrome. Without regard to stereotype character of these changes, more expressed reduction of trophic segment of microcirculation and different ratio of reverse and permanent violations lead to morphologic differences in ischemic and nonischemic zones.

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M.M. Dolzhenko, Yu.O. Luchinska, S.M. MymrenkoDynamics of duplex scanning of extracranial vessels after coronary artery bypass grafting in patients receiving angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.

The aim – to study the changes of duplex scanning of extracranial vessels parameters in patients receiving angiotensinconverting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB), to prevent graft stenosis related to the biochemical blood parameters. Material and methods. The study included 170 patients with coronary artery disease and post-infarction cardiosclerosis after coronary artery bypass grafting (CABG). They were divided into 2 groups: 105 patients received standard therapy and ACE inhibitor enalapril or lisinopril (20–40 mg daily), and 65 patients intolerant to ACE inhibitors received ARB valsartan at a dose of 160–320 mg daily. All patients underwent duplex scanning of extracranial vessels, contrast multispiral computer tomography (MSCT) of coronary vessels and biochemical blood tests. Results. After 12 months of observation patients receiving ARB had significantly less intima-media thickness than those treated with ACE inhibitors (0.80±0.01 compared to 0.90±0.02 mm; Р=0.001). After 12 months of follow CRP level was statistically higher in ACE inhibitors group (Р=0.02). Compared to the immediate post-surgery period, at 12 months after CABG we observed a significant decrease in total cholesterol, low-density lipoproteins and atherogenic index in both groups. Yet, the level of atherogenic cholesterol fractions remained high. During MSCT it was found that in the group treated with ACE inhibitors, compared to ARB, there was a significantly higher number of patients with graft stenosis (17 and 4 patients (23 % and 8 %, respectively, Р=0.03), but the difference in number of patients with the development of new stenosis was not found (28 patients in the ACE inhibitor group and 12 in ARB, 38 % and 23 %, respectively, Р=0.08). Conclusions. One year after CABG surgery ARB treatment was associated with significantly less intima-media thickness, lower CRP level and lower number of patients with graft stenosis. These results allow to recommend ARB valsartan as an effective means of graft stenosis prevention after CABG. This drug has a pronounced anti-inflammatory effect, affects endothelial function and intima proliferation.

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O.I. Mitchenko, V.Yu. Romanov, M.V. GvozdykEarly markers of atherosclerosis in women with еssential hypertension, metabolic syndrome and subclinical hypothyroidism.

National Scientific Center “M.D. Strazhesko Institute of Cardiology NAMS of Ukraine”, Kyiv, Ukraine
The aim – to examine influence of subclinical hypothyroidism on early markers of atherosclerosis and cardiovascular risk in women with еssential hypertension and metabolic syndrome. Materials and methods. Women (n=134), mean age 56.8±0.5 years with еssential hypertension and metabolic syndrome were included into this study: 1st group (n=33) with subclinical hypothyroidism, 2nd group (n=32) with subclinical hypothyroidism receiving levothyroxin treatment, 3rd group (n=34) with overt hypothyroidism and 4th group (n=35) with euthyroidism. Measurements were made of body mass index, thyrostimulating hormone (TSH), free T4, lipids profile, carotid artery intima–media thickness (IMT) and ankle-brachial index (ABI). Also SCORE scales for total
cardiovascular risk estimation were used. Results. The plasma concentration of TSH was closely associated with cholesterol levels (r=0.59; P<0.01) and LDL-cholesterol (r=0.55; Р<0.01). The IMT in the 1st group was more (0.98±0.04 mm, P<0.05) than in the 2nd (0.87±0.03 mm) and 4th (0.83±0.04 mm) groups. ABI in the 1st (1.05±0.11) and 4th (1.00±0.11) groups was significantly lower than in the 3rd (1.13±0.13, P<0.01) group. We found higher prevalence of high risk in women with subclinical hypothyroidism compared with the 4th group (euthyroidism) – 36.4 vs 11.4 % by SCORE scale and we didn’t
find any patients with very high risk. After we reestimated risk including results of sonography examination carotid artery and low extremities (ABI), we found increasing prevalence of high and very high risk in women with subclinical hypothyroidism from 36.4 to 76.4 %. Conclusion. Our results showed that subclinical hypothyroidism influences cardiovascular risk in women with arterial hypertension. Hypothyroidism has association with increased level of total cholesterol, LDL-cholesterol, IMT, decreased ABI. Hypothyroid women with hypertension under levothyroxin treatment have better lipids profile and lower cardiovascular risk compared with hypothyroid patients without levothyroxine replacement therapy.

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М.G. Іllyash, Т.А. Аndrushchenko, А.V. Basanets, L.V. DolinchukMоlecular and genetic analysis of left ventricular hypertrophy in coal miners of Ukraine.

The article focuses on actual problems of occupational health and genetics aiming to improve the existing system of primary prevention of cardiovascular disease (CVD) in coal miners in Ukraine, by identifying genetic markers of genetic predisposition to the development of left ventricular hypertrophy. The purpose of investigation was to develop contemporary methods of primary prevention of left ventricular hypertrophy in CVD in the coal miners. Fourty six hypertensive coal miners and 47 healthy coal miners controls were enrolled into the study. All patients had more than 5-years experience of underground work. The study revealed one variant of combination of allelic polymorphisms of genes AGT, AT1R, GNB3, EDN1, MTHFR, one of which was associated with predisposition to development to left ventricular hypertrophy. It was established that AGT*TT genotype was a risk factor for development of left ventricular hypertrophy (χ2=13.84; Р≤0.0001). Genotypes associated with development of left ventricular hyp ertrophy were AGT*ТТ, AT1R*СС, GNB3*ТТ, GNB3*СТ і EDN1*ТТ. On the contrary, AT1R*АС, AT1R*АА, GNB3*СС, EDN1*GТ, EDN1*GG і MTHFR*АА genotypes were not related to the development of left ventricular hypertrophy. The study of genetic structure of the population and search for molecular genetic markers of risk for CVD is considered a most promising was to the CVD prevention.

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O.M. Kovalyova, O.V. HoncharInterleukin-33 and left ventricular structural and functional remodeling in hypertensive patients with obesity.

To investigate interrelations between interleukin-33 serum levels and left ventricular structural and functional remodeling in hypertensive patients with obesity. Eighty hypertensive patients (34 male and 46 female) in the age of 59.2±8.2 years have been observed, including 26 patients with the 1st degree of obesity and 27 with the 2nd-3rd degrees. The control group was composed of 10 practically healthy age- and sex-matched persons. Methods of research included echocardiography with transmitral blood flow and lateral mitral annular motion investigation, and interleukins-33 and -1β serum levels investigation using ELISA. Significant increase in both cytokines’ concentrations compared to healthy persons was observed. Cluster analysis revealed peculiarities in both cytokines’ levels distribution that were related to the structural and functional remodeling in observed patients. Left ventricular myocardial mass, myocardial mass index and relative wall thickness were the highest in patients with level of interleukin 33 more than 73 pg/ml and interleukin 1β more than 28 pg/ml (cluster 1) – 311.3 (271.5; 381.0) g, 160.5 (142.8; 185.8) g/m2 and 0.539 (0.484; 0.604) respectively; those patients had the highest rate of concentric hypertrophy (90.0 %), increased ejection fraction (73.5 (67.3; 79.8) %) and high prevalence of type I diastolic dysfunction. Prevalent increase in interleukin-1β level (more than 25 pg/ml with interleukin 33 less than 73 pg/ml, cluster 2) despite relatively low prevalence of left ventricular hypertrophy (55.0 %) was associated with the most significant changes of diastolic filling: early diastolic mitral annular peak velocity (E’) of 7.68 (6.50; 9.67) cm/sec, E/E’ ratio 8,34 (7.11; 9.04), pulmonary wedge pressure 12.26 (10.72; 13.12) mm Hg, and the highest rate of diastolic dysfunction (85.0 %, 70.0 % of type I). Values of interleukin-33 more than 71 pg/ml with interleukin-1β less than 25 pg/ml (cluster 4) were associated with relatively low left ventricular mass and hypertrophy rate (with equal prevalence of concentric and eccentric variants), the highest E’ values (11.04 (9.49; 12.00) cm/sec) and rate of normal diastolic filling (33.3 %), the lowest E/E’ ratio (5.78 (4,14; 7.74)) and pulmonary wedge pressure (9.07 (7.04; 11.51) mm Hg). A significant increase in interleukin-33 and interleukin-1β serum levels in patients with hypertension was observed compared to healthy persons. Prevalent increase in interleukin 1β level was associated with most significant changes of diastolic filling, despite low rates of hypertrophy. On the contrary, prevalent increase in interleukin 33 had a most favorable influence on the severity of left ventricular hypertrophy as well as diastolic filling.

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O.S. Sychov, A.A. Borodai, T.V. GetmanClinical predictors of the left atrial appendage dysfunction in patients with non-valvular atrial fibrillation.

National Scientific Center “M.D. Strazhesko Institute of Cardiology NAMS of Ukraine”, Kyiv, Ukraine
The aims – to determine association between severe left atrial appendage dysfunction and CHA2DS2VASc score.
Materials and methods. The overall 303 patients with persistent and long persistent were examined consecutively by transesophageal echocardiography. In addition to measurement of the left atrial appendage velocity (LAAV), the atrial appendage was examined for the presence of spontaneous echo contrast (SEC) or thrombi. Results. Severe SEC 4+ was found in 7.09 % of cases, LAA thrombi – in 6.71 % and LAAV ≤ 25 cm/s – in 24.32 % of patients. We found that CHA2DS2VASc score ≥ 2 was significantly associated with LAAV ≤ 25 cm/s (OR 2.18; 95 % CI 1.76–2.6; P=0.007) and SEC 4+ (OR 4.93; 95 % CI 4.37–5.47; Р=0.006). CHA2DS2VASc score ≥ 4 was significantly associated with LAA thrombi (OR 3.1; 95 % CI 2.13–4.06; P=0.033). Conclusion. In patients with CHA2DS2VASc score ≥ 2 transesophageal echocardiography must be performed because of significantly increased risk of severe LAA dysfunction in this group.

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L.N. YakovlevaCombined antihypertensive therapy: focus on fixed combination of enalapril and nitrendipine.

Kharkiv Medical Academy of Postgraduate Education, Ukraine
The problems associated with arterial hypertension, being a powerful, independent and potentially easily detectable and correctable risk factor of fatal cardiovascular events, are reviewed. Despite the development and introduction into clinical practice of highly effective anti-hypertensive medications, adequate control of blood pressure is achieved in
only 30–50 % of patients. The reasons for this low rate of blood pressure effective control are the difficulty of the target blood pressure achieving with monotherapy and low patients adherence to treatment with several drugs. This review discusses the advantages of antihypertensive medications fixed combinations in general, and the combination of angiotensin-converting enzyme inhibitor enalapril and the dihydropyridine calcium antagonist nitrendipine, in particular. The results of clinical studies showing high efficacy of this fixed combination in achieving target blood pressure, good tolerability, organ-protective properties and positive influence on the prognosis are presented.

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Yu.V. Zinchenko, A.V. Doronin, O.Yu. Marchenko, S.V. LizogubDifficulties in diagnosis and treatment of ectopic atrial tachycardia.

National Scientific Center “M.D. Strazhesko Institute of Cardiology NAMS of Ukraine”, Kyiv, Ukraine
Shupyk National Medical Academy of Post-Graduate Education, Kyiv, Ukraine
The presented clinical case showed diagnostic difficulties in diagnosis of ectopic atrial tachycardia, absolute nonefficacy of administered antiarrhythmic therapy along with high result of catheter treatment method. Use of modern diagnostic methods (Holter ECG monitoring, medications tests and intraсardiac eleсtrophysiological examination) may help to precisely diagnose arrhythmia, as well as to introduce moderately invasive methods into practical arrhythmology.

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Ya.M. Logvinov, О.J. Zharinov, K.O. Mikhaliev, O.А. YepanchintsevaEchocardiographic assessment of structure and function of atrial appendages in non-valvular atrial fibrillation.

Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
State Institution of Science “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department, Kyiv, Ukraine
The possibilities of contemporary echocardiographic methods of investigation of atrial appendages structure and function are reviewed in the article. The characteristics of advantages and disadvantages, as well as clinical value of traditional and new technologies of atrial appendages imaging are provided. The echocardiographic criteria of changes of atrial appendages state in non-valvular atrial fibrillation are described. Original data are presented.

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