Ëŕ­Ó┐Ý˝Řŕţ■ | English
usaid banner

Issue. Articles

╣1(52) // 2017




1. Editorial


Cardiovascular diseases in Ukraine as one of the characteristics of public health

I.V. Drozdova1, A.A. Babets2, L.G. Stepanova1, L.V. Omelnytska1

1 SO «Ukrainian State Research Institute Medical and Social Problems of Disability Ministry of Health of Ukraine », Dnipro
2 SO «Dnipropetrovsk State Medical Academy, Ministry of Health of Ukraine»

Objective — to develop approaches to the assessment of morbidity and primary disability due to cardiovascular diseases (CVD), as the characteristics of public health.
Materials and methods. The analysis of the CVD incidence and prevalence was conducted in compliance with the manual «Regional peculiarities of public of health of the people of Ukraine», published by the «National Science Centre “Institute of Cardiology named after acad. Strazhesko” NAMS Ukraine». Analysis of primary disability was peformed according to the guide «Basic indicators of disability and medical and social expert commissions Ukraine for the year 2015» government issued «Ukrainian State Research Institute of Medical and Social Disability Health Ministry of Ukraine». With the use of adaptive methods of short-term forecasting, the analysis and prediction of the morbidity/disability indices was performed. Some new terms were proposed for application: «hidden» morbidity/disability (the difference between the index point forecast for a given year and the actual figure for the same year); «Point forecast»
(a unique morbidity/disability); «Prediction interval» (confidence interval of the morbidity/disability indices for a specified probability of the forecast existence).
Results and discussion. It has been established that in the period of years 2014—2015, the following indices increased in the adult population of Ukraine: CVD prevalence by 0.59 % (63684.8 per 100 thousand population), primary disability due to CVD by 1.03 % (9.8 to 10 thousand population); the morbidity decreased by 1.4 % (5064.2 per
100 thousand population). During this period, in the  working-age population,  the CVD incidence increased by 0.05 % (3612.8 per 100 thousand population) CVD prevalence increased by 1.39 % (33213.2 per 100 thousand population)
and primary disability  decreased  by 4.08 % (9.4 to 10 thousand population).
The adaptive methods of short-term forecasts indicate the possibility of growth in the adult population the CVD incidence in Dnipropetrovskaya, Zhytomyrskaya, and Mykolayivskaya regions; CVD prevalence — in Dnipropetrovs­kaya, Chernivtskaya and Chernihivskaya; primary disability — in ZaporizhskÓya, Rivnenskaya, Ternopilskaya, Khmelnytskaya regions. While the population of working age will increase the CVD incidence in Zhytomyrskaya, Zaporizhskaya, Ivano-Frankivskaya, Mykolaivskaya, Sumskaya, Chernihivskaya regions, Kyiv; CVD prevalence —
in Dnipropetrovskaya, Zhytomyrskaya, Zakarpaskaya, Ivano-Frankivskaya, Kyivskaya, Kirovogradskaya, Lvivskaya, Mykolaivskaya, Odesskaya, Sumskaya, Ternopilskaya, Khmelnytskaya, Chernivetskaya, Chernihivskaya regions and Kyiv; primary disability — in the Zakarpatscaya, Zaporizhskaya, Kyivskaya, Kirovohradskaya and Khmelnytskaya regions.
Conclusions. During the reform of health care system in Ukraine, its reorganization on the basis of health insurance, there is a need for development of new approaches to the organization and operation of monitoring evaluation systems of morbidity/disability indices as indicators of public health of the nation. The development, determination and calculation of new morbidity/disability indices will enable more in-depth analysis of trends change, create foundations for improved management measures in the health system to prevent possible negative trends.

Keywords: cardiovascular diseases, morbidity, disability, monitoring, forecasting.

List of references:
1. Ajvazan SA, Bezhaeva ZI, Staroverov OV. Statistika,1974:240 (in Rus).
2. Babak VP, Biletskiy AJ, Pristavka OP. ╠▓VVZ, 2001:388 (in Russ).
3. Kovalenkţ VM, Kornatsk│ˇ VM. NNZ «▓nstitut kardiologiji im. M.D. Strageska», 2012:211 (│n Ukr).
4. Yemelyanenko TG, Zberovskiy AV, Pristavka AF. RIK NGU, 2005:224 (in Russ).
5. Ipatov AV, Drozdova IV, Xanjukova IJ, Matsuga ON, Chuyko AL. Porogi, 2012:387 (│n Ukr).
6. Xobzej MK, Ipatov AV, Drozdova IV, Xanjukova IJ, Matsuga ON, Sidorova MG et al. Porogi, 2011:269 (│n Ukr).
7. Kendall M, Styuart A. Nauka, 1976:736 (in Russ)
8. Lukashin YP. Finansi i statistica, 2003:416 (in Russ).
9. Ipatov AV, Moroz OM, Golic BA, Perepelichnaya RY, Xanjukova IJ, Korobkin YI et al. (Chernyak SI (Ed.). Aktzent PP, 2015:166 (│n Ukr).
10. Ipatov AV, Moroz OM, Golic BA, Perepelichnaya RY, Xanjukova IJ, Korobkin YI et al. (Chernyak SI (Ed). Aktzent PP, 2016:175 (│n Ukr).
11. Statistica invalidnosti. Rezim dostupu: http://rosspolit.ru/socialnaya-politika/rabota-s-invalidami/statistikainvalidnosti.html. (in Russ).
12. Dorogoy AP, Kirichenko AG, Revenko IL, Manoylenko TS, Moroz DM, Adaricheva ZG, Kravchenko VV. K, 2015:354 (in Ukr).

To download áá
full version need login

Original language: Ukrainian

2. Original researches


Biomarker of insulin resistance in patients with prediabetes, the combination of type 2 diabetes mellitus and arterial hypertension and increased body mass

O.M. Belovol, L.R. Bobronnikova, O.V. Al-Trawneh

Khark│v National Medical University

Objective — tţ study the effects of glypican 4 on the development of insulin resistance, and structural and functional myocardial disorders in patients with pre­diabetes, the combination of type 2 diabetes mellitus (DM 2) and arterial hypertension (AH), and increased body mass.
Materials and methods. The study involved 34 patients with stage II and 2nd degree of with AH without carbohydrate metabolism disorders; 31 patients with pre­diabetes and AH; 37 patients with comorbidity of DM 2 and AH course. The control group (n = 20) was the most comparable in age and sex to the patients surveyed.
Results and discussion. Changes in the glypican 4 levels in blood serum were observed in patients with isolated and combined course of the disease and found raising glypican 4 at the 1st and 2nd groups of patients compared with the control and reduction in patients with the combination of DM type 2 and AH (p < 0.05). Positive correlation relationship of glypican 4 with HOMA-­IR (r = –0.52; p < 0.05) was proved in patients of the 1st and 2nd groups by the level of glucose (r = –0.48; p < 0, 05), BMI (r = –0.48; p < 0.05) and HbA1c (r = –0.57; p < 0.01). Positive correlations of glypican 4 with LVMM (r = 0.48; p < 0.001) and LVMMI (r = 0.46; p < 0.001).
Conclusions. It has been established that Glypican 4 took part not only in the IR formation, but also in the structural and functional myocardial changes in patients with prediabetes and AH. Glypican 4 decrease in blood serum is common among the patients with DM type 2 and AH, and this indicates the loss of compensatory capacities of adipose tissue aimed at correction of the IR. Changes in the concentration of glypican 4 in blood serum has pleiotropic effects on the prediabetes course, DM type 2 in AH and elevated body mass, that is of interest to further research and study.

Keywords: prediabetes, diabetes mellitus type 2, insulin resistance, arterial hypertension, glypican 4.

List of references:
1.    Gangyi Y, Ling L, Wenwen C et al. Circulating preptin levels in normal, impaired glucose tolerance, and type 2 diabetic subjects. Ann Med. 2009;41:52-56.
2.    Hui JZ, Hui P, Yan C et al. The Changes of Serum Glypican4 in Obese Patients With Different Glucose Metabolism Status. JCEM. 2014;99 (12):2697-2701. Doi: https://doi.org/10.1210/jc.2014-2018.
3.    Jin JC, Hye SM, Kitae K et al. Long-term study of the association of adipokines and glucose variability with diabetic complications. Korean J Intern Med. 2016;14. Doi: https://doi.org/10.3904/kjim.2016.114.
4.    Ke L, Xiaohui X, Wenjing H et al. Glypican‑4 is increased in human subjects with impaired glucose tolerance and decreased in patients with newly diagnosed type 2 diabetes. Acta Diabetologica. 2014;51:981-990. Doi: 10.1007/s00592-013.
5.    Lili Z, Ling L, Mengliu Y, Hua L, Gangyi Y. Elevated circulating vaspin levels were decreased by rosiglitazone therapy in T2DM patients with poor glycemic control on metformin alone. Cytokine. 2011;56:399-402.
6.    Marinou K, Christodoulides C, Antoniades C, Koutsilieris M. Wnt signaling in cardiovascular physiology. Trends Endocrinology and Metabolism. 2012;23(12):628-636.
7.    Milewicz A, Kuliczkowska-Plaksej J, Lenarcik-Kabza A et al. Serum glypican‑4 levels and its association with cardiovascular risk predictor in women with polycystic ovary syndrome and healthy controls - ​pilot study Endocrine Abstracts. 2015:37.
8.    Oda E. Metabolic syndrome: its history, mechanisms, and limitations. Acta Diabetol. 2012;49:89-95.
9.    Strate I, Tessadori F, Bakkers J. Glypican‑4 promotes cardiac specification and differentiation by attenuating canonical Wnt and Bmp signaling. Development. 2015;142:1767-1776.
10.    Ussar S, Bezy O, Blüher M, Kahn CR. Glypican‑4 enhances insulin signaling via interaction with the insulin receptor and serves as a novel adipokine. Diabetes. 2012;61:2289-2298.
11.    Ying X, Qian Y, Jiang Y et al. Association of the apolipoprotein B/apolipoprotein A-I ratio and low-density lipoprotein cholesterol with insulin resistance in a Chinese population with abdominal obesity. Acta Diabetol. 2012;49:465-472.
12.    Yoo HJ, Hwang SY, Cho GJ et al. Association of glypican‑4 with body fat distribution, insulin resistance, and nonalcoholic Fatty liver disease. J Clin Endocrinol Metab. 2013;98(7):2897-2901.

To download áá
full version need login

Original language: Russian

3. Original researches


The role of silicon in clinical and pathogenetic construction of systemic sclerosis

O.V. Syniachenko1, V.Ya. Mikuksts1, E.D. Iegudina2, M.V. Iermolaeva1

1 M. Gorky’s Donetsk National Medical University, Lyman
2 SE «Dnipropetrovsk Medical Academy of Health Ministry of Ukraine»

Objective — to determine the silicon levels in blood (SiB) and hair (SiH) of the patients with different course of systemic sclerosis (SSc), determine the effect of endogenous silica and silica levels in the atmosphere in the regions of living such patients on clinical and laboratory signs of the disease, and identify the prognostic criteria.
Materials and methods. The study included 63 patients (11 % men and 89 % women aged 16 to 67 years). A limited SSc form was diagnosed in 43 % of cases, and in 57 % the diffuse form; the mean disease duration was 11 years.
The I degree of pathological process activity was established in 41 % of the patients, the II — 38 %, the III in 21 %.
The SSc positivity by the presence in serum anti-topoisomerase autoantibodies (aScl70) was revealed in 78 % of cases. Silicon levels were measured in serum and hair by atomic absorption spectrometry, and silica contamination of the atmosphere was assessed in patients living areas.
Results and discussion. The increasing by almost 75% of silicon levels was established as typical for SSc, and it was mostly apparent in cases of the diffuse disease form. With this, SiB content influenced on the aScl70 parameters, on the development of Raynaud's syndrome  and liver injury, the SiH levels affected the nature of the esophageal and kidneys’ changes, disorders of myocardial excitability and rate of the pathological process progression. The SiB accumulation tightly correlated with the levels of the atmosphere silica contamination, which determines the aScl70 formation, severity of SSc, the severity of sclerosis cardiomyopathy and nephropathy, thus possessing the prognostic value.
Conclusions. Systemic sclerosis is accompanied with the elevated silicon levels in an organism, and endogenous and exogenous silicon actions on the patients’ organism participates in the  clinical and pathogenetic construction of the disease.

Keywords: systemic sclerosis, silicon, course, pathogenesis.

List of references:

Đ´Ŕ˝ţŕ ŰŔ˛ň­Ó˛ˇ­ű ╣ 2
1.    Al-Mogairen SM. Role of sodium silicate in induction of scleroderma-related autoantibodies in brown Norway rats through oral and subcutaneous administration. Rheumatol Int. 2011;31(5):611-5. doi: 10.1007/s00296-009-1327-3.
2.    Bei Y, Hua-Huy T, Nicco C et al. RhoA/Rho-kinase activation promotes lung fibrosis in an animal model of systemic sclerosis. Exp Lung Res 2016;42(1):44-55. doi: 10.3109/01902148.2016.1141263.
3.    Bello S, Rinaldi A, Trabucco S et al. Erasmus syndrome in a marble worker. Reumatismo 2015;67(3):116-22. doi: 10.4081/reumatismo.2015.826.
4.    Boulanger M, Bienvenu B, Marquignon MF, Letourneux M, Clin B. Systemic sclerosis and occupational exposures: About a case in a driller-powderman. Rev Med Interne. 2015;36(8):551-4. doi: 10.1016/j.revmed.2014.09.003.
5.    Chaouch N, Mjid M, Zarrouk M et al. Erasmus’ syndrome with pseudo-tumour masses. Rev Mal Respir 2011; 28(7):924-7. doi: 10.1016/j.rmr.2011.06.003.
6.    Charni Chaabane S, Coomans de Brachène A, Essaghir A [et al.]. PDGF-D expression is down-regulated by TGFβ in fibroblasts. PLoS One. 2014;9(10):108656. doi: 10.1371/journal.pone.0108656.
7.    Dowson C, Simpson N, Duffy L, O’Reilly S. Innate immunity in systemic sclerosis. Curr Rheumatol Rep. 2017;19(1):2-12. doi: 10.1007/s11926-017-0630-3.
8.    Freire M, Alonso M, Rivera A et al. Clinical peculiarities of patients with scleroderma exposed to silica: A systematic review of the literature. Semin Arthritis Rheum. 2015;45(3):294-300. doi: 10.1016/j.semarthrit.2015.06.004.
9.    Gumuchian ST, Peláez S, Delisle VC et al. Exploring sources of emotional distress among people living with scleroderma: └ focus group study. PLoS One. 2016;11(3):0152419. doi: 10.1371/journal.pone.0152419.
10.    Jiang M, Yu Y, Luo J et al. Bone marrow-derived mesenchymal stem cells expressing thioredoxin 1 attenuate bleomycin-induced skin fibrosis and oxidative stress in scleroderma. J Invest Dermatol. 2017;26(1):172-8. doi: 10.1016/j.jid.2017.01.011.
11.    Lafyatis R, York M. Innate immunity and inflammation in systemic sclerosis. Curr Opin Rheumatol. 2009;21(6):617-22. doi: 10.1097/BOR.0b013e32832fd69e.
12.    Marie I, Gehanno JF. Environmental risk factors of systemic sclerosis. Semin Immunopathol. 2015;37(5):463-73. doi: 10.1007/s00281-015-0507-3.
13.    McCormic ZD, Khuder SS, Aryal BK, Ames AL, Khuder SA. Occupational silica exposure as a risk factor for scleroderma: a meta-analysis. Int Arch Occup Environ Health. 2010;83(7):763-9. doi: 10.1007/s00420-009-0505-7.
14.    Pattanaik D, Brown M, Postlethwaite BC, Postlethwaite AE. Pathogenesis of systemic sclerosis. Front Immunol. 2015;8(6):272-82. doi: 10.3389/fimmu.2015.00272.
15.    Rubio-Rivas M, Moreno R, Corbella X. Occupational and environmental scleroderma. Systematic review and meta-analysis. Clin Rheumatol. 2017;14(1):223-9. doi: 10.1007/s10067-016-3533-1.
16.    Troldborg A, Nielsen BD, Kolstad HA, Olesen AB, Søndergaard KH. Silica exposure and the risk of systemic sclerosis. Ugeskr Laeger. 2013;175(8):501-3.
17.    Wei P, Yang Y, Guo X et al. Identification of an association of TNFAIP3 polymorphisms with matrix metalloproteinase expression in fibroblasts in an integrative study of systemic sclerosis-associated genetic and environmental factors. Arthritis Rheumatol. 2016;68(3):749-60. doi: 10.1002/art.39476.
18.    Zielonka TM, Demkow U, Radzikowska E et al. Angiogenic activity of sera from interstitial lung disease patients in relation to pulmonary function. Eur J Med Res. 2010;15(4):229-34.

To download áá
full version need login

Original language: Russian

4. Original researches


Early diagnosis and adequate treatment of patients with cor pulmonale

A.L. Alyavi1, D.A. Rahimova1, Z.T. Sabirzhanova2

1 Republican Specialized Scientific and Practical Medical Center of Therapy and Rehabilitation, Tashkent, Republic of Uzbekistan
2 Tashkent Pediatric Medical Institute, Uzbekistan, Republic of Uzbekistan

Objective — to expose the psycho-vegetative disorders, to asses the quality of life of the patients with bronchial asthma (BA) with the changed parameters of the cardio-pulmonary hemodynamics, as well as evaluation of comparative efficacy of the ozone and herbal therapy in the complex treatment of this category of patients.
Materials and methods. The study was aimed on the investigation of the relationship of psychological factors and state of the quality of life of patients with the right ventricular remodeling and involved patients with BA, complicated with cor pulmonale (CP). Besides, the efficacy of the ozone and herbal therapy in the complex treatment schemes.
Results and discussion. As a result of investigation, the development of maladaptative conditions of the psychical regulatory factors was defined, that were stipulated with the reduction of ventilator pulmonary ability and prolonged cerebral hypoxia. In BA patients with CP, the development of the RV dilatation resulted in the more pronounced aggravation of the quality of life in terms of their physical state and level of satisfaction with treatment.  In patients with BA, complicated with the CP and pulmonary hypertension this maladaptation was apparent in a form of emotional state and decrease of the quality of professional capacity (p < 0.05). This should be taken into account on the stage of the treatment choice.
Conclusions. It has been established that ozone therapy against the background of standard therapy promoted the reduction of the disturbances of psycho-emotional status and improvement of the quality of life of patients.

Keywords: bronchial asthma, pulmonary heart, pulmonary hypertension, right ventricular hypertrophy and dilatation, the right ventricle of the heart.

To download áá
full version need login

Original language: Russian

5. Original researches


Heart rate variability, serum chemerin and nesfatin 1 in patients with hypertension associated with obesity

O. M. Kovalyova, T. V. Ashcheulova, S. V. Ivanchenko, O. V. Honchar

Kharkiv National Medical University

╬bjective — to investigate the relation between serum chemerin and nesfatin 1 levels and parameters of heart rate variability (HRV) in patients with hypertension, depending on the presence and grade of obesity.
Materials and methods. Holter ECG monitoring was performed in 82 hypertensive patients aged 60 (55 to 66) years (include in 26 overweight and 39 obese patients). The patients were divided into four groups: the 1st one consisted of patients with hypertension and normal body weight, n = 17, the mean BMI value 22.75 [21.5 to 24.0] kg/m2; the 2nd group included patients with hypertension and overweight, n = 26, BMI 26.85 [25.84 to 27.60] kg/m2; the 3rd consisted of  patients with hypertension and I grade obesity, n = 16, BMI 32.44 [31.8 to 42.8] kg/m2. The serum chemerin and nesfatin 1 levels were determined by ELISA using Human Chemerin and Human Nesfatin 1 ELISA Kits (Kono Biotech Co., Ltd., China). Statistical analysis was performed using Statistica for Windows 6.1 software package (Statsoft Inc., USA). Statistical analysis was performed using Mann—Whitney, Pearson criteria. Quantitative parameters were described with median (Me), the values of the upper (UQ) and lower (the LQ) quartiles sample.
Results and discussion. The results of intergroup analysis showed significant differences between the groups of hypertensive patients with normal weight and groups of patients with overweight and different grades of obesity in the following parameters: HRV as SDNN24, rMSSD, average daily heart rate, TF, HF, LF/HF and circadian index (CI)
of heart rate. Correlation analysis in hypertensive patients with normal weight showed a strong negative correlation between levels of chemerin (r = –0.9) and nesfatin 1 (r = – 0.7, p < 0.05) and serum SDNN24 and SDANN24; strong positive correlation (r = 0.7, p < 0.05) between serum levels of both cytokines and the number of ventricular ectopic beats (VEB); strong positive correlation (r = 0.8, p < 0.05) between serum chemerin and LF/HF ratio. Patients with hypertension and I gr. obesity had a strong positive correlation (r = 0.8, p < 0.05) between serum chemerin and LF component of HRV. Hypertensive patients with high grades of obesity had a strong positive correlation (r = 0.7,
p < 0.05) between serum chemerin and VEB and a strong negative correlation (r = –0.7, p < 0.05); between serum chemerin and CI. Serum levels of nesfatin 1 in this group negatively correlated with SDNN24 (r = –0.7, p < 0.05).
Conclusions. The HRV indices in patients with hypertension, overweight and obesity indicate the presence of autonomic imbalance with attenuation of parasympathetic activation. For patients with hypertension, a rigid circadian rhythm of the heart is typical, the severity of which depends on the presence and grade of obesity. The correlation analysis revealed significant negative relationship between the serum nesfatin 1 and general HRV in the observed patients. Serum chemerin levels in patients with overweight and obesity were not associated with indices of general HRV, but in most clinical groups showed a direct relationship with the markers of sympathetic hyperactivation — capacity of LF component of HRV, LF / HF ratio and, as a possible consequence, a number of VEB.

Keywords: hypertension, obesity, Holter monitoring, adipocytokines, metabolic syndrome.

List of references:
1.    Bilovol OM, Kovalova OM, Popova SS ta in. Ozhyrinnia v praktytsi kardioloha ta endokrynoloha [Obesity in cardiologist and endocrinologist practice].(Ukr). Ternopil: Ukr medknyha; 2009: 620.
2.    Zharinov OY, Kuts VO. Kholterivske ta frahmentarne monitoruvannia EKH [Holter and fragmentary ECG monitoring]. (Ukr). Kyiv; 2010:127.
3.    Zhuravleva LV. Sovremennaja strategija lechenija arterial’noj gipertenzii. Metodicheskie rekomendacii dlja vrachej internov, vrachej kardiologov, vrachej terapevtov, vrachej obshhej praktiki [Modern strategy of hypertension treatment. Guidelines for interns, cardiologists, internists, general practitioners]. (Rus). Har’kov, HNMU; 2013:24.
4.    Kovaleva ON, Ambrosova TN, Ashheulova TV, Getman EA. Adipokiny: biologicheskie, patofiziologicheskie i metabolicheskie jeffekty. [Adipokines: biological, pathophysiological and metabolic effects]. (Rus) Vnutrennjaja medicina [Internal medicine] (Rus). 2009;3(15):14-19.
5.    Kovalenko VM, Kornatskyi VM. Problemy zdorovia i medychnoi dopomohy ta model pokrashchannia v suchasnykh umovakh [Problems of health and medical care and improved model in modern conditions]. (Ukr). K.: Hordon; 2016:261
6.    Mal’ceva LM, Shishkin AN. Variabel’nost’ ritma serdca kak prediktor serdechno-cosudistoj patologii u pacientov s metabolicheskim sindromom. [Heart rate variability as a predictor of cardiovascular pathology in patients with metabolic syndrome] (Rus). Vestnik SPbGU. 2012;1:18-22.
7.    Jabluchanskij NI, Martynenko AV. Variabel’nost’ serdechnogo ritma v pomoshh’ prakticheskomu vrachu. Dlja nastojashhih vrachej [Heart rate variability in care practitioner. For actual doctors]. (Rus). Har’kov; 2010:131.
8.    Alexander ═, Paul JM, Richard A et al. The relationship between heart rate variability and inflammatory markers in cardiovascular diseases. Psychoneuroendocrinology. 2008;33 (10):1305-1312.
9.    Ayada C, Toru Ü, Korkut Y. Nesfatin‑1 and its effects on different systems. Hippokratia. 2015;19 (1):4-10. [PubMed].
10.    Bartness TJ, Shrestha YB, Vaughan CH et al. Sensory and sympathetic nervous system control of white adipose tissue lipolysis. Mol Cell Endocrinol. 2010;29(318):34-43. [PubMed].
11.    ┬ozaoglu K, Bolton K, McMillan J et al. Chemerin is a novel adipokine associated with obesity and metabolic syndrome. Endocrinology. 2007;148:4687-4694.
12.    2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hyperten. 2013;31(7):1281-1357.
13.    Haensel A, Mills PJ, Nelesen RA et al. The relationship between heart rate variability and inflammatory markers in cardiovascular diseases. Psychoneuroendocrinology. 2008;33:1305-1312. [PubMed].
14.    Barbosa-Ferreira M, Mady C, Ianni BM et al. Dysregulation of Autonomic Nervous System in Chagas’ Heart Disease Is Asso­ciated with Altered Adipocytokines Levels. PLoS One. 2015;10(7). Doi: 10.1371/journal.pone.0131447. [PubMed].
15.    Shah RV, Murthy VL, Abbasi SA et al. Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study. JACC Cardiovasc Imaging. 2014;7(12):1221-1235. [PubMed].
16.    Villareal RP, Liu BC, Massumi A. Heart rate variability and cardiovascular mortality. Curr Atheroscler Rep. 2002.;4:120-127. [PubMed].

To download áá
full version need login

Original language: Ukrainian

6. Original researches


Clinical and laboratory parameters in patients with chronic heart failure with preserved ejection fraction and type 2 diabetes mellitus

Yu. S. Rudyk1, ╬. ╬. Medentseva1, O. V. Vysotska2

1 SI «National Institute of Therapy named after L. T. Mala of NAMS of Ukraine», Kharkiv
2 Kharkiv National University of Radioelectronics

Objective — to investigate the features of clinical and laboratory parameters in patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (DM 2).
Materials and methods. The investigation involved 83 patients with HFpEF of II—III NYHA classes (32 males and
51 females; mean age (62.9 ± 9.7) years), including 45 patients with HFpEF and DM 2 and 38 non-diabetic patients, as well as 10 healthy individuals. Blood glucose was determined with glucose oxidase test; glycated hemoglobin (HbA1) level with by immunoenzyme method (ELISA); serum insulin levels were measured with enzyme multiplied immunoassay, and index HOMA-IR was calculated. The serum levels of ST2, NT­-pro­BNP, TNF-­alfa in were determined with ELISA. To assess lipid metabolism, levels of total cholesterol (total cholesterol), HDL cholesterol, triglycerides (TG) were determined. The size of the left atrium (LA), right atrium (PP) and right ventricular (RV), end-systolic and left ventricular end-diastolic dimension (ESD, EDD), LV EF, the speed LV early diastolic filling to the flow velocity in systole ratio (E/A), isovolumic relaxation time (IRVT) and slowing down time of blood transmitral flow early diastolic filling (DST) were investigated with Doppler echocardiography.
Results and discussion. In patients with HFpEF and DM 2, fasting blood glucose, insulin and HOMA index were higher than in the group without diabetes (p = 0.01). The lipid exchange indices, total cholesterol, TG were higher in patients with HFpEF and DM 2 than in patients without diabetes (p < 0.05). The fibrosis markers ST2, NT-proBNP and TNF-­alfa levels did not differ in patients with HFpEF and DM 2 and non-diabetic. NT-proBNP level was significantly lower in the control group than in patients with HFpEF (p = 0.001). Comparison of diastolic LV parameters revealed significant differences in the ratio E/A, indicating a diastolic disorders aggravation in patients with HFpEF and DM 2 (­ < 0.05).
Conclusions. The results testified that patients with HFpEF and DM 2 have expressed metabolic disorders in a form of hyperglycemia, hyperinsulinemia, insulin resistance and dyslipidemia compared to the non-diabetic patients. The LV diastolic dysfunction is more pronounced in patients HFpEF and DM 2 than without it. The DM 2 presence was not associated with the increased levels of ST2, NT-proBNP, TNF-alfa in patients with HFpEF.

Keywords: heart failure with preserved ejection fraction, diabetes mellitus type 2, ST2, insulin resistance, lipid metabolism.

List of references:
1.    Aurigemma GP, Gottdiener JS, Shemanski L, Gardin J, Kitzman D. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: The Cardiovascular Health Study. J Am Coll Cardiol. 2001;37:1042-1048.
2.    Brunner-LaRocca HP. Inflammation in HFPEF: key or circumstantial? Int J Cardiol. 2015;189:259-263.
3.    Canepa M, Strait JB, Milaneschi Y et al. The relationship between visceral adiposity and left ventricular diastolic function: Results from the Baltimore Longitudinal Study of Aging. Nutr Metab Cardiovasc Dis. 2013;23:1263-1270.
4.    Carolyn SP. Diabetic cardiomyopathy: An expression of stage B heart failure with preserved ejection fraction. Lam Diabetes & Vascular Disease Research. 2015;12 (4):234-238.
5.    Cas AD, Fonarow GC, Gheorghiade M, Butler J. Concomitant Diabetes Mellitus and Heart Failure. Curr Probl Cardiol. 2015;40:7-43.
6.    Chackerian AA, Oldham ER, Murphy EE et al. IL‑1 receptor accessory protein and ST2 comprise the IL‑33 receptor complex. J Immunol. 2007;179:2551-2555.
7.    Diabetic Cardiomyopathy; Summary of 41 Years. 2015 The Korean Society of Cardiology.
8.    2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.
9.    Frioes F, Lourenco P, Laszczynska O et al. Prognostic value of sST2 added to BNP in acute heart failure with preserved or reduced ejection fraction. Clin Res Cardiol. 2015;104:491-499.
10.    Goode KM, John J, Rigby AS et al. Elevated glycated haemog­lobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus. Heart. 2009;95:917-923.
11.    Greenberg B.H, Abraham WT, Albert NM et al. Influence of diabetes on characteristics and outcomes in patients hospitalized with heart failure: are port from the Organized Program to Initiate Life saving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J 2007;154:277.e1-e8.
12.    Hogg ╩, Swedberg ╩, McMurray J. Heart Failure with preserved left ventricular systolic function. Epidemiology, Clinical Characteristics, and Prognosis. J Am Coll Cardiol. 2004;43(3):317-327.
13.    Horwich TB, Fonarow GC. Glucose, obesity, metabolic syndro­me, and diabetes relevance to incidence of heart failure. J Am Coll Cardiol. 2010;55:283-93.
14.    Jia G, De Marco VG, Sowers JR. Insulin resistance and hyper­insulinaemia in diabetic cardiomyopathy. Nat Rev Endo­crinol. 2016;12 (3):144-153.
15.    Kane GC, Karon BL, Mahoney DW et al. Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA. 2011;306:856-863.
16.    Lin YH, Zhang RC, Hou LB et al. Diabetes. Distribution and clinical association of plasma soluble ST2 during the development of type 2 diabetes. Res Clin Pract. 2016;118:140-145.
17.    MacDonald MR, Eurich DT, Majumdar SR et al. Treatment of type 2 diabetes and outcomes in patients with heart failure: a nested case-control study from the UK General Practice Research atabase. Diabetes Care. 2010;33:1213-1218.
18.    Mogelvang R, Sogaard P, Pedersen SA et al. Cardiac dysfunc­tion assessed by echocardiographic tissue Doppler imaging is an independent predictor of mortality in the general population. Circulation. 2009;119:2679-2685.
19.    Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93:1137-1146.
20.    Nichols GA, Gullion CM, Koro CE et al. The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care. 2004;27 (8):1879-1884.
21.    Nodari S, Manerba A, Vaccari A et al. Six-year prognosis of diabetic patients with coronary artery disease. Eur J Clin Invest. 2012;42:376-383.
22.    Romeo R, Scalisi C, Tafuri L et al. Different characteristics of chronic heart failure (CHF) in elderly diabetics and non-diabetics. Arch Gerontol Geriatr. 2010;50 (1):101-104.
23.    Shane Nanayakkara, Kaye DM Management of Heart Failure With Preserved Ejection Fraction: A Review. Clin Therapeutics. 2015;37 (10).
24.    Weinberg EO, Shimpo M, Hurwitz S et al. Identification of Serum Soluble ST2 Receptor as a Novel Heart Failure Biomarker. Circulation. 2003;107:721-726.

To download áá
full version need login

Original language: Russian

7. Original researches


The role of ST2 in patients with acute myocardial infarction with ST elevation

O. V. Petyunina, ╠. đ. Kopytsya, Ya. V. ═ilova, L. L. Peteniova, N.V. Tytarenko

SI «National Institute of Therapy named after L. T. Mala of NAMS of Ukraine», Kharkiv

Objective — to investigate the role of ST2 in patients with acute myocardial infarction with ST elevation (STEMI).
Materials and methods. The study involved 65 patients hospitalized to the Intensive Care Unit of SI «National Institute of Therapy named after L. T. Mala of NAMS of Ukraine». The selective coronary angiography with stenting of infarction depending artery were performed to all patients. The ST2 levels were detected with ELISA with the use of reactive Presage ST2 Assay, Critical Diagnostics, USA. Statistical data processing was carried out using the package Statistica 8.0 statistical software (StatSoft Inc, USA), Microsoft Office Ex˝el 2003).
Results and discussion. It has been established that  increased ST2 levels testified about the early remodelling of left ventricle. It levels in women was higher than in men, proving their greater vulnerability to the coronary injury. The presence of stable angina before myocardial infarction contributes to the lower ST2 levels, confirming the development of collaterals in this group of patients.
Conclusions. The increased ST2 levels testify the presence of the early LV remodelling. The ST2 levels after the STEMI was higher in women than in men, proving their greater vulnerability to the coronary injury.

Keywords: acute myocardial infarction with ST elevation, ST2, left ventricular remodelling.

List of references:
1.    Protasov VN, Skvortsov AA, Koshkiina DE et al. Ispolzovanie sovremennych biomarkerov v stratifikatsyi riska patsientov z serdechnoy nedostatochnostiyu. Kardiologicheski vestnic. 2014;4:100-107.
2.    Anand SI, Rector TS, Kuskowski M et al. Prognostic value of soluble ST2 in the Valsartan Heart Failure Trial. Circ Heart Failure. 2014;7:418-426.
3.    Bonnie K, French B, McCloskey K et al. High sensitive ST2 for prediction of adverce outcomes in chronic heart failure. Circulation. Heart Failure. 2011;4:180-187.
4.    Ciccone MM, Cortese F, Gesualdo M et al. A novel cardiac bio-marker: ST2: a revier. Molecules. 2013;18:15324-15328.
5.    Demyanets S, Speidl VS, Tentzeris I et al. Soluble ST2 and Interleukin‑33 in coronary artery disease: relation to disease activity and adverse outcome. Plos ONE. 2014;9(4):e95055. Doi:10.1371/journal.pone.0095055.
6.    Hamm CW, Bassand J-P, Agewall S et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569-2619.
7.    Kohli P, Bonaca MP, Kakkar R et al. Role of ST2 in non-ST-elevation acute coronary syndrome in the MERILIN-TIMI 36 trial. Clin Chem. 2012;58(1):257-266.
8.    Wang TJ, Wollert KC, Larson MG. et al. Prognostic utility of novel biomarkers of cardiovascular stress. The Frammingham Heart Study Circulation. 2012;126:1596-1604.
9.    Weir RA, Miller A M, Murphy GE et al. Serum soluble ST2. J Am Coll Cardiol. 2010;55:243-250.

To download áá
full version need login

Original language: Ukrainian

8. Original researches


The potential of alfa-lipoic acid and zinc sulfate in correction of cardiac rhythm abnormalities in patients with type 2 diabetes mellitus who have had myocardial infarction

V.G. Lizogub, N.V. Altunina, ╬.M. Bondarchuk

O.O. Bogomolets National Medical University, Kyiv

Objective — to investigate the dynamics of cardiac rhythm abnormalities in patients with type 2 diabetes mellitus (DM) who have had non-Q-myocardial infarction (non-Q-MI), during treatment with alfa-lipoic acid (ALA) and zinc sulfate (Zn).
Materials and methods. The examinations involved 49 patients (mean age — (60.97 ± 1.59) years) with type 2 DM who have had non-Q-MI. To the basic treatment of patients, ALA 600 mg/day and sulfate Zn 248 mg/day were added during 4 months. The assessment of cardiac rhythm was perfomed at baseline and after the treatment completion.
Results and discussion. The comparison of the baseline data of ECG Holter monitoring (HM) of the investigated patients with the subjects from control significantly higher prevalence of supraventricular (SVES) and ventricular extrasystoles (VES) (­ < 0.0001), paired SVES (­ < 0.0001) and VES ≥ 10/h (­ < 0.05) in postinfarction patients with type 2 DM. Besides, in these patients the following events were reveled: SVES ≥ 60/h, VES ≥ 30/h and VES ≥ 60/h, paired VES, group SVES and VES, polymorphic and early VES. In addition, in examined patients it was recorded the paroxysms of supraventricular tachycardia (SVT) and atrial fibrillation (AF), «runs» of ventricular tachycardia.
Analyzing HM ECG data in patients with type 2 DM with a history of non-Q-MI after 4 months of using ALA with Zn sulfate, it was found a valid decrease in the prevalence of SVES by 8.2 % (p < 0.05) with the reduction of register pair SVES by 18.3 % (p < 0.05). It is also recorded a positive downward trend in the paired VES by 16.4 % (p < 0.2), group SVES (p < 0.2) and VES (p < 0.2) by 14.3 % and 10.2 %, accordingly, paroxysms of AF by 6.2 % (p < 0.2) and SVT by 8.2 % (p < 0.2).
Conclusions. The use of ALA and Zn sulfate for 4 months in patients with type 2 DM who have had MI, has a positive effect on supraventricular arrhythmias, reducing their prevalence.

Keywords: cardiac rhythm abnormalities, type 2 diabetes mellitus, non-Q-myocardial infarction, alfa-lipoic acid, zinc sulfate.

List of references:
1.    Balcioglu AS, Muderrisoglu H. Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular conse­quen­ces, diagnosis and treatment. World J Diabetes. 2015;6 (1):80-91. Doi: 10.4239/wjd.v6.i1.80.
2.    Bodiga VL, Thokala S, Vemuri PK, Bodiga S. Zinc pyrithione inhibits caspase-3 activity, promotes ErbB1-ErbB2 hetero­di­merization and suppresses ErbB2 downregulation in cardio­myocytes subjected to ischemia/reperfusion. J Inorg Bio­chem. 2015;153:49-59. Doi: 10.1016/j.jinorgbio.2015.09.010.
3.    Broskova Z, Kyselova Z, Knezl V. Ischemia-reperfusion injury of the isolated diabetic rat heart: effect of the antioxidant stobadine. Gen Physiol Biophys. 2013;32(2):285-292. Doi: 10.4149/gpb_2013028.
4.    Cao X, Chen A, Yang P et al. Alpha-lipoic acid protects cardiomyocytes against hypoxia/reoxygenation injury by inhibiting autophagy. Biochem Biophys Res Commun. 2013;441 (4):935-940. Doi: 10.1016/j.bbrc.2013.10.166.
5.    Đastiglione RC, Barros CM, Boa BC, Bouskela E. Micro­cir­culatory effects of zinc on fructose-fed hamsters. Nutr Metab Cardiovasc Dis. 2016;26 (4):310-317.
6.    Chen X, Bing Z, He J et al. Downregulation of peroxisome proliferator-activated receptor-gamma expression in hyperten­sive atrial fibrillation. Clin Cardiol. 2009;32(6):337-345. Doi: 10.1002/clc.20566.
7.    Deng C, Sun Z, Tong G et al. α-Lipoic acid reduces infarct size and preserves cardiac function in rat myocardial ischemia/reperfusion injury through activation of PI3K/Akt/Nrf2 pathway. PloS One. 2013;8 (3): e58371. Doi: 10.1371/journal.pone.0058371.
8.    De Sensi F, De T Potter, Cresti A et al. Atrial fibrillation in patients with diabetes: molecular mechanisms and therapeutic pers­pectives. Cardiovasc Diagn Ther. 2015;5(5):364-373. Doi: 10.3978/j.issn.2223-3652.2015.06.03.
9.    Dudek M, Knutelska J, Bednarski M et al. Alpha lipoic acid protects the heart against myocardial post ischemia-reperfusion arrhythmias via KATP channel activation in isolated rat hearts. Pharmacol Rep. 2014;66(3):499-504. Doi:10.1016/j.pharep.2013.11.001.
10.    Foster TS. Efficacy and safety of alpha-lipoic acid supplemen­tation in the treatment of symptomatic diabetic neuropathy. Diabetes Educ. 2007;33:111-117. Doi: 10.1177 /0145721706297450.
11.    Israil CW, Lee-Barkey YH. Sudden cardiac death in diabetes mellitus. Herz. 2016;41 (3):193-200. Doi: 10.1007/s00059-016-4421-9.
12.    Karagulova G, Yue Y, Moreyra A et al. Protective role of intracellular zinc in myocardial ischemia/reperfusion is associated with preserva­tion of protein kinase C isoforms. J Pharmacol Exp Ther. 2007;321 (2):517-525. Doi: 10.1124/jpet.107.119644.
13.    Khan MI, Siddique KU, Ashfaq F et al. Effect of high-dose zinc supplementation with oral hypoglycemic agents on glycemic control and inflammation in type-2 diabetic nephropathy patients. J Nat Sci Biol Med. 2013;4:336-340. Doi: 10.4103/0976-9668.117002.
14.    Marelli AJ, Mackie AS, Ionescu-Ittu R et al. Congenital heart disease in the general population. Changing prevalence and age distribution. Circulation. 2007;115:163-172. Doi: 10.1161/CIRCULATIONAHA.106.627224.
15.    Migra M, Kovar F, Mokan M. The arrhythmias in patients with diabetes mellitus. Vnitr Lek. 2013;59 (5):361-365.
16.    Nakou ES, Mavrakis H, Vardas PE. Are Diabetic Patients at Increased Risk of Arrhythmias?. Hellenic J Cardiol. 2012;53:335-339.
17.    Reiterer G, Toborek M, Hennig B.  Peroxisome proliferator activated receptors alpha and gamma require zinc for their anti-inflammatory properties in porcine vascular endothelial cells. J Nutr. 2004;134 (7):1711-1715.
18.    Schoen T, Pradhan AD, Albert CM, Conen D. Type 2 Diabetes Mellitus and Risk of Incident Atrial Fibrillation in Women. J Am Coll Cardiol. 2012;60 (15):1421-1428. Doi: 10.1016/j.jacc.2012.06.030.
19.    Shah MS, Brownlee M. Molecular and cellular mechanisms of cardiovascular disorders in diabetes. Circ Res. 2016;118 (11):1808-1829. Doi: 10.1161/CIRCRESAHA. 116.306923.
20.    Ying Z, Kampfrath T, Sun Q et al. Evidence that α-lipoic acid inhibits NF-κB activation independent of its antioxidant function. Inflamm Res. 2011;60 (3):219-225. Doi: 10.1007/s00011-010-0256-7.
21.    Ziegler D, Schatz H, Conrad F et al. Effects of treatment with the antioxidant alpha-lipoic acid on cardiac autonomic neuropathy in NIDDM patients. A 4-month randomized controlled multicenter trial (DEKAN Study). Deutsche Kardiale Autonome Neuropathie. Diabetes Care. 1997;20:369-373.

To download áá
full version need login

Original language: Ukrainian

9. Original researches


The prevalence of ventricular premature beats and phenomenon of heart rate turbulence among the subjects with cardiovascular diseases and risk factors of cardiovascular events as per SCORE scales

A.I. Vytryhovskiy

SHEE «Ivano-Frankivsk National Medical University»
Ivano-Frankivsk Regional Cardiological Center

Objective — to study the prevalence of ventricular premature beats and phenomenon of heart rate turbulence among the subjects with cardiovascular diseases and risk factors of cardiovascular events as per SCORE scale, to develop new approaches to the prediction and prevention of life-threatening arrhythmias based on the assessment of their status and effects on the heart rate variability and turbulence.
Materials and methods. The study involved 603 patients to determine the role of heart rate (HR) variability in cardiovascular continuum and 319 patients to study the role of HR turbulence and their role in the formation and progression of sudden death based on the Holter monitoring of cardiac rhythm. All patients were divided into four groups: 1 group consisted of patients with coronary heart disease (CHD), without the associated risk factors, such as smoking, obesity, metabolic syndrome; 2 group included patients — tobacco smokers for more than 2 years; 3 group involved patients with metabolic syndrome, without existing CHD or hypertension; 4 group consisted of  patients with metabolic syndrome and existing hypertension. The control group included 149 subjects. The HR variability, turbulence and prevalence of HR disorders was performed with the use of Holter monitoring system CardioSens 2008, CardioSens + V3.0 and CardioSens CS («MEDICA-HAI», Kharkiv, Ukraine).
Results and discussion. It has been determined that prevalence of both isolated ventricular arrhythmia and simultaneous ventricular and supraventricular arrhythmias was significantly higher in  the tobacco smokers vs healthy individuals. Among the smokers, the high percentage was observed of the unfavourable ventricular premature beats in a form of both early premature beats and group beats, and it was significantly higher (almost in two times) than is healthy subjects. Arterial hypertension in subject with metabolic syndrome insignificantly increased the incidence of the ventricular premature bears. As compared to the heathy subjects, the metabolic syndrome dis not significantly increase levels of the ventricular arrhythmia prevalence. Among practically healthy people, every fourth person had deviations of the indices of HR turbulence, and every 17th subject had considerable deviations and respectively the high risk of sudden death.
Conclusions. Determination of the heart rate variability and turbulence is quite simple, non-invasive, affordable screening method for early detection of patients with the susceptibility to sudden cardiac death in the general population.

Keywords: ventricular fibrillation, sudden cardiac death, heart rate turbulence.

List of references:
1. Asots│ats│ya kard│olog│v Ukra│ni. L│kuvannya shlunochkovikh porushen' sertsya ta prof│laktika raptovo│̈ sertsevo│̈ smert│. Rekomendats││̈ Robocho│̈ grupi z porushen' ritmu sertsya Asots│ats││̈ kard│olog│v Ukra│̈ni. Ki│̈v 2012:27.
2. Gensh N. Rekomendatsii American Association po uluchsheniyu vyzhivayemosti bol'nykh posle vnutribol'nichnoy vnezapnoy ostanovki sertsya (2013): kratkiy obzor. Medicine Review. 2013;2(25):13-24.
3. Lipovets'ka SY. Al'ternats│ya zubtsya T │ turbulentn│st' sertsevogo ritmu - ​ne │nvazivn│ markeri raptovo│̈ sertsevo│̈ smert│. Aritmolog│ya.2013;2(6):32-42.
4. Rekomendats││̈ Asots│ats││̈ kard│olog│v Ukra│̈ni. L│kuvannya shlunochkovikh porushen' sertsya ta prof│laktika raptovo│̈ sertsevo│̈ smert│. Ki│̈v 2009:68.
5. Shlyakhto YeV, Bergardt ▓R, Parmon YeV. Turbulentnost' serdechnogo ritma v otsenke riska vnezapnoy smerti. Vestnik aritmologii. 2011;38:49-51.
6. ┬erger JS, Jordan CO, Lloyd-Jones D, Blumental RS. Screening for cardiovascular risk in asymptomatic patients. J Am Coll Card. 2010;55:1169-1177.
7. Berkowitsch A, Guettler N, Neumann T et al. Turbulence jump - ​a new descriptor of heart-rate turbulence after paced premature ventricular beats. A study in dilated cardiomyopathy patients. Eur Heart J. 2001;22:2941.
8. Berkowitsch A, Zareba W, Neumann T et al. Risk stratification using heart rate turbulence and ventricular arrhythmia in MADIT II: usefulness and limitations of a 10-minute holter recording. Ann Noninvasive Electrocardiol. 2004;3:270-279.
9. Ghuran A, Reid F, La Rovere MT et al. Heart rate turbulence-based predictors of fatal and nonfatal cardiac arrest (The Autonomic Tone and Reflexes After Myocardial Infarction substudy). Am J Cardiol. 2002;89:184-190.
10.    Grimm W, Schmidt G, Maisch B et al. Prognostic significance of heart rate turbulence following ventricular premature beats in patients with idiopathic dilated cardiomyopathy. J Cardiovasc Electrophysiol. 2003;8:819-824.
11.Grimm W, Sharkova J, Maisch B. Prognostic significance of heart rate turbulence in patients with idiopathic dilated cardiomyopathy. Europace. 2002;3(153):146-152.
12.    Kawasaki T, Azuma A, Asada S et al. Heart rate turbulence and clinical prognosis in hypertrophic cardiomyopathy and myocardial infarction. Circ J. 2003;7:601-604.
13. Proclemer A, Dagres N, Marinskis G, Pison L, Lip GYH, Blomstom-Lundqvist C, conducted by the Scientific Initiative Committee Europian Heart Rhythm Association. Đurrent practice in Europe: how do we manage patients with ventricular tachycardia? Europian Heart Rhythm Association survey. Europace. 2013;15:167-169. doi: 10.1093/ europace/eus436.
14.    Schwab JO, Coch M, Veit G et al. Post-extrasystolic heart rate turbulence in healthy subjects: influence of gender and basic heart rate. Circulation. 2001.;104(490):2324.
15.    Watanabe MA, Josephson ME. Heart rate turbulence in the spontaneous ventricular tachyarrhythmia database. PACE. 2000;23(II):686.

To download áá
full version need login

Original language: Ukrainian

10. Original researches


The peculiarities of hereditary predisposition to arterial hypertension and osteoarthritis in the centenarians of Subcarpathia Region

R. V. Kozoviy

SHEE «Ivano-Frankivsk National Medical University»

Objective — to determine clinical and genealogical peculiarities of the risk of developing arterial hypertension and osteoarthritis in the centenarians.
Materials and methods. The detailed clinical and genealogical, as well as statistical analysis of genealogical trees of 486 centenarians living in Ivano-Frankivsk region has been performed.
Results and discussion. It has been established, that 56.79 % of centenarians had first­ or second degree relatives with arterial hypertension and osteoarthritis. Among centenarians with genetic predisposition, there were 108 (39.17 %) males and 118 (60.83 %) females. The comparison of the degree of genetic family history in centenarians has revealed close to a probable predominance of genetically predisposed males (χ2 = 3.19; ­ = 0.074). A strong correlation between the degree of arterial hypertension in first degree relatives, parents, brothers, sisters (r = 0.711; 0.699; 0.686 respectively) has been proven. The development of arterial hypertension in later life of centenarians was defined as the peculiarity of the expression susceptibility genes. The authors established that among the examined centenarians, the predisposition to high blood pressure and its implementation in the phenotype was most commonly maternally inherited rather than paternally. The fact that 49.21 % of the examined males had mothers with osteoarthritis was revealed as peculiarity of osteoarthritis inheritance among centenarians of the Subcarpathia region. The genealogical trees where the proband’s father was affected by osteoarthritis were recorded twice as rare.
Conclusions. The presence of first­ or second degree relatives with arterial hypertension and osteoarthritis is of great importance for the development of arterial hypertension and osteoarthritis in centenarians as confirmed by 56.79 % of genealogical trees. The peculiarity of concomitant pathology manifestation in centenarians of Group I was the presence of relatives with two studied signs in 36.30 % of cases. There is a twofold risk of inheritance of arterial hypertension and osteoarthritis if they are inherited maternally. The results of clinical and genealogical study indicated polygenic and multifactorial inheritance of arterial hypertension and osteoarthritis in centenarians of the Subcarpathia region

Keywords: arterial hypertension, osteoarthritis, clinical and genealogical analysis, genetic predisposition.

List of references:
1.    Bochkov NV. Klynycheskaya henetyka: Uchebnyk. 2-e yzd., pererab. y dop. M.: HEOTAR-MED, 2002:448.
2.    Hlushko LV, Koval'chuk LYe, Symchych KhS. Diagnosis of hereditary predisposition to hypertension under conditions of rural family medicine (UKR). Klinichna ta eksperymental'na patolohiya [Clinical & Experimental Pathology] (UKR). 2010;4(34):16-19.
3.    Kravchun PG, Olhovsky DV, Kadykova OI. Genetic aspects of the pathogenesis of arterial hypertension in patients with diabetes mellitus (UKR). Medytsyna s'ohodni i zavtra. (UKR). 2012;3/4(56-57):61-68.
4.    Krylov AA. To the problem of combining diseases. (Rus) Klynycheskaya medytsyna (Rus). 2000;1:56-58.
5.    Rehional'ni medyko-sotsial'ni problemy khvorob systemy krovoobihu. Dynamika ta analiz: Analitychno-statystychnyy posibnyk (UKR). Kyiv: NNTs «Instytut kardiolohiyi imeni akad. M. D. Strazheska»; 2013:236.
6.    Sydorenko A, Endr'yus H. The UN leads the research program on aging in the 21st century (Rus). Uspekhy herontolohy (Rus). 2000;4:269-270.
7.    Shuba NM, Voronova TD, Tarasenko TM. New aspects of pathogenesis of osteoarthritis and ways of correction (UKR). Ukrayins'kyy medychnyy chasopys. (UKR). 2012;2(88)-III/IV:113-119.
8. Smith SC, Collins A, Ferrari R et al. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). J Am Coll Cardiol. 2012;60:2343-2348.

To download áá
full version need login

Original language: Ukrainian

11. Original researches


Carbohydrate and lipid metabolism in patients with coronary heart disease and obesity with different genotypes of the gene of interleukin 6 (C 174G)

O.▓. Kadykova

Kharkiv National Medical University

Objective — to assess the carbohydrate and lipid metabolism in patients with coronary heart disease (CHD) and obesity depending on the different genotypes of gene interleukin 6 (C 174G).
Materials and methods. The complex investigation involved 222 patients with CHD and obesity. The comparison control group included 115 patients with CHD and normal body weight. The control group consisted of 35 apparently healthy people. Additionally, the patients with CHD and obesity were divided into subgroups depending on the genotype of gene interleukin 6 (IL 6) (C 174G): group 1 included carriers of G/G genotype (n = 131), group 2 consisted of subjects with C/G genotype (n = 67), group 3 included carriers of C/C genotype (n = 24). The study of polymorphous locus of IL 6 (C 174G) gene was carried out with the method of polymerase chain reaction with electrophoretic detection of findings. In order to control carbohydrate metabolism, the level of glucose was assessed with glucose oxidative method; the whole blood glycated hemoglobin (HbA1˝) levels were measured with photometric technique through the reaction with thiobarbituric acid; insulin levels were defined  with immunoenzyme method. The lipid metabolism indices were defined with enzyme method on autoanalyzer in fasting blood serum and by formulas. Moreover, the anthropometric parameters of the waist and hips measurements (WM and HM), and neck measurements (NM) were defined. Quetelet index for obesity characteristics and insulin resistance HOMA-IR were calculated using the known formulas.
Results and discussion. The investigation of carbohydrate metabolism indices in patients with CHD and obesity depending on genotypes of polymorphic loci C 174G of gene of IL 6 showed that the values of glucose, HbA1c, insulin and HOMA-IR in patients with genotypes C/C and C/G did not differ from the normal values. In turn, the genotype G/G was associated with glucometabolic disorders: insulin level and HOMA-IR were respectively (12.51 ± 0.63) mc
U/ml and (2.48 ± 0.39) units, which exceeded the values of healthy people. BMI in patients with G/G genotype were significantly higher values at 13.84 and 13.97 %, than those with C/G and C/C genotypes respectively (p < 0.05). There were not significant differences in anthropometric indices (waist measurement, hip measurement, waist/hip measurement, body mass index, neck measurement). No significant differences in lipid parameters depending on the polymorphic locus of the genotypes C 174G gene of IL 6 were found (p > 0.05).
Conclusions. G/G genotype of the polymorphic locus C 174G of the gene of IL 6 in patients with coronary heart disease and obesity had a negative impact on carbohydrate metabolism by hyperinsulinemia and IR progression, whereas lipid metabolism in patients examined not related to any of the polymorphic genotypes C 174G locus of the gene of IL 6.

Keywords: coronary heart disease, obesity, the genotype of the gene of interleukin 6, carbohydrate metabolism, lipid metabolism.

List of references:
1.    Cardellini M, Perego L, D’Adamo M et al. C‑174G Polymorphism in the Promoter of the Interleukin‑6 Gene Is Associated With Insulin Resistance. Diabetes Đare. 2005;28(8):2007-2012.
2.    Fernandez-Real JM, Broch M, Vendrell J et al. Interleukin‑6 gene polymorphism and insulin sensitivity. Diabetes. 2000;49:517-520.
3.    Ferreira AP, Ferreira CB, Souza VC et al. Risk of glycemic disorder in elderly women adjusted by anthropometric parameters and cytokine genotypes. Rev Assoc Med Bras. 2011;57:565-569.
4.    Henningsson S, Håkansson A, Westberg L et al. Interleukin‑6 Gene Polymorphism –174G/C Influences Plasma Lipid Levels in Women. Obesity. 2006;14(11):1868-1873.
5.    Ho KT, Shiau MY, Chang YH et al. Association of interleukin‑6 promoter polymorphisms in Taiwanese patients with type 2 diabetes mellitus. Metabolism. 2010;59(12):1717-1722.
6.    Kubaszek A, Pihlajamaki J, Punnonen K et al. The C‑174G promoter polymorphism of the IL‑6 gene affects energy expenditure and insulin sensitivity. Diabetes. 2003;52:558-561.
7.    Phulukdaree A, Khan S, Ramkaran P et al. The interleukin‑6-147 g/c polymorphism is associated with increased risk of coronary artery disease in young South African Indian men. Metab Syndr Relat Disord. 2013;11:205-209.
8.    Saxena M, Agrawal C.G, Srivastava N, Banerjee M. Interleukin‑6 (IL‑6)-597 A/G (rs1800797) & –174 G/C (rs1800795) gene polymorphisms in type 2 diabetes. Indian J Med Res. 2014;140(1):60-68.
9.    Sun GQ, Wu GD, Meng Y, Du B, Li YB. IL‑6 gene promoter polymorphisms and risk of coronary artery disease in a Chinese population. Genetics and Molecular Research. 2014;13(3):7718-7724.
10.    Teixeira AA, Redublo Quinto BM, Dalboni MA. et al. Association of IL‑6 Polymorphism –174G/C and Metabolic Syndrome in Hypertensive Patients. BioMed Res International. 2015;2015:1-6.
11.    Tretjakovs P, Latkovskis G, Licis N et al. Interleukin‑6 gene promoter –174G/C polymorphism and insulin resistance: a pilot study. Clin Chem Lab Med. 2007;45(9):1145-1148.
12.    Underwood PC, Chamarthi B, Williams JS et al. Replication and meta-analysis of the gene-environment interaction between body mass index and the interleukin‑6 promoter polymorphism with higher insulin resistance. Metabolism. 2012;61:667-671.
13.    Vozarova B, Fernandez-Real JM, Knowler WC et al. The interleukin‑6 (–174) G / C promoter polymorphism is associated with type‑2 diabetes mellitus in Native Americans and Caucasians. Hum Genet. 2003;112:409-413.
14.    Xie F, Qian Q, Chen Z et al. Chitinase 3-like 1 gene‑329G/A polymorphism, plasma concentration and risk of coronary heart disease in a Chinese population. Gene. 2012;499:135-138.
15.    Yang Y, Zhang F, Skrip L. et al. IL‑6 gene polymorphisms and CAD risk: a meta-analysis. Mol Biol Rep. 2013;40:2589-2598.

To download áá
full version need login

Original language: Ukrainian

12. Original researches


Changes in the physical properties of the oral fluid in chronic obstructive pulmonary disease in comorbidity with coronary heart disease

N.Yu. Emelyanova

SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv

Objective — ​to assess the change in the physical properties of the oral fluid and the state of local immunity in chronic obstructive pulmonary disease (COPD) patients in comorbidity with coronary heart disease (CHD) against the background of basic therapy.
Materials and methods. The study included 130 patients diagnosed with COPD in comorbid with CHD (main group) and 71 patients of the comparison group with an CHD diagnosis. The control group consisted of 20 somatically healthy patients. A dental examination included a questioning of patients with detailed complaints, clinical examination of the oral cavity, examination of the physical characteristics of the mixed saliva (salivation rate, viscosity, pH) and the level of slgA in the oral fluid by the ELISA method.
Results and discussion. It has been established that the most frequent complaints among patients were dryness and burning in the oral cavity, distortion of taste, halitosis, hyperesthesia and bleeding gums. The frequency of occurrence of these complaints was significantly higher in the main group. It was noted that in the patients of the main group the rate of salivation significantly decreased (0.150—0.300 ml/min), the viscosity (5.800 units) and acidity (pH = 6.50) of mixed saliva increased. In patients with COPD in comorbidity with CHD, there was an increase in the concentration of sIgA, which may be due to antigenic tissue irritation by microorganisms.
Conclusions. More than 80 % of patients with COPD in comorbidity with CHD have typical dental complaints. One of the side effect of basic therapy for COPD and CHD can be attributed to changes in the physical properties of mixed saliva, expressed by a decrease in the secretion rate, as well as increased acidity and viscosity properties.

Keywords: chronic obstructive pulmonary disease, coronary heart disease, xerostomia, salivation rate, viscosity, secretory immunoglobulin A.

To download áá
full version need login

Original language: Russian

13. Reviews


Syndrome of pulmonary hypertension at the comorbidity of chronic obstructive pulmonary disease and coronary heart disease

╬.╬. Krakhmalova, ╬.└. Hetman

SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv

The review highlights the results of recent scientific researches with investigation of the topic problem of the contemporary cardiology and pulmonology, the formation of pulmonary hypertension syndrome in patients with combination of chronic obstructive pulmonary disease and coronary heart disease. The prevalence of this complex of symptoms has been considered, as well as its effects on patients’ survival, the main factors of pathogenesis, the role of cytokine imbalance, endothelial dysfunction, and genetic disturbances. The topicality of the investigation of new biochemical markers of pulmonary hypertension has been outlined.

Keywords: chronic obstructive pulmonary disease, coronary heart disease, comorbidity, pulmonary hypertension syndrome, pathogenesis factors.

To download áá
full version need login

Original language: Russian

14. Reviews


Dyslipidemia in chronic kidney disease: some peculiarities of pathogenesis and correction

V. A. Chernyshov

SI «National Institute of Therapy named after L. T. Mala of NAMS of Ukraine», Kharkiv

The review is devoted to an actual problem of lipidology such as secondary dyslipidemia (DLP) in chronic kidney disease (CKD) and some peculiarities of its pathogenesis and correction. A place of DLP in the structure of traditional and non-traditional factors of cardiovascular risk (CVR) in CKD is shown. A contribution of CKD in elevation of CVR is discussed. Some pathophysiological mechanisms of DLP in nephrotic syndrome, chronic renal failure, diabetic nephropathy as well as after kidney transplantation are considered. The data about peculiarities of blood lipoprotein(a) concentration and the role of paraoxonase activity in the development of DLP in CKD are given. Special peculiarities of DLP correction in persons with CKD connected with statins, fibrates and omega 3 polyunsaturated acid prescription are expounded.

Keywords: chronic kidney disease, dyslipidemia, pathogenesis, correction.

List of references:
1.    Berezin AE. Triglyceride plasmalevel elevation and cardiovascular risk. Ukrainskyi medychnyi chasopys. 2009;71(3):70-76. (in Russ.)
2.    Dzyak GV, Egorov KU, Kolesnik EL. Pitavastatin - ​a new HMG-CoA reductase inhibitor: the peculiarities of clinical pharmacology and the perspectives of usage in treatment of cardiovascular disease. Arterial Hyper. 2013;32(6):9-15. (in Russ.)
3.    Ishuk VA. Lipid exchange abnormalities correction in patients at high cardiovascular risk. Ukr med chasopys. 2011;84(4):64-65. (in Russ.)
4.    ╩uryata AV, Frolova AE. The perspectives of omega‑3 polyunsaturated fatty acids application in patients with cardiovascular disease and chronic kidney failure. Zdorov’ya Ukrainy. 2008;187(6):61. (in Russ.)
5.    ╩uryata AV, Frolova AE. Lipid spectrum and vascular endothelium function in patients with the 3rd stage of chronic kidney disease. The efficacy of combined therapy with ezetimibe and atorvastatin. Ukr med chasopys. 2011;86(6):71-73. (in Russ.)
6.    Rudenko VG. Enlargment of indications for omega‑3 polyunsaturated fatty acids in clinical practice: cardiological, vascular and non-cardiovascular indications. Krovoobig ta hemostaz. 2008;3:73-76. (in Russ.)
7.    Al-Jameil N, Khan FA, Arjumand S et al. Dyslipidemia and its correlation with type 2 diabetic patients at different stages of proteinuria. Biomedical Research. 2014;25(3):327-331.
8.    Amman K, Benz K. Statins: Beyond lipids in CKD. Nephrol Dial Transplant. 2011;26:407-410.
9.    Berglund L, Brunzell J, Goldberg A, Ira J. Evaluation and treatment of hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97(2):2969-2989.
10.    De Vuono S, Ricci MA, Mannarino MR, Lupattelli G. Dyslipidemias and chronic kidney disease: a focus on pathogenesis and treatment. Clin Lipidol. 2014;9(6):673-681.
11.    Eren E, Yilmaz N, Aydin O. High density lipoprotein and its dysfunction. Open Biochem J. 2012;6:78-93.
12.    2016 ESC / EAS Guidelines for the management of dyslipidaemias. Atherosclerosis. 2016;253:281-344.
13.    Hermans M. Non-invited review: prevention of microvascular diabetic complications by fenofibrate: lessons from FIELD and ACCORD. Diab Vasc Dis Res. 2011;8:180-189.
14.    James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet. 2010;375:1296-1309.
15.    Jun M, Foote C, Lev J et al. Effects of fibrates on cardiovascular outcomes: review and meta-analysis. Lancet. 2010;375:1875-1878.
16.    Kalaitzidis R, Elisaf M. The role of statins in chronic kidney disease. Am J Nephrol. 2011;34:195-202.
17.    Masquita J, Varela A, Medina JL. Dyslipidemia in renal disease: causes, consequences and treatment. Endocrinol Nutr. 2010;57(9):440-448.
18.    Nakamura T, Sato E, Fujiwara N et al. Coadministration of ezetimibe enhance proteinuria-lowering effect of pitavastatin in chronic kidney disease patients partly via a cholesterol - ​independent manner. Pharmacol Res. 2010;61(1):58-61.
19.    Prakash M, Phani N. M, Kavya R, Supriya M. Paraoxonase: its antiatherogenic role in chronic renal failure. Indian J. Nephrol. 2010;20(1):9-14.
20.    Precourt LP, Amre D, Denis MC, Lavoie JC et al. The three-gene paraoxonase family: physiologic roles, actions and regulation. Atherosclerosis. 2011;214(1):20-36.
21.    Reiner S, Catapano A, De Backer G et al. ESC/EAS Guidelines for the management of dyslipidaemias. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) developed with the special contribution of European Association for cardiovascular Prevention and Rehabilitation. Eur Heart J. 2011;32:1769-1818.
22.    Riella LV, Gabardi S, Chandraker A. Dyslipidemia and its therapeutic challenges in renal transplantation. Am J Transplant. 2012;12:1975-1982.
23.    Rye KA. Biomarkers associated with high-density lipoproteins in atherosclerotic kidney disease. Clin Exp Nephrol. 2013;18(2):247-250.
24.    She ZG, Chen HZ, Yan Y, Li H, Liu DP. The human paraoxonase gene cluster as a target in the treatment of atherosclerosis. Antioxid Redox Signal. 2012;16(6):597-632.
25.    Shoji T, Abe T, Matsuo H et al. Chronic kidney disease, dyslipidemia and atherosclerosis. J Atheroscler Thromb. 2012;19(4):299-315.
26.    Shoji T, Emoto M, Kawaghishi T. Atherogenic lipoprotein changes in diabetic nephropathy. Atherosclerosis. 2011;156:425-433.
27.    Solati M, Mahboobi HR. Paraoxonase enzyme activity and dyslipidemia in chronic kidney disease patients. J Nephropathology. 2012;1(3):123-125.
28.    Soran H, Hama S, Yadav R, Durrington PN. HDL functionality. Curr Opin Lipidol. 2012;23:353-366.
29.    Suchy D et al. Ezetimibe - ​a new approach in hypercholersterolemia management. Pharmacological Reports. 2011;63:1335-1348.
30.    Tsimihodimos V, Mitrogianni Z, Elisaf M. Dyslipidemia associated with chronic kidney disease. Open Cardiovasc Med J. 2011;5:41-48.
31.    Tudor MN, Mitrea A, Popa SG, Zaharie S et al. Apolipoproteins: good markers for cardiovascular risk in patients with chronic kidney disease and dyslipidemia. Rom J Diabetes Nutr Metab Dis. 2014;21(3):185-191.
32.    Varga E, Seres I, Harangi M et al. Low high-density lipoprotein cholesterol is not responsible for decreased paraoxonase activity in chronic renal failure. Kidney Blood Press Res. 2012;35(4):265-272.
33.    Watts GF, Karpe F. Triglycerides and atherogenic dyslipidemia: Extending treatment beyond statins in the high-risk cardiovascular patient. Heart. 2011;97:350-356.
34.    Yamamoto S, Kon V. Mechanisms for increased cardiovascular disease in chronic kidney dysfunction. Curr Opin Nephrol Hypertens. 2009;18:181-188.
35.    Yamamoto S, Yancey PG, Ikizler TA. et al. Dysfunctional high-density lipoprotein in patients on chronic hemodialysis. J Am Coll Cardiol. 2012;60(23):2372-2379.

To download áá
full version need login

Original language: Russian