The aim – to study the occurrence, features of clinic, to develop the tactics and methods of surgical treatment of left ventricle posterior-basal area (LV PBA) , to estimate the methods of resection of aneurysm in such location «from within», the plastic repair of the LV defect and to determine the future of the aneurysm sack.

Materials and methods. Surgical treatment was performed at 6.307 patients with CAD in М.M. Amosov National Institute of Cardio-Vascular Surgery within the period from 2000 – till 2009 (10 years). In 1.011 (16.7 %) of them CAD was combined with frontal-superior septal aneurysms of the left ventricle (FSSALV), LV PBA was diagnosed in 58 (0.9 %) patients. Out of 58 patients with LV PBA, the resection of aneurysm was executed at 35 patients. 23 patients with the wall of the small LV PBA consisting of the muscle tissue and without mitral insufficiency did not undergo resection of the aneurism. Only coronary artery bypass grafting was performed.

Results and discussions. According to the statistical data of 6.307 protocols of operations for CAD, we fixed that LV PBA developed at 58 (0.92 %) patients. In the structure of heart post-attack aneurisms of the left ventricle (n = 1.069), surgical treatment of posteriorbasal aneurisms was indicated in 35 (3.4 %) patients. The efficacy of LV PBA resection «from inside» technique and LV plastic reconstruction, which was estimated in the dynamics, confirmed a substantial 41.8 % end-diastolic volume decrease accompanied by end-systolic volume decrease and 27.0 % EF increase, end-diastolic diameter LV, systolic pressure in pulmonary artery decrease by 53.3 and 39.2 %, respectively.

Conclusions. Aneurysms of the posteriorbasal areas of the left ventricle which need surgical correction comprise 3.4 % of all postinfarction aneurisms. Small LV PBAs are subjected to resection if their walls consist of thin connective tissue and are linked to mitral insufficiency. The unique method of LV PBA resection and LV defect plastic repair with a further hermetic suture of the aneurism sac edges is characterized by simplicity and availability. It provides a good effect of LV geometry restoration and its systolic function improvement immediately after the operation.

Keywords: aneurysm of the left ventricle, aneurysmectomy, endoventriculoplasty.

The aim – to analyze the effect of statin therapy on exercise tolerance, endothelial function and indicators of systemic inflammation (serum levels IL-6) in patients with hemodynamically insignificant coronary artery (CA) atherosclerosis.

Materials and methods. We examined 70 patients with hemodynamically insignificant atherosclerosis (HIA) of 1–3 CA, according to X-ray contrast angiography (AG): 44 men (62.9 %) and 26 women (37.1 %) of mean age 55.4 ± 1.3 years and 50 practically healthy individuals with intact CA and negative results of a treadmill test (control group). The survey included: evaluation of serum levels of total cholesterol (TC), high density lipoprotein cholesterol (HDLC), triglycerides (TG), low density lipoprotein cholesterol (LDLC), endothelin-1 and cytokine interleukin-6, endothelium dependent vasodilation (EDVD) and endothelium independent vasodilation (EIVD) of the brachial artery, treadmill test. Atorvastatin («Atoris» KRKA, Slovenia) in the dose of 20 mg/day, acetylsalicylic acid in the dose of 75 mg (once a day) and metoprolol for antihypertensive and/or antianginal therapy (75 ± 25 mg/day) were prescribed to patients with HIA.

Results and discussion. The levels of total cholesterol and TG were not significantly different in patients with HIA from those in the healthy group (at lower levels of HDLC and LDLC). After 6 months of receiving atorvastatin in the dose of 20 mg / day the patients with HIA revealed the reduction of TC by 41 % (p < 0.01), LDLC – by 39 % (p < 0.01), TG – by 25 % (p < 0.05). Target LDLC (< 2.5 mmol/l) was achieved in 57 (81.4 %) patients. Time and power consumption in patients with HIA were significantly lower than in the control group (all p < 0.05). During the treatment, the frequency of positive tests decreased by 59 % (p < 0.05), the occurrence of ST segment depression at a load of < 7 MET – by 83.5 %. Power load increased by 13.4 %, its duration – by 15.5 % (all p < 0.05). At the same time, both indices reached the average level in healthy individuals (all p > 0.05). The reduction of EDVD was observed in 32 (45.7 %) patients with HIA and in 3 (6 %) healthy individuals (p < 0.05). 23 (32.9 %) patients with HIA, unlike healthy persons, manifested a spasm of the brachial artery, which indicates a pronounced endothelial dysfunction (p < 0.05). Average EIVD in the groups did not differ (p > 0.05). After therapy with atorvastatin for 6 months, EDVD in patients with HIA increased by 37 % (p < 0.01) and reached the level of healthy individuals. In patients with HIA the serum levels of endothelin-1 was 4.5 times higher (p < 0.001), interleukin-6 – by 94.3 % higher (p < 0.01) than in the healthy persons. After treatment the levels of endothelin-1 decreased by 47 %, of interleukin-6 – by 42 % (all p < 0.001). Inverse correlation of an average degree was revealed between the intensity of LDLC reduction (in absolute and relative terms) and absolute and relative increase in exercise tolerance, absolute and relative EDVD and significant decrease of serum levels of endothelin-1 and interleukin-6 (all p < 0.05 – 0.001).

Conclusions. Patients with HIA (according to X-ray contrast AG) have endothelial dysfunction (according to flow-dependent vasodilation and serum level of endothelin-1), which is accompanied by a significant increase in the content of proinflammatory interleukin-6 in serum and clinical presentation of stable angina of I – II FC with ischemic response in the test with graduated exercise in 31.4 %. Treatment of patients with atorvastatin in the doze of 20 mg/day for 6 months led to an increase in exercise tolerance by 13.4 % with a decrease in the frequency of ischemic response, which was associated with an increase in EDVD by 37 % and a decrease of serum levels of endothelin-1 by 47 % and interleukin-6 by 42 %. Positive dynamics of these indicators correlates with the intensity of the lipid effect of atorvastatin.

Keywords: endothelial function, coronary atherosclerosis, exercise tolerance, interleukin-6, endothelin-1.

The aim – to study the role of hyperinsulinemia in the formation of adipokine profile impairment in overweight and lipotrophy arterial hypertension (AH) patients.

Materials and methods.We examined 72 overweight AH patients (21 men and 51 women) of mean age (59.39 ± 1.61) years with concomitant lipotrophy (body mass index > 25 kg/m2). The control group consisted of 21 practically healthy patients (7 men and 14 women) of mean age (43.38 ± 3.11) years. The examination included the determination of: height, body mass, waist circumference (WC), body mass index (BMI), glucose levels in the blood serum, glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), cholesterol of high density lipoproteins (CS HDL), apolipoprotein B (apoB), adipokines, of tumor necrosis factor

Keywords: arterial hypertension, overweight, lipotrophy, carbohydrate and lipid metabolism, adipokine, adiponectin.

The aim – assessment of left ventricular (LV) systolic function with the level of apoptosis of mononuclear cells, the state figures of hemo-vascular homeostasis, endothelial function and serum level of TNF-α for elderly patients with chronic heart failure (HF) and a history of Q-myocardial infarction (MI).

Materials and methods. The following indicants were determined in 20 healthy persons of 60–74 years and 80 patients with coronary heart disease (CHD) and postinfarction cardiosclerosis: end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), the size of the left atrium (LA), levels of aggregation platelet activity, vasomotion endothelial function, TNF-α, fibrinogen, antithrombin III, plasminogen, protein C, von Willebrand factor, spontaneous and induced apoptosis. Depending on the value of LVEF the patients were divided into two groups: I group – 36 patients with preserved LV systolic function (EF > 45 %) and Group II – 44 patients with impaired LV systolic function (EF ≤ 45 %).

Results and discussion. The value of ESV was in the control group (41.7 ± 3.4) ml, in group I – (76.75 ± 7) ml, group II – (132.4 ± 8.6) ml, EDV – (103 ± 14.3), (151.12 ± 13.4) and (203 ± 12.4) ml, respectively, EF – (65 ± 2.5), (49.13 ± 2.82) and (34.7 ± 2.3) %, LA – (3.35 ± 0.25), (4.24 ± 0.12) and (4.95 ± 0.27) cm. The lower LVEF indicates an increase in the activity of platelet aggregation (spontaneous aggregation – by (4.7 ± 0.3), (6.35 ± 0.48) and (8.27 ± 0.9) %, respectively, adrenaline-induced – (41.8 ± 2.3), (51.66 ± 4.41) and (68.24 ± 6.7) %, ADP-induced – (37.5 ± 2.2), (43.9 ± 3.1) and (58.02 ± 4.28) %), severity of endothelial dysfunction (output volume rate of skin blood flow – (1.30 ± 0.13), (0.87 ± 0.06) and (0.65 ± 0.07) ml/min/100 g, respectively, endothelial function – (73.6 ± 5.3), (59.7 ± 4.1) and (47.9 ± 4.6) %), activation of plasma hemostasis (fibrinogen – (2.85 ± 0.042), (5.27 ± 0.58) and (7.54 ± 0.83) g/l, respectively), antithrombin III – (100.6 ± 2.3), (73.4 ± 2.3) and (67.5 ± 1.7) %, protein C – (0.95 ± 0.10), (0.65 ± 0.04) and (0.55 ± 0.04) units, plasminogen – (103.1 ± 1.8), (74.4 ± 2.5) and (66.9 ± 2.7) %. Deterioration of hemo-vascular homeostasis in patients with severe systolic dysfunction of the myocardium promotes activation of apoptosis (spontaneous apoptosis index – (25.5 ± 2.3), (42.4 ± 4.1) and (68.5 ± 7.8) %, respectively, the index of induced apoptosis – (32.3 ± 3.1), (52.2 ± 4.6) and (73.72 ± 8.63) %.

Conclusions. In old patients with chronic HF and a history of Q-myocardial infarction, the decrease of LVEF is associated with increased levels of apoptosis of mononuclear cells, more pronounced increase in levels of TNF-α, increased platelet aggregation and activation of plasma hemostasis, as well as deepening of endothelial dysfunction. In old patients with chronic HF, the activation of apoptosis is correlated with the deterioration of hemo-vascular hemostasis, as evidenced by the presence of the correlation between the level of spontaneous apoptosis and the level of fibrinogen (r = 0.24, p < 0.05), TNF)α (r = 0.65, p < 0.05), endothelial function (r = 0.3, p < 0.05) and the degree of spontaneous platelet aggregation (r = 0.28, p < 0.05). The progression of systolic dysfunction in old patients with CHD and a history of Q-myocardial infarction is closely associated with activation of apoptosis, as evidenced by the presence of the correlation between the level of spontaneous apoptosis and LVEF (r = – 0.33, p < 0.05).

Keywords: hemo-vascular hemostasis, myocardial remodeling, systolic myocardial dysfunction, elderly patients, apoptosis.

The aim – to study the natriuretic function of kidneys and determine the influence of renin-angiotensin-aldosterone system (RAAS) activity on natriuresis in different salt-reactivity types of essential arterial hypertension (EAH).

Materials and methods. 56 patients aged (47.1 ± 4.4) years with stage ІІ EAH have been examined. The effective plasma volume (EPV) was estimated by glycemic and postural tests as well as by sodium taste threshold. Renal sodium handling was assessed by clearance tests during maximal water diuresis. Plasma levels of angiotensin II and aldosterone were measured by immunoassay. To determine the salt-reactivity types of blood pressure (BP) we used a dietary protocol that consisted of both lowand high-salt regimens.

Results and discussion. The patients were classified as salt-resistant (n = 20), salt-sensitive (n = 26) and «paradoxical reactive» (n = 10) ones. The salt-resistant patients during both regimens preserved renal sodium handling, constant extracellular fluid volume, euvolaemia, and absence of significant BP changes, which associated with an adequate modulation of RAAS activity. Natriuresis in salt-sensitive patients was preserved only in low-salt regimen. On the contrary, a high-salt diet, due to the insufficient RAAS suppression, induced in them a relatively increased proximal sodium reabsorption, extracellular fluid retention, hypervolaemia, and a significant increase of BP. In «paradoxical reactive» patients, the low-salt regimen led to a relatively increased natriuresis caused by insufficient proximal sodium reabsorption. That led to haemodynamically significant hypovolaemia and compensatory RAAS hyperactivation preventing EPV reduction and causing the increase of BP. High-salt regimen restored an adequate natriuresis and extracellular fluid volume.

Conclusions. Salt-resistant patients with EAH have normal RAAS activity that associates with adequate natriuresis and euvolaemia in both low) and high-salt diets. In salt-sensitive hypertensive patients, a high-salt diet induces insufficient RAAS suppression that causes renal sodium retention and hypervolaemia. In «paradoxical reactive» hypertensives, a low-salt diet causes excess of natriuresis, hypovolaemia and RAAS hyperactivation which leads to a stable BP elevation.

Keywords: essential arterial hypertension, blood pressure salt-reactivity, renin-angiotensin-aldosterone system, sodium chloride, natriuresis, effective plasma volume.

The aim – to compare the blood insulin and glucose levels during glucose tolerance test (GTT) in patients with optimal or normal blood pressure (BP) and grade 1 arterial hypertension (AT) with consideration of presence and severity of obesity.

Materials and methods. 58 patients with grade 1 AT were examined (average systolic BP – 150.0 ± 1.6 mm Hg, diastolic BP – 90.1 ± 1.0 mm Hg), mean age 47.9 ± 1.1 years. The control group consisted of 35 patients with optimal or normal BP (average systolic BP – 121.3 ± 2.9 mm Hg, diastolic BP – 78.3 ± 1.1 mm Hg), mean age 46.5 ± 1.3 years (p > 0.05). Daily BP monitoring was done besides the office BP measurement. Glucose and insulin level and homeostasis model assessment – insulin resistance index (HOMA-IR) were checked during fasting and postprandial (1 and 2 hour after meal) GTT.

Results and discussion. Obesity was revealed in 32 (55 %) patients of the main group and in 3 (9 %) patients of the control group (p < 0.001). Insulin level in all three probes was significantly higher (p < 0.01) in hypertensive persons than in the control group (14.84 ± 3.52 vs 9.97 ± 1.68 μIU/ml, 60.57 ± 3.74 vs 37.63 ± 4.81 μIU/ml, 33.85 ± 3.86 vs 17.89 ± 2.71 μIU/ml respectively). Peripheral blood glucose concentration in one hour after meal was bigger in the main group (7.03 ± 0.29 mmol/l) than in the controls (5.92 ± 0.29 mmol/l), (p < 0.01). Index HOMA-IR was higher in the hypertensive than non-hypertensive persons before meal (3.06 ± 0.34 vs 2.26 ± 0.50, p < 0.01), in one hour (19.48 ± 1.96 vs 11.01 ± 1.92, p < 0.001) and in two hours (8.21 ± 1.11 vs 4.31 ± 0.72, p < 0.05) after glucose load. In non-obese patients with grade 1AT, insulin level in an hour after meal was higher than in the control group (52.76 ± 6.26 vs 36.38 ± 5.06 μIU/ml, p < 0.05). Differences in insulin and glucose levels and index HOMA-IR were not found between persons with combination of AT and obesity and non-obese hypertensive patients (p > 0.05).

Conclusions. In comparison with non-hypertensive persons, patients with grade 1 AT, 55 % of which are obese, are characterized by a higher glucose level in one hour after glucose load and insulin concentration before meal and in one and two hours after glucose load. Even non-obese grade 1 AT patients with normal GTT are characterized with an elevated insulin concentration in one hour after standard glucose load as compared with the control group.

Keywords: arterial hypertension, hyperinsulinemia, obesity, glucose tolerance test.

The aim – to perform a comparative estimation of change of heart rate variability (HRV) indicators during myocardial infarction (MI) of the posterior (inferior) wall of the left ventricle (LV) with or without involvement of the right ventricle in dynamics of the acute period.

Materials and methods. 40 patients with first LV MI with Q-wave of the posterior-inferior localization in the first 12 h from the disease onset were surveyed. 20 patients were included in I group with MI of LV posterior-inferior wall and involvement of the right ventricle (RV); II group included 20 patients with LV MI of the same localization, but without involvement of RV. Definition of time and spectral indicators of HRV, and Doppler-Echo-CG investigation were performed in all patients on the 7–10 day and on the 20–24 day.

Results and discussion. A significant decrease in time indexes – SDNN, RMSSD, pNN50 (all р < 0.01) was found in both groups of patients in comparison with the healthy persons on the 10 day of the disease, at rest. During this period of investigation, when the heart rate was identical, all indicators of time area of HRV in І group were authentically lower (р < 0.05) than in ІІ group. Significant (р < 0.01) increase of all three time indicators of HRV in comparison with the results of the first inspection was noted on the 24 day in ІІ group of patients, whereas only SDNN was essentially (by 42.9 %) elevated (р < 0.05) in І group. The values of SDNN, RM SSD and PNN50 in І group remained significantly lower (р < 0.01) than in ІІ group. Considerable (р < 0.01) increase in LF/HF relation during the analysis of spectral distribution indicators in both groups of patients as compared with the healthy persons was noticed on the 10 day,. At the same time, the LF/HF value in І group was significantly higher (р < 0.05) than in ІІ group. HF indicator in І group was authentically lower than in ІІ group (р < 0.01). Significant decrease in initially raised LF/HF relation (by 1.2 (р < 0.05) and 1.4 times (р < 0.01) in I and II groups, accordingly) was noted in both groups on the 24th day. The decrease in LF/HF relation in both groups in the dynamics of hospitalization on the 24th day occurred at the expense of HF increase (by 1.32 and 1.28 times (р < 0.01) in I and II groups, accordingly). The analysis of correlations between the basic HRV indicators at rest and indicators of intracardiac haemodynamics revealed significant inverse correlation of high force between SDNN and dRV, authentic direct correlations of different force between SDNN and FSRV, LVEF, HI. significant direct correlations between LF/HF and dRV and significant reverse correlations of different force between LF/HF and FSRV, LVEF, HI (all р < 0.01).

Conclusions. The analysis of time and spectral indicators of HRV during MI with involvement of LV and RV on 7-10 days of the disease revealed that there was pathological activation of sympathetic nervous system and a more pronounced oppression of the parasympathetic part of the vegetative nervous system than at isolated MI of the same (inferior) localization. They remained till the 24 day, despite the absence of LV systolic dysfunction and considerable improvement of RV systolic function.

Keywords: myocardial infarction, right ventricle, heart rate variability.

The aim – to assess the influence of combined antihypertensive therapy with angiotensin converting enzyme inhibitor and betablocker and metabolic therapy with trimetazidine on structural-functional state of the hearts, intracardial and systemic hemodynamics in hypertensive patients with heart failure in old age.

Materials and methods. 96 patients (60 men and 36 women aged 70–89 years, mean age 81.9 ± 0.4 years)) with essential hypertension (EH) with or without chronical heart failure IIa (CHF) were involved in the study. Parameters of systemic, intracardial hemodynamics, structural-functional state of the heart were investigated by transthoracal Doppler echocardiography on Hitachi EUB-525 (Japan) equipment; creatinine clearance(CC) rate was calculated by Cocroft–Gault formula before and after 9-month treatment in two modes: enalapril + metoprolol and enalapril + metoprolol + trimetazidine.

Results and discussion. Long-term antihypertensive therapy in very old patients with EH associated with CHF resulted in positive dynamics of clinical symptoms, a significant drop in blood pressure by reducing cardiac output at constant stroke volume and slowing heart rate. Antihypertensive treatment led to acceleration of initially low CC by 10.6 % in patients with EH and by 7.4 % in patients with EH and with CHF: adjuvant therapy with trimetazidine enforced this positive dynamics – CC raised by 23.5 % and 13.2 %, respectively. Regression of left ventricular hypertrophy was accompanied by improvement of both initially preserved systolic function and diastolic function deteriorated by type of abnormal diastolic relaxation. In patients with EH, ejection fraction increased by 3.7 %, while adding trimetazidinе – by 9.1 %; in patients with EH with CHF – by to 8.1 and 12.2 %, accordingly. E/A ratio in patients with EH increased under the influence of antihypertensive therapy by 7.4 %, while adding trimetazidine – by 18.4 %, in patients with EH and CHF – by 12 and 16 %, respectively.

Conclusions. Additional prescription of trymetazydynе, a drug with metabolic effect, causes a significant positive dynamics as compared with standard therapy manifested by further improvement of diastolic (4.0 % increase in ratio of early and late left ventricle inflation rate in EH with CHF and 11.5 % – in EH) and systolic (4.1 % and 5.4 % increase of ejection fraction, respectivelyfunctions and creatinine clearance (5.7 and 12.9 % increase, respectively).

Keywords: arterial hypertension, diastolic dysfunction, very old age, enalapril, metaprolol, trimetazidine.

Anatomo-physiological preconditions and risk factors of a vertebral artery syndrome development are considered in this article. Modern views are presented on the treatment of the problem of vertebrobasilar insufficiency resulting from a non-atherosclerotic defeat of the vertebral arteries. Comparison of indications to operative treatment of patients with atherosclerotic and non-atherosclerotic defeat of vertebral arteries is made. The procedure of conducting the operation of vertebral artery decompression and the indications to the application of this technique in practical medicine are presented in detail.

Keywords: vertebrobasilar insufficiency, vertebral artery, vertebral artery syndrome, extravascular compression, decompression.

The review of literature includes the modern problems, methods of diagnosis and surgical treatment of acute varicothrombophlebitis among declining and aged people at different stages of phlebology development; presents the indications and contra-indications to surgical interference; scrutinizes the choice of tactics and volume of surgical access.

Keywords: acute varicothrombophlebitis, ultrasonic duplex angioscanning, declining and aged people.

Problem of metabolic syndrome (MS) is one of the most urgent in the world today for adults, children and adolescents. The growing prevalence of obesity, arterial hypertension and dysgenesis of sex hormones in children and adolescents, the high frequency of carbohydrate and lipid metabolism demonstrate the relevance of the diagnosis and early treatment of MS in this age group. The developed diagnostic criteria for MS are mostly focused on an adult. However, the initial manifestations of MS occur during childhood, which determines the need to develop standardized criteria for diagnosing MS corresponding to features of a child organism. In this regard, in 2007, the International Diabetes Federation adopted new criteria of abdominal obesity and MS in children and adolescents. Prevention and treatment of MS should be directed to the main links of the pathogenesis of this syndrome – obesity and insulin resistance, and include pharmaceutical and non drug treatment. One of the new directions in the treatment of children and adolescents suffering from complicated forms of obesity is the study of the efficacy of metformin. The main pharmacological effects of this representative of biguanide group include increasing tissue sensitivity to insulin, suppression of hepatic glucose production, reduced compensatory hyperinsulinemia, normalization of lipid profile. In addition, it is assumed that metformin has antihypertensive effect and stimulates glucose transport into target cells of insulin.

Keywords: metabolic syndrome, abdominal-visceral obesity, insulin resistance, dyslipidemia, arterial hypertension, disorders of carbohydrate metabolism.