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Aim. To study the prognostic significance of atherosclerosis of one and several vascular systems in patients with high and very high cardiovascular risk (CVR).Material and methods. The study included 171 patients with high (26,9%) and very high (73,1%) CVR. All patients underwent duplex ultrasound of the carotid and lower limb arteries. The composite endpoint (CE) was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results. The follow-up period lasted 31,1 (17,8; 47,9) months. CE events occurred in 29 (16,9%) patients: cardiovascular death — 3 (1,75%) patients; nonfatal myocardial infarction — 7 (4,09%) patients; nonfatal stroke — 6 (3,51%) patients; coronary revascularization — 13 (7,60%) patients. Cumulative survival of patients with high and very high CVR with atherosclerotic plaques in the same vascular system did not significantly differ from that in patients with intact peripheral arteries (p=0,977). The event-free survival of patients with combined lesions of the carotid and lower limb arteries was significantly lower in comparison with patients with one vascular system involvement (p=0,011). The combined lesion of the carotid and lower limb arteries was associated with an increase in the relative risk (RR) of adverse cardiovascular events (RR, 3,15 (95% CI, 1,02-9,74; p=0,046), adjusted for sex, age, and peripheral arterial disease symptoms.Conclusion. In patients with high and very high CVR, atherosclerotic lesion of two vascular systems of peripheral arteries is associated with an increase in the RR of adverse cardiovascular events, adjusted for sex, age, and peripheral arterial disease symptoms. The presence of atherosclerotic plaques in one vascular bed was not associated with an increase in the risk of CE events.

1 Кафедра акушерства и гинекологии педиатрического факультета (зав. -акад. РАН, д.м.н., проф. Г.М. Савельева) ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия; 2 ГБУЗ «Центр планирования семьи и репродукции» ДЗМ, Москва (глав. врач -О.А. Латышкевич) Цель исследования -выявление факторов риска развития истмико-цервикальной недостаточности (ИЦН), определение возможности своевременной ее диагностики и коррекции во II триместре беременности. Материал и методы. В про-спективное исследование включены 257 пациенток с одноплодной беременностью во II триместре (в сроки 13-27 нед беременности). Среди них 93 пациентки были госпитализированы в гинекологическое отделение с диагнозом: истмико-цервикальная недостаточность. Критериями включения в основную группу (76 пациенток) являлись симптомы ИЦН, установленные по данным трансвагинальной эхографии и мануального исследования, которые чаще выявлялись в сроки беременности 16-22 нед. У 17 наблюдаемых не было выявлено укорочения шейки матки при ультразвуковом исследо-вании -они были исключены из анализа. У 164 беременных течение беременности было физиологическим, без изме-нений состояния шейки матки (контрольная группа). Степень выраженности ИЦН оценивалась на основании балльной шкалы. Коррекция ИЦН проведена 70 (92,1%) пациенткам из 76 наблюдаемых основной группы: цервикальный серкляж (по методу McDonald) осуществлен 41 (58,6%) пациентке до 22 нед гестации, акушерский пессарий установлен 29 (41,4%) беременным после 22 нед беременности. В том числе последовательное использование 2 методов (хирургической коррек-ции и применения акушерского пессария) выполнено у 3 (4,3%) наблюдаемых. Результаты. Коррекция ИЦН была эффек-тивной у 66 (94,3%) из 70 пациенток, подвергшихся лечению ИЦН; в том числе у 1 из 2 наблюдаемых -при длине шейки матки 10 мм. Своевременные роды произошли у 62 (88,6%) пациенток и у 4 (5,7%) роды были в сроке гестации 34-36 нед. Преждевременно родили 8 (11,5%) из 70 пациенток. После проведения цервикального серкляжа своевременно родили 35 (85,4%). Преждевременные роды произошли у 6 (14,6%; отношение шансов -ОШ -0,10; 95% доверительный интервал -ДИ -0,02-0,94): у 2 -до 32 нед, у 4 в 34-36 нед. После использования акушерского пессария своевременные роды произошли у 27 (93,1%), преждевременные роды -у 2 (6,9%), в сроке до 28 нед (OШ 0,14; 95% ДИ 0,014-1,23). Заклю-чение. Состояние шейки матки необходимо оценивать у всех беременных, в том числе в группе риска преждевременного прерывания беременности, начиная с 16 нед беременности. Своевременное выявление ИЦН и адекватная ее коррекция эффективны, так как способствуют пролонгированию беременности до срока более 34 нед у 94% пациенток.Авторы информируют об отсутствии конфликта интересов. Objective -to identify risk factors for isthmicocervical insufficiency (ICI) and to determine the possibilities of its timely diagnosis and correction in the second trimester of pregnancy. Subject and methods. The prospective study enrolled 257 patients with mono...

The aim of the study was to research the relationship between carotid atherosclerosis markers and ultrasound parameters of Achilles tendons (AT). The study included 150 patients at high and very high cardiovascular risk (CVR). All patients underwent a carotid ultrasound scanning. We evaluated carotid plaque, carotid plaque score (cPS), carotid total plaque area (cTPA), and the percentage of stenosis. All patients underwent AT ultrasound with an assessment of thickness (Achilles tendon thickness [ATT]), width (Achilles tendon width), and cross-sectional area. An increase in the ATT ≥5.07 mm was associated with a 4.55-fold increase in the relative risk of carotid atherosclerosis (sensitivity 68.3% and specificity 62.5%). Direct correlations between the ATT and carotid stenosis ( r = 0.277; P = .004), cPS ( r = 0.225; P = .035), and cTPA ( r = 0.305; P = .004) were determined. An increase in the mean ATT by 1 mm was associated with an increase in cTPA by 8.09 mm2 (95% CI: 2.26-13.9; P = .007) and carotid stenosis by 4.11% (95% CI: 0.64-7.60; P = .021). Thus, in patients with high and very high CVR, an increase in ATT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the markers of carotid plaque burden.

Aim. To estimate the prevalence of inflammatory residual risk in patients with stable atherosclerotic cardiovascular disease (ASCVD) and establish the relationship between concentration of C-reactive protein (CRP) and the presence of the polyvascular disease.Materials and Methods. The study included 120 patients with stable ASCVD. The plan of the instrumental study included ultrasound scanning of the carotid arteries and lower limb arteries with measurement of the ankle-brachial index. The concentration of hsCRP in the serum was determined by the enzyme-linked immunosorbent assay.Results. An increase in the content of hsCRP ≥ 2,0 mg/l was detected in 45,8% of patients. Clinically significant lesion of one vascular bed was observed in 41,6% of patients, two – in 36,6%, three – in 21,6%. In the group of patients with atherosclerosis of the three vascular beds, the median value of hsCRP was 3,28 (1,77–5,67) mg/l, which was statistically significantly higher compared to patients with the involvement of one vascular bed – 1,56 (0,68–3,92) mg/L. An increase in hsCRP over 2,0 mg/l was associated with an increase in the relative risk of a patient with polyvascular disease with a atherosclerosis of three vascular beds 3,63 times (95% CI 1,06–12,4; p = 0,04) with adjusting for gender, age, obesity, diabetes, smoking, cholesterol levels and glomerular filtration rate.Conclusion. Inflammatory residual risk was observed in 45,8% of patients with stable ASCVD. An increase in CRP was established with an increase in the number of affected vascular beds. An increase in hsCRP over 2,0 mg/l was independently associated with an increase in the relative risk of a patient having an polyvascular disease.

Aim. To assess the morphometric characteristics of Achilles tendons in patients with familial hypercholesterolemia (FH) and to identify factors associated with an increase in their size.Материал и  методы. Totally, 100 patients included, with severe primary hyperlipidemia, defined as an increase in total cholesterol ≥7,5 mM/L and/or lowdensity lipoprotein cholesterol ≥4,9 mM/L. All patients underwent duplex scanning of carotid arteries. Ultrasound examination of the Achilles tendons was carried out on an expert class ultrasound equipment Samsung Medison EKO 7 (Japan) with a linear sensor, frequency of 7-16 MHz. Thickness of the Achilles tendon (anteriorposterior dimension (APD)) was measured during scanning in the longitudinal section, width (transverse dimension (TD)) — scanning in the cross section. The measurements were made 2 cm proximal to the calcaneus.Results. Among the participants, 32 (32,0%) had definite/probable diagnosis of FH. In patients with definite/probable FH the mean values   of APD were significantly higher in comparison with patients scored 5 or less points (DLCN) — 5,50 (4,70-6,10) mm vs. 5,00 (4,50-5,40), respectively (p=0,04). TD of Achilles tendons among this category of patients was also statistically significantly higher in comparison with the rest of patients — 14,0 (12,9-15,4) mm and 13,2 (12,2-14,2) mm, respectively (p=0,04). In correlation analysis, the relationship between the growth of patients and the APD of the Achilles tendons (r=0,34, p=0,001), the TD of the Achilles tendon (r=0,28, p=0,009), CIMT and TD of the Achilles tendons (r=0,21, p=0,05), amount of carotid plaques and TD of the Achilles tendon (r=0,26, p=0,01), total percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,27, p=0,01), maximum percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,28, p=0,007). According to regression analysis, factors associated with an increase in thickness of the Achilles tendons for more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and high-density lipoproteide cholesterol.Conclusion. In patients with definite/probable FH, mean values of width and thickness of the Achilles tendons were significantly higher in comparison with the rest of the patients. According to regression analysis, the factors associated with the increase in thickness of the Achilles tendons fro more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and HDL high-density lipoproteide cholesterol.

медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет), Москва, Российская ФедерацияСиндром исчезающего промежуточного бронха -это разновидность периферических бронхиальных стенозов, развивающихся у реципиентов донорских легких в сроки от 2 до 9 месяцев после трансплантации. Отсутствие своевременной диагностики и эффективного лечения приводит к снижению продолжительности и качества жизни. Представленное клиническое наблюдение демонстрирует успешное продолжительное лечение синдрома исчезающего промежуточного бронха у пациента после трансплантации донорских легких с применением методов интервенционной бронхологии.

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