Цель. Изучить пуриновый обмен и перекисное окисление липидов (ПОЛ) в зависимости от степени тяжести острой сердечной недостаточности (ОСН) у пациентов с инфарктом миокарда с подъемом сегмента ST на ЭКГ (ИМпST), выявить изменение данных показателей под действием тромболитической терапии (ТЛТ). Материал и методы. В исследование включен 91 пациент, средний возраст 60,8±1,2 лет. В зависимости от степени тяжести ОСН Killip I-III степени, больные ИМпST разделены на три группы, при наличии показаний всем пациентам проводилась ТЛТ. Оценивали показатели пуринового обмена (активность 5′-нуклеотидазы, ксантиноксидазы и уровень мочевой кислоты), ПОЛ (активность супероксиддисмутазы, каталазы и величина супероксиданионрадикала). Результаты. В условиях энергетического дефицита формируется порочный круг увеличения активности ферментов пуринового обмена, нарушения равновесия антиоксидантной защиты (АОЗ) и прооксидантов. По мере прогрессирования ОСН происходит увеличение активности ксантиноксидазы, что, в конечном итоге, приводит к повышению МК и развитию отека легких. Выявлено повышение активности АОЗ у пациентов после ТЛТ, что является компенсаторным механизмом организма в ответ на реперфузию, однако не позволяет стабилизировать пуриновый обмен. Заключение. Таким образом, пациенты с отеком легких имеют максимальные нарушения пуринового и липидного обмена по сравнению с другими пациентами с ИМпST. ТЛТ способствует повышению активности АОЗ, но не приводит к стабилизации пуринового обмена.
Objective - to explore influence of valsartan monotherapy use and its use in combination with hydrochlorothiazide (HCTZ) on pulse-wave velocity (PWV) and central arterial pressure (CAP) in patients with arterial hypertension (AH) of 1-2 grades in international VICTORY clinical trial. Materials and methods. The international multicenter prospective randomized clinical study VICTORY that lasted for 16 weeks included patients with 1-2 grades AH. In patients who previously received antihypertensive therapy a 7 days washout period was carried out. All patients started their therapy with 80 mg valsartan (Valsacor®, KRKA, Slovenia); in Russia the starter dose of Valsacor®, KRKA was 160 mg in previously treated patients that did not influence the study results. If after 4 weeks of treatment BP was more than 140/90 mm hg (more than 130/80 mm hg in high risk patients or in diabetes mellitus patients) the dose of valsartan was increased to 160 mg (320 mg in Russia) or diuretic in fixed combination with valsartan was added (160 mg valsartan/12.5 mg HCTZ): Valsacor® H 160 (KRKA, Slovenia). If target BP after 8 weeks of treatment was not reached valsartan dose was increased to 320 mg or fixed combination of valsartan and diuretic (160 mg/12.5 mg) was used. If target BP after 12 weeks of treatment was not reached - valsartan and diuretic 320 mg/12.5 mg were used. PWV and CAP (SphygmoCor®, AtCorMedical) were assessed at baseline and after 16 weeks of treatment. The primary endpoints were assessment of the impact of studied medications on aortic stiffness, aortic augmentation index and comparison of absolute medians of reached central and peripheral BP reduction with baseline value. Results. Of 365 patients included in the study 74 were included in PWV and CAP study subgroup. Valsartan and its combination with HCTZ were effective in CBP reduction. The mean absolute reduction of central systolic and diastolic BP after 16 weeks of treatment was 19.7±12.9 mm hg and 13.9±8.5 mm hg, respectively (р
Objective: To assess the relationship of arrhythmic events such as supraventricular arrhythmias and asymptomatic arrhythmias and their long-term association with adverse events among patients undergoing chronic hemodialysis.Materials and methods: a study was conducted involving 87 patients undergoing chronic hemodialysis with a 10-year follow-up period. At the inclusion stage, sinus rhythm was registered in all patients. A total of 87 patients (47 men and 40 women; mean age 56.3±16.1 years) took part. All patients underwent Holter monitoring (HM) of the ECG after each hemodialysis procedure, 6 times in a row, and the indicators obtained during the echocardiographic study were also evaluated.Results: after evaluating the results obtained and statistically processing the data, it was found that 71.2% of patients had arterial hypertension, 30.6% had type 2 diabetes mellitus. During HM, supraventricular arrhythmias were detected in 43 patients (49.4%); these arrhythmias were short-term, asymptomatic and stopped on their own. Age (hazard ratio [HR], 1.07 per year; 95% confidence interval [95% CI], 1.02 to 1.09) and right atrial enlargement (hazard ratio [HR] 4.31; 95 % CI 1.33 to 14.12), which showed a direct association with supraventricular arrhythmia in multivariate analysis. During 48 months, 67 patients died, the main cause of death of which was cardiovascular disease (58.4%). In the Cox model, the variables associated with all-cause mortality were C-reactive protein (RR, 1.03 per 1 mg/l; 95% confidence interval from 1.00 to 1.08), age (RR, 1.07 per year; 95% CI, 1.00 to 1.08), supraventricular arrhythmias (RR 3.42; 95% CI, 1.34 to 7.91). Patients with supraventricular arrhythmia had a significantly higher risk of non-fatal cardiovascular events (hazard ratio, 4.41; 95% confidence interval, 2.18–8.89).Conclusion: a direct relationship has been demonstrated between the presence of supraventricular arrhythmias during chronic hemodialysis and symptomatic AF, which will develop in these patients in the future. The main aggravating factors associated with mortality in patients on dialysis were supraventricular arrhythmias, advanced age, and elevated C-reactive protein.
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