BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

АГ-артериальная гипертензия, АД-артериальное давление, ДАД-диастолическое артериальное давление, ЗПА-заболевание периферических артерий, ИБС-ишемическая болезнь сердца, ИСАГизолированная систолическая артериальная гипертензия, кфСПВ-каротидно-феморальная скорость пульсовой волны, ЛЖ-левый желудочек, ЛПИ-лодыжечно-плечевой индекс, МРТ-магнитно-резонансная томография, ПАД-пульсовое артериальное давление, плСПВ-плече-лодыжечная скорость пульсовой волны, ППИ-пальце-плечевой индекс, РА-ревматоидный артрит, САД-систолическое артериальное давление, СД-сахарный диабет, СКФ-скорость клубочковой фильтрации, СПВ-скорость пульсовой волны, ССЗ-сердечно-сосудистые заболевания, ССО-сердечно-сосудистые осложнения, ССР-сердечно-сосудистый риск, УЗИ-ультразвуковое исследование, ФВ-фракция выброса, ХБП-хроническая болезнь почек, ХПН-хроническая почечная недостаточность, ХСН-хроническая сердечная недостаточность, ЦАД-центральное аортальное давление, AIx-индекс аугментации, CAVI-сердечно-лодыжечный сосудистый индекс, D-путь, пройденный волной, Δt-время запаздывания. Recently, there was plenty studies published on the arterial stiffness assessment, and importance of this was proved as an independent prediction parameter, together with standard cardiovascular risk factors. In current document, we collect and structure the available clinical and scientific data from abroad and Russian studies. The aim of current publication is the need to bring a reader the importance of demanded in clinical practice ways of arterial wall stiffness assessment, information about conditions when it is important to the assessment, and available restrictions, as the issues remaining unresolved.

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О Б Щ А Я Р Е А Н И М А Т О Л О Г И Я , 2 0 1 2 , V I I I ; 2 33 И н ф е к ц и о н н ы е о с л о ж н е н и я Одним из проявлений синдрома системной вос палительной реакции является повреждение эндоте лия с развитием расстройств микроциркуляции. Как известно, брюшина непременно отвечает воспалени ем на любой патологический процесс, индуцирован ный инфекционно воспалительной или травматичес кой деструкцией органов живота [1, 2]. Поэтому острая хирургическая патология, осложнившаяся развитием разлитого перитонита, не является исклю

BACKGROUND: Iron deficiency is a common comorbidity in many patients with chronic heart failure. AIM: To study the parameters of intracardiac hemodynamics in the patients with chronic heart failure in the presence of iron deficiency. MATERIALS AND METHODS: We examined 179 patients (36 men and 143 women, mean age 71.6 7.9 years) with heart failure of functional class 2-4 (NYHA). All the patients underwent a clinical examination, a 6-minute walk test, a general blood test; the level of NT-proBNP, iron, transferrin, and ferritin in blood serum were studied; the percentage of transferrin saturation with iron was calculated. The presence of iron deficiency was assessed based on a decrease in the level of serum ferritin less than 100 g/L or ferritin ranging from 100 to 299 g/L and saturation of transferrin with iron less than 20%. All the patients underwent echocardiography in one-dimensional, two-dimensional and Doppler modes (pulse-wave, constant-wave and tissue) in standard positions according to the generally accepted technique. RESULTS: It was found that in the patients with chronic heart failure and iron deficiency compared with the patients without iron deficiency; the end systolic volume of the left ventricle, the size of the right ventricle and the systolic pressure in the pulmonary artery were significantly higher, and the speed of movement of the fibrous ring of the mitral and tricuspid valves and the working capacity were lower. Significant correlations were established between the concentration of iron and ferritin and the parameters of intracardiac hemodynamics. CONCLUSIONS: Iron deficiency in the patients with chronic heart failure without anemia contributes to an early initial decrease in cardiac contractility with an intact ejection fraction.

In order to assess the prevalence and dynamics of changes of basic parameters of obstructive sleep apnea syndrome (OSAS) at mucopolysaccharidoses II (MSP II) cardiorespiratory monitoring was performed for 17 children. Slight OSAS (apnoea-hypopnoea index (AHI) was 1.5-5) was diagnosed in 4 patients (23.5%), moderate OSAS (AHI was 5-10)-in 4 patients (23.5%), severe OSAS (AHI was higher than 10)-in 2 patients (11.8%). AHI median at Hunter syndrome was 5.3 ± 6.9/ hour. In the group of infants (1-3 years old) slight OSAS (AHI is 0.8 ± 0.3/h) dominated, whereas in the group of teenagers-sever OSAS (AHI is 10.9 ± 9.4/h), a median of blood saturation with oxygen (SpO2) was 87.5 ± 10.6%, desaturation index (DI)-10.4 ± 13.3/hour. On the whole, OSAS was diagnosed in 58.8% of children and increased with increasing of the disease severity. Thus cardiorespiratory monitoring is necessary for revealing children with moderate and moderate-to-severe OSAS, followed by prevention of life-threatening conditions, the occurrence of which is possible at this syndrome.

The clinical significance of iron deficiency in patients with a combination of heart failure and diabetes mellitus has not been studied. 67 patients with chronic heart failure and diabetes mellitus were examined. In all patients, the clinical manifestations of heart failure, asthenia, anxiety, depression, the concentration of glucose, glycated hemoglobin, iron, ferritin, transferrin, soluble transferrin receptors, hepcidin, erythropoietin, NT-proBNP were studied, echocardiography was performed in one-dimensional, two-dimensional and Doppler modes (wave, constant-wave and tissue) in standard positions according to the generally accepted technique. Iron deficiency was diagnosed in 42 patients. We have established that the deficiency of iron stores in patients with heart failure and diabetes mellitus contributes to an increase in the clinical manifestations of heart failure, asthenia, anxiety and worsens the indicators of central hemodynamics.It was found that the deficiency of iron store in patients with heart failure and diabetes mellitus contributes to the disruption of various links of iron metabolism and an increase in the clinical manifestations of heart failure, asthenia, anxiety and deterioration of central hemodynamic parameters.

Приведены данные о распространенности анемии у пациентов с хронической сердечной недостаточностью (ХСН), возможных механизмах развития анемии у этих пациентов. Проанализирован уровень С-реактивного белка (СРБ) у пациентов с ХСН на фоне анемии и латентного дефицита железа. Проведена оценка эритроцитарных индексов: среднего объема эритроцита (MCV), среднего содержания (MCH) и концентрации (MCHC) гемоглобина в эритроците, распределения эритроцитов по объему (RDW). Изучены показатели обмена железа у пациентов с ХСН в зависимости от уровня СРБ, наличия дефицита железа и анемии: уровень сывороточного железа, ферритин, трансферрин, коэффициент насыщения трансферрина железом. Анемия легкой степени наблюдается у 23% больных с ХСН. У 34% пациентов с ХСН отмечается повышение СРБ. У 70% пациентов с ХСН выявлен дефицит железа. У лиц с повышенным СРБ увеличивается RDW и уменьшается насыщение траснферрина железом. При анемии у пациентов с повышенным СРБ отмечается значительно более низкое содержание ферритина, чем у лиц с нормальным уровнем СРБ, что свидетельствует о более значительном истощении тканевых запасов железа у данных пациентов. Ключевые слова: хроническая сердечная недостаточность, анемия, железо, ферритин, трансферрин, Среактивный белок, эритроцитарные индексы, дефицит железа.