The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

9-15

Authors: Kolomytseva I. M.

162 patients (89 men and 73 women) aged 69 ± 10 years were observed at the annual stage of supportive drug therapy after implantation of pacemakers in DDD/DDDR, VVI/VVIR and CRT-P/CRT-D modes. Changes of hemodynamic parameters were taken in consideration according to the functional class of chronic heart failure (CHF FC). Pacemakers implantation and supportive drug therapy led to transference of patients to the lower CHF FC with more significant results in CRT-P/CRT-D mode, normalization of heart rate (HR) in all CHF FC and stimulation modes, systolic (SBP) and diastolic blood pressure (DBP) in DDD/DDDR and CRT-P/CRT-D modes, end-systolic and diastolic volumes (EDV and ESV LV), left ventricular ejection fraction (LVEF) in CHF FC II in all stimulation modes and CHF FC III in DDD/DDDR and VVI/VVIR modes and size of the left atrium (LA) in CHF FC II in all stimulation modes and CHF FC I in VVI/VVIR mode. In thickness of posterior wall and interventricular septum of the left ventricle (LV PW and IVS), the sizes of the right atrium (RA) and right ventricle (RV) significant changes in any of CHF FC were not noticed, which requires drug therapy amplification. KEY WORDS: permanent pacing, сchronic heart failure, functional class of сchronic heart failure, hemodynamic parameters, annual stage, drug therapy

21-24

Authors: Petrenko O. V., Yabluchansky M. I.

The systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) daily profiles incidence was studied in 53 patients with arterial hypertension. A significant difference in the frequency of occurrence of different types of SBP, DBP and PP daily profile was revealed. In the structure of SBP daily profile «nondipper» and «dipper» types were dominated, DBP - «dipper» and «overdipper» types, PP - «night-picker» type. The conclusion about the need to evaluate not only the SBP circadian pattern, but DBP and PP also to improve the quality of arterial hypertension diagnosis, prognosis and treatment was made. KEY WORDS: ambulatory blood pressure monitoring, systolic blood pressure, diastolic blood pressure, pulse pressure, daily blood pressure

30-33

Authors: Rudenko T. A.

A role of blood glucose levels in the development of interstitial collagen has been studied in 84 patients (53 women and 31 men, average age 60 ± 2.4 years) with coronary heart disease (CHD). All patients were divided into twocomparable groups: a study group including patients with coronary heart disease andtype 2 diabetes mellitus (DM) and a control group consisting of patients with coronary heart disease without DM. All patients received standard medical therapy as recommended by the European Society of Cardiology. The level of blood glucose in both groups was assessed by the standard technique, a degree of interstitial collagen volume fraction (ICVF) was measured using the formula of J. Shirani et al. The data were processed by parametric and nonparametric statistical methods. It has been proved that hyperglycemia in type 2 diabetes contributes to the development of ICVF, the degree of which increases with the rise of blood glucose level. A high level ofICVF in patients with coronary heart disease and diabetes type 2 can be a predictor of myocardial dyssynchrony development and heart failure progression, therefore, a close monitoring and timely correction of changes of blood glucose levelsare recommended to prevent the complication development. ICVF evaluation should become a routine diagnostic method in all patients with type 2 diabetes. KEY WORDS: interstitial collagen volume fraction, type 2 diabetes mellitus, coronary heart disease

41-44

Authors: Tselik N. E., Shevchuk M. I., Martynenko A. V.

The relationship between the duration of the complex QTc ECG and clinical signs of arterial hypertension (AH) in 54 patients (16 men and 38 women) 1-3 degree and I-III stage, mean age 58 ± 18 years, was investigated. 3 classes of QT interval duration were allocated: classified shortened (< 320 ms), normal (> 320 ms and < 440 ms), classified prolonged (> 440 ms). The binomial distribution of frequencies of studied parameters in classes of the QTc interval for alternative criteria was determined. The duration of the QTc interval in the sampling was 350 ms – 490 ms. The proportion of the normal range (> 320 ms and < 440 ms) was 0.85, classified prolonged (> 440 ms) – 0.15. The probability of occurrence of QTc prolongation ECG increased in elderly patients, obesity, abusing of alcohol, mild and moderate degree and stage II AH, diabetes mellitus, atherosclerotic cardiosclerosis, stable angina functional class (FC) II, HF FC III and II A stage. Dependencies of the elongated QTc of ECG from the sex of the patients have not been established. KEY WORDS: arterial hypertension, duration of the QTc interval of ECG

49-56

Authors: Makharynska O. S., Zhuravka N. V.

HMG-CoA reductase inhibitors (statins) are the most prescribed class of drugs in the world. Some authors suggest that positive effects of statins were reported for statins against pneumonia. These positive studies data were counterbalanced by at least one negative prospective cohort study. Where lies the truth? Better understanding the statins influence and their potential role in pathophysiological pneumonia mechanisms is needed because of high quantity of subjects receiving statins with numerous medical conditions significantly associated with increased short-term mortality. KEY WORDS: statins, pneumonia, outcomes, statin effects

11-21

Authors: S. A. S. Belal, N. A. Vodyanitska, M. I. Yabluchansky

Changes of systolic blood pressure (SBP) in biofeedback (BFB) sessions with closed loop of paced breathing (PB) and heart rate variability (HRV) during standard drug therapy of arterial hypertension (AH) was studied. 275 patients with 1-3 degree of AH (143 men and 132 women, mean age 58,55 ± 7,99 years) was divided into two comparable groups: 1 - BFB (139 patients) in investigated PB loop, 2 - control group (136 patients) with BFB without PB. In both groups was performed 10 sessions of BFB. Changes of SBP depending on the stage and degree of AH, gender and age was assessed. BP was measured by the method of Korotkov’s with monometer Microlife BP AG1-20 in same conditions. Data were processed by parametric and nonparametric statistics. It is proved that the use of biofeedback in the loop of PB and HRV significantly (p < 0.01) exceeds in efficiency an isolated drug therapy in control of SBP at any stage and degree of AH in patients of both sexes in all age groups. Extent of the effect increases with the stage and degree of the disease and not related to the sex and age of the patient. Findings allow to recommend this technique in clinical practice.

27-34

Authors: S. O. Dubyna

The norm of morphometric indicators of bone structures of an orbit for population of 96 people at the age of 48,6 ± 3,2 years without pathology of craniofacial area is established by method of a computer tomography. Means, confidence intervals (р = 0,05), correlation and reliability of distinctions in morphometric indicators of a skull and an orbit by groups on types of cranium are defined. In frequency distribution of the studied population by types of cranium brachiocephalic people are 63 %, dolichocephalic – 27% and mesocephalic – 10 %. In groups by types of cranium among linear indicators of an orbit length of a medial wall statistically reliable decreases from dolichocephals to brachiocephals, length of lateral wall, orbital floor and roof and also orbital breadth – from mesocephals to brachiocephals. Orbital height between groups’ types of cranium reliable does not differ. An angle between medial and lateral walls of orbit statistically reliable increases from dolichocephalic persons to brachiocephalic. The interrelation of changes of an angle of orbital entrance inclination and types of cranium is not observed. The number of statistically significant correlations between morphometric indicators of an orbit increases from dolichocephals to brachiocephals at the absence of a reliable difference between them. Average degree correlation is noted only between orbital breadth and lengths of medial wall and orbital floor; orbital depth and lengths of the orbital floor and roof; between lengths of the orbital floor and roof – at brachiocephals, and also between lengths of the orbital floor and roof – at dolichocephals and mesocephals. The conclusion is drawn that when planning reconstructive operations at bone structures of an orbit it is necessary to consider the available distinctions in length of lateral wall, orbital roof and floor, height and breadth and value of an angle between medial and lateral walls by types of cranium.

39-44

Authors: M. S. Maltseva

97 patients (55 men and 42 women) with implanted pacemakers (PM) in DDD/DDDR, VVI/VVIR and CRT modes were investigated. Pacing mode, location of the right ventricular (RV) and left ventricular (LV) electrode, percentage of the right atrium (RA), RV and LV stimulation, percentage of atrial flutter (AFl) and atrial fibrillation (AF), percentage of ventricular tachycardia (VT), base frequency of stimulation, RV and LV electrode impedance, RV and LV electrode stimulus amplitude and duration, RV electrode sensitivity, R-waves sensing, stimulated and detected AV-delay, interventricular delay, the minimum refractory period were evaluated in acute postoperative period (3-5 days) and six months after pacemaker implantation. Patients were divided into classes 1 (normal QTc (320-440 ms)) - 41 (42 %) of the patients) and class 2 (long QTc (> 440 ms)) - 56 (58 %) patients) of QTc interval duration. For data processing were used standard statistical procedures by Microsoft Excel. QTc interval prolongation is most often observed in patients with VVI/VVIR stimulation, normal QTc interval duration – in patients with CRT. The same part of normal and extended QTc interval duration is observed in patients with DDD/DDDR stimulation. Prolonged QTc interval duration is associated with more frequent RV electrode implantation in heart apex, higher percentage of AFl and AF, LV electrode impedance, RV and LV electrodes stimulus amplitude, detected and stimulated AV-delays, minimum refractory period in first six months after PM implantation. Patients with increased QTc interval duration after PM implantation require more intensive monitoring of stimulation parameters and enhancing medication.

49-52

Authors: I. V. Shanina, D. E. Volkov

100 patients (46 – women, 54 − men) 69 ± 7 years old with implanted pacemaker in three QRS complex duration classes (under 120, 120-149, 150 and more ms) were investigated in the early postoperative period, six months and a year of permanent pacing. Basic pacing rate, atrioventricular (AV) delay (stimulated and detected), ventricular threshold, ventricular lead impedance, percentage of ventricular pacing, percentage of atrial fibrillation/flutter time were measured. Basic pacing rate, stimulated and detected AV-delay, as well as the percentage of ventricular pacing were not associated with QRS complex duration classes and had not been changed in observation stages. Ventricular threshold, ventricular lead impedance and the percentage of atrial fibrillation/atrial flutter time in the annual monitoring stage were defined to QRS complex duration class. Ventricular threshold in the first six months of observation was not changed in any QRS complex duration classes and grew at an annual stage in class 3. The impedance of the ventricular lead in the first six months decreased in all classes, it was stabled at the year in classes 2 and 3 and was continued to decline in the class 1. Percentage of atrial fibrillation/flutter time was initially higher in class 3, and was decreased in six month observation stage, however, without reaching the values in classes 1 and 2.

59-62

Authors: E. E. Tomina, E. P. Kamenskaya, P. V. Lebedynets, V. V. Tomakh

The article concerns a clinical case management of patients with polycythemia vera. The data are given from the laboratory and instrumental diagnostic methods, clinical diagnosis, selection of the optimized treatment and modification of the habit of life.

71-80

Authors: O. V. Petrenko

Review devoted to chronotherapy of hypertension. The questions of chronomedicine and chronobiology, biological rhythms, especially circadian regulation of blood pressure, types of daily blood pressure profile violations, the role of de-synchronization of biological rhythms in the development and course hypertension, opportunities to optimize antihypertensive therapy with the method of chronotherapy using alpha- and beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, diuretics, calcium channel blockers and melatonin are contemplated.