KnnHrqHA xApAKTEphcl4KA 14 KoM opEr4RH ocr np H

60
MEAI4U[4HCKu
nPErnEA,41,2005,Ne3
14KoMopEr4RH
ocr npH nAUHEHTI4TE
KnnHrqHAxApAKTEphcl4KA
PE3vtlTATI4
oT PErk|CTbPA3A CbPAELIHA
CbC CbPflEt{HAHEAOCTATITI{HOCT:
Lt
HEAOCTATITqHOCTHA KAPAI4OnOrH HATA KnHHHKA " n pOO. KHPhn H H({OBCKI4"
H. Craxqesat, C. Trueeat, B. fropaanoeatH A. I-ygea2
tKap4uonoruqHa
uluvoacxra",
"flpo$ Kupr,rn
KfluHerKa
YM6AJl- l-lneeeH
?Knuuuxano KapAronorhnc r,rHreH3fiBHo
"{apvrqa
or4eneHfie,YMEiAfl
Vloauna"- Co$un
CutttcRl cHAR.AcrERrsrcs
rNpATTENTS
ANDcoMoRBrDrry
WITH HEART FAILURE: RESULT$ FROM THE HEART FAILURE REGISTRY
oF THE PnOp. CHICSOVSK|CARDTOLOGY
Ct-tr.rrC
N, Stanchevat,S" Tishevar,V. lordanoval and A. Goudev2
tClinic
of Cardiology"Prof.K. Chichovski",
UniversityHospital- Pleven
2Clinic
of Cardiology,UniversityHospital''fzarilzaloanna"* Sofia
Pegtoue:
Knrcqoeu.qyMr:
Adpec 3a KopecnoHdenqun:
e aHaJtr3Ha Kr!4Hr,tqHara
xapaKTepncrntau Komop[enra Ha H3cnerqaaHero
6ttAxocna npr4naqneHTurecr'c cHMnroMHa
cbprqeqHaHeAocrarbqHocr(CH) lll
u lV QyHrquoHanexKnac (QK). Pesynrarure ca nonyqeHror p€mcrbpa 3a
ctpAeqHa HeAocraruqHocrHa KapguonoruqHaKflnHnxa"flporp. Kvrpnnguvoecxn". B xero ca BnucaHr4
Bcl4qKr4
nocneAoaarenHoxocnnrann3upautA
naqlteHTuc
CH
lll
u
lV
OK
no NYHA:a nepuo.qor 10 ueceqa, Kol4rooTroBapnr
ArafHo3a
na OpanuHraMcKnre
Kpurephusa CH. Or axnnqexure 166 naqnexru 92
(55.4V') ca Mrrxe, 96 (59%) ca Ha B'b3pacrHaA 65 rog. u 81 (56.20/o)nuar
(@14)
> 45o/oflpraxeHnre npeo6na4aeaCH ctc saSpaKqhFHa u3rnacKeaHe
na3eHa cDl4 (n . A2ft5.6%1, a nplr Mbxere - cr4cronHaTa4rac$ynxqnn
(n = 42151.9%).
.(aagecer n '{erupt4(14.4%) or naqueHrr,trecrpagar or XO66,
or rqx 13 (54%) ca urxe. Axeuufl uMar 23.8Yo,ot rax 24.3o/o
ca lV OK. XEH e
ycraHoBeHa
npn 6 naqneHru(3.6%).3axapeHAr,ra6ertun 2 uuar 3g naqnexrvr
(23.49%),ov rnx 17 (43.5o/o)
ca Mbxe, AHauHeea3a npext,taf,HMt4oKapAeH
taHuuar
52
rnx
or
32 (61,5%)ca Mbxe. a 3a aprepranHaxunep$aprr
{31.3%).
roHlrF- 115 (69%),or Kor4ro63 (54.8%)urxe. XrnoroHr4rnplr nocrbnBaHero
ca nuann 18.60/o,
or rflx 54 50hca lV oK. HeuanKaqacr or naqlreHTlrrec AeKOMneHCUpaHa
cH r,tr'rarcbxpaHeHaOh, Koero no-qecro ce xa6nogaBa npn
xeHrro, Mr'xere ca B no-Mfia.qaBb3pacr,npil Tsx npeo6nagaaarcltcronHara
gncsyxrqun u MuoKapAHhnr
ux$aprr xaro Hari-qecraernonoruil na cH. AxeMUflTae qecra npH naqr4eHrilTe
crc cH, oco6eHonpu re3n cbc 3axapeHAl4a6et, lr qecrorara i e ronxoBa no-ronflMa,xonKorono-BHcoKe <DK.3axapHunr
npu naqneHTurecbc cH c ucxennqHaerlronoryrR,
Ara6er npeBanr4pa
oco6exo
npn re3u, npexhBen|,|MilOKapAeH
Ux$aprr" flpaau Bneqarn€H[e BUCOXI4f,T
npoqeHT
HanaqueHrhrecrc cbnbrcrBaqa XOEF.
cbp,qeqHa HeAocrarbqHocr,perucr-bp xouop6rAHocr
"
ffp Ha1n CntsH,t666,KapduonoauuHa
KnuHuKa,YM6NV, 6yn. "f. Ko,tee"gA, 5g00
tlneeeu, O 064/886-37OGSM: 088 7V4g946, e-mait:nadia7706@hotmail.com
The aim of the presentstudy rs analysisof clinicalcharacteristicsand comorbidity in patientswith symptomatrc
heartfailure(HF) lll and tV NyHA class.The results are from th€ heart failure registryof the prof. chichovski cardiology clinic
in the UniversityHospitalof pleven. All consecutivelyhospitalizedfor decompensatedHF lll and lv NYHA class accordingto the Framinghamcriteriapatients over a period of 10 months are included.Among the 166 patients92
(55.4%)are nren.96 (09%)are over 65 years old and gl (s6.2%)have ejection
J,-^.:^i
/rr\
_-r'^
rA^^
AEo/
Uc
r.,i+tr nrocanrod
crrctnlin
frrnnfinn
nrorrrilc
ln
ihe
KHnPErnEq,
MEAr.tUr4ltc
2006, li5 2
EH OAKTOP'CI
Mo3brrEH TPH!,PETHq EHnEnTH[ I'1TyMOP'HEKPOTHI{
TA OUEHKAHA NAH}IEHT'ITECbC CbPBEqHA HETOCTAThI.IHOCT
tt, cx. Txurertt, Ct, $onaroe', cr, Kropruxlst N A. Fygee'
- nrsBoH
no rapa?tgnorrrH polMrronorllc.YMEAnif Crpgl*cKit"
yMEAJ.I
no QyHKqxoHtrH{AhrrHocrhxa,
,l' Crpaxcru"- nneBos
tH6l4P.6AH'Codvw
- Co$rn
flo Kf,pAnonorgR
c gHyoHShBoH
cenop, YMbAJ]"Uapnrlal4oa8Ha"
Bnrun
IN THE
N.
slnstltute
of
TRIURETIC
PEPTIDEANDTUMORNECROSISFACTOR.O
EVALUATIONOF PATIENTSWITH HEARTFAILURE
r,
9n, Tlrchevet,st. choloko"t, st. Kurkchlov!and A. Goudov'
UMHAT'G. Stranokl"- plev€n
ol Cardiologytnd Rheumatology,
of FunctionalDlagnosls,UMHAT'G. Stratuki"- Plsven
BulgaridnAcademyol Sclonce- oofia
and lmmunologyol Rcproduction,
*Teafllocloanna"- Solla
of Cardlohgywllh lnlansiveCareUnrt,UMHAT
rir i
.' i.
riiii
;l:il
'':i ;,
Perprrc;
ycTaxoBoHq
u qHTo(hdqrec He6nsronpnnrHaI Fpbgxaraxa HenpoxgpMoHnre
(Cl-l).tlonra HaHau,loTo
ra nporHo3anpg xpoHnqHa
clpAoqHaxe.qocrarbqHocr
xgcto{rrHa c Aa @ oqoHFponnra H0 nnasusH}ire (o([exlprqfirl Ha MoSltrxuq Harpuyp€Ytirqor
nenrna (NTprogNP)lr ryMop-HeKporrrrvuna
<lamop(INFHr htxg4a npn CH. I npoyt{Borroro
o) raro npoAltt(Toprr
ca arnpqenu 127 na}lsnoeHeCH or ll go lV 6K no NYHA. OT(oxro 69 uuxe
l{HoHTH
C |Cnr,tH}r{Ho
na cpeAxaorlpacr 6'1,0r 8.4 roa. flarluoxruro ca noaroaoreTcnlo
167o/o)
no fttBoAHr OoocrpeHsxpoxr,rqHo
xocnnTanllrrpar{t4
Cl-|.B Aexn Ka Aoxocn$Tanulaqknra ca ocbulocraex{ cyaxAopTHhna6oparopxtr u Oysxunonerxn nr.
cnoAEax$tH c t!O?a g€xotHakFlbosa llocneABgf{o
Ha NtproBNPn TNF-a.
Tupceu ce rpafixr,rporynrorh,loot,tHrpsHhxarot pcxocnnran.$aquf,no no.
ooA xo o6ocrp€ra CH I prilrt,ris xa 0 uscaqa, nooeqeor 2 xocntranxlrqr,tr
(:a 1?1 naqrerrt,|
3t 1 roA{l{{l l,tjrx Cr'pIoq[o-c1,AOBE
cutpr. f'lpOcnoAcHrir
(95.3Vc)!a cpoAHo387 t 117 AHs.nol€ sAltr rrbporqogKpaoHporynrer 6 pc"
rncTpupil{nptl 54 naqilolru (44,6%) npu oA]rogaKropxllnaHan&aNTpToBNP
(t2 t 32.9f, p < 0.0001)noxl3arxaqnva npeAsrrlrnt<a
croiHocr 0a nbpohqxarq fpalHa qon 3! pltnh(a or TNF.q tLz= 1 i. p ' 0,76).flpn naqrexnr, roC(oxqgHlp6no dosoAxa 06oclpekgxpoxrqHaCH. nnaci'reHara
nt|TanHlhpaxs
qun ra NTpToBNP
npsAl AexocnnlanhiBq69ro
AonpnHscni4arhMo ra npeAcKgsttfic Ht ficxona,
Knlo{oor f,yMxl
rrolrqeH Ha?puypeflqo'|nonrilA, rytop-Hexport4.ieH
S6Krop, cbpAoqHdx€.
AgoraTtqtKrcr,nporH0ro
,|Jyor
Uf
+a
"l'.
8ummary:
'rAOAUnAHtJooa'KnUHuKe
nOkeltduonoauAu peswamonoeun'YMEM
Cnpaxcru', yn. uleopauKo'i6c"tvoE, 6800nneeex
The rclttionshlpof neurohornrones
and cytoklneBwlth poof prognorir h chronlc
heerl fallure (HF) hae alroadyboon €stohllghed,The alm of this studywar to
€valualotho rols ol plocrrlsconc€ntfalionot N.tcrmrnalproBNP (NTprotsNP)
and lumornecrosislocto{(TNF.(I)as prodlctorsc'foutcomsIn HF. One hundred
8nd twanly"ievonpatlrnts wllh $ynptomalicHF ranglngfrom ll to lV NVHA
funcllonalcl6st worc included,0tthem 09 matee(57%) wrth mean age 61,0 t
E.4 yesrg.The pat{entsworoconcec\rliv€ly
lrooDltalizqd
duo to exacorbalodHF
On thg day ol dltchargcttrndrrd loboralorysamplcswerc obialned,ochocardl,
ogrqphywrE pcrlormgdand vonousplremr tor NTproBNpand TNF.q lvas col.
lrcted. Tho prlm!ry cndpqlnlwa6 definoda6 tohospilallrallonfor oxacerbatcd
HF wllhln 6 mqnthr after dischergelhols l[3p 2 ho3pltalltationsln 1 ycar or
'J9,r
I
ri.t
1j r.,;l
tl
t,
"J
,"1
' t . ,l
:Ji.
rti
.ti.'
lrl
?iii
:il
.i,'
,i,.
:it'
w
)
JIPNKECTBOHA
KAPIUON03HTE8
EINIAPH9
HEIIHBA3I{BHO MOHIITOPI,IPAHEHA EOEKTA
OT IIPIITJIOXGHI4ETO
HA TAEVOSIMENDAN
NPN IIAUI4EHTI4C HPICbK IEFUT
H. CranqeBa,C. Tuurena,B. fropaanosa
r{HaL'rr,rFrr{Ka llpocb " K upll;r 9n.roucKr,r
Kap4no,ror'fi
"
yMBAJI "leopru.rCloartcru" - ll:renen
l
I
I
l
I
(
bpAeqI.IaraHenocTaTlbquocr
(CH)e
rcrHHaareHcr.rHlpoM,pe3ynTaToTpal
crpyKrypHr4 n Sysrcqronar.
Jrr,rqHr'r
Hr4Hapylueldils.HA c'bpAeqHusMyc.
r<y:r.5
CH ce xapaKreprr3r.{pa
c: HeBpoxyMopanHaax.
rHBar,lr,rrI,
ro1-rr1)KeHa
ilclN{neFra
syurqur u HaMa.
;reu cpl,r3l.r.recKrl
KanaLIlrrer,c aKTI4BI4paHe
Hape.
K6M Konro cna
Ir.rua rlarclopt{ Ha lyb3nit-rreHnero,
laT T.r{ap. TIHTOKHHH.
Tynrop lleKporr.{qHrrrircfaxrop (TNF-c) e onn.
curFr3il [:bpBi.{nbr npe3 1975 r. flpnHagxexn ru
cen erTrcfllotoHa npo Hrr@.n
au arop Hlrre qHToKI,IHlt,
Ilpes 1990r. Levine H qbrp. cto6ulanar, qe cpe,uHa'
ra ccpyNrFra
KOrrueHTpaunrHa TNF-u e [oBI,IueHa
npll rraur.rer{TrrTe
cr,c cH B cpaBHeHr4e
cbc 3Apal[
To:pr cfax'r ce norBbpx[aBa oT peflfiua
14HniiBr,r.qn.5
{e
eABaHl,r-qno Ka3BaT,
Ilpyf I,I aBTop 14. H r{ro,Trco r.I3c-rr
e0
lroBrruraBulFrero
Fra
KoHrIeHTpaul4qra
Ha
TNF-a
Pesroue
npaBa 3aBlrcr.rMocrc 're)Kecrra n $ynruLToHuIHw
TrpceuemoHd ltoeu HeuH6a3u6Hu
nemodu3a oqetffio
rctac CH.2o AHarHgtr Ha raHHHTeB npoyqBaHeT0'
na eQercma
om nposarcdauamamepanufr,KaKmou tt{t
npoeHnamanpu na4uevmumectc ctpdewtaNedocmaSOLVD noKa3Barre r-rneHutrfl3a no-BplcoKacw{'
m64Hocm(CH) e na)rceHnpo6neuHo culpeMeHHorno
HIll,
Cr,,C
HOCTrrpH nAUUeHTLITe
cH C IO-BI4COKI,I
rcapduonoeua
u uKoHoJvturrecKo
c KrtllHuqHo
3Ho4er.urc.
rra TNF-cr n cepyva.aBeporruo no.{o6Ho Ha Hel,
[fpocneduttucMenem natlueHmltc dunamamtrcHu
Koppoxop\{oHr.rre,cepyMHr.{re
HHBaua TNF-cr 6tzrirauot
duonamus upeQparcmepua
CH, Ha rcoumoe nplutuJterl
,'tr4ra 6r,aar fipenl{KTopra :a $yHuuonaJtnvtfl Klt6
3a n6p6un6m B SuteapttaKaaquelusmceHsumrcomop r4KrIt{Hl{qHL{txon Ha re3u rlaur4enTfi.LlurorrHl'ttt'
Laevosimendan.Oceen upes cmandapmilume
rullztLtLt*
B rracrFrocrTNF-a, He ca nprqnna sa CH, Ho Tfi0{&
uu, QyurcquoHmHu
u,ta6opamopuuuemodtt,etrte
rcmr m
Ta cBp'bxcKcnpeclulBoAr.{no fipofpecuq H& riles}'
om mepctnunmae otrcHeHupesusc.nednaHe
Ha cept'.MKaN,{elllrarzrallccpyHxuus
r.{peMoAenr,rpaHe. ^tl
HamaK,oHupHmpauun
na TNF-a u NTpToBNP usxod[4 rplil na HcBpoxvMopll-rHara
aKTnBau]l-q
npl,lLn
uo u c,tedKpan Ha 24-qacaaamaunQysunxa .,vtedurcae HoBr{flr6rronaapxep
NT-proBNP, rcoirroe c Beqr
ileHma.
ponfl 3a Al{tlrHo3aTaua CH, MoHI,ITopll'
/Xot(a3aH.'l
palle Ha crf erra or repa[]Iqra4,8,llu nponrosaTdlll
CI{.6 Pa:,rr.rqHI4aBTopt4c't,o6u1aBar,qe H3cr'IeAgl:
He'ro t{zl rv{o3r,r{cH
Frarpr.{yperr4rreH
nenr"a (BNlll
ButrapcxaKapAnoJroflrrr
2005,I l:220-224
r,r FrcrlotHflHear(TI,rBeH
npeKypcop N-terrntlld
l-
ff'
/l rtrlrr
Ir
t
Il.
&'
Ir i
W.
a !r[7 di
/ (.'{ Fle ,r"n
-,l\ fih /n !'1tY.r-1-rrrrErrr.|tr'
( i5$_rvr"-fi_"Fre*.
15 ll'.El'{"I1.EI_.UI-rj'I'L'
C. Tuweka,
B, fropgaxaha,
H" Cmanue*a,
A. Heilxala
q)eKLll4o3eH
l/| Henpeo,qojlvleH,qOKapAHT
$4anflsofia+,{epHa
cna6ocr. Ha gcnqxlr nsHacuuaua AogaLeuueHrfice npvrno)Kr4
vosimenclan1? vr/xr ea 10 rururyruu nocfleAEauar{Hq)y3r,rr
0,1 mr/rr 3a 24 qaca.
nofl pocnegnsaril ca xervrognrJaM[qHnre
fiaearenn,EKF r xnrxrqHo noafluflBaHe
ira 2 qaca, exoKapAuorpa$cKrdre
npoMe-
Kapgua oeuqtat<AuHuKa
"npoS. S-p K. Vu\ra1ew"
.
iui't'
I
i:
TT a .lrg
firl|;tl'lr
HA FCIr[AtU[C E{p[ChK Cb]FA]rEemHAEEIIT
r,
,i
fltrirtrn
il.H.l5i.tEi-pli.Yt"u"R'.Al*.a3"
<1t, iina)cn
ira npi4Jioifi€Hrle
Ha
P*ttoaot.'ilpegcraaeHu ca nbp6'rre ner ctlyqan 6 6b;rrap.r,rrr
KanureBnRceH3HTl,l3aropLevosimendan a neqeHuero Ha naL{ileHl'r4
c xpoul,r'+nao{"'0crpeHa xllnone6miHan gacromxa clapgeqHaHeAocraftrqHocr.
BcN.rxr,rener narlrleHTHca Mbxe c Jll4naruBHa
KaprqronaTrq,
l'lpr,rncr,ruxlrnpec qecrll pexocnrirtuln:Jaumu.
c .0.o6wanr'rr-r
c Hc3arrononure- tlM Ftpn{.lanannTRpH1\ nnonl/t l, ^nFn
..r._
reqeHr4t)
- - _ - _ nntrAu nprfloxeHeroHaSIMDM'e nDoBexnaHo
neHeoeKr.
*a UHrlySranra,
KrrDqBeHe
oqeuxa xa crKlr.rcrao0ugyrwul SIMDAX', Levosinrendan,xpoukrr{H;tcl6r:rrlrer-r3,
xunoJ}e6l,rlr*arr crortHmeTo
e HanpaaeHa
cne,q1 u 3 Meceqa. lTgregc
s actofi na cbfJAeL{
Ha HenocrarbqHocr, Ar4narari/rp,}iax apr.irlsnarrrr.
raaeMecrenHnre Ka3yct4:
ill
fi,
F
F
["
Frl
ll,
E:
r,
tt-
t"
&:
fli.:
t{i
$'
f,trr
ffi;
Oonr,rvxaracbpAeqHa Henocrarb(CH) e snavnM 3ApaBeHnpovr-rocr-
ff
f,
!
S,
Arra*,
A tur rF ^r u5v.t .' T
6.r,r
F5
r r!r 'vr,yu,
e
KBaq cKbno neqeHt4e14BoEeuJAo qecru
xocn4Tann3aqnilH BnoureHoKaqecTBoHa
xr4eor. EnaronpnrrHunt e$ercr na ACEprre('), 6eta.6norepvtT€rlar
unxm6vrro
r,{HanocnenbKHacnupolronaroox(qBbpxynpexrlBffeMocTTau nooSxoluuocrTa oY pexocnHTafl[3aufi]4npH naq!4eHTHcbc cr4cronHaCH e nr:xagas.Onnrtr c ulHorponqe 7e yPSnUqaHhMeAilKaMeHTil
nOKa3Ba,
qecToTaTa
Bar crJrbpTHocTTa
Lr
Ha xocnflTarfi3aqur{Te npll naqneHT[Te cbc 3anpenapacrorasaCHol'?'),
Enrr4ranhcoBr4Tg
ryr ytrvtql
d - - - - - - . . - - - . "
uJtstvttperxrvn
- J , - - *
Y\Pvt\t
- -
- - , .
bbP^y
Dlr-
tlecfHocTra u ca He\TpanHr4 no oTHouJeH!4eHa cUbprHocrral'"J.
Fesonacxocrra npr rrpnfloxeHlrero
lra rHTpaBeHoSHr4 r4HoTponHfi Me,qfiKaMeHTmI o6eKT Ha 3aJlbn6oeeH'T npoyuBaHilR npeg nocfle.gHhre ro[unn. Hgrua
npeKil AoKa3arencrBa 3a ToBa, qe re3H
MeAnKaMeHTr yBen{4qasaT cMbpTHocTTa, Ho HfiMa H HeOCnOphMr4saKTH 3a
IflXHATA NOT3A NO OTHOI.IJEH$E
HA KflMHuqHara KapTHHa npu nauileHTrTe cbc
CH{'1'r5'.
Har,t"rongmoronpoyqBaHe c ilHorf.roneH MeguKaMeHT e npoBe8eHo npfi
11,,,
|i
1ir
li;i
'
i.l:
1ll
t;
i.
l:
I ,
i.
i
LevosimenrJar)
e Hos Kapprlor4HorponeH Mel{Ul(Jf.lc:HT iiel ,leqL:FirlEtrr{a IieKoM'(4
r\u
v, '.
a'^i,
I vvr
yuvrq
/4oq
vvnvc)nvl
fla nerlcTF.rle:
Karur4eBa
ceHMgXaHn3Mil
gr4Tngaur4f,
na Mnotpnnatuexrure{1}'3)
r nepr$epxa u KooorapHa BasoAnnarallL4r{
!rpe3 orgapnge na A-[Q-:aBUCfiMfiTe
KaCtrpneqxara$ynxr.1rl
flHeeu KaHaJnai?32n).
yee.q{4t{aaaHo
ce nct[o6ple;r6e3 3xaqr4nno
Ha K[4cnopoAHara KoHcyrvlai]4t'" " r.r r-iE:
npeEu3efiKEiancrfcr-rrlilanHoMa.nhrHer{11
purbMHt4 Hapryr!eunlrGl.3a p;tsr:rtxa or
Mej.itlKat/lCllTtl
ApyftlTe KapJ"ll,lt)ll|'lOTpOnH!1
Levosimendan r,rraa(>nnronptlrreH ed)err
Bbpxy AM*qHara nporHo3a H npe)K[-48]'reD|VVr rq trv/r
r ldul4grl!ll9
U
lC,) nc1 Url
po(,.
B Ka$gr,ronoru1r.ruarra
Knr,1HrKa,,l-l
p-p Kl.tpnn Ll0.1.toGclii1"
ita /'lbfrSrr f!1'T 3
Lelosirnendart
Surapt'tx npr4n$)|ll4xrr.4e
npu ncr 6onHrt c ,qrlnararu16HaKapgrlonarran u pe$pzrKrepHa CH. f.lo orHoLUeHne
eruonorllf,ra rra CH /tsalra clr narlfienTr{Te ca c narloilal'r,l']l"ri]nrlnaTaThaHa KapalloMt{onart4n.EBardaca c !{5C 14nocrr,lHQaprrxa Kapiu,Jnarlrr't r 1 n;lur,rert' c uir-
t4.KU, 41'rotrurrreH
rurx.75 xr.
Ernuot ceus: tll4uonaruquaflunararmBHa Kapgr4oMvronarfiR.
XSCH - lV Qr.
noqeH
Cuunmouamura:
34.qfi h npr.l
ycnnnt, necHeSHaq4refi
HHQr43'lqecKn
Ha ,qeceT
r'ia yMopa npu vStiwqaB€'Hg
'!'u
, pq.
v j ^u
^au
FlJsonuqq
rflqq
v
n9P'
Ha
BaBaeKcneKropauHn.
)tsenuqaBaHe
rerflor{) c 3 Kr B nocnenHaTacaAMlrqa.
OiaxrnuAencmamys.yepeneHo o6up
cbcrorHi4e. aKpour,raH03a,
3acTotiH14
uJuuvv BeHu .qo aHrytyc uangn6yne,
- 34/mun.: llsocrpexo
raxr{.q{,1cnHefi
oe3ilKyjrapHoAHuiaHec ape6Hn Bfl.
xpnnoea e 6enogpo6HlrreocF{oeil.Taxllpr,rrrur4qHa
CI{-Cq - 98/rvrurn.
fanonex
prirbM. KopeMHa.qHHBOTo
HarpbAFil4fi
Koul,xenap Ha 4 cr,nor pe6penara gura no MKJI.KpaurHuum
c ororlr4no noA/^--,,-,..-vct-(l.retr.{vrrc.
n,,-I ryrrv
-
lvrg^,
pglyJldpgtl,
AH - 80/60mmHg.
chMerpurren,
npoE*x<a4ena32-acmp.
WY,ETln
951narluexrra
c Mvrnpnnox,
SocooAre- 120
crepageHilHXH6trTOp.
Pe*ynrarure ne
noxaoBar 6naronpnarxll eQexru Ha 100
Mnnpuxoxnpegnnaqe6o.Ou1enoBe'{e,
crpaHHqHuTe gBneHuR ca flo-qecTh B
roynera c MnnnilHo!.t('or I pe3yr.nla.THa
pa3oqapoBaqwre pe3yrlTarfi oT npr{noxeHueTo Ha uHTpaEeHo3HH LlHOTpOnHr.l
MeauKaMeHTr eeponevrcKHre 14 aMep!1xaHcKr4pbxoeotrcrea 3a neqeHrie sa CH
(c H3npenopbqaar re3!r MeAHKaMHT!4
xrtnqeHile Ha .Qnroxcran)na He ce npunafaT prn4Hrio, a caMo Karo MocT KbM
TDaHcn'taHTauugo7r8).
cnwaa.l
!{nusuyg!
-+- cAH
80
---r-- nAu
1,.
pu
H
cq
40
20
o
t--1l ^ ^
ctL
CbBPEMEHHA
MElr{Ur4FrA
log. LVII, kn. t/2006
33.Monoaa, D" T. Argiroaa et S, Monou.
.lupuserythenrarosus^
- Semin,futh,ritisRheum.,
22,
p antibodiesin patientswith
Antiribosomal
lupus 1993,335-J49.
glomerulonephritis.
- Clin. Nephrol.,55,2001,Ne5. 41.
The,l.-.
S.eta/.furtrribosomalF proteinantibodies
421425"
rn dilferentpopulation,s
of patientswith systemic
lupus
34.Mu, E. et al. Autoantibodies
againsteukaryotic erythematosus.
- Br. Rheumatol.,32,lgg3,
J.
65T665,
proteinL7 in patientssufferingfrom systemic
lupus 42. Thi,garujtrt,
P. et S. Shapiro.Lupus anticoagulants
erythematosus
and progressive
systemic
sclerosis:
fre_ and antrphospholipidantibodies,- Hematologyf
quencyand conelation
with clinical,serological
and OncologyClin" North Am., 12, lggg,II6TllgZ"
genetic
- Clin.Exp"Immunol.,
panmeters.
100,1995, 43. Wn Bucltt:m,tVl.A. et p. S. Tofts,Magnetization
ISl, 1gg-204.
transf-er
imaging.Neuroimaging,
* Clin. North Am.,
35. Qstrw,S. G,u al, CerebraJ,
atrophyin systemic 10,2000,n1-758.
lupus erythematosus:
steroiddisrue inducedphe_ 44^Vila,P.etal. Preva.lence,
fbilow_upand clinicalsignomen? AJNRAm,J. Neuroradiol.,3,
!gg2,2I-23. nilicanceof the anticardi<ilipin
antibodiesin normal
36.Parker,
G.u M. pAustin.A clinicalperspectrve
- Thrornb,Hemost.,72,1gg4,
on subjecrs.
20gAB.
- Aust.N. Z,J. psychiatry
SPECT.
29, 1995,Ne3. 45, Vest,.S.G. sr a/. Neuropsychiatric
lupus erytlre518-520.
matosus:a l0-yearprospective
studyon the mlue of
37.Petz,L. D. eta/.Serumand cerebral
spinalfluid diagnostic
tests.- A*,J Med.,99, 1995,i53{63.
complement
and serumautoantibodies
in systemic
lupuserythematosus.
- Medicine,50,Inl, Z5g_275"
Agpecga kopecnoagenqu*
38.Sabu,
A. etal. Neurometabolite
markersof cere_
.[-p CunreouMono8
bral injury in the antiphospholipid
antibodysyn_
IGuuuka no pe8uamolozlurdromeof systemic
lupuserythematosus.
_ Stroke.
29.
MeguuuuckuyHu6epcumem
1998,2254-2250.
V.t,,,Vp8uu"Nsl3
39.Steinman,
C. R. CirculatingDNA in systemic
Co$w 1612
lupuserythematosus.
Association
with centralnervous systeminvolvement
"let:02f 9448348
and systemicvasculitis.
_
Am.J. Med,,67,lng, 429-435.
E-mail : doktor*n:onov@yahoo.com
40.Stinnler,M. M., p.M, Cateniu F.p
fuisnorioJr.
Magnetic
resonance
imagingof the brainin systemic
no(nt'bnuna:
m.okmombpu
2005e.
HEBPO)ilMOPMFI,AAKTTIBAIJUN NPU CbPEET{HA
HE[OCTAIbrrHocT
c noHr4XGFrA
YI 3AIIA3EHAOTAXqNA \TA YI3TAACKBAHE
H. Cmax*cfiat, Cn. Tu*egat, Art. f7ge0 t
Kapguoaoeauxa
ktuuufui,JIrfBA,4 _ IIaelJu ,.
KnuwAz zo Aapgtotoeaa
c uamexSu1cu
cehnop,y,M6A/1,I,!apu4ailouttua,,Cofrun,
Pegloue XponuunamacbpgeqHaHegofiurnb\rlrocm (cH)
e couudrr.no3Haqururgpa8ennpo6aev, Boqeurgo Bucoh
6orecmHocmu cr&prnHocm'Baorueuokatrecm6ona:lu8om
u Bucokupa:rxogu3aAeqe'uc.3acpot6oueHume
aH&\luu
ua
namoQuuoroeuuHumeMo(ll'lt3MuHa culrgpo*l cH npegonpegorrm
neao8at, upr6**, gua?Hoi.,^eqcHueu npo?no3a.Bercnopno
gokasaue
Qakmtm'qe cH ce xapakmepu:upt
tk*u6upa'e Hapeguuarre8poxyruopa^Hu
Mexallu3Mu
kamo
penuri-a'zuome':lu'.algocrns
"po
pono8amacucmeMa'
curunamukyco8ama
nepBua*arna"., 6*og*or'npu
u
nenmugu,utrmokuHu,Ba:onpecun
u rampukcnu MelnanonPomeuHil3u
"*p,ripemuqHu
. Tpaguuuounoce cMrrma,qe cuMnmoM'ama
cH e p..yrunam Ha cucmo^HagucQpfuiu, kor.
mo Hau'qecmo
ce o6ekmu8uruPa
qPel orokapguozpaQckua
noktamor Qp*ku* ua u:m,uck6arre,
EgBauanocacgok
ce okar.a,ue rua.
1
log. LVII,kn. 1,/2006
C'bBPF,
MEH HA MEIII4UI4I-IA
qumelHa qacm om nauuenmume cbc CH uMam 3ana3eHa
kocmo nocrnalJxSr,npoctm ga,ru CH ctc saQp,rkuu.rrHa u3m,\.rck8aHe,
're ue8poxltropar\Harnaakmu8auus e Mnoao
n&leua cucmoAnaQyukuua uMa aua ozuquu namoQuuo.roeuuitu Mclialrulur"r.l"Lra.te;{<ga,
o(ogHa, uakap u $Pa3ena B nqc.ra6a cmeneH,Ho no.sagu6o.reriu iilc-req6anur ci neo(r.toqurruB nta:u nocoka,
Kalo.lo0u gf!ru: Gpgetlna Hegocmambqnocm,3ana3eHr;.
,|plkuii.rr ua urni,rack6arre,
Hetipoxproprunua
akmu6aqw.
N. Stancieva,
Sn. Tisheva,A. Goudev- NEUROHUMOIL{I ACI'NAI'ION IN HEARI'FWIJJIU WITH REDUCED VS
PRESERVEDEJECION FMCTION
Summary:Chronicheart failure(HF) is a major healthprobicrnieadin; rc,rncrc.rscci
nrorbrciiryanciinortality,poor qualiry
of life and high economicburden.Sophisticated
analyses
ol' the p,lthophysio)ogrc
rncclrrnisnrs
o[ t]re heartfailuresyndromeare
indispensable
for its right diagnosis,treatmentand prognosrs.
with neurohumoral
il[ is associlred
activatronof certainmec]ranismsincludingrenin-angiotensin-aldosteron
system,sympat,hetic
vasodilators,
ncrvouss)'stcm,
nxtriuretlcpeptides,
cytokines,
vasopressinand matrix metalloproteinases.
Traditionally
syrnptonlatict'lF rs ass<:crated
wrth systolicdyshrnctionassessed
echocardio
graphically
with the parameterejectionfraction.Only rcccrrrll'rt h.',sbe.n ,rppreciatcd
dr.rt i malor proportionof hean failure
patientshavepreserved
ejection6action.This fact raisesthe questronil I{F vith prescrvcd
s.u*srolic
ftLnctroncharacterizes
with the
samepathophysiologic
mechanismsas systolicdysfunction.It seernsthat ncrirohumoralactrvatiotrrs very srmilar althoughto a
lowerextentbut furtherinvestigations
are necessary
in this rlirecti,rn
Kcy words:heartfailure,preserved
ejectionfraction,neurohurnc,rll
actir,rtron.
(CH) qecmomamae Nl&il(o no-Huci(aom 50010.6
XpouuunamacbpgeqHa
Marrko ca
Hegocmambquocm
e 3HaquM
3gPaBeH
pa3rvlepu.npoylr8airuqma,lt{runrocpa8ru8am CH c nonulcena
npo6^eMc enugeMuqHu
c8'lpsanc Bucoka6orrecmnocm
u cMbpmHocm,
6A0- u 3ana3euaOm. K,.tloqo8;lmapolr Ha lre8poxyrr(G
rueuokaqecm8oua tku8om, Bucokupa3xogu3a ,\e- p&^*ran'rilakmu6auu u pal8umuemo u npozpecugqeHueu e Hau-qecmama
npuuuHa3a xocnurrr2;\ri
]2- ma Ha cllcmolFlaml CH e ycrnaHo8ena,8
gokamo
Pa:6upaHemo
e
Ha
ocHoguacmo
xa
CH
oue
Hecurypna
namo$wuoloeurlHume
npu
Bce
u ca lteuur.t
Bu ira cuHgpoMa
u3cleq8aHu,s
He?o8ama
npa- o6xogurru ueleHacoqeHu
B ma3u noco
CH npegonpege^r
BunnaguazHma,
AeqeHue
u npozHo3a.
llpegnaeanu
cr kri. He:r{iucuMoon1 Qi4 u.ru enruoloeurrnaHa xpopa3nuqHu
Moge-Au
ua c,rclkrru.rrHuqrlirm r CFI, n c[i1:ox\,]vrop
3a xapakmepu3upaHe
;L\llJrrra akmu8aqu.flr,Ioic
npouecHapeMoge^upaHe
HaA.s8ama
ka:nrepa
u llli()?- ga 6r'gc o5ekmu8u:lrlpallilrrpe: pa3luqllu n6opapecwlmago CH. A8mopumeca eguHogyurllu,qe nropHu u Qynkuuollil.\flu nokalameau. Om Eua
CH ce xapakmepwupa
c He8poxyNropa^Ha
akmr.r8a- cmpaHa npu CI-l e no8uureua akmu8nocmrxa Ha
peHuH-aHzuomeruun-angoccuivrnamulqrcoBama
nep8na cuctneMau noiruicHa
uufl,zAkoxmo Bkrloq8a
lttpx Ha meru aBmepono8amacucmeMa,cuMnamukyco8ama
uepLiHa lna3una napacurlrnanrukvco8ama.
ncn- nloHoMril guc{,yulntrurc E.rpua6uaumembm
cucmeMa,
Barogurramamopu
u nampuyPemuqHu
Ha cbp
rvrcnla- cteqHamrqecmolr.r (l llM u no8uuenume HuBaHa
mugu,UumokuHu,
Baronpecun
u MampukcHu
qe nopenuLrc$pun."FIIIV ompa3'r8a npoMeHume B
AonpomeuHa3u,
[rnau zogurlu ce npueMa'Jre.
noNrne- npogi,,.ulrume^llocmnralra cbcegHu RR uumep8arru
cuMnmoMHama
CH ompa3q8anoHu.t<eHama
na Qyllkuu.nHa,l-s8amakauepa,kosmo ce o6eknul- u e u3pe3Ha 6il{aHcupaHllqcbpgeqeHkoumport.to'tt
qpeoexokapguozpaQckus
kpumepuu
ce qpe3 BpeucBuu qecmomHuMemoguHa
Burupa
Qpah:,ur I4:rurep8a
Hawrn^ack8a:He
/AI /. Ha npl8 noeAegma:u konqenuul u3z et(ga npuetr{u8a. Oka:Ba ce o6aLIC,trc
qacm om nauueHmumecbc cuMllnpu 3Haqume^Ha
moMu Ha CH H.sMacucmoAHagucQyHkuurru (lil
aHaLlJlra cbceglrlrmcRR uumcp8aauHa EKI 3anulrper 2,1 qtL:o{JEKf xorrmepMoHucaHatr.rlr-.tecmo
rnopuHl,"'flauueurnurlrcc xpoHuqHaCH uMam 3lta-
c
vurn€,\uonoHuker Hltv 6 cpa6Henuecbc 3gpa6ume
HenpoMeHeHa.s
Hanoclegrk Bce no8eqeBnuuaruc ce
CH c egHakb8
lrugu8ugLr.''
flpu uanpegHa.\a
Qynku
HRV
lcrac
NYI-IA,
emuo^oalr-fi
no
ulroHancH
Ol4
omge^r Ha cH cac 3ana3eBaoyl, lorreuume nonyAaUuoHHunPoflBaHwl nokas8am,,{e oko,{o 500/oom
nauuenmumecbc cH ca cbc 3ana3eHa
om,o' .r 6
me3u, o6x8arqauu xocnummu3upanu naquenlnu.
vo;kc qa 6tqe pa:,tu.reri."Totu Qtk. gonpuuacf,3a
npo?riocnluqHamaoueultii rra pucka orn cMbpm,r3
cMbpm,r4
Bk,{oqrnne,uroBue':lnurt c'bpgeqHa
li,.l
l!1
RSSFeeds\5
N--^
N:\-\
N-\
N'NN\\,.N
NN.'N
I
I Articles&lssrres
NswsandMeciia
Forl\uthors
Jourrrnllilfi)
\i*i:i[]
L o Q r nl R e g i s t e rl S u b s c r i b e
\,\i-
$ri:r,,,rh,
f . i r , , .f r r , , ' i r : r l
I
v
All Contenl
S i ) a r c fl
A c c c s sp r o v i d e d
b y P l e v e nM e d i c aU
i nilersity
e , S u p p l e n r e n tl .) a r ) { , r - : ' ,
r l - C t R *R I \ " ) $ V o l u m e 1 0 , l s s r - r 2
< P r c ' v i o uA
s rliclo
rr
1,,
'
.
'
A PS C z o r s - l o2 o In ci d e n r:eo f C Ib usi{ o r ) i ,} ,' ii,.,tiif'
' i
With lscheruic l-{eart Disease-:\ {Julrr; 1\':r,r : .\
Retween Indian ancl Bulgai'iiiil Patiertls
,,' ',',
.
i :'r I
l.ly[] .jiiiir-e-ii,
-l,ttr.rit\i:\,il-$]l..j\i.i{i.,ir]i!l1
r'
I i
'|
l{
t,rll
:r
r,ri
, ,' j I ,\
'..1!,j,-,i\.1jl.iil.i)..ii.l.i:rji..iiltrijr..i..Lli.!.i.jt,:.l..l..ill::l
DOI rriitr..
"':iil}ri.l-"i
.|trt\\1.:i!
, :i||Irrji
{ill
i .i, r.,.,t rr trtii,l:lllglt:
a\i{ittiiill
iir
....
:
I
I
.: irr'
i..,irrirrrliltr
rl i
Article Or-rtline
r. t.,tl;:i1..)\.ti
i.ili:l
Il. .Q.l:l.tlt.it-.ll.r-it"i..r\rlil\l.ittr.i.
lll. ll,q.!I,ii_\::.
lv.i.l.i.il.iijlt,:t.liiil
V. i.iljtilil.i!i"i.l.|l.1-!.i...11:lj,lii!-t,irr.l
Vl. \\1iviy1$5
i ,r.
,
.
r .i i
.
:
T l l e o b j e c i i y eo f t h i s s t u c l v i s t o a n E r i \ { ; ea n c l c o r n P a r ei l r r : l r o v i r , : i . r
!
. l l r m l ) l r l S a r c li ) n
Objective
i.,i .\ ..1t.r\tirr\i,t),\\i\\\
ri.i,rr\.t.l1ir1.iir")ilUt!i|$sN
.,ir ,t.l\$f r\:iir\. it$\l
,. i .
,, ,, '
'l ]
. t l I J r . . , l r. i
.i,
t: l..rr
,irtlriii,illr:lrrNis rlsk in
I
. r \,$
li,,r
.
i s c h e r n r ch e a d d i s e a s e i n B u l g : r r : ra r r i jI n d i a .
'
D e s i g n : C r o s s - s e c t i o n a l s l u d y a f i l o n g p a i i s i ] l s v i i { he s t a b l i : i i l c i l i j 6 , , r '
r
:
r
1 il
", 1, ..
'i
i.
c
m e r j i c arl e c o r d s , C l i n i c E
a lx a m i r r a t i o n i n c i u d i n g l r e r i g h l w e i q h t r r ri i, i, i irr.(,l i
ri'i:,.ir ,,
,.r i,'
.
r
ri
.r'
,
I
:r,.
I
.,.1.
il
,,1
\, ,,.i,
i,\.r r l
Q b e s i t y ( B M>
l 3 0 ) a m o n g m a l e s i s l 6 T i , a n d a m c n g ; l e r n a l $ f i : i i l ( r t r i r :i r' : l ' r . i r , i r , , i i . r
p . J t i e n l s t h e v a l u c s a r e l l t . 2 3 i i . 3 2 . q ; ,1 8 Y 6 1
, s r ) i a n d . 1l i i f r l r , i r ; i . , c i i . t , 1 h . f ,
r
!
r ,
r,
i
. J,r.r,
1o:,r,,,r
li,)n
CClnClttSiOn
(.t
.rt
;
.1..r',;,'
.ilt,\i\.il\\
i . , . i ' . : : ; r ll
i r
i.. rr I
i
. . : i i r l i \ r r i { : r l $ l l i \ jl l J \ i $ i l t $ i N
i . i r : i : . . r \ i l l t\ \ l t \ . r $ !
,r,
1 , ; , ; { r l l . ' , . ' r lrji i s S u u 3
r i
r , r i rr
r ril ll
i.r
i
,.rir.i:rl
til lr..:iSitaliJ$({
:
. i. i \
I i,. r,,l
,
r
lrr
i:t-r,r
]un p tc ij,:r:ton
i n c i d e n c oo f O b c s i t y ( B l M>l 3 0 ) a i r o n g lm a l e s ;i s : 1 9 ' j ia n d n t u t ' , , , r J n i ' r. :i i l i
F
. rl
i
r c s L r l t sl h e p a l i e n t s w e r c a n a l y i o d f o r t h o s l u d y .
ir I
a r e w i t h C l a s s l lO b e s i t y ( B N3{ 5l . 5 - 4 0 ) a n d l % i s \ r i t h C l a s $ l lO
l 0 o : r i l ' r r iI , l
.i
i.r,\
r ttl {-ll.ftiil$i\flti
'
i I
i n c i d e n c e O b e s i t y a n d w e r e c l a s s i f i e d b s s e d o n b o r j \ ' [ l a s : ; l n r - i , . ] r i { l l . , lj t , i . . ' ,
F f o m t t r e s t u d y . i t w a s s e e n a m c \ f l g t h e l n d i a n p ; r l i e n i s r l l i wi -eJrr!i )i l \ r l r li l, r. l , r '
, .l
r.:
o l J a n u a r y 2 0 1 2 a n d 3 1 s t D e c 2 t ) 13 w i t h e v i d e n c e o f i s c h c r ni o l r c t r r l j
l ]l 0 l l l i . 5 - : i 0 l l 0 1 i , . i r ,
N o r n l a l B l \ 4(1B l \ 1 1 1 8 . 5 . 2 5 ) . 4 0 ? i , i r r e O v e r w e( iBgM
,i
,$
I
'
ir
f l o s p i t a l . P l e v en - l i u l g a r i a e r n dD o p a t 1 r n en t o f C a r c J i o l o q rll-,o. i r { l f : \ 1 i . .
il .
Ir .
C o c h i n . K e r a l a I. n d i a . 4 ! 1 6 p a t i e n i s r v t r o w e r e a d n r i t i e d i n t C
n ei r r r l i o l : r . i : . f r i l , j r l r i i
i),,,r
a n d N e L r r o C e n i e r ( L H I N C ) , C o c l r i n , K e lrnadl ar a. b e { w o e n l s i - l l r r c . r i r ' l i .
i ,i
w h o w e r c ; r c l n r i t t e di D i i r e C a r c l i o l o g yD e p a r t m c n t . D r . C e o t g i : l l , ; u r s i i i
ir..l ' . i.
I{gSf-fitS
-, l:ir...
.
)..
s'
D e p a r t m e n t o fC a r d i o l o g y . M e t l t o o s : S t u d y l v a s c a r r i e c j o r i l i t r l i r c C . i i , i i r, il ,, t
I n c i d e n c o o f o b o s i t y i n p a l i ( } n t : jw i l h l s c i r e m r c i l L . a i l - t t i i s e i l : irnu i r r o r i r t , '
.li:
r rrr'
, r r n r p l J S l r ' c li J n
Design anciMethod
i
.,irilJ ,\ r\g\N il)$i"irF$r{ti{:
risir
.rirr rl.r,l,r{.r..lii,.::
.,r l.l::rriiltl,','rl )
l : ; $ l . r i ,?r
\rl!ii:'\ii
RSS Fceds \.ril\ \'ii\bil+
Login I Register I Subscribe
NNN\\N
N_"\NNN:\NI
.
For l\tllllol's
and l\ledia
l'lews
All Content
Access pro\'iilscby Fievenl'ledicullJillvrlrsll\
.- Fri:.,\,io*:r
r'\rticle
' .3
2' Supplemenl ' arlcr
.N\l:\\\ Volume 10' lssue
*N",ul'.ul
l.
...l
* r'lr t { t
AP SCzo r 5 -xo 1"9P r:eva]enct) o f {-{-v1-r
'i
ii. i l.::
i\{eilitr-rsinPatier.lts\,\ri'thTsc}-ltllrlll][.]\i.ll.
ir l,,i
Nnr-\i lt lt I \
Compara'tive a'nill)rsis Lic {-u'celt
Popuiiitior"l
lii.i.-Ltsl-l:rl-llii
i',i-lti:::::l:.ll
L,i.llt-\1....1i,$rq:r.
l\
i I \ iit\$!ii l.r;i.r.1..$il'.,lai-llirli
r1i,ll.
rlll..l.i.).,,\1..i.
r \-\!l
,ll jlirl(,..
\lrii $i\r{lr$\it\cuii
iii)\ifi\t'i\$ {\ \lNl
l'
lr i\t l. li\'iL\l\
.,',l i). i'l: L,$ l
jL il) Io :r:{r::r)l
Objective
ol l-lyperlerlsiof orliJ L'\riri"'l
Analyz,*:anrj coo)pare tno fitov'Ilerlfii
lrrdla'
a
l
n
d
B
u
l
g
t
i
i
r
i
'
\
i
i
l
h(]rlrtdiSease
:
J Lr r r f 1r 1:' ) ' r i : (i r r r
n,r ^r\tg6l
Design alltr $'Lt'r.i
; 1 11 r 'i
a i l l o l r g 4 7 0 p n { i el l l s n l i ; n r 1 ' 1 1 ' ; 1
C I O S S - s i e c t i o n as lt i i d y w i : s d o i l o
Jririiill'r'i
l
s
{
o
l
G f . a i S t r i ) n s k li - l o : i p i l at lr l o v $ i l - B t r l { ) : r r i l b c l i $ " e o f 1
l - o L r i c l e s f i e i t t ll r i s l i t r i i : r i i l i r i \ l l
lrdmitledintheCilr{iioiogyUeLrortnlon'l
b e t w e o n1 s t J u n e 2 0 1 2 a n i l 3 l : i t D o c 2 0 1 ? \ ' i i l h e v i C c n c $ t : i r r r : i t ' r ' t r '
rrr
D i : r b e t e s N l e l l i t u s : r r r tlli l l f ) i : i i r ' r L l l i i
forprevalenceof llyperltlnston
llr r r i " t i : "
i
r
l
r
l
r
r
d
i
r
r
i
E
m
n
r
i
n
a
t
i
o
t
t
p a t i e n t : ; ,o l r i n r e t l i c a l r e c o f d s C l i l l i c a l
'r'l
F i l s t l n u a r r c iP o s l - p r i i i i i r i r rilri i r
L a b o r a t o r y r e s ( l l l si n c l i l c l r n sH D A I c '
il!ii:l\'
iilrl
irli
i]r]ai)"te{j
werc
t-llpertension ar)d Diabeles ["'loliitus
ii
'i
I
:
'l
rr
:
|'
i
)Il'
:l
i
lt :
i: " :
lr |
l')illirir:.\$i]N$vi\l$$ct\.
\ r'\ririr\\illt\, lllt\ $*Ntr{}1.
ir l
r' i
tr '
ri
:'
l
'
\.'.trl.:.\. l. :irLr!l 1
i
ri\\iil ili]l.r':l{:i\:{l$ $tfu*{ilNs{*
i ri.rl:itf\siir\ls \"i\$$lNi\')illi\l
' .lii lr l'i:l':(;l'lfi
Resuits
Froil
the slutjy i{\'vas $een tllati{wils
I
i i i'
:isBrl iiriltthij plil\'illilil'ri:j
lr i
I
"
p a t i 0 n t S W i t h | S c h e n ] i c H e a d D i s e a 5 c . w h e l 0 i ] s 7 , i . 1 , i t l 1 D t r i . l l i t l l : l : . l lI . . ] l i l : l
i
i"
i'i
nsiofl ilillorl!:i ilre l'\diilfi lli\irr
<0.1]1).The prevalenc€j of Pre-h-\'ierie
I
i rr
'
\'
ptcvalence oi i.lia$i:i|s Ll' llrl
t
u
'
O
i
)
t
t
t
t
t
(
p
v
a
l
u
e
patients was 18%
i
i
1
rir '
f"lirllriiili
Diolrri:ii":r
wilh
of l3ulgailan patlenls wqre
wltereas 34.,,.,o
'
i
l
'
iirl
i
palierlis is 21 % :iild airiorlti
Tolerarlce alnlorlg tile lndlan
.l|teiricicenceoiCADaIorlgsit|\li]eriSkfitolcii)|Oiii0t3i\i]ii]i\1..,
lilulQi:l shollri
dote illion anii corll.fol ol rl:\h
bc r:orliiiilrliili:i rr
iii i r'
ItiN
.rii\i$ir \{:r lll$\'\$} $I*ilt$l
,ii| $rll\rill i\\ th$$s Nlltr
t. fr lrtili \l1i fl\Nilrt$lls
r '.i{rl :l i:li:li.it 1
i$tl
rl
'
\ljri.l{..Ail
I
rr ' l
J ri | . t l
Discussion
'l '
'
II
tJN
ri\ li\\t\\l!ifnN\\i itr $nit**N
'
r
r.l r,i
l
DOI : 10.527
2I jimab.2012
183.345
M A R K E R SO F
C H A N G E SI N T H E I M M U N O L O G I C
E L A S T I N D E G R A D A T I O NI N S U B J E C T S W I T H
M E T A B O L I CS Y N D R O M E
EdwardMekenyan.Nady'aStancheva,
SnejanaTisheva
First Cardiologital Clinic UI,lH,lT "G. Strctnski"- Pleven,
Medical Universit1'Plt:vtttt,Bttlgnria.
ABSTRACT:
Background: It is known that metabolicsyndrome
characterized
by diabetes,hypertension,dyslipidemia,and
central obesity is associatedwith the syndrome of early
vesselsaging,characterized
by a changein elasticityofthe
v e s s e l w a l l . T h e e a r l y m a n i f e s t a t i o no f t h e m e t a b o l i c
syndrome in younger people in the modern society, leads
to earliermanifestationof the complicationsof early vessels
aging, and the combination of severalrisk factors is cruciirl
and leadsto accelerationofthe vesselsaging. Elastin is one
of the main building blocks of the of the vesselwall. Its main
characteristicis its elasticity, allowing the vesselto restofe
its shapeafter stretching or shrinking. Loss of elasticity is
a key component in the pathogenesisof cardiovascular
complications.
Materials and methods: A study is conductedon 62
s u b j e c t sw i t h m e t a b o l i c s y n d r o m e w i t h o u t v a s c u l a r
complications and 42 controls. The main objective of the
study was to compare the imunological markers of elastin
degradationin both groups and to assesstheir relationship
with the risk factors characterizingthe metabolic syndrome.
Results: When comparingthe mean value of AEAb
IgG in the control group and subject group with metabolic
s y n d r o m e( r e s p e c t i v e l y0 , 4 5 I - 0 . 1 1 a n d 0 . 5 4 I - 0 . 2 9 )
statistically significant higher mean value of AEAb tgG in
t h e g r o u pw i t h m e t a b o l i cs y n d r o m e t, : - 1 , 8 5 ,p : 0 . 0 3 i s
observed.When comparing the mean value of ATEAb IgG
in the control group and subject group with metabolic
s y n d r o m e( r e s p e c t i v e l0y, 4 5 l - 0 . 1 3 a n d 0 . 5 5 l - . 4 3 )
statistically significant higher mean value of ATAb lgG in
t h e g r o u pw i t h m e t a b o l i cs y n d r o m e F
, :6,83, p:0.01 is
observed.There isn't a statistically significant difference in
AEAb IGM and ATropoEAb IgM in both groups.In the
whole sampleAEAb IgG showedpositive correlationwith
total cholesterolwith a correlation Spearmancoefficient r =
0,25, and p : 0,02, with triglyceride levels with Pearson
total cholesterolrvith a Pearsoncorrelationcoefficientr:
0 , 3 3 , a n d p : 0 , 0 0 1 . T h e C o r r e l a t i o n sa r e d e s c r i b e db y
rcgressionanalysisand the relationshipis linear.
Conclusion: lt is provedthat the AEAb IgG and
AtropoEAb lgG are significantly elevatedin the subjects
r.r'ith metaboI i c syndrome w i thout manifestedcardiovascular
complicationscomparedrvith the controlgroup,whereasno
difference in AEAb IgM and A'l'ropoEAb IgM has been
o b s e r v e di n t h e b o t h g r o u p s .
Key'rvords:Metabolicsyndrome,AEAb IgG, ATEAb
IgG, risk lactor
Ii;\( l((ilt()tiND:
lt is knoivn that metabolicsyndromecharacterized
by diabetes,hypertension,
dyslipidemia,and centralobesity
i s a s s o c i a t e di v i t h t h e s y n d r o m eo f e a r l y v e s s e l sa g i n g ,
characterizedby a changein elasticity of the vesselwall.
'l'he
e a r l y m a n i f e s t a t i o no f t h e m e t a b o l i c s y n d r o m e i n
y o u n g e r p e o p l e i n t h e m o d e r n s o c i e t y ,l e a d s t o e a r l i e r
nanif'estationof the complicationsof early vesselsaging,
and the cornbinationof severalrisk factors is crucial and
leadsto accelerationof the vesselsaging. Elastin is one of
t h e n r a i nb u i l d i n gb l o c k so f t h e o f t h e v e s s e w
l all. Its main
cltaracteristicis its elasticity,allowing the vesselto restore
its shapeafier stretchingor shrinking.Loss of elasticityis
a k e y c o m p o n e n ti n t h e p a t h o g e n e s i so f c a r d i o v a s c u l a r
c o n r pilc a t i o n s .
N u n r b e r o f s t u d i e sh a v e s h o w n t h a t t h e i m m u n e
s y s t e m r e f l e c t st h e p h y s i o t o g i c a lc h a n g e si n t h e e l a s t i n
metabolismin the vascularrvall. In the recentyears,using
irnnrunologicalmethods,changesin elastinmetabolismis
cramined,as a sign of vascularaging in high-risk subjects
r.r'ith
cardiovascula
r mplications.
co
Thereisn't sufficientinformationaboutthe natureof
t h e i r r m u n e r e s p o n s ea g a i n s tt r o p o e l a s t i na n d e l a s t i n
c o r r e l a t i o cn o e f f i c i e n ot f r : 0 , 3 5 , p : 0 , 0 0 1 a n d w i t h L D L rretabolism in patientswith metabolic syndromewithout
levels with Spearmancorrelation coefficient r: 0,29, and p cardiovascularcomplications.The data on the prognostic
: 0,006. In the whole sample ATropoEAb IgG shorved value in the evaluationprocessof early vascularaging is
p o s i t i v e c o r r e l a t i o n w i t h L D L l e v e l s w i t h S p e a r m a n scarce.Therefbre,the attemptto determinethe changesin
correlationcoefficientr: 0,29,p = 0,006and with levelsof e l a s t i na r r dt r o p o e l a s t i m
n e t a b o l i s mi n r n e t a b o l i cs y n d r o m e
/ J of IMAB. 2012.vol. 18.book 3 /
345
D OI : r0.5272I jimab.20l2l83.342
M A R K E R SO F
C H A N G E SI N T H E I M M U N O L O G I C
COLLAGEN TYPE IV DEGRADATION IN
S U B J E C T SW I T H M E T A B O L I CS Y N D R O M E
SnejanaTisheva
EdwardMekenyan.Nad1,aStancheva,
First Cardiologit'al Clinic UlttH,lT "G. Strqnski" - Pleven,
Medical Univer.sitl' PI avan, Bulguri a.
cardiovascular
complications
ABSTRACT:
sl'ndromeu'ithoutmanit-ested
B a c k g r o u n d : C o l l a g e n i s t h e m a j o r p r o t e i n c o n r p a r e dr v i t h t h e c o n t r o l g r o u p a n d t h e r e i s a s t r o n g
b e t w e e nt h e A b a n d t h e r i s c f a c t o r s .
c o m p o n e n t o f t h e v e s s e l s .C o l l a g e n t y p e I V i s f o u n d c o r r e l a t i o n
exclusively in the basal membrane and doesn't forrn
individual fibers, but instead is presentedas a polygonal
Ke1'rvords: Metabolicsyndrome,AEAb IgG, ATEAb
amorphousmatrix that is associatedwith laminin and other IgG, risk factor
matrix macromoleculesto form the unique matrix basal
m e m b r a n e .U n d e r t h e i n f l u e n c e o f t h e r i s k f a c t o l s
It,\('KGt{Ot"lNI):
characterizingthe metabolic syndrome, a variety of basal
C o l l a g e n i s t h e n r a j o r p r o t e i n c o m p o n e n to f t h e
memranedegradingenzymesare activated.This leadsto an v c s s e l sC
. o l l a g e nt y p e I V i s f o u n d e x c l u s i v e l yi n t h e b a s a l
early changesin vascular wall and acceleratesthe vascullrr nrernbrane
and doesn'tform individualfibers,but insteadis
aging The early manifestationof the metabolic syndromein p r e s e n t e da s a p o l y ' g o n a la m o r p h o u s m a t r i x t h a t i s
younger people in the modern society, leads to earlicr associated
rvilh laminin and othermatrix macromolecules
to
manifestationof the complications of early vesselsaging. form the uniquematrix basalrnembrane.Under the influence
Loss of elasticityis a key componentin the pathogenesis of'the risk tactorscharacterizing
the metabolicsyndrome,a
vrrrietyof basalmemranedegradingenzymesare activated.
of cardiovascularcomplications.
Materials and methods: A study is conductedon ii2 " Ih i s l e a d s t o a n e a r l y c h a n g e si n v a s c u l a r w a l l a n d
s u b j e c t s w i t h m e t a b o l i c s y n d r o m e w i t h o u t v a s c u l a r acceleratesthe vasculal aging The early manifestationof
complicationsand 42 controls.The main objectiveof the t h e n r e t a b o l i cs y n d r o m ei n y o u n g e rp e o p l ei n t h e m o d e r n
study was to comparethe imunological markersof Collagen s o c i e t y l, e a d st o e a r l i e rn r a n i f e s t a t i oonf t h e c o m p l i c a t i o n s
typr IV degradation in both groups and to assesstheir of early vesselsaging.Lossof elasticiryis a key component
relationshipwith the risk factorscharacterizingthe metabolic i n t h e p a t h o g e n e soi sf c a r d i o v a s c u l acro m p l i c a t i o n s .
syndrome.
Results:When comparingthe levelsof Anti Coll IV
M,4t'ril{tA t,s AN D MI.IT'ttoDS:
Ab IgG in the control group and subjects with metabolic
A study'is concluctedon 62 subjectswith metabolic
syndrome(respectively0.28 + / - 0.08 and 0.40 + / - 0.1l) a s y n d r o n r er v i l h o u tv a s c u l a rc o m p l i c a t i o n sa n d4 2 c o n t r o l s .
'l'he
statisticallysignificantlyhigher levels of Anti Coll IV Ab
r n a i n o b j e c t i v e o f t h e s t u d y w a s t o c o m p a r et h e
IgG were determinedin the group with metabolicsyndrornc, irrrunologicalmarkersof Collagen t1'pr IV degradationin
F : 3 0 . 2 9 9 , p = 0 . 0 0 0 ,I n t h e w h o l e s a m p l eA n t i C o l I V A b b o t h g r o u p sa n d t o a s s e s st h e i r r e l a t i o n s h i pw i t h t h e r i s k
lgG showednegativeconelationwith HDL with a correlation flictorscharacterizin_9
the m etabolicsyndrome.
Spearmancoefficientt:0,26, and p = 0,02.The antibodies
showedpositive correlationwith the diastolic pressure(DP),
R[]SI.IUI'S:
blood sugar (Gluc), total cholesterol (Tchol), triglyceridcs
When comparingthe levelsof Anti Coll IV Ab IgG in
(Tg) and LDL. The positive corelationswere with Pearson the control group and subjectsrvith metabolic syndrome
conelationcoefficientas follows: DP - r :0,22, p : 0,04; ( r e s p e c t i v e0l y. 2 8+ I - 0 . 0 8a n d0 . 4 0+ / - 0 . l l ) a s t a t i s t i c a l l y
Gluc - r:0,27, p=0,01;TChol - r:0,30, p:0.005; Tg - r=0,34, s i g n i f i c a n t l yh i g h e r l e v e l s o f A n t i C o l l I V A b l g G w e r e
p:0,002; LDL - 10,32, p:0,002.
cle:terrnined
in the grouprvith rrretabolicsvndrome,F :30.299,
=
proved
p
Conclusion:It is
that the ACol IVAb IgG arrd
0 . 0 0 0 [, r i g L r rle.
are significantly elevated in the subjectswith metabolic
342
/ J o f l M A B . 2 0 1 2 ,v o l . 1 8 ,b o o k 3/
,,\liJtllr't'l'}5ll0
lmmunological changesin collagenmetabolisnrill llrchvgrel'trcnsivctrlnliclltslr itlr rnetalrolicsvnflrome
Authors:
N . S t a n c h e v a l , E . M " k " t t y u r t I , K . G o s p o c l i nSo.ul '|i.s i r c rl' .. 1I I n i u e r - s iIri ro,s, p i t i (l li c o r g , r S t r a n-spklie v e n Bulgaria"
Topic(s):
Snroothmuscle
Citation:
C a r d i o v a s c u l a r R e s e (a2r 0c 1
h 2 ) 9 3 ( S u p p l .I ) . S l l i
Metabolicsyrdromeis associated
with earlyvcssclaginr.:.
r-'lrirtrelcli.zccl
br charrscs
irrthc i,ascular
wall
elasticity.
The fibril proteinselastinandcollagcnnc(iupl\'
yascular
iurnnlx)rliultplacciir llrc stltri-:1Li;e
r.rl't5c
wall,
andthehemodynamic
properlies
of thevessels
arcdit'ccthtlcpcntlcrrt
on tlic c()niposili()r'l
anclorganization
of
thc extracellular
mabix.The aim of thc stud1,
is 1ttcvltlrtilethc iutrrrLutologicll
punrrrrctcrs
ol'collagcnnrctabolism
in subjcctswith familialprcdispositionfor hypcrlcnsirirr
rvithhigh n()1'n)al
irlooclplcssrrrcanclnrctabolic
js
syndrome.A "case-conh'ol"
study condLtctcd
ou l.ll pcl's()ns.
l6 r.rf'tliern
ureprclrrpcrlcnsivc
rvith metabolic
syndrome.The methodsof the studyarebasedclnihr-'rnzvlnc-lrnlicilirlrnLurosortrurt
assil\'litr the detectionof
specificar-rtibodies
andthe depladation
proclucts
ill tlrrr:.;.)nlnl.
Ill)rrerrsrrr('lncn'r.
slitristiual
rlcthoc]s.
Results:A weak linearrelationship
was dctectccl
belncr.:u
thc pulscpl.cssLtre
r [,Pi rt busclineancilgM-coll().(x)!.).
rV-gror'rpantibodiesin prehypertensive
groLrpv 0 l()-l r
r 0. itll p ,.,0.0J lttlri,ecn lgCi-coll-illand
lgM-collJ-antibodies
anticollagenic
antibodicsa :,tronr,corlcliriitrlr\\,usrlctcctcd- r,- 0"f20 | 0.522x;r:
0,90;p: 0,001.Also a stong linearrelationship
rsestafrlislrctl
hctuccnllrc tpuurtilics;
ol'ls(j-anticollagen-Ill
antibodicsand lgM-anticollagcn-tipV- antibodics- r.' 0,1 I 7 | -,.l5 .r: r.., 0^fil0: p ..=0.{X)).-fhis relationship
dcmonstrates
that IgG - antibodies
againstcollagcntt,pr:lll tirnrriu thc initiirlstlgcsol Ilvgrcrlcnsion
anclthcrcis
a relationship
betweentheirlevelsandthoscasainstcr:lli:scntr'1tcV'..,\ sillnilicunll'clirtiol:ihip
i,r,as
cstablished
betweenlgA-collagenlV-and lgA-collagcnl,ypc-[rrritil.roclies:
I ().1-57
)i 0. -]t)5:r 0.-i2,5.
p . 0,02.Highly
correlative
relationsliip
wasestablished
betweenthecxrhurrgt'o1'1u,,\-coll-lV
urrtllg(i,coli-lll-antibocly
y:
+
0 , 1 5 8 0 , 3 9 6x ; r : 0 , 9 0 , p : 0 . 0 0 0 1 . S t r c hc o r r el a t i i ) irri ' u su l s ol l r u u t bl c l i i c c nl g : \ - r : g l l - l Va l d I g M - c o i l V-antibodyy: 0,145+ 0,41x, r: 0.9:p ='0.00()i. f'ronrtlic rn',t'sli!]utiorrs
carrictlout.a significant
lincar
rclationshipwas foundbetwccnthc levclsof lgC coli-l-untib,rtlics
untl I5gl\l-coll-l\'-arrti-l-ror-lics:
y :0,264 +
0,864x; r: 0,612;p : 0,0007.A significant
Iincalr:otrJll(it,rri
\\ ils alsott,rrrncl
bctrvccrr
thc lcl,clsof IgM-collV a n dI g G - c o l l - I IaI n t i b o d y : y : 0 . 1 l 9 x 1 . 0 1 1i: 0 . o 9 1 p
. {).(X)l-1.
Conclusions:
Inprehyperlensive
patientsr.vithrnctrr[r,-riir"svndl()n)c
{hecollaScnIurr.ror..cl
of IgG-class
tlpe IV
'l
collagenis significantlyintensified
comparedto hcalllr',srrlrjcc1s. lrisot'errlscr t:rrtr,.:lir;c
lhc bloodDl-essure
valuesreachthe levelscorresponding
to bclrdcrlinr,
lr|te|iirlltr ltcttt'nsion.
))1''iinrx[r.1
4-1-2010.89
i liI
N S.NvNNi:\
SN^NNNN\
NN\$ii \
N"i
NNNKN.\::iI
$.il
sR-NN$,{S'\'ii:
,'
.r\ ir\,\ll )
i :.N{ I ' V S $ N $ H t r {
J"r,\ri',; N,li\\$ \ $ N \ N W I T I . I
N\-{NYS
I.NC
rl lii :,::I::lr\'*l\'\"
Natl!a S{urrclr,.
A,ssern( jorrti,.'.
lJ ( lririi r'/ ( ,
l ) l n . s t i i r t t ,t , :
Si;rc'nrr' .\,rr '
l 1 ( l i 1 1 l r ' , , .;r
l.i
lrt,,i
.r
'rriillii'- Plc'veni
r:,,1ril'irrr. 1t u d c ilt.t' of
r{
l .r
) . ' i a ni l n i r K u l k c h i c v z ,
'
l
riiil'11,r'rt
Ittuttna "
So/irr, drir'(il r
A{}tit w.\{."$:
'),tlt'il:\:l-.li'il i] \ii illt\.rti,
llCl1lld0. heart
' t l l , i l ' i t i t r .l l . ' r r i l r i l r ] ] r . :i , , . r y i r , . i i i r \
.\i \
[ ] u t k g r o u n d . ' H e a r t f i r i l t n ' er ' l l ] r , 'i s t r s u l t i i ru s s r , , . '1 '
w i t h r c d u c 0 d s v s t o l i c l u n c t i o n . I : l l c v a t c d I - . i l' I i
conccutr.ati<;rrs
ol'N'l pr-olJNPanclhcart ratc lrrrirrlrililr i l ( '
et ' r . r ' o r so
a r u p r e c l i c t r r ,o
e u t c o n l c i n l i F p a t i e n t s[ r r r tt l r , . .. ri l i .
I ' c r . rc,l a t l a i r o L r il 1 s p l c d i c : t i v c\ a 1 u c i i r i r l t r c n t s , , ii t h I l l ) r
l ) f c : L . r c\ ( l : 5 ' s l o il c l l t t t e l t o r r .
'fhc
I
IturTto.st'utttl utr:/ltotl.;.
uinr o1-tlris .s1url',','
i
prognostic
value
l
cleterminethe
of irredisclralgt ,\1*i-.ir, i\' '
..
a n d l r c a r t r a t c v a r i a b i l i t ) ' ( l l R V l i u p a l i c n t s u i t h r e , , L r.,
p r e s e r v e c is 1 ' s t o l i c l i r n c t i o t - ta d n i r l t c t l l i r r t l er - : o i t u t t r i. .l r :i l
',
fAte
,t\ 1,.
it,il.rr ll
. l , ' r r t , i l i i r i r , l l j r . i . . . t i i i i i . l. f r , . tri t ( r s tl i c q t r c n t r c a s o n
t , l i j i i i r r , l i r r i ll . , . L l i t r l i t . ' i i ' r s 1 1 i 1 1 1 ; 7 . 1i1l -o3n] s .
I I ri ,:i', I
,t , t I
i f , i i r i r , , . ' l l i i :r , . l r i i , t L : ; , ri rq' r .. : i t l u t t i c a t l yi l l p a t i e n t s
, r j ' i i , , r r ( ) ; . . 1r' i, t t r , . i t l , . l l t i t \ t ; t r t t f - i t t t , e S i V e
I :,lt,1..::
I
r r , .1 i 1 q , ; 1r ir 1 , i , , ' , i i .i i. :. : i i : . .r i . 1 . . i i r , . ' r ' , ' r . i l i i ) l t s h i p b e t l v e e t i p o o r
r : , r r . t, .'
, .i i r , , l t , . i J ; r . i t r , : : l c l . l i r r i l o t t c h
sas alrcady
i . r , ' r .i . r r i r , r '. lr i r , . : i i l. . . i iI \ 1 , . ' 1 1 1 q , l 1 i l i i ii {l !' 't t; ii v i t l i r l ni s p r e d i c t i v e
cotrgcrstivcllF. Onc huntlrccland twctltv-scvcrr lratir.'rri , ' L i
cvalr:atcd al the tinrc o1'disclrargc itv rri.::ri rl
',
cchocaldiogt'itphy,c()nvcrtIiottallabor-atolr tusts. pirr:.i,
N ' i ' p r o 1 3 N Iar n d L l o l t c r B C G l o r l l R V . l ' h c p r i u u t l y r ' r t t l l , ir I
o1'the study .,r,cledcfined ils l!'uclmissi(in lirr. lll' rlLnrr I i ,
'
l . r r s l6 n r o r r t h sa l ' t c r d i s c h a r g c .n r o r c t h a n 3 l r o s p i t l l i : i
{irr I yc:rr',or curcliacdeath.
j
plt|('rlt ,
Rc^lrrll,s.
Onc liLurdrcclanr,ltr.r,crrIv-onc
' i l l t l . , : t 1 , , t. , r l r . , . 1 i ; i. ,l l r . i i i ,. i : , r . l . r r i i i ' , . \ t li il ll i p a t i C n t sr V i t h
i . r , . , l l , , i l . i l { i , \ j l l , r t i t r r r l t r , i : . , r i l i t i " tnl ri c r o l c o { , b r a i n
w e r e l o l l o r \ , e dl b r r l c a n o t ' 3 8 7 r I l 7 d a i , s .F i l i r , - l i r r i i1. r . r;r' i r i
! 4 4 ( ' t o , 1h, ia c i r c - d u c c c ls y s t o l i c l i r n c t r o n . [ ) c s p r i i ' , l l
s i g n i l i c a n t c i i f f ' e r c n c c si n t h c c : l i n i c a lc h a r a c t c irs l r i : : , , i i l
paticnls u'itlr IIP u'itlr rctlLrccclr s prcscr-r'cds)rslolic lir;r, l l , i
pfognosis in both groLrps\vas poor. Prcclisi:halgcN I pr, ! ) . jl
'',li'
lcvels lve-rcprcclictir c ol' w orse oritcoure ir rcspecii r .' l'.
s y s t o l i c l i r n c t i o n . K a p l a n - l V l c i c rs u r \ i v a l c u r t c s s l l r , t r , ' 1 i rr
N T p T o B N P . ' i 0 0 p g l u r l r \ , i r sa s s o c i a t c t lu ' i t l i : ; i g u r l r ,
u'olsc outcoure in both groups and llli.\''<l() nrs \\ ,rs r ' '
o t c v e n t o c c u n e n c c i n t l t c l e t { u c c d s y ' s t o l i ci i r n el i . , ;
,]iti
F l i t \ z r c l l c c t c d t l ' r cs c v c r i l - vo 1 ' t h es y s t o l i c c l v s l i r r r t t , . , , I I j
rcducccl systolic llnctiun group.
C o r rt 'I t Liso us ; l n h o s p i t a i i z c dI - l I jp a t i c n t r l r r " cii-l r 'r i l , t . t , '
N T p T o B N P l c v e l s a t - ca s s o c i a t c dv r , i t l rp o o l l l r ' ( ) u u r , \ r , , i
p a t i e n t si l r e s p c c t i v c o f ' s y s l o l i c l i r n c t i o r ru l r i l c I I I { \ , ' r , i L . : t,
t h c s c v c r i t y a n d p o o r l t r o { n o s i s o n l v o l ' h c a r r l n r l L i r , .\ .i l l
recltrceds_vstoliclinc1ion.
r!
l . r i t r i , . . r , . . ,r . i , , , l t , r , , i i r . . r
;r., ii,,,..itr,:tttin
c li rt rl - k c r i l i t l t
i ' r , . i r ) , ' r r r i i i i , ,r . i , r r l t i i r r r L , ' :i rl il ,) :, . r . : i l t . t i i \ . 1 { c a t f t l i . l t e v a r i a b i i i t y
,,jil\. rr iii
r ..i rr,,r'
l l . l r . : i i t : r . , , , . t , i , i . , iri , i 1 1 , .i rl l k l i l l c a r d r a c d e a t h
t r i r , . i I i i l : l , r . r i . r l t " r i i i rp: t. t t f i c p r o g n o s t i c
r . i i i ' , r ' i j L \ q 1 , 1;1, r r : i . ,f . r i . : r r r . . , , i i i r r , t ,i .i ti , 1 , ( ) e a r u li inaf lh r c t i o n
,r
i : , .r i t l
i l \ ' : , :i
, t l r i , r t I r c s r u r t | t i r t r tt h a t t h c
iil)
i i i t r r , i , r ' r l i i l i . i , r { i t r i r l i I t i s c t r l l f s _ v s t c t l ti S o n e
i t i ' : r ' , - .. ; r . l i l r ' , 1 , . ' . r. tcl . r r ' i.i a l l v s r r c l t l c cna r d i a c
ir'llllr l;
I i l i : . r , l t ] ' 1 , , ( . i l l r r il l\l,i i 1l \ ' ) i \ : i t l c h c f[sa l ' e d r r c C t c d
i l i ' i \ , , , , - ' ': l , i \ i
Ilr il
l r . . , ' : i .r , l i l r l \ r n c l r r - o n itcJ t " U
. sually
li
i r r l . t r l , i . ' i ,i i i l , . . . r i l , i ,,.. 1 , . : r i i i i r . . 'ai inr r lrl ri t t l c t s k n o u , n
' : i , , \ i . r . , : ' ,i . - ' d: ; v l l o l i c l i u r c t i O n
il.i'. r. r,l I ,l
irll,.i.,.
lit,' . riri i,i
itii!
lJ'
t\
r r,,i
lj
i
ll
i'i\
r.i
I
i i i r , , ' rt r : r 1 o t l c t c r t l l i t r e t h c
I r .r . ' I ' t , I I J . i , il ,i ,r . . i
' \ ,i i i ,i r ) i r i r ! ,. r i i : ' . t r . . :l o e a lc l l i i c c o t u n r i t t c c
' . 1 , 1. 1 r 1
. ' ' l l ' i r . " "i . l t .
'.'.i1 r)llicnt! rvlio tirlflllccl
t l . . r ; t iii ri,' lrti wcrc hospitalized
r r i l i i r e r i n r a l o l o g yi n t h c
r , i r . J , r ' i n[ ) l e r ! - nB. u l g a n a
il{l!. ;:ol. 14,ItookI / 89
Irtt Surg2003;88:83-86
IntraductalAspiration Cytologyand
Galactographyfor Nipple Discharge
G. Baitchevt, G. Gortchev2, A. Todorova,,, I). Dikor''+,.
N. Stanchevaa,I. Daskaloval
1Department
of Surgical Oncology antl 2Depur.t
rttent of Cryrrccolttgr1,
LItttt'arsittlC.ctrtre
of Ottcology,
Pleaen,Bulgaria
"Departmentof Pathologyand aDepartntentof tltuliologtl,McclicnlLlniucrsittl,I)lr(;t:n,Btilgaria
The objectiveof this studywas to assess
the cliagnostic
valueof preoperative
cytologyand
galactographyin women with nipple discharger.rsinga simple intraductal aspiration
method. From May 1997 to February 2002,\72 patients with unilateral, spontaneous
nipple dischargewithout palpable massesunderwent intraductalaspirationcytology
followed by galactography.Major duct excisionwas performeclin 133of 155 successful
cases.Pathologicalfindings showed solitary p.rpilloma in 65 cases,breast cancerin 16
cases,fibrocysticdiseasein 17 cases,papillonratosisin l2 cases,ductal hyperplasiain 11
cases,and finally, duct ectasiain 12 cascs.our resultssl'rowcdsensitivity of 7s.0,,/o
and
58.8o/o,
specificityof 85,3ohand,62.4o/u,
ancl overall accuracyof 85.19'i,
and 63.2oi,,
respectively, for cytological analysis and galactography.This suggeststhat the intraductal
aspiration method for preoperativecytology and galactographyis a minimally invasive
and well-toleratedprocedurethat seemsto be useful in differentiating between benign
and malignantlesionsin patientswith rrnilateral,
spontaneor.rs
nipple clischarge.
Keyuords:Breastdiseases- Nipplc dischargt'- r\spirationcytcrltlgv, (i.'rlaciography
dischargein nonlactatingbreastsis an
NTiPple
I \ important complain$ it indicatespathologic.rl
changesbasedon endocrinologicor local abnormalities' Although most commonly dischargeshat,e a
benign etiology,10%to 15/uof the casesAre(lssoriated with cancer','2
Ihc preoperativoer'.rluationof rripple discharge
ilclucled cytolggic c,xamiltrtign lexiotiative cytJtt.rgv)and galactograph!,.I-lo,"r,ever,
the diagnlstic
^i.l,ra.u <f cliagnoslsof spontancor-rs
nipple dis.'h.rrge.has been lorver than that of aspiration
t ytologvfor othcr brcastlcsions.,The secondpreop-
ReprintreqtlestS:C.Baitchev,MD,DepartmtlntolSurgica|()lr.tlltrg..',
Bulgaria
E-mail:gbaitchev@hohnail.conr
ini Srrg 2003;88
J BiomedClfnResVolume6 Number2,2c.13
RISK FACTORS FOR CORONARY ARTERY DISEASES: A STUDY AMONG
PATIENTS WTTH ISCHEMIC HEART DISEASE IN INDIA (KERALA)
C5rril James"",
Thankachan V. Attacheril',
N. Balakrishnan',
Diana K. Gaydarova",
Nadya Y. Stancheva",
Ivan P. Gerchef,
Shreya Ohri',
Snezhana T. fisheva'
'D ep
artment of Car diology,
LourdesHeart Institute andNeuro
Center(LHINC),
Cochin,Kerala,
India
"D epartment of Car diology,
Medical University - Pleuen,
Bulgaria
Summary
Coronary artery disease (CAD) is a condition that
devel<lps
dueto accumulation
plaquein
of atherosclcrotic
the epicardialcoronaryarteries,leadingto myocardial
ischemia.It is theleadingcauseof deathworldwideandis
a commoncomplexdisease.
A srudywas carriedout in a
group of 496 patientswith acute coronary syndromeor
with angiographicor stresstest evidencefor coronary
artery disease,admittedto the Departmentof Cardiology
at Lourdes Heart Institute and Neuro Centre during the
period June-August 2012. The risk factorsstudiedwere
hypertension,
diabetesmellitus,dyslipidemia,body mass
index, smokingand family history of CAD. The results
thatin bothmalesandfemalesof the Indian
demonstrated
populationstudies,diabetesanddyslipidemiaweremajor
risk factorsfor CAD, while hypertension
was not a major
risk factor. Therefore, early detection and treatmentof
diabetesmellitus and dyslipidemiaplay a vital role in
preventionof CAD in Indianpopulation.
Key words! coronary artery disease, risk factors,
hypertension,
diabetesmellitus,dyslipidemia,body mass
index
Introduction
Corresponding Author:
Qrril James
Departmentof Cardiolory
University Hospital
8A" Georgi Kochevstr.
Pleven,58oo
Bulgaria
email: drclzrilj arnesfglyah
oo.corn
Received: Novembert4, 2or2
Revision received: June 18,zor3
Accepted: June 26, zo13
CAD is a conditionresultingfrom accumulationof
atheroscleroticplaque in the epicardialcoronary
arteriesand leadingto myocardialischemia.It is a
commonmultifariouspublichealthissuetodayanda
leading causeof morbidity and mortality in both
d e v e l o p i n g a n d d e v e l o p e dc o u n t r i e s I l ] .
Cardiovascular
affectsmillionsof peoplein
disease
both developedanddevelopingcounFies.Althougb
the rate of death attributable to the diseasehas
declinedin developedcountriesin the past several
decades,it is still the leading causeof death and
extortsa heavysocialandeconomictoll globally.In
low andmiddleincomecountries,the prevalenceof
cardiovascular
diseasehas increaseddramatically.
By 2020, the diseaseis forecastedto becomethe
major causeof morbidity and mortality in most
deve)opingnations[2, 3]. CAD includesa spectrum
o f d i s e a s e m a n i f e s t a t i o n sr a n g i n g f r o m
qECTOTA
HA CbPAEqHATA
CPABHI4TEflHA
OHEHKA
HA BAPLIABhlflHOCTTA
CnPflMO3gPABt4nnqA
nPr nAqnEHTVC nCOPr4A3!4C
tr E. lvlrrl..r]lr.t
C. Ttluren. Fl. C tr'ri-t.rl,:e
I1'xpea xapd uonoeutt Hit |n llt tLtt':.a fl pocf:. l'(ttltun t| uvoecxu"
t)p c t-tu l e'I n - l'l n e e e t t
M e d u tquu c x L, y H I t t-:t
OF HEARTRATEVARIABILITYIN PATIENTSWITH
COMPARATIVE
EVALUATION
P S OR IA S IS
VERSUSF{ EALTHY
INDIVIDUALS
S. TtsHrvR.N. Srnt',tr.Ht,,vrr
ANDE. lvlEKEN'/AN
First Cardiolo!1i; ()111111:
Prol Ktrrl Cltit:ltLtvski
- Pleven
Medtcrl Unr,"'ersttv
nor{a3ame, 3a aemoHoMPes,oue. Bapua6unuocmmaHa cbpdeqHafii.i(tect)totratlHRV) e uHdLrpeKmeH
t{amo anpa3sea aenlotloMHttt kottmpan Ha cuHycoHama peeynaLlun Ha cbp)e,tHo-cbdoaama cuct,\(.!t"r.r,
atta
aL2an
T. n--att
n:
Ha aeeetnamuaHafila peeynaqttl ua capdeuuama
noKa3amen 3a Hap\"tLi.ra6i.iH()
rJHeH
deiluocm e cna6o npoyLteHnpu naLlueHrnuc ncopita3uc * de:puano3a. 3.t Kofimo e nocnedno epeMe uMa
dauuu aa cucmeMHug i xapaxmep. Pezynrnantttnie ont uatnpa(ieHrteaHanu3 ebpx.ynaLlLreHtnuc mexKa
tldlvrlteHui B c'dLtHot]l nat a-tanenutne - meHQoprvtaHa ncopuaguc u KoHn|ponunoKa3San ['Ltt ttt)t'n,HLt
deuLl,un,u3ucKeau"lano-no0po6HLtu3cnedeau,Jr'Gl,l)xv?ortnLi(tt{tu nztr|ueuntu.
Knrc.roeu dyuu: eapua5unumHecm Ha u)p)eeH{tt1a qecttonta, ncopLta3uo,SDAI/N
Summary. Heaft rate variability (HRV) is an tntlirt:c[ 'tlrlrcator of ,ttttononrtc regulation <t[ cardtovascular system
reflecting the autonomic control of the sinus ri,de. i ril.s t>arly si91rtof ttnpalred aLttononticreErlation of cardiac
which recenl.lyhas presenled evidence of
function is poorly studied in patients with psctriasis'* dr:nrratur.sls
systemic nature. The results from the analysr:;o/ ir;llre.rrtswlih .severepsor/as/s an<l controls show discrete
slLrr/lesan a large nuntber of patients.
changes in one of the parameters- a trend thar rirqLtit=:; rtore clt:tarle<-l
Key words: heaft rate variability,psorlasls, SDAA/^/
BbBEAEHl,'E
Bapra6rnHocrra Ha cbpgeLrHaraLlecfora
( H R V ) e h H , q h p e K T e Hn o K a 3 a r e n 3 a a B r o r . r o M HaTa perynaL\nA Ha cbpAeL{Ho-cbAoBara O4cTeMa, KaTOOTpa3sBa aBTOHOMHT4F
KOHTpOnHel
cw.]ycoBtt[ Bb3en t1, 2l HRV naoxe Aa iiLAr}
nvHehHn il eecr3MepeHa qpe3 cTaHAapTHr4
TOTHT4MeTOAr4 3a OqeHKa Ha aBTOHOIV1iralA
H e p B H ac h c T e M a i l A a H a M e p h n p h r o x e H m e [ 3
pr4cKoBaTacTpaTilQr4KaqHFHa naqileHrrlTe r,1
rfxHara nporHo3a [1]. HRV e pe3ynrar or
Mexfly
HenpeKbcHaroro
B3ailMo,qeicrBfie
Ha CilHyCOBr,lrBb3e.n.
cnoHTaHHaTaaKThBHOCT
cHMnarfiKycoBara h napachMnarhKycoBaaKt.rlBH O C T1 4x y M o p a n H h r e Q a K r o p r [ 3 ] . t l o B p e M e
Ha crcTofla apTeprarlHoTo HanfifaHe ce no"
BnuaBa, 6apopeqenropnTe ce Apa3HFr, !rpe3
30
Hylineyc rpaKryc cornrapilyc
ce cThMynilpaT
n p e r a F l f r r r 4 H r l r e H e B p o H r lH a B a r y c o B l 4 FH e p B
1 4B 2 r r y c o B a T aa K T h B H o c Tc e n o B f i l u a B a . B c r H y c o B f l qB b 3 e n H a M a r F B ac n o H T a H H a T a , q e n o rfpfi3allHq H RR-ilHrepBar-bT ce yAbnxaBa
t4l llapacrnnarhKycoBara HepBHa chcreMa
n p e A r 3 B | 4 K B aB L I C O K O q e C T O TOHcTqTv r n a q ] 4 hH a
- t{pe3
cr'p.qevHara qecroTa 11Hr4cKoqecToTHil
B a f\ / c o B , , 1 FH e p B . c N r u n a r n x y c o B a T a H e p B H a
c r 4 c .ef M a n 0 n q n H f l B a H / c K o q e c T o T H t 4K o n e 6 a H t A t : 1t 1 ] B t r c o x o . { e c r o r H H T e o c l l t 4 f l a q h r c e
per,/nilpar orlacTil or pellenToprl B 6enrre
gpuboae n oreacrn or LieHrpanHara HepBHa
c i l c r e M a . H a f i - r o n s n o 3 H a L l e H f i e3 a p e r y n h p a He Ha qecTOTHrlTeKOrle6aHrF Ha cbpEe\lHaTa
\recToTa rlMaT 6apopeqenTopr,lTe, MexaHopeu e r - r r o p n T er x e M o p e u e n r o p n T e B K p b B o H o c H 1 4 -
Ct, P,1p,11;.161'q'bllo R 713ASOI]F BAH tl F,, 43, 20 12. Ne 2
ps
HHnffiffi
MT#ffi
HmyHonornq
Har HKupaHHTe
rxpeTeffiF{&i
npnAHua
*erm&pom
c Mreraffimmsmwmm
,Q-pE. MexeHRH,A,or.{.4-pC. Tuueea, A-p H. CraHqeea
. n p l a n\ r v o o c x n " , M V - r p . f l r e i r e i r
f l a p a a x a p A r o n o r t r q H aK n f i H h R a , , f i p o $ K
A r e p o c x n e p o a a T a e x p o H h q H o , n p o r p e c h p a u l o 3 ; ; 6 o l r u , r r t L , , . ( r . r , r 1 l, a. rl c i l i i t j r ) r f r t ' L r ' r r l r l a r r o i f ] , r r ) r r c r \ r h r c ! , c p e A H i l r e a p J ral 4n n e r a 6 o T e p h h H a o p r a H h 3 M a . 3 a n o - p a u H a r a i l n z a a a u n p o r p e c h , rl r , i t f r p ! . i , 1 o ci n) cr l 1 1 r \ i rI ) , 4 c K o t ] (1r1; r x r o 6 - r rK, O M T I o H L . T H
q ,p e 3 f i M y H o n o r r i ( r g r 1M r t c r A 4 , c e n p o y . r r J a r n p o M r l r - r f i T eH a k p . r 4 H t 4 T et n n { A p a t n
^ v r A V A c r 4 H A p o M .B n o c l e , 4 n n t e r o A v 1 H L 4
n p o A y x r n ( A G E s )x a r o 6 e l e r : a
c b A o B o c r a p e e H e n p t a B r l c o K ( ] p , 1 c ) { o t s. /' r. 1
r l L r ,c.lic t l > p f { C ! F r o - c t A o u r l ' y ' c r o H i H e H t 4 f l .
: e r a 6 o . n h r e H c i l H A p o M , K t , c H h r . n r l K 1 4 p a i rnhl ) ( r a y K r h , a r i r r - A G I s a H r h ' r e / r a .
K n r c q o e h g y n n r , rM
pu npo8exAaHeroHa npoquna|{ThqHilnpefneArlcpcl.l ! l r , l i r l l , 1 i - r l r i . ] l , ) t j i l t t C
flA CbAOBtlR eHAOTer, nOpaAt4
il.t tfyilxrlrtlril
pa6orerqara nonynaqhn ra rp. flreeeH 3a nL,pHoA.l . / i f l c i ) a , r t i i l 1 { x. / l { ) M l { r l j l , 1 p i r i " l {l :1 i 13 i r 3 C X O H C I p t l K l O p H t 4 T e M e A 1 4 a T O uapr 2009 f. Ao RHyapr4
2OtI r., oct ulecrBr4xMe
ilpoyrl- { ) r i . t i o t i - t o i . a n 1 r ; . 1t t r - r c t r , , t i i (! ;. .rf{ i t i ; 1 ,n p o . u b 3 t l i l n i J T e n H H , n p o - p a c BaHe,cpaBHnBaqoHfiBaraHa aHrhre/rara(or xrac lgG u lgfulJ I c J r r ( ' r 1 ,l1l p, ( i ' O l ' i C l l I \ i l l l l J l l l l r r 1 4L e A r l i . l lA y l i l A - ' r i l ) O - a T e p O f e H H h .
cpeqy AGts MelHAynrL(a c nera6onrreu cfiHp\poM6e: cr,l J n i ) 1 . / r i i l 1 i l 1 1 r ! r o A r , r f - i l , ul c e f i r ) ' f o . / l r r M o t i H h M a H h e c e o r A e . n n
yc/roxHeHrn(n=62) h 3ApaBh4o6poaonrlr (n=42).flre
,qoe14
qe AGEsAblgG r AGEsAblgM ca crarncr4ve.Kr4 l ; ( : , 1 - 1 5 ; i n , t l r . r t i Li rl i of l , ) T f ) \ ' l r l l , l t l r : r clrl , , r < l r . l t t t r t nr l h K h p a H h n p o ycraHoor4xMe,
- A G E sA
. G E sc a x p a f i rpyna cnpnMo.nhqalac 7 . r v r <(r:ri .cri v : l n c egrli' l ( a t i o i er n d p r o o u c t s )
3HaqhMono-Br4coKt4
npr4xoHTponHaTa
p
e
a
H
L
l
r
l
}
4
,
f
r
f
)
o
l
\
r
;
{
(
1
f
o
1
t
r
/
t
,
4
K
t
l
l
)
a
L
L
i
i
l
n
l
)
1
1
K
0
1
1
T or r | o x o 3 H a T a
F
r
r
l
mera6orrlren chHApoM(p<0.05).Toaa npaemameKaro h3llal
) K\/fi4, n rl n fi
t
ri!,
l
{
{))'i
l
Ii
t.:
)
i
l
il
C
l
l
l
C
h
l
O
tia
tui
Orl
1"1
l
rt
Cl
C
J
l
LrO
AH a MO,nenoparquranrenra$rqNpaHeHa npoAyKr.lrirrd
Ha r-43\.repnBaHe,
i
1
,
r
)
i
H
,
r
V
f
,
n
e
L
l
H
o
B
x
.
:
'
l
.
1
c
e
r
1
1
r
J
i
r
J
e
.
;
n
p
o
q
e
c
l
r
c
e
xoHTpo/lhh
V
r
a
A
a
n a A G E s ,A G E s A b su $ o p m u p a r e H a a H r r r e H - a H r n r n r ox ( r M '[e
nreKcr B paHHHTe
Hamer,l6olrrHhRc!11-r- p , r o r ; . ) r i . l i 1 f("rrr c c r r , , l v , r o r , r r x r , r p a x c ) . r r p o t l r c H n rc r p y K T y p a eranu or pa3Bt,lThero
r a r . r( , y l x r i r . r l r a H J n p o r u J r - r f l I e 0 e H c r p a L l e n v n d p H t i nM a r p f i K c
pe3HcreHrHocr.
ApoM,pecn.uHcy,/lhHoBara
, t 1 ; e . lr . 1 6 p : i ; y L ; , r i r f - ' f rKap t ( T r ) r , - r r ' r H
t l p t ' j x t l c r i l ; < .T o s a B K n t o q B a
Arepocxleporara e cbcronrme,npu koero ce sa6rir:Aar:;r
:a4ebelneaHe Ha cbAoBaracreHa B pe3ynrar Ha ilHThNla,lrio
H a r p y n B a Hxe a K y M y n a q h fAl a ^ v n v A n . C H a n p e p , e a H e r ioa
HJ cbaTepocKnepoTHqHrfl
npouec ce yBenrLlaBa11qecToTara
yc/lox(eHrF.OcxoaHtzrepHcKoBH
AoBtaTe
Qaxropra3a pa3Bhrrl-
1 . 1; v l i J r i i ) 0 l v l O / l f l i y , / r l ,i1l iT
l ei l , ' l i t C T L f l ;1l 4K O / l J f C H a /H O e T OB O A I 4p , O
3a6ornsaHe'l
ero Ha arepocxnepo3araxaro rr,rynru$aKTopHo
ca o6e4uueHr a o6rq crngpoM, HapeqeHruera6ornrex cnH4pora.flaroreHe3araHa mera6o,rutumncrHApoM He e Hani,nHo
h3flcHeHa.
Hai-nprerrlauaTaxhnore3ae Ta3h3a hHcy.rllfrosarl
pe3l4creHrHocr
{hP) xaro qeHrpaneHK.4roqoB
$axrop, coups.
aaul a64onnznanHoro
3ar t,crnBaHec ocraHa,4HTe
RoMloHeHTil Ha chHAporrna.
xrlnore3a,
Cnope4 Ta3h rnoKoqeHTpi.lqHa
(rcHco l r o B o p H o r on b p o h q H oH a p y u e H u ee 3 a r b c r f l B a H e r o
r e . r 1 1 1ro. t , r < i u f u l r lM a l l l l r l r < c/ t n v H a 6 a 3 a l n ; r r a , v e H r 6 p a H a ,x a r o
. o3tt
l . ' c ' i o p r r u l ei r l i r f r l l o r l c c f r r cf,1 a l ) l H H o c b l l c a o c r a p e e n e l 2 l T
i l p ( i r j , r , i ti l i , i r - l o c r l . J ; t t u l f rf ou r i r i { r p a f r i _cl e o ( b u l ( r - c ] 8 R B a3 a A b ^ b l
i S p i i , r , I o - i t J l ) i ] M r . ,f i c l l J . r l i l K c eT o 3 a c n fJ f i p e A h r \ 4 r 1 oA b , r l r o x h { € ( t t i g lr e r l ) o T c r . 1 r " 1 ci .rl p y i r r y p i r n r e K o i l l n o H e H T i 4H a c } e A t 1 H 1 4 4H, HO
L C t a i . r ' ) l t 1 e . n i C lH H , C A O C f I O U H i ' 1 :l le; i C e f H a T Hn p O T e |H
/ , r l o L i . , a b re r o ; 1 { {l -i l. 8 ( . r r o , 1 D ir , 1M k c , r 1 1 f l r, ' 7 6 y r r n t r -$ n 6 p u H o r e x ,
I J q i r 1 , , r 1 1 1 1 o rl,r465p' r.i t' ' i . [ . r t t t N r t l t ; i l r r cn f ] o r e t 1 H 1 4
cn
, eg o6pa: 1, 8 , l l i f l o r 1 J 1 . ( p t r i . T o i . t l Ii lllr,Ll , l i r l Q o p M r l l r J TO t i u l n l t r u t y H o n o ' . 1 . 1 r ' [\1] n f l l o n r l , I { ) c ' 3 y / l l . i lr i . l r : o 1 t r oc , ' o 6 p . t i y g a n o n y n a q H f l
i r ,; . rH , r' r . A i i Es J H T r 4 T c . ' l(iA G t " s i \ l r s ) . , { o x a : ; r l o r : , . r e A G E s h / v l a r
t l Cf ;]ll r1arl tvl(-rOT l.1
il l, Til tll r l n ( r CXO/ICT
!.1'a),
l XOll il t4fl n p Ote NH'51.
ThqHo-AerepMuHApaHo
AAU xpa+ATe,rlHo-npeAh3B14xaHo),
.r
pe3hcTeHTHOCr
i ] r 1 r ,l1( ' r J r : l { , t l t ) l } l l l l l L l A lB [ e p y M { ] } r a 3 A p a B 1 4
lrtlr'r-AC[:.S
h nOCreAtsaUlara
.s xpoHr.l,tHa
HHCynhHOBaTa
l r ( , L r f ; l r i r ' l ^ I :nl O t h n A f l i r , , M e X a H f i 3 t , M
h e - l l . 1 l J , 1l , r1e 1 ) l C l l ) i i i l t l l i i lO
x H n e p f . l H c y , n h H e cMah, ,f b
l u z v t r : n o r n q u rx" o l a n e n c a r o p HM
xaHh3M14
3a Bt,3craHoBffBaHe
HaeueprrixNR 6alatc 11noAAl,p- l i , , L , r r l ,T. t , , i r i t 0 t I p c | \ 4 e r ] l ' i l f i t c r : T f r y t , l f y l l r l.'1' p r l 3i t l S i t u A e l-1puMC a l ; ) V h L { r ' l ' i 1 1 n f 1 O f l C O i M . i c ] l i t ' l ; 1 .
)HaHeHa eyrnuKeMr4qHoro
c-bcronHheB opfaHta3Ma.
62
a II
b p o n0 9 , 2 0 1 2 , f o 4 r r r r X
o630t
REVIEV
6brt rapcxrt k/\Plr4c 1r.i f i.;
r c M X V l l ,2 0 i 1 , N g 1
'"':
t,i {. "
V r..: v.":
AOf(O3AXEKCAEHOBATA
*tl;: l o r ' . i ' l ' : '
VM 3e. /','
*,1,t'. ? , :
K,5arcapd*luega1, E. MexCIunn^.Li
'RattleClta
'!
1
nu Kat)tt:t0:
''
2Kamedpa
ti :.
n0 \(ii.4tit1
:::,.'::,,t.1,'i
:) r'j1,,,'
1,',
1,"t'i ;'. !.j; * 3 H ALI EH H ETO
(7i,
";.";'.'.r:t..fii
,t,1:l : ii..ii3
i
"1.lul
. ( t . | . 1 ' : i l . : t , : tt;i l, . i ' .t ' .
, :,.'i:,i
: ,'t
.t..:
,.'.:t ..', 1
::..' .ti
r '
,
'
t! P. KoMca-ftex4oea'
' ilne:t;eu
,ir.t,'.
; 'i.r:r:()9'l
,''t,,-;r,r. :t
D O C O S A H E X A E N O I C & , 7 , i :[. :| L : : i l : v i : " ' : .i; '1: \ t : . ' i . : " | { " \ .
.:'i.)::;1i.')i,)
| : I i i 4' :,i:.:.:,,''
.'rrrlR. Eausa-Penxova
tDepaftment
'' t tr' ' 1 .. )
QfCari,::
; t t" ' . ' : ' t , ; i ' , ; " , : i ' , l ,t -" i:levgn
'
Peroue:
X i t n e p r o w t n r ae f i a * i e i iA i ) t : . , i . : .
:
'/
,,
l
,l
ti
'
",'r'r,i{:r1!'t.;r \,r{0f06pci4flri(ie
"
". .''rr 3:i i(.,.1tj rlt1a (aTer0pit\-
1.
I0pr'10r O[OUhai.J0pe.ti; hl-] i:, I
l 0 x a 3 a T e n c t g a .i l g i i O 0 i : i i l B , " .
!.ifrBQri.r
FA Dl',A i i.,ut:* Avt', : :'.'r,'
i l 3 0 i e / ] B a H ei.l p e r r i i ; ; ' r : , ; , , , r , . ,
t:.\\,i{: l'}
i.
.:,li.t1qje,ra)t,t li8-tc Hanptl\tt
'.;,t
: ': i(
Ca B f D0qeC -
{
-r .r11:.}itri!.':Ha n0Jlf HgHaC|4]i
', .' 1l.ai1i)ivrt'thltg n naT0n0filqF;
I
lt
: r t l i e : v a a t F t i l ! f , € l i r q , {, l ' a f , ' , , ,
I e n p O q s c r B c p r a i . l r : ] - , r ea r ; ; : .
:\l
l.ri .,',r-lilHrrEii' I3*1Hu nlacTftjF",
:.
f J e r V f a : O p qf' !1* . , . s r i ' , j ' i l H s C l C} r a D i i i r r E : l ? : t , ! . e :. : '
neDijl,.leHlanilyr/,cg?t't tt|."it '.',:
:f
' 1r ,l riiSl'liTt:lf; ;?0 80b3(dl0 l'l€&,1
' '11 )
1 1 .g : i r l t l - t ! 1 qn p l l T e 3 t l t . .
i
) . :lr.J'1 ':)I i.al7. I ltltlT0 ,lf'li-
l
:
tlAt'pXeHlleT0 tlrl e n0-8,1ii,1i1
Knoroargyl,ru:
Agpoc:a
ropecn0fiAen{lt{i
Summary
Keywords:
a p r g p i , l a r a tX. lf l l t L r l C h r l ti : . . ; , , " f
-ba,o"op;a:l,,.r1..,,
',
.
!-p (pacrlMrpa
.
,i
,1. v!- i":-(1
ren.:064886140331,ririi:!:,,i,1.1
.
is an ,rpri,;:^l: ; ,
Hype(ension
iactors
ol fheirfe"styre
and\r,2t''::,,::'f:l
0f hyp€rtensioi'r.
Ctheifarii'i ; I r |,
ciata
htvebee",
decades
t({,,trl' .'' t . '
(PUFA)
as a conrponeiri
o1ilre:r,.,; l : l
:, ,,
levels
intl]edrsla't'p{:.rl1ii.,
EPA.
asweilas fesults
.., j,. i
0f e],iJet\':tt:i()'.,
, ' y c L 1 . l e : : S rl H
c :.'+. , : ' ; : . : : : .
\ / i s 5 n r i : af l L r ' 1 2 t ] . ' . . , ;
Adress
for
correspondencej i 8 9 : { J , : J i : : i le - n . A , ,r . t r i t 1 , .. i
envrronnre-'
ai't r irn:?r.ius
' :r l i ; n . 0 l i r ? ti n c i e a st en e' ,
r l;
'l
I
i
. ",tit:lurr.*{)verlhe pasl :,.
{attye: :
ri ;')l /uri$alr.riated
,. :,rlif)nsh,r
|.tlrreenDlA '"
lirfril triiilnlelllai fll;:
. ,:14 .t?t,.j'rlS
Afehtghel
It
I
;
t
jt
:':,
"
t
t":
I
l.
: ,...:..1F.i-1"1
8d6t,t'J;;'
t
I
Xnnepronrsrae BaxeHr 6e3cficpi'l, t . : l r . r l
3a6ann*;:, t'.
$arrop 3a cbp.qeqHo-cbgonr,r
'>, ' i l r l
Cnopeg nocflepHmre
npoyqnaHr4n
3
42,8o/oor Mbxere v 3gJoh 0T ){ellt.t;,
pacr Mexi,qy
25- vt 64-roAuuirap,1-,3;'
{.
t('
)
,r-, )
'
( n ' 1 O On
u
vvv
/{j-
" : S n e H)rneM a rn c :
A N H O T OH A N R T A H C
.
"ii;iliT0pti OT OKOnF:'
,,i18OTi{a(TO h OT 8-:
vrrli
I
t,
JJJ
Qrio-\'l*i:,.
ijBA i{ r
.i-
I.IATPOMfifii ' ; ;
?'i"
I
!
L'l
I'
';'"1
-t
F
i1 .:i ,qt1ii'
U. X. flyxar+a7',C, I h;r:;sir r
| ' , ! * ; , . t . i ) - ; t . ; , ) : t : - ,"1 ' . .
'
'
i1';;7'91;;;"";':';:
'
it
| '':.. ..^.b':1UiCil.
Pvnrypati
I ::'
ir - 1 ' l
7,.i"1;.:,1v';;,
Ha a:epCC{IepCTllrrlii:l
" "
'1
',\
:: t
,
8l,l CbpUe SflHil He iie/|\"::1
-i;()r,]f;{l':6i'.ti:\;r:at : :.
t',.
i
flTCTBau-Ii.l
'
l
r
:
"
.:
Aa ob:le lnpen3.^rill
Tp 0 tul60 Lif.1
Tl"lrlTe r I 11{,,) li lloT* r : i.rr,
t1t,1i;t-r
f.i,rkl"'iCll
1.i1.,j :;iaT;lIa
1
- r:'iq3*1 *hCnpgC14fiHe
l)
:r, I .l ,j.,lr:.yr.ltliOl'i8Tp!1LlHA
oj .:,i,t:uil':;1 rlL.lti naLlt'leHTt1
,'
l,
T€XHt!Ka .13 Ce Cn{-fiif;:ir'1 i:ti;.;"1"t
c o c T b p ' < : O * ' , 1 & ; ) ( : ri lL l ! i ; 1 : 1 ' r . '1 , , . : ' I
rn tl Kon DC.;(irl l-1
t 1.
'1.
, . ' - - .- ;; ' - 1
| - li '
"''iT
CLlHApOl,l ;1 40 Ki:llH!1"lii.i :i;tlli!',;: ,'
tttl
aD
r*rr-^\,r
rirlr{ 53iHi1l8
c
.t, ;; 3'::.:-i: {OpOh{apgH
, ! . i ' : 1 r ' i : , f; ; 1 , 1 .? 3 - l v 1 a 6 F X a
i
'l
i
ll
I
l(
-.,lr:f4i-',i:).:r1
. -)
}{{:i;t:ii.t.rir,
.
;\,::',
CD63. CDtiilF i,r CDI i;,1,\;3t-:;,'',:-:':
paXa
j :';i]. 'r.J IiByUBeTHO
"l--i :.liLlrlf."19i Flr:
r;
tlH*AC,xi
cc:"r:J
'
'r\
r
tl
:,
-, .
.
i
i.i:t-10
t{r,tyHoQn.vt ilec ue
o|jBe;i:
(:
r^
rl,:. :
CnegH tlTe r:rO t l6O Ur,li.f.l1,1li l1ii
:',
rj Flii. :" i':i.t-:
c n rH lt $ :.1l:;l :-iTHc il i) ? ;11-ij
C OCTirp \{ll0Kapleil
iiA J'titn|1
,,,;;;1";i;l-..1:"lLj!16
f 'n
! .a i ' C n p r
' l i , . l . 1 P: : ' ; P .
K0gTO ''iOili{
"'
Uen ua npoy'-l6aH6rn e c {:iit.r . il'
l,tlrnunr
;1. C. 8elxo8ar.
-:i d
r-.,ti:
I
Pealoue:
TpentfCU;rl'r1:E
il OCTbP
r
.t
:
.::
J
/T -J LaJaJ a
','
[Jll.
l.-:ti1.)qC:pt1-
C L l f l : i ' t ( j ; . l K J l " i : ' i i ( ;: ; 1 ; - ' i i r - " I r .
MrlOKAplsil f,:l{(bapKT
l-1pmnaut.reHr;1rec ccrop iti,:f
" ''l -:'-ti1-;1 3 a{-
Tt4BUpaHO C":CTCiHlle , i{0,:i'i ;l'.,
nOn3SaHi,l TiC 1,1i:Cllr.l1i"iii :.1:i:i]r'::
: . \ . ( : ' : . .a b c ; t f f h l , 1 e
i
:':,''i1,1
,1 .
i t : - l ; : { :; l - i 2 C D ] 5 J
Ha TpOl''fC';1,i-xt* i:lr
6 0 " : r - r : 1. l
,ibr€l
tu]0.{8 CA
ii€ iLl"'lrl ;ilii-.;tl': i.t
qH*tj 3L .,e::!iai? i'erlei{,
Knto.{oaLl gyrrrd:
-i,'--i,'fnL"rr
-'
Onoyrlr,rtcr,re-tri.n.
.-
:
(".:
; : ( ....
-
llr:;' : i,:
;'*{:-}1.r, ' l ' l T ) l , , t i "
._t, i.
T. H. Lttkanav
J, l- i'
"S.I llsha'r:l
,i
iii;/14;; !':1'::
t
i),j,:..:.t:':";"".
Sumrnary:
leis 3li{'.1
P:a1e
,:
ptariue 1r?.,1i:i;:
60
l a:i:i
r
,''
r- 1-,t;
ii:,
I
:: '
:'
,:
t;l{:r'*irC
Ir'i:ciic
57
nPErnEA,44,2008,Ne1
MEAt4tll4HCKLl
AHEwtttR
r,1
TyMop-HEKporHL{EH
oAKTopB nporHo3ATA
HA CbPAEL{HATA HEIOCTATbL{HOCT
A . l - y g e a l ,H , C r a H , { e e a tC, . T r . r u e e ar2 C . K r o p x v r e n 3
tKnnunra
- Co$r.ln,
no Kap,quonorr4ff
c 14HreH3rlBeH
ceKrop,yN4SAJ1
Ly'oaHHa"
,,1-laprqa
'Knnnnxa
yMSAI1
yl
no KapAfionorhn peBMarolo[,ir],
Crpaucxr" flneeeFr
,,1-.
tOerqnn
no MoneKynnpH
r ,al N l y H o n o r hr n6 l z 1 P5, A H
A N DT U M o R
N E c R o s tFsA c r o Rr NT H Ep R o c N o s l cE V A L U A T T o N
ArueulR
O F P A T I E N T SW I T H H E A R TF A I L U R E
A . G o u d e v l ,N . S t a n c h e v a tS
, . T i s h e v a 2a n d S . K y u r k c h i e v 3
lClinic
o f C a r d i o l o gw
y ilh IntensivC
e a r e U n i t ,U l l H A T " T s a r i t s aY o a n n a "- S o f i a
'Clinic
o f C a r d i o l o gay n d R h e u m a t o l o g U
y M H A T" G S t r a n s k i-' ' P r e v e n
3Section
o f M o l e c u l alrm m u n o l o g yB, u l g a r i a A
n c a d e m yo f S c i e n c e s
A u e u r R r a B c en o B e q ec e p a 3 n o 3 H a BKaa r on p o b n e v n p u x p o H t l q H a rcab p A e q H a H e A o c r a r b q H o c(rC l l ) c e u p r a r c r - r e r i r a r al e O n a r o n p f i R r Hnap o f H o 3 a .
B p u : x a r a H a r y M o p - H e K p o l , l q HQ
Har x r o p - a n S a( T N F - o )c n p o r p e c n n T a
Ha
x p o H u q H a rcab p A e . { HH
a e A o c r a r b L r H o( cCrH ) e y c r a n o B e H aH, o p o n f l T aM y 3 a
n p e A c K a 3 B a H ea n e 6 n a r o n p r l r r H a rnap o r H o 3 an p r C H e c n o p H a .i l e n r a x a
n p o B e A e H o rnop o y r l B a HeeA a c e o u e h h n p o r H o c r r 4 q H aproan q H a Q a r r o p n r e
a H e M H tf 4
, T N F - on p r lx o c n h r a l l 4 3 h p a Hnra l { h e H Tcr 4x p o H t 4 l u a
CH, B npoyveaHero ca BKnrc.reHfi
127 nau,ueuwlc KnfiHrgHor13flEelaCH or ll no lV OK no
N Y H A ,o r K o H r o6 9 u r x e ( 5 70 " , / "H
) ac p e A H aB b 3 p a c r6 1 . Et 8 . 4 r . f l a q u e x r n T e c a n o c t e A o B a r e r H xOo c n i l T a r H 3 ! 1 p anHor n o B o AH a o 6 o c r p e u ax p o H t 4 t l H a
CH. B gern Ha Aexocn,lranrl3aqr4fira
ca ocbu.lecrBeHrcraHAaprxr na6opaTopHHr43creABaHrifl,
exoKapAhorpaSv,n
n e B3eraBeHo3Ha
KpbB3a il3cneABaHe Ha TNF-o. KpanHr,rre
la npoy.{BaHero
Llenra
ca 4eSraHupaH14
Karo pexocnuTant,t3allrtt
no noBoAxa o6ocrpeHaCH e paMKhreHa 6 r,,leceua,
noae.leor 2
xocnilTanh3arlilh
3a 1 ro4rHa rln11cbpAeqHo-cr,AoBa
cMbpr. [lpocnegeHr ca
12'1naqreuru (95 3%) 3a cpe.qHo387 t '117 pata.iloue e4nn nbpBt4qeH
KpaeH
pe3yflrar e perhcrp14paH
npu 54 naquerru (44.6%).Kaxro npr.re.quoQaxropHHsT
, a K ar n p u u l - r o r o $ a K l o p Har lH
f i a n l i 3u u r r oT N F - o( Z : = 1 . 1 7 ,p = 0 . 7 6 ) ,H r a =
=
T o a H e M u q r a( X 2 6 . 7 2 ,p 0 . 1 5 )n o x a s a a rB p b 3 K a
4 xf fo A
c H e 6 n a r o n p H R T HHl 3
n p n C H . H e y c r a u o a r , r x Mcel a r r l c l 4 q e c K L3l H a l i r M aK o p e n a q n o H HBap ' b o K a
M e x A ya H e M ! 4 F r1a4n n a 3 u 4 e n a K
r ao u L l e H r p a qH
l ra
nT N F - q .B r a x a n p o B e A e H o r o
n p o y q B a Hnep [ n a q r l e H r f xl ,o c n h r a f l r n 3 [ p a H
n o! 1n o B o AH a o b o c r p e x ax p o H r 4 r t xa CH, nna3MeHara
K o H L l e H T p a LHpal nT N F - o n p e A r 4A e x o c n r T a n h 3 a q i lrR
aHeMhFTa
He ca 3lallur,/r/He3aB!,1criM11
nporHocrt4gtm
Saxropr nph naqheHTu
c u c C H . H e o 6 x o 4 n l a cna n o - v a L L l a 6 Hn rp o y q B a H u3r a y c r a H o B q B a Hpeo n f l T a
H aa H e M u R TnaT N F - cB n p o r H o c r r 4 r r Hoaqr ae H K a
H aC H .
Knto.roeHAyMH:
a H e M 1 4TFy,M o p - H e K p o t n v$eaH
a e A o c r a r b L { H oncpr ,o r H o 3 a
x r o p ,c b p A e q H H
Adpec sa xopecnodeHupfl:
,Qot1.Aceu l-ydee,Knuuuxano xapduono?un,MEAn "Uapuua L4oaxua",
yn. "Eanouope" 8, 1527Co$un, e-tnail:agourlev@abv.bg
Summary:
A n e m i ai s o f t e nr e c o g n i z e d
a s a p r o b l e mi n c h r o n i ch e a r tf a i l u r e( H F ) p a t i e n t s
p r o b a b l yw i t h s t r o n gi m p a c to n p r o g n o s i sT h e r e l a t i o n s h i o
pf t u m o r n e c r o s i s
f a c t o r - a l p h (aT N F - o )w i t h t h e p r o g r e s s i o o
n f H F h a s a l r e a d yb e e n e s t a b l i s h e d
b u t i t s r o l ei n p r e d i c t i n tgh e o u t c o m ei n c h r o n i cH F i s s t i l lc o n t r a d i c t i v T
e ,h e a i m
o f t h i s s t u d yw a s t o e v a l u a t et h e r o l e o f a n e m i aa n d p l a s m ac o n c e n t r a t i oonf
s f o u t c o n r ei n h o s p i t a l i z eH
T N F - qa s p r e d i c t o ro
. n e h u n d r e da n d
d F p a t i e n t sO
t w e n t y - s e v e np a t i e n t sw i t h s y m p t o m a t i cH F r a n g i n g f r o m l l t o l V N Y H A
f u n c t i o n acl l a s s w e r e i n c l u d e d 6, 9 m a l e s ( 5 7 . 0 % \w i t h m e a n a o e 6 1 . 9 i 8 . 4
ll ,r,l
,t
1
I
l\ g ;t '1r ''Jt
!t v,s<-
AHEMHfiH XPOHHL{HA
Cbp[Er{HAHEIOCTATbTIHOCT,
ETHONOTNfi
PA3NPOCTPAHEHI4E,
. KNHHhL{HO
3HAL]EHVIE
V NEL]EHHE
A. l-yAee1,
M. ilpeAOscrrl'h l-i.ClRLrqEsA:'
1(apduonoeuqHa
MEAJ| Llaputlahoaua" * Co$un
KnuHuKa,
2KapduonoeuqHa
* flneeeu
l,4EAn'T Cntpaucxu"
KnuHuKa.
ANEMIAANDCHRONIC
HEARTFAILURE,
PREVALENCE,
ETIOLOGY,
C L I N I C AS
LI G N I F I C A NA
CN
E DT R E A T M
ENT
A . G o u o r v l ,M . P n r o c . v s r n
, ,tto N . S l e t o r E v n 2
- Sofia
CardiologyClinic,MHAi' "TzaritzaYoztnna"
- Pleven
CardiologyClinic,MHAT "G Str-anskl"
Pesrcue,Anettunmae qecmo cpeqaHa npu nauueHrnLt
(XCH),
c xpoHLtqHa
cupdeuuauedocmama,.tuocm
HoHflMaeduuuocmaHaeuule
sa ueiluomopa3npocmpaHerrcte.
Ts eoditdo snowalalie HacuMnmcMume
u do
uananeu.@€frvaffi,umemnpunaL4t]e|tmumecyL4epeHaumexKaXCl-|.Arteuttgmaer.l$a6uCuM
pucKoaQaKmopga noeuweHa3aAafl>rar,tocn,
npoaHocmuqeH
cMTtprnuocrt,
now KnLtnLtLreH
ffixco, qecmu
xocnumanna1uuu BnoweHoKaqecmlo Ha xulont upu nalLlLtenmurne
c XCII. KttuuuquumecbcmogHtJg,
cebpsaHu
c noeuweHpucK3a pa3zumueHaaHeMunripLtrruLlueHfftLt
c toMnpoMemupaHa
cucmanHaSyuru1un,
(XEH).Ileueuuemo
ca uanpeduanama
ebspacm,)KencKLtflm
non,xpaHut.tHetna
1u(tpeunauedocrnaml,qHocm
Ha aHeMusmanpu 6onuume c XCH ece ou-p ce ducxyrnupa.Vnornpe1amaHa epumponoemuH-cmuMynupaqunpomeuHu(ECI1)usenexdao6eqaaau meparlesmueeu
uemod, xoima nodnexu ua donunsumenHuKnuHuttHu
npoyLtlaHue.
flpomuuaqomo B MoMeumaeonflManteNdyuapodHO
npoyqsaHeRED-HF
uscnedeaeSexmaua dap5enoemux-an$a
ebpxynpoeHo3ama
npu ma3uepynanauueHmu^
Knpqoeu dymu:xpouuuuacapdeuuaHedocmaml'qrloc/]r,
aueMrJfl,
xpaHuqHa
6u6peuriauedocmamuqHocm,KnuHuLruu
nocnedcmeusu usxod,neqeHue,cap6enoemuu-an&a
Summary. Anemia is commonly seen in patienis with cnronic hearl lailure (CHF), but there is no
consensus
regarding the prevalence of anemia tn these patienls.Anemia has itecn associaled wlh
.--\#
worsenedsymptoms
andreducedfunctional
slalusin pallenlswithmc:derate
to severeCl-lF.Fufthermore,
prognoslic
it hasbeenidentifiedas an independent
risk factorfor morbidity,mortality,negativeeffecton
the outcomeof lhe disease,greaterlikelihoodof haspitalization
and worsenedqualityof life, Clinical
circumstances
assoclaledwithhigh riskof anentiaare alcterage,fernalesex.chronicrenalfailure,The
stimulatingproteins/FSPJ
utilization
of erythropoietic
rs a oromisingtherapeuticmethod.The recent
'l'he
clinicaltrialswiilprovideevidencefor theirbenefirs. ongorngFiED-HFtrial is lesllnglhe effectof
darbepoetin
in patients
withHF ar)dancmta.
alfaon prognosis
Key words: chronicheart failure,anemia,chrontcren,tl fatlure,clinicaiconsequencesand cutcomes,
treatment, darbepoetin alfa
PegnpocrpaHEHtlE
4.,
. , D .L, ' ^i c^ -u- ,r, ^o^- y o o rA o s s o $ u n l t U t t t t 3 a a H e M f i R .C n o p e g
(C3O)aHeMilflTa
CeeloeFrara
3ApaBHa
opraHr3aquff
B urH4ycrpmanHilTe
crpaHr npn6nfi3hrenHc
or
< 13.0 g/dl npu
KoHLleHTpalir,ln
e: "xeMOTnobNHoea
0,4 Ao 2o/ooT HacefieHileTo
e 3aCerHaTO
oT XCH.
v, < 12.0 g/di npr xeHilre" [40], a cnopeA
Ts e u npilquHa3a oKono200/o
or xocnhTanu3at{r4t4- N4b)Kere
l-laqraoH
Hara 6u6pevua SoHpaLlrne:,,xeMorno6ran
pasaurure
re [5'1].B
oKocrpaHil ce u3pa3xoABar
< 12.0g/dl npn N,lbxere
N nocrr-roBa
KoHlleHrpaqrfi
no 1-20/o
3a neqeHileHa 6onoT 3ApaBHhn
6toA>xer
onper\neHonay3Hl4Te
xeHil" [26]. TesNcraHAaprHn
Hfirec XCH [10].Tesn Sarru npaBflrXCH cepuoH
c Su3fiotofttttHulTe
r4O6LLleCreeFr
npooneM.
3eHMeAfiqilHCKL4
3ApaBeH
tefieHilnle ca cuo6pa3eHil
ncnynauuoHrtilTe
ocoOeuocruHa il3cneABaHilTe
PasnpocrpaHenilero
Ha aHeM[ffTanpu naqhu pa3eHTilc XCH u c HficKaSpaxqrn Ha il3TnacKBaHe rallreHril l-{erpn6oa Aa ce npeHe6perBaT
(OlA%)Baprpa B ullpoKr,lrpaHrqfi or 4 Ao 61%
irhKr,lreB crofrHocn{TeHa xeMorno6fiHa(XE) u
naboparo(cpesno1B%)12,4, 8, '13, 18, 19, 24, 34, 37, 39,42,
Ha noKanurreOonn,avnu
xer,4aroKpr4Ta
Booequn a geQ nnilqhFTa,
pa3npoc- p'r.r
l,r,B-unpet(!ire3i,4npor r,1
50, 52, 54, 59].CnopegHauu Ll3roqHuqfi
yBenuqeHoTo
MHOfonpoyqBaHnflAoKyMeHrupar
rpaHeHuero
Qll% e oxono
ir npu nnqa c noHn)KeHa
pa3npocrpaHeFlue
cpeA naqHeHT[Te
pa3nilKaqacrnvHoce oORcHRea
Ha aHeML4flTa
22o/ol1l.l-onRraara
c
c 6t6peunu
pa3n/qHoroTbnKyBaHe
c XCH r oco6eHonpr xouop6fiAHocr
Ha TepMNHa,,aHeMrlq"
or
143cJleAoBarenilTe
npoyqBaHrff. . r s \ J u r r r o o n v r ^ , n q r r y w , Q H 8 f l 8 B b 3 p a C T , T e X K O 6 O n H U
Ha ny6nhKyBaHure
-,^ a^ ^ a^ ^
C t p 4 e , r H o - c r , g oseau6 o n n B a H i l3n8, , 2 0 0 7 ,N e4
tt,^
33
EOEKTOT 14HTEPMhTEHTHOTO
NPhNOXEHHE
HA NEBOC14MEHEAH
nPn nAqnEHTHClrC CbPAEqHAHEEOcTATbt{HOCT
c HHCbKEEEI4T
C. TuurEgRl,
t-I.ty'oeg.luoen-Ilnne
anz,H. CrRl,irsnl u B, ly'oepnHoenl
'KapduonoeuqHa
KnLtHuKa
KupunLluuoecxt.t",
YMEAII "l-, Crtpaucxu"* llneeeu
,,l1po.Q,
'Qeumpanna
* Llneeerr
KnuHuqHa
na6opantoytLts,
YMEAII"f . Cntpaucr<u"
NONINVASIVE
THERAPY
MONITORING
OF LOWOUTPUTPATIENTS
LAEVOSIMENDAN
ON INTERMITTENT
S. TtsuevRl,P. Yononxove-Laleva2,
N. Srnrucrrva'enn V, YononnovAl
1
Car{iology Clnic."Pyof
UMHAT"G. Slranski" - Pteven
. Chichovski",
'Central
ClinicalLaboratory,UMHAT"G. Stranskl"- Pleven
Pesrcue.Hanpaeeuae oqeHKaua e$exma onr npoeexdaHama
npu
mepanu+,KaKmorJHa npoeHo3ama
nauueHmume
cac cupdevaauedocmambqHocm
Ha neaocuMeudau.
flpocnedenuca
cnednpunaaaHemo
deauadecemnaLlueHmu
c dunamamueuarcapduonarnun
u perltpaKnepHa
cupdeuuasedocmamt',lHocm,
Ha Koumoe npunoxeHJa nbpBu nam e Eaneapu+KanuueeusmaeHsum[]3arnop
neeocuueudau.HanpaseHae oLleHKa
om neqeHuemoua 6-usMeceu.Oceeuqpescrnaudapmtume
KnuHuqHu,
fyuxtluouanuuu
na5opamopuuuemodu, eQexmum om mepanusrn{le aLtetreH
KoHu LtpesuscncdaaueHa cepyMHama
ueHmpauunua NT-proBNPusxoduo ucned Kpt)sHa 24-qacoaanauuSysunua uedurcauenma.
Knrcvoeudyuu : NT-proBN
P, neeocuueudau,ct,pdeuu
a uedacrnamuquocrtl
Summary. Looking for new noninvasivemethodsfar therapyntonitoringas well as for the prognosisin
palients with heart failure is a major clinicalanC economicalproblem in the conlemporatycardiology.We
have studied twelve patientswith dilatedcardiomyopathyand refractoryto treatntentheaftfailureto whom we
have appliedthe calcium censitizerLaevosimendanfor the firsttime in Bulgaria.Ihe resu/tswere assessedafter
6 monfhs.The effect of the therapy has been evaluateclby standardclinical,functionztland laboratorymethods
as wel/as by the serum concentrationof NT-proBNPbeforeand after a 24-hourinfustionc>fthe drug,
Key words: NT-proBNP,laevosimendan,heari failure
BbBEAEH14E
peHrreHorpa$nn
Ha6enungpo6 r,tcbpqero,EKI-r
e HoB KapA[oexoKapAnorpaSnn.
Ileeocur'reudau
hMa ABa ocHoBHt4
r4HorponeH
Kor4To
MeAUKaMeHT,
Clpgevxara HeAocrarbqHocr (CH) e KnhHilqeH
c[HApoM, pe3ynrar or pa3nnqHil crpyKrypHt4il QyHKanLlHeEa
ceH3t4TfisaLltlF
MexaHH3"bMa
Ha Ael,lcTBrle:
Kqt4oHanHfi
HapyueHuF Ha cbpAe\iHt4fiMycKyn [5].
il KOpOHapHa
Ha
M!{o*rnaMeHrure
u
nepnQepHa
CH ce xapaKrepil3r4pa
cbc: HeBpoxyMopanHa
aKrriLrpe3
Baqnn,noHilxeHanoMneHa$ynxqrn n HaManeHSu. Ba3oAhnarar..p4F orBapflHeHa AT0-:.aahcltMttre
KanqueBuKaHarr{ [7]. Toea AaBa B'b3MoxHocr3a
3!4qecKilKanal{ilTeT,c aKrilBripaHeHa peArL{aQaKHa cbp.qeqr-rara
no,qo6pnBaHe
Synxqhn 6es 3HaqnMo
TOpHHa Bb3naneH[eTo,KbM KOHTO
CnaAaTT. Hap.
y8e-r-r.1!aBaHe
Ha KhcnopoAHaraKoHcyMaqnn[14].
r"$4TOKr4Hr4.
tzlspas Ha HeBpoxyMopanHaTaaKTfiBaut4fl
llopo6peuara noMneHaSyHxqrr ce xapaKrepil3tlpa
npfi CH e HoBilqr brorrrapxepNT-proBNP, Kor4roe c
c HaMarFBaHeHa rere/lrlacronHoro HanFraHe(TAH)
BeqeAoKa3aHaponn 3a AfiarHo3arana CH, 3a MoHrlu reneAuacror-rHl4F
o6eu (TAO) Ha nflBara KaMepa
ropupaHero Ha e$erra or repanilera [4, B, 13] n :a
(I1K),
r.oero or cBoR crpaHa BoAu .qo noHHXaBaHe
nporHo3araHa sa6onqeaHero [6]. Paenfiqur aBropri
qe
c e K p e q r n r an a B N P o r f l K R i c h a r d sh c b r p . c b o 6 crooqaear,
r3creABaHero Ha Mo3bqHurHarpHyperilqeH nenrfiA (BNP) r/ Ha HeroBr4ffHeaKrhBeH
Ha BNP h
ulaBar, LrenpoMFHaTaB KotlLieHrpaqHnTa
Ha
npe,qhKrop
npeKypcopN{erminal proBNP (NT-proBNP) gobaan
HeroBure npeKypcopHe no-Mou-ieH
BaxHa nnSopruaqnnsa e$erra or neqeHilero,crpapoFTH
peXH
F,
neHcaLlfi
n
He
hn
B9Ba
Be
OCTTa
3a n
.qeKoM
rnQnxaqrnra Ha pficKan nporHo3aranpt4naqneHruorKonKorochMnroMarilqHaraoqeHKa1121.
re c xpoHr4qnaCH [3]. NT-proBNP npearrxox<,qa
B n p o y v a a u e r oR U S S L A N [ 1 0 ] c e y c r a H o B n B a ,
,le LevosimendanHe Bo.qilAo eKcrpeMHaxfinoroHt4tl
Qpaxqnnra Ha r3rnacKeaHe(Ol4) no orHouJeHreHa
nporHo3npaHe
Ha cMbprHocrra npil CH [11].
,1,rrlr4cxeMMF,
HO peAyllilpa pucKa oT BnoujaBaHeu
CranpaprHrare MeroAr43a oLleHKana e$exra
c M b p r n p n O o n u r c, t n e B o c r p a H n aC H t 4O M t 4 .
o r r e p a n u q r a n p u n a U u e H T [ T ec b c C H B K I F c l B a r
U e n r a H a n p o e e A e H o r ot 4 3 c n e . q B a Hee A a c e
n p o M F H aB c n M n r o M [ T e v + n 3 f i K a n H u n c r a r y c ,
o l l e H h q p e 3 K n H H t , l , r HSr ay ,n x q u o H a n H t af i n a 6 o p a -
8
38,2007.Ne1
c bpAF_rtit
o-cbAo Br43A6oJl,lBAHI4F,
Ahnosl all paticntsrvith atrialfibrillationarehypertensi',
o ln r t l i a l l l h r i l r i t r o nr ) c c u r st h, n tc l e t e n n i n ct hs ee a s i ect 'o n v e r s i o n
the early stagesof llte developmeut
thr'rci:, t o s i n u sr l r v t h n r .
of hypertension
Ko' rlorrls: etriaI 1i briIIrt j on: ar'lcrialhypcrlension
a lowcr dcgrceof rcnrodelingand fibrosiso1'thcatril rvlrcn
CY N D ] T O ME I N P A T I E N T S
B P I D E N I I O I , O ( ; ) ' O } I ] ' I I I i ] N ' I I : I ' ^ \ T } O I , TS
\\
HOSPI:IALYSED ll tt Nlrl\\'D'l)|,\(;N()Sil) lSCIl,,\t'.N'llCFII|ARTDISEASE
, S t l u r c : l r * ,l 1. (ri,er c l r c vS, . l ' i s l r c v a
1 3M
. c k c n y r nN
r
t
iu
i
Lltrivcrs /)t I I 51ti 111l (i r orgt S'tru rt.ski, l' l at,crr,Il trl,gtLr
ivrthncu'l!'diiignoscdischacrtric
ABSl'RACTT
hcalt discaselor a perodof
The mctabolicsyndrorne
u'u:rediugnosedwith rnetabolic
hasbeor rccentlylccogrnizlrl I ycar.Anronr:thcm 99 ("14')i')
as a mLrltiplex
risk factorfor cardiovasculal
disease.
AccolcJrnrl s 1r r c l r o r . nl ren. ; . l a i l cgdi u c u s et o l c l a n c cw a s p r e s e niln 2 7 o f
ofAfP lll, a personis diaguoscd
n t - rr l i t r r r c i a h o l i cs r ' ' n d r o m (c. 2 7 , 3 % )5. 4 p a t i e n t s
rvith metabolicsyndrorncit i l r c l r a t i e
atry threeof the folloi.vingfive critelia are net: abcloruinal (54,5!,i,)*,clc tlrlbetic:s,
All cr{'thcnr rveLehyperlensive.
90
obesity,serumtriglyccrides,
low flDL clrolcstcrt-rl
high blood peticnts(90.9fi,) lraclabdonrinolq[e:sit!.36 of tltc patients
pressure,elevatecl
( 3 6 , 4 ' l fl)r : r dh i q ht r i g l y ' c c r i t ilec v c l sn n c 6
blood glucose.
l 3 ( 6 3 , 6 % )h a dl o w
Purpose:to analysethe epiderniologyof mctabcriiert'lDL lovcls.
(-'oncl
patientsu,ithtrewlydialnoscr.l
syndromcatlronghospitalized
rrsious: I I i glt prc'r'rlcrrcc of rnctabolicsyrrdrotne
i s c h a e m i ch e a r t d i s e a s c .I s c h c m i c h e a r t d i s c r s c u a s is r high prcdictor'""*
factol tirr r1o clopiug ischaemicheart
d i a g n o s e db a s e d o n t h e l b l l o w i n g c r i t e r i a : p r ( ' \ i ( ) u \ r l r s c a s c .
rnyocardialintarction,anginapectoris,ol ischemicchanscs
in elcclrocardiograrn.
ischacrnichcart
l{cv lvords: uictabolic sr,uclrorng,
patientsrvelehospitaiy:iccl d i s e a s cn.r c v a l c n c c
Results:225 consecr.rtive
ANALYSIS OF :\'ON-\I\t.\'LIL.\R,\TI(IAI, F.II}IilLT,,,\l.ION ETIOLOCY
E. Mekcnyan.n*.Stanciro,u,
l, (iclchcr",S. Tishcva
('i
t
l;i, P I c'vcn,BtrIgur ru
I
I
a
i
t
t
|
trun.s
i
5:p
t
c
u
rgi
S
Univcrs 0t
ABSTRAC'T:
B a c k g r o u n d :A t r i a l f i b r i l l a t i o n ( A F ) i s r h c r n o s r
c o m m o n l y s e e n a n : h y t h m i ai n c l i n i c a l p r a c t i c e . l v l o s t
frequentlyatrialfibrillationis associated
rvith an underlying
structuralheart cliseascsuch as valvular problcnls,llcitrt
f'ailurewith chamber dilatation, coronaly artery discasc,
congenital heart disease,hypcrtrophic or dilatc<l
cardiontyopathy,
and atriaI septaldefect.Atrial fibli]];rtiorr
may bc secondaryto reversiblecallses,and treatrnentof llrc
underlyingdiseasesusuallyterminatesthe arrhytiiniia.
P u r p o s e :t o a n a l y s c t h e p r e v a l c n c eo i ' d i f ' f o r c n t
e t i o l o g i c f a c t o r s i n p a t i e n t sw i t h n o n . v a l v u l a ra t r i r l
f i b r i l l a t i o n .R e s u l t s :3 2 4 c o n s e c u t i v ep a t i e n t sr v i t l i n o n valvularatrial fibrillationwerc evaluated.ln 204 (63'1
,') t.hc
22/loJltutuIB;
Issur:201I,vol.
t7,Ahtr.1/
plimalyrcusor1brirtrialfibrillatiolrs,asarterialhypeftension.
3 ( )- ( 2 5 9 0 ) . , v c dl ci a g n o s e d
u , i t h i s c h a c u r ilct e a r td i s e s ea s a
prinraryrclson 1brr\1.'.Ischernichcartclisease
wasdiagnosed
: r c v i o u sr n y o c a r d i a l
b a s c do n t h c { b l l o w i n g c L ' i t c r i a p
i n f a r r : t i o na. n s i n a p c c t o l i s , o r i s c h e n l i cc h a n g e si n
c l c c l r o c a f c l i o g l a n4r0. - ( 1 2 9 l u o) f t h c p a t i e n t sr v e r ew i t h
t h y l o i dq l a n dd j s o r c l c r .
( ' o n c l r r s i o n sA: r t c r i r r l h , v p e l tnes i o n i s t h e p r i m a r y
cluct<-r
lcasoniirr atrialljbr-illation
carly andrapidprogressive
atlirl rcnroclclinil
anclatrialfibrosis,which is a rnorphological
prcrc,quisite
lbr thc rnauif'e
stationof atrialfibrillation,
Iiel' rvords:atriallrbrillalion,ctiology,rnorphological
c l ia t rg c s
ii rii
r.u\r
NIN$.ii
i\\\NN,$liN
P;\l{^lilN $'\").it r,l,l l,
I i { ) \ , \ . i l , l N I ' 1 . , \ It {. A N l )
sYNi),\(.l'ln.\
P . P c t t c i ^D . l t r i i r ' . r ' ,
L)(P(!t'ltiti'ttlt'i
t"rr,i
.'ii,r: I
AtsS'I-R{C'I':
t:li
l i l r i ' . ' j r 1 : ,, a . l 1 r r . r ; 1' ,r r i o c l i t x l .
S y n d a c t v l y i s o n . - c t 1 ' t l t er l u s t c o n l n x ) n r o l l i r \ , ' l )
r i r a i l o r m a l i o nc l f ' t h cu p p c r l i n r b . S - " - n c l a c t ycl ya u h c : ; i r r t 1 r Ii )
conrplcrxanclcotnplclc or i rtcottrplctc.ll'acli t i onall-r'.()l)L'ii t l ) j
l , i r ' { . 1 } i l l l )i i
w a s p o s t p o l t c d L r n t i l a g c 3 - 4 y c i r r s b u i c u t ' L c t t t i rt r , : t ' '
surgcorlscio rclcasc a1ilgc 9 itlontlts to I )'clr.'l'ltcrr, llir: t,' I ]
: ' ,' . t t r i . 1 ,i,. i
1i,.: . ll
]ll
il
r i ; r i t ' n 1 so i ' p : r t i e n l sw i t h
;, t'i sr ntlactl'ly with
. ,.r
i i : r i .l l r ' ; r l r i t l n k t y l y "
iiir Ii\ii\\li$Nl\,iii\\i\NNiNN
ii\
NlN,ll.$ll'llii
iii,\r
N \ N l i l ,[,.irr
[.]l-J'Jt^\Stj\[I\.i { \i
!lozltariirtl l:i (, r
'i
l)t,ltrtt ltnt'i;l ;,
\i{.r),\\
i . ) l . i r r i . i rl l' r \ i l l ! i i. l \ : , ' f { . 1
j'..1ir..,
, ,-l
i\ \ I
I)rr i'i' ' l',r l
i
ll
I IosS'itttl,IitnrLt,
l) Lrigur itt
ABST'II;\C"I':
I { c c c n t l y , u l t r a s o n o g t ' a 1 l h 1i ,s t h c t t t r t ' i r . ' i r , : L
o r l h o p e t l i c s a n c l t r a r r m u t o l o g r ' . l t i s c l ' l ' c c t i r- : , . 1 j {
c v a l u a t i o n o 1 ' . j o i n ti r r v o l l ' c m c n t i n p a t i c n t s u i L h , i i i i . ' ,
( , r t i l o l ) c ( l i r :c l i s e a s o s a
, n d r u a - vb c u s c l u l i n i l i r i g : n o : r rr' i I r
i r r t t r c l t r i t o r - i n st h c s o { ' t t i s s u c s . ' l ' l t c n r c t l r , r t l l i r ' ; t l r i
( . :i l r ) t
liii I
I
, , r i r l t ' iI r i i t i " i i l l a n l i t o t n i ca t c a
r l, Itrlll\
f.ir{ ..'1lr:liii 'Liii
tiiil i
I ) i'.
{ri
\ll
lrllil.
.ti\ I l
.'i i
r]
t,t,.|)
'.,.;.
. 1.rr
l l i . r ' ) . i ))r.lrCt() lfAulIai aggntS
l r ) ' , r ' i l ri r o r c " t h e r a n g e o f
l . ir ' I ' i ) l
r' to rlcsclibe only thc
r ' r i , ; , i , l r l i l i n { . L ir r r l c r s l a n c l i r . r g
li.)
t i r r s l l r : l d c r" i o i n t i s
i l r r r o . i, r l c s r n a t o r n i c , i
. liulpinl' lrirl obtai'
i1r
i n v a s i o n a l , a c c u r l l c ; u r c lc o n v c n i c n t o n c . r l i r i : ,1
o r l l t o p c d i s t t o a t l u i c h a l r d c o s l e l ' l ' e c l i v i :r n r t i , , I
'llrc
cValtration.
a i r n o l ' o u r r c l ) o r t i s t ( ) l t r \ . r si!lr
tN$ti$
l l l s ' l ' l d i { } \ r l { } 1 " ,{. I ii
l,,dl ili\ I I'i
[.
\ r l g [ 1 1 1 , .1 1 ,
L r r i t ,t ' , r '
'']
\ \ I { - \\ { ; l { \ ' l } E l t ' t E N S I V E
.\r i
l'
,i
ABS'I'R,\I]'I':
B a c k g r o u n c i a n t l i r i r r t : A l t c r i a l l t \ p . ' r i ' : i r ' .o r ,
r r s s o c i a l e cr vl i t h e a r l l " a r . r d
l l r p i c lp t o g f e s s l v ca t r i r t lr u i i ' , 1 ,i.: r ' .
u
,
an(l atrial l'ibrosis" liich is r prcrcquisilr i r l'
r n o r p h o l c l g i c arlu i r n i l c s t l t i o no f a t r i a i l j b r i l l r t t i u r r. ' 11 . , 1i . ' , '
r
t h c d i s t r i b i r t i o no 1 ' a t f i a l t ' i b r . i l l a t i o (nA | ) i n p r , r , i
c r s s c l l t i ahl y p c r t c r t s i r i nu ' i t r - lr . l ' c t et r c a t c d a l l ) c l r l l rt ' t r ' , i ,
i i
C a l d i o l o g y a u d R l r c L t m a l o l o g l 'P l o f - . l ( . ( - i t i t r h i , rr '
P l c v c n f o l t h c i l c r i o d ( ) l - . l a n - 2 ( ) 1 0- j ( ) - . 1r r n - l i l , ) . r ,
conducleci.
R c s u l t s : i i i t a l n t r t l b c t ' o l ' p a t i c r r t s- 9 5 - 1 ,o i r , rl ' r t r t i ' I
r v e r c t i i a g n o s c d r v i t l r h l , p e r t e n s i o n .L ) f ' t h c 1 ( \ 1 i ri i r i ' l l ' . ' : , I
p a t i c n t s - i 2 4 r , r ' c r cn ' i t h a t r i a l l r b r i l l a t i o n - . 1 r 1 " , , .i i i r , j i : , r '
p a t i c n t s r i ' i t l r a t r i a l l ' r b r i l l a l i o n( n ' , 1 1 4 ) . u i t l r , \ l { r : i . : r . , ( '
( 9 4 . 4 ? ' i , ) a n c l t h o s e r v i t h o u r t h - v p c r t c u s i o nlr)ilcrt ti . I , ) l
lilll,ltL'11i
r ) : ' \ i l r r r t r i r l t ' i b li l l a i i o n ( i \ I j ) w i t h
l , l l - 1. )t ( , 9 ( l u i l , u i t t t p c r s i s t c n t
t . ' r , 1i it ,i ' .\ . , \ i l i l i l f o x i s n r aAl F 6 0 a l c
'l.irir.
i i ,..' \ i ' ,
t , . . . r i .i r l t i i i , . i i i i l { } l t , i ) r i i r . t t : r , ' , ' l l r l r * ' i s i s t e l t t o l ' p e f l x a n e n t
. . i i ' . , i . i i r \i ., r i r i I I l l
; i i i . , | , i i , - ' l . r l r ,ni u n t i r e | o 1 - p a t i e n t s r v i t h
i u L , : . . . r , . i i , , l . ' i . . : 1 " . , il t , r . , rr . \ \ ' , . ' t v^ .r it r t d u r l l i c l n o 1 ' A t " ta n c l
i l i ! \ , . . ' l ' ' . r ,. ! 1 l t l 1.
i r l i J l i i ; ri\r - . rorl ' . \ l l . F r o t n t h e t o l a l
i t r , ri r r , l r ' { , . ri l : I i . t i : i l r i i f t \ l f I i r \ t f t 1 l i t l t C l l l ' \ t r I 7 4 ( 7 E ? 1 , )
. : r 1 , - i i r i r ; , t i r .r' n l ' \ i i , l i t I l i t l i , ) l r : r v cl c s st h a n 5
{ 1 , rr 1 11 r }
1 l ' 1 1 ' i' " r
\ii
''il.
il
,'r1,.
r i,. ,l'i ')'",) ltirvc no lristory aud
| 1 , " ': r' .\ ' r . i 1 : . .l g a o l ' p a t i e n t s u , i t h
| ) , " ' ; r ' , 1 r i . ! ci l s e o t ' p a t i e n t s r ' v i t h
,.i:..'1.
r r r i . rr i i i r ' 1 ' r c l t e r r s i o
i st ra m a j c l r
i . r i .l r ' : , r r . r n to f ; i t r i a l f l b r i l l a t i o n .
I r'rrl.
/ ,',. .)01l,;,itl.17,lltstr. l/
21
Ahrost all paticnts ri'ith atlial liblillation arc lrvpert\'irsi',-'
t h e e a l l y s t a u e so f t h e d e v e l o p r n e n to f l i 1 ' p c r . t c r r s i o{ 1r rr r ' i .
a lou'cr dcgrcc oi'r'cnlrticling and (ibrosis of tlrc rtria ll
1 i ii
il
i\!J"r\ rir'tr {l\
N'
'i' rlN\l
N'
I
ai
ABSTIIACT':
'[-hc
r u c t a b o l i sc y n d r o n rhca sb c i ' nr o c c r l i ] r- c\ c r \ , ' r ' rl
as a multiplexrisk lactor1brcardiovasculaf
diserrsc.,\ccoiii, ll
o l ' A l ' P l l l , a p c r s o ni s d i a g n o s crd' ' , ' i tnl rr c t a t r o l isc! 1 r d ! , ) i r ri
,..
a u y l h r e eo 1 ' t h el o l l o r v i n gf i r e c r i { c l i ai r r c i n c l : r i b t l , ' i l r ,rli
obcsity,scrunrtriglvccridcs,kxr I lDl- clrolcstcrollrirrlrl.i, (
prclssure.
clcvate'cl
blootl glucose.
l ' u t " p o s ct:o a u a l y s ct h c c p i c i e n r i o l o govi ' n r r i r r i , ,i ,
pi.lt.ielrts
u ith ncwlr",iirir.ll', )(
synclronrc
amor.lg
hospitalizcrl
i s c h a c n r i ch c a l t d i s c a s c .l s c l t c n r i ch c a l t t ' il s c l l r c ' t
d i a g r r o s c cbi a s c c lo n l l i c l - o l l o r , r ' i ncgr i t c r i l : p r , " ' r\ , . l l
' i r . , , ,t'
m y o c a r d i ailn l i u ' c t i o na, t t g i n ap e c t o r i so. l i s c h c n r i e
in clcch"ocardiograrn.
I { e s t r l t s2: 2 - 5c o n s . - c r r ct i rP l l i c n l s u c l c l r r i s l - . r l r t i .
'
i liirrl
i r . l r il r , 'ir; . riil l p c r t c r r s i t r t r
'\
l ' , i . " , l , i i l l I {. :.i}r N l l { ) : \i i ' t r} , l ' . \ ' l ' l E N l ' S
,l
r
i
'
'
I
il' \i .'rt
. l l i g ) i i l : \ ' , $ { r i i \ , t , \ N $l } { s t t A s l t
IiPID[.]]trlil$.\ ir ii I
ts\
t-r{}sP{'ll\[,\ )i],.: I N r | ' i \ i ; ; r
[ ; . I \ l c k c r r v u r] ". j l r i ,
I J r , . ,"
l)lrjli.'\ I r. 'J;lSlel (()ilvCISlOll
l.\-$ii\NN
,.i
i:i$Il
L , ' r r l tt ' l r l i l
I.riir I
.,ii',.irlli
.L,l'l'
lrr1'l \
.lr
l"
,.,,,
. i r r ( l i - r ' i \ c l i X ' l r p e r O dO f
,:
. ' . 1i ' i l l ' r r r c l r i r o l i c
\
.
1
: ip r c s et ) l i n 2 7 o i '
i r i r r 1 i r . , .. . . ' i , i - : . : .1, r , 1 , . tr i , , (
':
I i l l i t . . . . : i| 1 1 . " ' , r i . l : l r,r I -l j"'ir ). -{4 paticnts
l i u i ' i i r i r r ' p e r - t e n s i V9e0.
i l l,,'i r l l
1,".,.ir . l i' o t' 1ltc paticnts
i r , , . r{ r t , r 1
iri ,.{.,.'1,
\ li I i r:.1((r.i.(',)o)lrtrd lorv
i . i i - ' t ' \ r . ti l '
'rlll
;i
)
'ti.i
l t , i , , . ' r l ,r r " i I i . . r , . 1! : \ r . . i
li'. I
.-',lr
il
rL,li
ll:l
, I ; ! ' l r.
,i.
i\
)l\
i \'.. it rll\tliitloilf sytldrolne
r " r l r, i r l ! i s r : h i r c t n i ch c a r t
i . i . . ll l l
ri .,
-t\..{, i'ritf'll\
\r
lt )il'ijiltl.
:i
. r : r l r - ' , l r. f i s c h i r c r t r i ch e a r t
i ri'\ilit.ll.\
'l\i\
Ni
N)iil,,'N
.\N.'\t-\'S$$ { il \ . i l \ . * i
l r . N I c l ' c r r lri r , . i . l : r l ( i . 1 .
[.rllr','.rltr ,r],, l : ' r i
,i'
ABS'I'RAC'I':
llackglor-rnd: Atliirl l'iblillation (AIr) is th,.' t . : . l
{ri.
c o l 1 1 m o 1 r l )s' c e n a r r h l t h n r i u i n c l i n i c a l l ) l ' r r ' l i r !
f i c q u c n t l y a t r " i a fl i L r l i l l a l i o ni s a s s o c i a t e du r t i r i i n u l r r l r ' i . ,
s t t ' u o t u r i r lh c : a 1 1r l i s c l i s c s u c h a s l a l v i r l a t - p l o h i c r i r ' . . J . . 1 .
f'ailtuc rvith charribcr dilatation, cororlarl altcrr ri:
c o n g c n i t a l h c a r t d i s c a s c . h f i r c l t l o p h i c o r ' , l 1 1. )
c a r d i r i r l y o p a t h y , a r . r tai t l i a l s e p t a l d c f e c t . A t r i l l l i r r r i l , . r
uray bc sec:ondarvto revcrsiblc causr)s.arrrl trerrirr.:rii
r u r c l e r l y i u gt l i s ea s e sL r s u a l l -tve r u r i n a l c st h c r r i ' r l r v i l i rirrr
P u r p o s c : t o a n a l y s c t h c p l c v a l u r c c o l ' , l rl I l \ l
e t i o l o g i c t a c t c i r - si n p a t i e n t s r v i t h n o t r - r ' r l i ' u i i r i t i
,ii
t l b r i l l a t i c l n..[ { c s u l t sJ: 2 4 c o n s e r c u t i vl cl a t i r l r t s ' ,
v a l v u l a r a t r i a l t i b r i l l a l i o n r v c r c c v a l L r a t c d 1. , ,l { } + , { ' ' ) i i
22 / JollMilB: IssLrt
201Lrol. l7..,l|tstr.L
iri
l. \ ii
i,t
.r.,
:l
\l.l:ill
). trrl
ti,i,tiirl
'll.l
I t t . l, \ , r\ { r } \ I { ( } l 0 ( ; \
lrl,'lii I
I r,
lrl
\\
'. rilcr-ial hypertension.
r ' , i ' i ..r.ruir,:lrcirrt disi:sc as
;,r.,,
L
lil
lril l{'
'.':,:,ir'i,
.'\li,.lj r: I'.rr' t
, , r . l l l , i ) . i r . t . : i , l l i t l , . .r , r r
.ir
r l i . r t r i , i . r i , . t . . l i i , . ' i t : , l i i, , , t l '
a
, ii ro:rtSrr',rtSCiiagnOSed
I't-'i iotts lll)/Qc'rd ^l
r ' l r c r nr c i : l r a n g c s i r t
i,\r l-lliii0rlts rvere 'uvitlt
. r r t t i t i t ti s l I c p r i m a r y
'. lrttrlt:tJrttiprogressivc
iririr is a rnolpholcigical
ii i:rl l'ibrillation.
'riolortv. ilorphological
Cneutra.ntr3rlpaII
ltaytrclrcl,Bc-Iuo rixpilrtoitol'ttrI,
6e.nogpo6rr
Ir 60rcc'rn, rredrpo,roll rl, 4)| r3| ro'r'cpllrI uu,
crroprrrarr BocrrrraNrcrrrururalrllrr IIAIi
McgttqlrlrcrcltYlurncpcn'[cr - | l"ircrrcn
I{aleapa,,Burpeurrlr6o,rccnr''
yMEAJI .,[-p l-eopruCrparrcrcr"^
l:Azll- I l-,re
rrcu
{-p Ha4r IO,rufi lros:r Cra n, rcBlt-Xprrc'rorlr
'rvr\rol)
Mo3t.leu lrarpuyl)crurrenucrl r'rfirlr
HeKporrrqeurlanrop rr naplraOrr.rur
rel na cr,l)ilcrrnlu':l
rlecToTa B KJIIIHI|KO-II)OIHOC] nrrl|lt t it orlcilt{il rril
Cb l)Aerl IIiII'a IlCAOCTaTbrl IIOCT C I I ( )I I llt'ltCI Iil CI t l)11l\l o
3aua3erra
crrcr-o.rrrra
{lyrrxl1lrn
AB'TO['li(I)El'A'i
H a i l H C e p I a L I l 4 O l l e HT l l y A t A I l r ) . r l \ ' ' l l l l l il tl c
H a o 6 p a 3 o B a r e J l r { a H H o y r 1 1 1 cs r C r , ) r t . . 1 [ O l i l ' O l )
flrenclr,2007 r.
O K - ( r y u x r t u o r a ; r c HK r a c
O('- (rpaxrrrr rracxr,crrlaric
X K M I l - x t t n c p r p o d r t t v t r aK a p , , l r o l i i l o r a r l r t
X( )ljl; - xpor rrt.rna o6crp),Kr t{una iicrro;lgro6rlr6o;rcc l
t t l - M O - 1 l { x , i}l 1 c c r r y a l r o l r i r r r o r r r x l r o c r l r : r r
I { l l C - r t c r r p a ; r r r irrc p n r r r c r c r c N r i l
lh,nc/terrrrc
X p o n n . r t r a r ac b p . { c q l r al r o l t o c l i l r " r , r r n o ci Cl l l / r : l r , r u , r ; r ,l,rri ,i r . r t l J i r [ ] i u l e i r .
C O I I H a T ' I C IH
I H K O I t O I t [ t t t e c K I ' tI l p 0 6 , [ e N { I I l l c l , R l ] c t \ l c i l U i l r r r r ' r ) , i l \ ' ! i i ( . r i l , , 1 ) l i l i T . r r c ( J t i i l r i l
'rcxt(il
6o,.IecllrocT tt cr'rl,prilocr.
lililltJr'Ir{.1fitaiIi,t c ri-lolrr,]rr) liil,lr( r)rL) Ilr )rr.rJr(rr.
l I C n p C K l , C I l a ' r 0H a p a C . I B A l l l lI,l ) ) I { j l l t O ' f C K I > l l OC ' l l l \ l t A I l l ( ) , l a ' i r r l l i i ( ]l l l \ ( ' \ ' l l ) t l I l l l i l l l { l 1 l l l l t
uitLlHcilTlt fc.
/ l r , - r r I l rt t - l j l H l t t r( ' l l c c t t I t t c l r a n t c K a f ( ) c r i r H B l r r r . ' r i li l . i r i l , . r r ( ri l r . l , r i r ( i l r \ i l r \ i l f i r
.Ia3tI
tl
nOpillIH
l I l ) t { r l H I I a l ( ) J I C N ' l l l ' r Cl l i l l l . r l O r t l l 3 } J l ) i l l r l lr ( , , 1 ' l r l i r l l l r l I l l r r \ , \ ' l l l : l l l l l ! l
tllK,qloqtlaxia ltalllicHT}'tc
riollpllhri
irlr:t
{lli
clrc cHN,iltrr)t\lla ( II" lr() rur:n,-'l
l \ t H O K a l ] j l a .I : J l n a t t a r t o c , l c , ( r . Kc e o 6 p ' b r I l a r i l l i l ] | l t i l l i c r r : r r l r ; r r . r ' 1' .l \ ' r J ; r i l j r r( i l r r r t i r , c ( ' l l
[ t o f a T I a c c I I p c j l c l l l t ] s t K i t K ' l ( )c n o i l H X e l t i l - f l l K a r r c I , e t i i i l i l . r ( t r i l ( r . 1 ,r t r i r i l r l r r r r r r t r r : r r r
t l c T o B i l c c / 1 i l i l l - o ' ] l n N I at p ] ' i l a c l , c c u ( ) ' l K J I I i l [ l r i l t i t x l t l ) l t , l r
i ' i l r ' r l r l i t ] l t ( ) i l r i t l t l ) ( r ti l ( \ I l "
l l O - l a C l e f i lX t t l C l ) a l ) ' l l l l U I e , l a l l l l I l I ] l a 3 l l l l i t C O K ae i t I I C C( ) l l l ! l l t l . l l . i r \(l ) ! l i r , l l l l l .
vctittt<t8cttlt
ttc6ral
ottptrllilala
C1'll/lcrtllill'
tIlYrt'lt]'ilt'l
c
Bl')l,'iKilll
nllo|ilo'ril
(lcctola
trptr
(] Itot{Hxcil
polf
ilp()tnocil{,lilata
lra
lrclrll()\()D\r{)ftirc
xp()ilHrilril
ltplr ('ll.
la
( l l.
llrt,rttt
8ctl.tltt
N-tcpNnllirtcn
\tr)ir,
lr
,r(
lrr;re , c-
rrrIHll[,rJ tiil( il, r
Ill)(\\trtriIr l1r- rillll
cll
lr.r'l)lr\p(
]rir
liIril{r
rl'rt( }r rr'tJnr
r-'
r
, 4 . Jl ' p r o l l N P
N - t c r n r i r t a lp r o l r r a i r rn i r l l i r r r c l i c] r c ] r t l ( l i. ' \ \ 1 , i 1 ,l r r r . p , r r r r , r . :rrlrr ; L r l r ' 1 r
a , l t l r a / l N [ : - e r l r t , ' r n r t i t l l n a 6 u . r r n T c T n a c l , p , r ( c , t r r a ri aI l,l r\ c c r o] lrrl'ri r rrl, l l r \ i r f i r i ' i l i t j '
Ca
IIpollcr{i/rla}lH Lr nAltltetllll
llrl.Locl:ll'1,'rri,)rll (
C1'C Cl,p,lctlllA
Il,rlrlliliellli
\,{l!((r Jiiii
r l l v r t x t t l l l/rC ' l l l l C O / . l [ c c n p l u r c t t aK - i t n u ] t K o - n l u) ooren l r r . r ( ) u (r l . a r r i l ( l | , r p l r v , r r c r .
a x o i l T o c j l u o r l p c N r c n uJol i l Y q a c l B a fN l p r o l ) f . 1 1 ' .l \ i
r r r l l i l \ ' . r \ o r i r ( ,r ' . r r i p : r l
C l , O l R C l l { ( ) t l a I t c l } l l o \ } i \ , l O i ) & l t l i l l i le f l H r a l l r l r .
I t i l t l tI r r t , t , , , l \ r ' l l i , l r ( ) l r r l r I l i l r ! 1 , ) l r { i \ l l l . l
I l l r c c t r t t o c l . i i l i l { \ N l c r t i l c r l r l i r\ i l l , r i ! P r r t r j p i r \ i , J I r i , r i r l ) o \ 1 i l ( l l
c . t , c S a n r l ; c r t l tc n p q u o n o r r l { ; ' K r : r rcar t c r o , : n r a4 r r r n i r t r r r , r 1 . r ' r: l i p r r ' l l l ' . 1 ' . I N l . r r r r l l i t \ " r
, l J ) C I l l l t ( ) l t t l \Il l i l n i l \ 1 ( l n t l f C t r i t i i - t t r . t q r lfliltl , r l l l ' r U l l l ' 1 ,L,.:. , r r : , ] ,, - , , t r , r r r ' , ) ; ; i l \ l t q l
B H C O K O p H C K O B I I TICI i l I l l t c l | i l ] I l o o t l t ( ) ] l t L l t J I C n l l ' t c ( i l 1 l r 1\ . l J . . r i l r r . l i r i r J i l r n l rIrr r ) | i l , i r l
I i J l o u l a t l a l t c l t a C i l H c N l i , p t r r l ) 0 3 t r p o t t o o u r , r c r { r r r r | | ( \ 1 : ll r \ r ! . ' r L ' I c r l , l ! o l r n
!llcperviliirtHtilprrCll.
('rr,:rrlL {r,rrlriirirrrilr
ltoKa3a'rcrn lLlc il(lltput{ccilt 3il Il()-,rl()fpil'in
er,f
l I| ( } r u o c l l r , l r
xoc'r'o c oT c'l,iltccttleHo 'Jltartcltr{c jlt (}llnJ\r{,llPrlllr' lrit rr lr;l)elr}nrtlnJ!J-
Cll.
pcxa6uJlHtltUttoll(]il u
l ) c c o t l t J a - r t ! t ] a t t t t ( ) l t c Ii rl 0 i t \ o . L I l ] l r \ t r
iir,il
r()-N\lr
l l a l t H c HI H .
l \ 4 t t o r o t l r a r r t r p r t u l r -r t ( ) r ' n c n t , t c n ; l l r i l , n r r
lll)ofl{or]l
Htillo
illllcpllil-IIll(i
JItarlcilHe
IIA.JI'ltlltc
tltllt
IInH
Ntor(crlb t.
K()il ti)
,rler\()cUt!tajIltNilrrtt.
rt.ri,
;l
' . 1I
,r,ilrr,1l rr
1'ril
Irh JIr
ltlr.llacKlrlluc/<Dll/rrrtc;tocnilt,,rcn()frolr()l)Kl,\r.lrJ\|r'ri,
r',ir
il
l ' r o l l l \ .1 ' r
,l1,;rr
.'lh
l( lliirlli\i.
ll\t(l
mm/muJ
i::
-lt
II
'r
Haga CmauueBa, C u r :i l , ; n a
l r' l ' u u l r ' l l l
Nadya Stancheva, S n r z l l : m t a[ ' i r t r rl ; r
$t*#
R
T
ll
Il,
I
l,,I
[!ll .
EKf.11],(,:::fril[--il
rt,fi
lffi
n'{!Lr'eF.9fi
lffi
llil,,li:
ul*
^:pblkoBogcm8o h :,n,ilr nnn
JLi\"
]
{
I
i r 1 l , t r , r , , , , , . , , , , 1 , . . .{, i, i l
3a cmugeHmuno MeguquHa
for nreOicalstudents
iTrn/,5
78
Eitrt.;..:,-,'
t He,rri Jrirrinn/: t\r:;te CorCiavqsculo
r Core 4 (SI )
P203
r r L rl c l ' ; r t t' s o l l : . . : r ' r r l l itri il - , - 5 : - . r , i : n t c l vt l o b i l i t y , s e l f
( l t ( ] . : l 1 t Lr .Ll s l a.l i c t i ri i r r . rt . r r r . l s1 o b c , n , i l n t a l .H e n c e p r o p e r
Analysis of parameters of EuroQol 5D-5L
to assessthe quality of life in patients with
Permanent atrial fi brillation
bc ccxrsidercd
f i . , . i r r r l r : . , ,r,1.r c l r l r l - r r I i t . i l ri ,l lrrrlL, " t i f , s- :l t o L r l d
r l r r j - ,l.):l r t rret i i r r I r ' r l r :t:r ) i t ' t I i ( r \ ' \rll t c i r - q u a l i t y . loi f e .
C J a m e s , rS T i s h e v a , rK G o s p o d i n o v , rD G a i d a r o v a ,I
N S t a n c h e v a ,S
r O h r i , l D Y a k o v a , rM H r i s t o v , l
1)-.44
T C h a k a l o v a ra n d S J o s e 2
,,'ritltra.triai fibrillation in
l'.i;l< i;:rcrl:ors
r;'.s:;r.:,cil*,";*lrl
;,:.clult.:;
ciirrlincsc,rJur"rr:f
er tlier zl;geof 60-a systmatic
tMedicolUniversityPleven,Pleven,Bulgorio2MOSCMedicolCollegc,
Kolenchery,
lndio
lntroduction:
Atrial
sustained
atrhythrnia
arlhythmia
with
resulting
-Fibrillalion is thc rnosl conrnr url-r
and
the
most
Assessrlcnt
( ' , l s l < l r r r . i ; : r : ,. rnf : E l u e r r l ( i r a n l ; r r , l l ' l O L . a L r - W a l k e r l
hctcLogcn o r:
rcgards to thc individual
symptoms.
L13yler.rr
spccttrrr'
| , r :r,:lrli).,' 1r.'rr.rr.t
r\lrilltlirfdlt'Fet,:,tlt of Nursrng & Midwifery,
.rl
i ( ; ; ' . r l r l i : r C _ I' ,
of quality
ol' lilt hrr:,
received increasing attention as an outcolre nreasUre(,i tlt.(
subjective sequel of the disease.The firnctional cl'li t ,r:
this chronic condition, as pcrceived by the paticnt u,,ultl
be estirnatedby introducing the quantitatir,capplolt i o,
Health Rclatcd Quality oiLif-c (HRQoL). J'hc airri li tl i:
i - ir
study is to analyzc thc parantctersof EuloQol 5l)
patientswith pcrrnancnlatrial hbrillation.
Method: Questionnaircbascd cross scctionul s1trcl..rr.r:
donc among 256 paticnts admittcd in thc Dcpaltnrfir. ..).
Cardiology in thc University Hospital with pcnnarcni :ilii:l
fibrillation (confirmed frorn history obtaincd lrorn 1.:"1s11
and fi'om old medicai records) bctrvccn Jst Januarl 10I ait(l
31st December 201'1. EuloQol 5D- 5L clucstiomrrir. * L
iirtroducedin thesepatientscluringthe hospitalstay.[rLrr'( .r1
5D - 5L conrplises ol 5 dimensions: nrobilrtr', scll'-.ar,,r.
usual activitics, pain/discomfolt and anxict),,-dcplr':L('rl
Each dimension has 5 levels: no probicnrs,sliulrt probl n:;
lnoderate problcms, scvere problcnrs and cxtrcnrc pr()bl: n' j
Results: Mcan age ol'the study population r.vas7l : -i \. ars.
The distribution of the group bascd on scx is nrrrlc I jr.
(44%) and fcmales - 143 (56%). Among thc paticnt: vi11
pennancnt atrial fibrillaticxr, on basis of EuroQol il)
5:
in case of mobility 160%r,verer.vithmodcratc problcurs. (11.,
with scvereproblcms and6(%u'ith extremc problcnr-s.I i: 'o .ri
the patientshad rnoclerateproblerns,E% had sevcre ploLr::r L:
andlo/u were with extrelxe problems on sclf calc dln)cn l(jn
When consideringthe dimensionpain/discontlbrl..11", hrri
tnoderatcproblems,22o/ohadscvcrcproblclnsand 11",,lirrrl
extreme problems. In case of anxiety/dcllrcssiolt. iS", hrril
;:rodcrate problelns, 24oh had sevcrc protllcr-ns lnri .21.,
wcrc with cxtreme problcms.With usual aclivitics.10", hrrt
modcratc problems, 16Tohad scvcrc problcnrs antl (r" , hrrt
cxtrcmc problems. Thc paticnts r,r,ithcxlrcrnc 1'rr-oblcni:crr,1
tcl be with highcr agc and were majority of fcn'ralcsc..;.i, : : .!
thc dimcnsionsof EuroQol 5D - 5L.
!'ul'p,l:'r'r l.lirtr.rrth lliiri su1-l:Jslc(ltl rirt idcrrtillcation of
i , r r ' , l i l l l . l r l , . l r 'i il ri i-i:rir. r, 'i:s; l r i t i n t l i i r r t r i t r l l u r - t o r - r i h i c h c o n t r i b u t e s
1 r .n fill,, rltrrino.rsltt.r.lillll rlla:ionrr\l:). Clr.rn'eut
research
r . . 'cl l l r ' ri t . . l 1
\ , 1 ( t r ) i , i .o\ l ' ; r r t r il l L c l ri-srt , i ri in c r c a s i n g i n t c r c s t t o
\ ('iltllrlr "ulrrli:;',iillt 1rl: havc dif1'crentrisk
crliibli'r,r,,rlr,.:ilt,:r'
j . L L 1 ( )cl ,' :. ,' l l l r l r r i tri, , : 1 lorl r i a ri t ( l u l t : I l t c p r i m a r vo b j c c t i v eo f
t l L i rr c , i e, r , , rr r st o r c L u n i r lr'i,s l . l. i r c i o r si r s s o c i a t cud, ' i t hc a r l y r . nr r ' l \ l r : rl : t l r r l l :i i; i : u t i t r : ' c irl.tlt l c l l h i , : r g co f 6 0 .
l i l : { l t l r l i : \ \ , ' q 1l 1 5 1 l1j r' 1c 1l \ : r i ' . r r r uIl: r ' t l t r r t co f H c a l t h C a r e
i r r r ' e l l i t t i ( ; r r L r l c1l 1 , - r, s. l 0 l . j i t i : ! : J I t r l t l c la s y s t e m a t i c
t , ' \ r J . , \i,r r r l r : \ . r r l' rf ) ' , l l t ) l - l ' . 1 ' I : \ 1 I : i r \ S I : .l ' s y c l N F O a n d
( l \ , \ l r l t l \ r r) \ , - ' n t L ) .- 1- i',ir. - 1l,). : L i ac \ i i a c l c d i n c l L r d e dr i s k
I : L t . i i ) l ',l ltl l l t \ ' (llr r i i-i . t r " ' r ' n i l rllllr el . : , o c i a t i o n s .
.iilr,i:rl1:r:\rr.t ,ci,.rtr:r'rl .1.'i')i. Irrpr.:'5lnd fbuncl eleven
i i . ) r e : - , , rl ri r r l : ' 1 i ; i ; i t :i.i.. , i c , . t h L r t t l t L' ili(.l\iu a s e - c o n t r o l S f u d i e s
i L iI n r . l r l r r :i n i l L n i o i rc l i t r - ' r i - \r1. r , s tu f t i r c r c t ' i c u c d s t u d i e s
f . ) , r : l r : i , -,' r( li . ' l c r ' l ) t o l i l r i ) i i l l l r ) t r s ( l u i . c c S
ol'biaS. StrOng
l l . ; : o t : r r lri n : \ \ ( l i , i f l ) o t ' l . J Ir il l r l i t , . tr. i s kl n c t o r si i s t c c Ji n t h e
t r l ' i , -1' , , . ' l r ., ,(r ) n 1 . ,t r n - 's r l i u l )r r i 1 t ,u s t : o n g r n c t h o d o l o g i c a l
t , . rr l i i r I r r i l i : ' . r t : l l i c { i r r1ul : t , . i i r r i lt os r s i n g l c n u c l c o l i d e
i.l.i
1 , r . rt:r,l,r , . , i r ; . l l { 5 i ) J i ' )r : r l l l l l ) ( ) l n t l r ' L se s s o o i a t i o nw i t h
(
'
1
,
(
,
.
.
1
.
.
;
:
'
i
(
'
,
,
i
i
i
l
l
:
,
.
r
q
'
t
r .rl . l : i ' . { ) 0 ( r ) .
.'.l tl
i
( r r i r : ! : r s i r u l ' ,1: i t l t r l , r i i r r n s i t : 1i ' t, : t , . r c c nd i f f ' c r c n tr i s k
, . i r l r l l . . u * \ , 1 , ' , . r - *l r i ! , : l r l , "l r r , , a i r n t a n r o n g f a r n i . l y
r rrrlllrill:.
l. ltr.ritl lt:;ll.r:ltiiot:,' \\!lC
EuropeonHeortJournolAcuteCordiovosculor
Core20 I 5; :
Llo.r.i.aN, I 1.
AF
riark: l. i-;rb'ic
c,l':,Lrl-r)r'r)af''/
oI kr-'yfirrCings.
F ii r r i t n g s
[i s l i;ic:.r:r::
( e tt'l:.:o':l;r'lron
siurl e:; iifr'P
r : I l , l 1 5 5 { r 8 :l,i f ' l ) r ' : . 2 ? 0 i l l l
I r i l r r i r r : ri t c
l,'
( t i i i : t i t r c : ,S , : t v c r i l
o : i i i l 8 , { 9 s , oc, t; t - t . 3 9 )o R t . 3 ,
l 9 , i : aC - l1 0 7 - 1 . 5 8 )P = 0 . 0 0 5 6
R i r , 1 r9 8 ,( . 9 5% C t t . 8 - 4 .t 9 )
i) cr ril!i
( L,::i:i
,/l r\ olllia
i I lii,
l'l lil
Conclusion: The study rcvcaiccl that thc incitlcnc ri
anxiety/depression and pain/discomtbrt arc al u l.rishci lut,.
in patientsrvith permanentatrial flbrillation, r.iheLeas , h.:r
rr'l)ofte(l between
r L i r ,:l i J \c r f l f ! ( ) r ' i i r i i si r . r ' , c l l x s \ r ) , r r { l n rocb e s i t v i n a d u l t s
L n . i t r l r ' , ' l r l r .l lr ( ) 1 1 r ( ) n r ' l u '1( {, .lrrr l t L : r . r r l u l t s .
I t i l l r , ' . i l r r 1 , 1I r : c t i o l
i,,t,:rcl .tc,r-1r]-i' i,f,lt[
LL,rr
]
it
r 78. (95% Ct. 7.02-7.07)
',:99.
( 9 5 %C l . 1 . 5 3- 5 . 8 5 )
Hl;1.
7| . ( e s %
cr r.3-2.25)
Hn.
4 ? .( 9 5 %C t 1 . 3 - 1 . 7 2 )
! ' l r r 1 1r 1 ' rl l i l { l )
: i "8l
acc.sagePub.com
AcuteCardiocCore20 I 5
l7
T a b l e l . C l i n i c a lv a r i a b l e s
Age. years
67!18
HF de novo rr (
r5 1 5 0 i
S r , l j , r r'
Malesn (%)
18(60)
N Y H A l l l / l Vn ( ' . I
'.,:,3
\)'/ J
S i t atr i v : r b r i C i l c ,r i , r ) '
3t3
HTA n (%)
23 (77)
H F r E Fn ( % )
,2 Il'.,1,;
L l e r : r - [ i i r : r l , l r ra: ;t L J i s c l L a r 'np ,(:% )
24 (80)
Diabetesn(%)
ll(37)
HFpEFn (%)
54t | |
Leftventriculari :,''1
eGFR(DMRD)
lschemiccardiopatia ll (37)
f a r ' 3 c rI c , 1 ; .i l B a r ., l l : : , : l r i r Enl ( ? ' . )
Bli;)
.:7.5:tl7
Hospitalstay,d:. s
6 .;':t\
H R a t a d m i s s i o fr (r ( ) r
!'9:L| 9r
n (%)
Dilated
cardiomyopathy n (%)
9 (30%\
' r , ' r r l r - ' ,l ' 1 r ; 1 r 1 - 1 n 1 1 )1 4 2 ( 8 5 - 2 0 0 )
6 (19)
l I C l , ' , , ' l \ t { , \ i l; r , -r : ] i : , c i r r i ' 'g r(:% )
-i;Lr-:,,t
, . . . : : ;i:Irl - , , t : ' 1 , , 7 1 , (.7. i1 1 1
(.1
5 , : ll r - i ; l oi r 1 1 " 1
2l (70)
I r ' t t ra
r i i r i r rd: L r s r;:: Ldi i : c l t L t 1 , e ,
nrqil.llr
5t 1.3
33 (48)
P89
r n r i l s r , , r : , . ' i . . l. ' . , ,
Acute heart failure in a patient with
iatrogenic cushing syndrome on
treatment for gout
r r t : t i i t ; r L i r r ti r s, . 1 r , irni l r . \ ( l l : l r t l r : - r i L r ' rb' e
s .t a - b l o c k e r s a n d
L . r r r . r i l , ,i l s t l l l
t,l' clrdiomyopathy.
l ' u 1 t : r L ' .\ \ i r s . r t i , t - ' . 1 n i t l r t r r l l . t . u l ( l u r ( l h e a r t f a i l u r e
l l i r i o s il ' l o n , . . l r 1 1 i u l , . ) r ' l s l r ir.: d , . rt cr i r o l p g y i n v c s t i g a t i o n s
( r j n l , I l l a ( l i i i i l l l i l ( ) : i. ,r o i ' I , rl | r r r t t ' ; r i .(' r r s h i n g ' s s y n d r o m e .
l i l r r t n i . r l i , l t , r r i s l 1: : } l . ' r ' i : r l ,l ,I ) c r l r t lJ ( ) s t c r o i d s a n d s t a r t c d
S Tisheva,r
N Nil<olov,r
S Ohri,rK Gospodino'.I
C James,r
D Gaidarova,r
D Yakova,r
R Pencheva,l
N Sirachkar
and S Jose2
r ) n t l " . r i r l l l ) r ' i t l r i . 1 o t - r , . . r . r : t i(r,rr.l c h i c i u e .
Fcbuxostat
l u n t i l i t r . , " l r r ' , r n l i ( r l i : .l ) l r { i r - : n* l l s i r r r c l c lt t r e c l i c a lf o l l o w l r l l \ r 1 i t - " l r r : t ( ' . i i l | i i ! i i u l ' i i r 1 ' r : .( ) l c c l r c t c a r d i o g r a p h y
2MOSC
tMedicol
University
Medicsl
Collci,
Pleven,
Pleven,
Bulgorio
lndio
Kolenchery,
s j r r i ' , r I, : r ) r 1 r l r ' , . i q , . 1 'r1t 1 . ' .I l i o - l 5 o o l r t J r d m o n t h
; r n t i - . 1 ' , , 1 n ( ' r t r ) n t . t : : .l ) i l . i n l t i l r c t b l l o r v u p p e r i o d
t , r rj i r \ f , r ] | l ) r ' { ) r . r : t li i . r r l l r L ' s I l . l - } \ l l r c d u c e d a n d
I n t r o d u c t i o n : A r n o n g u n c o l n m o n c a u s c so 1 i l r r . ig l ) L r : L r l i r \ i l
f a i l u r e , e n d o c r i n ed i s o r d c r ss u c h a s C u s h i n g ' s S v l t ' f , , r : L e l l l i l r c l t , , l, l : \ , . : l i r l i : t \ u l L - : l r l , .1' 1 o t i ,. t t T a c k sa n c l d c c r c a s c
can be sited. Paticnts with Cushing's Syntlroirr lrr,,c
ncarly 4 times incrcascd cardiovascLllar nror.iirlir\ :rs
comparcd to the gencral population. latroscnic ( L sl inrr's
Syndrorne(causetlby treatrnentwilh corticoslcroiir;) .s i irc
lnost conllnon form of Cushing's Synclron'rc.
C a s c : A 4 l y e a r o l d r r r a l ea d n r i t t e d t o t h c I ( ' - , , , , t l r
h i s t o r y o f b r c a t l . r l e s s n e sas n d b i l a t c r a l p c ( l u l c i i , : I i r
o f 2 l v c c k s d u r a t i o n w l i i c h i n t e r . r s i t l c dd u r i n u i l r c I , . L ' r t
3 d a y s . S i n c e 2 0 1 0 p a t i c r l t i s o t r t r c - a t n r L ' n\ t\ i r h i r i l r
d o s c s o f c o r t i c o s t c r o i d b y a G P f o r t ' c c u t - r c ntti r i . r L i ,r i
o f a t t a c k so f g o u t a n d l a t c r o n p a t i e n l h i n r s c l f c ( \ t 1 , n r . . t l
o n t r e a t m e n t w i t h c o r t i c o s t c r o i c l sd u c t o t l r c r ' c , . l l r . r t
symptonratic rclicf. On admission paticnl u s r,,ilt
1 - e a t u l eosf c o n g c s t i v eh c a l t f a i l u r c a n d h v p o - 1 f n i t , n t l i .
P - U 0 / 5 0 ) . P a t i c n t w a s c l i n i c a l l y c u s h i n g o j ( l l l l l r , .r s
5 4 0 p g / m l ( n o r m a l 0 - 1 0 0 ) . S e r u t nt r o p o n i u a n d I r - I ) i r r , . t
w a s n e g a t i v e .U r i c a c i d l e v e l 8 6 2 r n m o l id l . T f I : r ' r : ; t 1 ,d.
s e v e r e g l o b a l d i l a t e d c a r d i o r n y o p a t h y r v i t h I . ' . ' l i , ,I
2 8 o / o .P a t i e n t w a s t r c a t c d w i t h i n t r a v c n o u s 1 r ' uj t r r t i , c
a n d i o n o t r o p i c a g e n t sw i t h g o o d c l i n i c a l i n r p l i , c r . : r r i .
C a r d i a c c a t h c t c r i s a t i o nd c n o n s t r a t c d n o n r u l ! ' r ' , r i r . \r
arlerics. Extensive invesligalion Ibl arrloi lr rrr,.r.
i n f e c t i v e a n d i n l l l t r a t i v e c a u s e s c a r d i o n r y o p u l lr. \ ' ,r .; c
nogalive, Paticnts rcportcd alcohol intalic r', r: r 4
acc.sagePUb.com
lll lirl)lti:it/t!].
':;
( q l t t t ' l l i l i o n : ( r L : ; l t i n l . r : . . ,1 1 ,r r l l r r s . t t t u n c o t r t m o n b u t
pLrtr:r,tru
i vl l r ' , i .r ' r i i r l r , L r l l ' , t ( ) l < i r l l r t c d c a r d i o r n y o p a t h y
j
l
,
.
,
i
r r 1j : l ri l l L i . : . n t o : i 1 t ) L 1 i . r li 't i ) t r r , l . i c di r t p a t i c n t s w i t h
Ilrij
l t r l - , . '-r, , t l i : , , r l i : , t . r i,l.' , i l r t i r f s , j , i c \ o q e l l ( ) u s S u p p l y .
I t r . i L . d i cr , t r : ' r
o l ( r . t: i j r " L : r r t c LLoj : ; i s 1 o b e a v o i d e d .
"f
i t i , : i \ . 1 . . ( r - ' : ; r' ,i , . l t r r ' - ' .isj l l h l L | r t : l t ;, c s l r n c l n r i r n y a d v e r s e
r ! ' r t j 1 i ) n . , i t t u r : c r , . i t i r r l l ' - : rlit 1 ' 1 ' r i ; u ; r l i t i inn t p o s c n c e d f o r
. r);r l l : r 1 i c r 1 : .I 1 r : c : t l s s t r o n g t n c a s u r c s t o
l L r r t l l i ri : L i u L . : l t l t 1
lirrrittlrr'llLic li rr.sr ol'r1rilg: oblIirrctl on plcscription in
p l r l , t r r . r ti ' - ' : t
P'C)
A r , n a l y s i s o n t h c F , z r r a i - { 1 c t e r "osl ' t h e E u r o Q o l - 5 D
-l! L ;,Lrlo
r n g p a t i e i 1 t ; r i , ' 1 ,i i[ " 1 , i 1 qq6f p D e c o m p e n s a t e d
l-l*;rrt
l-aiiur',:
-l
'i'af:ov,r,
;, isllrvr, !' ilhri, D
C j r r r - , t : : ,S
lY Hristov,l
l ( C o : ; ; , o r . i r r r , v i. i i : l i 1 : r r - o v : r ,f r . S ! l r r r : i r c v r ,T C h a l < a l o v a l
rnd S iosl
! , 4 t ' . 1 t < qllr
! i ' r j i l , ' I ' r , ! , r , / ) 1 , , ! r , r ji,: ' , g : i , : t : ) C t S C M e d r c a l C o l l e g e ,
Kr:lt,lcrr:r /rirr
l oar r e2 0 I 5 : 4 : 5 - 3 4 8
E ' .r. ti p ( ' ( t: t l - lr :n r t I c rt r n o 1 , \ , i 1 e( r r t d i r ' , ' i ' t s c t C
Frrr6fr317
t l/ecrf ./,:.',.rr'"c1.
.:tasculorCore 4(Sl)
lcit;l.t::Jorr-li
t6
Introduction: Acute dccompcnsatcdhcarl l'ailulc i: h.:
worsening of the syn.rptoms,t)'pically dyspnocl. oo(lr'I:r
and fatigue, in a paticnt with cxisting hcart tliscasc. r'h.:
condition is causcdby scverecongeslionofnrultiplc or3 urs
by fluid that is inadequatelycilculateclby the lirilirg ht,n'
T'he psychological and physical irnpact of tlris contlil t,ir
is very disturbing. The airn of this studf is to analvzr tlir.'
in-rpactof acutc deconrpensatcdheart thilurc on tlre rlLr, rt',
of life of thesepatients.
Design and methods: Qucstionnairebascd cl'oSssccii.nirl
study was donc on 312 palicnts aclrlitled u'ith rr,ul,-'
decompcnsatcdheart failure (cstablishcdby clinicll rn,.l
diagnostic methods including chcst radiosraplrv. r'i .l()cardiogramand laboratoryinvestigations)
in thc Dcprrrtrrcril
of Cardiology in thc Univc-r'sity Hospital bctu ccr-' 1 t
J a n u a r y2 0 1 3 a n d 3 1 s t D e c c m b c r2 0 1 4 . l 3 u r o Q o l- 5 l ) . 5 1
questionnairer,vasadnrinisteredin thesepaticntstlLrriul tlrc
followup visit within I month of dehospitalisatiou.l:rnr,'J,rl
5D-5L comprises of 5 dimensions: mobilitl,. seil' \'llr.
usual activitics, pain/discorrfoft and anxict)',dcprcs.:ol
Each dirnensionhas 5 levcls: no problcm, slight pr.obl.'rr,;.
modcrate problems, scvereproblcms and cx1l'cmcprolrlt nrlr
l ) i l l X l ' r . , t : I r , r r : ; ' ; c : ,l:l ,r c i n r l t r r i - ,r :l r l i i r . r t t . , i o f l c v o s i m e n d a n
i r i l l ' ' , r r ' iIr r l r t c . . l u l r l i l r, r l ' l r 1 i -: 'r r r cll) : i ' , ' C : ) o S ( ) m i st ttiact l t si n
p i r l i r ' rt : i r r i t l t r r i ' , i t l ' r c i ,irt i. : ; t t l i r i l r L t cl , r r .i ll 1 d t r r i n g I y e a r ' s
jt lt{l\
N i l r l c r i r r l i : r r r r l r n r - ' l h o t l r : t r : ' P : r t i e n.1 n i t h A l l I ; w e r e
i r r , - ' l r r t l - 'ir. lr o t r r s l r r r l r ' .. l ( l I u . i , - ' L r Lu: .c l - c i r . r n d o m i z e ciln t h e
g r , . \ . l l \ : ' , 1i t : r o r i l r r s , . J' i l . , - ' ii ) \ : . 1 | ] J t ( i i - I )2. 5 p a t i c n t s w e f e
t ' : r nl l t r r z , , ' r li t ) l r i j : l o i t i
l , ' , 1 ' r i t 1 1111. . 1 . "i n f i r s t o u w a s
j i r i r i i r , , 1 's t : r . r r l )a. n d 1 - l p a t i c n t s
1 . l t ' r ' l i r ' ; l r , 'r,).r1! e i . l i 1 l r c t r , , ' l t
h l r i i . l . , t r r t t r r r l' . c . . L r ; i i r r r , , : r . irl rt lrr i s i . ' r r {i 1 . 2 + 0 , 1 ) t l u r i n g 6
l i ) ) i l ) l i ( , i r i i l r , . :: 1 : r l tr : I l r r r ' 1 : r l : ] ,. r n i l t l r , - ' .ri o i n c d l h ! ' g l ' o u p
j
I 1 r . ' n r r t l r t l ei r l r i ' i ) . t - r l l i . ' i l i r5 l ; i , t , i c a r s . b t r d y m a s s
i r r t l . : r I i . ' , I . . 1 . , ' i l l l l l t l i c l l s \ \ ! l l l i r : , s , r . s , - '' 1i l t i r n c s : b e f o r c
I \ i r r i l r s i ' r {r lr ) 0 ) . ; t i i n t , r r rl t / i , l l l , , r r 6 n t o n l h ( M 6 ) a n d
i r r I , r o i r l i i . r l ' 1 1 . 1) . . \ . l l t l i c r : r 1 i . ' n l s' , ' , c l cc v a l u a t e d w i t h
lr(l:i l) tr.t1., lLnti [.1t:t]icll ( )ulcr)nrrs Study Dcltlcssion
( . r u . i t , \ r l l l i r r ' r ' . r ,l i l r - : i r i ' r l i n , n i . rt r 1 ' s l r r t i r a n d \ 1 1 2 w e
l r . r r . i l i - l \ l ,' . ' t i ! l l i ) l r t i \ ' l r i, \ \ j t , r I : L l S r \ .
i l ' r i L l l . . J (.l' . 1
I { c ; r r l t r : I t , : : . i tt l t o t l . t l j l ' , i r r ( l ; , r r t r i r| ' i r t s f 7 ' ) 1 o( E p a t i e n t s ) ,
. i. l r ; ' u : r . l l : 9 6 ( 2 p a t i e n t s ) .
i r , ( i r o r r p . l - i ( , " r { - i 1 r r 1 l 1 1 ' 1 ri ri .. (1
r \ , t b l t s : l i t t r ' . l i t ' p t . : : , , ; ict : \ r r l i ) l o l l l i h i . r i .ii r p a t i c n t s ( 5 5 % ) i n
s : i r r l i i . 1 : l l ; . r t i c r l 1: ,6 l ' , , ) i r g r r . r r rIl rl u r ( iI p a t i c n l s( 5 6 % ) i n
Results: The study revealedthat aurougpalicnts ri i1hr. rric ! r r L r p l . , \ l i e l i . l 1 ; 1 , r 1 111r 1ts1l r . r r i rr r i l l ' c r c t l i o r l t l c p l c s s i o n
f i l ' ' , , , r 1 ' l - i t t i e i tti l:ti r t t ( , . : l 1
) . 5 . i " , , i r t l t i r ' L i p2 a t r d 4 0 0 %i n
dccompcnsatedhcart firilure, on thc basis of liuloQoM)5L, in case of dimension mobility - 36% hrd nro(l\' 11!' g t : rr r P i . i l ) r r .t i : , r i i ) i r i ) c l it c ( l \ \ i l l t , \ ' ( r t : j c n i n g o l ' a gl l r a d c s o f
problems. 28oh had severc ploblcms ond 8g/o\\clc /i,1. l ( , i J ) r r r t ' l r r ; 1 1. : t l l c . i , c . r i . r r r t rl i l r i i t r c : . P l i n / d i s c o m f o f i
problems. 37oloof paticnts hacl rnodcruttcprol.i:tit
l r r r l r i l f t i . . " l r ' r l \ : l ) t c : i i l ( )Inl i r ! i f o i l | l . i t . L r r . t o V c n l e n<ti n 3 0 o %
cxtl'c111c
26"h had scvcrc problcms aud 5ulo wcrc rvith c.r1:.:ltt' i 1 1 1 y l o r r l t- l ; r t t r l i t , r I t - . r r . l i l , j l t ( ) t l l i ' ' r , i r r g r o u p 3 b y t h e
( ' l { l r ) l : i : r r i ' , . \ l l i r t l i } ) , I ) i i : ' . t . c , r c t L' n l L l o u p ) o n 1 8 7 o ,
problerns on self-care. ln considerationo1'the tlinrcr ,iol
'l
pain/cliscomfoft- 28a/oreported modcrate protrlcnrs. 2',
iri,rclr.r.'r1
i l ) r l i ) L l l - ;I . u t r i i l t r ' , t r r l L ' ; ( ' i , l i n g l y o t r l 5 o % a n d
severe problems and 8%uextret-neproblems. In cusl .ri I I I o ( r ) l l i | . l i c , l L t l ' " i ( ) .
anxicty/deprcssion- 209i,had nroderatcproblcrtts.-1S".h;rrl
, r i l r r , . ' n r i r rirr r i i r s i c r t i n p a t i c t r t s u ' i t h
sevcre problcms and 22Yo of patients werc u'ith c\lr )r'i(.
rr'.1.
llrl. lt rii(luiJrsrnortality. irnproves
problcms. Whcn considcring usual ac1ivit1,ciintcusir,rtol
I s . ,r - ' l t o : o t t t : r l iici i l l u s . w h i c h i s a n
E L r r o Q o l5 D - 5 L , 2 6 0 o h a d m o d e r a l c p l o b l c n r . 1 8 " , , h , ' t l
i r ' t l r a1 . , 1 r t. ! r_' r1 1l .)rr ' ( ) g n o s iosI i i f c i n
severcproblcms and 10olowerc with cxtrcrnc protrlcn':
i i : i l r r c n 't. r L l i . \ i ) s i r n c n c l a ni n f t t s i o n
r r r , , 'i:r r r , t tr i r r : i n i l i l c c x p e c l a n c ya n d
Conclusion: The study rcvcaled that thc iu0j(1,n1.i!.1
of anxiety/dcprcssion, pain/discorntirrt, pt'oblcrrts t:rlr
mobility, self care and impainncnt of usual activilv rr! ar ir
high rate in patientswith acutc clccompcnsatcd
hcurl lr rlu'c
Hence proper psychological and ph),sicll lehlbilit .ti,rrr 1 , 9l
is to be in.rplementedin addition to the phannacoli,,i.al
thelapy, in patientswith acute decompensatedhclr.t lllr r': [ - l ' : a " r '{ ; l i l r , r r ^-e i r l r e n r a i r r c a u s e o l h o s p i t a l
ti r.,a.tl: arrrcl lyl o r"lri d i t.r o{- nry,.rc arcl i al i nfarctio n
in-ordcr to inrprove thcil qualitl, of lifc.
i n r,n'orrr e n
-[rr.:tyll':,,r':r,i
I'J
l'..l1, c Ltl,.rrrcsl<eyar
I A. l-cortov;r.
and
P9l
. ( ,[ ] o i r l l e , , , r
Evaluating the long-term effectiveness of
Levosimendan use on the quality of life in
patients with advanced heart failure
i\ r'i;r-\//(,rifi
rrr ocarclialinfarction
1.1
()rncnrverc divided
n r i d d l ca g c o f 4 5 - 5 9
I Katsytadze,r
K Amosova,lI Prudl<yil
and O Gerula2
)O. Bogomolet's Nstional Medicql University, Kyiv, Ukroine 2Kiev Alcrtr
.iilic i"vlcd;,:J/
L/|rrcr:;iiirr;crrrt,:/;./ l4cchnikov, StPetersburg,
l i , u ; i( i / , l : , t , . i i fi r 0 r l
ct
Clinicol Hospital, Kiev, Ukroine
EuropeanHeortJournolAcuteCordiovosculor
Core20 I 5 . 4 5 :i4ll
Do$n ori..d frr
:r
:
acc.saSePuD.com
-
a
0cusTt
a
HELP.
C*HIACTAHA
o
H0Mt
a
Circulad*n : tardi*vascrel;lr
f\---l:-
vuarlry
\*J
*fl.
*-_ J ^
anil LJtltcrlr"sIf3i
American
Heart
WN Association*
W
Skip to niain rragecontcnt
l.
2.
3,
4.
5.
6.
7.
Abstract241:Evaluationof the Paranreters
of the HuroQol- 5 D euestionnaire
Am o n gP a ti e n tsWi th l sch e mi cHear tDiseaseW ith Nor m alanclnevated BM t
Ct'ril Jarnesl,
S h r e v aO h r i l ,
-l
S n e z h : r n a i s h e r aI ,
I)ilytna Yalior,a1,
llaltiu Ilristovl,
Nadia Stnnchevaland
Soumvn.Iose2
fir\uthor Atll]iarions
pleven,llu lsur.iir
I . 'Univ I losp . Dr. GcorgiStr.anski,
2. rNIOS('NedicalClollcsc.Kolcncher.r'.
Indil
Abstract
O b j e c t i v e : ' l ' h ce p i d c r n i co 1 ' o b e s i t a
y n c lo b r : s i t lr' ' c i a t c dr r l l b i t l i t i c s i s u n i n t p o r l u p pt L r b l i ch e : l L l tcl r5 1 l l e ' g c .a n t i i s
paral|eledb.".'gr.or'i,ingincidenceof.rnetabolicsl'ndt.ortlcrtllic|laetsiL5il|l1jl]g
heartc]iseaseandotherather<rscIeroticl,ascuIarerett|s''|itcll:irclill|tllit.lt1lnt1lac|rll.lItcstclll'irttil.
r,erl,cjistr"rrbing.Inpracticaltertttstlrc
ptlticIlt-ctru|dlrccstitnatet1brirrtroc1uciltgt|let;uarltitlr1irL,lt;r1l11r;1g|1trJ'.J|e.rlthI{cljtctlt.lulil1
Aim: The airn ol'this study is to cvaluatethe irnpacto1 o[rcsi$,on qualitl, of iilc o1'paticnisrrirh ischcmichearl
discase.
Design and method: Qr.restionnaire
hasetlcr.,rsssccli()lti-rl
slLr.irulrs eortrlLrelcd
urtrrrnullrticrrt: rr itlt cstablisheci
Corotrar\'Ar1er1DiscaseaclrnittedintheDe1urtntctlttri(.lrr..1rr,ltll-r]tllhtillircr.sitrlltr:1lj111.5](rllir1i..'rlrsrrItrltc
a d r r i t t e ciln t h c C a r d i o l o g l D e p a r t m e n b
t c t $ , c c nl s t o l . l i L I u r r r2- r( ) l l i r n t l - l ( ) t l t . l r i n !2- ( ) l l n j t h a c L r t qc :o r ( ) n i l r ) ,
s}rtdromeor cor()narvangiographico; Elcctrocalcliourrplrl
cviclcnccol ischcrrricr
ltcurt cliserscucr.c irrelLrLjccl
i' thc
s t u d y s. t r a t i l i e db 1 ' a g c s, e xa n d B M I ( n o r n r anl ' c i g h t1 3 . 5- : + . 9 . o r c l u c i s h L2 - 5- 2 9 t i . i r b c s c- t { } a n t ul b o v c ) L
. r:roeol
- 5 D ( E Q - 5 D )w a s a d n l i n i s t c r cidn t h c p a t i c n t sc l u l i n gt h . : i rl r o s p i t l ls t r _ r l.( 1 , 5 1 ) ( - ( , n r p r i s c s
5 t l i r p r , p : , i , r pnsr :o b i l i t _ r .
r
o
r
problenrs.InodcratcpI.oblenrs.sevcrcprobIcrnsatltiL\1Tc]1ldlrrrl|tlcnt:',].hclrcig]rt.ricilIlrlLtt.lhasic|alrtlr.
paramctersrvererecorded
Results:Mean age of the participantswas 65.1+ 10.6rcars. \'[alc lbnralcluLionirs 0.76. 'l'lrcclisrlibLrtiop
ot patic.trts
i r r I l f v l l g r o u p sw a s 3 6 . 8 y o 2
l 4 . 4 9 6 31 8 . { i % .S t x t i s t i c u l l , ' . i r t n i l l e u!nl itt ' l r ' r ' c l t chc c\ t l c c r r I } \ , 1I u r r r r r p r r c r c s c c l l i r r
l l s u a l a c t i r , i t )( p = 0 . t ) 0 5a) n d s c l l - - c a r(ep - f ) . 0 4 4 )d i n r el s i \ ) n so l L t l - 5 1 ) - 5 1r r i l h
) u1r c o r ; ticn t h c o b c s c .\ \ r c
| , i 1 y 1 . g( 5
hirr,'clbtlndsigni1icant|ypclsitivecotr.c|atiortbelrl'cetli}\|IlLIlLlLtsl.tllltuli''
a n d a n x i e t l , ( R = . 0 . 3 6p
6 - 0 . 0 4 5 ) .M e a n I l M t o 1 ' p a t i u n Lr si t l r e r t r - c r r rI cr . o h l c n t sr v i t l rc r t r . e r l c
1 - r r - o h l c rnl ri lsh u s r " n l
acti\'itiCsissigni1icantl1,'grcater.thant|-roserr'itliiotrerlntcttsj[rtll.pl.illl].'tlts.
I r u rc l r i r : h enr r e i nt r c .
C o n c l u s i o nO
: t l r s t u d l ' r e v e a l e dt h a [ I s c h e n r i ch e a r lr l j s u r r ey l r l i c n t sr r i L h r r l r e s i t ll r r r t li n r p r r i l e r(l. ) , r 1i.n t e r r l s o I '
hca]th,nrclbilit1,,t-tsuaIactivit1'.discorrl1br.t
s c r r s oc f ' o rc l i r l Iu c l l l . c i n e .
Key Words:
(lrrrlnitr.r'ancl)<liscasc
Obcsil.r
( l u a l i l )o f ' i i l c
1, 2015
e 192 Journal ot Hypertenslon Volume33, e-Supplement
Rosults: Tliis study sholvcd thc prctlonrinancc o1'wonrcn agrd bctwc!:l) i1) dnil 1),)
years with incomplcte prirnary cducation and hypertcnsion dirgnosis tirrc ol nrorrr
than l0 yctrs, r\t the (ime of data collection, 2l 8 (-54.97c) pcople in rhc sri\r( ol
THE EFFECTOF STATINSIN ERECTILEDYSFUNCTION
r \ . S n r r r r r r t z * ,C i . S i o n i s ,C . l l ) i r z a l , , r rA, . P a s c h a l i sl,l S t o u g i a n n o s A
, . Tlikns.
('111iii1r/cr;9.r
I ) t'pu I I tt t( ltt. Ii Ipt s I I o t p i t al,,\t | rcn s, GllEllC E
M i n a s G e r a i s h l d n o n n a l b l o o d p r c s s u r ca n d 1 5 8 { 4 3 . 8 % ) p e o p l c i n t l l c s ( a r eo l
SAo Paulo. lt was lbund thdt drug trcatulellt occurs predominantly in con)bililti(rrl
wilh thc class ol'thiazidc diuretics associatcd witb angtotensin lI rntug<tnrst:. I hc
study shols that 25J (63.7 o/o)people with hypertcnsion enrollrci in rlrr Iianril-r,
Hr'althcarc l-inits consurnc lrrore thal one drug pcr dai,in tlte last rveck jrr \{rrra:
O b . j c c t i r c : I h c t c r t r c r c c l i l e d ) , s i i r n c t i o t {r E D ) , r v h i c h r e p l a c e dt h e e m o t i v c w o r d
'inr1-.s1",,.".'
i s l l r c i l a l r i l j t y t o 5 t r f l a n d n t r i n t a i r ra n e r c c t i o n s u l l i c i e n t t o a c h i e v c
'l
r c r r r r l j n l c l c r i r r L s e . h c e t i r r l o l r vo I t l r j s c o n r l j t i o ni s u r t r l t i l a c t o r i l lb u t i t i s u s u a l l y
Gsrais rud 201 (55.8 7o) in liio Paulo,
i r t l n t r u l c ( l r o \ i r s f u l r rl re ' j c , t r s c r r u s c c l L . l , r : n d r l t h c l i a ' L d v s l i r r r c t i o n . l v l a n y r e c e n t s t u d i e s
C0nclusions: The data prcsentcrdsuppo(s rhe conlclusionthat the nlltih\p(rrcrr\L\,-.
prcscriptions for tl]c Salnplc ilrc consistonl with tlle recilrntc,)iicd guidclilres fr()lI
I r a r c i r i t c n r p l c r l o l i r r k t l i c g r r r r v r r l lr r c i r i c n c c o l . e r e s t i l c d y s l i r n c t i o nw i t h o t h e r
e l L r s c s ,c s l r c t : i r l l r l n p l t i c n t s s u l i , : r i r r gf i r . r n re i u c l i o v a s c u l adl i s c a s e s ,f h i s s t u d y
airn. to iqr c51j 1q111s
lhu rclat i trnshiPol urr'ctilc dy'sfunctionrvith dyslipidemia and the
p u r s i b L ci r n p r c t o 1 \ t ! { i n s c ! oc r e c r i l ed t s f u l c l i u r r ( n o t r c c c i v i n g p h o s p h o d i o s t s r a $ e
tho pljnrary carc docuurents ol lhc I\rinistry ol Hcalth, sinco lbe iln{ih)'pcrlc]rsr!r\
crtnsutnedby users o1'the public health systL.lll.lrc in a cornlrjnalion rccrrgnilc(j rs
cffcctive.
illrrlritors)
'l
lh1" I
EFFECTS
OF METOPROLOL
ANDNEBIVOLOL
ON
EXERCISE
BLOOOPRESSURE
IN PATIENTS
WITHMILD
HYPERTENSION
A. tlirdane, !1. Oz.dum',rn,H.U. Yaz,ici. Eski.tcltir O.vrnrt,qrt:t Url',rrsrtr' .\clrrrl
o.[ M e di c i ne, I) aJ.ta rt ne ril o.l C urd i o l o 91, Es ki s e h i r'l' U ]l K I:\'
Objective: l)evglopmsnl of exaggeratcd hlood pressure lcsponsc to c\rrcr,c l\
shorvtt to be associatedwillt iucreaseclcardiovascular nrorbid.ityand mortrlLtr. J\"e
planned to cornptre the inlract oftrvo beta blcrckcrs,rnctoprolol ald nclri\i)lol. olr
alterial blootl pressurc during cxcrcirc in prticntii witll nrild Itvpcrtcnsrorr.
l)esign und rnethod: A total 01 (r0 patients (13 nrales,47 fcuralcst nrern ilgc:
54.3*10.7 ycars)were cnrollcdinthcpressntstudy, Ihcpalicntsscrcrrridr,rnll
selected to leccivc eitler ncbivcilol 5rng/dlLy (n=30) or nrctoploloi 50rrrr/tlrr
( n = 3 0 ) t b r 8 w e c k s . A t t h o c n d o f t h e 8 t h r v c ' e k ,e a c h o f t h c p a t i e n t sr c c c i v c i l
exclcisc stlcss tcst accordilrg k) Ilrucc prcrlocol and thcir bl(Dd prcssurc'i \\'crc
rcnrcasuredaflerresl, cxercise, and rccovery,
Rtsults: Illood prcssurcs wcrc dctcnnincd t() bc sitnilirr bct$ccn n)r:lopf{rlol irrl
nebivolol groups during lest, exercisc. and rccovcr)'pcrio(ls. N'Ic{ofrol,1l ilrr.l
n{rhivolol rt!:hieved sirnilar letlrrctiorrs in blood prcssnfes clur'in1lrcst nn(l c\cr
cise. Ilowcvcr, five paticnts in ncbivolol gloup rnd tbLrr paticnts in nrct,rprr,lrrl
group dcvclopctl cxaggeratcd I3P lcsponsc to exercise but tltc dillercncc bettrr:cl
mctoprolol and nchivolol rvas nol rnetningful (P=0.-17).
Conclusion.s:'fhc results ofthe prcsent study sho\vcd thrt mutoprolol iinrl ncf ivolol
establishedcorupitable effbcts on thc control of blood pressuresduring crt r r isc i:r
thc patieuts with nrild hvpertensious. lloth netoptolol anclnchivolol can rcdr( c r ardiovasculaf risk via redrtcing exaggetated BP response to cxcr'cisein hypcrt,-n,rilr:
patjcnts.
EFFECTOF SINGLETABLETOF FIXED.DOSE
AND ATORVASTATIN
AMLODIPINE
ON BLOOD
PRESSURE
AND LIPIDPROFILEIN YOUNGPATIENTS
'I'islrrr.
r.
N. Stucircva. D. Yukova, T. Chakalova. A. \inakiever. lVL Fftistov, .S.N.
U n iv er.ri ty I I tt.rlti t u l, It i rs t Ct rd i o l o g y C I i ni c, I' l et'c rt. l) LILGA R L\
1o
Objcctivc: Hypertcnsion ;rnd dyslipidemi:r rre two of the nrosl qs1111111,111r
<tccumingcaxliovascrtlar lisk fact<trswhich (ogcthcr ciruse an incrcasu in iur ',n,1 )
hcar:tdisease+elatedcvenls tlrat is nore thart sinqrly {ddilivc tbr alticiIalcii ,rvLll
raLes'lvitheach conditi0n, Data have shown that cven rchlivcly snrxll lcduc{i,,nc in
both blood pressure rnd cholostcrol lcvcls can lc'ad lo large reductions il tlr. r rsL
lbr ciudiovascular events. Fui:lhcrruore.it is vcry in]portalll to lrcJl )'oun! 1,.rricrri.,
'Ihc
ob.jcctivc 0l this
tdcquatcly in ordcr to prevcnt caldiovasculu conrplications.
study was lo invcstigate the cllects ol'a single pill of;rnrlodipinc (5 rrrg)r'atorrrrrtrt
rn
(lOtng) ott blood prcssurc and lipid prolilc and adhcrcncc to rncdicirtiol) in \t)urr$
hypertcnsive patients with rlyslipidenria atrclno ltislory ol.ischaentic hcarl drs.:asc.
Desigu and ruethotl: This cornbination tublet was tdministcred to 59 pitticntr (.1(r
nrales) with lnean age 47 { 2.4 ycars, and bloorl pressurc, lipid prolilc. rcnal'lir ur
lunction wcre measuled 0t t)aseliug, l, trnd 3 ntonth.s.Mcclicrationadhctclce u.rr
cxaniined using a clLrcstirxrnailett 3 fironths.
LDL-Cholcstcrol, triglyceridcs and lotill cholesterol wcrc \iBr)ili!.n1lv
decreasedat 1 and 3 nronrl$ conlpured with trasclinc.Dal[ shows lbal mcau hll:.']irrc
of{icc tsP of 164/98nrtnl{g leduced b,v l9/9 tnntl'lg (o 145/90 nlrllllg xl I nt,'ntll.
Ittsulls:
I
1ll Alll,JS
(:fti.rTR(rL #R()UP
Il..l;
I n..l*
ltt.8r
I r ?r
r i\lfir txtrr i/*, \r{r t IIII' LlDtrilrxrir$r I lrtltr of I,lr*dihl)f;dultrrrdt)
- t){0.05
'l'hc
I)csign :rnd rlrcl horl:
s turlv i rrcludctl I 0l ) rnrrlcpi(icuts (rgcd 40-70 yerrs) wittr
r r n i r l u cr i s l i l i r c l o r d ) ' s l i p i d c n r i : {r n o n c o l ' t h c n r \ \ ' i l sr c c c i v i n g l i p i d - l o w e r i n g t r c a t '1')rc
n r 0 n t ,i i r ) dc r c c t i l c r l 1 , s l u i l c t i o r r . d i a g n o s i so l c l c c t i l e d y s f u n c t i o nn n d i t s o x t e n t
u c r u l r s s 0 s i c du s i r g t l r c i n l c n r c t i o n a l r l u e s t i o r r n t i r ee r e c t i l ef u n c t i o n ( I l E I i ) , i l } t e
l o u e s l i r ri e c sr r l l l r c i n t c r n a l i o n i l (i [ r u s t i 0 r r n l i r ei n c l i c a t es i g n i f i c a n te r : e c t i l e
dysl]nc'l
r ron. ()rirlrh()lcstcrol ( Cl { OL), [rrv ( L t)L) rnd high (l1DL) density lipoproteins and
'fhe
tligl_vccritlc s t'liRG ) rr eLcar;cssctl i n irll pirrtrciprrrr
ls.
study group was divided in
r i l 0 : . u l r : 1 1 o 1 1 1 - . . g u c l r ! ( ) r r s i s l i n l : o l - 5 i ) p uItri cr rnhrcsl i r s t s r r b g r o u p p a t i c n t s r e c e i v e d
ru slrtin ir1()r!n-strtirr)rilllc thc \cc()nd srrhgr,ruplcceived no treotnrent (control
eroLrp;.r\ll thc plrrticiplil(r rrcrc Lctr.rilrrinctlu'itrg thc sarneptr>ccsses(completion
c l u cr l i o r r n i i i r cI I l l [ - d c t e r m i n r t i o n i t i l o o r l l c r v c l so l C ] I O L , L D L , H [ J L , T R G ) a l l e r
rhrccntonllrs.
I t c s u l t s : l r r l ) r c s u b g r o u p { ) l ' l ) a t r c r t sr c c c i v i n g r t a t i n s t ) l e I I E F s c o r e e r n e r g e da
j l i t i 5 l i c r l ) \ s r g n i l i c a t r li n s r e - a : c: i l l c r t h r c f n l ( , n t l r so f t r e a t r r ] e l t( 1 6 . 3 f r o m l l , 4
priot lrcut:runt, l'.',(),()5) conrirarcd to rbr c0ntrol group rct)ecting an important
i B i l ) r o v c r i l t ' t ti D c r c c t j l u d Y s l [ , ] c 1 i ( ) liI f r t r l t I ) .
( ' ' o n c l u s i o n s :I ) a t i c n t sr c c c i v i r ) ! l i p i d - l ) \ ! c r i n t t h c r a p y { i r r 3 m o r r l l r ss i g n i l i c a n t l y
rntprrtvcJlrothlrpidprLrliicslndclc(lrlcd)'iilun.tioncon4larecitothccontrolgroup.
l l r c ie l i r rc r n L n u s j n g s t i r t i n sl ( i i r r p r o v c t h c i r c h o l c s t e r o l e v e l sm a y e l ] c r g c a s i g f r l i t : i D I i n r l ' r 0 r ' 0 l l ) c n il n c r t c l i l c l i r i ) ( l l o r ) ., \ l t l r o u g h s t i l l i $ sa r e n c l tr c c o m m e n d e d
.rsprirr,irrlrcltfncltlorcrcctilcclislLrrrctionltnrcnwithnortnalcbolesterollevels,
t h i s c l l r f l i , ) u l d i l ) l ) r ( ) r c c i n r | l i r n u u i n l r l | c r c l t o l c s t c r ( ) l e l n i cp l t i e n t s t r e o t e dw i t h
s(,ltiils.
IGNORED
ANDNEGLECTED
CAUSEOF ACUTELEFT
HEARTFAILURE.
PHOSPHORUS
DEFICIENCY
IN
MASSRY'S
PHOSPHATE
DEPLETION
SYNDROME.
GIVINGI.V.OR ORALPHOSPHATE
MIGHTSAVETHE
LIVES
S . ( ) . K c r k c f : 1 . ) ' . S a g l i h , : r : . S . I ( r r i r i l l . Y . K . l c . : n 1 ,A , Y i l d i r i n r l , N . P a y l a r z .
t Nutrtttttt' EritrcLttiort ttrul I rrrirti.ttgIltt.spital, !ntanal fulttlicittc, Adttnq,
1(.ri/{tf . : ,Srr,r-/lh,rII:-l.tt't ttrr.tion iln!l )\'!.liltnlagv IJnit, ;ltlntu, TURKEy,
'j Ntrr:rirri, l:tlrrcLtlit,tt rtttLlT'nrinitt,q I'lospilttl, (.'ordictlog1,,t\dttna,'IURKEY
O b i c c l i r c : l n t h r s s t u d v w c i n | c s t i g r t c d s c r u m p h o s p h o r u sl c v e l s i n p a t i c l l t sw i t l l
r ( u t c l c l t I t e n r tl u i l u r c .
I)esign irnd rnc(lrorl: i\ totrl t.,l 2 I 5 piut)eipantJ, I I5 palionls with acute lcfi heart
tliiltrrc rncl [()(l conrrrrls, wcrc flrrollcd in thc studt' Pilticnts applied to cmergency
roonr u,itlr the crrnrPlrintsol hcnrl l.iiLr.rrrrverc rrsrcsscdbvechocildiogrtpby. Ejco.
t ron lrractiorr ( h l;) l* c ls I os'cr tl r.ur509i, rvcre trcceptcdas heart failute. Patientswitlt
. v p e r p a r a t i r v r o i t l i : t nt,l u o t t i c h c a t t h t l t i l u r o .i t l c t l h o l i s t n i, n t a k e o f
rcrai rljsordcrsh
n r e d r c u t r o n st h r t r h c r p h o s p h o r r r sl c v c l r v c r c c r c l u d e d , M e a n p h o s p h o r u sl e v e l s
()t circl) gfouI rlcrc Iicrsufctl rrrrdcornp,rrcd trach 01hcr,SPSS 12,() package prog r , r n r ( S J ) . 5 ..\l n c , .( i h i e l g o , I l l i r t o i r ) r v r s u s t d l o r s t r t i N t i c i l la n t l y s i s . C h , i s q u a r e
tc:l wlrs u,icd lo c()ruPiirec:)tcgolrcirl nrc.rsulcs bcnvcen tlte groups. Mann whita u d t o l 3 9 / 8 8 a t 3 f n o o l l ' t s . N { c a o s y s l o l i c p r c s s u r e d e c l c a s c d s i g n i [ j c a n t l y a t l , , n r l 1s-r
3
Ll o1 I lcst u,as uscd lbr cor;tprtrisotrttl nrrttcrical lncasurements between
nronths.The results ol'the questiounail'eshowcd thar 94 % of patients * crc sati sfir'rl
l s 0.05 in all
t h c t \ \ o A r ( ' u l ) s .l . c r c l o f s t u t i s t i c l l r i g n i i i c a n c c w r t s c o n s i d e r e c a
rvith this medication. No scveLcadversc cvents wcLe observed.
Itrfls
Conclusions: This combiuutioll l'Jblct cortrollcd bollt hypcrtcnsion rDd dtr)iptdcntiu well in 1'oung paticnts. The control o( two of tltc trrtjor crrdiovrscttlrr ri.k
frctor's nright suggcst the prcvenlion of atherosclerosistry this medicttion. ln .riltlition, this nedication is cxpected to ilrlplovc mcdication adhercnce uhiclt is a rcry
irnportant prerequisitc for successfi,rltrcatmcnt ancl prcvcntion cspccialll in r,ruril
Ilrsrrfls:'llrcrc rrcrc lJt {()(rti) sonlr'n ,rnd 67 O\lo/o)mcn in tlte present
\ r u ( l v . l i l ! ' n r r r l i r r i r g c r , a s 5 2 . ( i : Ll 2 . l l e r r r s . l ) e r r r o g r u p l t i cc h a l a c l e d s t i c so f p a r rlLrftnls \rcrc nor signilicrntN ditlcrcnt hetrvccnthc groups. Mean EF levels
, , i l r r , r L r l r ss c r c . l o . l : :i : { i J i n P ) r o r P l r r t cd c p l c t c ( l g r r u p : t n d 6 0 . 0 * 9 , 7 i n c o n 'l)rc
trols.rcslrcitivcll
d i . l l e r c ' r r clcr c l r r e s r rt r r r ) g r o 0 p s w 0 s s t a t i s t r c a l l ys i S n i f i c { n t
Daticnls.
@2015WoltensKluwerl'{ealth,Inc.All rightsreserved.
Copyright
Abstract:P25l
Clinical experiencewith combinationtherapl'nitlr Olnresafianand Amlodipine in treatment of
resistanthvpertension
Authors:
CJamesl,sTisheval,AYanakeval,NStancheval,DYakoval.Mllrirtoul.KGospoclinc,vl,TChakoloval,
lMedicalUniversityPleven- Pleven- Bulgari4
Topic(s):
Hypertension
Citation:
Objective:Theobjectiveof this studyis to analysetheellbctof flxeclclosecombinationtherapy* ith
Olrnesartan/Amlodipine
in the treatmentof ResistantHypeltension.
Design:Questionnaire
basedcrosssectionalstudyamonspatientsr.vithResistant
Hypertension
defined
accordingto theESC guidelinefor Management
of Alterial Hypertension.
Method:The studywascarriedout among128patienlsadmittedrvithhistoryand24hourholterblood
pressure
monitorevidencefor Resistant
Hypertension
in theDepartment
of Cardiologl,betweenI st July2012
with historyof ResistantHypertension
and3l st July2014.Patients
wcresorr'ened
r.vith24 hourholterblood
pressure
monitoringandthosewho fullfilledthecriteriafbr l{esistantHl,pertension
accordingto the ESC
guidelinefor Management
of ArterialHypertension
basedon thetreatmcnthistoryand24hour holterblood
pressure
monitoringwereincludedirrthestudyafterobtaininginfbrmecl
consent.Patientsincludedin thestudy
were startedon therapywith Olmesartan/Amlodipine
at ll.rcd dosecourbinatioualongrvith diureticandBetaBlocker.Patientswerecontinuedon this fixed dosecornbination
therapl'for 3 months.After the3 month
periodpatientswerereassessed
with control holterbloodpressure
rnonitorinsto accessthe efficacyofthe
treatmentandthe circadiancontrolof arterialblooduessru'c.
Result: Fromthe studyit was observedthat90 patients(70.319',)haclreachecl
optimalcontrolof arterialblood
pressweby the fxed dosecombinationtherapy\.vithOlnresartan/Amlodipine.
20 patients( 15.640,6)
hadnon
optimalcontrolof arterialbloodpressureand12patients(937%) continuedto be rvithresistanthypertension
in-spiteofthe maximaldosageof the fixed doseconrbinationthcrapyu,ith OlnresartarV
Amlodipine.6 patients
(4.68%)discontinued
the treatmentdueto pedaledenra.We observedfi'omthe screeningholterblood
pressrue
monitoringthat38 patients(29.68%)with resistant
wererron-dippers
andallerthefixed
hvpertension
patients
(10.93%)
dosecombinationtherapywith Olmesartarr/Amlodipine
r:nl.r,l4
rverenon-dippers.
Conclusion:The studyrevealedthat fxed dosecombinationtherapvu'i1hOlmesarlar/Amlodipinein patients
with Resistant
Hypertension
hashigh efficacyandminirnalsidecflbctsrvithgoodcircadiancontrolof arterial
bloodpressure.
S24 EuroPReventCongress Abstracts May 2015
Abstract;Pl45
Incidenceof diabetesmellitus among patients*'ith ischemicheart diserrse: a comparative
analysis
betweenindian and bulgarian patients
Authon:
cJamesl, srisheual, DYakoval, MFlristovl,KGospodiuovl,NStancheval,sohril. TAttacheril2.
s
Jose3,lMedicalUniversityPleven- Pleven- Bulgaria. 2[,ourclelJeartIlstitule anclNeuro Sciences
- Kochi lndia"3MOSCMedicalCollege- Kolenchery- India,
Topic(s):
Diabetes
Citation:
Objective:The
objectiveof this studywasto analyseandconrpare
the inciclence
of DiabetesMellitusamong
patientswith ischemicheartdisease
in BulgariaandInclia.Design:Cross-secriomal
stucll,among
patientswith
establishedCoronaryArtery Diseaseadmittedin the Departmentof C'a.diology.Methocls:Studyr.vas
carried
out in thepatientsadmittedwith IschemicHeartdiseasein theCarcliotogy
Departments
in lhe respective
hospitalsin Bulgariaand India . 496 patientswho wereadnrittedin the CardiologyDepa(mentin the
hospitalin
India betweenI st June2012 and3l st Dec 2012 and476 patientswho r,vere
aclmittedin the Cardiology
Departmentin BulgariabetweenI st of January2012 an,J-l tst Dec2013with acutecoronarysyndrome
or
coronaryangiographic
or Electrocardiography
evidenceof ischemicheartdisease
wereinclucjedin the study.
Patientswereanalysedfor incidenceof DiabetesMellitusandLnpairecl
Glucosetolerance.
Datacollectedfrom
thepatients,
old medicalrecords,ClinicalExamination
autll,aboratoryresultsirrcludingHbA lc, Fastingand
Post-prandial
bloodsugarvaluesandtreatmenthistorl firr DiabetesMetlitusrverearalyzedfbr the study.
Results:Fromthe study,it was seenthatthe incidence
of DiabetcsMellitusis 57o/oanrong
hrclianpatientsrvith
IschemicHea( Disease,
whereas34% of Bulgarianpatientsarewith DiabetesMellitus(p >0.01).The
Incidenceof lmpairedGlucoseTolerancearnongthe Indiar patientsis ZlYoandarnongthe Bulgarianpatients
is
19%@ value<0'01)'Conclusion:Thereis statistically
signiticantcliffbre
ncein the incidence
of DiabetesMellitus
amongpatients
with IschemicHeartDiseasein IndiananclBulgaria"but in thelncidence9f ImpairedGlucose
Tolerancethereis no statisticallysignificantdifferencebetrve,en
thetwo populations.The prcvalenceand
incidence
of CAD alongwith the risk factorprofilevary greatlyacrosstheregionsof theworld.Earlydetection
Diabetes
Mellihrsandcontrolofglycaemicstatusby clrugsanddietaryrlodificationsin caseof intpaired
Glucosetolerance
play a significantrole in thepreventionof CAD in bothpopulations.
A cost-effective
preventive
strategywill needto focuson reducingrisk lactorslrothirrthe indiviclualanil in thepopulationat
large.
Abstracts S25
P145
Incldenc€ ot diab6tos mollltus among patienis wllh lgchemic hoart diassse : a comparativo analysis bctwoon Indian and bulgarlan poilonlg
C Cyril Jrmcs', S Tislrcrr', [)- \,ukora', N4 Hristovr, K Ciospodinovr,N Strnchcvar,
S Ohri'.'l' A(tachcril'. S .losc'
ti|illiil
Ihfi'.4ity I'!o4r, ['hu:n, Bullq,uitt,:l.pw,h l!.ilil Inilttu!. ttl .t1tnt SLutu.u, Iitrtt:,,
ltuhq,',1'l O SC M ali ral ( hl I c tt, ftlol,:nr /ruy, I ndio
Toplcr Dtabstes
Objcclircr Thc objrclivc of this study war to analysc und comFn.c rhc iilcidcnucoI Dith.({s
lvlrllltus !rnotg pnricnts wirh ischcnrrchenrt discrsc in Bulgaria rnd lndia. Dcsign: Cr0s,s!'cliortl sludy tlNng p{ticils wirh rslablishcd Coronilry n rrcfy Discrsc ildtnittcd in t)rc
l)cpartntcnt ol Cilrdiology.
lvt(tllodsrStudy wss corricd out in thr f,atief,ts0drDlttedNitb lschetniu lhilrt rliscasciD tlrc
C r r d i o l o g t l ) ( p r f l m c n r 5i n t h e r c s p c c r i v hc o s p i r a l si n D u l g a r i aa l d I n d i a . 4 9 6 p a r i e n l rw h , )
uere rdmitrcd in rhe C{rdiology D€partotent in rhc h()spital in lndia betNecn lst Junc lUll
und llit f)cc 2012 and 4?6 Fd(icnts who Ncrc ndnli(cd i[ th{ Cadiol(t(} D(n]rltrrc|l i|
Billgarifl b.lw.tn l$t of inDurry 201? rnd ll5t Dcc 201:] wilh acurc corotrdry slrdronc ol
coronnry dntioUrilphic or Elccrrocardiogrrphl cvidcrrcc (\f irchcilic hcar! orscil$q wcrc
inclurjcd in tlrc study. l)0ti.nt$ wcrc analyscd for incidence of l)i{lEtes Nlcllitus a0J
lrttprircd Olucost tolerance.l)rtx collcctcd liorn thg lutientr, old nredical rccords, (llinic{l
ExdnlihAliorlrnd l-dberiLory resullsincluding l.l bA I c. Fasringand Post-prrrrdialblood sugur
vrluer nnd lrcatment fiistory lbr f)iabctcs Mellitus rvcrc anrlyzed for the study,
Rqults: From th? itsdy, il sns sccD thnt thc incidcnce of Di&butcs Ntcllitue is 57ou'ramoug
lndian paticnts wilh IschcnricHeart Discase, whcrcrs 340/ of Bulgariun paticnts arc with
Dirbctcs i\'lellitus(p >0.01). Thc Incidenccoilmpaircd CilucoscTo[.rance itmong rhc IndiNil
prlienar is 2l'% and d0ron8,thc Bulgrrio0 prticnrs is l!'d (p vnluc <0.()l ).
(irncluskrni fhcre il stu(istrcullysignitjctDt ditl!rcilcc in thc iDridcilce of I)irbercs lvlellirur
ailxxrg narientswith lschcillic l.lcart l)iseusein Indilr orrd Bul{trria, b!t in LheIncidcnce of
lntpaircd Clucose T()icrancc thers is no stsrisricrlly signilicant rliffcrcncc bctNc(tr th( r\vr)
pol)uhtjons, Thc prcvalcnccrnd incrdcncc ol-CAl) along with thc risk fictor prolilc vary
grcrtly {cross (hc rcgions of thc workl. Etrrly dctecrion Djabctcs Mellitus xnd control oi
glycacnricstatur by drugs und dictnry lnodific(tions in casc of inrpaircd Clucosc lolcrtrncc
phy r significantrr)1. in th. prc!?ntion of (.:AD ir borh prrpulorions.A cost-cffcorivepr(vcntivc sthleg)'will need to focus on reducing risk lirctors both in thc individual rnd in the
nopulBtl()nat Inrge.
by 0ua5ton J!no 17,2015
oownloldodkon cpf.s0!€p!b-ronr
564 EuroPReventCongress Abstracts May 2O15
FN
E taol ot cl|.ng.r ln drdLn
rMhm on nort Uty In .ld..|y
!. Ludovit Gmprr', M Bcndzh', I Gerparove'
'Utbtig
Hwpital ,I,crirhr, Bntkloo, Slooeltupllit,tlryriht
Clininl G*titt, Combt Uriwtil1, Entblew, Slonl Ropublit
?6ldllwrs&
hyprrtff.tn
prll.ntr
of &blo0|,,Gwtit
anl
lipoprorcin (LDL), hiSh dsdty lipoprotcin (HDl-), ritlyridc,
Hb.lc, ryrtolic rnd dirdolic
pmur,
hirtory of lypcnmrlor,
typt 2 diahcu ocllitu, didipidmir,
nicotir rbul rnd
anrmnatic family data of oronlry diar
hirtory, rtrol€, typc 2 dirtgo
rnd rudd6 qrdir
ddth (SCD) wlr drlutcd
lo thc l-p (.) Lach.
with nma
n-ahr
lr thc, finr 3roup of 20E mpbyo
with Lp (.) <60 n&idl (ron ric 4l + l0 !G.r|l
Abstrssts 565
orLDL only in h€RP <2.0n9/L md LDlx < 120.0m3/dlrubgoup*
CordrloB Our &tr mr to l) .uDDortth protctiw mh olL.HDL prniclc r8|inrr LDLmodirtrd modifntimr bt oridrtiE ntclurint
ir snlflt
vi.|| S.HDL 2) rhc oEmir|nr
gctn
of irdemmtior rnd {hypa)6lcnlr
GlfcrlEly ric|}ut! rEh rmirrion(
rDd 3)
LDL{ cotsturtiotrr rbow thc @tdf Fii
c|n rbohh/tlut
r|t. rrej.tioni
lErv6 Lud $HDL nokculrr rubfnabr rnd or|.Dl. which dacru funho dadlod anatyrir.
FffI
pho3ph.tldylcholln -t.tt .dd .p.cfil.
M.dr.|il.dc
appro.oh on.ndoih.lal
Ip-.
.lit/h.r.odoil
tlm humfr-to.ooDpri.tlon
l ttedL.
PF Prulo Fcrnendo Fcmrn&r Birpor, PO Rodri8ucrr,ltM Brndrm', R Bcmardinot
'.J{o UtiniS oJ Ljrbt, CEDOCINM,
IitN, Pdir4lol,'IPMA, DhAo, Iibu, Potupt,
' FSTM. lPutit, CIRM, Pnit&, Potu2cl
topb Upld.
PvF.t Cli.tF iD frttt sid. profflc rod thcir rrtior m ommn l€tuE olEnrd in lh.
M6l Sytd, olqily, dbbcic or CaD, rnd rlodttod witb clithd ouicoro. Wc .cntly
yirt PPA/AA nrio in
nponod lhrt .ldoahctrd lipu (EL) n& podtiEly rsirtrd
hmt nrd Elod Cr|l (nEq) mbnn'l
EL, r bcd-tctrll l|ornodimr yirh I clrrttric
Itird connhubd lor So.HirArp, h cutidly
tyrcphorpholipu
I PLAI bur rlo pmu
(LyrPLtl) Eriviiy, if ryl mi|nrior trta phc, tower& nrlnly HDL. Tlr curhr dru
crtart rtd complc|ml prwlou obrMtior,
by odnt cmputrtioill
modch.
Mtlho& Conpur|tioul DFT nrtlro& w
urcd to rnrlyr th. ttructlE lnd chdtonk
propcrb of md
Don-?wlttaloob l6tSfi2'PC mol6cubt |pcii. Thc ;lobd mininum
conijuntbr
w
ur.d ftr thc llrd oDriniurio[.tudy.
ndhr Edotlcld lipr* .hovrd , poitlE tmd vlth ll:l(Dt + n-9)md m:5n.3(EPA) snd
nc|rtls wlti lt:2t.6 rnd 20:a|t{ (AA} rnd €l
uocirtiou wiu 22:513(DPA} rnd 22:6nt (DBAI In RECr. CorErrio optinizrtio B!LYP/ts31O(4p) drtr lndlorc lor I6:ODPA"
rc md I6:GDHA-PC th.lortrt ffi6r r. hobrrd nohculcr, rnd borh FC rpocic. rhow.d
th. bwt .rd th hithdt CocldirtrnG, 21.020 rd !0.t1 0, rapcrivcly. No rllnl,lqnt
dilT.ffi
w
obmod bclK
l6:Gll:tn-9.rc rnd I6{LAA.PC in qc of COCidir.
trm. Hoffi,
rtc lettr rborrcd th. !0€t C - O(nllc - O(m2) rod Ca.Co dirtrrc rnd
thc fom tlE hiShot or. lnlcEtlnSbf , lD t 6o.EPA.rc f h dru'g
b.tt|En N{holi* rnd
th. orto! rtoil In tl)c.rol bdborl rF dtDifioDttt loH 5.5t 0, J.J9 0 rod J.l? 0, for
COl. CO2 rnd CO3, ong.Fd rith ottd PC molcuhr rpocicr rnd ulnlt qith 16$AA.
rc (1.420. ?.2f 0 rd 6.!6 0, upctlwly). Thc C'Gl o! dlsrol b.ctboE for l6:&AA.PC
tbored th.lo6t Frtbl Munitm chrrlr (+0.03! r.!.) @np.nd with orhcr rn2.PCmolc.
aLr rFi.. (c.t. +0.065r.u. for EPA).
Crrldor
Thc bw dhtrF
bets
nltrojor rnd tlrc crrbon il rnl of dyool bcclbonc
€! Inldfd tilli ctc bond in lhir !o.iri6 rnd chrn8a thc rpocificity rDd/or tbc ,t ric
bindrrE for ot lyii. trhd of EL. Tt dilfcm
rh.
h ryl chrh Etio en inl!ffi
prfhl pro,patla olrc nohcub? .p.cin in nonohJcn/tilrlcr,
rnd rLo EL rdiviry. Th.
pEant ftault Dct fosrrd thc rolc of EL u Ptl I rDd IFoPLA I, ud m
thc
diflcffi
of
found hs! a! rho inicrc
th. lft|r rrd/or rhr rpc.d of rctl nlprtio[
rnd ihc Huhint
iydrclytic prcdw1r of EL.
POoa
Ob.dft lnd bodt m... Indan li acrrL dron.|t
ryndrcn ! avalurilon ol th. outoom.. durlng h€ph.Irtlon
.nd at o*t[f,
totto]u,
I C lulio pll Goncelvo Pcrcirrr, p Moairtl, B Mrryitol, A Dclgadol, L Abrcur,
n Silwrio'. L Fc'rcin Dor Srnror', J Olivcirr Srntorl
tHupinl
$, T&t6b, Ctilli.tcg, Vim, Pobjal,'Hw4itol
9n T.6roti., tnt twl M.l,itiv,
Vin, Puagol
Togh Ob.drt
PuF..t ll lr r tm
lrcl tlul obadtt, r m individud cmDoMt of rhc Mcrrbolic
Syndromc,b cbdy nbt d to erdldrEular
dlsE, How,
lt Hr
thrt oltr p|ticnb
vitt eL sroirry ryndrom tcnd to hrw bdrcr ilro.t.i.m out6rE, olla rfcnrd to r.
'otcrity
prndor',
thc
ln tDir iludt thc .uthon comprrc mrtrllty nra dudnl bdpltal ilry rrd at om ycar fonow.
up il obac rnd ron.obdc padaota Funhcnrort, body nrl in&r (BMl) vdu erc omprFd batrE th. de$d
rnd tuiliyiq popubdon.
M.tlol
h . Etro.pE$s ttudy of !.tiGntr dmlttr.l to thc c|diobjr
Dcprrtmnt of I
mtrallzd bosttrl for $uta comrry ryadmrng thc rilhon rDl),r thc BMI rnd cliniel
orbm|a duint hotlttrli,rrid
rrd oE yar rlla dirfurp. lt mr ond&rcd obcrlry wlm
BMI rr ruFior to !0 trn2. Stdrtkrl rulyrir wu nrdc urinl SPSSvl?.
hle
Tl' nudy populrtiotrcoDdnr of I lll prri{rrt,6t.9.z6 mlc, rjr 60.l2:t12.67yan
o!| otvhict zlt (l9.l.A) Ec obac. Pr1i6u w dividodiiro 2 goupr, thc Obac 1rcupfroup A (flt,t% mL, rF 64.6t+12-t?)an old) rnd tbc Noaobac 8roup- troup E (6t,6%
nrk ?0.16+12-alFn
old), dti no rutlnlel dilTcm
ii n (p-0.6,13) or r8.
(p-0.!65). No rrrdniql rijniftrm
w obcnrd ehd cmpuint mortrlity bcrw6
(11.2% n 7.1*;9-n,691
rnd rt oE.yat
trcup A rrd ,'olp B du.irt ho5itrliutio
folbv.up (2.!9t n !.1%; p-9,1991.
WtFt cottpadll 8Ml vrl6 bu.d oo ost6m durinj torpitrliutiol,
rhc aroup of docerd
prthrb r rupivint prticns.loHd thc folbwlal vrln: 2?.05*1,!0 lt/D2 w 2?.ll*a,10
f !n2 (p - 9.521. 11osa*r, I drti.tid dilTcrum ru ohcnrd rfia mp$ir3
BMI vduo
rllcr oFlar folop-up, rh. uuttr rn 2r.at+2.a? t&ln2 E r.3?+4. | ! lgn2 1p- g.g151.
Crrddor
Thc rtudy of rhir gopulrtim rhosod oo djaiiort
diflss
il ourcom
bdE
oln rnd mn-obqc pticrtr, thu lol h prdtu
witlr thc 'obcity prrrdor'.
How,
rhar onprrinS BMl, rhhou3h N ditfm
ur found durin3 borpiuliation,
lhcrc sr ! rignificrntly high.r BMI in thc runivinj paliou rncr tha oF)qr follor.up,
Tlir corroboratc ffndinjr in rvcral rtudio in *hic} it ir *kmwlcdjad thrt ov.Mighl
pstimu with coronrry dicr* hrvc r lorcr rirl of ordiovsuler rnd iotrl rcnrliiy thrn
prthnB ir rhcbw rDd nomrl wight group.,
P30g
A^ahlr ol th. prarlcmr oJ mrlrbollc slardbm.ln prlladr rlth rtid nbdlhtloD In
lha rcglon ol Plmn, Bulgtrta
D Dilyam Yalova', S Tirhcvrr, M Hriltovr, C Jamcrr,S Ohril, A Yanalcvrr,
N Starchcvr', K Gorpodrnov'
'li^ipdti' Horlibl Gcorfi
Shauli, I).lartnat ol Cotltolop, Pbw, Dil1ou
loplc Ob.dty
Alnr To rnalyc th. pnvolf,nc of rutrbolk .yodroG (MS) In p.rhtrrt dri Atrtll 0brllhdon
(AF).
Mclho& rnd Mrtairh: Tbc rtudy prr oDdwtcd rmonl I |5 prticnrr dnltlcd to Flrd Clnlc
of C.rd;olo&/, Univcniry Ho.pitrl . Plctm, Buljrrb trctwD rh. lrt of April to thc ld of
Ooohcr 20ll whl daumarod wi&c
of Atri.l Fibrillrrio!, Prtiatr w crrmircd for thc
pwrkE
of .tuirl hyp.f,mrion, dirb.6, dnlipidrqnir rid ohqitt. DaU fron cuffil
rnd prdiou mGdkd mrd., toScthrrwith r 2l.hour ECO 'un4 r|, ulFd,
Wc ar
incd thc pE ud po.rprrndirl blood 8lmE hw\ lipid profile, ula clrcumfcruta, tErtm6t of rrtrirl hncrtcn.iotr rnd dydifi<bmir. Prtiot| p.i chsi6.d sith MS Eordint
NCEPATP lll critcrir. . Wc srched for thc Elrrion taw
the ongomu
of Mctrbollc
Syndrom rnd iridcm of rtrirl fibrillation,
n4ltt F om thc rludicd populrtion vith Atrirl Fibrilstio! 5a prri.nlr wcc dieSndcdvith
M.t'trcli. Syndrcm, of which 26 rrc |m rnd 2t woma. Of rl| D.rhr yilh Mctrbolh
ryndrom. rnd ltrlrl nbrllhtion 2l psrior rF *ith prrcxyrnd atrirl tlbrilhtion rDd 30 rtr
hevioXchronk rlrirl fibrilbtion. ?9 prriair rE with wrht ciEmfcm
rbow th uDDct
limit, 12 of shich rrc mn rnd l7 mm.
l0a p$icnt. hrw rtud|| typcrtodol rad rtrid
rl,l
0brillarionof which 60 rrc m6lc rnd
rrc fmdcCorludor Mcubolic Syndrom i. vidcly rp€d rmnl p.tidtr eilb rDtd flbritblim in tb.
rludlod popuhtjor. A lilht cornbtioD balffi rny of th. empomr
of th. narrbotc
ryndrom rnd th. rtri.l fib.illstion wx found. Thit corcbtion i. quEd not orly bt th.
cffeL of thc Efrr.t. @mfpHt|, bul rko bcrur of rLir rdditiw rehanim of tbr
ompontntt of Msttollc SyndtoE,Wc ob.lrwd rtronl coftlrtio! tttwl
rba numbat
of cohponor of Mtubolic Symdrom with thc imidcE of Atrhl Flbrlllrtlo,
Abstract:PJ05
Analysisof the prevalenceof metabolicsvndrome in patientswith atrial fibrillation in the region of
Pleven,Ilulgaria
Authors:
l,
DYakoval, STisheval,MFlistou l, CJu*., I. SOirril. AYanakeuaI,N Stanclreval,KGospodinov
lUniversityHospitalGeorgiStranski,Depafiment
of Clanliologl,-Pleven- Bulgaria,
Topic(s):
Obesity
Citation:
Aim: To arulysetheprevalence
(MS) in patients
of metabolicsyndronre
r.vithAtrial fibrillation(AF).
MethodsandMaterials:The studywasconductedanong I l5 patientsaclmirted
to FirstClinic of Cardiology,
UniversityHospital- Pleven,Bulgariabetrveen
the I st oI ApriI to the I st of October20 I 4 rvith documented
evidenceof Atrial Fibrillation.Patientswereexamined{br theprevalence
of arterialhypertension,
diabetes,
dyslipidaemia
andobesity.Datafrom curent andpreviolrsmedicalrecords,togetherwith a 24-hourECG
record,wasanalysed.
We examinedthepre andpostprandial
bloodglucoselevels,lipid profile,rvaist
circumference,
treatmentof arterialhypertension
andctyslipidaemia.
Patientswerecla.ssified
with MS according
NCEP ATP III criteria.. We searched
for the relationbetueenthe comnonents
of MetabolicSvndromeand
incidenceof atrialfi brillation.
Results:Fromthestudiedpopulationwith Atrial Fibrillation5-1patientsn'erediagnosed
with Metabolic
Syndrome,
of which 26 aremenand28 women.Of tlrepatientsrvithlvletabolic
s-"-ndrome
anclatrialfibrillation
24 patientsarewith parorysmalatrialfibrillationand30 areharing chronicatrialfibrillation.79 patierrts
arewith
waistcircumference
abovethe upperlimit, 42 of whicharenteuand37 womeu.104patientshavearterial
hypertension
andatrialfibrillationof which60 arernaleand-14arefbrrrale.
Conclusion:MetabolicSyndromeis widely spreadamongpatientswith atrialfibrillation in the studied
population.
A tight corelationbetweenany of thecomponents
o{'themetabolicsyndromeandtheatrial
fibrillationwasfound.This corelationis causednot only by theel1'ects
of theseparate
components,
butalso
because
of theiradditivemechanismof thecomponents
o1'lvletabolic
Syndrome.We
observedstrong
corelationbetweenthenumberof components
of MetabolicSvndrontewith theincidenceof Atrial
Fibrillation.
i . : . r1 l i i i i r . : r i
This documenl does noi have arii
olriltne.
Pi)slur
lliHsuiliilli,.ri i::\
i:\r l i "\ . . r
PP23S-SUr\
E U R 0 QOL- $L)\ r I
F[:\.\I ; l l . .
CLII'JICAL
\Vi : I i .
PATIHh.IT$
. . 11,
i i.,jl,i,,ijili.'f \':i$r-i,liO F" l- H E
i..irjII i::f:i $''l,..lN
i\L
"ltr'l
: . i , . l l . 1i j. I i : r i : : i i r i " l ' i - N S t V I
, , i , , . , , I i : :l " l I i r , 1 .
ilri .,lll li i:iL\ll\r.)ill
["\*lsulurllt] I
Llc,r:yriqht,:ililLtl "i i::l:
l. li,il.t: i iINi :ti.rl]itilt\
| | i\i ri li iur':llii:i\j
.
I
Rccqm m endcd
a.ti{t L:r.,
Cilinq articlos (l,r)
ii:r iicefs,)r:i
or contributors.
Science
.. ' i:,.tril nnre. v sit oLlr f$$i\iil::: page.
s1l2
six monthsfoltow up. The statisticalanalyzeswere perforrnerd
usingWitcoxonsignedrank test.
Results: Seventyfour severe obese patients (61F/13M)with
median age 39 118-64)years old and median preoperati're
body massindex (BMl) 45.0 (34.6-60.'1
)kg/m2 were inctuclecl.
The mean preoperativeweight loss was 9.1+6.42kg anclslx
months postoperative weight loss was 25.7 r 11.36kg. V/e
found a significant correlation between preoperatrve arrd
p o s t o p e r a t i vw
e e i g h t l o s s( r = 0 . 3 ; p . 0 . 0 0 1 ) .
Conclusion: There is a positive correlation between prt oprerative weight reduction and postoperativeweight lossafter
bariatric surgery.
References
[1] CassieS, MenezesC, Birch DW, shi X, KarmatiS. Fifcct
of preoperative
weight loss in bariatricsurgrcaIpatienl;: a
-,7
systematic
review.Surg ObesRetatDis.2011 Nov-Dec;7(6)'.7(:) .
E, DisseE, Espatieu
P, PoncetG, Lavil!-'r,\.
[2] RobertM, Petascini
Goui[tatC. Preoperative
fat-free mass:a predictivefactlr oi
weight lossafter gastricbypass.ObesSurg.2013Apr; 2';(4):
446-55.
D, DuffyAJ,BeLtRL.DoesPreoperatrve
WeightCh,rn,ie,
[3] Eisenberg
PredictPostoperative
WeightLossafter Laparoscopic
Roux,:n.\'
GastricBypass
in the ShortTerm?J Obes.2010.
Postcr presentations
{n the gror-rp
wjth overweiqhthypertensivepatients the mean
s a s w { ) r s e ,b u t n o n s i g n i f i c a n t t y .
; c o e o I t h e p a r a m e L e rw
Conclusion:Our findingsshowedthat individuatswith obesity
a n d h y p e r t e n s i o nh a d i m p a i r e d Q o L i n t e r m s o f h e a t t h ,
mr>bility,Lisualactivity, discomfort,and anxiety. Hence, nonobesc,hype.rtensjves
had a bettclrsc'nseof overattwett-being.
Disclosure'
of lnterest:I'lone.
Deciareci
Paediatrics
P P 2 3 7 - 5NU
Outstanding abstract
THE IMPACTOF NUTRITIONAND BODY WEIGHT ON
I N T E S T I N AALB S O R P T I OANN D E N D O G E N O USSY N T H E S IOSF
CHOLESTERO
I NL C H I L D R E N
K . D i t t r i c h r ,U . C c g t a r e k zJ.. T h i e r y : ,W . K i e s s l ' 3 ,
A. Korner'r. rDept. af Women's& (hitd Health, University
of Leitrtzig,Centerfor Pediatric Research,zlnstitute of
LaborcttoryMedicine, CIinicaLChemistryand lAolecular
Diagnostics,UniversityHospitul Leipzig, 3Dept. of
Women's& Cltitd Health, UniversityHospitalfor Children
tncl Atlolesce'nt
s. Leipzig, Gerntany
Disclosureof lnterest: NoneDectared
PP236-SUN
EVALUATTON
OF THE PARAMETERS
OF THE EUROQOL-:iD
UNDERNORvIALCLINICALPRACTICE
QUESTIONNAIRE
CONDITIONS
ON HYPERTENSIVE
PATIENTS
WITH NORMAL
AND ELEVATED
BMI
5. Ohri1, R. Komsa-Penkovaz,
P. Tonchev3,S. Tisheval,
A. lzmaytovz,N. Stancheval,T. da Silva2.lCardiotogy,
2Biochemistry, 3Surgery,Medical University-Pleven,Pleven.
Bulgaria
Rationale: The epidemic of obesity and obesity-relatedhypertensionis an important pubtic heatth chaLtenge,
increr iing
worldwide and paratletedby growing incidenceof metar.otic
syndrome.The aim of the study is to evatuatethe impact of
obesity on the quality of life of hypertensivepatients.
Methods: This randomized questionnaire based cr,)sssectionaI study was conducted in the Cardiotogy Cirnic,
UniversityHospitat.123 patientswith hypertension,strat'fit:cl
b y a g e , s e x a n d B M I ( n o r m a lw e i g h t 1 8 . 5 - 2 4 . 9 ;o v e r w c . g i r t
75-79.9, obese 30-35) were chosenat random.
lrclusion Criteria: Patientswith diagnosisof essentiaIhyilertension on regutarmedicationfor at least the last 6 morih;.
Administration of the EuroQot-5D(EQ-5D)at the tinre ,.rf
admission of the patient. EQ-5D comprises 5 dimensiiln:;:
mobility, self-care, usuaI activities, pain/discomfort arrcl
anxiety/depression.Eachdimensionhas 5 levets:no problL'm:;,
siight probtems, moderate problems, severe probtems, and
extreme problems.The height, weight, smoking/nonsmoliiylq
status and standardlaboratory parameterswere recordc.,.
R e s u l t s :M e a n a g e o f t h e p a r t i c i p a n t sw a s 6 0 . 3 t B . ' l y r a r s .
M a [ e / f e m a t er a t i o w a s 0 . 6 7 ,s m o k e r / n o n s m o k e
0 r. 2 6 .T h e d i s tribution of the patientsin BMIgroupswas 20%/51%/29ii.
l,ttean
s c o r e o f m o b i t i t y ( P= 0 . 0 3 4 ) , a n x i e t y / d e p r e s s i o(nP= 0 . 0 4 1)
a n d q u a t i t y o f l i v e ( P = 0 . 0 3 1 ) w a s s i g n i f i c a n t t yw o r s ( ' ] n
the group of obese hypertensives,whereas pain/disconrfort
(P --0.074), self-care (P =0.126) was non-significantlywors::.
Rationale: ln obc'se subjects. etevated serum chotesteroI
is orrc of thc rrajor lactors [t;tding to cardiovascutar
: o n r p I r c a t r o ra
i sn d i s a t r e a d vp r e s e n ti n c h i t d r e n . I n t e s t i n a l
: h o t e s t c r c Ia b : ; o r p t i o ni s s u p p o s e dt o b e i n e q u i l i b r i u mw i t h
c n d o g c r r o ussy n t h e ' s r sH. o w e v c r i n a d u l t o b e s e i n d i v i d u a l s ,
lhere is sorre evidencethat this homeostasis
can be impaired.
Methods: To assessthe proportion of chotesterolabsorption
a n c l s y n t h e s r s ,n o n ' c h o t e s t e r r os lt e r o l s w e r e m e a s u r e db y
llqurdchronratography-tandem
rnassspectrometry.The cohort
c o r . r s i sol sf 1 9 5c h i t d r e n( B Bg i r l s ,1 0 7b o y s ,a g e d5 t o 1 9 y e a r s )
i n c l u d i l r g1 6 5 l e a n a n d 2 8 o v e r w e i g h a
t n d o b e s ec h i l d r e na n d
B M I - S t )rS
a n g e df r o m - 3 . 7 t o , 1 . 9 D
. l e t a r yi n t a k ew a se v a l u a t e d
b y I f , r o dd i a r yf o r 4 d a y s .
R e s u l t s : C h o l e s t e r o ts e r u m c o n c e n t r a t i o nd i d n o t d i f f e r
signlficantlybertweenobese and lean children. For BMI-SDS
a posilivc corr€rtationwas for.irrdwith chotesterotsynthesis
l b s o r p t i o ns h o w e d
t = 4 . 7 4 : p = 0 . 0 0 1) , w h e r e a $c h o l e s t e r o a
a n j r t v c r s cc c r r t l a t i o nw j t f r B M I - S D(Sr - 0 . 3 8 ; p . 0 . 0 0 1 ) . L e a n
:hridrcn ;l.rowedsignificantlyhlgher f ruit (209.7g/ day+180.1
v s . ' 1 1 1 . 0 7 g l d a y8:4 . 6 ; p = 0 . 0 1 0 ) a n d c a r b o h y d r a t e
intake
( 2 6 0 " 8 9 / d a y l 7 6 . 5v s . 7 1 7 . t > g / d a y5:4 . 1 ; p = 0 . 0 0 9 ) , o t h e r wiser no dil'ferences for nutrients and chotesteroI intake
vrere found. In the cntjre cohort. for markers of chotesterol
syr-rtire'sis
a significantlypositive corretation with fish intake
w a : o b s e r v e d ( r , , . 0 . 2 0 1p = , 0 . 0 1 5 ) .w h e r e a s c a r b o h y d r a t e
intake was significanttypcrsitivecorrelated wjth markers of
c h o t e . s t e raobl s o r p t i o (nr = 0 . 1 7 :p - 0 . 0 3 7 ) .
Conctusion:Despitec.qual.
chotcsteroIserum levels, the retalionshipo1'choleste.rol
absorption and synthesisis supposedto
b e r r o d i f i c dw i t h h j g h e rb o d ym a s sa l r e a d yi n c h i l d r e n .D i e t a r y
intake sht-rwed
only weak associations
with surrogatemarkers
of chote.stero
aL
b s o r p t i o na n d s y n t h e s i s .
D i s c l o s u roef I n t e r e s tN: o n eD c , : t a r e c l
H e a r tF a i l u r 2
e006
H e l s i n kF
i , i n l a n d1 7 - 2 0J i r r e ,2 0 0 5
Dnaa
1
Abstract:629
C i t a t i o nE:u r o p e aJno u r n a l oH
f e a r tF a i l u r e
S u p p t e mnet s2 0 0 6 V
, o l 5 ( 1 ) p a g e1 4 7
N - t e r m i n apro
l b ra i n n a tri u re ti cp e ptideand tum or necr osisfactoralphaand
o u t c o m ei n p a ti e n tsw i th h e a rtfa i lur ewith r educedvs. pr eser vedsystolic
function
N Stancheval,S. Tisheva2,S. Kurkchiev3A Gouclev4
I University
Hospitalof Pleven,CardiologyDeparlment,
Pleven Bulgarta,z Pleven.Bulgaila;r
Bulgarian
Academyof Science,Sofia,Butgaria,4Zarizalrnnna LJMHATClinicc:fCardiology.Sofia,
Bulgaria
Background:Elevatedplasmaconcentrations
of worse
of NTpToBNP
and TNF-alphaare predictive
outcomein heartfailure(HF)withreducedsystolicfunctionbutthereare few dataabouttheir
predictive
valuein patientswith preservedsystolicfunctron.The aim of this studywas to determinethe
prognostic
valueof predischargeNT-proBNPand TNF-alphain patientswith reducedvs preserved
systolicfunctionadmittedfor decompensated
congestiveHF
patients
Methods:One hundredand twenty-seven
at the timeof discharge
by means
wereevaluated
levels
of echocardiography,
anil TNF-alpha
conventionallaboratory
testsard lrjasmafcr NTproBNFr
The primaryendpoints
of the studyweredefinedas reaclrrrissicn
for HF drrrrng
the first6 monthsafter
discharge,
morethan2 hospitalisatrons
for 1 year,or caroiacdeath
patients(95 3%)',riere
days ln
Results:One hundredand twenty-one
followedfor meanof 38Zt'1'17
the subgroup
of patientswith preserved
systolicfunction(n=67,55 47o)eighteen(269%) have
reachedat leastone of the primaryendpointswhilein the subgroupof patrentswith reducedsystolic
patients(66.7%)havehadan event(t=4738 p<0.001)Predtscharge
function(n=54,44.6ok)
thirty-six
functiongroup(Kruskal-Wallis
NTpToBNP
levelswere significantly
higherin the reducedsystolrc
p<0.00001)
test=21
rntheTNF-alphalevels(Kruskal-Wailis
.6'1
whiletherewas no drfference
,
p=0.63).Usingunivariate
test=0.225,
analysisleftventricular
ejectionfraction(LVEf),NYHAfunctional
preclictors
classand NT-proBNP
of outcomein bothgroups NTpro-BllP
levelswere independent
provedto be an independent
predictor
analysisas wellwhrleTNF-aipha
of outcomein multiva.iate
provedto be a predictor
Kaplan-Meier
analysis.
of outcomeneitherin univariate
nor in multivariate
levelthe worse
survivalcurvesshoweda steepinitialslopesuggesting
thatthe hrgherthe NTpToBNP
concentration
the short{ermprognosisin the threegroupsof patientsdivrdedby the NTpToBNP
> B0Opg/mlwasassociated
with
percentile
according
to the nonparametric
method,NTpToBNP
significantly
worseoutcome.This was not confrrmedfor TNF-alpha
withreducedsystolicfunction
Conclusions:AlthoughNTpToBNP
higherin patients
is significantly
of
in HF patientsirrespective
withpoorprognosis
highpredischarge
NTpToBNP
levelsare associated
systolicfunction.
{2.,
^^-- A
?.q#q flE{rT f^ll.ljL loub EEi
JllV illt\o8or)eux
C O N I F E R @ r s a r € g r s r € r € d I r a . i o m a r k o l f l , . e rN- .l iFel i,a, fn' r. e
AStfazengCa$
e 362 Journalof HypertenslonVolume33, e-Supplemenl
1, 2015
Conclusioru: Total scorebaselineSBP and p-AR helpsdetemine the cflcctivcncss
of RSD in order to reduce BP. The method needs furths studv.
C A N A N H O S P I T A LA D M I S S I O NM O D I F YT H E C O U B S E
OF PATIENTSWITH RESISTANTHYPERTENSION?
J. Ribeirol, A. Coneiar,R. Ferreira2,P. Mugadol,J. Mesquita Bastosl,
A. Santos2. 1 Aces Baito Vouga, Aveiro, PORTUGALZ
Centro Hospitalar
Baixo Vouga, Aveiro, PORTUGAL
L O N G . T E B MV A S C U L A RS A F E T YO F R E N A L
SYMPATHETICDENEBVATIONASSESSED BY MF
IMAGING
C . O t l I , R . . S..S c h n r i c d e) ,r M . L e l l ] . R . J a n k a 2 .T . D i n i n g I , R . V e e l k e n l .
R.E. SchrnietlerI, M. Llder2, A. Schnrirl:. I Department of Nephmlogy and
If 1'pcrt ert i on, Friedrich -A le.xander U nive rsi u- Erlan gen- Niimberg,
Erlangen, C ERMANy,'
Departntenl af Radiologv, Friedrich-Alemnder
Unit:e r5 i 1t^ Erlangen- Niirnbe rg, Erlan gen, G ERMANY
ObJective: Albeit the unfold of recenl discovsies regarding non-drug thcrrpcutic
approachesto resistanl hypenension (RH), such ascatheter-bascdrenal dcnervaiion,
its role is gening more boldly defined. The conect diagnosis of true RH rcmains the
foundation towards proptr patient seletion and palpable benefits. The aim of this
study was to evaluate the value of a short hospiral admission to accurately itlentify
eligible patiens to RD.
C)bjective; Renrl dcncrvatjon (RDN) emcrgcd as a treatment option for reducing
blood prcssure(BP) in patientswith treatnrentresistanthypertension(tRH). Howcvcr, conccms have becn raiscd rcgarding the long-tcm vascular safety afler RDN.
'lhc
goal of the cunenl study was, thcrcfore, to conducl a prospmtive clinical trial
on thc long-tem vasculil jntcSrity of the rcnal a(eries and the pedusion of the
rcnal parcnchyma assessedby magnctic resonanceimaging (MRI) as well as the
rcnal function in the long rcm follow up after cathetcrbased RDN.
Dslgn and method: It was cmied out a retrospective descriptive cross.sc-rtional
study, encompassing RH patients followed in ambulatory regimen, who ucrr' hospi'
talised between January 2009 and December 2014 and actively engagcd in a rcstrict
dietary and pharmacological plan.
Des-lgnand method: In our single ccnter investigatorinitiated study,5l patients
u'i(h true TRH (office systolic BP> = 140/90 nrnlig and 24-h ambulatory BP
nronitoring> = 130/80 mmHB; at leasl 3 antihypcrtensivedrugs at maximum tol-
Results: A total of l4 patients and l5 admissions were identified. The averagc age
was 62 yean old and 60% were women. Tbe average duration of hospitalisxtion
was 3 days and two RH cases were due to a secondary cause. The patienrs wcre
using an avemge of 6 antihypertensives agents (including diuretic), prevailing the
cenlral action and calcium channel blocken.
All patients had uncontrolled BP in ABPM prior to hospitalisation (24 h BP aver,
age was 158/ 108/ 85 mmHg for systolicy'mean/ diastolic, respectively, with 38%'
hypertensive load), Avemge cardiac frequency was 7l bpm, pulse pressure was ?5
mmHg, and only 20% had a dipper pattem. W;th the hospital admission, all patjcnts
have improved BP values (average pressure at discharge of I 35Ii 4 mmHg) and rvith
fewer medication (median of five agents). All parients kept follow-up (mcdian of4
months after discharge), with an average BP of 160/ 79 mnHg. One patient had a
cardiovascular major event (sroke) afts hospitalisation.
Concluslons: All casesin this study w€re pseudoRH, with two patienrs ( l47c) having a secondary cause identified. Ttre remaining cases were probably consequcnce
of adhesion failure to medication and healthy life habits on an daily basis. Ttrcse
resulls stress the importance of correct RH recognition in a controlled environmena in order to avoid false indications for non phamacological solutions such as
RD.
OUR CLINICAL EXPERIENCEWITH COMBINATION
THERAPY OF OLMISARTANAND AMLOOIPINEIN THE
TREATMENTOF RESISTANTHYPERTENSION
T. Chakalova-Ymcheva, S. Tisbeva, A. Qnakieva, C. James, N. Stanchcva,
D. Qkova, M, Hristov, K. Gospodinov, E. Evtimov. University Hospital Dr. G.
Stranski, Pleven. BULGARIA
ObJective: The objective of rhis study is to analyse the effct and side effcctr^
of comtrination thetapy of Olmesarlan/Amlodipine in tre trcatment of Re sistant
Hypertension.
Deslgn and method: Querstionaire based soss setional study among padents with
Resistant Hypertension according to the 2013 ESC Guideline fu managemcni of
Hypenension.
Study was canied out in 64 patients admitted with history and holter blood pressurc monitor evidence of Resistant Hypertension in the Cardiology Depanment
between I st of July 2013 and 3l st of July 2014. Patientswho fulfilled rhe inclu,
sion ctitefia by the initial holterblmd pressure moniterwere started on combination
rherapy with Olmesartan/Amlodipine along with diuretic and Beta-blocker. Patien(s
were analysed with conn'ol questionaire and holter blood pressure monitor after 3
months for the effect and side-effects and the circadian rythm of blood pressure
control.
Rsulls: From the study it was seen thar 45 (70j1%) of the patients included in
the study had rcached optimal conbol of blood pressurc. l0 patieDts (l 5.64%) had
non optimal control of blood pressurc, 3 patients (4.68%) stopped the trea(ment
due to pedal oedema. 6 patients (9.37%) patients continued to be with resistanl
hypertension inspite of our maximal therapy. From the initial holter blood pressure
monitering it was obsened that l9 patients (30%) included in rhe study were nondippm andaftertherherapy with Olmesarnn/Amlodipine combination it was found
that only 7 patients (10.93%) were non- dippers.
Concluslons: From our study we obserued that the combination therapy with Olmesartan/Amlodipine in patients with Resistanl Hypertens;on has high efficacy and
minimal side-effects with good circadian control of Hypertension.
crated dose including one diuretic agcnt) underoenl catheter-basedRDN using
rhc Synplicity FlexTM cathctcr (IvlcdtronicInc., Palo Alto, CA). Follow-up MRI
was pcdormed at a median of I I months (intcrquartile mnge 6 - 18 months)
after RDN on a l"5T MR unit (lr{agncton Avante, Siemens Medical Solutions,
Iiriangen, Gemany). High resolution MR angiography (MRA) and MRI results
were conrpared to the bascline digital angiographic imaging of renal arleries
obtaincd at time of RDN. ln cascof unccnainties(N = 2) cathelerangiographywas
rcpcated.
Results: Both officc and 24 h ambulrtory BP were significandy reduced 6 and
l2 months af(er RDN all (p<0.001). Rcnal function remained unchanged6 and
I 2 months aftcr RDN. In all paticnts MRA excludcd new or progressionof preexisting low grade renal aflcry stenosisas wcll as focal aneurysmsat ihe sites of
radiofrcrlucncyahlation. In nonc of the paticnts ncw scgmentalperfusion deficits
in eithcr kidncy wcre dctectcd or N{RI.
Contlusions: No vascular or parcnchymal complicrtions after radiofrequency
bascd RDN were detectedin 5l patientsfollowcd up by MR imaging.
EFFECTSOF RENAL DENERVATIONON BLOOD
P R E S S U B EB U R D E NI N A M B U L A T O B YB L O O D
P R E S S U R EM E A S U R E M E N T S
IN PATIENTS
YI'ITH
R E S I S T A N TA R T E R I A LH Y P E R T E N S I O N
IN A LONG
T E R M F O L L O WU P
A . N a h l e r r , T . l : m b e r r r , C . R e i r e r l , V C a m m c r l , M . R o h l a 2 ,T . W e i s s 2 ,
K. llubcr?, S. Schwarz t, H Blcssbergerl, J. Kammlcr r. C. Steinwends l.' Unz
Central Hospital, Johannes Kepler Universin, Linz, AUSTRIA,
t lUtlhtlminenspital Vientn, Venna,
AIlSTRIA
Objective: Cathcterbased ablation of ncrvcs arrrundrenal arteries(renat deneruation, RDN) by the use of radiofrcquencycncrgy can rr:duceblood pressure(BP)
in patientswith resistantarlcrial hype(ension (RAI{). An)bulatory blood pressure
Dcrsurements (APBM) providc a full BP profile by a high numbc of readings,
resulting in a high reproducibility of BP levels.We systematicallyinvestigatedthe
rffect of RDN on thc BP burdcn in ABPM in a (onsccutive seriesof patients l2
nl)Dths after RDN.
Design and method: Patients suffering from RAll were treated by RDN after
crclusion of secondary causcs of hypertension. RAH was defined by a mean
sysk)lic office BP> l60mmtlg. ABPM for 24 hours rvas pcrfomed 3, 6 and 12
rronths alicl Rl)N. Paticnts werc classifiedas rcsponden, if the 24 hour average
systolic blood prrssure dropped by more than 5 mmHg aftq 6 months. BPburdcn was defined as the proportion of systo)ic,/diastolic blood pressure values
of morc than I 35/8,5mmH g during daytime and of more thrn I 20170mmHg during
nighnime.
Rcsults: RDN was pcrlormed in I 86 paticnts,rcsponderclassificationwas available
in I 03 parientsand the rcsponder rrte was 467c aftcr 6 montbs. The mean 24-hour
B P r c d u c t i o n i n r e s p o n d e r s w a s1 7 . 2 + . l 5 . 9 m m l l g s y s t o l i c ( 9 5 q a C l - 1 2 . 2 : - 2 2 . 3 ,
p < 0 . 0 1 ) a n d 9 . 0 + I l - 6 n r r n l J gd i a s t o l i c( 9 5 7 cC I . 5 . 4 ; - 1 2 . 7 ,p < 0 . 0 1 ) a f t e r l 2
nlonths(n = 4 I ). In responders,syslolic/diastolicBP-burdcndccreasedfrom median
'161571o
to 30/257o during daytime and from mcdian l0U631c to 44125?c duing
nighttimc at 6 months (p < 0.01 for all comparisons).BP burden remained at 391279o
during tlaytime ^nd ^r 51l20qc during nighnime (p < 0.01 fo all vs. baseline)after
I 2 nronths.
Conclusions: In rcs;xrndcrsto RDN wc found a significantand sustainedreduction
of systolic und diastolic IJP burdcn in ABPM ou( to I ? nronlhs.
1, 2015
e 138 Journal of HypertenslonVolume33, e-Supplemenl
Resulls: Values of diastolic blood pressure were significanlly diffcrcnt bctwcen
patientswith MVA and all patientswith CAD, with higher values in patientss'ith
C A D ( 8 1 . 4 0 + 1 0 . 8 3 v e n u s 8 4 . 8 4 4 1 2 . 5 3 1 p = 0 . 0 3 0 ) . W h e n c o m p a r i n gv r l u e s
of diastolic blood pressure between the groups (MVA vs. stable angina, unstablc
angina, NSTEMI and STEMI), significantly higher values were noticcd bctwcen
patienrswith MVA and patientswith NSTEMI (81.40 + 10.83versus85.47 * I L.10:
p=0.027) and patients with MVA and patients with STEMI (81-40+ 10.83
versus 90.51115.98; p<0.001), while there was no significantly diffcrcnce
betweenpatientswith MVA and stableangina(81 .40 * | 0.83 venus 82.20 * 10.2| :
p=O.642) and patients with MVA and unstable angina (81.40* 10.83 vcrsus
81.20*9.58; p=0.905).
Concluslons: Values of diastolic blood pressure were significantly diffcrent
betwe€n patients with MVA and CAD, more precisely between patiens with MVA
and patients with NSTEMI and STEMI, while the significance was not prcscnr
between patients with MVA and stable and unstable angina pecloris.
EVALUATIONOF THE PARAMETERSOF THE EURO
OOL- 50 QUESTIONNAIREAMONG PATIENTSWITH
I S C H E M I CH E A R T D I S E A S EW I T H N O B M A L A N D
ELEVATEOBMI
I,
C. James S. Tishevar, K. Gospodinovl, D. Yakoval, M. Hristovl,
T. ChakalovaI, N. Stancheval, A. Yanakeval, s. ohri I, S. Jose2,D. Gaidaroval.
t Universiry Hospital Dr.
Georgi Stranski, Pkven, BIJLGARIA,z UOSC
Medical College, KoIenchery INDIA
ObJectlve: Obesity is curently a leading epidemic and an important public hcalth
challenge. The psychological impact ofobesity in the patients with Coronary ancry
disease can be very disturbing. In practical tems the functional effect of an illncss
and its thaapy upon a patient, as perceived by the patient - could be estimated by
inroducing the quantitative approach of- Health Related Quality ofLife (HRQoI,).
The aim of this study is to evaluate the impact of obesity on quality of life ofpaticnts
with ischemic hearl diseas€.
Design and method: Questionnaire based soss sectional study was conducled
among 520 patients who were admined in the Cardiology Department bctwecn
lst ofJanuary 2Ol2 and 30th June 2014 with acute coronary syndrome or coro
nary angiographic or Electrocardiography evidence of ischemic hearl disease wcre
included in the study, stratified by age, sex and BMI (nomal weight 18.5 - 24.9,
overueight 25 -29.9, obese 30 and above). EuoQol - 5D (EQ-SD) was admin
istered in the patients during their hospital stay. EQ-5D comprises 5 dimensions:
mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Esch
dimension has 5 levels: no;noblems, slight problems, moderateproblems, severe
problems and exreme problems. The height, weight and basic laboratory paramctcrs
wqe recorded.
Results: Mean age of the participanis was 65.1 * 10.6 yeus. The distribution of
patients in BMI groups was 36.8%1 24.4%/ 38.8%. Statistically significant differences between BMI groups were seen in Usual activity (p = 0.005) and self care
(p = 0.044) dimensions of EQ-5D-5L with pooresl outcome in the obese. We have
found significantly positiveconelation between BMI and usual activities (R = 0-23.1,
p = 0.001) and betweenageand anxiety (R = 0.366 p = 0.0z15).
Mean BMl ofpaticnrs
witb extreme prcblems with extreme problems with usual activities is significanrly
Breats lban those with lower intensity of problems. Patients with exueme anxiery
tend to have highs mean age.
Concluiom:
Our study revealed that Ischemic heart disease padents with obesity
had impaired QoL in tems of health, mobility, usual activity, discomfort and anxiety.
Ilence non-obese ischemic heart disease patients had a betls sense of overall wcllbeing.
D E L E T E R I O U SE F F E C T SO F C O L D A I R I N H A L A T I O N
DURING EXERCISEIN CORONARYARTERY DISEASE
P A T I E N T SD
: I F F E B E N T I A LE F F E C T SO F I S O M E T R I C
ANO DYNAMICEXERCISE
R. W;lliams, A. Hryood, H. Foh H. Gu, B. Jiang, M. Lumley, S. Ani,
P. Chowienczyk, M. Marber, S. Redwood, J. Clrk. Sr. Thomas' Hospital,
Inndon, UNITED KINGDOM
ObJecllve: Shovelling snow is the biggest cause of exenion-relaled cardiac death,
involving isometric and dynamic exercise. However, mchanisms underlying deleterious effects of cold air inhalation (CAH) during different exercise stressors are
poorly undentood. We measurcd haemodynamic responsesto handgrip and cycling
in coronary artery disease (CAD) patiens, 4 CAH, to assessthe effect of CAH on
afterload.
Deslgn and method: Eight subcritical CAD patients (62 + 9 yn) underoent randomized stressors:-l5oC cold air (CAH) or room air (RAH) inhalation for 5
minutes, combined with handgrip (30% maximal voluntary contraction)or cycling
with an incremental work load for 5 minutes. Crotid pulse wave analysis and
echocardiography were perfomed at peak stress. Heart rate (HR), mean ancrial
pressurc(MAP). and systcnric vascu)arrcsistancc(SVR) were calculated.Pl, P2,
arrgmcnlalionpressurc(AP) and Buckbcrg lndcx (BI) were derivcd using custom
soflwarc. A loxcr BI ratio inilicutcs incrcascdrisk of mvcardial ischaemia.Data
prescntcdas nrean* SD.
Results: CAll signilicantly rcduccd Bl rrhcn cornbined witb either handgrip or
clcling. CAH, compared lo RAH, increased afterload (MAP) when combined
w i t h h u n d g r i p ( l 1 5 . 8* 2 2 . . 1 v s 1 3 0 A
. 8 ? 6 . ? n r n r l l g , p < 0 - 0 0 1b) ,u t n o l w h e n c o m bincd with cycling ( I I 7.2 * | 6.8vsI I 9.5 * I ll.9mtnHg,p = NS). P2 and AP, which
are closcly rssociatedwith nryocardial contractility, increasedwilh CAH during
hrndgrip excrcisebul nol during cycling. lJowever CAH only causeda significant
increasein I IR when combincd with cycling ( I 30 1 9.7vs | 40 * l0.l bpm,p < 0.05).
SVR dccreascdwith cvcling and increascdu'ith handgrip during RAH. CAH did
not change SVR during handgrip or cycling. Thcrc were no significant differences
bl'tween baselinc measurcncntsand RAI]I at rest.
fo
E
ROOil AIR
COLOAIR
'
' '' . ,,'',|' '' { l'.'
-r
l
i
=t
;a
5i
J!
Conclusions: This snrdy shows, for the first tinre, that CAH significantly increses
mtocardial oxygcn dcnrandrnd thc risk of ntyocardial ischaemiaduring isometric
or dynanric cxcrcisc. I lowcver the mechanjsmsappear to be distinct. CAH likely
causcs an incrcase in syrnpxthctic drivc, rvhich wbcn combined with isometric
cxcrciscrcsultsin steadyslatc(afterload)and pulsrtile increasesin arterialpressure,
tic lattcr being drivcn by incrcasesin myocardial conb'acti'lity.Yet dynamic exercise
resultsin a sultcicnl rcduction in SVR to ovcnidc any increasedrcsistancecausd
by CAH, witb thc principal deteminant for increascdmyocudial oxygen demand
b c i n g a n i n c r c a s ei n l l R .
I M P A C TO F S H O R T . T E R M
E X E R C I S ET R A I N I N GO N
A R T E B I A LB L O O D P R E S S U B E ,D O U B L EP B O D U C T
A N D O T D I S P E R S I O NI N P A T I E N T SA F T E R
M Y O C A R D I A LI N F A R C T I O N
V S r o i c k o v r ,M . D c l j a n i nI l i c l " S . I l i c r , M . S r o i c k o v 2 ,S . S a r i c 2 ,D . P e t r o v i c 2 ,
I.. Nikolic 2, J. Cvctkovic 2, S. Andonov 2. I lJnit'ersiry,of Nis, Medical Faculty,
Institute ofCardiology
Niska Banja, Nis, SERBIA,'z Institute ofCardiology
,\iska Banja, Ni.r, SEftBIA
Objective: The ai m of $is study was to cstrhlish the influenceofshort-tem exercise
naining on artcrial blood pressurc(BP), double product (DP) and conected QT
dispcrsion(QTdc) in diabctjc pat;cntsafter myocardial infarction (MI).
Design and method: The study involved 375 prtients afier MI (mean age 57.1
years).Paticnts wcrc randomly dividcd into thc phlsical training group (TG:333
palients) and non training group (NTG: 42 paticnts). Diabeteswas presentin 107
(32.1 %) paticnts in the TG and in l4 (33.3 7o) pat'ientsin the NTG. In all subjectr
cxcrcise lcst wcrc pcrlormed und aftcr thal TG paticnts were included in rchabilitation rcatmcnt for threc wecks. TG paticnts wcrc instructedto follow a traininS
program using the bicyc)e crBomclcr (l0min,2 times a day) and walking. Thc
paticntscontinucd lo tuke the samc mcdicaments in same doses.
Results: Bcfore starting with the program of phvsical naining, TG patients with
d i a h e t e sh a d s i g n i f i c a n t l yh i g h e r v a l u c so f Q T d c ( 8 1 . 4 a 2 5 . 9 v s 6 8 . 9 * 2 3 . 4 m s ;
p < 0.001), whilc thc valucs of DP, systolic and diastolic BP did not significantly
vary in comparison to (hosc uithout diabetcs.Aftcr three weeks in the TG patients
with diabctes,wc havc found signifrcantrcduction of systolic BP from I 38.2 + I 3.4
t o 1 3 1 . 7 + l l . [ i l r r r r l l g ( p < 0 . 0 0 1 ) ,o f d i a s t o ] i B
c P from 87.0*?.8 to 83.8+8.2
m m t l g ( p < 0 . 0 ( ) 5 ) ,o f D P f r o m 1 2 2 0 3 . ?+ 1 9 6 2 . 2t o I 1 4 6 3 . 1 + l 7 0 0 . 8 b e a t / m i n
x m m l l g ( p < 0 . 0 0 5 ) ,o f Q T d c f r o m 8 1 . 4 * 2 5 . 9 t o 7 3 . 8 + 2 4 . 1 m s ( p < 0 . 0 2 ) a n d
o f g l y c c m i a f r < r n r8 . 2 * 3 . 2 t o 7 . 2 a l . 9 m n r o l / l - ( p < 0 . 0 0 5 ) . I n T G p a t i e n t sw i t h -
1, 2014
e335 Journal ol Hypertension Volume32, e-Supplemenl
incrcmcd LAVI. Howcvcr, Fivc year MACE was not rclalcd to carly systolic t3l'
response to cxcrcisc.
C a r d i o v r s c u l a rR i s k F a c t o r sc o m D a | s o n b e t v J e e n1 9 9 3e 2 0 1 3
I pprarT
2ol I {n.215)
l!91 lr.25li
-
;.
;*-.;;
l,l l.l3lr
..C.OO1
vrrAMrN
No srcNrFrcANT
ASSocrAroNBETwEEN
l4Ot90mmlle
1. r. L
I b.!r.(tCl
.0.OOI
D LEVEL AND HYPEBTENSION IN COAL MINE
WORKERS: EvIOENCE FROM KAILUAN STUDY
z 2tkqlm'
i.t i l
l2 l',i69)
.0.00 1
ls r';i.{1t2r
0,o07
':i8)
0.620
a;;;
X. Jiangl, M. Pcng', S. Chcn':, S. Wu r, W. Zhangt.t Funai Hospital und
Cardiovascular Institule, BeUing, CHINA, ) Kailuan Ceneral Hospitol,
Tangsan, CHINA
Objective: Mtamin D insufficiency is vcry common in rvorld-widc. Epidcnriologic evidence has dcmonstmted that 25-hydroxyviiamin D [25(OH)D] is invcrscly associatcdwith hypcrtension.Cuncntly, the available data in thc llcld
are lacking in China.
Design and melhod: This study is a pan of Kailuan study. thc final samplc
group consisted of 3894 participants (including 2620 undcrground minc workcn and 1274 surface worken)who rcceived pcriodic health cxaminalions during September 13,2012 and Deccmbcr 24,2012.lnfomation on dcmographic
factors, pcrsonal history and medical history wcre collected. Hcight. wcight.
blood prcssure,plasma 2S(OH)D, fasting blood glucose, total cholcslcrol, lriglyceridcs, low-dcnsity lipoprotcin cholcsterol conccntration, crcatininc and
high sensitive C-rcactivc prolcin wcre mcasurcd.
in lhc surResufts: The mcan of 25(OH)D was 24.42+16.'llnmol/l
face group and 20.22+l5.2lnmol/l
in the undcrground group. Thc numbcr (%) of vitamin D dcficiency, insufficicncy, inadequacy and sufficicncy
were 732(58.3), 424(33.7%)86(6.9%), zndl A(l.l%\n
the surfacc group
177'7(70.2%),62'l(24.8%),115(4.s%)and
l3(0.5%)in thc undcrgroundsroup .rcspeclively.No significant assmiation betwccn vitamin D lcvcl and thc hypcrlcnsion were found in the multivriablc regrcssion analyscs.
Conclusions: Mtamin D dcficiency was common in coal minc workcrs and surface workers in nortbcm China. Howevcr, no significant msociation bct$ccn
vitarnin D level and hypcrtension were found.
RlsKFAcroRsrNA GRoup
I ppl678l cARorovAscuLAR
OF HEALTH PROFESSIONALS. TWENTY YEARS
FOLLOW-UP
T. Jardim, W. Banoso, A. Sous4 T. Povoa, B. Chincm, P. Jardim.
Hvpertension League, Federal Universitl ofGoias, Goionia, BRAZIL
Objective: Veri!, in a cohort ofhcalth profcssionals,prevalcnccand evoluticrn
of cardiovascular risk factors (CVRF) in a twcnty ycars inlcrual.
Design and method: We analyzeAa group ofhcalth professionalsat thcir firsl
year in collcge and twenty years lalcr. They answered a qucstionnaire aboul
CVRF (hypcrtension, diabetes, dyslipidcmia, family history of carly CVD.
smoking habits, drinking habits and physical activities practicc). Cholcstcrol.
glyccmia, blood pressure(BP), weight, hcight, body mass indcx (BMI) and waist
circunfercncewcre evaluated.Values ofp.0,05 werc considcredsignificant.
Results: From 28 | subjccts (62,99% womcn, mcan age of I 9,7 ycars), data fronr
2 I 5 individuals (59,070lowomen, mcan agc of39,8 yeare) wcrc uscd for comparison 20 years later.Therc was an incrcasein hypcrtension(PA>:l 40x90mmllg)
ovcrueight (BMl>25Kglm2) and dyslipidcmia (total cholestcrol>200mgklt,)
and a decrcase in scdentarism.There was no change on prcvalcncc of othcr
CVRF evaluated.The analyscsofsystolic blood prcssurc(SBP), diastolic blood
pressure(DBP), cholestcrol, glycemia and BMI showcd clevation in mcan valucs of all thesevariablcs.
1rt-),. i,)
ohol Conlunrption
ouls{u6r.T.!r
EP - bra.ld pre33ur.
ei!l
0,tr17
il 9.,i751
v.lu..rhosnlnr.r(.'tuil.n(..sold!.1q..
- bodr hrr.
rnd.,
l e t w e e n1 9 9 3 a n d 2 0 1 3
i , l e a nv l l u e s o t B P . B M l . g l y c e m r aa n d c h o l e s t e r o b
r 9 9 r ( n2 8 l l
srio(m,nri8)
r..:.:1.
I
,r"t..'t
BMlllr/mrl
|
G.YrtMtA(',,9/dt)
|
;.
(,rou!ILRULrfS/d(l I
lilu.5
sho*n
in h..n
sBF
!rsrrllc
blo4d
v.lo.s
n'.s.or.
.n!
|
20rrln 2lsl
p'
1
:-.. lJ
.:0.(l0i
|
,1,r,,..
<o,001
.(: ,ir
,o,00:
I.r ,: I
.0,001
'.,r.
I
.-..rrr
ir'..{.. li
|
1....1."
slandrrd
CEP-
4.ilr1
dr.3roll(
on
ilDod
t-Srr d.nl
!'.sf
Ltr.
T.sl
Bnr-
.0,irO'l
lolnd.p.nd.d
bo4
d$.
3.mpl.!
lnd.i
(lonclusions: In r cohort of hcalth profcssionalsuc found a significant elevalron in mcan valucs of SBP. DBP. cholcstcrol. IIMI and glycemia in a twcnty
lclrs irrlcn'al. ln thc rnalyscs of prcvalcncc-of ('VRF thcrc was an lnctcase rD
hlpcrtcnsion, olcrucight and dyslipidcmia und a dccrcrsc in sedcntarism.
I pF.i6.rrl
pREvALENcEoF HvrERTENSToN
AMoNGpAlENTS
HEABTDISEASE.
A COMPARATIVE
WITHISCHEMIC
BETWEEN
INDIAN
ANDBULGARIAN
ANALYSIS
PATIENTS
( ' . J r m c s r . N - S t a n c h c v a1 ,A . Y a n a k c v a : .K . C i o s p i ' d i n o vr . S . O h r i r ,
S. Tishcva I, S. Jose '. t Deltortnent of (ordiolo..q', J,<tunlesIteqrt lnstitute and
(l)f lNC). Ktnrlt, Cothin, INI)lA.: Dcportnrcnt of Catdiologt,
,\'tuttt (.-<'ntt,r
,l I cI i cu I Lin i'a rs i t.r'P l.'ven, f I c'r(n, B 1.1
LG,l Il I A
Objrrtire: Thc rrbjc-ctivcoflhis sludy is lo anrlyzc and compare thc pr!'valcDce
o l ' H y p e i l c n s i o n a m o n g p a t i c n t su i t h I s c h c m i c h c a r r d i s c a s ci n B u l g a r i a a n d
lntlia.
D c s i g n a n d m c t h o d : C r o s s - s c c t i o n aslt u d y a n o n g p a t i c n t sw i t h c s t a b l i s h c d
Corurary Ancn' Discasc rdrrittcd in tbc Dcparlmcnl of Cardiology. Mcthod:
Slrrdy uas canictl oul in thc Cardiology Dcpartnrcnl - I)r. Gcorgi Stranski HospilJl. Plc\cn- Bullaria and DcpanDcnt til Cardio)ogy, Lourdcs Llcarl lnstitute
r n t l N c u r o ( ' c n l c r ( l . l l l N C ) . C o c h i n , K c r a l a . I n d i a . P a r t i c i p a n t so f t h i s s r u d y
tcrc -196pilicnts who rvcrc adnrittcd in thc Cardiology Dcpartmcnt, Lourdes
I Icarl Instirutc and Ncuro Ccntcr (LIllNC), Cochin, Kcrala, India bctwccn lst
.lunc l0 I 2 rnd J I st Dcc l0l 2 rnd 476 prtir-nts \\'ho wcrc admittcd in thc Cardiologv Dcpitrtmcnt.Dr. Gcorgi StranskiIlospital I'icvcn- Bulgaria bctwccn I st of
January20 I 2 and I I st Dec 20 | 3 wi th aculc coronary syndromc or coronary angiogrrrplricor Llcctrocardiographycvidcncc of ischcrnic hcart discasc.Paticnts
u'erc rnrlyscd lirr incidcncc and history of Ilypcrtcnsion. Data collcctcd from
ihc palicnts. old rncdical rccords, Clinical Examination rvith ambulatory blood
prcssurc moniloring and Laboralorv rcsults of thc prticnts were analyzcd for
thc sludv.
e336 Journalof HypertensionVolume32,e-Supplement
1, 2014
Resulls: From thc study, it was scen that thc incidcncc ofhypcrlcnsion is onlr
39oloamong lndian paticnts with Ischcmic Hcart Discasc.whcrcas 74ol o1'Bul,
garian palicnts Bavehistory of hypcncnsion (p <0.01). Thc Incidcncc of Prc-hr'pcrlcnsion among the Indian paticnts is l4%oand among lhc Bulgarian nJri(-nr\
is l8%(pvaluc>0.01).
( ' o n c l u s i o n s : l . f h c r c w a s n o s l a l j s l r c a l l ys i g n i f i c a n rs c x a n d a g e d i f f c r c n c c s
i r c t l r a r c l t cs r t t < r [ 1 nIqn c x a r n i n r - dp o p u l r l i q n . 2 S l l t i : i l i c ! l l ) , s i g n i f i c a n tg r e a t ! ' r r l c ( ' h o l u s c \ \ i l s d c l c c l c d r n r n a l e - sb. o t h i n u h o l c n o p u l a t i o n sa n d i n t w o
g r o u p sd i v i d c d b 1 ,a g c .
Trbl+ I (ignrcttt ruoloD!.nd rltohol urc in r|r traoinrd populatior
Conclusions: Therc is statistically significant diffcrcncc in thc occuncncc of
Hypcrtcnsion among palientswith lschcmic Heart Discascin Indian and Bulgaria, but in the Incidencc ofPrc- hypertension,thcre is no statisticallysigni6cant
diflercnce betwcen the two population. Thc prevalcnccand incidcncc of(A[)
along with thc risk factor profile vary grcatly across thc rcgions of thc uorld
Early detcction and control of Hypcrtcnsion, may bc cvcn trcatmcnt of Prchypcrtension sbould bc considered as a prevcnlive mcasurcs for CAD in both
populations. A cost-effcctive prevcntive strategy will necd to focus on rcducing
risk factors both in thc individual and in thc population at larye.
Cltrr.e
Jnnbrr rl
irbl..r:
:.19
bx ...o
IN A POPULATION HYPERTENSIVE WITH CHRONIC
OBSTBUCTIVE PULMONARY DISEASE
l0c
r:.d J, - rS r.rtt
34
:r t..
!"lt
.l,I otjerr
asld 1{ - !5 yurr
!3
t 1..
:,tl
Itn
K. Hoffmam', P. Matyjaszczyk r:, W. Bryl t.t Poznan UniversiN oj lvedical
Sciences,Departmenl of lnlernal Diseues, Metabolic Disorders and.4rteriul
Hyperlension, Poznan, POLAND,2 Primary Care Physiciun Practice
Mogj aszczyk, P leszew, P O LA N D
Objective: The authors cstimatcd thc prevalence of sclectcd cardiovascular
risk factors among primary care palienls in thc district of Pleszcrv,a lorvn
with | 8 thousands of inhabitants, located in wcstcm Poland. In this study rvc
prcscDt age and sex diffcrenccs in cigarctte smoking and alcohol usc in thc
cxamined population.
Design and method: The study population was rccruited from primary carc phy^
sician pmctice in Wiclkopolska (Poland)and consistcdof68l paticntsagcd 35-55
y., incfuding 299 males (43,9%\ and 182 fcmales (56,1%). Thcrc wcrc 295 subjecs agcd 3545 y., including ll3 males (38,3%) and 182 fcmalcs (61,7%), and
386 subjcctsaged4655 y.: 186 males (47,6%) and 200 fcmalcs(52,49lo).Palicnts
wcrc nked to answer questioDsconccming lifestylc in thc study qucstionnairc.
Results: Cigarctte smoking was dcclared by I 82 paticnts (26,7%): I 00 fcrnalcs
(?6,2Y,) and 82 males (27,4Vo). Among subjects agcd 35-45 y. tbcrc wcrc li.l
smokcrs (28,5%), whereas in older group 98 subjccts (25,4%).'Nc didn't find
statisticallysignificant sex and age diffcrenccs in smoking. Thc most oftcn givcn
answcr conceming alcohol drinking was: "l drink alcohol occasionally,oncc a
wcck or lcss frcquently" (this answer was calculatcd 6 3 points). Both in u'holc
population and in two groups divided by age, wc found statistically significant
sex diffcrcnces in alcohol drinking: male subjccts uscd to drink morc alcohrrl
units and more frequcnlly. All rcsuhs arc prcscntcd in Tablc l.
rgrd.tl
-{f
nlr. r!.d16-!i
;rrrt
tr.rtt
{_!
- Ut4dl
I rout I dor'r rinrl rkohdl il rll-'l dnttr rlcoiol ie th p4 ba I dai &uL
tr F!t:
3 pout -l &ui rkcf,olecr:roull'.
cr r rrd o
{ ta.m "l &uir rkof,ol srnl
r ru.l.. bc u
w,
. 'l &irl l-, rl.olol d:
ary
3 poic: arL :objc
rloLoi uit: crq oy.n
6 F ts B.l. :ub(E - "l dff\ I l.r d I r]folol l@hrrt lelcolol w: arn d* "
Design and method: Dcscriptive cross-seclionalstudy.Donc in 5 hcalth ccntc-rs
ofAraba (Basque Country, Spain).
LIVING lN WESTERN POLANO: PATTERNS OF
CIGARETTE SMOKING AND ALCOHOL USE
rgr{.13 -t!,rwr
fi-ocro rgrd {{ -:f;rrfr
Objective: The aim ofour study was to detcminc the prcvalcnceofcardiorascular risk faclors in a hlpcrlensive population with Chronic obstructive puhnonary disease (COPD).
THELrFEsryLE
oF GBlpRrMARy
cAREpArrENrs
t1.1..
l.U .rti<t,
fiont
J. Itunaldc-lriso, G. Mcdiavilla Tris, l. Lopez D Miasprc Mugucrza,
M, Pinel Monge, M. Ruiz Macho, M. Lopcz Alonso, E. Lz De Uraldc Pz D
Albcniz, A. Sauto Guticnez, A. Rodrigucz Femandcz,M. Bcnadc Zubiri.
S. Dcl Amo Cachan, M. Dos SantosAlencar, A. Ruiz Dc Loizaga Arcllano,
L. Bastida Eizguine, A. Lopez D Vifra-sprcMugucza.
Comarca Araba, Vitoria-Gasteiz, SPAIN
I ppr65il
.rrEiD.d
rr.,
;i.
lliii rratii
.fp.rrb
ii
oF cARDrovAscuLAR
RrsKFAcroRS
I ppr630l pREvALENcE
Conclusions: Il's a fairly cardiovascularrisk population but control lhcir risk
factors is quite acceptable.Insist that they do not have to smokc as it is in many
cascsthe causeoftheir OCPD.
.{ltobl
P.ra..ir!.
ol
ppuletior
[]oL
At oa
Results: The population is 308 people. 80.84oloare mcn. Tbc avcragc rgc rs
71.94 + I - 10.33 yeam. 28-57o/oarc smokers.The avcrage Body Mass Indcx is
29.31. The 28.57Voare diabctics. 3.9oAhave had a prcvious strokc. thc 9.?,19i,
previous myocardial infarction. The 38-96Y, have hypcrcholcstcrolcmia- Thc
13.96%o
have atrial 6brillation. Thc 10.71% have heart failure. Thc lasl syslolic
blood pressurewas 137 + / - l6 mmHg and dirotolic blood prcssurclhc lasr 78
+ / - 9 mmHg. Thc 88.31olohave an electrmardiogram.The last 6gurc of cholcst e r o l i s 1 3 9+ / - 3 8 m g / d l . H D L c h o l e s t c r o l5 4 + / - l 7 m g / d l . T h c l a s l r c c o r d c d
creatinineis 0.96 + / - 0.48 mg / dl.
rolltt
I
pEGarl
:rr.
:.'lt
!lr
r_13
l6 J..
1.66
11.:".
1.9',
:lcohol csrtl.r'.'
ias Equutif
nq
&y.irlrg ": trob rubjs
6q.
d.v.
- e
a dnd ti2
-
pBEvALENcE oF MTcRoALBUMTNURTA AMoNG
MIDDLE-AGEO POPULATION OF CHINA: A MULTIPLECENTEB CARDIOVASCULAR EPIDEMIOLOGICAL
STUDY
G. llro. Z. \\Ians. L. Zhang. Z-.Chcn. X. Wang. M. Guo. \'. Tian,
L. Shao, M. Zhu. Stute Key l.abitqton'ol CudiovusculLtr Disease,Fuv'ai
IIrrypitul. N,ttirnul Cut<'r.ltn'('anliov<tsculqr Diseu:<'s.fl<,ijing,CHINA
O t r j c c l i v e : F c w s t u d i c sh a v c c x a m i n c d t n i c r o a l b u m i n u r i a( M A U ) i n C h i n e s e
populations. Wc rsscsscd asscssthc pr!-yalcncc of NIAL] rnd the relalionships
u ' i t h o t h c r c a r d i o v a s c u l arri s k f a c l o r si n C h i n c s cp o p u l e l i o n s .
D t r i g n a n d n r r l h o d : D i t a f r o m a c r o s s - s ( - c l i o n asl u r r c y o n r i s k f a c t o r s o f
c a r d i o v a s c r r l a dr i s c a s c . w h i c h w c r c c o n d u c l c d i n 2 0 0 9 - 2 0 1 0 . T h c r e w c r e
rbout I 000 parlicipenls for crch of rcsc-archpoprLlationsincluding southcrn
a n d n o r l h c r n . u r b r n a n d r u r a l i n d i l T c r c n tp a r t s o 1 ' ( i h i n a . w i t h i n t c r n a t i o n a l
s l a D d i r r d i z c cd x a r n i n a t i o na n d r n e a s u r c m c n tH
. a l f ' t h c s u b j c c t sw c r c m c n a n d
halI u crc u omcn; lhcir agcs rangcd from -15 to 6.1 )'cars. Out of ihcm, there
w c r c l 0 J l 5 p a r t i c i p a n t sw c r c c l i g i b l c f o r a n a l y s i s i n o u r s t u d y . M A U w a s
tlcllncd as lhc urinc albunlin to crcrtininc (ACR) ralio at 30 lo 300 mB/g
l i o r n a s i n g l c - s p o tr n o r n i n g u r i n c s a n t p l c .
Results: Thc orcrall pr*alcncc of MALt is l?.?6')i, in total population,
u ' h i c h u a s b i g h c r i n f c m a l c t h a n i n m a l c ( 1 5 , 0 4 9 2vns . 1 0 . 0 9 % , P < 0 . 0 0 0 1 ) .
T h c p r c v u l c n c c o f M A U w u s l 9 . l 7 q o i n p e - o p l cu ' i t h o b c s i t y h i g h e r t h a n
t h o s c o 1 ' o v c r u , c i g hat n d n o r m a l w o g h t ( l 9 . l 7 o i v s . I 2 . 0 6 % v s . 1 0 . 3 3 % ,
P . : f ) . { ) 0 0 1 )w
, a s h i g h c r i n p c o | l c $ i t h h v p e - r t c n s i c rtnh x n t h o s c o f n o n h y p c r l c r ) s i o n ( 1 9 - 9 5 9vi rs . t l . l 7 ? i ' . P " : 0 . 0 0 0 1 ) :r v a s h i g h c r i n p c o p l e w i t h d i a b c t c s t h a n r h o s co i n o n d i a b c l c s ( 2 5 . 2 4 % v s . l l . l 8 % , . P < 0 . 0 0 0 1 ) L
. ogistic
r c g r c s s i o nr n r l v s i s s h o w c d t h a t g c n d c r ( O R = 1 . l i 5 . 9 5 9 ; C l : ! . 6 1 , 2 . 1 3 ] ) ,
body rrrss indcx (for overwcight group: OR-0.75,959f,C1[0.64,0.87], for
n o n n r l g r o r r p :O R : 0 . 7 5 , 9 5 % , C l [ 0 . 6 4 . 0 . 1 1 7c1o r r p a r c d u ' i t h o b c s i t y g r o u p ) ,
t r i g l y c c r i d r ' ( O R = 1 . 4 - ] ,9 5 ' 2 i , C I :! . 2 - t . 1 . 6 - 5 1 )d, r i n k i n g ( O R : 1 . 2 3 , 9 5 % C I :
[ ] 0 3 . 1 . , 1 7 )h. i g h s c n s i t i v i t yC r c a c l i v cp r o t c i n ( O R = 1 . 0 1 . 9 5 % C I : [ . 0 0 ,
l . 0 J l ) . n o r t h c - r n c r ( O R = { ) . ?9, 15.' r " CI : [ 0 . 6 5 . 0 . 8 ] l l , h ] , l c r l c n s i o n ( O R : 2 . 4 2 ,
9 5 ' l ' o c ' lJ: 2 . l - 1 . 2 . 7 6 1a)n d d i a b c l c ' s ( O R = ) . 9 1 , 9 5 9 , i ,fCl .16:l , 2 . 2 6 1 ) w e r c i n c l c p c n t i c n t l vr s s o c i a t c dq ' i t h M r \ U .
C o n c l u s i o n s : N l i c r o a l b u r n i n u r i ar v a s f < r u n dl o b c c o m r r o n i n m i d d l e - a g c d
p o p u l r t i r r no l ' C h i n a . c s p c c i a l l v i n p o p r r l a t i 0 nu , r t h t r b c s i t y .h y p c n e n s i o na n d
d i r b c l c s \ , l r c r o a l b u r r t i n u r i ai s a s s o c i a t c dw r t h g c n d c r . r r c a , h y p c r l c n s i o n ,
d i a b c l . ' s .c l r i r k i n c . h o d y r n r s s i r r d c x .t r i - u l y c c r i d ch, r s h s c n s i t i v i t y C r c a c t i v c
P r o l ci D .
1, 2014
e354 Journalof HypertensionVolume32,e-Supplemenl
Design and method: Trained intervicwcrs collcctcd dcmographic ptrirrncrcfs
(agc, sex), anthropomctric data (wcight, hcight, ncck circumfcrcncc. urist
circumfcrcnce), hypcrtcnsion mcdical history and obtaincd blood prcssurc o1
1 4 4 8 a d u l t s ( a g c a v e r a g c= 3 5 . 5 + l 8 . l y c a r s . m e n = 4 5 . 7 % ' )l i v i n g i n B u kavu city with an appropriate cuff size. The probability of hypcrtcnsion (BI'
>= 140/90 mmHg or laking antihypencnsivc drugs) was asscsscdby multiplc
rcgressrons.
Results: In th€ cntire study population, systolic blood prcssurc (partial r
0 . 1 5 , p < 0 . 0 0 0 1 ) a n d d i a s t o l i c b l o o d p r e s s u r e( r = 0 . 1 1 , p < 0 . 0 0 0 1 ) * ' c r c
indcpendcntly conclated lo the ncck circumfcrcnce aftcr adjustmcnt for agc.
BMI and waisl circumfercnce. The NC test lo predict hypcrtension showcd an
arca undcr the curve of0.687 (NC threshold value > 33 cm, sensitivity = 56.6
o/o,spccificity = 76.8%) in womcn and 0,817 (CC thrcshold valuc > l5 crn.
scnsitivity : 66.1 o/., specificity = 83.0%) in mcn. Finally, subjccts in rhc third
NC tcrtile had more frcqucntly hypertension (adjustedOR = 2.8ti, p < 0.0001)
compared to those in thc first terlile after adjusting for abdominal obcsity and
advanced age.
Conclusions: The study shows a relationshipbctwcen the ncck circumfcrcnccs
and hypcrtensionhowever additional studiesarc necdedIo con6m ifit's a dctcrminanl or not of artcrial h)?ertension indepcndcntly of othcr insulin resistancc
markcrs in the black population.
I pplsstl
oTFFERENcEs
rN24-HouRAMBULAToBvBLooD
PRESSURE
ABEASSOCTATED
WITHDIFFERENCES
IN NEUROENDOCRINE
FACTORS
tN OBESEMEN
J. Jeppescn r, C. Asfcrg 2, U. Anderscn '?,A. Linncberg r, P. Hcdley {,
M. Christiansen ', J. Cstze s. t Deportment of Medicine, G lostrup Hospirol.
U n i vers ity of C ope n h agen, C I ostrup, D E N M A R K, : Depo rt men t of
Diagnostics, G lostrup Hospital, Un iversit.v of Copenhagen, G Iostrup,
DENMARK, t Research Centrefor Prevention and Health, Glostrup Hospital,
Universiry of Copenhagen, Glostrup, DENMARK, ! S!atens Semm Institute,
Copenhagen, DENMARK, t Department of Clinical Chemistry, Rigshospitalet,
Univers ity of Copen hagen, Cope n hagen, D EN M A RK
Objective: To investigatehow differcnccs in 24-hour systolic and diastolic ambulatory blood pressure (ABP) are associatcd with differcnccs in ncurocndocrine factors in obcse men.
Design and method: In a cross-sectionalstudy, we investigatcd 103 obcsc
healthy medication-free men. Twenty-four-hour systolic ABP rangc was 106170 mm Hg, and 24-hour diastolic ABP range was 60-99 mm Hg. Wc mcasurcd
froting plmma conccntrations of glucose and fasting scrum coDccntrations 01'
insulin, mid-rcgional pro-atrial natriuretic pcptid€ (MR-proANP) and B-typc
Datriureticpeplidc (BNP). We also measuredfasting plasma conccnlralionsof
rcnin, angiontcnsin II, aldosteroneand noradrcnaline,and wc measurcd24-hour
urinary noradrenalincexcretion. Wc calculated insulin rcsistanceusing the homcostasismodcl of assessmcntof insulin resistance(HOMA-lR). and u,c uscti
linear rcgrcssion analysis with adjustment for age to cxaminc associationsbctwcen 24-hour systolic and diastolic ABP and the aforcmcntioncd ncurocndocrine facton.
Results: Twenfy-four-hour systolic ABP was ncgatively associatcdwith MRproANP (8=-0.32, P<0.01) and BNP (8=-0.05), although the latcr association
was not significant (P=0.60). TWenty-four-hour systolic ABP was also associatcd with HOMA-IR (B:0.29, P<0.01) and with 24-bow urinary noradrcnalinc
cxcrction (B:0.21, P=0.02), plasma noradrcnalinc(B:0.27, P:0.01) and plasma
aldosleronc ((0=0.20, P{.04), whcrcas 24-hour systolic ABP wm not significantly associalcdwith plasma renin (B:0.08, P:0.39) and plasma angiontcnsin
ll (B:0. | 0, P=0.29). TwcnV-four-hour diastolic ABP was negativcly associarcd
with both MR-proANP (0:0.a5, P<0.01) and BNP (B:0.22, P=0.03).Twcntyfour-hour dirotolic ABP was also associatcdwith 24-hour urinary noradrcnalinc
excrction (8=0.27, P:0.01), plroma noradrenaline(B:0.31, P<0.01), plasma rcnin (B=0.20,P=0.04), plasma angiotensinII (B:0.21, P={.03) and plasma aldosicrone (B{.20, P:0.05), whereas no significant associations wcrc found u'ith
HOMA-lR, glucose and insulin.
Conclusions: Based on normal human physiology, highcr BP leads to highcr
circulating conccntrations of NPs and lower activity of thc rcnin-angiotcnsinaldosteronc systcm (RAAS) and thc sympatb€tic ncrvous system (SNS). ln this
persptrtive, lhe negativc associations found betwecn 24-hour ABP lcvcls and
the NPs were uncxpected, and the positive associations found bctwccn 24-hour
ABP levcls and several RAAS componcnts and noradrenalincwcrc also uncxpcctcd. Nevcrthcless, these findings could be rclcvant to our undcrstandingol
thc pathophysiology of obesity-relalcdh)?crlension.
{-ppr8-0;l
pREVALENcE oF oBESrry AMoNG pATTENTs
WITH ISCHEMIC HEART DISEASE. A COMPARATIVE
ANALYSIS BETWEEN INDIAN AND BULGARIAN
PATIENTS
( . l r t r c s L . N . S l l l c l r c l a r , A . ) ' r n a k c v ar . K . ( ) o s p o d i n o l r , S . O h n : ,
j
S. Tishcva :. S. Jos.- '. DL,purtntnt of ('ur,lrclogt, Lounles lleart Institute
tnrd ,\.:uro Ccnttr (l.lllNC), (.ochin, Ksttlu, Ctrhin. INDIA,: Depurtment of
('anliolott. Medi<uI Univct sitt PIeven,Pltru, BLlL(;.1RIA
Objcctire: Thc'ob1t-clivcolthis snrdy is to analysc antl compare thc prcvalence
ol-I)iabe-lcs Mcllitus among paticnls with ischcmic hcarl discase in Bulgaria
and India.
l)csign rnd melhod: Cross-scctionalstudy amons paticnts with cstablished
( oronrrryArtcry Discasc rdlrilrcd in thc I)cpartrncnl of Cardiology. Mcthods:
Study urs canicd out rn lhc Cardiology Dcparlmcnt Dr. Georgi Stranski Hosl)ilal, I'lc!cn- [3ulgariaand Dcpartmcnt of Cardiology. Lourdes Heart Institute
a n d N c u r o C c n t c r ( l - l l l N ( ) . C o c h i n , K c r a l a . I n d i a . . 1 9 6 p a t i c n t sw h o w e r e
irdnritlcd in thc Crrdiology l)cparhncnl. Lourdcs llcart Institule and Neuro
( c n t c r l L l l l N ( ' ) , C o c h i n . K c r a l a ,l n d i a b c t u ' c c n l s t J u n c 2 0 1 2 a n d 3 l s t D e c
l()ll irnd 476 palicnls u'ho ucrc admitlcd in thc Cardiology Dcpartment, Dr.
(icorgr Stranskr lJospital Plcrt-n- Bulgaria br-trvccn lst of January 2012 and
,l I st Dcc 20 I I wilh Jcutc coronrry syndronrcor coronary angiographicor Elcctrocrrriiography cr itlcncc of ischcnric hcart discasc.Psticnts were analysed for
incitlcrrccObcsity and wcrc ckssified bascd on Body \'lass Indcx (BMI). Data
collcclcd frorn thc lil(icn(s, old nrt-dicalrccords,Clinrcal Examination including
he'ightucir:ht rnd abdominal circurnfcrcnccand Laboratory rcsults thc patieDts
rr crc analyzcd for thc study.
llesulls: From thc study. il rvas se'cnamong thc Indian paticnts 79lowere Unt i c r o c i g h t ( l l M l < l l i . s ) . 2 - 1 9 ' ;a r c w i l h N o m a l B \ ' ! l ( B M I I 8 . 5 - 2 5 ) , 4 0 % a r e
o v c r r r c i g h l ( 8 M 1 0 2 5 . 5 -- . ] 0 )2, 0 % a r c w i t h C l a s s I O b c s i r y( B M 1 3 0 . 5 - 3 5 ) , 9 %
a r e \ i t h C I a s sl l O b c s i t y( B M l . J 5 . 5 - 4 0a) n d 1 9 1i,s r v i t h C l a s sI I I O b c s i t y( B M I
: .10).n rrrong thc Bulgarian palicnts thc valucs arc lo,'..23yo,32yo. 18y", lsyo
r r r r dl l ' l i , r c s p c c t i r c l y .I n I n d i a n p a t i c n t st h c i n c i d ! ' n c ! o' f O b c s i r y ( B M I > 3 0 )
arrtrin{ nralcs is l6ori,und among lcmalc paticnts is 45'vo,Among the Bulgarian
prticnts thc incitlcncc of Obcsity (IIMI >10) among nralcs is 29o%and among
f c m i r l cI r J l i c n t ri s 6 2 q ; .
C o n c l r r s i o n s :I n c i d c n c co f o b c s i t y i n p a l i ! ' n t su i t h l s c h c m i c h c a n d i s e a s ci n
rirorc rrnon[ lhc Bulgarian po1;ulationand the- incrdcncc of obcsity is more
i i r n . r H l c n l r l e s i r rb , ' t h t h c l o l ) u l a t i o n
FE18.07
rHE EFFEcrsoF DTETTHERAnv
ALoNEoR
COMAINED
WITHANTIHYPERTENSIVE
MEOICATION
ONTHEREDUCTION
OF BLOODPRESSURE
fi Juktrrljcvic l. V Stojanov r, K. Paunovic r. D. Lovic '.t Institute ofHygiene
ttrl f'ladi<al Etolog, l'ucu14't,l Medicine, l.tnit'ersitv of Belgrade, Belgrade,
SI:RUl.,l.: illulriilisciplinurt (-<,ltc,rJh Blutd PressurcDisorders, ('linicql
(. anrre rl Strbiu. Fnuln oJ ltlditine, B,'lgrade, SERIllA,3 Clinicfor Internal
D istLues I ttt er.i,lttli cu. Ni i, Sl:.R BlA
()bjectile: Thc aim of this study rvas lo asscssthc cflccts of thrce-month diet
thcrapr alonc or cornbincd wilh anlihypcncnsirc thcrapy on blood prcssure.
l)csign and rrrtthod:'l'hc study compriscd 72 pcrsons*ith clcvatcd blood pressurc \!'ho u cre trcrtcd for obcsily at thc Instilulc of I I) gicnc in Bclgmdc in 20 I 0.
50 pcrsrrnsrvcrc currcntly trcatcd q,ith anlih)'pcncnsivc nrcdications,whereas
22 pe'rsonshad no antihypcrtcnsivc lhcrrpy. All pcrsons wcre prescribed diet
lhcrrpl consistingtrf I J00 to I 600 kCal pcr day. Blood prcssurcwas measurcd
b1'oscillomctrl'al thc bcginning ofthc study. and allcr lhrcc months. Thc diffcrcncc: bclw(-cnthc groups $'cfc lcstcd wlth Studcnt's I lcst for paircd samples.
llrsulls: Al thc bcr:inning. thc avcr:rgc systolic blood prcssure (SBP) was
1i9..19t2{).21nrmllg,avcragcdiaslolicbloodprcssure(DBP)was90.7l+11.75
nrrrl Ig li'r thc l holc sanrplc(sinrilar in both groups).A i!'r thrcc months oftherilpy. thc ilvcragc SIIP was I I7.{)4 r | 6.44 nrrDHg, avuragc DBP was ti I .41+9.23
nrnllg lbr the u,holc samplc lsirnilar in both groups). Pcrsonswith antihypcrl c n s i r c t h c r a p yh a l c r c d u c c dt h c i r S B P b y l 0 . 6 l r l 6 . 9 t l m n H g , a n d t h c i r D B P
h\ 6.71I q.44 nrmllg fronr basclinc-After thrcc months, most pcnons with antih t p c r l c n s i v ct h c r r p y , h a ds l a u cI h y p c r t c n s i o n( 1 6 p a l i ! - n t s , 3 2 . 7 % )l,4 p c n o n s
(2l.i.69i) had prchypcrlcnsion, l,l pcrsons (?8.69i,)had nomal blood pressure,
and 5 pg15en5(10.2 ?i') had slaSe ll h),pcrlcnsion.Pcrsonswithoul antihyperl c n s i l c l h c r r p y h a r c r c c l u c c dt h c i r S B P b y ' t i . 6 4 : l 1 . 3 6 r n m H g , a n d t h c i r D B P
b 1 t i . S { ' : 1 0 . 2 3r n r r l k l r o r r b r s c l i n c A l l c h a n g c sf i o m b a s c l i n cw c r c h i g h l y
s t r r t i s t i c a l lsyi { n i f i c r n l .A f i c r t h r c c n o n t h s , r n o s tp c n o n s * i t h d i e t t h c r a p ya l o n e
1 2014
e475 Journal of Hypertenslon Volume32, e-Supplemenl
Conclusions: Available cvidcncc supporls an associationof thc main air ptrllulants with an overall incrcasc in the risk for typc 2 diabctcs.This 6nding nray
have implications for population-basedstratcgicslo rcducc diabclcs risk.
MyocARDTAL
rscHEMrArNrypE
I pp2?J8 | sruoy oF STLENT
MALES
2 DTABETIC
A. Kasscm l, Y. Kishk 2,A. Hmsan r, M. Abdclwahab r. t SohagFoLuln'of
Medicine, Sohag, EGYPT, r Assuit Foculty ofMedicine, Assuit, EGYPT
Objective: Tlre aim ofthis sludy is to dctect thc prcvalencc ofsilcnt myocardial ischemia (SMI) in tn€ 2 diabclic malcs in Upper Egypt and io sclcc( mslc
diabctic population who should be scrcened for SMI. Thc relation of various
cardiac risk factors in typc 2 diabctic males was also studicd.
Design end method: The study include one hundred type 2 diabctic mrlc
patients with negative hisiory of angina or anginal cquivalcnt symploms and
thirty apparently hcalthy males as a control group. Laboratory cstimalion of
fasting and post prandial blood glucose level, lipid profile, glycated hcmoglobin (HbAlc), microalbuminurea, and C-reaclivc protein was donc for
all participanrs. Non invasive tests (NITS) including l2 lcads rcsting ECG,
trans-thoracic echocardiography, trcadmill cxercise ECG, myocardial pcrfusion imaging were done for all participants and paticnts positivc for onc or
morc NITs were subjccted for coronary angiography.
Results: Aflcr the results of coronary angiography, 20 paticnts wcrc posrtive for significant coronary artcry stenosis in onc or more vcsscls in patients with DM, while it was refused to be donc by the paticnt in lhc control
group. fie patienl group was subdivided into two subgroups according to
the rcsults of coronary angiography, 20 paticnts positive for SMI (positilc
for coronary angiography) and 80 paticnts ncgative for SMI (ncgativc for
coronary angiography). Smoking, hypertcnsion, obesity, dyslipidemia, and
family history of IHD were significantly highcr in the diabctic subgroup
positive compared to those ncgative for SMl. Nincty perccnt ofpalicnts in
subgroup positivc for SMI had two or morc cardiac risk faclors whilc only
two patients had onc cardiac risk factor (10%). Mosl oflhe paticnts posiriYc
for SMI had have DM for than 5 ycars duration.
Conclusions: Type 2 diabctic male patients should be scrccncd for dclcction
ofSMI when they are above 50 ycars old, whcn DM duration is morc than 5
ycars ,in the prescnce of two or more cardiac risk factors and/or in paticnrs
with one or more of thc chronic diabetic complications. CRP is an importrnt
for selcction oftypc 2 diabctics who should bc scrccncd for SMl.
Tpp2?3rl
pREvALENcE
oF DTABETES MELLTTusAMoNG
PATIENTS WITH ISCHEMIC HEART DISEASE.
A COMPARATIVE ANALYSIS BETWEEN INDIAN
AND BULGARIAN PATIENTS
C. Jamcs r. N. SlanchcvaI, A. Yanakcva:. K. Cospodinov r, S. Ohri 2,
S. Tishcva r. S. Josc I. t Dcpurtnent <tl Curtlioktgt',Lrutrdet Heurt Institule ond
.Ycunt Cutar (l,lllNC), Kerula, ('oLhin, INDIA,: Depurtnent of Canliologt,
M <rIi t u I L' n i r t r si r;.*P I aven. P I at c n, B (.' LG.4R I A
Objective: Tlc objrctivc ofthis study is to analyzc and comparc thc prevalotcc of
Diabcls Mcllilus rmong paticnls u,ith ischcmic hcart discascin Bulgaria and lndia.
Otsign and mcthod: Cross-scclional sludy among paticnts with cstablished
Coronary Artcry Discasc admincd in the Dcparlmcnt of Cardiology. Method:
Study was carric-dout in thc Cardiology Dcpartmcnt Dr. Gcorgi Stranski Hospital, Plcvcn- Bulgaria and Dcpartmcnl of Cardiologv. Lourdes Hcart Institute
and Ncuro Ccntcr ( LHINC), Cs'hin. Kcrala. lndia .Participanlsof this study
wcrc 496 paticnts who u'crc adrnrttcd in thc Cardiology Dcpartmcnt, Lourdes
llcan lnstitutc and Ncuro Ccnlcr (LlllNC), Cochin, Kcrala. India between lst
lunc 2012 and Jlst Dcc 2012 and 476 paticntswho wcrc admittcd in tbe Cardiology Dcparrmcnt. Dr. Gcorgi Stranski Ilospital Plocn- Bulgaria between lst
ofJanuary l()12 and I lsl Dcr 201I with aculc coronary syndrome or coronary
angiographic or lllcctrmardiogrrphy cvidcncc of'ischcmic hcart disease.Paticnts wcrc anal;'scd for incidcncc of Diabctcs N,lcllitusand Impaircd Glucose
lolcrancc. Data collcctcd fiom thc paticnts. old mcdical rccords, Clinical Exarnination and Laboralory rcsults including HbA lc. Fasting and Post-prandial
blood sugar valucs and trcatmcnl history for Dia@ulcsMcllitus wcrc analyzcd
frrr thc study.
Resulls: From thc study, ir was sccn tlrat thc incidcnce-of Diabctes Mcllitus is
-5?7namong Indian paticnls u'ilh lschcmic llcarl Diseasc.whcrcas 347o of 8ulg;rrianpaticnts arc wilh Diabctcs Mcllitus (p >0,01). Thc Incidenceof lmpaired
Glucosc Tolcrancc among thc Indian prticnls is 2 I 9,i,rnd among thc Bulgarian
palicnls is I 9ol' (p valuc <0.0 I ).
Conclusions: Thcrc is statistical)y significant diffcrcncc in the incidence of
Diabctcs Mcllitus among pNticnrswith Ischcnric llcail Discasc in Indian and
Bulgaria, but in thc Incidcncc oflmpaircd (ilucosc Tolcrancctherc is no slatistically significant diflcrcncc bclu,ccn lhc two populrtions. Thc prevalenceand incrdcncc ofCAD along u,ith lhc risk frctor profilc vary grcatly acrossthe regions
ofthc u'orld. Eurly'dctcction l)iabclcs Mcllitus and control ofglycaemic status
b1,drugs and dictary modifications in casc of imparrcd Glucosc tolcranceplay a
s i g n i f i c a n rt o l c i n t h c p r c v c n l i o no f C A D i n b o t h p o p u l r t i o n s .
e659 Journalof Hypertenslon
Volume
1,2014
32,e-Supplement
lppfiA1
rNcroENcE
oF DysLrprDEMrA
AMoNGpAnENrs
C. Jamcs r, N. SlanchevaI, A. Yanakeva2, K. Gospodinov r, S. Ohri r,
S. Tisheva 2, S. Jose | . I Departmenl of Cardiologt, Lourdes Heart Institute ond
Neurc Center (LHINC), Kerala, Cochin, INDIA,: Department of Catrlblog.
Medical Univenity Pla,en, Pleven, BULGANA
Objective: Thc objcctive ofthis study is lo analysc and compare thc incidcncc
of Dyslipidcmia among paticnts with lschcmic heart dirase in Bulgaria and
India.
Design and method: Cross-sectionalstudy among palienls with cstablishcd
Coronary Artery Discasc admittcd in th€ Department of Cardiology. Mcthod:
Study was carricd out in ihc Cardiology Department - Dr. Gcorgi Stranski l lospital, Pleven- Bulgaria and Dcpartmenl ofCardiology, Lourdes Hcart lnslilutc
and Neuro Centcr ( LHINC), Cochin, Kemla, India .Participants of this study
werc 496 patients who werc admittcd in the Cardiology Dcpartmcnt, Lourdcs
Hcart Inslitute and Ncuro Ccntcr (LHINC), Cochin, Kemla, India bctwccn lst
June 2012 and 3lst Dec 2012 and 476 patientswho wcrc admittcd in thc Cardiology Department, Dr. Gcorgi Stranski Hospital Plcven- Bulgaria bctwccn I st of
January 2012 md 3lst Llcc 2013 with acutc coronary syndromc or coronary angiogmphic or Electraardiography evidence of ischcmic hcart discme. Paticnts
wcre analysed for incidcncc of Dyslipidemia bascd on thc fasting lipid profilc
md trcatmcnt history for dyslipidcmia. Data collcctcd from thc paticnts. old
medical rccords, Clinical Examination and Laboratory rcsults of thc paticnts
were analyzed for the srudy.
Results: From the study il was sccn that the incidcncc ofdyslipidcmia is 7l%
among lndian palients with Ischcmic l{eart Discase, and incidcncc of dyslipidemia is 827o among Bulgarian patienls with ischcmic heart disesc (p >0.0 | ).
Conclusions: Thcre is no statistically significant diflcrencc in the ccuncncc
of dyslipidcmia among paticntswith lschemic Hcart Diseasein Indian and Bulgaria. Proper managcmenl ofcholestcrol and triglyccride lcvels is significant in
both thc population for thc prevcntion oflschcmic Heart diseasc.
lTp,€:ll
lFp.as24l
WITH TSCHEMIC HEART DISEASE. A COMPARATIVE
ANALYSIS BETWEEN INDIAN ANO BULGARIAN
PATIENTS
coupARrsoNoF EFFrcAcy
oF rNTENsrvEvERsus
MILD PITAVASTATIN THERAPY ON LIPID ANO
INFLAMMATION BIOMARKERS IN HYPERTENSIVE
PATIENTS WITH OYSLIPIDEMIA
Y. Iwashima r, T. Yammki ', S. Jcmin r, Y. Ohta r, H. Kusmoki r, S. Hayashi I,
T. Horio', Y. Kawano r. t Nalional Cercbral and Cardiovucular Center,
Division of Hyperlension and Nephrclogt, Suita City, Osaka, JAPAN,
2 Notional Cerebral on<l Cardioyuculor Cenlen Division of Canliovasculur
Medicine, Suila City, Osaka, JAPAN, t University of Tsukuba, Faculq* of
Medicine, Tsukuba Cit.t, Ibaragi, JAPAN,' Department of General Intcrnal
Medicine 3, Kanuaki Medical khool, Okayama, JAPAN
Objective: Intensive as comparcd to mild statin therapy has becn provcn lo bc
supcrior in improving cardiovascular oulcome, whcrcas the cffccts of intcnsivc
slatin thcrapy on inflammation and lipoprotcin biomarkers are not wcll dcfincd.
Design rnd melhod: This study assigncdesscntial hypcrtcnsivc paticnts with
dyslipidemia lo 6 months administrationof mild (l mg/day, n=34) or inlcnsivc
pitavastatin thempy (4 mg/day. n=29), and various lipid and inflammarioD biomarkcn wcrc measured at basclinc. and 3 and 6 months atler the start of trcatmenl.
Results: Both pitavaslatin doscs wcre well toleratcd, and therc werc no rcrious
trcatmenl-relatcd advers€ evcnts. Aflcr 6 months, significmt improvcmcnts in
total cholestcrol, triglyccridcs, lowdensity lipoprotcin (LDL-) cholcstcrcl, LDL/
high-dcnsity lipoprotein cholcsterol (LDL/HDL), apolipoproteins B, C-ll, and
E, apolipoprotein-B/apolipoprotcinA-l (Apo B/Apo A-I), and malondialdchydc
(MDA-) LDL werc obsrcd in both group,s.Comparcd with the mild pitavastatin
gloup, th€ intensivc pitavastatin thempy showed significanily greatcr dccrcascs in
C rcactive protcin (F=3.76, p <0.05), lotal cholest$ol (F=10.65), LDl-cholcstcrol
(F=23.37), LDUHDL (F=123a), apolipoproteins B (F=19.07) and E (F=6.49),
Apo B/Apo A-l (F=13.26).and MDA-LDL (F=5.76) (p <0.01, respcctively).
Conclusions: Intcnsivc pitavastatin thcrapy may have a more favorable cffcct
not only in decreasing LDL-cholcstcrol but also in plciotropic bencfiLs in tcrrns
of irnprovcment of apolipoproteins, infl ammation, or oxidation.
poLyuNsAruRATED
FATTY AcrDS REDUCE HDL
CHOLESTEROL IN PRIMABY HYPERTENSIVE
PATIENTS INDEPENDENTLY OF METABOLIC
SYNDROME PRESENCE
G . ( ' o l u s s i .C . C a l c n a .L . A . S c c h r .
(-lini<a Malitu. Uniyersih oJ Lidine, Lidine, JT4LY
Objectire: ln Ihis sludy wc cvaludlcd thc associationbctwccn fatty acid compositkrn of rcd blood ccll (RBC) mcrnbrancsas a markcr of fatty acids intake
and thc rnctabolic profilc of hypcrtcnsivc pali!-nls wilh and without mctabolic
syndrornc(MS).
Design and nrrtbod: Fifty paticnts (agc 63tl( yr.. MiF=24/26\ with primary
hypcncnsion wcrc dividcd in thosc with and without MS (36% and &yq reslEctivcly) rcc()rdinglo thc 2003 AACE critcria. Fany acid composition ofRBC
mernbrancs.variablcs of glucosc und lrpid nrctabolism.and homcoslasismodel
asscssmcnt(llOMA) as indcx of insulin rcsistancc.ucrc cvalualed at baseline
and aftcr 6 monllrs of a dict charactcrizcdby 3 tinres wcckly fish mcals sup
plcmcnlation.Thc dict rvasdcsigncd lo incrcascthc polyunsaturatcdto saturated
fatty acid (PIJI'A/SFA) rulio in RtlC mcrnbrancs.
Results: n t basclinc hypcrtcnsivc paticnts wilb MS had higher BMl, HOMA
indcx. and triglyccridcs, glucosc, insulin. and C-pcptidc lcvcls, and lower HDL
cholcstcrol. PUFA. PUFA,'SFAratio, and n-6 PUFA thrn paticnts without MS.
Univariatc analysisshowcd a strong and indcpcndcntdirccl associationb€tween
PUFA,'SFA ratio in RBC nrcnrbrancsand IIDL cholcstcrol lcvels (r=0.606.
P<0.00| ). A ftcr 6 monlhs of fish mcals supplcmcntaliononly I I paticnts in both
groups of paticnts. with and without MS. incrcascd thcir PUFA,/SFA ratio in
RB( rlcmbranes (61% and 3496. rcspcctivcly). The only prcdictor of such an
incrcmcnl u'as lhc lowcr basclinc PUFA/SFA ratio (Odds Ratio 2.14c-20, 95%
CI from J.24c-40 to 0.ti7) in a rnodcl including also agc. scx, and MS prescncc. llDL cholcslcrol incrcascd in both groups of prticnts with and without
MS (t l 7Z. P<0.050 and t I 69/0.P.:0.001.rcspcctivcly). u,hcrcasonly patients
wilh NlS hrd :rn inercmcnl in insulin and C-pcptidc l!'\'cls (+27yo and +29/o,
rcspcctivcly.both P<0.05).
Conclusions: I IDL cholcstcrol is strongly and indcpcrde-nllyassociatedto lhe
basclinc PU|IA/SFA ratio in RBC mcmbruncsand also with thc PUFA/SFA ratio
incrcmcnl aftcr fish mcals supplcnrcntation.Although rhcsc findings suggcst s
posilivc cflccl ofthc PUFA/SFA rrrio on HDL cholcstcrol indcpcndcntly ofMS
prcscncc.thc concomilant risc in insulin produclion in patientswith MS could
linrit thc or crall bcncficial e-ffcclof thc inlcn,cntion in thcse oalicnts.
I pp.€2sl
sHoRTANDLoNGTERMoF A 3-MoNTHKETocENtc
DIETONCAROIOVASCULAR
RISKPROFTLE
INTHE
SETTING
OFCLINICAL
PRACTICE
A. Ciccro. B. Brancalconi.M. Brancalconi.
(lni\'<'rsln' ol B()Iognu, Bol ognu. IT.1[,Y
Ohjective: Kclogcnic dicrs havc bccn shown in lhe short-lcrm lo promote
u,cight Ioss. and to improvc sornc mctabolic paramctcrs ofobcse paticnts, in
highly spccializcdobcsity clinics. Our aim was to tcst rhc short and long-term
cllects ofa 3-nronth kctogcnic dicl on thc cardiovasculardiscascrisk profile of
orcnvcrghl-obcsp
c ! t i c n t s i n l h c s c I i n g o f B c n c r a lp r a c l i c c .
Design and mcthod: Wc consccutivcly rccruitcd 377 subjrca (M: 22%o,W:,
7ti9i,.rncana8c: .161l0 ),cars,rncan BMI: 3lr3). Thcy rvcrc instDcted to follow
a 3-month kctogcnic dict, and thcn lo gradually rccovcr to a balanccddiet with a
follou,-up visit al 6 and I 2 nrtrnlhs.Changcsin studicd paramctcrswas cvaluatcd
by AN0\/A for rcpcatcdmL'asurcs
Rsults: Aflcr thrcc months, thcrc *,iLs a sr€nincant improvcmcnt in body weight
(-7.615,6 kg), BMI (-2.842.3 kg/m2). Waist circurnfcmcc (-7,1+4,4 cm), Index
of Ccntral Obcsity (-0.01{.02), and % of far (--1,8{-i,8) (all, p<0.01), that fi,nthcr rnpro\cd at 6 rnonths (f,:0.05). and thcn rcmaincd constanl till l2 months
FPG (-tr,7rl5, 3 mgtdl;. llbAlc (-0.2i{).7%), LDL-C (-19,4+312 mg/dl), TG
(-21,4t61,2 rng/dt). gGT ({.ft11,4 mg/dl) and SBP (-10.5+12,8mmHg), DBP
(-2,2r6.2 mnrllg), PP (-tt.Llj12.6 nrmllg) improvcd aftcr 3 months and rhe stabilizcd Iill l2 nronths.IIDL-C (+l.titll,7 mg/dL), and SUA (-0,4*2,9 mg/dl) only
improvcd aflcr 6 nronths (p-0.05) and thcn surbilizcd till thc cnd ofthe study. Nc
significant changc in rcnal paramclcrs or clcctrolycs changcs wro obscrvcd bcyond
a rnild by significant dccrca*' in calce-mia(p<0.05) Thc long tcm body weight loss
u'a-shighcr in lhosc subje*ts r'xpcricncing a kctonuria in tbc fimt pcriod ofdict, and
rvas dirccllv rclalcd to thc basclinc txxly fal mass and invcscly lo the palicnl age.
e679 Journal ol Hypertenslon Volume32, e-Supplemenl
1, 2014
Conclusions: Hypcrtensivc urgcncics and emcrgcncics are a common clinrcal problcm for (hc hospital bascd cardiologist. Such patienls rcquirc hosprtal admission and in some cascs prolonged stay and thus ulilize a signi6cant
part of hcalthcarc rcsourccs. lt is speculatcd that many of thcse cvcDts could
have bcen prevcntcd lhrough beltcr palienl education or adhcrcncc to trcrlmcnl.
RELATED
HosnLrw rNNEwLy
fpp.4sr3-l cENDER
DIAGNOSED ESSENTIAL HYPERTENSTON
C. Papagcorgiour, E. Koroboki r, E. Manios r, F. Michas r, D. Kalliouris '.
C. Papageorgiou 2, N. Zakopnulos t.t Hypertension Center, TherapeutiLs
Clinic, Universit.v olAthens, Athens, GREECE,: 2'd Psychiotric Deportmenr,
Attikon Hospitol, University of Athens, Athens, GREECE
ObJeclive: A growing body of evidence indicate the implication of bostility
in the clicitation and course of hyperrension, however the exact naturc of lhis
phenomenon is poorly undentood cspecially conccrning the gendcr aspcct. Taking into account this cavcat the prcsent study focuses to investigatc thc gcndcr
related bostility in newly diagnoscd hperlcnsion.
Design rnd method: Thc study population consistcd of l0? ncwly diagnoscd
hypcrtcnsive Patients, 6l malcs (mcan agr-48.9t9.?) and 46 females (mcan
agc:50.7+10.9) AII subjccts undcrwcnl 24-hour ambulatory blood prcssurc
moniloring (ABPM) (Spacelabs 90207) in order to cstablish the diagnosis of hypcrlcnsion and lo cxcludc white coat hyp€rtension. Th€ subjccts wcrc mcasure'd
on a working day and were instructcd lo perform as usually.
Exclusion criteria wcre cunenl or rccenl use of medicationsincluding psychirtric and antihypcrlensive drugs, as well as the diagnosis ofany systcmic discrsc
or psychiatric disorder.
In ordcr lo asscss Ihe hostility status all subjecrs completed the Hostility and
dircction of Hostility Questionnaire (HDHQ) which prescnts sevcn biologicrlly^bascd indepcndent dimensions ofhostility. Acting out Hostility/Critic to lhc
Othcn/Dclusional-demngcd
Hostility/Self Critic/Guilt{ntrovexion-Extrovcrsion and Dircction.
Thc SPSS statistical package was uscd to slorc and analysc the data.
Results: Therc were Dot significanl differences betwecn the two groups conccming bascline charactcristics as well ss blood pressure mcasurcmcnts (officc
and ambulatory). Analyscs revealed lhat male subpopulation as comparcd ro
the fcmalc one exhibitcd statistically significant increase regarding th€ uryc io
aci out hostility(p= 0,014),an increasing intmversion status(p{),019), and thcy
showcd statistically incrcased the sclf mtcd self criticism (p 0,002) .On rhc
olhet hand the female subpopulation demonstraled an increased guilt dimcnsion (p=0,027) comparcd lo th€ mal€ one. Finally, conccming the diration of
hostility a clear dominance ofihe male population has been noticcd (p=0,001 ).
Conclusions: The study providcs further evidence indicating the gcndcr rclatcd
hostilify diflcrcnces bctween newly diagnosed hypcrtensive patients and lhis
linkage might deserve grcatcr attcntion from diagnosticians and hcalth profcssionals.
I ppA5.1r I cENDEB DTFFERENcEsAND pERsoNALlry
TRAITS ASSESSEOBY EYSENCKPERSONALITY
OUESTIONNAIREIN NEWLY DIAGNOSED
HYPERTENSION
C. Papagcorgiour,
E. Korobokir, E. Manios',F. Michasr,D. Kalliourisr,
2,N. Zakopoulost. I HypertercionCentenTherapeutics
C. Papageorgiou
Clinic, Universityof Athens,Athens,GREECE,t 2d PsychialricDepartmant,
Atlikon Hospital, University of ,4thens,/thens, GREECE
Objective Thereis growingevidcrre suggcstinggcnderdiffcrencesin esscntialhypcncnsionexplainedby thc spcrific role ofsex hormoncs.Howcvcr linlc is knou'n
aboutgcndcrdiffcmrcesconcming personalitytraitsin cssentialhypcrtcmion.
The aim of our study was to compareexlroversion,ncuroticismand psychoticism in mcn andwomcnsufferedfrom essentialhpertension at the time of thc
diagnosis.
Designend method: The studypopulationconsistedof 106newly diagnoscd
h)?crrcnsivepatients.
All subjectsunderwent24-hourambulatorybloodpressuremonitoring(ABPM)
(Spacclabs9020?) in ordc lo establishthe diagnosisof hypertcnsionand ro
excludewhite coathyp€rlension.The subjectswcre mcasuredon a workingday
andwere instDctcdto performas usually.
Exclusioncritcriawcrc cunentor rcccntuseofmcdications
includingpsychialric and anlihypcrrensive
drugs,ro wcll as thc diagnosisof any syslcmicdiscasc
or psychiaric disorder
In ordcr lo asscsspcrsonality lraits all subjcctscomplclcd thc Eyscnck Pcrsonality QucstronnairclEPQ) rvhrch prcsL'nlslhrcc biologically-bascd indcpcndent
dimcnsirrns of tcnrpcramcnl: I:rlravcrsion,/introvcrsion.ncuroticism/stability,
psych0lic rsn'socialization
Thc SPSS slatislilal prckauc wrts uscd lo storc and analysc the data.
Ilesults: Thc sarrplc consistcdof6.1 malcs (mcan agc=.lti.9+9.7)and 42 fcmales
(mcan agc-50.7r10.q). Thcrc u'crc not significant diffcrcnccs bctwccn the two
groups conccming bascline characlcristicsro wcll as blood prcssure mcasuremcnts (ofhcc und ambulatory). lJvpcrtcnsivc malc subj('ctsprcscnt significantly
highcr locls of psychoticism (p-0.t)03) and ncuroticjsrn(p{.04) compared to
hypcncnsivc fcmalcs. Conrparisonbctwccn thc 2 groups rcgarding cxtrovcrsion
rocalcd no slatislically significanl diffe-rcncc(p:0.4).
Conclusions: Thc prcscnt findings suggcstlhal pcrsonality lraits play an importaDl rolc conccming gcndcr diffcrcnccs in nc$'ly diagnoscdcsscntial hyperlension. l'hc diffcrcnccs in pcrsonalitytrails bctwccn hypcncnsivc men and women
should bc considcrcd in thc managcmcnt ofncwly diagnosedhypertensivepatients.
tTplrlsl
socroEcoNoMrc
srArusANDHvnERTENSToN
AMONG ADULTS IN AN URBAN SETTLEMENT
(KIBERA) IN NAIROBI, KENYA
B. Olack r. L. Snrcclh', F. Mangcn t. R. Brciman !. J \'lontgomcry r. t Kenya
Meditol Re.seurthInslitutc end Ceill<,rs for Disease Control ond Prcvenrion
('olluborarion, Nairobi, KENYA,: Global Disease Detcttion Division, Kenyo
Olfice of the US Cc'ntersJit' Disuue Control and Prevcntion, Naircbi, KENYA,
t .Vokercre Univusih, ('ollege ol lleulth
SLientes, Kanpala, UGANDA,
u l,<ndon S<ho,il of l]1'giene antl Trupical Mtdit ine,
Dcpartment of Non
Conrmunitubk Diseuses,Lttndorr, UNITED KINGDOT'|,' Emory University,
Clobal ltealth Institute, Enon'. Atlanra, GA, USA
Objectivc: Using cducation, mcupation and wcalth indcx as sociocconomic
mensurcs.rvc cxamincd lhc ass([ialion bctu'ccn scio cconomic statusand hypcflcnsion among adull rcsidcnts of an urban scttlcmcnl (Kibcm) in Nairobi,
Kcn1,a.
Design and rnelhod: Wc conduclcd a comrnmity bascd cross-s€ctional swey
arnong l5?8 adults agcd 35-64 ycars using the modificd World llealth Organi.
zadon STEPuisc approachto suncillancc ofchronic discasc.Multivariable logbinornirl rcgrcssion modcls wcrc use-dlo cstimalc associations bctwccn socio
cconomic slatus and hypcrtcnsion . Body Mass Indcx was included into thc model
as il rncdialcs thc assmialion bcnvccn smio cconomrc slatus and hypcnension.
Resulls: Thc prcvalcncc of hypcrtcnsion was 279"n\95% Cl 27-29\ with subslantial variationsacrosslhc agc groups (ltl9/o,35ohand 52o/":3544,45-54 and
55-6,1,rcspcctii,cly).Wc obscrvcd significantly highcr prcvalcnce ofhyperiension among participantsu'ith no fomal cducation 34.39; comparcd to those with
al lcast somc prim ary Q4.1rl,l, sccondary( 26.3%n)or rcaiary (25.6Yt) cducation
(p.:0.05). Prcralcncc Dfhypcrlcnsion for uncrnploycd parlicipantsand those cngagcd in casual cmploymcnt (2tl.ll9zo)was similar lo lhat obscrued for in participanls c'ngagcdin fomal (26.71%)or sclf-cmploymcnt (25.7%). Among five
scallh quintilcs, prcvalcncc of hvpcrtcnsion was highcst amongsl pcrsons in
thc 5th (richcsl) quintilc 32.9%. Comparcd to participanrswith normal weights,
ovcrucighl (PRR=1.4. [959/0Cl: 1.14, 1.73]) and obcs parlicipants(PRR=1.6,
l9-5%( l: l.2ll,2.041 wcrc morc likely to havc hypcrtcnsion.The modcl adjustcd
for agc and gcndcr indicatcd no assmiation bctwccn all thc SES measuresand
hypcrtcnsion.llorvocr, uhcn BMI was addcd to lhc model, having si least primary cducation rcduccd thc risk for hypcrtcnsionby ) 79l",(RR =0.83 l95o/oCl:
0.69-0.991).as crrnparcd to thosc \ho had no cducation al all.
Conclusions: lJypcrlcnsionamong lhc urban poor adults cannot be sotcly attrib
urcd lo SliS. Frrrthersludy is nccdcd lo dctcrminc whcthcr marginal incrcases
in rvcalth arc associalcdwith adopiion of habits &ssocirtcdwith incrcasedrisk
frrr h-r,pcncnsion.
oFrHEeARAMETERs
oFTHEEuBo
t-Frui16 I EvALUAnoN
OOL-5D QUESTIONNAIRE UNDER NORMAL CLINICAL
PRACTICE CONDITIONS ON HYPERTENSIVE
PATIENTS WITH NORMAL AND ELEVATED BIII
S. Ohri . C. Jrrncs r. K. Gospodinov r, N. Stanchr-va',R. Komsa-Pcnkova2,
S. Tishcva'.' Dcpartment of Carlioktg,, (lniyersih llospital, Dr Georyi
Slrtnski Plucn. BL I-CARl.4,: Dclrailmqtt oJ Birn hcnisn, Medicol
Uniyerstn PIt'vcn. Pltven, BIiLG ARIA
Objective: Thc cpidcmic ol obcsity and obcsity-rclalcd hypcncnsion is an imp o r t a n lp u b l i ch c r l t h c h a l l c n s c .i n c r c a s i n gw o r l d u ' i d ca n d p a r a l l c l e db y g r o w i n g
1, 2014
e680 Journalof Hypertenslon Volume32, e-Supplement
incidcnce of mctabolic syndrome. Thc psychological impact of thcsc chronic
conditions can be vcry disturbing. In practical lcrms thc funclional cffcct of
an illncss and ils thcmpy upon a paticnt, as pcrccivcd by thc paticnl- could bc
'Hcalth
Rclatcd Qualitl
estimatedby introducing the qualitative approach of of Life (HRQoL).
The aim ofthis study is to evaluatc thc impact ofobesity on thc quality of lifc
of hl,pertcnsive patientsDesign rnd method: Randomizcd questionnaire based cross-scctional study
was conducted in thc Departmcnt ofCardiology, Univcnity Hospital. 130 patients with hypcrtension, stratified by age, sex and BMI (nomal weight ltl.5
24.9; overueight 25-29.9, obese 30-35) were chosen at random. Inclusion Criteris: Palients wilh diagnosis ofcssential hypertcnsion on regular mcdication for
at lcast thc last 6 months. Administmtion of lhe EuroQol-SD (EQ-SD) at the timc
of admission of thc patient. EQ5D comprises 5 dimensions: mobility, sclf-carc.
usual activities, pain/discomforl and anxiety/deprcssion. Each dimension has 5
levels: no problems, slight problcms, moderat€ problems, scvcrc problcms. and
extrcmc problems. Thc height, weight, smoking/non-smoking status and standard labomtory paramcters were recorded.
Results: Mcan age of the panicipants was 63.1+ 12.6 yean. Malc/fcmalc
ratio was 0.TS,distribution of patienls as smokcr/cx smoken/nonsmokcr
wts 2Oo/.112.3Vo167.2/o,
The distribution of the paticnts in BMI groups u'as
Most patients had no intake ofnuts in thcir dici. Statisli37.7o/o/28.5o/o133.87o.
cally significant differenccs bctwcen BMI groups wcre seen in Usual activit-v
(p=O.005) and Sclf-care (p:0.O44) dimcnsions of EQ-5D-5L with poorcst outcome in the obcse. We have found significanlly posilive conclation bctwccn
BMI and usual activilies (R={.234, p:0.0O1) and bctwccn age and anxicty
(R=0.366 p:O.045)-Mean BMI of palients with extrcmc problems with usual
activities is significantly greater ihan those wirh lowa intcnsity of problcms.
Patients with extrcme anxicty tend to havc higher mcan age.
Conclusions: Our findings showed that individuals with obcsity and hypcrtcnsion had impaired QoL in terms of hcalth, mobility, usual activity, discomfort.
md anxiety. Hcnce, non-obcse hypcrtcnsives had a bencr scnse ofovcrall wcllbeing.
rNpuREsruoy rN
oF DEATH
I pp.4sl?I ADJUDrcATlot{
MALAYSTA BT VEREAL
t
pfii8l
pREVALENcE oF ANxrEry, DEnRESSToN,
COGNITIVE IMPAIRMENT AND THEIR ASSOCIATEO
FACTORS AMONG MALAYSIAN ELOERS WITH
HYPERTENSION IN TWO BURAL COMMUNITIES
R. lr'luhanradNur Inran. I. MuharnrnadAfif. F. l\4ohdAriff.
Linitarsiti Teknologi M.4R.4.Selung,n. MALAYSIA
Objcctive: Il;pcrtcnsion is a major chronic discasc which incrcrocs trcmcndously
throughoulthc ycars cspcciallyamong thc cldcrlv. Il may lcad to both; major and
minor complications.Dcprcssion,anxicty and cognitivc impairmcnt in individuals
\\,ith h)?cncnsion arc ussmiatcd with thc yxxrr outcomcs of the discase. This srudy
aims to dctcnninc thc prcvalcnccofdcprcssion.anxicQ, and cognitive impairment
runong cldcrly palicnls wilh hypcrtcnsionallcnding hcalth clinics in Hilir Pcrak
and Sabak Bcmam districts bcsidcs idcntifing significant factots thal are ass{>
ciatcd with anxicly, dcprcssion and cognitivc function in lhc same study group.
Design and m€thod: Cross-scctionalstudy was canicd out in six randomly selcctcd hcalth clinics in Hilir Pcrak, Pcrak and Sabak Bcmam. Sclangor ofMalaysia. A total of lrvo hundrcd and ninc cligiblc conscntingrespondcntsparticipatcd in thc study. Thc basclinc socio-dcmographicand clinical variables were
rccordcd through facc to face intcn i('w. Thc anxicty and dcprcssionsymptoms
*'crc asscsscdusing validatcd hospilal anxicty and dcprcssive scalc (HADS)
u'hilc cognitivc impairmcnt function was asscsscdusing Eldcrly Cognitive AsscsstncnlQucstionnairc(ECAQ). Dala analysis was donc using x2 tcst, simple
and multiplc logistic rcgrcssions.
Ilcsults: In this stud."-.thc prcval!-nccof anxiclv, dcprcssion and cognitive impairnrcnt among thc cldcrly patientswith hypcrlcnsion wcrc 16.30lo,18.2o/oand
12.4-vorcspativcly. From the sludy, s'cight mcasuremcnl (50.002) and body
ma.ssindcx (p-0.005) $'crc found to bc significanlly associalcdwith anxiety
rvhilc cognitivc irnprimcn( showcd significan( assciation with cducational
lcvel (p<0.001) and agc (p<0.001) ofa palicnt,
Conclusions: Study showcd relativcly highcr prcvalcnce ofdcprcssion mtber
th$n anxicty and cognitivc impaimcnt among lhe cldcrly hypcrtcnsiv€paticnts
in Hilir Pcrak and Sabak Bcmam districts.C)urfindings could hclp mcdical stafr
rdcntif, high risk paticnts with hypcncnsion for scrcening ofmental disorders.
l:ducation ofcarcgivcrs and mcdical staffabout old agc dcprcssionmay increase
its ratc ofdctcclion and facilitatc imorovcd trcatmcnl.
AUTOPSY
K. Ng, K. Yusoff, N. Abu Bakar, N. Zainon, R. Salleh, N. Mohd Ghaali,
S. Norlizan, M. Yacob, M. Azizi Ramli, N. Mohamcd Nmr Khan. Universiti
Teknologi MARA, Sungai Buloh, MALAYSIA
Objecrive: Prospective Urban and Ruml Epidemiological Study (PURE) has
becn conducled in Malaysia since 2007, VA is used lo adjudicate dcalh cvcnls
and to classify the broad patlems ofmortality occuncd during the cohorr follow-up.
Design end methodi A goup of non-medical rcsearch workcn hc ben lraincd
to pcrform VA - a systematic retrospective inquiry interviews with lhc family
members or caretakers of imminent decedents by using a slandardizcd and validated checklist tool. Subsequently, they were needed to dcscribc thc chronology
of evcnts, the app€aranc€ of signs and symptoms, progression of the discasc.
history of similar episodes in the past and the dctails oftreatmcnt rcccivcd prior
to death, if any, in a narmtive VA reporr. To enhance accuracy, any copics o1'
relevanl supportive medical documents, if provided, were submitled togcthcr
with the reports. Afler reviewing the VA reporrs, traincd clinicians csigncd thc
most likcly COD bascd on the casc dcfinitions sct by PUR-E study aDd thc I Olh
rcvision of lntemational Classification ofDiscases (lCD-l 0).
Results: From 2009 to 2013, a total of l2l cases of death were obscrvcd in
PURE cohort population of 729? subjccts. Only 2!.lo/o dcaths occuncd in thc
hospitals and certificd by medical doctors. There were 5.87o deaths (7 cascs)
ccrtificd by non-medical registrars as "died ofold age". Afler adjudication for
all dcaths, non-communicable diseases(NCD) were the lcading causc of dcath:
representing71.9% (87 cases)ofall deaths.Cardiovasculardiscascsaccounlcd
for the most NCD deaths (63.5o/",51 cases), followed by canccr (28.?%, 25
cascs), and diabctes mcllitus (2.3%, 2 cases).
Conclusionr: Cardiovascular disease is still the leading COD in Malaysia. VA
is useful assessmcnltool to adjudicate thc COD obscrvcd in PURE study. lt can
reduce the misclassifcation ofCOD and reduce thc proportion ofdeaths anributed to unspccified causes.
porAssruM
ANDroDrNE
ExcRETroN
t pp-csrrtl soDruM,
AMONG NEW ZEALAND ADULTS: IMPLICATIONS FOR
PUBLIC HEALTH
R, Mclcan. S. Skcaff, S. Williams, J. Edrronds. J. Mmn.
LinivcrsiO ef Otago. Dunedin, NEn' ZEALAND
Objcclive: To quantify ;npulation intakc of iodine, sodium and potrosium in
Nt'w Zcaland adults lo asscssthc bcsl approrch for a sodium rcduction stralegy
u h i l c o p t i m i s i n gi o d i n cr n d p o l a s s i u ms t r l u s .
Design and method: Population birscd surucy of Ncw Zcaland Adults, using
urinary cxcrction as an indicalor ofdictary inlakc.
Rctu,ccn Fcb-C)ct 2012. adults agcd lll-64 ycars wcrc randomly sclc.cied via
thc clccloral roil from lhe citics of Wcllrngton and f)uncdin, New Zealand. A
snou,ballingtcchniquc wm also employcd to obtain a samplc size ofat leasl 300
adults. Participantshad hcight, wcight, and blood prcssuremcmurui, and were
askcd to collcct a 24 hour urinc samplc.
Ilcsulls: l0t adults complclcd thc sludy. Mcan BMI was 26.7 kg/m2, and mean
sy,stoficblood prcssurc was l26mmllg. Only 23Vo (95% Cl 18,28) of adults
had an Adcquatc Intakc of potmsiun. and'760/o(95% CI 71,81) of adults had a
sodium cxcrction that cxcccdcd rcsomnrcndcdUppcr Lcvcl of intake for sodium
according lo rclcvant Nulricnl Rcfcrcncc Valucs. Mcan 24 hour urinary (24hU)
sodium cxcrction was 3373 mg/day (95% Cl 3208, 3519) (3833 mg/day for men
and 2914 mg/day for womcn). Mean 2.1hU potassium cxcrction was 2728mgl
day (95% Cl ?611. 21i4.{)(300.5m9day for mcn and 2463mglday for women).
\{can sodjum potassiun}ratio was 1.3. Thc mcan 24hU iodinc cxcrction wa
I 2.1(959;Cf I I 7. I 32) pg/day and 32lo (95oh Cl 27,31) of thc population had a
2.1hrurinary iodinc cxcretion < I 00 pg/d3y (lhc EstimatcdAvcmgc Rcquircment
for iodinc).
(lonclusions: Ncw Zcaland adults had marginal iodinc intakcs, high sodiurn
intakc and low potassiumintakc. H igh sodium and low potassiuminlakcs are as-
e291 Journalof HypertensionVolume
32,e-Supplement
1, 2014
I pp.iAd
nREVALENcE
ANDcHARAcrERrsncs
oF
TBEATMENT RESISTANT HYPERTENSION
CONSECUTIVE OUTPATIENT ANALYSIS
IN
K. Okamura, T. Okuda, S. Goto, K. Matsumoto, S. Sumi. T. Arimura,
R. Mitsutake, K. Mori, H. Tojo, K. Matsuo, H. Urata. Fukuoko Unitersin'
Chikushi ltospital, Chikushino, JAPAN
Objective: The purpose ofthis study was to rctrospcclivcly invcsligrtc prc\ alcnce and characleristics of trcatment-resistancehypertcnsion (R-llT) in
conscculive outpatients, since such paticnts would be candidatcs for cJthcIcr-basedrenal sympathetic dcncrualion (RD).
Design and method: Consecutive hypcrlensive outpatients (Junc 2009-May.
2013, n=999) in our hospital wcrc recruitcd for analysis. The paticnr of R-tlT
was dcfincd as SBP ovsr 160 mmHg taking threc or more antihypcncnsivc
drugs wilh more than rouline doscs, which was tbe samc selectivc BP condition for RD.
Results: This invcstigation found only 26 (2.6%) R-HT patients. R-HT group
includcd 8 (31%) CKD paticnts with less than G3a (cCFR < 45 mllmin/1.71
m'?).Comparcd to non-R-HT group, R-HT group showcd significanlly highcr
age (3 wcre not in l5-85), BNP, urinary albumin-crcatinine excrclion rarir'
of spot urine, pulse wave vclocify, le{l ventricular end-diastolic diamctcr and
intrerucntricular scptal thickness measurcdby UCG. Hcmoglobin, scrurn albumin, cCFR, plasma rcnin activity, plasma aldosteronewerc significantly lowcr
in R-HT group. Urinary Na./creatinineratio was tcnd to bc highcr in R-llT
group.
Conclusions: Our retrospcctive cross sectional study rcvealed thal the prcvalence of R-HT among gcnerally lrcated hypertcnsives was quilc low. R-llT
was in high risk and appcaredio be under high salt intake. Our suncy rcvcalcd
that otly l5 paticnls (1.5%) out of999 hypcrtensive outpatients matchcd rvith
sclcction criteria for RD.
HypERrENsloN
rNHrcH-BrsK
l-FpJ434l REsrsrANT
METABOLIC SYNDROME WITH REDUCED GFR
S. Ohri, K. Gospodinov, N. Stanchev4 C. Jamcs, A. Yanakieva, S. Tisbcva.
Department of Cardiolog;, Universil'Hospilal, Dr. Geotgi Stranski, Plet'en,
BULGANA
Objective: The melabolic syndrome is a constcllationofmetabolic and vascular
abnomalities that include insulin resistance,ccntral or visceral obcsity. hypcrtcnsion, dyslipidemia and oxidative stress.The dcvelopment of a particularly
rcsistant form ofhypertcnsion in these individuals can be attributcd to a nurnbcr
of factom including vasoconstriclionand inappropriateactivation of thc rcninangiotensin-aldoslerone
systcm.This case dcmonstratcsa high risk paticnt wi(h
mctabolic syndrome and poorly controllcd rcsistanth)pcrtcnsion. Additionally
due to thc inadequately controlled hypertcnsion she was bcginning lo dcvclop
rhythm disturbances.
Design and method: Casc description: Female Caucasian63ycars agc was rdmitted in the Cardiology Department, Universiry Hospital, Plevcn in May 2009
with complaints of fatigue, dyspnca, precordial discomfort, anh).lhmia and palpitations precipitated by modcrate physical activity. The symptoms srancd duc
to poor ambulalory BP control with BP valucs reaching upto240/l 40mmHg. Thc
hyperlensive crisis usually continued for about 30-40minutcs and camc undcr
control only with Chlofazolin tablet. Prcsence of long lem poorly controllcd
hypertension, Diabctes Mellitus type 2, H)?ercholestcrolemia, ovcrucight and
family history of cardiovascular diseascs worsencd the patienl's prognosis.
Paraclinicsshowed hypcrcholesterolcmiaand GFRd5ml/min/l-73m3. lnrcrcstingly. on normal ECG th€ patient registered sinus rhythm but during ihc occurrence of hyperlensive crisis, the evening of admission, a shorl pcriod of Atrial
Fibrillation was recorded with spontaneous conversion to sinus rhythnt on normalization of the BP. Echocardiography dcmonsratcd cxtcnsive hy.prcrtrophic
changcs in the intcrventricular scptum and posterior wall of thc lcft vcntricle
with diastolic dysfunction. The therapy startcd in the clinic wilh appropriarc
antihypcrlcnsives and OHD.For the alrial fibrillation we adviscd the srralcgy
olusing RhythmoDorn as per necd. On CHADS2 VAS score=3 and Apixiban
2x2.5mg was started.
Results: On cxercise stress test good BP and HR control was achievcd and aftcr
2 wccks on follow-up checkup the dose ofChlofazolin was reduccd to Jxl/zrab
due to poor tolerace to normal BP valucs.
Conclusions: Therapcutic shalcgy is successfulon proper asscssmcntof risk
factors and comorbiditics. Thc use of loop diurctic provides a small numbcr of
larrc rolunrc nrclurilion. In ischcnric hc:rrt tlisc.rsernd rcduccd GFR, ACEI n h i h r l ( ) N$ i t h r i o u b l cc l i n t i n r t i o na r c r c o u i r c d .
coMpLrANcErs A pREDrcroR
lTp.14JFi LARGEARTERTES
OFMYOCABDTAL
ISCHEMI,A
IN RESISTANT
HYPEHTENSIVE
PATIENTS
R. \'lodolo. A. f aria. A. Sabbatini.N. Ilarbaro, V- Fontana,N. Conca,
I f agnani. Il. N4orcno.Univ'rsih, ol Cuntpina.t Cuntpints. BMZIL
Objcctive: il\?L-rlcnsion is thc mosl prcvalcnl and sirlnificant modifiable risk
l-rrclorlirr coronar; hcarl discrsc. A parl of thcsc hvpcrtcnsive patientsprcscnts
rcsistanlhvpcrtcnsion(RllTN). rvhich irrrprcls grcalcr cardiovascularrisk, and
rltcrcd rilcrial clastancc,rvrth highcr artcrial stilTncss.Mvocardial ischcmia inr'idcncc incrcuscsrlong uith blood prcssurc (BP) lcvcls. Ilowevcr, the prcvalcncc of myocrrdial ischcnriain pdticnls *'ith Rl ITN is unknown, as wcll as the
luclrrrsassocirte.tl$ i1h it.
I)rsign and ucthod: Wc cnrollcd 129 palicnts wjth tluc RHTN regularly follorvctl in our spccialty h1'pcrtcnsionclinic and cvaluarcd thcn by rcsting and
dipyrirlanro)c phannacological strcss myocardial pcrfusion scintigraphy. Palrcnts \\crc thcn dilidcd in tw(r groups: u'ith (l-I{Hflrl, n-36) and without (NIRllTN. n-9jl) mvocardial ischcnia. Biochcnrical nrarLcrs.llow mediatcd dilaliorl ilod pulsc \\'r!c \clocit) (c1--PWV)wr.rc also cyalurlcd.
Rcsults: Thirtv-six (189;) patir-Dlshad mycrcardialischcnria.Thcre was no diffcrcnt c hctl'ccn groups rcgarding agc, gcndcr. biochcrnical parametcrs,ofhce
rrrd 2.1h-,\Bl'N4BP lcvcls. Palicnts in lhc I-RtlTlri group wcrc morc likely dia b c t i c ( - 1 1r s . l l 9 u n ,F < 0 . 0 5 ) a n d o b c s c ( 7 5 v s . . 1 0 9 u "p.< 0 . 0 0 1 ) .A d j u s t i n g f o r
rgc, I)Nll ard bcta-bloc[crs usc, nrultiplc logislrc rcgrcssion showsl that that
d i , r t r c l e(-O
s R 4 . 8 ; 9 5 9 r { . ' l :1 . 2 - 1 9 . 3p. < 0 . 0 { ) l ) ,f f o r vr n c d i r t c dd i l a t i o n ( O R 0 . 2 7 ;
9 , s ' l i , ( ' l :0 . l l - 0 . - 5 , 1 p
. < 0 . 0 0 1 ) , n r i c r o r l b u m i n u r i a( O R 2 6 . 4 ; 9 5 o / ' C l : 6 . O - 1 1 7 ,
p.,(r.0()la
) n d c f - l ' W V < l ( h n / s ( O l L l ? . 8 : 9 5 9 i ' C ' l?: . 9 - 5 63 . p < 0 . 0 0 1 )w e r e i n d c pcndcnl pr<'diclorsof ischcrria.
(. onclusions: Thcrc is a high prcvale'nccofmyoclrdial ischcnriain paticntswith
R l l l ^ - . D i r b c t c s .m i c r o a l b u m i n u r i a n d c n d o t h c l r a d
l ;sfunclionareassociatcd
l() nry()crrdial ischcmia in RH'fN. Intcrcstingly rnyocardial ischemia was assrrirlcd u,ith thc absc-nccof artcrial stiffncss in lhcsc paricnts.This may instiltrtc s(rrncncrv aspcctsof coronariopathy and )argc irncD, rigidity in this unique
grorp of Rl iTN patie-nts"
oF REsrsrANTHypERTENsroN
AT
I ppro:6 I pREvaLENcE
THEHYPERTENSION
CENTRAL
UNITHOSPITAL
SAN
CBISTOEAL
TACHIRA
DURING
2009.201
3
J. Lolrz-llivcra r, S. Scrocchir. S. Lopcz:. F. Suarcz:. M. Bonilla r, W. Zcrpar,
S. Pcrcira '.' V Dr'purktn,"r(ct, Unidtd de HipcrteDsion,4ilerial, Hospital Josi
,\,lt Iiruus. Sun Cri:ltihal, VLNE7.UELA.: Iist uelo d<',\l<'litinu, Universidad
d L'L os . 1nd as. TrtLh rr a, Sa n Cr i.st i ha l, y E,NEZ U'L L.4
Objcctir e: Rcsislrnl hypcrlcnsion is a conrmon clinicrl problcm faced by both
prinrrrv carc clinicians and spccialists.Whilc thc c\act prcvalcnce of rcsistant
h)'pcrtcnsionis unknown. clinicrl (riels suggcstthJl it is nor rarc, involving l07o
to ll)'r'oof sludy pariicipants.As oldcr agc and obcsity arc : of thc strongcstrisk
Jiclos Rcsisllnl hyl)cdcnsion is dcfincd as blood prcssurc thal rcmains abovc
goal rn spitc of lhc concuncnt usc of J antihypcrlcnsivc agcnts of diffcrcnt
classcs.Irlcallv. onc of thc J ascnls should bc a diurctic . Thc fomer includcs
falicnts \\'ho lrck blood prcssurc control sccondary lo poor adherenceand./or
JD inrdc(luatc trcallrcnt rcgirncn, as wcll as thosc uith idcntifiable causcs of
htlcr tcnsionl-hc rrrn rvascvaluirtcdprcvalcrrccofrcsistant hvpcr'lcnsionol thc Hypcrtcnsion
unil in Srrr Cristohal.tluring2009 - l0ll.
I)esign and nrethod: An obscrvationel,crosscctionalSlud),,including all pal i t ' n 1 sa t c D d c dd u r i n g 2 0 0 9 t o 2 0 1 3 , a l m i r u s o f l h r c c a n t i h y p c n c n s i o n
a g c n t sa t
nr;uinrirl doscs,includingdiurctic.u ho not rcachcd targcts systolic and diastolic
bloocl prcssurc.undcr140/90 mm mcrcun,Excludcd non irdhcrcnt paticnts, using thc N{orinskv ll ilcm nrctlicationrdhcrcncc scalc psucdohypenensionusing
a 2.1hour ABPlil, a }lobilograph NG.and tdcntifiablc causcs of hyperlension.
pcrlhrrrcd Iaboratorytcsl xnd imagcs.
Rcsults: Of 2ll-50clinical rccords u,crc includcd 73,{ \\,ho mccl all inclusi6n
rvcrc classificd as rcsistanl hypcrtcnsion. l2 famale,
cnlcria. onl)' l5 (1.91{9/o)
ag(-a\crcec t'as 65.27 ycars. all scdcntary.hypcrlipidcmic, in a higb and very
h i g h r . r r t l r r r r a s c u l ar jrs k . 1 0 u i t h ) c l l r c n t r i c u l a r h y p c r l r o p h y ' . w
1 ith angina.l
q i t h n r - r o c r u r l i ai nl f r c t r o n .a n d 2 * ' r t h s t r o k c . l l h a d a n a n o n d i p p i n g p r t t c m .
hcart failure
New approachesin treatmentof acutelvdeconrpcnsated
120091[800]
N. Stancheva, K. Bakardgieva, V. Jordanovu, S" Tisheva. f,lniversity Ilospital Geargi
Stranski, Pleven, Bulgaria
at improvingoxygenation
Initial therapyin patientswith acutehearlfirilurcslroulclbe <lirectecl
as well asprovidrngs)/mptornrclief. We investigatedthe
andpatienthaemodynamics
of nesiriticle,
recornbinant
hBNP, and
tolerabilityas well as efficacyof intravenousinfl.rsit.rn
heart
(Simdax),calciumsensitizerin paticntswith acutely'decornpensated
levosimendan
failureof any etiology.They receivedeitherpenranentintravenousnesiritide(2 rncg,&gbolus
(Sirrrdax)(6-12 pg/kg inlirscdover l0
dosefollowedby 0.01mcglkg/min)or levosinrerrdan
in ) at icast24 hours trndr.vere
minutesfollowedby a continuousinfusiono | ().I prg,'kg/nr
status.self'-assesed
overall
followed for I month for changesin their dyspneiranc'lr,vell-being
firr r,vorsening
o1'FIFsyrnptonrs,
healthstatus,NYHA classfunction,hospitalization
anl,possiblcsideeffects.
frequencyof visitsto the emergencyyard,cardiacolrtput(CO). erncl
Thirty nine patients(31 weremaleswith a mcanilge of 68-t7 ycars)wcrc included.Twenty
inlusion fbr at least24 hours.Most of
nine receivedNeseritideand 17 receivedLevosinrendan
the patientshad no changein dyspneaand wcll-beingon the sixth hour. But all of themhad
minimal or moderatedecrease
in dyspneaand irnprolernentin their lvell- beingon the
twentyfourthhour. At the beginningof the study.lll patientswere in NYHA classIII. One
month later26 had improvementin their classlundion (p=,,0.0037),3 rcmainc,din the same
The total numbero1'hospitalizations
in the l2 nronthperiod
class,and 5 patientsregressed.
prior to therapywas 28, which declinedto 0 cluringthe ncxt month tbllor,vinginitiritionof
therapy.One patientonly had visitedemergencydopartnrent
becauseof'u'orseningHF.
BaselineCO increasedfrom 4.60+1.92 Llnin (nreanr, SD) to 5.0+2.06l-imin (p<0.05)and
NT-proBNPdecreased
from 1900.56+78.08
tt, 425.07L57.8pnrol,ll(p<0.05)tbr tht:Nesiritide
groupandbaselineCO increasedfrom 4.32*l .78 t.4nin (rnean+ SD) to 5.19*2.0(rL/min
(p<0.05)and NT-proBNPdecreased
pmoliI (p<0.05)for
from 2111,6*83.5to 327.17+4'2.8
the Simdaxgroup.Therapywas well toleratedby all paticnts"Syrnptclmatic
lrypotension
was
not observed.We are goingto follow up thesepaticntstbr six monthsto asscsstheir survival
-Ihese
statusandrehospitalization
resultssuggest
due to acutelydecompcnsated
hcartlailure.
that both Nesiritideand Levosimendan
may havozrninrportantrole in FIFpatientsu,ith acute
decompensation
on top of standardmedicaltreatmcnt,rrnprtrvrng
their quality of life.
Additional studiesareneededto determinethe el'f-cct
o1'these
drugson survivalstatusand
frequencyof rehospitalisation.
Citation: EuropeanJournalof HeartFailureSupplerncnts
2001);Vol. 8(2)
Date: Monday,June1,2009
SessionInfo: ClinicalPosterSessionIII: Acute hearrl-ailureNatriureticpcpticles& Prognosis
(08:30-12:30)
PresentationTime: 8:30 AM
Room: PosterZone - Clinical
NTpToBNPand heart rate variilbilitf in the prognosisof hcart failure
[20091[890]
N. Stuncheva, V. Jordanova,K. Bakard.jieva,S. Tislrcya.('nitersiO, Ilospitul Georgi
Stranski, Pleven, B ulgaria
Introduction: Heartfailure(HF) is associatcd
r.r,ithrreurohumoral
activationanclautonomic
dysfunction.The aim of this studywas to evalunlcthe role o1'predischarge
hearlrate
variability(HRV) andN-teminalpro-brainnutriureticpepticie(N'fproBNP) as preclictors
of
outcomein patientshospitalised
for acutelvclecr:nrpcnsatccl
chronichcartlailLrre.
Methods: One hundredand twenty-seven
patientfiu,ith sylrptomaticIlF rangingfiom II to
IV NYHA functionalclasswereincluded,69 ntrlcs (57.09'i,)
rvitli rlean age{i 1.9,r8.4years.
The patientswere consecutively
hospitalizeddur:to aggravatecl
HF. On the clayof discharge
standardlaboratorysampleswere obtained,echocarcliograph_v
was perforrred and venous
plasmafor NTpToBNPwas collected.24hout'llolter [rC]Grvasperfirntrccllirr 46 patients
(38%) in the day of discharge+1 day with Cardiotenssoftu'arc.All the rcsultsrverccalculated
automaticallyandbeforethat artifactshadbecnclcietedmanually.The primaryenrlpointwas
defined as rehospitalizationfor aggravatedHF in 6 nronth aftcr disc,harse,
lnorr:than 2
hospitalizationsin 1 year or cardiacdeath.
Results:One hundredand twenty-one(95.3o1,)
patienlsrvcrclbllowcd fbr meanof 387+ll7
days.Fifty-four (44.6%)of themreachedat lcastone of the enclpoints.
At unirrariate
analysis
==32.93,p.<0.0001)
both NTpToBNP(chi square: 32.93,p<0.0001
) and I-{RV(chi :iqLrare
provedto be significantpredictorsof outcomc.N'l-pnr-EINP
prclr.edto be an indepenclent
predictorof outcomein multivariateanalysisas w'ellwhilc tlt{V did not. Kalrlan-Meier
survivalcurvesshoweda steepinitial slopesuggestrng
that thc highorthe NT'proIlNplevel
andthe lower the HRV the worsethe short-tenulll'ogn()sis
in the tlrreegroupsof patients
dividedby the NTpToBNPconcentration
and FIRV irccorilinqto thc nonparametric
percentile
method,NTpToBNP> 800 pglml and HRV < 5()r.ns\,r,ere
assocriatecl
rvith signilicantlyworse
outcome.
Conclusions:In hospitalizedpatientswith HF plasnraconcentration
of N'fproBNp and HRV
at dischargeare predictiveof outcomein HF.
Citation: EuropeanJournalof HeartFailureSulrplcrncnts
200r):Vol. g(2)
Date: Monday,June 1,20Q9
SessionInfo: Clinical PosterSessionIII: Acute hcurtthilureNirtriurcticpepticlcs& Prognosis
(08:30-12:30)
PresentationTime: 8:30 AM
Room: PosterZone - Clinical
l ' . r i l i ' . . f ' t , r t , i : . r i;'t . i r r . i t ) i l ' i
pj**4.
Effectof transferfrom furosemideto torasemideon
tolerabilityin patientswith chronic heartfailureNVHAll to lV
, H e r g e d l e v a 2 , H B e n o r f , K G o s p o d i n o v,l E M e k e n y a n l
S T i s h e v a l ,N S t a n c h e v a l V
, ue to more
B a c k g r o u n d : T h e h y p o t h e s i sw a s t h a t t o r a s e r n i d e d
p r e d i c t a b l e p h a r m a c o k i n e t i c sp/ h a r m a c o d y n a m i c si,n d u c e s g r e a t e r
i m p r o v e m e n t si n f u n c t i o n a la n d s o c i a l l i m i t a t i o nt h a n f u r o s e m i d ea n d
r e d u c e st h e f r e q u e n c yo f h o s p i t a l i s a t i o ni ns p a t i e n t sw t l ' rc h r o n i ch e a r t
, n d o m i z e du. n b l i n d e d
f a i l u r e( C H F ) .P a t i e n t sa n d m e t h o d s :P r o s p e c t i v er a
study in 196 patientswith CHF (NYHAll-lV)"treatedvrithfurosemidein the
past 6 months who were all transferredto torasernidecn top of their
c o n c o m i t a n t h e r a p y . E n d p o i n t s :C l i n i c a le f f i c a c y .s a f e t y , t o l e r a ' o i l i t y .
hospitalisation
f osr a p e r i o do f 6 m o n t h s .
R e s u l t s : C l i n i c a li m p r o v e m e nw
t a s o b s e r v e di n b o t h g r o u p s , b u t t h e
trend to improve by at least one NYHA class was significantonly in
t o r a s e m i d e -( P = 0 . 0 1 4 ) ,b u t n o t i n f u r o s e m i d e - t r e a t epda t i e n t s .T h e r e
were no differenceswith regard to adverse events and hcspitalisaiion
d u e t o C H F . O v e r a l l ,t o l e r a b i l i t y( P = 0 . 0 0 0 1 ;a n d i m p r o v e m e nt n d a i l y
) ere significanth
r e s t r i c t i o n(sP = 0 . 0 0 0 2w
l yi g h e r ,n u m b e ro f m t c t i o n sa t 3 ,
6 a n d 1 2 h a f l e rd i u r e t i ci n t a k e( P < 0 . 0 0 1a t a l l t i m e p o i n t s )a n d u r g e n c y
v e r s u sf u r o s e m i d e t o u r i n a t e( P < 0 . 0 0 0 1s) i g n i f i c a n t l yo w e ri n t o r a s e m i d e
treatedpatients.
C o n c l u s i o n : C H F p a t i e n t st r e a t e dw t h t o r a s e n r i d ge a i n a h r g h e rb e n e f i t
, ue to torasemioe's
i n q u a l i t yo f l i f e t h a n f u r o s e m i d et r e a t e d p a t i e n t s d
d u a l e f f e c to n b o t h c l i n i c asl t a t u sa n d s o c i a lf u n c t i o n .
E u r o p e a nJ o u r n a o
l f H e a r tF a i l u r eS u p p l e m e n t sV, o l u r n e1 1 S u p p l e n t e n t
(Cnlrne)
( P r i n t )I S S N1 8 7 8 - 1 3 1 4
1 , I S S N1 5 6 7 - 4 2 1 5
C o p y r i g h@
t E u r o p e a nS o c i e t yc f C a r d i o l o g y
'1
1 : r ',t j ; l i , i : ,
P 1* S 4
Effectof transferfrom furosemideto torasernideon
tolerabilityin patientswith chronic head failureNVHAll to lV
S T i s h e v a l ,N S t a n c h e v a l V
, H e r g e d l e v a 2 ,H B e n o r f , K G c l ; p o d i n c v rE M e k e n y a n l
B a c k g r o u n d : T h e h y p o t h e s i sw a s t h a t t o r a s e n r i d e d
, ue to more
p r e d i c t a b l e p h a r m a c o k i n e t i c sp/ h a r m a c o d y n a m i c si,n d u c e s g r e a t e r
i m p r o v e m e n t si n f u n c t i o n a la n d s o c r a ll i m i t a t i o nt h a n f u r o s e m i d ea n d
r e d u c e st h e f r e q u e n c yo f h o s p i t a l i s a t i o ni ns p a t i e n t sw i t h c h r o r i i ch e a r t
f a i l u r e( C H F ) .P a t i e n t sa n d m e t h o d s :P r o s p e c t i v er a
, n d o m i z e du, n b l i n d e d
study in 196 patientswith CHF (NYHAll-lV) treatedwth furosernidein the
past 6 months who were all transferredto torasemideon toc of tl-reir
c o n c o m i t a n t h e r a p y . E n d p o i n t s :C l i n i c a le f f i c a c y .s a f e t y , t o l e r a b i l i t y .
hospitalisation
f osr a p e r i o do f 6 m o n t h s .
R e s u l t s : C l i n i c a li m p r o v e m e nw
t a s o b s e r v e dr n o o t h g r o u p s , b u t t h e
t r e n d t o i m p r o v e b y a t l e a s t o n e N Y H A c i a s s w a s s i g n i f i c a n ct n l y i n
t o r a s e m i d e -( P = 0 . 0 1 4 ) ,b u t n o t i n f u r o s e r n i d e - t r e a t epda t r e n t s .T h e r e
were no differenceswith regard to adverse everntsand hcspitalisation
d u e t o C H F . O v e r a l l ,t o l e r a b i l i t y( P = 0 . 0 0 0 1 ;a n d i r n p r o v e m e nitn d a i l y
r e s t r i c t t o n(sP = 0 . 0 0 0 2w
) e r e s i g n i f i c a n t lhyi g h e r ,n u m b e ro f m r c t i o n a
st 3,
1 t a l l t i r n ep o i n l s )a n d u r g e n c y
6 a n d 1 2 h a f t e rd i u r e t i ci n t a k e ( P < 0 . 0 0 ' a
t o u r i n a t e( P < 0 . 0 0 0 1s) i g n i f i c a n t l yo w e ri n t o r a s e m i d ev e r s u sf u r o s e m i d e treatedpatients.
C o n c l u s i o n : C H F p a t i e n t st r e a t e dw t h t o r a s e m i c lgea i n a h i g h e rb e n e f i t
i n q u a l i t yo f l i f e t h a n f u r o s e m i d et r e a t e d p a t r e n t sd, u e t o t o r a s e m i o e ' s
dual effecton both clinicalstatusand socialfunctrori.
E u r o p e a nJ o u r n a o
l f H e a r tF a i l u r eS u p p l e m e n t sV, o l u m e1 1 S u p o l e m e n t
( P r i n t )I S S N1 8 7 8 - 1 3 1 4
1 , I S S N1 5 6 7 - 4 2 1 5
iOnlrnei
C o p y r i g hO
t E u r o p e a nS o c i e t yo f C a r d i o l o g 5 r
l
p 1s s 5
" ;
: . ' r : "- , . ' 1
Torasemide(Trifas)in clinicalpractice-ownexperience
. H e r g e d l e v a 2 ,H B e n o v ' S T D i m o v ' ,K R V a s s i l e v l
N S t a n c h e v a lS, T i s h e v a l V
B a c k g r o u n d : L o o p d i u r e t i c sp o t e n t l ye x c r e t ew a t e ra n d e l e c t r o l y t eas n d
thereforehave been Wdely prescribedfor the treatmentcf variouskinds
of edema for a long time" The potent diureticaction of loop druretics,
however, often causes hypokalemia,and therefore potassiumsparing
d i u r e t i c sh a v e a l s o b e e n s u p p l i e da s a c o n c o m i t a ndt r u g . C h r o n i ch e a r t
failure(CHF) is the cause of significantmorbrnrortaiity
all over the r,vorld
a n d i t s i n c i d e n c ea n d p r e v a l e n c ea r e i n c r e a s i n gF u r o s e m i d ei s t h e n r o s t
c o m m o n l yu s e d l o o p d i u r e t i c T
. o r a s e m i d ei s a l o o p d i u r e t i cb e l o n g i n gt o
t h e p y r i d i n es u l f o n y l u r e ac l a s s . l t i s a h i g h - c e i l i n gd i u r e t i ct h a t h a s a
l o n g e r h a l f - l i f e ,l o n g e r d u r a t i o n o f a c t i o n a n d h i g h e r b i o a v a i l a b i l i t y
comparedto furosemide.
M e t h o d s : D e m o g r a p h i cc, l i n i c a l a, n d p s y c h o s o c i adl a t a w e r e c o l l e c t e d
b y q u e s t i o n n a i r eas n d m e d i c a lr e c o r d r e v i e wf o r 1 9 6 p a t i e n t sw t h H F
(aged 64,1 t 11 years, 56 o/owere male, 60o.,'o
were in New York Heart
Associationclass lll/lv).Medicationadherencewas rnonitoredolrlectively
for 6 months. Cardiac event-free survival data were obtarned by
patientifamily
interview,hospitaldatabase,and death certificatereview.A
series of regression and Cox survival analvses were performed tc
d e t e r m i n e l t h e t h e r m e d i c a t i o na d h e r e n c e m e c J i a t e C
the relationshio
b e t w e e nd i u r e t i ct r e a t m e n at n d e v e n t - f r e es u r v i v a l .
Results: Cardiac event-freesurvivalwas worse in oatientstreated wrth
f u r o s e m i d et h a n i n p a t i e n t st r e a t e dw t h t o r a s e m i d eP. a t i e n t st r e a t e dw t h
furosemidewere more likelyto be nonadherentand 2 trmesmore likelyto
e x p e r i e n c ea n e v e n t t h a n p a t i e n t st r e a t e d' , , u t ht o r a s e m i d e( P = . A 1 7 ' ) .
D i u r e t i ct r e a t m e n tW t h t o r a s e m i d el e d t o n o c h a r r g ei n t h e p o t a s s i u m
levels with time. Diuretictreatmentwth torasemidewas not a significant
p r e d i c t o ro f e v e n t - f r e es u r v i v a la f t e r e n t e r i n gn r e d i c a t i o an d h e r e n c er n
t h e m o d e l , d e m o n s t r a t i n ga m e d i a t i o ne f t e c t o f a d l r e r e n c eo n t h e
relatronship
of treatmentwth torasemideto survival.
C o n c l u s i o n : M e d i c a t i o na d h e r e n c em e d i a t e dt h e r e l a t i o r r s h ibpe t w e e r r
treatmentand event-freesurvival.lt is importantto design interventions
t o i n c r e a s em e d i c a t i o na d h e r e n c e .T o r a s e m i d eh a s a d d i t i o n a la c t i o n s
s u c h a s a n t i a l d o s t e r o naen d v a s o d i l a t a t i oenf f e c t s .T h u s . t o r a s e m i d ei s
recommendedfor CHF treatmentinstead of furosernidealso because of
its safetyas far as diselectrolitemia
is concerned.
E u r o p e a nJ o u r n a o
l f H e a r tF a i l u r eS u p p l e n r e n t V
s ,o l u m e1 1 S u p p l e m e n t
1 , I S S N1 5 6 7 - 4 2 1 5
(Online)
( P r i n t )I S S N1 8 7 8 - 1 3 1 4
CopyrightO EuropeanSocietycf Cardiology
COMPARISONBETWEENTHE IMMUNOLOGICALCHANGES
IN ELASTIN, COLLAGEN AND ADVANCED GLYCATION
TURNOVERIN HYPERTENSIVEPATIENTS
ENDPRODUCTS
MELLITUS
WITH AND WITHOUTDIABETES
E. MekenUdn';N. Stancheva';M. Atanasova'; Sn.Tisheva'
F i r s l ( ' l i n i c o f t - ' e : 'lr ' l
l)t, l:,t t itr ,'.'t, , 1 i
Introduction
by developmentof a!herosclerotir
Atherosclerosis
is characterized
plaques,increasedarterial stiffnessand vascularaging.Arterial
hypertension and diabetesmellirus are major risk factots for the
The major
earlierexpressionand progressionof atherosclerosis.
febrileproteinsinvolved in the extracellularmatrix of the vessels
are elastinand collagen.In recentdecades,immunologicalmethods
are used to determine the elastin and collagen degradationand thcir
advancedglycationend productsas a sign of vascularaging in highrisk subiects,The objective of the study was to compare the
immunologicalmarkers- anlielasDnantibodiesclassIgG and IgM
/AEAb IgG, AEAb IgM/, anticollagen antibodies classIgG and IgNl
/ACoUIVAbIgG, ACoIUVAbIgM/ and antiadvancedglycaiion end
productsantibodiesclassIgG and IgM /AGEsAbIgG, AGESAblgl\'1
in
hdth
drorrns
Hypertensives
without
diabetes
I' I i, "t
Ir
1i:
"'
Materials and methods
A s|udt' is conclucted on 62 subjects with arterial h)'Pertension
$ i t h o u l v . r s c u l a rc o m p l i c a t i o n s d i v i d e d i n t o t w o g r o u p s - 3 0
s r i b j e c l sw j t h d j n g n o s e d D i a b e t e s M e l l i t u s ( D M ) a n d 3 2 w i t h o u t
Main obiective
To comparc thi: immunological markers - antielastin antibodies
class IgG and IgM rAEAb IgG, AEAb 1gMi, anricollagen antibodies
c l . r s sI g G a n d I g M , A C o l l l V A b I g G , A C o l l l V A b I g M / a n d
antiadvarrced gll,catron end prodr"tctsantibodies class IgG and IgM
iAGEsAb IgG. AGEsAb I€JN'liin borh groups..
Results
Whr,n comparing the levels of AEAb tgG ,Fig. 1, and AEAb IgM /Fig
2,'bolwt'cn lhe trvo groups with and u,ilhout diabetes, there was no
s k r t i s t i c a l l v s r g n r f i c a n t d i f l c r e n c e , r e s p e c t i v e l y :0 . 5 1 a n d 0 , 4 6 , p >
0 . 0 5 ;a n d 0 , 2 9 a n d 0 , 3 4 , p > 0 , 0 5 .
Hypertensivc's
without
diabetes
Hypertensives
with
diabetes
H y p e r t c n s jv c s
with
diabetes
2
),,4
r,2
t,6
0,8
AEAbIgGA490nm
Fig.7, Comparisonof AEAbIgG lewls in both groups
0
0,4
1,5
1,0
0,5
ACollAl'lgM A 490nnt
Fig. 4. Conrparison oJ ACollIVAb IgM levels in both groups
When comparingACEsAbIgG /Fig. 5/ and AGEsAbIgM /Fig. 6/
levclsbetweerrthe tu'o hypertensivegroupswirh and u'itttout
diabetcs,no statlsticallysignificantdifferencewas found,
r e s p c c t i v e l0
v r. 2 0a n d0 ,i B ,p , 0 0 5 ;a n d 0 , 4 6a n d0 , 4 5 ,p > 0 , 0 5 .
Hypertensives
without
diabetes
Hypertensives
with
diabetes
Flvpertensives
wltnout
cliabctes
0
0,r
o,2
0,3
0,4
0,5
0,6
AEAbIgM A490nm
Flg. 2. Comparlson of AEAb IgM levels ln both group s
flypcrtensi ves
rvith
cliabetes
When comparing the levels of ACollIVAb IgG lFig.3/ and AColtIVAb
IgM /Fig. 4/ in the two groups no statistically significant difference
was found:respectively0,59 and 0,40,p> 0,05;and 0.42and 0,52.p'
0,05.
Hypertensives
without
diabetes
0
0,1
0,2
0,5
0,4
0,5
AGEst\blgG A 490nm
F i g . 5 . C o m p a r i s o nof AGEsAblgG levels ln both groups
I Iypertensives
withoul
diabetes
Hypertensives
with
diabetes
I{yperten s ivcs
rvith
diabetes
0,1
0,2
0,3
0,4
0,5
0,6
ACoIIAbIgGA490nn
Fig. 3, Comparison of ACoIIIVAb IgG levels in both groups
0,7
0
0,25
0,5
0,75
I
ACEsAbI9,\{ A 490nm
Fig. 6. Conrparison of AGEsAbIgM levels in both groups
Conclusion
The identifiedchangesin the immunologicalparametersof elastin,collagenand AGEsmctabolismdid not differ in subjectswith arterial
hypertensioneither with or without DM, which allows us to assumethat the intcnsificatjonof the turnoverof the febrile componentsof the
ptecedingdiabetesmellitus which is
extracellularmatrix startswith the onsetof arterialhypertensionand it. is dcterminedby insulin resjstance,
a late complication when the changesin the vessel wall have alreadv t>ccurrerl.
Key words
Arterial hypertension,DiabetesMellitus, vesselaging,elastin,colagcn,AGEsantibodics
-
(llt.it.rtrrt:
Comparisons of Pulse wave velocity levels betwen Behget's Disease r:nci
control group.
---'l
5,2 t:2,43
SAEI(C2)(Gm3- |
LAE, (C1): large afterial elastisite
Control group
(n:20)
p valu(
13,6+3,64
o"s
6,01+2,6
index, SAE, (C2): small
afterial elastisite
I
I
l
o.2r
index.
l,r Llrtrrr :.
lti .,'rril. ii..r lrtt.r.'. r tliu levcls ol the iDmunologicrl
r i l i 1 r l r, i. . r r ; i r j l \ i. ' l r L . l r r ,. Lr l L i r , r l r . i rl : r \ l r i s l , l 1 1 r l r r S ( I O R B c h a r t .
\ l r t h o r l ' : \ . . , t L r , li r L L ' r . l u ( t i . l t n l i ) 1 f r l i ( t \ A l \ u b i c c t s u e l c \ t f a t i l i c d a c c o r d i n g t o
t l r . )' i ( 1 1 { . l l f . l . l r r r I r l ) L l I r | l r , r r , : : i ) r , l i . r l , ) l . r . r t r l r n r l i r l u t i s k . ' l o d c t e n n i n c l h e
L r i r \ .1r r f : : l ! . r r tr l i l i r r l | . r r ( l \ i ) ) r ! : r r ' . r l l r . : t r ( . L r l t s u c u s e d t h c n t e t h o d o f F i s h c r .
',\'L:n -orrl)iL
llfsul(5:
lli:' 1 lf rll.;il .,'r.1r ot \l:.\b Ig(i in tlte thlee gloups we
lclrlririr.,1..\lrlr\Li,Lil':r:jrl...LIr(]ill(r,rr.,:,t)'i,c{!rljdcnecintervalbetwccnthe
l i o r L I N i l l r l o r , , , r t il lr ! l L i r s f , i [ . ] \ l ) r . i ;
l ] l ) . r r l r l. ) c t $ c c r t l l c g r o u p u i t h l o w a n d
L l l l c : r l . - . l i i . l . ' rli t L S l l 1 ' . l . i l l ) ( r l ) i 1 , r 1 1 ' , ' , 1 , , , 1 1 r! er o u p $ i t h i u t e r n t c d i a t er n d
r i - 5 1 ) { ) . 1 - : : l. ) . , ) . i i - r I ' i ; . 1 ) r r t ' \ L ' s , , l r u L r t t t l l t i o n c o u l d b e d e t e m r i n c d
[ r ! \ \ ! t : f l i r f ] - , r 1 . r , , \ ] : \ ' j q ) , 1r l r . r r r c , r i : ! r o t r p : .
( o r r c l r r : r o r r \: l l \ b i l l ' l i . l r ' i r l t . ! u 1 , . t . 1 1 . , . . . , n r i ) , , 1 ; c s l i s s r r c i l t e d u i t h t h e i n i t i a t i o n o f
l l t t ; , 1 , . . , r , l i l l i r t l I t : , . , r t : ' r . i. . , t , . . . i , n r , ! J L i J r t L P r o e c s s . $ i e h i s a c c o m p a n i c d
lrlrirri.
l , r l l , l r . , c 1 . , , 1\ l , r l r l r ( i
\ i r i i r r i , l1 l ) c S C O R E c h r r t r n d A E A b l g c
i-lrL:lrrrr:ti,L
i ' r , ' r r r i r . L l L l , , . i l r , ,l l : l t - f i l r - t r r r ' \ c r , , L i r l . r i l , ; , r L e t r r . t l r c h i g l r c r t h e c a r d i o v a s c u l a r
r),\,, I
-l)rll lhcrclorc.thehighvascula
1 , , : l t r. ,r 1 r . . , . . r ( l , r l r j \ . ( { ) l i l r : r \
ilr\ r. l, ,, rlirl lrr L|1.'ri il Jii\r\\. 1(,..\\ ('l , l.l:1jlt urnovcr.
PP-t3.1
Evaluation of Changes at Echocardiographic Parameters alter Renal
'I'ransplantation
at Paticnls sith ltnd Stage Rcnal l)iscase
I'l'- 1.1()
Ar:LtErt, Mustrtfo Serktn Korakaf, iran Krlnlkaltt', rlr:a rllr,.r'.
Rc/ikEntrc Alt&ii. Ibrdltin f)tnir', Giiltckh Siilelnntlu'
lMinistr\
oJ lltulth foktt Got<nnrcnt llosltitul. Dcl\trtilrnt tll Ctttditl,,r,
:Mini.\tr\
of lledtlt Nildc Go|t,rnncnt llo.tl,itul. Dcl\trttncnt ol (trLlk)11)!:\
J,l^d(ili:
Llni\'(,rtitt,,\<ltool
o.llvlttlitin(, l)cl'(rtnknt o.lCdnliolo!r .\utttl\,t
Univer.titl ,\chool ol lvlcdi itte, l)el)Lolrntntof lltclthntlo4, ,\rtttLllLt
Sirr!lt.( 'rrrrniur .\rlrr\';ll
llil.1()
l)irlifnts llrrtlcrgoinA Coronarl
:',t1.
/ 1 , / r , / , ' i i' ,\ l ) t , t n t i t t
i t r i , u , t j , , t , , , , r , t,
t.
l!t!\
11tit
l
Angiographl
l : t n r L LIhp r k .
l)
't,j
!titnt
lli)lqe Lgitint \'( ,4rLt,\ttriltu
i.!!),t)it
Introduct()n: Chrcnic rc'nalfrilurc lCRF) is chrrxctcdzchv clrronic.frorr! " v( ir rLl
i n c v e r s i b l cl o s s o l n e p h r o n sd l r c t o v l u i o u sd i s c a s c s . ' l h cl n o s l c o r n i l l ( J r ), . , s ( , r i
dcath at cnd stagc rcnal disease(ESRDt is cardivlscular(C\') conrplic.rtiorr' At tlr .
s t u d y ,$ e a i r n c dt o e v r l u l t e t h c c h a n S ca t e c l t o c r r d i o t r r p h i cP r r r r r n c t . r . . , l ( . :r . r : r L L
transplantationwhich is acccptcdas lhe best trerlllrcnt Dodrlit\ lor ESlll )
I,
Nlethod: Tlrirtl' four paticntswerc included into thc studl voluntrrily wirl, .r1,i,lir(1
A k d e n i z U n i v e r s i t yF
. r c u l t y o f N l c d i c i n e(, l r g a o ' l r a n s P l x n t u t i oLI r r t iot r n c l , l r r rr,' , r :
outpatient unil. planncd for rtnal transplantationfrmr live drrnors. \\rl]1 LielDrrr
opcratioodatcs.EchocardiograpliicmeiLsuremcnts
wcrc p('rlbnne(lprco|.rrli\. l) .rJr
rt postopcrativc6th nronth.
l'tndrngs: Lcft rtriunr (l-A) was nlcasur('danclin ordcr to cvalualcsizc iurl l( rcr .):r:
of leli vcntriculc (LV). interventdcLrlar
scptrl thickness(IVST). lcli !cntriirril |ilil
t l i a s t o l i ed i a m c t t - (r L V E D D ) . l c l i t e n t r i c u l ee n d s i s t o l i d
c i r n r e t e r( L V L S [ ) t , j , , , s 1 i j r . 1
wall tbickncss (PWT) u'crc ncrsured, cjccti(nl .iiactirrr (.Dl;) rr iis rru,r\rL, d ;r.,1
conrPilredPreopcriltivel\and iit postoperative6th nronth.Thcre rrrs Jn ililr',i, c re I
{t all piuamcte(s whcn prcope(atiYcaod fostoperilli\c 6r.h trr{)nth r.rlrr. r rr
conrparedancl there was statisticrl signiliciancctTablc L1.
Conclusron:There was an statisticallysignificart irnprovcmcnlat xli parrrr!r! i \\ llfrl
p(eolrcrative aild postoperali\c 6th nrcntb echocardittgraphit l)iuiDlrlil . \ (r '
c o n l f i a r c dW
. c s u g g e stth a ts i g D i l i c a ni n
l r p r o v e m c nat l c a r d i a cs l r u a t u l cr n i l l L f ( l r ) r ' ,
c o n r r i b u t ct o d r ' c r e r s i n gp o s t o p c r a l i v cl n o n a l i t ) . P o s t o p c r a t i r cc c h o j r r i l i l , . , f l l i l r , '
Ircasulenrcntsol prtients who under\\'cr( rsnal transplaDtnlioir
should I'c 1.r,rrrr.ri
on a rcgular basis.
( )l)irfttl \ ): Irr
Table 1
! r L . r L l : r r l . ' J r . r ' ( l r . l , . , s l ' - r t l n r r . , J r i r j ( ) I r r l i ! - n t s. r r d l l . 1 ( 6 1 7 o ) o f 5 6
l , i L I i f r ,l (r .L I 1 , i ' . ,.!' 1 . , , .
l l e s r r i t r : \ 1 , r t . rllL L r r ri l:
I . l l . l l l t p . r l r r - r r r r r r o \ i i s L r n d c r f o n cr o u l i n c C , A G w e r e
r : r r l L L ( Lr ,) L1l j : , r r i r l ! . . r : L
5 r( , r r r . , . , 1 , ' t ' , t , 1 i r r ) ^ r ( ) ( l l l ' i i ) p a t i . t t s . T l t e r e w e r e s i x
i , r ; ) : . . 1 . , i. . i 1 . t . r { r l , r t . i ) r l . t l l . l r i 1l - , t i , 1 , . R _ l l l . 1 6 ( ? 1 t o ) t y p c L I a n d l 2
I t'i
1 \ r , . I l l 1 ' L t i r,
L r ' ( i i r , l i i Ll !, ) l r . . r t . { ' r t l . L r , l rci !l n \ \ i l i c i ( ( i o n .
{ o r } r l i l s r , , r s : , ) r , i j L lr \ , r l , r | , i [ 1 ] i t , , L r r , , D I rC
]
tire titrcly \LrcI clrrring roulinc
' r r t l j . t r . , t l r c r . ' ur , r t i , r r r L l . l t i t , l . r r . l , - t , r ' Li \ ( l : i . - l ' . i i l a l g i o ! r a p h i c s e l i e s a n d
Patameters
r i i r , , , , ) ' l \ l i L , 1 ,r r L ' r : . ' 1 1r L ; L !r l 1 1 l ci t t c i t l e D c co i s i l g l c c o r o n n y
r Lt ( l i r - ' \
l l i l c l \ ! r l r L l ! r ( i ; : ' L r ) : t l , r. , , r o : r , r r i . l r i ( l \ l S ( \ , r : . r L . r r e l r \ c e n c ( \ f o n A _ y a n o n a l y i n
, . . , t t . l rt , . i , i , , ) t i i l l ! l \ ' r j t L l \ . : , , 1 " l t r : r L , r \ \ f , ) . , 1 \ r l t t r \ m s c l i t l u s i n g l c r o n i c
. nrr. It ,' Llltr. rLi .r.r:r 1., rlLrrrl' lrurr i io:(i. rr rngiographv (CAG) or lound
r ! i L i r r L i j r p , r t r , , r i , . l ) , r \ . t i r i r . r t . L ) l L l l r . r . r r i i n c i ( L L ' n c eo i 0 . O 1 4 - 0 . 0 6 6 7 o i n
I r r r ( r . L Il ) | L r l , r l iI ' l l ( , r , , 1 l l r , \ L i l : ' . r r , l i e r r r r
..,i,1,'lir.,f[.].,'. i.Ir lrr l,ti..]tl\'.1 lr. l1|1lnli. ci
r ! ; I t t i , , i r , r r i . r L L l i : c .l rt , r L l t . rLel - , l L l . f l L l r ,L r : r: l . i {
, r r f , , r t ! : r l , , l r L . . L l , i t . rl i a i l , . \ u r t i l ( !
l \r
..r i r .1.
. l i n r c l l l v n , r D i i - ! t r i n c a nht o w e v c r
.Inc1.5rna,,'ra. acutc myocudial
\ l t r r r b c r t j g nc o u r s e m o s t o f t h e
r\ritLll()l)\\SlLtdicsitwasShowDto
r
\lethorlr:\(,\".ilitr.t.,.rlro,l. rl.!l rlr,illL:l:0(.\(;perlirrniedbctrveenl998
'r'jl\\t,,r't:
L,r!l
: l \ N i . ( ) 1 i , , . . 1 ' 1 1r.,,' 1r L L t , , i Jr . , l u t ( r u l : t u d \ . P a t i c n t s w i t h S C A
\,:r!,rlr
t i r t a l r L ) \ t ! ! t . , t j _ \l r , ' i : t i L ' 1 , ) i l . r lr I\ L ' n t ' l , l i l c s c l c a t c t j b c t u c c n t l t c s c y c l i l s
rLi,1ir,.Lrrr,
i L r i , . r l 1 r r L t L r . . , i l \ ( - , \ l , . r t ! c n L .\ \ ' e r c r l c t c n r i n e d . T h e c l a s \ i,,r.r r i.lr.tr,L)tr.jlr,Lr.t.l\.(i,iii1!r!'llclas\ilicationsdclinedby
-llr.
iirjtli .rrl I ri,L,,r. rLl ,orlir:1,-..
l'rrr:Lrs :\:lcl! cotsi\ts of thrcc groups
. L ! a | , r l i nI l ( , r l . f , , l i i . , - . r l , r \ ! r ) r { , r . r i r I r : i L
lr]\('l!cd. l,rpton and collegues
rri
i.
L ( . r r . , rt , r
, l . L . r r r .' L l l r c L L i r Lr ) i L r \ , L r ' ,i t : r l t r : i r r .i . i r , ; I l r i ' r r , j , r r S t o t h c o t r - r j r t a t i o no l a b n o n l a l
( 1 , r , ) f| \ r L r ' i r \ \ r L i t r ! ri i i ' r l i L : t l r t r r r l r l i . o t L l l r r r . . i r r r r s - 1 9 ( 5 8 r , ; . ) p a t i c n t s h a d c x p e J r r r ' . . . \ L! , . ! r 1 r r ' r. L f , i r rr r , . L . t r r l \ 1 ) : i l ' l r i i r ' n r . l l . ( l c r t r t i t l r a l d ! s p n e a . t h r e e ( . 1 r 2 , )
lr.(i ..rr.. l,( l',rrr (l' r ).1(1
lLtrl erctlional angina and palpi
l r . Ll ) i l i r r l 1 r r . . , r r i " '
l l L l i t r t , i I t . l \ t ' , r r / ' , r l | i , 1 . \ . l r : l i r r i r l l t l r 0 . . t i t r l s r r r c o P c . l ' l u e c o f t h e p a t i e n t sw e r e
r ( l r l r t r , , ,l j t i t i r i r ! r L f l r . L ln : t i r , . L r r r ! . -r '-t' r , r 1 , i l . n t s h ( l p r f i < r l o g i c S f - T c h a n g e s
r , L rL : ( i
PfeoDerativemean lss
Postoperativemean fss
I
Pv
JE
LA (cm)
3,57+0,58
LVEDD(cm)
4.65+O,74
LVESD(cm)
3,101O,66
26,35+0,43
O . o)(1
IVST (cm)
L,L7+O,22
1 , O 8 -o , 2 1
0 , 0 {) 1
PWT (cm)
1.13+O.20
1.O71O,13
o . o'{l
62,35+8,O6
70,3810,73
o . o rt 1
EF (7o)
Echocaadiographic
0 , O)( 1
3,19'0,41
3 . 7 91 0 . 5 5
I
0 . 0 1l 8
parameters
i | . . r t , r '. . , . e r i i
l . r , , i L r, , r . r s f r r r , l - l r i i r : l l - i 1 . 1 { ) . o r o l r r \ r n ! { i o g t x p h i c \ o f
. . 1 1 r \ r r , r . r . ( 1' . r , . t r t r . r r t l r: ( , \ , . , 1 1 r . ' i , - r , l r r r c c i s O . l l r i C o r o n a r y a r t e r y
. . ri ) r j L .ttL . . L r r' l r r ' ' : , , ' t r . l r j , r \ 1 r o r r i I t , i I c . . r . . ' r l r l r i s u t l t l c nc a k l i a c d e a t h i n y o u n g
. t r l i r , , l , r i . , i i i : t r , , , . r .. r r I ' , . , ( r t , - i r r. u r ! t . l t . L l L l t ( , r ' d c rt o l o w c r t h c r i s k o f
. L r , I l ,i r . . r r L l L . Ll.t:l t l r I t t r ,
\ u l i r r i t ) j r) l . : p c " r l L r 5 [ ) r ) t t 5 n t c n$) i t h h i g h e r s u d d c n
l){,
r l r r ' l i . r ri l , ; r t l rL r \
r i',
lt\.r:
PP-135
Correlation bet$een son€ Imnrunokrgical Paramet€rs,\gainsi l)lartin rrrr, tl't
Score Risk Chart
,\jlszlturkaTislu'vat, E<lwtrd Mtktntntt, Natlid Stutcltcrtr',IIrlttt,t r\r,tn,t',, r
KoD\l dnI til U o\ podt tlol
l First
tr , r
Cltuic oJ Curdiologt lJMHAT "G.Strtntski" I'letctL.BulgLLtitr.21),,1,,,,:,,
Bitkttt lvlll - Pltven, Bnl;+rriLr
lntroductron: A(herosclerosisis a clrronic,progressive(lisersetllxl iillcel\ tllL ill rrl
L a l e ro l t h e h r g c a n d r u c d i u mr r t e r i e so [ t l t e b o d 1 . N u n r b c ro f r i . k f r r t o r . . r . 1 r . , ,
rcnls oI nctabolic syrdrome, coDfibute lbr its errlicr mrnilcstati()nand pt,'gr. ;s||
Thc primary mechrnism lbr avoirling the complicationsofthc athcrosclcr()tie
1,,e.,t
i s a n c r r l y d e t c c t i o no [ t h e v a s c u l ear g i n gr n d p r g v e r t i o n S
. o f a f { l l c d s l r t r . r t . 1rrt.: ,' r r
is pcdornrcd b)- thc SCORE RISK CHART. Vascular aginil is assrre
r.Lrr,ln rtlr
rccclente.l turnovcr of thc fcbrilc protcin ehstin wiclr is tlrc nrain conr|oilcrr n 'rL:
rtrrrclureol the lcsscl u'all. A constelhtion o[ [rarkcrs rrc rcriuirt'Llfor l)r',1..-r.1.
stratilicition an(l earlv assessncnlof the nxnlhological vasculrr rlranitc'.
c 13.1
l)orvnloadcd
l'rom: https://content.online.iacc.org/
on 0 | I 24l2ll6
l,\((
\ , , , 1 , l ' 1 , ( . 1 ' , L, r
I'SC Abstracts/PoSTERS
7
11t:
tzil* vr,,*J1,.2/t"t1'ri2z'.)
12,'1:1,,. 1
7& / zo 74a2,)r.?a4r.
?54 227"94
2 ri'*1.',)
n
72.r.2"1
.,
N. Stancheva,
n':\.t
K.Gospodinov,
[. iVlel<enyan,
lt. (r15y1;;t
Pleven-BULGARIA
t::., I
r.17?v.,27t-2it,t?:,
?,2:4tJ
t:.tt i.,,',:.., ' , i :
73 t zI 2?2,:tzt?ac
Sr
* ?1t ?wt 77a7t2t?4
227
B = l l D l s d r ' ,G .F o d orr, G A b r a h a r nP' , L c g r a r l v ' . : ' , I r . .
' Steged-HUNGARY
t 0ttoh/a'CANADA,
J Hodnrlol,t:
tt 1l
.. :.,
t,i1',2 t;it./:7t:rz':.:2t
79 t zz ,'rv-i)tr,zt'7;t...tv;
,Z7,a
r.ra.-Z
t7::1i'4, aTt2tt1,
[. Shavarova,
Z. Kobalava
I. Darmaev,-r,
l',4oscovlRUSSIA
*r
Vr,}
/ st {*ra?aazt{}?
1t74.zvz.a,,r.:1::,:::,,:.
,.
%&/ zl ?..ttttz,t7t:? t7t:7-'zt?:t,i
l. Darmaeva,
E.Shavarova,
Z. Kobalava
A40srcw-RUSSIA
t /t 7*2{}'.4
A9f} LA?.84911,
T?tt
C.Diaconu,
F.Badila,
G.0p
N. Carstea,
A. KostovA. Da
BuchorestR0MANlA
"t&
z}?vi?7,zt:z,:t::,ziazt
v,..,.,t,..:,,,::
/ za {2t}t.1-1-sl
jZTtZZTztt'.7.v.2V?7,.TtV172177:?:t"
l',?tT
V,_Plattgv,Y Chuyasova
Kirov'RU55lA
t*,
7Z t tz 7"tu7t*741;'t
,?2r.4{}?ztt?-t"1}}
l-C4CIa,T.Daiki,G.Oanko
Budopest'HUNGARY
:tz:.::..:
i&{7?21
?.2w
72 / zs t/,.tt*z*?:.atzt'"tz*tzr"
*{ t
/ tz 1nz?r1*{tLr
",,;i2
{){ ?4'{}?:472,}
Lli;..
K. Protd5ov
n
, T.Myagmdrsur{1Irkutsk-RUSSIA,r UIaonbo]to r-A/tA
N60LIA
.t&
t-zz"7t,)ztlvtl/-:..j1..-r:17:.
11: ;..
1:z?:i'z?
/ zz 2,J1.,1,:?:,zt'a:t
I. rVlarotta,
tu1liccardo,
L.A.ferira
G.Albano,
Naples'ITALY
?.,..:/'-' .
tt:t,a?t.v?1v7iittr,.
% / ze ?ai:';,,.J?1".',t27:?r.1ri
a,',,12:.,..,.
/.i',.i|.,
.:,.1,. :
2i) 1* -ztJZli 1,ra
2.t2r7-i211'
2
l. Kiss,l. Barna,T.Daiki,G.Dankovirs,
E.{.(:itr:t
BudapestHU!,tGARY
,i. t:?t ?r,tzz'f t.AAq.V4Z5t
AlZt
', R.Zarrink
1.Hasselstrom
.f.
KJhanr, K.Manhemr, l. I
' Stockholm,. Skovde,i 6ttt
lo L?.Tz.gz4'422v
V.3
'lj'/; t
?/v.{47
?lzt*7.
t
l-1.PenaSeijo1,M. Rodrig
L.ValleFeijoo5.B.ValleFe
7,
[4. NInezFern6ndez
J./\' Sontiogode Compostelo
I Pontevedr0-SPAIN
5
',."/,,
atv
1.,
?24/J'1t-7:;:;:,:,i
?,i.:..t:..i:..
% / ze t?2,-ttlrz1zTt/{-r.s?Z?lzt}'z:i27V-7zl.,rV:.7:
772r)472Vtr52r.3?;i;
ttt?t,t,:...a.i,::... i'. ,' :, ,a
R.Mohebi,B.Yazdani,
tul.B0zorgrndncsh,
F. 1at'.t,::t.,:'
f,':, l1
tehron-IRAN
t zg t''zt*wr.*ts*?r
7LZ
E.Tintea,
[. Badila,
C.Diac
N. Carstea,
A. KostovA. Da
Buchorcst-RO/',4ANlA
Vlz/ v
t' t
*a*zTtt ?&v,'
zji:itzl"*,
4*"r.24.'*Y
* 4{2.727:}31
T.7
r,T.Aflnsoyr,K.At
B-_Altun
6.Suleyman3
lar
' Ankora,2lstonbul,l Anta
t
l;"2t ts u'{??qzt?4?,1{
..217t
rJ?.,7t.
fr.V?.iztZr3?
lz2j{171:.
12
/r-.AbdsrchmagR.Bandia
8andung-IND0NESIA
z1a2u6
My ESC CongressServices- AbstractPreview
D o c t o rN a d i aS t a n c h e v a( E U D l D : 2 0 5 8 4 1 )
UniversityHospitalOf Pleven
l s t C a r d i o l o g yC l i n i c
Georgi KotchevStr. 8A
5 8 0 0 - P l e v e nB u l g a r i a
P h o n e: + 3 5 9 6 4 8 8 6 1 4 0- F a x : + 3 5 9 6 4 8 8 6 3 7 0
Email : nadia_stancheva@abv.bg
T i t l e:
I n c i d e n c ea n d p e c u l i a r i t i eosf a r t e r i a hl y p e r t e n s i o inn p a t i e n t sw i t h p s o r i a s i sv u l g a r i s ,
T o p i c:
0 1 . 0 0- P r e v e n t i o n
and Epidemiology
Category:Not Memberof EACPR
Option : Young InvestigatorAward (YlA)
l e o r g iS t r a n s k iP, l e v e n ,
S N . T i s h e v a l ,K . G o s p o d i n o v lE, . M e k e n y a n l N
, . S t a n c h e v a lD
, . G o s p o d i n o v-l ( 1 ) U n i v e r s i t yH o s p i t a G
Bulgaria
fntroduction:
Psoriasis
e a chronicinflammatory
skindisease,
mediated
by the immunesystem,whichattacks2-3o/o
of
the population
withan increased
cardiovascular
riskprofile.Objective:
A surveyof thetypecaseandis connected
controlwas carriedout.Themainaimof thestudyis an analysisof thefrequency,
heaviness
anddegreeof controlover
hypertension
arterial
andcontrolsfromPlevenregion.Materials
andmethods:
A case-control
or cohortstudywas
groups:patients
whoneedsystemictherapy(n=103),
conducted
of thefollowing
withmoderate
or severepsoriasis
(n=101).
according
controlgroupof comparable
ageandsexwithoutpsoriasis
Bloodpressure
was measured
to the
(WHO)aftera ten-minute
recommendations
restin a sittingposition
withthecuffput
of theWorldHealthOrganization
manualsphygmomanometer
was used.Threemeasurements
weremadewith2 minuteinterval
on thearm.A standard
between
them.Theaverage
valuewas takenas referent.
Measurements
weremadeon bothhands,the referent
value
(SBP)>130mmHg,
beingthehighest
value.Hypertensive
wereconsidered
subjects
withsystolicbloodpressute
(DBP)> 85 mmHg,or treatment
diastolic
bloodpressure
for previously
hypertension.
We examined
themean
diagnosed
(PBP)in the psoriasis
groupandthecontrolgroup.Theseparameters
SBP,DBP,andpulsebloodpressure
of the blood
pressure
wereanalyzed
in thestudiedgroups.Results:An important
increase
in the
resultis a statistically
significant
pulsepressure
prognostic
of patients
with psoriasis.
lt is knownthatpulsepressure
is an important
indicator
for
upcoming
cerebrovascular
accidents,
especially
withvaluesabove50 mmHg.In thisstudytheaveragePBPof
subjectswithpsoriasis
was 54 mm Hg.Thisfactallowsus to assumethatin psoriatics
the rigidityof thevascular
wall
is higherhencetheriskfor developing
is greater.
An extremely
cerebrovascular
accidents
Conclusion:
highfrequency
of
arterial
hypertension
was determined
bothin thestudiedgroupandin thecontrolone.Withthe advanceof age,the
pressure
severityof arterial
hypertension
increases,
whomanageto controltheirarterial
andthe portionof patients,
decreases.
Theyoungpsoriatics
theirarterial
do controlmorefrequently
bloodpressure.
http://escol.escardio.org/MyESC/modules/congress/AbstracVAbstractBeforeSubmit,aspx?abstractlD=gGrlawodOyXJ2GPtt%2b%ZSWGThuSgpi
1l'l
M
PREVALENCE
AND TRENDSIN /\TRIAL FIBRILLATION
AMONGPATIENTS
WITHARTERIALHYPERTENSION
OUREXPERIENCE
M EDICAI.I'NIVIiRSI'I'Y
OF ILEVEN
MekenyanE., N. Stancheva,
K. Gospotlinov,
T Chakalova,
S. Tisheva
Clinic of CardiologyandRhcurnatology
"Prof.K. Chichovski"
(AIt) in paticntsovcr ugoof l8 is dcfincdas svslolicbkrod
Arlcriulhypcrtcnsion
prgssure
equalto or higherthanI 40 rnnrHgarrd/ or diastoIicbloo(lprc':sure
equaIto
or highcrthan90 nrmHgor itlcntifiedasclcvntedin plticntswith nrulriplcprclious
rne&surctncnts
takingsntihypertcnsives
drugs. ( I ).
Depcnding
on the€tiology,hyperlcnsion
is primary(cssentiol)
tn(l sru)ndcfy- in
whichtheelwatodbloodpressure
is dueto another
endocrinol
ogical,rcnrl,
disease;
ncurologiculandothcrs.Thc dcvclopmcntofcsssntialhypcrtcnsionis thc rusultol
thc interaction
of envircnmental
t'actors,
li{'estylo
andgenDticprc.t!spositiorr.'l'hc
longcvolutionofhypcrtcnsionlcadsto a nunrbcrufpathologicalchangcs
in borh
smallartcricsandarteries ofmediurn and largccaliber,This leadsto iur irrcrcased
pcriphcralvascularresistancc
with subscqucntdurnagcto otlcr organsrnd s1,stcms,
Them0intlrgct or'gansorethebrsin,heartandkidney.Increasedperipheralvascular
'l'hc
resistancc
lctrdsto an increosedpreloadwhich increases
lc{i vcntricuiarsrress,
prcssure
cnddiastolic
leadingtr:u haenotlynanr
ol'thelefl ventrioleincrcases,
ically
significantstressto thc left atriunr.Hypertensionis associated
\4'ithearly aodi.rpid
progressivcatrial remodelingand otrial librosis, which is a nrorpbologrcal
prerequisite
for themcnifestation
ofatrialfi brillation(2),(3).
Of (l,c htil
tunrh(t
!l
= -r14) w!r$ with rt;hl
J'{tiLnts 34% (n
fibdll!rio(
t tDmlhc frtrcr!5 wirh .rrial tibilllrtion(n - J14),with AH w.E 306(94.,{%)
I rcnr rbr paucnlswirh atrinl tibfillstion (n - J:4). with AH wcE 30d (94,4%)
0tr.|rh,'scurthoulhypcdcf,sit4uqrcIE (5 69;)
A surveyon the distributionol'atrial fibrillation(AF) iu patientsu irh essrntirl
hypcrtcnsion
who werc lrcatedat l)cpartmcntof Cardiologyand Rhcuuulologv
P r o f .K . C h i c h o v s k" iM U P l e v e nl b r t h e p c r i o d0 l - 0 1 , 2 0 1 0/ 1 0 - 0 0 . 2 0 1 0r ,v i r s
conductcd.
Total uumbct of patients- 954, of whorn 918 /96%'/werc dirgnoscdu'idr
hypcrtcnsion.
AF clsssiflcation:
Ifa first detect€depisodoofAF sclf-termioatcsin lessthan7 tiays antl rhcD
anothorcpisodobeginslateron, theAIr is c$ltctllroro.r.vsnol
,4F. Althorgh
patientsin this categoryhnveepisodeslastingup to 7 days,in mosrcasi:sof
paroxysnral
AF theepisodcs
will sclf-terminrtcin lessthan24 hours,I I insrcr<l
thc episodclastsfor morc than 7 days,it is unlikcly to self-tcrminrtcand ir is
calledpersislent
AP, In this casc,thc cpisodcmay be terminatcd
by cerdiovr:rsion.
Ifcardiovcnionis ursuccosfulor it is not attcmpted,
ondthe episoduis ongoing
lbr a long timc (e.g.a year or morc), the patient'sAF is calle,J
pcrmancnt,.,
0
2c0
a6
'l'hc
ilern lgc of pulicilts witt paroryrrnnl AF ir 59,5y.
Tl). nrcrna8. ot pllroh!r*ith pcfiiFrcntor lr.rmlncnlAF ir 71,8y.
Ofthetotslnumberof paticntswith atriulfibrillation(AIr)n"302u,ithparoxisrnal,,\F
weren-102(3 l%) andn-222(69%)with persistentorpennonentAF.
Dlstrlhutlonby gendcr:
Amongpatientswith paroxismal
AF 60 aremsn (59%)and
amongpatientswilh pcrsistcntor pcnranenrAF 108arermcn
(49Y0),
Dlstrlbutlon by rgel
Ftom the paticntswith poroxysmalAF 66 arc over 55 yearsof
age(65%)and36 arcbelow55 yearsot'age(3596).
From thc pationtswith permanentor penistontAF 180arc over
55 yearsofagc (8lo/o)and42arebclow.55yearsofagc (19%).
?.Ld
t0
s
fl
s
lo
ril
Fdlnd
Af
f.&6rii
F.da.d
d!.dmd
f
l"ron thc k)1rlnunrbcrof paticntswith pnroxismo(
Al.-54 (53%)have
ovcr5 ycartluratiuno1'AI'land48 (477o)hlrvolessthan5 ycarduration
,:fAl L Frrnr lhc lo[rI numbcrofpaticntswith pcrsistsnt
or perm0nent
,\F 174(789/0)
huvcover 5 ycar durationof AlI, 30 (13%)haveless
thrn 5 r'clrs of durationofAH cnd 18 (99b)havc no historyand
o h v s i c a l d altbar A H ,
COLLAGEN IMMUNOLOGICAI, CHANGES
A MARKER OF E,\RLY \/ESSELAGING IN
PREHYPERTENSTVE
PATIEI{TS WITH
METABOLIC SYNDROME
N{ED]CAI,UNIVERSI'I\
OF PI,NVI]N
N . S t a n c h c v a 'E
, . M c k c n y a n r ,K . ( i o s l r o ( l i n c r vS' .. I ' i s h c r r r '
l . r \ s r g n i l i c r u r tc l a t i o n s h irpv r s c s t r b l i - r l r cbt cL t r r c c nl g . \ - c o l l a g c nl V - a n d
i g ' \ - c , r l l r r r c rl ltl ' c - l r o t i t r L , t l i c)s' - 0 . I 5 ; r { 1 . 1 9 5r: - ( t , 5 2 5 p; - 0 , 0 2
Background
a
Metabolic syndromcis associatcdwith carly vessclaging, charactcrilcd
by changcsin thc vascularwall clastie:ity.
Thc fibri1protcinsclastinanrl
collagenoccupy an importantplacc in thc structurcot thc vascularu,rll.
and the hcmodynarnicpropcrlicsofthc vcssclsarc tlircctly tlopenclcrrl
on
thc compositionantl organiz-ation
of thc cxtracclluhr nratrix
-r"'i,,,I*]:--l
::[-J
'"ili- r - r ' ' : . l i i
L i i I l
'"I ';:^."i.'"^;';,.;i'
"
Aim
" "
liclattonslttplttl'tL'Ln Ig.1-ttllagart ll'ail
To cvaluatcthc irnmturologicrlparanretcrsof collagr'nrnclabolisnrin
subjcctswith familial prcdispositiur lbr hy,pcrtcnsionrvith high nornal
blood prcssureand mclabolic syndronrc
lg.1-colltt;qcn
tvpc-l ontihotlies
5 . I I i g h l \ c o rr c l r r l i v cr c l r li , ) n s h i pr v r s c s t . t brls h c db c l w c c nt h c e x s h a r g e
L ' l ' l r r \ r ' o l l - l V r r r lt gl l i - u o l l - l l l - a r t i b o t l y y - ( l . l - ( 80 , - 1 9 6 x ; r = 0 . 9 0p1=
( r , 0 { JI0
Methods
A "case-control"study is conductedon 127persons.36 ofthem urc
prehypertensivcwith metubolic syndrcrnc. The mcthods ofthc studv rrc
basedon th€ enzyme-linkedimrnunosorbentassaytirr the detectionof
specificantibodiesand the tlegradationproduotsin the serum,iJP
m€asuement, statistical methods
Results
ll<,ldIi,tn:lti1.tlvlttttt
l!:.1 colI I'r'atttl |2y(i coli-lll-uttibod.r'
1 Slr('n! c().r(lrlr('n $lrs al.L' tbuil(l bct\\ccn Ig,\-c011-l\ rnd IgN{-coll-l'r i n l r l ) ( j ( l \ ) = ( - r l. . l 5 r { ) . . l1\ i r
0,9: p.={),0{l0l
l. A weak linear relationshipwas detectodbetweenthe pulse pressrrre
r I)l)
/ at baselincand lgM-coll-lV-group cntibodiesin prchypcrtcnsivcgroup.v
0.294x0.009:r (r.19;p 0.{}2.
r/-.dL rr r-t tM .oll v e
i*.e:1 lv iBlngdl
l l c l t l r t t i i r i t tb r ! \ t ' ( n
-i
Relotionship benvecn the pul.\e prcs,\ut? PP / ond lglr[-collll'-5ytorrp
ontihodics
2. BetrveenlgG-coll-llI and IgM-coll-l-antibodicsrnticollrgcnic
intibodies r strongconclation was dctected- y - 0.?10 +0.522 x; r
0 . 9 0 :n = 0 . 0 0 1
E
l,l l-Loll-ll
S r g D r l l c r t n tl i n c a r r c l r t r , r I s l t r p \ \ r s 1 \ , 0 ] 1 (ll) c l \ ! c c n t l l c l c v c l s o f l g G 0 . : 6 . 1 0 . 1 1 6 4x ; r =
c r l l l - l ' . r r r ( i l r r r r l i : r' r r r l I g N l - c o l 1 - l \ L r r t l t - i r t ' J i c s : )
ir 6lli l] t),1j1)rJ1.
;
Ia0 !olttAB/ku
3. Also a strong lincru rclationshipis cstablishe,d
bctwccnthc quantiticsof
IgG-anticollagen-llIantibodiesand IgM-anticollagcn-tipV- antibodics- y
= 0.2 I ? +5 t 5 x: r = 0,820; p = 0.002.This rclationshiptlcmonstrutcsthrt
IgG - mtibodics againstcollagcn typc lll lbrn in thc initial stagcsot
hypertension and thcrc is a rclationship bctwcen thsir lcvcls and lho*e'
againstcollagcntype V
c" ."*^B&!<.trv ^B
i
i
.
='.
"
(ou V
AE
: ,,
l ' l e l t t u t t t : l t i l t 1 l ,l r r r , ' r r t / ; r / r L ,
Relationship between lgG <'o I I JI I und Iglv[-tol l -l-ant i bodie.s
anticol lagenic ant i bodi cs
t r r r , ll t 7 : l , l . t o l l - l o r t i l : o r l r
lt <,1l1G-col!-l-urtrl.vilit:. ,tnl {git{< olt-ll'-
l i . S t u , l g l r r r c a rt o r f e L l t l o l \ \ ils irls()l(,un(lbftwrcr
() It9 r l 0ll: r
V r n d I u ( i - c o l l - l I I r n l r l r ( ) d v rv
a
lli:1ilil,)it.rlti/t hLttatt
..
tltt, l,,ttl:
lhc lo cls of lgM-coll.
(r.(,9.r;n..0,0014.
;', "
ol Ig,lfltll
l un,l TgG<oll-lll
antilxtls'
-">b-
,
,
-
IlelatioNhip between th? quantiries oJ'lgG-anticollagen-lll uutibodics ual
I glV-ant icol I ugert-t1pc l/ - t n t i bod i es
Conclusions
ln prclrypcrtensivc paticnts with rnotabolio syndronir' the
turnoler of IgC-class type lV colhgen is signiticanlly i
conpared lo heclthy subjects.'l'hisoccurseven bsfire the
prossurc values reach thc levels conesponding to b0rderlin<i
:rflcri.rl h1'p;rtunsion.
S t r r n r k i .I ) l c v c r .[ l u l g r r r r
EFFECT OF METAI}OT-IC]
SYNDROME TN
PREHYPERTENSIVI.]
PA]'IENTSON ININ{UNOI,OGICAL
CHANGESINTELAST'INNIETABOI,ISM
\t!:utcAt_ L \t\'f,:HSt.r'r
OF'PLEVEN
StanchevaN., Mekenyan 8., GospotlinovK., Chaka|:va .f., .l.ishcva
S.
Georgi Stranski University Hospilal I)lcvcn Ilrrlsiiria
Background
Objective
Materialsand Methods
Results
AnexccssofEDPinthcDrchvoert!'nsi\cpersoD\mtnpJrl-dtotlteuonlr0l!11,rtp\,r\!iliLl)lLshi(l
Ir
The levels ofthe two intjiearrr-s
Groups
Begiming
One year follow up
l)th!c.l - J>lusttn itgntrl;uitt
7.i):p
{).01
I i ; ( l T ' r rrrn l r
X .I.SI)
II
Prehypertensivepersons
Controls
2o
0.-11l:.{),(Xr1
0 . 1 . t 3r - 0 . 0 : 5
Prchypcrtensi
vc pcrsorrs
Controls
i,
-.1
2ll
0.(rllr,(,.()lj
0.215r0.{)ll
3tr
0,0t
9..4t"
0,0r
y,t,1.ttit/(.s
i{t ,rt !j.,,rt:,.,(.u.,\i,
<.1;r) \t)
'l-hc
t c s t s . c o n d u c t co du r b y l : t . . l S At l i d n u r s h o w s l i l l i s t i c d l l v
s i g n i l i c u ntrl r i l r r . r r t ,: l ' . ( ) . ( ) 5 w i r h r c s l ) c ( lL oa r r t i c l r s t i n
a n l i L r o r l r ce hs s s I c A . l g G a n d l g N t i n t h e
prcnypencnsrvcrnd controls.Thc Icvcls ofthc rntihodics
ar., n'rqseiltcrrl
rn r.. c l
Groups
Prehypertensive
persons
Controls
36
20
_t
T u l r l t : . ) - l . i : t t ' i . r , t l , r n i i L t i t , t i tttt n ! i l t r t . l r . t i r r i i t l
IgG
X +SD
Ig\1
X rS[)
Ig;\
X i' Sft
0,597+0,056
0,37710,093
0 . { r 9 5 , - 0 . (I } 5
{ ) . { ) l i 5 2{ )r .I 7 7
I,0I(i+0.t29
{ ) . 8 5 r ) + I{ 5
) ,7
l.l9
>0,05
1 . 67
'0.05
1tr,.lil1tltit.l)tjt,i.: ,. ,
I
?q
'0.()5
i,
Levelsofantibodics agtinsr gll'crted clastin in prchypctlensjvepcrsons
tn(l cl,irrl ) l ; \ ' r r c n r ' l s t g r r r l l ; r n r l i , t l i l l c r cI ihl te.l e \ c l s o t ' l h c | n t i b o d r c s r r c p r c s e n t c t d
In lable.3
ACEs
X +SD
Cloups
Prehypertensive
persons
Controls
0 , 30 3 a 0 , 0 1 , i
0,334r0,023
JO
2ll
F
'l-ablc.3
0,54
>0.05
- ,lntihotlt(.\
dtuil,;l
utlutti.:t.:Ll ti!it
:t/ir,i
t'tttl
/tittt,/tir
t.t iti
lir
/t
,,
,l
)
Conclusions
In prehypertensive
personsrvith rnetaboricsyntrromesignilicrntly i'crerscd:rr(,rrrs.r
elastolysis.
e l i r . i t r n( l c l r f i l ( L l l i o l f ! : l t i ( l e \ \ ! r ! i ! i r q . 9 1 s s g 1- s i l n o l . z L . e c l c r a t e d
X I V H A U h O H A ' I E HK O H T P E CN O K A P A H O N O T U R
P r a s u g r e9l ( 9 , 2 % ) : 0 - H o H p e c n o H 4 e p6r 6
, ,7%(6) ca
xrlneppecnoHAepn,
3-rr,la(33,3%) ca repaneBrrqeHnpo3opell cpeAHannou.{noA KpHBara7,44 t 2,4.
Cneg nrpeoro M3cneABaHe
ce HanpaBilnpoMFHaB TepanugTaHa naqileHruTe,HaMrlpaqhcL'h3BbHrepaneBrnLlHllFnpo3opeq.
flpra racne,qeaHeroHa rpoM6oqilTHaraarperal{rir ri;l
30-nnpeu ce ycraHoBhcneAHoropa3npeAeneHrle:
Or 56 xuneppecnoHAeph
cneg uogr$rqhpaHe Ha repanhflTaca npocneAeHv38:21 ocraBar cbc cBpbxnor/cHar
'16
rpom6oqlrrexorroBop, enrasarB xenaHnr repaneBTriqcH
1
HoHpecnoHAep.
npo3opeqn ctaaa
flpr auann3 no orperHilTeBhAoBeP2Y12 amaroHrcrh ce ycraHoBrlcneAHoro:
I
I
I
Or 34 naqnesrh B repaneBrrqeHnpo3opeq6ea nponrHa B repanunra ca npocflegeHu19 - 7 craaar xuneppecnoHAeph, 11 ocraaar c onrhMaflHonorncKaHe,
a 1 naureur
flpr aranr: no orAerHure BrlloBr)
craBa HoHpecnoHAep.
aHTHarpeTaHTu
ce ycTaHoBrl
cueAHoTo:
25
(.)T I' il()r-lpecnoLrAepr,racrlqKrl il rpyfraTi:) Ha naLlileHT!1
n t l p i : r o f l i : : r { r a r Hrop e r 1 4 p a H Lcr C l o p i d o g r e l r B i l o c n e A c r B r 4 e
r r F c f l l t 4i al r r 1 1r i a n o - f l o u t l r e a H T r l . l f p e T a Hrr. t ,c a n p o c n e 4 e u u 6
' r i : l t r i S n l ' 1 f l r : ' r u H , t . , r4. . 'r i a t t l h a l [ ) e l t { ) p 1 1e l n H H a n p a 3 y r p e f l ,
l nfe p f i l e t 1 e A h H n p e I l [ ) ( j f ; l l 4 r ] i l i i : itls f p y r l a f a 1 1 ax L i n { - r p p e c r l O
r'illt nil()3opeL.l.
r-rr.ilti:rBitB I o p;tteE:l-T!1c
L ; 1 , a L r : r l 1 1 i . : I r ' 1 ( 1 e c3iH
1 3i l Y , 4 u J c i ro o y c T a H o g h n o - r o r ] g M o
ril r pot"tfroLllrilraTa af [)eraurr,] c Hoil']Te aHTharpei ior r'11.)Ki.ltrc
r a r i r r l c l r p r r d o r u o l u . i 4 o r p r i l r( T i c a g r e l o f p = 0 . 0 1 4 r P r a s u g r e l
p : : : f l , 0 : ) 7 1 f i i l i r o 1 4a l i c o l ( i t q e c r o r a i l i ] ) t r n e p p e . i r r o H A e p un p r l
\ f 1 1 . ) r l r e iIla. rl1 1, - l i lT p h T ea r f r t l , l a t p e r a t l tea O 6 u u , , t \ v np o l n .
f l p r t n p o c l i : 4 l u a H e l o l l a n i L l ; 4 e H r u r I c{ re y c r a H o B t 4f v ! H o r o
TJrrrr"tiu
t a p r u ' r a C r r n l o rB
, ; tn o T H c x a l H e i ou a r p o t , r 6 o q u t h r e n p f i
r , i ) . { r 1 i . : f r | rr1c,i i y B i j r i l l C c l o p i J L - r 1 t t : 1K, a r o i l o p l r n p i . 4n b p B o H a \ i r r i r 0 , / 0 r a I l o B a rr c \o i r f r . 1 MJAt F r i r) l o T r l c K a H e n, p i l n p o c n e A F B a f r ( l l 1 .C
r ( rV ( l f i : l f l t r U ' l l l i l p
e a T OB n O l e r 3 y I l l i l 1 t lI l p l . l i l A L l i l e i l 1 r 1 T K
(-Lrl',r
l Xl,lf lcp[]eCrl!Fiiiti[ ], Ti:lXil lir t] l"locoiialiroHpcCnOlgep. [l plt
j .O r t l l ) a l 1 tC4 l l O B 1 4 l iC: t H I r l a r p e r ; l t 1 T
f i ; t l l r 1 e l l f l 1 T (i p
C1O4n T n M a n F O r ( - r T r c f . ol fc , c o y c r a t i o t 3 i . lM l r . l 1 o r - t 4 c K ao l l p l t a 6 u n u o c r , u o
3 . t o i " l e r K ; 1l r i . tT O [ i a i l i ) r : M l ] l r z : l r j i ) H e O
T 0l c E p b x i l o r r l c K a H e K b M
( ' l o l l l J o i i r l r P I e r p J i { . . ' r j f u l , . 1 r iitl 1
[ )H
o 3 0 [ ] L r i lI l l l l l H i l N 4 a J l q B a HHea
llr)1ir1a ciit oi,;l:ti:iHe[it,3f\4oxil0 ts r0.rliltulnpoLleHToT cr]yLjailTe.
3 a x r r c . r e n n e . C ) r r r o r r y . r c r l r r eI a f * 1 1 1c r a B : t f i c H o , q e
( l l i i l l | l 1 l 3 l 1 - l l O f i O I J t l I e A f l l 1 4 i l l p r i i i : l i l l l n p O ( 5 r r e t " rC
a pe3hC. a6engsea ce
l ' : ) r 1 r f , o 1 r 1 rK: rr r l ! 1c l c r p i d O g r e l( ] p a r 3 f ) r ; u r c l jH
l ( ] ri i l { : } H
i . { l 1 U3 i ' l l l O -r O J l tL I i l c e C T O ;l i i l i : l X t lr l ep p e C n O H A e p U T e
j l o - l . 1 p o B r { at r/ H a r p v f e
t - l l i l r a r i l r , l i - r l T fcr O l ( C r 1 c r . : l . r A ; , r p r H a
a l - rf l r i l l p ( r r i r fr T a . T c B i : o r L L J , l , ft T fr J H . r o r t t u t o [ r , l A a n o c f l y x r 4
l ( ' ?l ( ) n i i e l l r l r i l O i l 3 3 y C r A f l O B t B A l l e H r l n i : l L , l r l e ; i l / T eC n O - f O t l ; l l \ , 1) ( e i , t o l l a f f l ! r ) t 1i l l c K , l r L r r r r rh) l r . { r -/ l ; J 1 . e i r a i i l a l l h c K o p e K Ltl li
[ /irl):ii] t I i i I I il);1.llilr,ll lt1ti ;l r1i r'l;lf l.rrlI,:iill.
Apnruuia H nEAc
0 3 . 1 4 . 2 0 1r .4,1 2 , 0 0- 1 3 , 0 0 . r .
Modepamopu:
npof.
T . , Q o a o a a , 6 ) 6 1 4i '.r ' p ( i l l J , ; n : : ; t t r t o .c l o r l . 1 1 l .T a t , , t . t a. ) c a
t t i ) . i , , r i a r l t . I l p o v . t c l , t r c a r 1 p 0 - h l ] l : t c r r l p a l l A r l i l ; i l ' i t l T eH t l B a H a
N-3.1. AHANl43 BbPXY PA3NPOCTPAH
EHt4ETO
HAMETAEOJMTHVIfr
nPil nAqrEHTtl
Ct4ti,qPOM
c nPEACbPgHOM'bXAEHEB nnEBEHCKA
OENACT
fl,.flxoea, M. Xpucmoe, K. Axeriuc, W. Oxpu,
K. focnoduxoe, H. Cmax,aeea,A" frHaKueea u C. Tuueea
l-ltpea xnuuuxa no xapduonoeus, YMEAJ1E-p ,,feop;u
Cn-tpancxu".Meducquucxuyuuaepcumem - llneeeu, 6tneapun
r;l 3:ixap r11frrlAfr14r
npo+rn, oii.nxr:rir,.a
ra Ha ranuKi)r;Lrr,n
J l a a l p t el l l f a I 1 t i a T t l X t l f l i j p T O i l t l t , 3 a x a p H h q
! I a l l 1 J l € i ' { ( l l M e T .F
or14r"r
hlle f,rilfl ril. ila ufleH]rirc ca Krracr$taLlupaAir i,ii',{}T14.q14
r r . rc ; , o . 4 c r : r { i o r u l e l( ) ! r F r l \ p o M
n o K p i l l e f M r l f e r . r aN C E P A T P l l l l i p i r r r r ) ; ' i . ree rcrr i l r r 4 c T r l q € ) c K
i l ra/K e r S P S S v I 6 . 0 . 1 .
P e " r y n r ; r t u . O r i l r c n , : J : i B ; l r ; ) r i :nr o n y n - u h ) t c n p e A c b p A H i ) r J r b u . r l { | r e: i $ ( 5 1 ! t ' ) r , : i tc H , t e r i l b o f i r 4 r e H
crHApoM, oT TRX
'l
. j l - 1l ' . , , ) . r i : rr \ 1b ) t { c . a 2 0 ( U 4 ? i , , 1c a ) } ( e f 1 1 4O.. - i l : c n e g a a H a T i ; l i ) / i r . - t i l l 1 5 0 ' , i ) l t i t U r l c l r t A ( . ( t c r ! ' t r r T ; r 6 a i , t i , l c rf lJH A p o M
r rir)oe r A c b p A H cM r r ) K l 1 c H ea, 1 i 3 ( 5 0 % ) c a c
u r;,ri.rofic,1.rr1i:tln
M { l l i l i : o r r r l T e Hc 1 1 | r l l r J , J r v. ln e [ ) M a H e S T t r on p e A c L p A H o M r , x -
tlen. !a ce aHaflh3hpapa3npocrpaHeHilero
Ha uera6o/ 1 . , ) r c . 5 l lr ' 7 i l ' l ' . , ) c ca i . r r r F H ; U ln p l , i r , + T (i lpr t f i e p r 1 4 ,o r r f l x 3 0
( ' ' 7 ' i i , ) r ; ; lM r , ) { e 1 12 i ) { f l f i i , ) - x e i J H . 6 5 1 9 3 ' } / or)a u r e H T u c a c
B
nrTHngchHApoMcpeA naqheHruc npeAcbpAHoMr,)Kqere
l i l l l l e p t O l - { t 1 itll n p e A c } , p f ? l - 1M
, r rRX 37
Ot ' x ( . a e H e O
S f l r : f r 4 . 1 . r l r 'X
flneeeHcxao6fiacr
(lis(li, ] c3 rn'rr)ii€r,
i-r:21 ( g0o/;) ca )r:eHr4.
Marepuan h MeroAh. flpoyvaane e HanpaBeHocpeA
O b c r , x < A a u e . l u l t : l a r O o f i i r r r r r l r 'cru' i r 4 l t ( ) u e L U H p o t ( op a 3 70 naqreHru, KollToca npherh s flrpaa KrfiH/Ka no Kapy[/EAIl
n
l
)
o
1
l lrl i r f l l ] i rn p f 4r a t l r l e H T r ' l T c n p e A c b l ) l l r . l 0M L ) q l e H e B H a [ J a Feoprur
Crpancrn"
nneaeH,
EunAt/onornfr,
,,!-p
rapile Mexqy 1 anpun u 30 roun 2014 r. c AoKyMeHrupaHo Til tr)r)y'iEnfrt iloilyt;lL{r4'. lr4oxg17ut;eiiu.ror Kot\r|oHeHTrlTeHa
r,,i'OJl tlTllLltl Cl1l1,'tpoi\4,1 l tpeAcl,pilHOtO trltr){(:lol1e AOKa3Bat,,1,;l
npeAcbpAHoMbxAeHe.flaqnenrnre ca npoyqefll orHocHc
pa3npocTpaHeHheTo
IJlJt,stiit. I-a:ilr Blrt:rxa Hil npeAcbpALrr) Tii()r.iitl(i)ilarfli:11lfl0r'tfjat
Ha apreprlanHaxfineproHl4F,
3axapeH
gr,ta6e1 AucnnnnqeMy
H ( . ! r oM t , , f i l t l r c C t t r : t . , t { i o l t , r r t r u c h i r t ] p o N lH e e c a M o n o p a A i l
,r 143aTnbcTFgaue.AHanurghpaHri
ca
np|,l XoCnUTar',il,43a- e ' [ ' i l l a ' r r ( ) r : l c i l i i t l r r j i l c l N t i r r ' , t . ] c t 1Ii'ftio, 1 , 1l t o p a : r 1 K y M y n a r u B AaHHr OT MeAhUMHCKaTa
AOKyMeHTaUhfl
H i l t l f ' , / i r i i ) r r r l C i , L r r : 1 , 1 1 ( r ' 1 1T1r,l-! r1llia.rl [ ) e . J B a i ) r l e ] l CXla1p a K T e p .
L\karav npeAnroBa, n au6ynaropeHxonrep 3a aprepharHo
XIV HAUHOHA'IE
[Kg|r rlqc
n-2.12.nPOTHO3Anpn 50nHH CbC STEMI
B 3ABI4CI4MOCT
OT CPOKA
HA 14HTEPBEHq14OHAflHATA
PEBACKvnAPn3Aq14F
B. Mypa, H. lTenxoe, fl. Beneecxu, l-. Kupunoea,
M. 3namaxoea, fl. fluuoe u h. fluuxoea
Eanaapcxu xapduonoeuveHuHcmumym,CEAI1K- Bapna
Llenra xa npoyrieaHeroe Aa npoBeprr.a6-Mece.lHara
nporHo3a- neranhrer npra6orun crc STEMI B 3aBhchMocr
peBacKytaor cpoKaHa il3BtpueHaTailHTepBeHqroHanHa
prl3alluqcne,qHaqanoroua ru$apxrrara 6onra.
Marepuan u MeroAH. llpoyvexr ca 300 nocneAoBarenr 6onur, nocrbnrnh e CFAflK - Bapna, 3a nepuoAaor
0 1 . 0 1 . 2 0 1 r1. g o 0 1. 0 1. 2 0 1 4r . C p e A n a r aB b 3 p a c rH a 6 o n r 1 1 re e 62.9 t 11.2 (32-94)roA.,or xouro 212 ca Mb)Ke(70.64,i,)
v BB - xeHn (29.4%).EonHrre ca pa3npeAeneHn
e 4 rpylrr.r
peBacKynaph3aLr,rlf
B 3aBUCr,lMOCT
OTCpoKaHa U38bpllleHaTa
or HaqafioroHa nu{raprrxara 6onKa:
I rpyna - peBacKynapn3npaHh
Ao 3-rrn qac - 81 6onHr,r
(61 ui,xe u 20 xeux) Ha cpegHaBb3pacr62.50 rog.
f l fpyna - peBac(ynapu3vpaHuMexAy 3-ruR r,r6-rrrl
qac - 88 6onxn (65 [/bxe H 23 xearn) Ha cpeAHaBb3pacr
63.03roa.
lll rpyna - peBacKynapn3L4palt4
uexgy 6-ranv' 12-u*t
qac * 66 6onuu (42 Mbxe u 24 xeau) Ha cpeAHaBb3pacr
63.53 ron.
fV rpyna - peBacKynapnstpaHnvex<gy 12-un n 24-ra
qac - 6B 6onnn (47 Mbxe h 21 Neau) Ha cpeAHaBt,3pacr
64.88 ron.
flpraecrvnr 6onHr e u3BbplrleHa
CKAI no MeroAaua Seldinger (c pa,qhaneH
Aocr-bn- 78 6onnu (26%), n c SeMopanel
Aocrbn-2226onnv QA%),c nocreABaqapeBacKynaph3aL{ht
Ha BuHoBHara
3a uH(iaprra KopoHapHa
apreprlc. llpegu Ci(At
HenocpeAcTBeHo
creA peBacKynapil3allhFTa,
npeAu Aexocnuranu3aLlrlnTa
w aa 6-us Meceq cnefq peBacKynapr.l3aqrlr'ra
neBoKaMepHara
rno6anHa cilcronHa SyHr<L1an
e oqeHFBaHa
exoKapAhorpa$cxra
nocpe4craoMneBoKaMepHara
SpaKur4rHa
(Oh), onpegennHano Meroga xa Simpsorr.
h3TnacKBaHe
Perynrarr. O$opnan ce reHAeHlll4r 3a no-MaflbK fleTanr4Ter,qo Kpar ua 6-rn Mecell or ua6nrcgeuuero npr 6opaHo (or I n ll rp.), il no-BrcoK
nHhre, peBacKynapr43r4paH!4
nerafihrer npu 6onHure or rpynhre c no-KbcHapeBacKynapu3aqur (lll r lV rp.). YcraHoaaeace o6parla Koper-raqilF
uexgy Ol4 rj cpoKa Ha peBacKynapu3allr4n
creA Haearoro
Ha uHq)apl<ra,
KaKToh no-roflqMacMbprHocrnpu 6onHurec
no-rloLUafl eBoKaMapHa
cpyHKr_$4s.
3axnpqexne. PaHo xocnuranlsvpalrre il peBacKynapu3r4paHh
6onrn uuar AocroBepHono-go6pa neBoKaMepHa
ct'tcronHa$yurqnn h neranilTerbr npr Tflx e no-Ht4crK,a
KbcHopeBacKynapnsnpalnre6onsr ca c no-floula neBoKaMepHachcronna SyHxqnr il no-ronqMacMbprHocrsa 6-r'4eceqHhcnepnoAua ua6nngerlre.
23
orul
rlo KAPAI"]_orl
N-2.1
HAXNNEPTOHHfl
3. PA3NPOCTPAHEHI4E
gr,tA6ET
H 3AXAPEH
nPH nAqhEHTH
EONECTHA CbPqETO_
C HCXEMI4LIHA
AHAnH3MEX.qy
cPABFrr4TEIrrH
t4rlgr4HcKATA14EbnTAPCKATAnonynAuhtl
!, K. I-ocnoduno*',
l{. fixeimcl
14./-epvei:', ,Q. 8xoeaI,
'f
fl. CrnaHqeaat, M. Xpucntoel , M. Oxpu', . Amauepun'z,
2
C. ptxac
u C. Tuuesal
' l'|t,
i Lca x fi L|r I t It.ii1 n r.t x tt1tri u on oa u x. YA,'lEAI I D- p,,Teop ? u
C | , , 1 ; a ; i i t , t t. M r ' i , , t t 1 t t i l c K yut l o o c l . , t - , t . t f i r c nIt--l-n r : i e u , } t n e a p u n
l- o irrcles H r:it ft l n st itut e
K ; tl ) 1t,.:n o ;,:ti,.ino or lcJeyr€'gr.ir,:
t . tl l t ' u r o ( J e r t t e r- - K a q t t i t .k e D a n a . 1 4 t d u s
Ierr. ll:r cr] i:rI i;rfl r3!,rpal !,'lil[)arBf]FBti T [)a3npocrpaHeH ileI O l l i l x t f t ( : . l p T o r l lt 4l 3u i t x ; t p H , l ' r , 1 r r ; r 6 lnj tp t l f r : ] u l l e H T H
c r,lcxer,,rrr,
rrra 6olrccr lia c1)puero s 6r-nrilpr,vr ',t l.4rq1aa.
Mar eJrnan !1 Melog14. flpoyvearrero
e
npoBeAeHo
r 1r r, o c a r n L , 1 1 e r i n
r , p 0 r l r i 7 6 f l 8 L . l r . i ( : : H 1K' o
l l l u p e a K n l - 4 H h Knao
i i i r p / : . 1 t 1 { . )rJr ur o. f) ' h l 5 A t l , . . q - p f e o p r r . . r C r . p a H c r n ' ' - f l n e e e x ,
l l r , r r l a l l . u r ,r " r e x g y 1 . U 2 A 1 2 n 3 1 . 1 2 . 2 0 1 3 r . n 4 9 6 n a q r c f { T , r , n l - , 1 1 { r r lr 4 K a p g l r o n o r l r q i l o o r , q e n e H 1 4 eL o u r d e s H e a r t
l n : , t r l u l r :r , rf l e r r r o ( j c n t e r - K o v r , + r ,K e p a ' l r a : l, l r ; 1 r r , n p e 3 n e [ ) r , 1 i r . ,ot ra 1 0 6 . 2 A 1 2 r . l 3 1 . 1 2 . i 0 1 2 r c o c : r , p r ( o p o H a p e H
( j r i . r J i p ( j r \ ra. h I 1 1 o r t r ) a $ c K 1114 Ii r4 e l r e K r p o K a p A 1 4 o r p a Q c K t A
4 oi r i . r . l i t . ( : i l C T E3a, l 1 1 L X c t l l t l q H Jt l . l l r . : c i i l a c L p u u T o . f l a u n e x i l 1 f i i c i r i t i t ( ) y L i r l | t : i a x H i t r i p r " u i i t , l , -3t a
, x a p e f i g u a b e r t 1H a p y I lrri f 1 t-lIi{)Ko3L1H
I OJlrr'p;]t-1c.o6e Xr ta :;Ha'l tl 3 c;t a HaMHe3aTa
r r a i l l i ) U / 1 \ ' f l l i 4 l t ) ,( l i Z l p t l l , 4 e i j i 4 l 1 1 4 i l CA
KO
1 4i ( y M e i i T h ,K n H H ' l q e H
r r p c rn o i l , i l ( J r i ' J \ rrhe J r H O a \ 1 6 \ ' ' r ; r T o llrof r - r p o n( e A F B a H e H a
r , l ) 1 . : , l r H of rriol J r r fa r l e n n a 6 r . ' p a o [ ) h r f ] c 3 y n r a r r i , B T o B a ! h c l r r r l l t t A l c , c r o i l r i [ , ( i i r H ; t K i i i , u r l a I a 3 i : t x a pH i i f t i a A H o t 1c f l e A
X p ; : l i i e l r e[,: l 1 1 T {l ,) l 1 4 C I O [ ] l l U Tl j?al J l € ] q t ) H t 13ea X 1 4 n e p T O H l1449
a ) i r i ( i t D r j lrJl r r a 6 t ) r
Pe;ynra-rr.
Iilrt.ry']3i]11e1n
r 1O K a 3 i i , q c 3 9 ' ) / o o t u t l \ v n -
C l ( l l l t l f l l t L t l e H T i l C r C X e l , l l , l g r l aU O l e C r H L iC l r D t t e T OC a L 4 M a n r 4
x 1 4 ; r { l p T ( ) r ' i lA
l ,O
. r ,K arI0 c b r i - l t 4 r rr p o u e i r r c p e ; 1 6 r , n r a p c K a T an o n y i l i r r . \ i l r re 7 4 ( J ; < r J . 0 1 ) . P ; r . ; n p r t r ) r p a i r e i . i t , 1 { jrrao n p e x i l n e p t ) r i f r " ] T , : tc p e g l r | i l l , r r . i c x i l I en i - l t - { l 4 e H teL 11 4 c i ; , a r c p e p 6 u n r a p i { . rr . ' r i t r , t } i r r L 1 1 8 ' ) i , ( p > 0 . 0 1 ) . L l e c r o r a r a H a 3 a x a p H t a q
ciir'1
iinr,r(;l:r e 5,rtl1,rl;)u;1 r.lr;ll,rr,icxlrie natltlellTrl, rplr 34% cpeg
6 t ' r r i ; p l l , r r e ( f . , > 0 . 0 1 ) . L l e c r o r a r a i l a F r a p y r i i e Hr n r c K o 3 e H
T , l J r { r l r c i l rc l r e ; 1 r ' r H / 1 ; f l . r t ; [ r 1rTaeL { r 1 e H } f ie 2 1 ' , r / , .a c p e p 6 u n r,tlir-iiil4rc1
- 9 ' L l (, p < 0 . ' . J )' 1.
3aKfiro.reH14e. Pa:npoc:rpaireLtrlcro r,1 \recrorara
Ii:(-)
Ha
l a t ' ' \ l i o a p i ] 3 n p o c t p i r H e t u r e T oi r i : p r a c x o a u r e S a r -
T r ) i i r l , r e l t r l i ) a t 3 l i i t ! r , 1 I 8 f i l r ( iu l r i : t : t n 1 1 qIHet 1p e r r o H i l H a
c i , r t ' | : r .f ] i r r i r o r ( ) 0 i r p t l B a H e L 1K L - H I l l o f i| 1 a p r c x o s u r e @ a r 'ti,'1rlr
Ilrrii;a Ai,r c[i I)a3rtc)KIl:ir rii]To npeBaHrrlBHh MepKh
s,r f4trC r] ABero ilonyllaqrli4. Peintafiunpara npeBaHThBHa
c r p . . l r e r r . 1 9r p r 5 a a . r 1 a o e c b c p e i l o T o q ! r B r ' r r l M a r r ; . 1 ecr oH a L p e aKx \ / 1 l f! ) i i H t l r r a B i t r i ci ) a 3 f [ - j o c rp i ] H e H v e r o H i t p 1 4 c K o B H T S
T f l l . r i 1f.. . i l l ] . J r l r r i ( , ) r l l ' . t n r 1 1 1
t 11r1i l ? l 1 f 3 r 1TAa, l ( a r { c p e A H a c e n e HilO l!., l..tllU LltJl0
43
XIV HAUI4OHANEHKOHTPECNO KAPNhONOTHfl
n-s.6.Acotlt4AqunHA METAEOJIHTHnfl
c14HAPOM
t4BHcOKOCEH3IITHBHHfl
C - PEAKTI.IBEHNPOTE'IH
F. Haudenoea
Cnetquanusaumno xapduonoeun,fiKQ 2 - llneeeu
Bpb3KaraMex<AyKoMnoHeHrl,rre
Hen. Aa ce r43cneABa
(MerC) il hs-CRP,Karo pr4cKosa ueta6onnrHrlflcyrHApoM
eu $axropu 3a cbpAeqHo-ctgoansa6onneai*rn(CC3) cpr:g
KnhHhqHo
3ApaBrlxopa.
Marepran n Mero4n. l4lcneqeaxu ca 500 xrlyrHprlrHo
3ApaBHnrqa or nneseHcxr4speuoH (201 Mbxe il 299 Nern).
CenerrrpaHu ca )-{acrHr.4qhre
c Mera6orl4reHcrugporvr.OnpeAeneHhca aHTponoMeTpvv'HA
u xeMaTonorhqHn
rr1.
noKa3aTeJ
Peaynrarn. Vuepeuoro HapacrBaHexa hs-CRP npr,l
Mtxere e cBbp3aHoc 2,41 nttu noBilLUaBaHe
Ha pr4cKaor
M e r C ( O R = 2 , 4 1, 9 5 % C l : 1 , 3 6 - 4 , 3 3 )f.l p n y u e p e H or r a pacrBaHeua hs-CRP nptaxeHnre ce Ha6nngaea5,03 nr,rrr
HapacrBaHeHa phcKaor MerC (OR = 5,03, 95% Cl. 2,2311,13).
o -^6-,,,,u r o v r r v r r - l oIr ^u^o -r^v, n, ^o 3 8 H l z lp g 3 y f l T a T i l T gO T n p t l n a f a H € l C ,
Ha MHOTOKOMnOHeHTeH
C T3 a O q e H K aH a p a 3 n r 4 K a T aM e ) K A y
cpeAH[Te crQfiHocrn Ha rpynnTe.
Ta6nuua 1
flrpaa Bropa
rpyna rpyna
I o p H arrpaHlrili
pal
AonHarpaHhqa PaiflrKa MexAy
HaAOBeptrTeneHcPeAHfie crohHocrx H aA O B e p r n c !
HaAEeTerpynH
HHT€pBan
l4HTepEan
C l\'leTc 6e: liilerC 1 , 4 9
3.73
t.o I
OnpepeneH e AoBephrerHiln hHrepBan c 95% aeporrxocl rofiro e 1,49+3,73. l-lonyverure pe3ynrarfi noria3lAr,
qe pa3nilKHTe ca 3HaL{ilMr4il c rorgMa BepoqlHocT Moxe Aa
ce rBbpAh, qe uMa Bpb3Ka Mex(Ay HrlBoro ua hs-CRP r sepoFTHocrra 3a Hanlrqhe ra MerC.
Ha $ltr 1 e norasaHa rpa$raxara Ha KBaprhnure Ha ,13Meperure croiinocrn aa hs-CRP e mg/l ira qernpil fpynil - Mb)iie (.
MerC, xesu c MerC, Mbxe 6e3 MerC n NeHH 6es MerC.
3 a x n p q e N u e . [ l p o y . r s a t t e r o i ] o r ( a 3 B a f i o 3 t 4 r t 4 B H aK o p e f : [ . i r 4 r rH a h s - C R P c M e f C . l - l o e r l r x e H l 4 e r i )H a H , 4 B a r aH a h s C l i : l P t : a C B b p l i l r ' i 1 c4 H a p a c T B a H ei ] : l B o p o u l H o C T T a3 a H e r O E i : : ] I ai l t r f i R a .
D i ; t i , t t r l t . . $ r a t ar p ; l K T r l r ( ah s - C f l P l \ r o x e . l a c e , 1 3 n o n 3 B a
r ( i : l f ( l! . ' t f { l l i l K a T O3pa o n p e A e f l t H e f { a p r c K a o T B - l , 3 H t 4 K B a H
Hea
l: l r' r'C,t, 6t,/ ic,rrlt i:)),[).!e(l ]o-cjb,tortl ycl to],H.; t {t4tt.
f ) p r u r r c i , . a r e a r e r a h s - C R P r r t , r 1l i r n g / L B c p a B H e H t 4 ec b c
c:roit,ocnt < 1.0 rrtq,ll. p'4cKbr o.r lvlera FlapacrBa4,85 nuna
'l
f r i l . r r \ 1 1 , ; { rl rc { J , 0 8 n b t L 1 f t p ' l ; 1 ( c f l 1 .
n-5.7. pA3nPOCTPAT-iEFfi4ITO
HA
TlcTlor-{onyluEHETo
n pH nAUHEHTH
C HCXEMT'ILIHA
60"fiECTHA CbPHETO
B N f l E E E H C K AO E N A C T
K. llNeiuc,
K. I-ocnoduaoa, H. fepqea, fl" flxoea,
H. Crna+\tea, M. Xpucmoe, U. Oxpu u C. Tuweea
I I by; $t t i rri t.tt tt t tta no x ; tiL,j u ot i r.;eu r, t/ il E/\] ! .,q- p fe op eu
/ulcrluritilcitt :/titiGOpcun)e!n- llneeeu, Eaneapua
L)ltpirr-ri;r:rr'',
L l e n . l . l l r c c a H a i r L 4 : r l t f ) af l i : r 3 f l p c i c r p i t H r r H h e r oH a r t o l r { l H C ) f r y u i e ' r c li loF l r .nl a i l f l r r } i l | 4( ; i ' r ] ] c r , 1 1 4 ' l rSt a
clnect Ha cbp.i'jl() tl [li i.U' r'{ .J ,tSn.1r;1.
Mtrepnan H rderogr,l. flpoy'loaHcro e nanpaBeHo cpeA
. i l ' r j i r ; . r i t t t c . r r 1 i , ( ) t 1 r ou i i n ; l r , i e l r i r I l t , , p t ' r ; th n A H A K Af t o K a p / r ' t r o r r o r i r . ' rY, l " i 6 / r f l , , I 1 - p l - eo p r u r C r p : l l c x l r ' . l l n e a e H - 6 u n r ' , : r i . r i ri . { [ . ] r . , l 1t ) t ) 1 2 A i 2 y 1] 1 1 2 i l } 1 ' . : t . c ( , c r r , p K o p o H a p e H
r i n " r i i p o M .a r r r o r p a r l c x u r l l r r e n a t r p o r ( a p A r o l p a $ c K h A o K a :lJ l el(r iEtit lJir t1c){r}fv[411
i']i:l6olecr Hat (;tp,4ijl o. flaqreHrrre
c ; , t6 i l J r t . 1n l i o y l t { : r ' i 131a p a t . i r t l l o c li ) i t t t e H t r €rl j a r i o r h f , H o n y u e H e .
O i j e r r H a a f r . , i l u 3 c i : r6 u r r r a H a t u l H e 3 a r iH
l a nauueHT[Te, crar el { nperneA, nabopoTopr ) i l N r Di ir l u ! 1 1 1 ' j i {i l, o1 r : l M o i r T r , r ( r 1 1i l1l q
l ; 1 v r : j l c l l s i i r i ! . i r B l t n K l q i l T e n r o E i { [ u rr l j o n o t * . ] H T . T r c r n x o n y Lil(lllilIO
12
'-t-'
.-l
t,
4
:
,f
-_:l=-.,
1:i
- -l_
--;
Eor.nr utilr
loaxu:ksu
H!'1Ut1rapH.
i .: :) I ir?'1llflr'1.
3 a x n x r . , i : i l t t e . C l c r l n t i ; { i . l r r i i . i Irrl r c f i c \ e M i a , . l F l6ao n e c r
: r , : ,r r L i r l , o T r i.t) { j 6 J l . l c T[ ] l t t , i l u t i , { . f r . , i i j l u l l J L r aB L l c o K aL l e c .r-r(.,rf0fiol-lylIcfrtjro
l..tfa ;lr
Er.f,lrrr"t.r .ir r$TOHoIl!tlJ€H€
f ; i , p x i , r i i ) x r ri . t l q r r : i r : r i - ; o rl o t ;r r - r ; ic b p q f l r o e 4 o 6 p e h 3 B e c r e H .
l , " r i ' U r t t , -l lro | r ) J i i ( ) r . : l f , l n a l t r l t l l t r l l , , O T l . 1l l iO
) T i O H O n y U . J g H eAr ao
' . r / . r ' | . l l , . l ) .,14 . t ' ; l . , d(rpl ( . . L C l , I 1 ..i '' Tf e
1,1
3
linTO h3nOtl:lllilH{?
r i r f r i r r r o r r o l i c i l \ i l l r c H e r oc. ) n c i r y t t a . t u ; i r a H a n p o y q B a H e T o
t ) i : i( 1 4 : 1 , )H f l r { o r i :ri' 1 tci r t i l y r . u r 4 r 1T1r p e 3} l r 4 B O T ici A . a 1 9 9 ( 4 2 % l
( - , r f i r r ( ; r ( ) l f r l i l l l i ' r l ; r ' - r u rO r n l t o y ' . r l i l H a r r arrp l , n a 1 4 8 ( 3 1 o / . ) c a
( , . , r n i(.irr r n r r r rn' )r / l r ; r l . j r: ' 1
2 r o l i r r r r , r , r{ j l ( 1 3 9 . , )c a 6 A n v 6 t B u A
il\,lr l'
9rr
o
Ce Ollpt:I]i-ljltl
Pc:yntaru.
C p e 1 1 n a q l r e H r r ' 1r c 3 i l n e a e l c r a
o6nacr,
i:]ri1ltijrtc Htl B il poyri BaIel o. ftc u.rt--1'ct ll to Re.iJ Bl4coKa qecTo-
3gpaDu ur:lr
:lqFariu:La:)iii
< D u r .1 . K a a p r l r n ! 4 TH
e a h 3 M e p e H h r ec r o f i s o c r l r 3 a h s - C R P B n r r t ' l
H a g e r r l p h r p y n r i- M t x e c M e r C , x e x n c M e r C , u t x e 6 e : M e r C r r
xexn 6es l\4erC
yqACTHE
xll HAqHoHAnEHKOHTPEC
no KAPAHOnOThfl
C MEXAyHAPOAHO
11
npocHHKa
6RxaxanacRHh
npnnaraH14Te
aHTHXhnepreH3L,tBH14
ca 1,56mmoliL.tlpu 47,1%ce ycraHoBRoa
OXon> 5 mmol/
- OXon> 4,5 mmol/Lu npn77,1o/o
- OXon>
MeAIKaMeHTh.
L, npu63,7o/o
Peaynrarn:B nupeoravanH[RcKpuHr.lHr
ca BKnrcqeHh 4,0 mmol/1.flpu 52,9o/o
ce ycraHoBRBa
LDL-xon> 3 mmol/l
7'116onHr.Muxere ca 68%, a xeHrre - 32%. 1|Yoca nan npn 73,9ok- LDL-xon> 2,5 mmol/|,Tf > 1,7 mmol/Lca
queHrnnoASO-roAruHa
Bb3pacru 33%- HaA70 roAr4HH.
B
KoHcrarhpaHh
npu 44,5o/o.
l-lpu55,3%ce per[crpr4parepahxTepamro
cetBKnNcqeHr4
538 6onnn,To e npoaegenocpeAHo
neBruqeH
KoHTpon
xa OXon < 5 mmol/|,npn 35,4%< 4,5
1,3 roguHncneAAexocnhraflx3atl4nra.
< 4,0 mmol/|.Tepaneeru,reH
Cpe4xoroaprepummol/ln npn2Q,1ok
KoHTpon
Ha
anHoHanf,faHe
sa rpynarae 138,5/83,5mm Hg, llpu 55,2%
LDL-xon< 3 mmol/lHManpn 53,6%,a npu 29,60/o
KoHrponbr
ce perflcrpupanoar4ureno
AH > 140190sa xepua6errqrare
n
xa LDL-xon< 2,5 mmol/I,IrnxgonoHurxaBaqa
repanuce
> 130/80ga Araa6ernqrre,
TepaneeruqeH
KoHrponsa AH e
np!.1naraHa
npu 62,3o/o
or 6onHure,Crarvlxnca npHnaraHx
nocrr4rHar
npu 41,1%,Axrrxnneprex3hBH[
MeAHKaMeHrh
ce
npn 59,1%,Qlr6paru- npn4,3%.lpyru nunr,qoHuxaaauln
nprnararnpn79,6%or 6onxnre,6era-6noxeprce npr4r'larar M E A h K A M E H T f i H E C A H 3 N O f l 3 B A H h ,
npn 82,3%,ACE nxxn6nropk- npn 61,8%,APE - npu 5%,
l,'lrnoqr: EonHrre c AoKa3aHa14EC,xocnuranu3tpaHn
-npn 22,3%,Auyperl4qn
- npn 43,4o/o, no noBo.qcreHoKapAHF,
Kaflq66Br4
aHraroHhcrr4
Mt4oKapAeH
uxQapxr hnh uHTepBeH- npu3,2o/o.
MeAxKaMeHTr4
Apyf[ aHThxHnepreH3[BHt4
uuq, ca c MHoronou KoHTponHa nhnr4AHrlnnpo$rn. Bunpel.lteogu: Sonxnrec AoKa3aHa
hBC, xocnraranr3upaHu KHAoKa3aHaraKopoHapHabonecr no,rrr 40% He nonyqaBar
no noBoAcreHoxapAhn,
HHOapKr
MHoKapAeH
hnHhHrep8eH- nHnHAOnOHnxaBaua
repanrn, a Te3hKor4To
I nonyqaBaT,
He
tlr4nca c nou KoHTpon
HaaprepnanHoro
HannraHe.
Bunpervr
KoHrponrpar nrnhAnl4TenapaMerph no4 nprUenHHTecrofiMacoBoTo
nphfiaraHeHaaHruxt4nepTeH3hBH14
MeAr4KaMeHTH,socrn. OXon r LDL-xon ca MHoroHaA xenaHnre nptaqeflHil
xoHrpoflHaapTepnanHoTo
HannraHe
cnopeAn3vcKsaq|,|'Ara croratocrr.
HaESC/ESHce nocrhranon no-ManKo
ot 112or 6onxrre.
It Nn10. KOHTpOflHA nhnHAHht nPool4rl yl H3EOP
HA AHTHNINEMHqHA
TEPANHf,NPh 6ONHNC UECPE3vnTATl4EITIfAPCKA KOXOPTAHA EUROASPIRE
III- EONHHqHO
PAMO
6, feopeueal, Cm. Haaxoa2, H, ffacxanoe., HuHa Feveea1,
H, llacxaneaal
1Ynueepc ume mc Ka Haqu oHanHa xapduonoeuuua 6onuuqa,
2Boeuxoueduquxcxa axadeuun
N N911. AHANI3 HA PHCKOBI,ITEOAKTOPI4
3A APTEPI4ANHATAXHNEPTOHHRB PETUOHA
HA nnEBEH 34 nEPHOAA 2008.2010r.
K. Earbpdxt'ueea,
E. Mexextn, H. Fepuee,H. Cmavqeea,
Cn. Tuuteea
Knunuxano xapduonoeusu poeMamonoeun,
YMEAI1"fl-p F. Cmpancxu";Kamedpa,.Kapduonoaun,
nynMonoeun
ueudoxpuuonoeun"
,MY- flnoeen
AprepuanHara xnneproHr.lff(AX) e oxavrM He3aBncr,lM
pr4cKoB
0 6gner
flpoyreaneroEUROASPIRElll (EuropeanAction on
$arrop 3a arepocKnepo3a!43a KnHHhqHhre
Karo ercxeMuqsa6onecr Ha cbpqero (hEC) u Mo3bqHocbSecondary
and PrimaryPreventionby Intervention
to Reduce
pona Oonecr (MCE). flpoyreuu ca rr;xoro6porlxrQarropn
Eventslll) UennAa ce ycraHoBt4
Aanr neKaprreB eBponeioT oKotHaTacpeAa, cTfina H HaqhHaHa xHsoT, KaKTor,l oT
cKurecrpaHllce npx,qbpxarKbMnpenopbKrTe
sa npoQuBr,Tp€rlHaracpeAa Ha opraHH3Ma.3a Hqror4oT Ttx HM€Kagpyxecreo. B
naKrlaKa
Ha EaponericKoro
KapAronorurtHo
qe no8uuaBar phcxa oT sbSHhKTerophqH14
AoKa3aretcTBa,
ToBanpoyqBaHe
3a nt'pBr nbr B3eyqacrlreu Bunrapun.B
- Hanp. HaAHopMeHo
BaHe
Ha
aprep!1alHa
xrneproHhq
T6paMoHaEUROASPIRElll 6nxa BKnroL{eHr4
6onHn,.lxoro
narno,
noBfirl:eHa
KoHcyMaLlhc
Ha
noHHXeHa
queHTr4
cofr,
c AoKa3aHa
KopoHapHa
OonecrI ahafl]43t'T
Qnorvecxa
HanoBenCrXO-eMOLlhoHanHO
HanpexeHHeH CTpeC,TtO6e cnopegAoxyMeHrhre
npI Aexocnhranu3aqhnra aKTHBHOCT,
AeHt,lero
't,qpyrfi, 3a gpyrr Sarropn, HanphMepHvrBoTo
Hl4HTEpBlO
Ha6OnHHTe
CneAnoHe6 ueCeqaoTh3nncsaHeTo rrcHonyuJeHe
xa
u
overa-3
ouera-6 nonHHeHacHToHr
MacrHr4
KHceflHHH
B
or 6onHHqa.
ce
BCe
oqe
HarpynEa
MaTep[an.
AfieTaTa,
AoKa3aTencrBeH
llenra Ha Hecronu.1rn
aHanr3e Aa ce noKaxeKaKce
l.lenra Ha Hacronu.loronpoyqBaHee oqeHKaHa pa3npocr(oHTponupa
npn 6onnure or Sbnraphe,
AucnnnlrAgMyrnTa
TpaleHrlerou prlcKoel4n
npo$un Ha nal{r4eHrrrec aprepnsKrroqeHh
B EonnrqnoropaMoHanpoyqBaHero.
anHaraxilneproHrlncpeA HaceneHheroHa peruoHflnesex,
Marepnanxr MeroAx:9pes crax4apreHBbnpocHt4K
3a
fpaxB nponepeHoro or Hac npoyeBaHeca BKntoLreHn
BctaqKH
BKnKrqeHH
e EUROASPIRElll AtpxaBh ce onpeAonpe3 nepnoga 2008-2010ronnue cbcronHneroHa 6onxrre, 3anrcaaxace npeAnucBa- AaHHHa FneeeH,H3cneABaHr4
HrTeMeA[KaMeHT]4
npHA€XocnhTanfl3aLluf,Ta
h npHeMaHu- 4uua, Ha naLlheHrhree il3MepBaHorphxparHoAH (cnopeA
qetrpanxa
npaehnarara C3O), h3MepBaHa
e ranneTa H e npoBeA€Ha
Te no BpeMeHat,tHrepBtoro
MeAuxaMeHrx.
B
ea
aHKera3a ocraHannre phcKoehSaKTopri,cBbp3aHhcbc grnEeponana6oparopun
ce aHanu3r4paxa
KpbBHnre
npo6r4n ce
na 14HaHrlHa
Ha xHBoTv rJ4naHa xpaHeHe,
h3cneAsaueOXon,LDL-xon,HDL-xonh rprrnrqepnAu,
flpeo6naAaeau{ara qacr or naL$4eHTure,
nph Kottro ca
Perynrarr: fitpeonavanxxnr cKpl4HuHr
o6xsau{a711
HanfiraHe
h3MepeHfi
noBrueHu cTohHocTr4
Ha apTepHanHoro
6onxr, B rHTepBtoro
ca BKnroi.reHh
538 6onnr,r.hrreperoro
e npoBe.qeHo
cpeAHo1,3 roqnnn cneA Aexocnurann3aqu- (63%) ca BbB Bb3pacroea rpyna uag 65 roAriHr.i,cneABaH!4
(57,4%). Or ectaqxhhsor 55-65 roArurHure,no-qecro )t<eHA
f,Ta.CpeAHlrerOXon B rpynara e 5,01 mmol/L,cpeAunnr
cneABaHh|4 npH MbxeTe, n npn xeHHTeqecToTaTa
Ha AX
LDL-xone 3,2 mmol/L,cpeAHhnrHDL-xonea vtxere - 1,1
xa ESC), Ycragoarmmol/u 3axeHyre- 1,18mmollL.CpeAxnrerphrflhqephAh e 42o/o(ogenaoaHHcnopeA Kpr4epr4ure
12
yr{ACTl,rE
xlrHAqt4oHMEHKOHTPEC
no KAPAIOnOrhF
C MEMyHAPOAHO
xMe, qe 27o/ooT xhnepToHr4qKhre
u 30% oT xr4neproHl4t{rTe
ca nyuaqr4.,Qanrarennara aKThBHocre yMepeHa npu 72%
OTX[nepTOH]4LlnTe
n77o/ooT Te3u,KOHTo
HtMaTaprepHanHa
xhn€proHH8.32To Ot xhnepToHHt{hrer 38% or Hexr4nerjroHrftlnTerqo6RBaT
con KbMxpaHaTacv, 99o/ooT aHKeThpaHr4re
KOHCyMnpar
xpaHa, 6eAHa Ha oMefa-3 H ooraTa Ha oMera-6
nonl/tHeHachTeHh
MacTH14
KhcenhHu.
lllraoAu. Or nonyvexure pe3ynrarr4Moxe Aa ce HanpaBflTCneAHhTen3BOAr4:
B flneaeH qecToTaTaHa aprepHanHara xhneproHtan
cpeA HacefleHreroe 6n[3Ka Ao ra3u npr
Mbxe s lrlsro,ixa Eapona (42o/o).flpn 1/3 or xuneproHhqr4Te hMa noHe ou.leeAlH pHcKoBQaxrop (rrcrrcHonyuexe).
HRiia AocroaepHa pa3nuKa Mex(qy xhneproH14rlr4re
orHocHo Ao6aBnHeToHa con KbM xpaHaTa,Ocrasa AhcKycnoHeH
BbnpocbT3a HuBoToHa oMera-nonhHeHachTeHhTe
MacTHh
KHCenHHH
B AHeTaTail phcKa OTh3RBaHa apTepranHaxHneproHhc,
N N! 12.NPOCNENfiBAHE
HANPOMEHHTE
BbB BETETATI1
BHATACb PAEr.t
HO.CrnOBA
PErynAqHrnPn hHAl4BnAV
C nOBnUJEH
CbPAEqHO.C}AOB
PHCK
fl, pyxdoea-llanteeat, p. Hexoe2,H, Eanoeal
tKamedpano
Qusuonoeun,MY - CoQun,
zCmydexmno ueduuuxa, MY - Cogua
CrcronnuRra, cBbp3aHh c noBhuleH c'l,pAeqHo-cb,qoB
pncx (aprepnanHa xHnepToHr,rR,
rvrera6onnTHh
HapyuleHhq,
3arnbcrFBaHe), uogu$rqnpar BereraruBH!4nKoHTponHa
cbpAeqHo-cbAoBaTa
chcTeMa,
l-[en: npocnegnsaHerpafiHocrra Ha npoMeH]4reB]B BereTaThBHaTa
crpAe\.rHo-cbAoBaperynaLlHF,oqeHfiBaHHno
aapna6ranxocrraHa cbpAsqHara qecrora (BCH) e orroBop
Ha cHMnaTHKyCOBa
CThMynaqnBy MnaAh HopMoreH3hBHH
HHAI,IBI4AI4
c noBfilueHcbpAeqHo-cbAoepr4cK(H+), cpaoxnBaHhc nnqa 6eo Qaurnxa o6peueHenocr(K).
Marepnan u MeroAl,r, B uHrepaan or noHe 6 r,receqa
AByKparHo6eue npoBeAeHa oprocrana,rna npo6a (Ol-l),
BKnpt{Baula3 nerr.,tuxyrxn nepuoAa - noxofi, H3npagsHe,
Bb3craHoBgaaxe.PernctpupauJe ce HenpeKbcHaraereKrpoKapAlorpaMa,
(Finapress)u nneHehHBa3taBHo
HanRraHe
TH3MOrpa$CKh
CKOpOCTTa
Ha nyncoBara
Ce H3qilCnRSaUJe
ernxa (ab-PWV). BCq h Bapua6ullHocrra Ha aprepHanHoro
HannraHe(BAH) 6nxa a*annsnpavn c nporpaMhre MlS2000
u iCardio.
Pesynrarr. 6eue ycraxoaeHa sneqarnf,Baqa noBropneMocr B npoMeHurexa BCtl no BpeMexa Ol-1.floxagarerqr
Ha BereTaTuBHnR
nor K no
oanaHc6eue axaqrNrono-HHcbK
B p s M eH ar p h r e n e p i l o A a( l O f l : 1 , 1 ;3 , 0 ; ' 1, 0 ; l l O f l : 1 , 4 , 4 , 1 ;
1 , 1 ) e c p a a x e H r ec H + ( l O f l : 2 , 8 ; 6 , 1 ; 1 , 6 ; l l O f l : 3 , 5 ; 8 , 0 ;
2,9, P < 0,05). CupgevHo-cbAoe!4srorroBop Ha On cbqo 3anaau cnequorqHocTTacH nph ABeTex3cneABaHhn.KoHTponlrro pearlrpaxa c HaManRBaHe
Ha o6u{ara BCH (or 4747 sa
3080 ms2,P < 0,05), .qoKaronpr H+ 6ewe xaparrepHonoKaqBaHero
Ha HHcKoeecrorHara
BCH (or 2515 sa 4790 ms'?),
BnHRHtlg
npn H+ ce no,Qovr,rxupaxeroHa chMnaruKycoB!,tre
rBbp)ri,AaBaLrLe
or no-ronqMaBAH il no-sr,rcoKa
ab-PV\A/.
O6cuxgaxe. YcraHoseHo6euJoHanh.ileToHaAhcKperHh, KnhHqqHoHenposBeHr, Ho rpaiHtr npoMeHr BbB BereraruBHara cbpAeqHo-crAoBaperynaqH9npx LlHAl4Bl4AhTe
c
noBhr.r.ieH
clpAeqHo-cbAoBpHcK,
l.1reogr, B saffio.{eHhe, h3non3BaHhTeHe}4HBa3[BHh
MeroAH pa3KpHsaTpaHHil npoMeHn B cbpAeqHo-cbAoBgTa
perynaqugI Morar Aa Ha[4epfiTnpunox€HH€B npeBaHTlBHaTaKapA!4OnOrl4R.
fpaxm 6e-Cx201, H@"HU'
n Nc 13. MhKPOAnEyMl4HyPl4tl 14nOKA3ATEI'1
HA BbTfl EXHAPATHI4F METAEO'II43bM
nPH Bb3PACTH[ n CTAPH XOPA C OCTIrP
MI,IOKAPAEH 14HOAPKT
tb.fpuaopoe, M. Cmaxeea,B. fiopdaxoaa
Knuuuxano rapduonoeusu paaMamonoeun,
YMBAII- Ilneeex
BueeAenue: hssecrHo e, \re nph Bb3pacrx]414craph
xopa e no-qecToarunhqHoToKn14HnqHo
Ha ocTnpoTr4r.raHe
p!4cM!4oKapAeH
hHOapKr(OMh), a cbulo qe np,,rBgeMaHe
Ha KnhHhqHopeueH!.1erpn6aa Aa ce o6cbx4aT cneqnQrvxra r yHhK€nHu3a crapure xopa $axropn. C yeennvaBaHeHa Eb3pacTraHapacrBa H r{ecroraTaHa oMr. npophcKoBl4x
iieHF ce r orHocurenHaTaponn Ha ocHoBHl.lTe
nporHocThqHoeaxxra Qaxropr, PeAnqa u3cneABaH[t oT
nocneAHr4reroAr4HhnoKa3Bar,ve ri,llrxpoan6yMllHypt,tnra
e cBbp3aHac no-BhcoKngranr4Ternpt4 6onHH c OMh, a
yBcbu-{o11c no-BHcoKacTeneHh Texecr Ha KopoHapHnTe
peAu. cbqeBpeMeHHo Ha ooHa Ha noBHul€Hl4tt
t4HTep€c
KbM HOBHpr4CKOBl4
H npOTHOCTXVHO
Ha h3cneAOBaTenHT€
aaxxu Saxrnpn sa OMh, AaHHlire3a ponnTa]4Mnpr crapu xopa ca orpaHrgeHH.
{en: ga co npoyqH Bpb3Kara na rr,lrxpoan6yunHypnAra A rnhKeM!4rTa,oLleHeHa!ipe3 HnBoToHa KpbBHaTa rnrcKo3anpu xocnhranh3a[.{Hqra(Kt-X), no noeoA Ha
O K C h H r a o r o H a H B A I c c K p a r K o c p o q H a rnap o r H o 3 an p n
6 o n x u c O K C , h n r e p e c n p e A c r a B n n B ax e B e H T y a n H o r o
H a n i l q H €H a B b 3 p a c T o B ar p a H [ q a H a n p o M f l H aH a o T H o chTerHara Donr Ha phcKoBilTet4 noofHocTHqHoBaxHhTe
Saxropn.
Marepnan u MeroAH: flpoaegeHo e npocneKrnBHo
30-pxeanona6nro4exnexa 123-ua 6onHrac OMl4. hacneg'
(meXAy
BaHHCa HhBOTO
Ha UrxpOan6yMHHOBaTa
eKCKpeqHt
3+ue u 8-rn gou cneA xocnhranu3allnnTa),cepyMHhreHHBa
Ha KpbBHarnpKo3a (KfX * po 12-un qac cneA nonaara Ha
crMnroMarhKaHa OM14),HaAlc (4o 6-un 4en cneA xocnnranuaaqnnra), Ha xonecrepona, TphrnfiLlepnAfiTe,
KpearhHSoc$orraxasara, xpearun@ocSoxrHasa-MB,xpeatnxrxa.
lpn o6pa6orKaraHa AaHHhreca h3non3aaHuKopenaq[oHeHI perpecfioHeH
aHan13.
Pe:ynrarr:
3Ha,lrMa KopenaqtaoHHa3aBrcrMocr
ce ycTaHoBFBaMeMy Bb3pacTTah ycnoxHeHoTonpor i 4 q a H eH a O M h ( r = 0 . 4 8 , p = 0 . 0 0 0 ) , M e x A y H r l B o T o
Ha an6yMrlHoBaTaeKcKpeqHc14Bb3pacTTaHa 6onxnte
( r = 0 . 3 5 , p = 0 . 0 0 0 ) , M e x A y B b 3 p a c r r a H H a n h q h e T oH a
7.fH INTEr?NAT/ONAL
A4EOiCAL
5C\ENT/FIC
AQNFERENCE,
14.
1 V
EIII,IAE M I{ O.iI Of Hr HA METAE OJII{THI{g CUTIj]IFUilil
CPEAnOIIyJTAUUflTA B fPAn II_TEBEH
A
E. Mexenna, IL Cnnrrqeaa, K. Eut<tpdJtcueBa,
Cx, Tuweas
Knunuxa no Kapduo:to?wtu pestratnoltoeu.n
K amedpa,, K ap 0u o"aozun, II 7"t -rto; tozus u eHdor<pu | | o.7ozun
M V- [In eaet t, Et.'tzupun
Abri
Agh
Akh
Alec
Alyc
Asd
Angt
And
Ankr
Arsn
llser
BbB EAEH L{E : M er"a6o,rrlruilfl
r cHHApoM,
xapaKrep}r3
r{pau ce cr{ &:t@rcffi
AX, gncnlrnnAei\u.rrr,
ce acourr{pacrc cuHApo}ra}ra pagHocrap€aner&,t
r.r3pa3rBau
ce B npoMriltaBcnacrHurlreTarracbAoBaracTeHa,flo-garuraw
MeTa6onHTHHfl
ctrHApr)M
it clBpet\telrHaTa
nonrvJlaUl.I'
Boj]ltt{ lo n€tspafieflr
ycnoxHeHHqra
or palrlrorocrapeettet{acbroBere.Cr,,{etaearreto
rn Hr[le.:t![EI
lra npoqeca Ha cTapeeHeHa cb.$gim€Tq,
QaKTOpH. -1911r)BO3a )',CKOprBaHel'O
fnt mmi
c o l l u a n l l a T a : l H l l tir, l \ r o c T H a c ! t } { A p o M ar t H e fo B } t T e v c " ' } o i F l ij e
ennAeMr.toJ"rolu,.rHil
:a uerabo;rHrHHt
cHHnpoM
cpeanon]rau]u n rpea["&ud'
AaHHH
.'tl
METOAH: Enn.'levttolorxqHo npoyqBaHecpeg non\'.qaullsra B rFe.I
ocbulecrBeHo rtpcl aUliel'e]l MeToA. I-la sc].t'lxtt EKJuoqeHHnaunef{Tl,i€8
AH, ranm ll rlrlr<poa,r61,rvt
HHypnff.
B
PE3yJITATI{: Arrxcrrrpaurr
ca 142nylrrnrracxyqaeH
npuluun, Cr rm 3?
Me'ra6o.irureH
cHlrlpol\rt{acpe,,{Ha
Bb3pacr63r.,or xollro i3-rra (89qiiIcac ,tJL
(49%) ca cl'c 3axaperr
or Mlxerr c
Arra6er,llpn92o/oor xeHHreu 809,'o
cl,rHApoMTaJrurra e cborBerHo tal 8Ocv rt 94cu. IIo aualluecll{qHg niaffi.ffi
arrKernpaHl.rre
ca c Ar.tcrr{nH.qel,ltrr.
flerrrlra ca c MHKpoM6yrtHrrpnr.
3A KIIOT{ EHI,I E : fl pcac'raBenHrepe3yJrrarunoKa3Bar,.re \rera6o-rrrmndtrT
li
e [Ir4poKo pa3npocrpailcH cpeA nneBeHcKaraflon-vnaur.uH nocraaf,T sflFql-olsm|&l
pa3uupeHo H no-'3a!'b.tOc)rleuo
rncreABar{cila npo6letta B pentoHa,
Kflto.rogrr qyr"rH:Nfera6oJlrtrerIcIIH,lpoM,ranan, AX
Ent ai I : edw ar d.-n eka n.v'un t il;.y,
a htt o c o m
lri.
'l':'ii'.
l,ii',
..:l:i:.
rl:tljil,r
i liii,1
:.,i
.i
:,,1i;r;
,l/tr
i.-
ltlil
'l
"4stu
Atici
/trigl
Attar
Baitc
Banl
Bmt
Boffi
Bstr
Baftl
Baud
Bebn
Bctii.
B&
Bcshr
Bctut
naztr
Bogd
Bq.F,
Aok
Ds*n
hlrgl
@o
"fr.
t()t)
tlu
lin
PA3IIPO CTPAHEHH E H A A PT n PHAJI Il 1tf A X H Il EPTOHVIII U
PNCKOBTITE @AKTOPT{3A I,IFC I] PE,T'IIOHAHA fP.
TIJIEBEH 3A N I'PHO tI,A2IIO7-2009I'Oi [T,IHA
E. Mexeann, I-. Itottxoou, Ktr. focnoduuoaa, II" Konapoea, Il. fluea , K.
loenodanoe, An. Vo6onoe, Acn. Huxo;too, Kp. Euxt pdlcueea, II.
Cmanveea,Ca.Taweoa
Knuuuxa no Kapduonozu.su pecrnomonozun
Kamedpa ,, Kapduonozun, Ifynuonozut u enloxpurtoto?un
MV-Ifnesen, Euzapun
ApreplranHara xn[eprouna (AX) e roJIrrMHe3aRHcIl\tpr{cKoB$axrop ra
6oirecrua crpuero (!{EC) u
arepocKnepo3a
H xJrHHHqHara
H u3f,BaKaror{cxeMr.rqHa
Mo3lqHocbAosa6orecr (MBC).IIper nocneAHaraAelialtan Euraprr HrMaroqrra
nH$opr.raqur3a pirnpocrpaHenHeroHaAX H HapHcKoBr.rre
$axropu 3a He.q.
lCt
of
.;^
ed
:d
rd
le
s,
a
g
D
IIEJITA ua uacrorlrqoronpoy.rBaHero
e oqeHKaHapa3rlpocrpaHeHlrero
l.rpHcKoBH.fl
upoQru Haaprep[anHara xnleproHr{r cpeAHacereHue'roo'r lheneu-rpa.[
MATEPHA"'MHMETOff:
B npore4enoro or Hac [poyqBaHeca BKrloqeHlr560 rpax4aur4Ha rp lheseH,
H3creABaHH
nper 2007 u2OO9roAHHa.Ha uaqueurnree [3r\repBaHo
rprarparHoAH
(cnopennpaeuam na C3O), H:rrrepnaHa
e raJrurrafi e npoBeAelra
aHKera3aocraHaJrlne
pncr(onnQaxropr.r.
PE3YJITAT?I:
flpeo6raAanaularaqacr or nauueHrure(63%) ca B'bBBl,3pacroBararpyna Haa65
roE{HI,r,cJre.[BaHH
orre3H BbB55-65roA.,no-qecroxeHfi (57,4o1t).(]rscu.rxn nauueHru
(OttetrqBxHacnopeAKpu'repu[re
nnplrMbxererinpt,rxeHHTeqeqrmarasaAXe42%o
croilHocrrlsa AH npu Mbxere 139/86uv t{g,anpu xeHrrree I 30/
ua ESC).CpegHlrre
oTxnnepToltHqKHTe
ca nyuartKHu 30ol)or x t,tilcp'ft)rl'tuHTe.
80. Ycratrosuxwe,\e17o/o
yMepeua
aKrHBHQcre
o'r
xnrrcpl()}rrrrlrr
tr H779i (}r"rrrH,KoHTo
npH
719lo
,{purarelHara
HrIMfrapTepnanHa
xHilcp'rortug.
or xlilrcp'l'or
rilrllr'rc Jlt>Ctilrut'r'c0;t
J29',o
Kl,r\'t
x parralitcH
a 387oOt HeXHnepTotlHl.ttrtc,
3AK]IIO9EHIIE:
B flnegeg qecrolarf, uRnp1-cl)iltrltn'r$
rircro r:6Jnr']xa
xHuclrrnrr cl)cl nirc(:Jlct
{o 'rir3rr
[pI{ Mbxe s HrToqHafirpotta(4X!rn).1]
e4trntle r u o r etr\'.rilllrr: \ ilt tcl)L()tiltIllrfc r.r]la'f
noae olqe e.qlrHpttcKag{rnrrop(rrotrottrtttynte
rtc) I lnt'.rir
4oc roRcpuill)alnrklt Mcx(A)'
XImepTOIIHI(I{ Ll HeXHne pTOllHttll o I tl{)Cllrt -4o6rttrItlc tr] rtil r:(lI Kt,r\t ]i|itillt |rl
KnrcvonugyMH:
AX, pHotoa$arnrp,Hlit'
E-mail: edward mekenyan(t0yahon.
rom
7.TH IT]JTEFINA,TIONAL
A4EDICAL
SCIEN'TlFlC
CONFEFlENCE,
17
OCTOBER
?OO9
CPABHITTEJIEH AIIAJIII3 HA KOI{TPOJIA HA
APTEPI{AJIHATA XIITI EPT O WNfl B PEI- tI OTIA H A TP.
-2009TONNI{A
IIJTEBEH 3A TIEPIIOtr,,r^z{.I07
E.Mexeunn, f.Itanxoea, Ktt.l-ocrtoOttHoBd,If.Konupoea, H.fIuee, K.
Acnlocrtodunoe,An.4o6aaoa,
Ifuxotoe,
Kp.IittxtplltcueBe,
H. Cmanrteea,Cn. Tuwes a
Knuuuxa no Kapduonozua u pe&ilqntoitolrut
K amedpa,, K apI u onozun, ff ynn ono.'ua u ert i oxp 14uo.,tozu.n
MY-[Ifleeea, Eanzapun
A p r e p l r a n H a r ax H n e p r o H u a( A X ) e r o - J r r r H
\ r e 3 a B 1 4 c 1p4HMc K o Bd r a x r o p : a
arepocKnepo3a
rl KJII{HHqHara
lr r43rBaKarorrcxeM]rrJna
6o,recrHac-bprlero(HBC) x
Mo36rrHoc'r'Aosa
6orecr (MEC). VcrauoBenae rrcHa KopeilarHBr{a
Bpl3ne Mex(try
HHBoroHaKoHTpon
sa AX a qecroraraua l'lBC u MCE Br,nperHcrrcreNrrnreycfirt{l
BcBeraHr4BoroHar(oHTpon
HaAH naprlpa$1exAy8 u 43o,/o.
e orlelrKar{a nunoro rrfl riorrrpolrr.rpa}rara
IIEr'ITA Ha Hacrotqoro npoyr{BaHer()
aprepaanuaxHneproHlrrcpeAHaceneHnero
or flleeen-rpa4 nper 2007 u 2009 n
MATEPHAJIH H METOAH:B nponeaerroto
or HacnpovirBaHe
ca Br;rrc.reHu
560
rpaxAaHnua rp fl.reaeu,r.r3creaBaHH
npe'r2007(42Oayurlr)u 2009 rolnHa( 1.10). Ha
'rp[xparHo A I I (cnopegnpaBrrnararraC3O), Hca altrer]{panu
naufierJTuTe
e n3MepBaHo
3aycraHoBeHa
B M!rr{0raraaprcptranua
orHoclloAaHHHTe
x ll ncpI o IIhe r 6pol n au,ra
ua ynoTpe6reaHnTe
or rtx MeAHKaMeHTH.
PE3yJITATI{: flpeo6raaasau{araqacl or rrarlueHrr.rre(63%) ca n},8Br,3pacroBara
rpyna Hag65 foArlHH, crreABaHH
or r€3r1B'r,B
.55-6-5
rol.. no-qecroxeuu (57,4%). Or
BCKttKH
XHnepToHr4qn
637oUrUepnarapTeplftulHoTo
cH r.ra^JrrraHe
ce/lMHriHo.
Be,rlH],x
Yc'ranosrxrvre,uenpez20A7136,3Voor xrfiep'roHr{qKltre
ca c KoHrpoxupaHo
cHcrorHo
HarlrrmHe(flog139 [ar\.{
Hg) u32,8%oor rrx ca c 4o6np KoHrpoI HalHacronHoro
Hulrtraue.(noA 89 uu Hg) flper 2009 r ca cbrBerrro38% yt 32,5oh.3a utxere
rle flpe32007 r.360/o
ycTaHoBl{xMe,
or XltueproHHIlHTe
ca c KoHTponHpar{o
cHCTo.rtHO
H€urrraHe(noA
139 uu Hg) u 35,5% or rqx ca c qo6rp KoHrponHa nuacrorHoro
HaruraHe.(no4 89 vrrrHg). flper 2009 r-37.3o,tou35,2'h
3AICIIOqEHHE: B flJreseHororo eAHarpera or xenril e u rrtxere c AX rorrrpo,rrrpar
eSemunHoAH. flo-ycuerneHe KoHTportrcpe,qxe HHTe.
3a6e:rmnace reuAeHurrr3a
uogo6preane KouTponaHacncrolrHoro aprepuaJrHoHa-n
r ra ne.
K.nro.rosr4yun: AX, CAH, AAH
E- mail : edward_mekenyan@t ahoo.cont
6.'H /N7EF?NATIONAL
MEDICAL
SC/ENT/F/r]
CcjNtrEFENCE,
2O-83
ACTABER
2A1O
POSTER15
DISTRIBI.J'TION
OFATRIALFIBITILLATION
AMONGITYPERTENSM PATIIIN]SIN CL INIC OIt CARDIOLOGY A){D
RI{EUMATOLOGYPRORK. CI I IC}IOVSKI
Mekenyan 8., Stsn(hcvuN,, TishevaSn.
Dept of CartlioIogy, (,ill,IHA'f "(i Strunski"
- Plevcn, Bulgurio
Medicsl Universit-1,
INTRODUCTION
A r t e r i a lh y p e r t e n s i o(nA F I ) i n p a l i e n t so v c r a g c o l ' l 8 i s d e { l r r e cals s v s l o l i cb l o o d
pressureequalto or higherthan I 4()rrrrnl Ig and/ or rliaslolicblood pressureequalto
or higherthan90 mmHg or identilredas elevatedin patientsrvith mulliple previous
takingantihypcrtensives
with carly
measurements
dnrgs.I{ypertension
is associatcd
andrapidprogressive
atrialrelnodeling andatrialfibrosis,r'"hichis a prerequisite
lbr
thenorphologicalmanifestation
oI'alriaIfibrillatron.
METHODS
A survey on the destributionof atrial librillation (AIr) in patientswith cssential
hypertension
who weretreatedat Departrnent
of Cardiologyand l{heumatologyI'ro1.
K . C h i c h o v s k"iM U P l e v e nf o r t h ep e r i o t0l l - 0 I , 2 0 l 0 / 3 0 - 0 6 2
, 0 1 0 .r v a sc o n d u c t e d .
RESUUTS
with lrypcrtension.
Totalnumberof patients- 954,ol'whorrr918 q'erctiia,a,noscd
Of
Frclmthepaticnts
thetotalnumberof patients- 324*ere u ith atrialflbrillation- 340lo.
with atrial fibrillation (n = 324). *'ith AFI rvcrc 306 (94.4",6)and those rvjthout
hypertensionwere 18 (5.6%).O1'thetotalnumberol'patientsr.r'ithatrial flbrillation
(AF) with paroxismalAFwere 102(31?6)ancl222(6991,)
with persistent
or pennanent
Aii 60 alc nreu(,59%)and alnongpatientsrvith
AF, Among patientswith paroxisnral
pcrsistent
orpernanelltA[' 108arcnlcn \49%).Fronrthetolalnunrberofpaticntsr.vith
paroxismalAF 54 (53%) haveover 5 yeardurationof AFI and48 (41o/o)
havelersstiran
or pcrmancnt
5 yeardurationofAH. From thetotalnurnberof paticntswitli persistent
30 (13%) have lcssthan 5 yearsof
AF 174(78%) haveover 5 year durationo1'AI-1,
durationof AH and 18 (9%) havc'uo history'and physicaldatafor AFL The average
AF qas -59.5'Ihe
averagcagcof paticntswith persistent
ageof patientswith paroxisrnal
or pemranent
AF was 7l .8,
CONCLUSIONS
ol'atrial
ftictorfbl the clevelopnrcnt
is a ma.lorprctlisposing
The arterialhypertension
fibrillation.Almost all patientsriith atrial frbrillationarehypertcnsive.In thc early
ling and
thereis a lorvercicgreco{'rentode
stagesof the developmentof hypcrtcnsion
thceasierconrersion
fibrosisof theatriawhenatriallibrillationoccurs,thatclctertnines
to sinus rhythm.
atrialflbrillation,duration
KEY WORDS: hypertension,
;i|{,W
ri,i:r,,,:ii.'ltirlifi,,1;i.ffiffi
74. AHNTI43HA AHfI4Of PAOCKI4TE
XAPAKTEPI,ICTI4KI,IHA TI,INA FIA
PA3KIIOH,'IBAHEHA JI'BA NPENHA
AECUEHAEHTHA APTEPII' NPI4 IIA_
UVIETI4C EI4OYPKAUI4OHHI4CTE,HO3I4 VINPld AH|I4O|PAOCI(I4 HOPMAIIHI4 KOPOHAPHI4CbAOBE
N
75. il l'Ol-H()C1'tr4riI-tA t)O"rDlI-[,\
-l.p
rcrtlN I) fl l']14 XO C Il I4'f AJII4'314P
AHVI
I I;\H14EH.i.I4CbC C.bPAELIHA
H EAOCI'AT'bLIHOC-["
(J.Tnulenl, I!. iiop4au,rna,
II. C'narr,rena,
C. Kropr.rucr.A. l'y/(cn
.r',Vf[; 1,;l ".,'l-lt /t'op,:tr ('trtprttrt'rttt" - lJ,'t<'rtcrt
I { . t t t t r t t t ;nt to r t t l , d | | o . ; t t , a t t tlt) ( 6 - v ( t n r o i t o , , r t n
"
" ['l1torlt.K. Lltrqoat'ttrt
[. Bacuner, Xp. Mareern A. Crvltlxona
Krtttuurca
no rcapdtrotaettst
Eonnu4o "Jloseue4"- Corfiun
Br,r$ypraulroHHr{Terre3r4u3aeMar orcono I 596
or o6uns o6en nnrepBerlur4orlanrlorperHpa-
I J m e t ) t ' u t t c :V c t ' l t t < l n e I I l L r r r l l ' r , ' r i ( i lur I I r r r r c u p o x o l ) \ r o r r 1Irc c r I c O - r r i t r o r r l ) r . r r { ' i l Ir{apl roal r I o l l r f l p r l
x p ( ) l I L t r It I i t c ' t ) l ) , r t Ic1r1 1 111g , r { t ) ca1' t ' ' l I) Ir I o c ' l ( C H ) ,
I - l t , - t t t t trtt i l I I i u n c T O I r . l c J t e j u r i l u cc l I l c c ] o r { e H } . t
p o , l f lf i t r I i r t l . : I l r " ] \ t e I I l UIi(t( ) H I t c t I l ) l t I I I . t t I: Il a N l o 3 1 , ( t t i l . r rf rl a rp i l v p c ' rn ( t c l r l r ( j i l ' rl . J i l( N . f p l o B N P )
K l r I O I I l ) C i l lK
. r' r ' ( ) lI)I i l r t l x o j l i r I I l t t . t\ o c I I t I l i l " ' l t . { 3 t { I
l
i
l
t
.
l
t
t
c HI.tt r : ' t , cc . I l
l)llt[,]
t
A,l<'ntodt : I) r t 1li'ir''rnltt rcr'() cil llr(-rr
r()rrc I t t I I 27 rtaI l r r r ) n T r rc l . a . r r n u r ' r ( nl r o
' l i rn c r l t C il - l o ' r ' I I a o I V
< l > l ( i r o N Y l - l i \ . o l K o l r r o ( r c )r r r , x c ( 5 7 , 0 9 ' 6 )n a
c p c l l r r a l ) ' r : i ) l ) { l c ' l 1' (,r9 + 8 , , 1 l o l n r r r r r . I - l l r r l t ' r e t { T r , t -
OT TO3I4THN CTCHH JIE3I414.
HAI NO.NOgHIIATA
I{o3I4 Ca pa3noitoxeHr,l IJ 3c)l(aTaLra,Trrjil npe/I.Ha rcclteH]IcHn-rrnprcphr. Aro cc npueMe. ,rc
xeMolrr,rHaMn(rul4TeQarropn ca Bolteur{ npr.l
t{tlrIl-{r4rfipnl{eTo !{ fl pOf peC nttTi:r I I a lTepoc KJIe-'
poTltqHaTa nJrilKil, 6n rpnonaJro Aa c'bulcc'fB\rBaT npeAHIeKUI4OI"lFlt4MeCTa, KaTOTOrrKI4Tett{l
pa3KJioH'BaFIe Ha apTeptiltTe, K'bAeTocTel.to3HTe ce cpetJ"{arno-rrecTo. B clyq2p, rre He ce yc'l
C C l . i I I O C , l L r , r I ( ) l l i l l ' C "I r- tl O X O C l l l l ' f i l J t l t 3 l l l ) i l l I I . l n O
'r'ar-roul4TaI(aBa rlpetrr4cno3rrrfr4n, ToBa 6r,r <>3I r o r r o ro: (l r r l c - t 1 - l c\ pr Ioi rl r I r ( |rr{ lC l - l . B , r t c t - rIlm , l e ltitLlaBa,to, rle IIe Mo)t(e lla ce ilpeABI4AI4Mtc'tox
o c r rI . t ifu t l l : l i l I ( t . 1i if cl 1{ r o c b U l c c l ' B c I I IcI f l ) H A | ] p TO Ha Ilb3HI4l(BaHeHA ilJIrlKa 14C',fel.to3!1,
KoeTO
L
' t t t t. , u r f i o p i l r o l ) r nt rr t l l t ' u i < t t r J ( ) r I l r - inr I: r] rc r e A OnpeAeJ'If aTepOCKnepO3irTA
KaTO CTOXIICl'tl(lCI
I
npol(ec.A,rrepuarrBlrorpyrn $axrnpr{, {i Hcxcr- I l a l l l l f l I l c I l 3 c ' L I B c I { 0 3 i l i I K l ) ' t , t }3 a l t S c _ r t e I ] I t a F I e
,rpc:E
r I - l S r \ N t cf o i [ . I ( p a l . r n a r a
Monl4HirMplrrHr.tre, 6 t'txtt6 t'tt tu o rrpe/IeJrflu{LI BbB r r r N ' l i r r o l l N l '
l l c j t c r L ) d ) r r I I r r l ) lrrllt K ; t ' f o p c x o c r r r { f a - t r , r 3 i u l t , tIftlo
TOqHOOnpeAeneHr.{MecTa. B npelcTarJeHo'ro n o g o , ; tr l l o 6 o c r p c r r l rC l j [ r p i . r l r K l l ] cr t a 6 t t e npoyqBaHe e FranpaBer-{
a}{aJil43Ha or"rfr4ofpa- c c r [ 1 . I r o n c , t co l ] x o c r t l t . t - a . : t t { l a r I ( t t I t r: lcrl a t . t B'b3HI4KBAHeTO l,t pil3BHTHeTO FIA ftJIaKHTe Hil
cbnoBe npu 800 rra- I l l t l l - r i II C b l ) i ( C t I I l { ) - C " l ' j I O I ] l l C l \ l b l l ' l ' ,
$uure Ha KopoHapHr4Te
I ' t ' t " t ' , t n t t t t t t u :I I p o c - ; t c . l c n l t c { l I 2 | f t i l n H c H T i l
III4eHTH.cpanuenn ca aHaToMI4(IHHTe
6elc:l,r (
9 5 . 3 q)2: . nc ; . r c , r n.ol i i 7 t I l 7 ; r r r r r .l l o r r e e , x u u
lla Ceflv{el-lTHTe,
brull.'lFIA
IbnXI4Ha 14AHaMeT"bp
oT4enfiI{ev'brilu Franpofpecvfl Ha LAD, ,1r,,Ir- I I r , p l l l t r l eI I K l l i r c i r p c 3 \ ' " , l fi t l ' c l ) 0 I I . l c ' tl ) L l l l l t t I n p I 4
(4-1.69l).I IpI'r c,'rr-rorlraxtopi'nrr
xHHa Ha CToHoTI,ILIHHTe
CefMeHTU, CTOTLIOTUC- .5.1rturtt.rcttt'rt
p
r
o
i l NP / x n r i r l i l i { l )i r- 3 2 . 9 3 .p <
r
a
u
r
i
r
n
N
'
l
HHtI Me)KXytrbIXI4HHTe, AHaMe',rpnre I,r Hatrur{il
0 . { ) 0 0 I) I l ( ) l \ t t J l l ' : i i f t r \ t H \ l iI lI p c , i l u Kf r u t t r l r c t c l i , i Hir pa3KJroHrrnal.IeFra aprepl4ure. OnucaHu cil
((il
x a p a K T e p r 4 c r n K H T en p u n a u H e H T r 4c 6 r , r c p y p u i - l r ( ) c ' rl' l I I ' r , i ) r t rI.ltr, l t T l rx l r l t i i | I l c J I . t " r .ttx o s l t f l r
pCfllCCl,lOI ILrlI il I Iil-'I l'13OI I l)Crlc-l t I Krl'l't)I iill 1-3FIat1!{or{rII4creHo314, TaKI,rBac KopoHilprrn 6olccr'
, n l N t I l l t p e r r t l . l K T o l I)Ina t . t 3 x o i t iN
l 'fproBN P, -;tRso6essac-qraue
na LAD H HopMaJrr{rE
aunrorpa(rK
l
I
\
,
r
c
l
)
r
t
r
r
f
a
r
l
r
l
n
t
r
t
l
t
r
t
I
I
i
l
u
l
'
f
itilctiBirrrc I.t cl.tccKH KopoHi'rprrr4
c'bAoBe.
1(UIH0l',O
i l l ) r c l l I l i r J r I r LI )l i l _ r l fil.rl t I c I I I ) r ' r. ( c x o c f t H 't
a.It t3ilI lH' .
/ | t c o ) t r : I I 1 l t t n r r n r ' I n r r , x o c r ] r n ' l l - r n I : ' l l r l ) t Hnro. . t
l r ( ) I l o , tttn r o C r o c ' r ' p c r txt p o H r . l , l r - rC
iliH, nJta3MeI I i l ' t i l K o u r t en l l ) i u u ' t f l n a N T p r o l l N P n l t e r n a e xt)c 11lll'ilil tl3illl I I tl JloIl pt{ llllcfl 3I ti:l(I ll i\Io 3i] npeac l i i l 3 l i l l l - t c l l { 1 n 3 x o : l [ r I t p ] , { r n l t l t . t et l n . t c s c c H .
It.ttit,t0 6 t r t)y,t rLt : \10:J],(lct t I {il1'l)I.1i.,[)c1't4(
teil nert 'l
-+1
I U l . C l , l l , : l c ( l I l l l l I c j l ( ) C I ' i l ' l - l , ( II t O C l ' . I I l ) O f I I O 3 l ' 1 .
i dW
,;iirlffitr$l,W;.
l,1ili,,,:1il,
23. I(JIVIHLTLII-IA
XAPAKTEPI,ICTVIKA VI
KOMOPbUAI4TETIIPI4
NA[I4EH'|I4TE CbC CI4CTOJIHAI4
A{L1AC'fOI tJA ^qUCOyH KIlH.rI:
PE3Y-IITATI,{
OT PE|I,{CI-bPA 3A
cbPAEqHA HEAOCTAT*bIjHOCT
HA
KAPAI4OJTO
t't4r{HA Klt 14HI4KA
..fIPOq).KI4PI4I TII,4tIOBCKI,I"
22. KOPEII4PAITIT4TTPOMEHI4BbB
BAPI4AEHJTnTETAHA CbPAEqHr4t
PHTbM H KAMEPHATA
EKCTPACI4CTOItw.fl , OTPA3.TI
BAr{ 14
IIOJIOXIIT EIIHVIfl, EOEKT OT
JIEI{EHHE HA CbPAEqHATA
HE4gglATbqHOCT C AI,IJIATPEHAO'
P. Ilpoxonona,M. Marneen,Ir. Haqen
YMEAJI"Ce.Anna", Co(tun
IUIBME, EAH
lI. C'rauqena,B. f{op.,rarr0Ba,
CH. Tuuesa, ,{. Iiyaen
Iluctu hfeduquHcKu
HrrcmumymIItt€B€H
Kttpduo.,tozu,tnu
uituHuti(r"IIpo|. i)-p K. tluqoBcKu"
Brpxy 20 6orura cbc cbpAeqHaHeAocrarbrrFrocr
( C H ) ( I I - I I I $ y u x u r o H a r r e n K r r a cn o
I k.t : ll:sc:rcdrirlr e K,.'r
u rIr4rrt-rara xapaKTepr,IcruKa
NYHA), .rreKyBaHuc II,I.IIATPEHI@ c
n rolropOr.r4IITera rrpr,{ rri.lqt{cHTI4Tecbc
rlocreneHHoHapacrBailru.qo3u
or 3,125no 25
Cl{c]'O-rlHaI
ll !.IIaCTOJIllaCl,pAerlHa tleAOCTaTbqMI, e npoyqeHo noBJr14qBaHeT
B ob p x y
FIOCT,
nOC,'lClIOBaTe,lLtO
XOCnnTa_IH3HpaI{}IB
napua6unurera Ha cbp.ueqHnnpr4'rbN((BCP)
"tlpocD. Kupun
K.rrr4uuKa
I(ap,xr,rolonl(rFrit
r4 KaMepHaraeKcrpacprcronr4s.HaMaaeuurr
9u,roncJ<lr"
crer
rrar.i
2003
r.
BCP npu 6olnu crc CH e noKa3aren3a
pe
ll{cmo}u.
Cs:t.ltaAoxvc
n{cl"bp,
n xoirro ce
noBHUreHcbpAerleHpI{cK oT TexKu KaMep}{r{
B
I'I
I,
f
C
BAT
BC
T,III
K
I-I
fI
OCr'I
CIO
BATC.II
I
IO
XOC
NHTAJTH3H
pHT6MHr{HapyureHr4fl,Hafr,-qecrvr cyrpr4rr.
paHlr IlAurlclt'II4 c /iu4itfHo3il c-bp/IcrlHa HeAoIlpoynaHero Blc'rrorrBa
Xo.nrep EKf, xaxro u
c'nrrbrlHoc'lIII u IV OK uo NYHA c;leAnaari
onpeAenqHeHa noKa3arerl4Te
sa BCP cyrplru
ll creAo6e,us norori t{ npu crtlMynaur4o}u{rl 20()3r.. KolrroorroBapflTlra OpaurruraMcKuTe
npo6n, npe/Iu reqeHl4eroI,IcneAe.qHoMeceqHa Kpll'l'epltl,l 3tl C])pne(l IIa I leAOCl'a'[br{FIOCT.
B pct'l,rclbp€rca nnlrcaun 166
r e p a n l r . f l .C X o n r e p E K f e y c r a H o B e H a Pesy":77ro,rru.
r{ n au HcI rTtr. xocrrHTaJrr{3},rpaHu
nocJrcjlo
Bare.rr
H
pa3Jrl4sHa
eKcTpacr4c'roJrl.rt
no TexecT KaMepHa
c lruarrroraCH :ra nepuoAalraii 2003 r. n p e A u v r c J r e A J r e q e u r 4 e r o .K a u e p u u r e
rlcripyapn200,1r. O"r.rnx55.4oioca v'sxe, 59 %
eKcTpac[cToJlHrr
HapyueHufl ce cBbp3Barc
ca r{a Bb:Jpacr
Ha.rr
65 r. -5(r.2
7b vuar @Vl > 45
xr4nepcr4MnarzKoTour.r
ATa npv CH, oco6eno
(2. I-laurren'rr{re
Ot4 (OI4 > 45
c.bc
3ana3eHa
cyrpl,rH. flpouenure B aBToHoMHr4l6n-,raHc
c';) ca npc-ult\,tuono-Bl,3pilcrrrr.i
xeHr,I, trpH
c
npe.[r{ tt cJleAIe\IeHI,IeToca r{3cJreABaHr.r
LIeCTO-tr1Ta
F:ot11'O
e
nO-\1&1Ka
I-Ia
,qOKyMeHTI{BbBeAeHaoT Hac MeToAI,rKa3a oueHKa Ha
npecl6,ra- Bara,lHI4g 5anagC B pa3,'1
I)lr] r n pexri nl r r \n{ oKap.len l urcllatrrx'r,
c I{MnaTI,IKO
HqHrr
xilnepToLiH'lil c no-foJlflMa
_taritapTeprtiLIrre'ril
rtecrorarrr
r{a lilxapcH ,U,rtt6er.Hglra pa3JII4Ka
ga BCP. VcraHoseno 6e, qe B pe3yrraror
1i0
tra x6l-1. aHc\4r,tfl,
irpencbpAHo
otllollr*lrrc
neqeHnero c ilV|7,\TPEHno ce Ha6rruiraBa
,re 13.67c oT naUneH\t
.
i,xlr,'He
reHo
e.
C],r-uccr
noBr4ueHBCP. noKa3BarureH.rr,eHulr.ff
Kb\{
(l)[4 rrlra'l AH
HopMaJIlI3I,IpaHe
Ha aBToHo\rHns6a-ranc. r i r r e c b c t r r r r r r t ne a
nrrl Hg.
Anrosotrtrara HenocrarbqHocrce no:oSpnea
3ui;-tdtqci tt tc. fl ii ul I c-HTrrre c ileKoN{neHchpaHa
.,qaCOBe.
3Har{HTeIHOlI B CyrpeUHHTe
KCTSTO
CII trorrrr-rircc trpctlcrAnrrlKaKToc uoHhxeHa,
oTpa3eHoB noTr4cKaHeHa xirnepc I [\{ n aT]I xor0 (Dl'{. -fc:lu cbc 3ana3eHa
Hnqra. Teru npoueHtr Kope.upar c )'srarrots€Ho r,rr\ii ir ctc Jiulri;eua
(Dll crr ilo - r3'l,3pitcTljr,r,
fio-rlecro xeHn, cr,c
TO HaMaI.ABaHeHa TeXeCTTaFra KflI{ep}"raTii
14
ilprcpr.tanua
.lJ\lpcu
xulrcprolnkttrrl
;trrlr6et
eKcrpacucronHa aprrrMlur clef, .reEeFUteTr!.To l r
c
no-\ia-rKir
Beporn'Irocr
r4N{[trI,IBC u
ila
pe3yJrTaT
no3BoJrrRa]lace npeJnoiox.It. qe ilptr
Fr
tto
r
rpr'x
l{
Br
Nr
Kaple
n
rr
uQapxr.
I e.{enr,reto14
3ana3eHa TeH,iIeHuHflKbM n0Bl{r..UaBoHe
Ha
ul I rLrl{q}{zll'aKaprHHaca cxoAH}t.XH noroHHtlta
BCP s reqeHne Ha Tepannrra ce nrc:o6pxaa
e
Heofttt.tzri:tna.
nporHo3ara sa npe)Kr{Bre}rocr npn CH"
MOMeHTI,IHa AeHOHOIUUeTOqpe3 flOKa3arerltre
2l
ffim
ffi&t
62. ONI/CAHI4E HA KJII4HI4T{EI{
cnyqAfr c I4EC* npExklB.flHr,rnET
M}IOKAPAHH HHOAPKTT4 t4
AJ{|I4OTPAOCKH AOKA3AHA BTOPA
LAD C trPOI,r3XOAOT AECEH
KOPOHAPEH CI4HYC,
40 6o,'rHr,r.
H napaNrerpuTc
3a JIK AnacrolHa
E-nr4x,A-nuK, E/A, Bn ua
Ittc$y'uxul,rr{
N{I.ITpitr'I
Il l{fl Kp'bBOTOK,OnpeleneHH nocpeAcT-
norrflon:rep-ExoKf,,rpegl(onop-[onnep-MVp TbKa}reH {otuep - cucro,'rHacKopocr
lv{o.qS a . p a n r r a A u a c r o l r r { ac f a : a E a u K b c n a
ruircroJTlra
$a:a Aa (20 6onr-ru)sa 6'^oet 12r,,'N'tcccll
oT
nocj-bntlaHero
urt. Bls ocHoBaHa
{D.
A. Cnacona,
3. Cnueonona,
!. fafi4apona,
rosa
6rrxa
onpeAencHlr
3 rnna IIK unacronna
fpuropon,E. Belqena,C. Tnruent,M. Cranena,
rlpH
lr:lcireAnaHlrre
Iuc$-vrrxqnrr
6olnu c
JI. Mlrxosa, B. fropganoBa,
K. fldlaucxu, l[.
X
C
H
:
CranveBa,
A. Eoraxnena
l) ygt,rxeHa IK pcjtaKcauurr- npu 30Voor
BucwMedu4uHcKu
lIucmumymf[neeen
C
o.rurrle
c XCH-ll OK;
Kapduonoeu.tHa
rcJ,tuHuKo
"IIpoQ.d-p K. Vu,.toscru"
- npn 6olunre c
"ncenror{opr\{:Lnlr3allnrl"
2)
Ipegcrats ce 60 - roAutueH rraut{eHr, XCH III <DK;
rr4n - npu 20Voor 6olunre
flponexan [erKparHo n Kap4r4oJrorHrrHa 3) pecrprrrcrr{Rerr
c
XCH,
Irpear{MHo
c IV <DKno NIYF{A.
K.nusuxa "flpodl. K. 9uqoncKr.r" MEAII
p
a
H
F
r
r
,
r
Karo
n p c n r l K r o p r {n a B C C n p n
fhenen 3a nepuoAa1988 2003 f. no noBol
6o.rrurrre
c
XCH
ce nocorrBarExoKf 6eresu
HerpaHcMypaneH
MHoKapAeH
uH$apxr 1988
.la
(ryHrqux, AoKaro
Hapyue
Ha
III(
arracrorlra
r., c;reAacr4M[ToMeH
nepr4oA2001r. npexr4urrr
cc
$Vl?(,
flBtllfl
Kbcel{
npcJluKrop
:a BCC npU
ocrbp AoneHMHoKapAeH
nu$aprr c Q :r,6e.u;
6orunle c XCH. TonaAoxassaHeo6xo[HMoc2003 r. Mapr r4 oKToMBpHpeann3r{paHtrllBa
rra o'r ccplu.iru.rExoKf nplr 6oluure c XCH
nopeAHrdl.oJrHLrMrzoKapAHnHnQaprru c
o S o p u e n a s r 6 e u v o c b t u e c ' r B l t s i l r r i . l na 6 r,reccua3a ouelrKa Ha nporHo3aravl
flo,'t3alil ol UptL[oxeltoT() rertcH]Ie.
S r . r 6 p u u o l u s a .f l p e 3 H o e M B p u2 0 0 3 r . c
ocbr.r{ecrBeua
CKAf c pesyJrrar: 14EC.
64.Ir4tnn\n- PEfyJrnPAIqA
[nyr,roHoBa KopoHapHa6olecr u BTopaLAD,
H3nr43alua
or neceH KopoHapeHcuHyc, fie't
TEPAfn4fl * CbPAET{HO-CbAOB
xeMoAr4HaMr4qHo 3HaqI4Mt{ CT9HO3H, nopaAr,l
KOeTOe HaCOqeH 3a OnTUManHa KOrrCepBaTuBHa repanuq r4 KoHTpon Ha pltcKoBure rparrclpu
sa I,IEC. Brnperu roBa npe3 rlrru 2004 r. c
peaJru3r4paH
[err4 Mr4oKapAeH
uH(taprr cr,c S]'
- e n e B a r l v l sB c b u a T a 3 o H a , n p o B e l l e H a
@n6puuolusa.
PI4CI( 14 IIOKA3ATEJII4HA
N TTNI4AHI4' M ETAEOJIH3bM
(D.JI.fpnropon
Kamedpa "Bompeutttu1otecmu "
BM tr4- il,teeeu4t. flteeeu,l]z',taapua
C,'rcn npoecltcrrHTerrpe3 rloc"TeaHoroAeceruircT14e
loiteN{r{ l\{HofoueHTpoBI,I,nlaqe6o
63.TUIKOI4OT HA'I-TIECTT{TE
KOU'fpOiriip:tHH
K_flr.tHl,rrlHH
oIIHTH Beqe HflMa
EXOKAPAI4OTPAOCKH
nAPAMETPr.{
c'bMHcHI4' u nOJr3ara oT arITr4nHcnI4nr,rAeMI,FI3A MOHI4TOPHPAHEHA
rrara rcpanrng. IlclsacrorrueM o6a{e, Bce oilIe
XPOHI4TIHATA
CbPAEqHA
\{IL[KO OTl{yxnaculr4're CCnpor]e)K{aT nvfi'''UulnEAocTATbqHocT 14 TflxHoTo
pcryxHpaua
repanHrr. O6cr>rclar ce pa3nr4rrHr4
IPOTHOCTI,{,,qHOSHAIIEHHE
rr[)uqr.rHH- B HeAocrar-br{Ha
cleneH cr6lrc.qaBar Ic lJir cr,Bpc!\rcr.rHHTCn pcn opbKH, HeAocTaTbH. XaaxnnerpoB, JI. flenena, H. Curueouona,
rrer-rKOr\,rrr;raltasc
Xp. Koxyxapon
na 6o,rHl.tre.Br{coKaIIeHa Ha
}{/l}{
,rlI{ n
n 0 FILixit BailIt{Te MeAHKaMeHTI4,
BCL{qKn
Vnueepcumemcrca
6otnu4a " Qapu4a ltroouila",
p
a
u
u
y
N
{
e
T
e
a
p
f
H
r
H
H
y
x
l
a
r
a
HoBtr
o
T
K,runurca
rcap)uo,toeuu
CoQux,
no
crpirrcn{r.{ :la noAo6prBaiic Frrl KoMnnaftanca
3a nepno.ua2003/2004roa. ca npocrreAeH14lra 6olrru !r ncKapr{.Crrueupcl.{cHHoBbnpoctr
exoKapAnorpa$cru100 6o,rnlr c pa3,rru(rHa e I{e ]Izl-qH,a ilpll KaKbBgtpAetlHO-C],AOBpI,ICK
err,roJrorr4t
na XCH, nocrbrr[Jru{Ha JreqeHr.te e o6ocnosirHo rrpoBcxrarlero Ha nunv'"n
p ef y.rlrrparjla'f cparr14r, r rpeABltA orpaHurreHl4Te
rlo noBoAHa r,r3ocrpsHeroii. flpocle4eHli ca
pecypcrr oTAcJlflr-rH
3a 3ApaBeo[a3BaHe.
cJre[Hr,rreExoKf noKa3arenr,r3a cr,rcro:rraJI K
T
r
,
p
c
c
r
t
c
r
o
Ira nporHocrurtr{o 3Haq[MI4
QyHxUrq u^VI>40%n Ql4<40Vo,crorn. 60 r.r
,,. lYw
lrth abovehaven'tbeenrevealed
in the control
roup of significantchanges.
'hus,
Nebilet is effectivemeansin treatment
f elderlypatients
79, IVTAIHO3A H JIETIEHHEHA
XPOHI{r{HATA CbPAET{HA
:IEAOCTATbTIHOCT - .IIOCTI,IIAT JIH
CbBPEMEHHHTE NPENOPbKI4,UO
AMBYJIATOPHATA NPAKTI4 KA?
C l t c t ' o . t n i r , r r r c ( r 1 , n K u n l1 4 i \ 4 a2r 4 7 o o ' r
- 28%. cveceFlaIr3c-"re^trlaHnre.
-ILlac'roJ'Ir{il
(ryuKUr{fle
28% n s )011o"[eBOKaN{epnaTa
H e o n p e l c - T e r rAa C
. ll nuxnOuropu(ACEn)
li5%,,6e'r'a6,rorcprr(EE) -- 32%,
no,ryyrranaf
aHl'aroLrHcrr.r
Ha ruitocrepoHa(AA) * 33o/ou
aHfr4orcH:lurr
II pettenropllr 6,roxepg,- 3%
o t 6 o - r r H r , t ' r [eI .p e n c l p r . n { T e , r H rA, ro 3 r { c i ' r
npl.r63,%ot.reKyBaHr.{Te
c ACEr.r,
Aocrr,rrrlarrr
l l % o r i r e K \ / g r l u 1 4 Tc ' cB B u 5 2 % o r
npl{eN{L'utlr4rc
AA. flptr ocrauaflilTe6o,ruitc AA
HaARUUtilt]anpHUe,ltta'l'a.
[. Ileftrer, B. Cnpaxona,
fr. froron,A. Aure.not, AO3IITa:]Hil(il,lTc,rIFIO
(CI-) ca npcAurlcBaHlt
CrpAc,lrlr r"rroKolr.r,rtu
npu 39% or nAu,ucrrrr.rre,
Karo 6l% ot r'lx ca c
npeAcbpaHoMbxAelrc. Tpu,teccr [poucHTa o'r
6oruurc cr,c crtrlcoll pl4lbNt u /lhacronHa
Kapduonoeuuna
wtuuurca
I,
X C H n p n c \ r a r C f . , L l n 5 , p e r u r r F rJor e q c H u e
luuoepcumemcrca
6onuu4a"CB.MepuHa",
n p o B c x A a r 8 5 % o r e l o , r F r r , { T er c. a ' r o 6 0 %
Medu4uncrcu
VnueepcumemBapna;
I1oJtyr1i111;1t
tllypauTpurt n 407o - rr{a3l{ArII,r
npaxmuKysaqu
neKapu- Bapna
O6uqo
AUlpeII,rrM.
,erapff oT aMbynaropHararpaKrlrKa (ArI)
3atcqtoqauue.
Haurnte AaHHr4noKa3BAT,rre l{iv{a
paHHaTa
oTfoBopeH3a
r,rToqHaAnarHo3aHa
n 3 t s e c r l l 0 r r o I u c H f l r ] ? i H e ] { a K J i l 1H r .r1I t { } J t
poHr,rrrHaTa
cbpAeqHaHeAocrarbqHocr(xcH),
rperre,r 3a llnalHoszrra Ha XCH H AfI.
lnoqtsaHeToHa JreqeHl4ea npocJleArBaHeTo hucrpyirtcr{Ttuulr.{'rcr{cTo.qt{3a ArlarHO3zIria
a eBoJuour4
ATaHa 6o"necrra.
XCH He ca 3acl'bneHltr,oc'r^aTrrlr:ro.
EXOI(f
(ryurur{rl
npenopboueHKir r{a c'bprerrlrala
ce rtpr.{J'rala
{et [a orreHHMKaKce r.r3nbrHqBar
HTe Ha EnponeftcKoro KapnrroJrorusHo B HeAocrarblreno6er\'rI'r r{rrrepltperaut{rrriiI,te
pyxecTBo 3a nocTaB{HeToHa Ar{afHo3a r,r r.Ie3aroBoJrr.no.rr[ra.
ACEU lr DF ce npr.{JrararB
er{eHr.rero
Ha XCH n pa6orara ua o6ruonpaxcy6onrrtuaJ'lHrrro3r,r, Ka'fo nocrcrHril'c ce
aKyBaulr4re
rreKapr{(Onn).
I43no,'I:lRa'r'
cpaBHt{Te-[HoprrAKo. flpr,t oxcl,lo
[amepuan u uemodu. l{screAnanu ca 340
ero-rrult
AA ce JlaBa'r'IlHeonpauAaHo
noJIoBI4nal'a
oJrHH C nOBr4IIeH CbpAeqHO-CbAOB pLrCK OT
BI{coKa,rto:la.C['ce npelrrrJcr]alI1 lrpn .qrrrlca
OIIJI npaxrllKr{ B rpa4 Bapua u o6ruunara.
Ha nHll]{Kziufir{.
T. Saxona,.{.Be.nencxn,
H. Befica;ron,
14.HnnoraeBa,A. Kau6ypona,
Xp. flnuurpora,
M. Tauea,IO. ftopnauoB,U. Ea.nrascxa
oJ'rHrrec ArlarHo3aXCH ca 91 (26,87oor
- 50 Mbxe u 4l xeuu, ua
rlrrrKu yqacrBaJrr4)
b3pacr72+9 (50 90) fo,qr4Hr,r,
NYHA rlrac
- IV. CeAeu.[ecerr,roceM nporreHTaor rflx
\{ar r,rcxeMr,rqHa
6oJrecrHa cbpqero (48% L I o K a p A e Hr 4 H @ a p K rw 5 2 % - a H f r , r H a
:rropuc), 93Vo- aprepr4iurHa
xr.{neproHr,rr
14
l% - wtanur4fiopoun.
%ynmamu.Cnnantouvrre v o6errusFrr4re
)J're3rz
Ha XCH ca.(oKyMeHTr4paHu
npu 47%
' 6 o a u n r e . ( D y H x u u o H a J r H r , r rKr rn a c e
rpeleneH s 69% or cnfraure. EKI- nvar
Hv^Kr4
6orur,t, Karo r,rHTepflperaur{srro
Ha pr4Tbue npaBeHan 99ok,a no
HorueHr4e
HoureHlleHa QRS uopSonoruq Ia ST-T
Ha rpbtrHa
oMeHr{- s 68Vo.PeHrreuorpaqpua
Karo
or
6olutre,
npw
43Vo
erKa e [paBe]Ia
2
H r r e H o B I 46 e r e g [ 3 a C H I , I M a r 3 V o .
(EXOK|) I,lMar 40% or
.oKap.ul4orpa$vrt.
3a CbpAeqHa
KaTOAOKa3aTeJICTBa
uHeHTHTe,
npu 227o.
ca
HaJIpIqe
cQyHnrxn B noKoft
5l
80. H'IKOI,,I CJIIYT,IAI'1C TEXKA
cbPAErr HA H EAOCTAI'bqHOCT,
JtEKyBAI It4 B KAPAI4OJ]O|I4TII{A
ILTIUH14KANIE,I}EFI
JI. Murxona,Cu. Tnurera,A. fygeu,
II. Crasqena
Bttcmhlcdutluttcr;u
iltecert
tr'ltrcmum),nt
Kapduoitottttttt(1 ti.tt,tttttti(t " IIpo(t. c)-p K. tluqo6<:Ku "
Crp4eurtir-raneJOcl'in'brrrrocr/CH i e iAl)irnell
npo6;rclr c ro.rtrrtr.r
il o(rl uect nerj a llr{a(lr,tNfocr or
l ( i t l t H l J ' l c t t a I S C " l - t r r o I I e a r r l r u i l t r t c -S u r w e ) " ' .
24o/oot 6oJtrtttre , IIoc't"bntJailrLlti Kap/tllo,rloIIIrI
H H K J I L I H I T K Hc ,i r o ' t , c C l l . C H c c - v c r a l { o B g l l aB
1-3Vo ot o6uala nonl,,rlzlul'1ttt{ Hapacrl}zl Ao
l\Vo c Ie D.6 5 roA u ur tt a Bb3pacr. C't,tpe lte H utrto
TepaneBTl{r{Hofrol}erennc Ha 6o"rtHtt'tccr,c CH
npoyqBaHt4s,
ce 6asrapaHa r\4iror-o6poitt-u4
ycTaHoBI l.rII1 /te] a IlJl Ho l'lc pBl{() -xy}10,TIflpH tl're
MexaHr43Mtr
Ha cr,rHJlpoMa.
flpe.qcrassMerpn cry{aq Ha rexKa cbprerlHir
HeAocrarbrrHocr(CH III-ry KJ'racno NYI-IA)
c nolluopraHHu ycno)KHeHnfl,JreKyriaHl.l
rl
Kap.unonorprqHa
KrrlrHr4Ka,rrpu Kotrro e rrpoBe
.ueHo oITTI4MaJIHOJIeqeHHe, CbfJtaCHOrrpe ilop'r,
rutre Ha ESC H e AoBerrotro ognansBaHeHa
cl{MnroMr4Te,
KaKTou nogo6paBaHe
Ha Karlec'r
Boro Ha xrrBor, flrpnuar cny.raile [auneHrKa
wa 50 roAlIHI,IM.C.n. H[KM/utuorrirrtrrrHA
KapAr4ouuona'rnnfuJIFE. Illlr
Ar{JrararlrBHa
cbulaTaenpeoAoJltHavMo3lJr{Ha'ta
cr,IMnroMaTI4Ka, BCJreACTBI4eTe)KKaAHn-VUHOrrHa xr{[oHarpHeMl,rt r.r Karo o6crAcHa la
pecl4HxpoHr43r,rpaua reparrutr /PC.T / u
HaCOqeHaKbM CbOTBeTHHtUeHTl,p.
Bropuar cay.raft e [auHeHT Ha 47 roAlrun lI,
.tl. M. c nocrMr,roKapAr,rrHanvJrararvlna KM ll
c AonLnHrlTerHarexKa vepHorrpo6sa lN crD)'I rx
ul4rr, xr4nonpoTel,IHeMzq,Mo3bqHacr4Mil ]'otvH'r'H
Ka, nocrl{ruaro xeMoA}rHaMrrqHo cra6 n,,-r
n :tt t pa
ue u o6crAeH Karo noKa3eH 3a rpaHc[-rraH]'rruux.Tperunr flalrileHT e ua 58 e]Iornrrn3arrnr{,
npeueHeH KaTo noKa3aH 3a TpaHcnnaH-r'aut4rt.
I4seoAI,Ire ca , qe cbBpeMeHHara orrri{MruFra
repafiufl sa 6orHr,rre cbc CH, ycneluHr{rrT
KoHTpon Ha Ko-Mop6lrAsara naroJrolnr, N{oxe
Ia zalanu BnouraBaHero Ha CH, la pcayrttrpa
yAb.IIxr{ npoAbnx}rrer.r Hoc rf a
cr,rMnToMr.IT€,II,a
n noAo6pu KarlecrBglo Ha )KHBor.ArexrrarHtlTo MeanKaMeFrro3HoJreqeHueHa rexKara Ctl
e npeAnocTaBKa3a AorIhllHI,rTeIIHacbBpetucHHa
HeMeAI4KaMeHTo3Ha
reparrr4lr,KaKBalo 6rr 6u.rrii
(Iecrorara Ha ocHoBHI4Te
IIet: na cc r.{3cr'IcABa
prrcKoBi{ (raxropr,r (P<D) npn 34paBr,rJrnua 6e3
CC3, Ho c Br4coKpHcKoB npo$ur or au6yla-ropr-rrlnpaKTl,.rKll
lu,r BapHa u o6tgrHata, u
Ha yctllrilgTa 3a
AA Ce OUeHrr rL[eKr]aTr{ocTTa
edlc rr rtn Horo rlrr4 l,r:st H6orH r,IrIHo IloBJtnl.BaHe.
Yuae'muu4u
u .uemo)u;Or rener au6yaaropHra
npaKruKr.rHa OIIII ca nog6panu o6ruo 340
r r a q u e F r r ac B n c o K C C p r c r n O I I J I c a
Iron'bJ'rrJr.iJur
nolpo6eH r;l,npocHl4K,Karo e
H 3 n o . r r 3 n avHo 4 n r p n u n p a H B b n p o c H I { KH a
E npon eii c Koro Kilpltpr
oJrorr4rrHo
ApyxecrBo
(EuropeHeart Survey).Ornu$epeHrlr4paHn
ca
o6ruo 84 yqsctrlrur.r 6e: Hurlrsue na ?IEC,
cbpllerlHrl
He,[oCTaTbr{HoCT I4Ir,I MO3bIIHO-
cr,noBa
6o,'rec'r,
Ha cperrraBb3pacr
62,4+11,7
ro.'r.(29-81roa.).
P t : s \ , , ' t r n a m uC
: l 1 4 3 B e c r I r aa p r e p I , I a n H a
(AX)
xHrrcprorrnl
ca 92%. C npe4xoxgauta
Nlr4rca 44%, a 3axapeH
Anc,'urnune
aua6er (3[)
uua'r 2696 or yqacrrrlrqnTe,AaHnu 3a oOuI
xonccrepo:rca Ha,Tlrqenpu 8970(907oor resu
c AX vr 860/o0r :re3ll clc 3[), sa HDLxo.rrccrepon- npr{ 63Vo(csorBerHo 65% u
59%), :ar LDl-xorrecrepoJ'r- s 29% (29Vou
2796),rpnrnruepvnv - s 6Vo(6% vr IVo). C
( I4TNI> 25 xr / v2) ca 72Vo,
HaArropMeHo l errJ'ro
(HTM>30 rr/
a c Lrcrr,rHcKo
3arrrr,crrrBaHe
M2) - 26,6%. Ma-ur,xe 6po.arHa flyruaqr,rreB
- 9,6o/o,Karo 22,9Voca 6unruu
N{oNieFr'ra
rryilirrrH.Ana P(DenHoBpcN{eHHo
r4Mar82,I%,
r p t { P O - 3 8 , 8 V o t, I e r H p HP O - l 1 , l % .
PCT.
E(rexrr.runor€rrcHr,rcua AX (< 140/90 mm
ocblrlecrBffBar
Hg) noFrecnrrH MenHKaMeHT
"
0,'c,
(< 130/
57 HOKorrrpoJ'rb'r
npn lua6eTLIqI,ITe
8I. KOHTPOJI FIA PVICKOBVI'I
*
80 rnm Hg) e MI4HuMa,qeHcaMo n 1,2%.
IIPOOI4JI NPI4 NI4UA C BI,{COK
npenopr,xu rov6uCr,r-racsoct,Bpcrr{eHHL{re
CbPAEr{HO-CbAOB PI4CK B
Hnpar{o
JrerreHue
Ha
AX
c
,4BaMe.[I,IKaMeHTa
AMBYJIATOPHATA N PAKTI4KA
npoRcxlar 74%, c rpn 49%, ac 4 lerapcrfr. ftoror, B. Cuparona,.fl.
Ilefiven,A. Arrre,ron, Berrrlcpe,r(crua- 13%. Or re3n c r43BecTHa
t,tn I.{AeMAt{ J'le rlc H lte c .TIUIII4AOnOHIDKaBaAHCJT
T. 3axona,A. Berencxn,
II. Befica.non,
I,I. Hnxo.raena,
Kaudypona,
Xp.finuutpona,
[.
M. Tauen,IO. fropaaHoB,
U. Ea.nxaHcxa
lrrrf NrernKar\{er{'rHnpoBexAar o6qo 29,7% cbc cl'ilrl4Hlt 16,2,44ra c cpra6parl413,57o.
flporrrHa u Ha(rHHaHa xr{Bor e npenoprrlaHa
l-ea Ktuuurcano rcapduonoeus
MEAJI "Ce.Moputru"
ilprr noBerreToBHcoKopHcKoBt4
IIaqlIeHTI4,Ho
Meduquncrcu
Ynuaepcumem Bapna
q
He
oo'r,urecrBflsaHero
ii
c
KoMrureKcHo.
p
O6u,onparcmuKy*at4ulreK u Bapna
.3axt nq euue: flr,pnt.r.rHara rrpoSr,rJIaKTI4Ka
Ha
CC3 - TbpceHe u Kopr4nrpaHeHa PO, ce
IlpoQu,rarruKara Ha cbpAeqHo-cbAoBu ra6ooc'buecrBflBa rracTurrHo npl4 Br4coKopI4cKoBpI
rflr,arwr (CC3) qpe3 uAeH'rn$uuupaHe na
6onun. ,leqcHuelo ua AX n alr6y.naropHara
BI4COKOpI{CKOBU
[aUlIeHTI{ }{ Onr4Tr4
3a npoN'r'lpucKoBl4rr
Kil ce .t1o6:ruxaBilAo npenopbtlB aHvre
Ha Ha
r,rMnpoQuJr e n:bpBocrenelrrri-'r npalKTr.r
3a,[aqa ua o6uronpaKTr4KyBarur4Te
JreKirprl crar{IapTu rro oTHolugr{rle Ha r.I3non3BaHeHa
(Onn) H KapAl,rono3r4re.
xo.r,r6uunpalrarepanHr. Kourpolbr Ha AX npn
)l
.ij' r,i:
l{)iLt.tcirrtctluyqttu xortdtettcttrtuu
30:ttituttr BiIIH lllecett - I)cttottarrru
cEKlIilfl BbTPEIItHIt 60J'IECt'Ul
KJ'IHHI,tr{HA XAIAK'I tip I|CT lt KA Il KO M OI'|;[IAL{T ET IIplI
If A U U EH TII T E CT'C Cb I'An tl H A H Ej.[()C]TAT:[ tI H OCT : PB3Y"IITATII
OT PB|.HCTITPA3A (lbl'A[]IIHA HEAOCTATLIII{OCT HA
KA PAT,{
OJIOt' U II HA K.[ I I TI I,{IiA " I I I'Oq). IT14P II JI TII,Iq OI]CKI,[''
I ' I . C r a u . r e u a . A . f r ' : r eu . B . i i o l u r a r r o u a
Kuntu)1tu " Buntpuuutu 6o.tcc'ntu", /','u1tr)tut
to,'ttltttu ti"'nuntKu,BMII -. il.leoett
Q c . ' t t t u n p ( ) . l t q 6 u i l c m o : l \ n i r . ' l 131 l a r ( , l r ' r n H ur ra f a x a p a K f e p H c r H K a H
x d u r o p 6 1 4 r a r e - rial p H n a u H e n ' n r ' r ec r , c u r \ , r l r ' o i \ r l r i c- lr , p : r lLel t a l . r c ; l o cat t - b r t H o c '(rC H ) l l l
r a l V O K r r o N Y I - l A . r ' r o c r e A o t s a ' r e - r i\ lo( c) i l l l T a . j r l | i l . r p a r { nr . .l r( a } r / l n O , r o r r t t i l . IKa, ' t H t { H K a
" t l p o r f r . I { n p r . r , rL l N q o s c K r l "n p e 3 f t L ' l ) r o . r ar r a i i 2 ( ) 0 3 r . - ( r c n p ; a p n 2 ( ) 0 ; l l :
M e m o t ) u : P e ' . l y l t l a " r t . tc' ta' el t o - r t ) t t c t t H
o t ' p c t t t c - t ' b p a3 i l c " l , [ ) , t J 1 3 tLtlcH; loo c r a r b q H o o r
"
f
t t a K a p A n o J I o r r L I H aK Jlr. r F r H K a l p o d r . l i r r p r r . -trl n , r o B c r t i r " .[ J n c r o c a B r r H c a ] { 1146 6
r l o c J I e A O B a ' r e J IxHo0c n H ' f a J I i l ' l H p a i l fi lra r U l c l l T nc . , U r a n r ot i t c 1 , l ) j l c r i l r aH e j l o cf a T ' tq H o c T
l l l n l V O K n o N Y H A , 3 a l r e p u o , t rr r a i i 2 0 0 i r . - ' r f e n p l a p r {2 0 0 4 f . . K o n r o o r r o B a p n T
Ha Opa M1,|
HraMc KH'reKpHreprlH 3a c.l,piteqita r"tc/l()c'r'a
r-t)rl rlocr.
Pcty.tmumu.' 3a rrcpr,ro;...............1a
i\,rai.i
l00l n anpft.l 2004 r: u pe lnc-rbpa ca bnHcaHH 166
n o c J l e l o B a l e r H Hn a l l h e r { T r .xr .o c n i l l a J r r l J l p a n r .ci : l r r . l l n o l a C ' l - l l i l r l \ / t D K . O r r f l x 9 2
A J t v t 5 5 . 4 oc a N { ' t ) K e , q h R ' r o c p c A r r a r l r l t a r r t r r : l r a } r ' r - l i r c l i n a H e c . 1 2 . ( r ? 6 . 5 t ) ' } o c a H a m r 3 p a c r
naa 65 n CpeAuara (rpaxrtnn fra H3'f-rilc
KnllHenprl )r(clnire e "111.8%,.
56.2% r'nrarQl,l > 45
%. 14.4% or naureHrule crpailar or XObB. ()'r'r'rx 5;l',16
ca Nlb)r(e
. Ancnruurvtvar23.8o/o,
olr'tx
2 4 . 3 % c a I V O K . X [ i l - l e ! , c r a u ( ) B e n ar r p r r- i . ( r ' l ' o , 3 a x a p c,tLt l n a 6 c ' r - r ' u2t rn r v a r - J 9
r fa u n e n ' r n n t u 2 3 . 4 9 o % o. l l r x 1 7 1 4 3 , 5 9 "c, 'o, 'N n , ) r i cA. u a r l r c : a 3 a n p c i r ( l r B n H
N,tHoKapAeH
'
i
a
u H ( r a p x r N n a a r - 5 2u u t t 3 1 , 3 o / oa. l ' a K D u i t a p r e p H a " ' l l t xaH i l e p ' f o r t H rl l 5 u n u 6 9 0 / o .
X r ' t r t o r c l H N nl rp h n o c t b n B a H e r oc i ' rl l v a l r t l 1 8 . 6 ' % (. ) ' r ' . r r x- 5 . 1 . 5 9c' a
o lV Oli.
O 6 s r , t r c i u t t e . 'I l a L l x e r { ' r ' H rce. r r e l i ( ) \n1c } r u r p i u r aC l l l l l l u l l ' O K c a o c o 5 eH a r p y n a
rroLrnivrrlp6nAH
H l h c r i r r a lc n c l r y r a , l n 4r ' p x ; , K nc.l ( ' r , r r o. r e q e n H eH q e c r t l
t lH
a u n e r " r r 1K
4o
. HT'o
p c x o c f t l 4 T a J I H 3 a r l HP
l . er ,: y , r r a r n r e r r ( ) 1 ' B l , l t i i ( , r 1 aral raarx ' r ' aH. : l r 1 ) r ( B aoH' r ' r \ , r H o f oa B T o p H ,
r r e a l r e M H g ' r ae r r e c l a n p r n a u h e l J T r . n .er ' b c C l I r r , r e c r o l a r a i i e r o J n i o B cn o - r o J ' r r \ ' t a .
K o i l K O i ' on o - B H c o Ke $ y u r u t r o H a , u l r n ' r r l r a c . L l c c l t ) , c b n - b - r c r B a [ l oc b c r r ) r H H en p u C l - l
'foil
e xqna erHo:rorfin.
e 3 a x a p H H r rA h a 6 e r .
n p e a a l r . i p aI r p l r n a I r { e r i ' rl . r ' r 'ccr , c C ] l - {c 1 4 c xM
c l c o 6 e n o i l p H r e 3 H n p e x i h B e n H \ 4 r l o K a p . l e r rr i n r l i a p x ' r . K o e r ( ) K o p c c n o H A h p a c
( t a r i l o p ' l a l , lE C . 1 4 u r e p e c H o
B c e H 3 B e c l H n{na r r . q e 3 a x a p H H r r ' , 4 u a 6I ce o c n o l l e l p } 1 c K o B
e . q e a n e M h t r a e n o - r r e c r a n p H n a L i n e r l ru l c c ' b c 3 c x a p er t A u a S c l u C l - ..l O . t a x u a n o H a f i r . r e c l a 1 ae T H o J l O r H fHl a C H e h F j C . o c g 6 e g g l t p c i , I i i l r l t . tN u l o K a p / l e nu u $ a p x r . i l p a a u
aOFF.
B n e q a T J l e H HIeI U C O K H f fnTp O U e H Tl l a I l a l l r l e l il l ' l ' l oCt , c C b l l l , ' l ' C T B i i t {X
l r a r c , i l o c r a ' t ' b t { n o c T ' .K o ! r o p 6 H A H T e r ,
K J t t o r t o t t t t i y u u : c H r \ r n r o r \ l u oc r , p . l o , 1
p c l . H c ' f } , p i.. l r { c M } 1 nJ.a x a p e i lJ l H a f r cl
93