Anton Kiselev

Publications

• 0.71

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  Selection of optimal dose of beta-blocker treatment in myocardial infarction patients based on changes in synchronization between 0.1 Hz oscillations in heart rate and peripheral microcirculation.

  Anton R Kiselev, Vladimir I Gridnev, Mikhail D Prokhorov, Anatoly S Karavaev, Olga M Posnenkova, Vladimir I Ponomarenko, Boris P Bezruchko

  Journal of cardiovascular medicine (Hagerstown, Md.). 02/2012;

  BACKGROUND: Selection of the optimal dose of beta-blocker treatment in myocardial infarction (MI) patients is problematic because of a lack of well-established guidelines. METHODS: We evaluated changes in synchronization between 0.1 Hz oscillations in heart rate (HR) and plethysmographic peripheral ... [more] BACKGROUND: Selection of the optimal dose of beta-blocker treatment in myocardial infarction (MI) patients is problematic because of a lack of well-established guidelines. METHODS: We evaluated changes in synchronization between 0.1 Hz oscillations in heart rate (HR) and plethysmographic peripheral microcirculation in response to a tilt-table test and to 3-month treatment with the highest tolerated beta-blocker (metoprolol) dose in 43 patients aged between 41 and 77 years with acute MI 6 months prior to the start of the study. Before the study the patients were treated with small doses of beta-blocker. Phase differences between HR and peripheral microcirculation oscillations were used to measure the degree of synchronization (S), and relative change in S from horizontal position was used to characterize the response to vertical tilt. RESULTS: Two groups of MI patients matched for clinical characteristics were identified on the basis of the results. The first group was composed of patients with decreased S as a response to vertical tilt at the beginning of the study. The patients with increased S during vertical tilt before treatment with the highest tolerated beta-blocker dose were attributed to the second group. The response to vertical tilt in the first group of patients was postulated to indicate the need to increase beta-blocker dose, and in turn, the response in the second group to indicate an already adequate beta-blocker dose. CONCLUSION: Assessment of synchronization of 0.1 Hz HR and peripheral microcirculation oscillations as a response to a tilt test can possibly be used as a guideline for selecting beta-blocker dose in post-MI patients.

• Selection of optimal dose of beta-blocker treatment in myocardial infarction patients based on changes in synchronization between 0.1 Hz oscillations in heart rate and peripheral microcirculation

  Kiselev AR, Gridnev VI, Prokhorov MD, Karavaev AS, Posnenkova OM, Ponomarenko VI, Bezruchko BP

  J Cardiovasc Med (Hagerstown). 01/2012;

• Pharmacotherapy quality in patients with arterial hypertension observed in primary care practice. Hypertension register data

  O.M. Posnenkova, A.R. Kiselev, V.I. Gridnev, V.A. Shvartz, P.Ya. Dovgalevsky, E.V. Oschepkova

  Rational Pharmacotherapy in Cardiology. 12/2011; 7(6-6):725-732.

  Aim. To assess (on the basis of Russian national guidelines on arterial hypertension (HT), 2004) quality of pharmacotherapy measures among hypertensive patients observed in primary care practice. Material and methods. Data on 12 604 patients with HT (7 819 women, 4 785 men, aged 59.5±12.0 years) fro... [more] Aim. To assess (on the basis of Russian national guidelines on arterial hypertension (HT), 2004) quality of pharmacotherapy measures among hypertensive patients observed in primary care practice. Material and methods. Data on 12 604 patients with HT (7 819 women, 4 785 men, aged 59.5±12.0 years) from 13 regions of Russia observed in primary care units during 2007 were enrolled in the study. Compliance with recommendations on decision making about pharmacotherapy need (risk category assessment) and adequacy were evaluated. Results. 64% of patients with HT had no drug prescriptions in their outpatient card in 2007. 4 880 patients from 12 604 enrolled HT patients (38.7%) had all data necessary for risk assessment. 3920 patients (31% of the whole studied group) had pharmacotherapy indications (high or very high risk). Only 819 HT patients (6.5% of the whole number of enrolled patients) had antihypertensive pharmacotherapy completely corresponding to their clinical status. Conclusion. The quality of pharmacotherapy measures carried out in primary care practice during 2007 did not conform to HT guidelines.

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• Interdependence of parameters of variational pulsometry, entropy of heart rate, temporal and spectral analyses of heart rate variability in normal state and in ischemic heart disease

  Durnova N.Yu, Dovgalevskiy Ya.P, Burlaka A.N, Kiselev A.R, Furman N.V

  Saratov Journal of Medical Scientific Research. 09/2011; 7(3-3):607–611.

  The research goal is to study the correlation between indices of variational pulsometry, entropy of heart rate, temporal and spectral analyses and heart rate variability in healthy patients and patients with coronary heart disease. Materials. Of the study are indicators of variational pulsometry and... [more] The research goal is to study the correlation between indices of variational pulsometry, entropy of heart rate, temporal and spectral analyses and heart rate variability in healthy patients and patients with coronary heart disease. Materials. Of the study are indicators of variational pulsometry and temporal and spectral analyses from 111 patients with coronary heart disease and in 61 healthy individuals. Results. Most parameters of HRV correlated with each other. In healthy patients the greatest independence was characterized by Mo and LF/HF, in patients with coronary artery disease — only by LF/HF Significant correlation with SDNN RMSSD, TP, LF, HF was determined. Conclusion. The variational pulsometry, temporal and spectral analyses of HRV and entropy of heart rate provide HRV assessment. The indices are interdependent and indicate interchangeability of methods

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• 0.12

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  Outpatient prophylaxis and treatment of arterial hypertension with application of mobile telephone systems and internet techniques

  A.R. Kiselev, V.A. Shvarts, O.M. Posnenkova, V.I. Gridnev, P.Ya. Dovgalevsky, E.V. Oschepkova, S.E. Evstifeeva

  Terapevticheskii arkhiv. 04/2011;

  Aim. To compare clinical efficacy of standard outpatient follow-up of hypertensive patients with efficacy of such follow-up with application of internet techniques and mobile telephone systems (ITMTS). Material and methods. Two groups of hypertensive patients were examined: group 1 (n = 97, 45% fema... [more] Aim. To compare clinical efficacy of standard outpatient follow-up of hypertensive patients with efficacy of such follow-up with application of internet techniques and mobile telephone systems (ITMTS). Material and methods. Two groups of hypertensive patients were examined: group 1 (n = 97, 45% females, age 49±11 years) on one-year ITMTS follow-up; group 2 (n = 102, 50% females, age 51±11 years) on standard one-year follow-up. Clinical efficacy was assessed by the rate of achievement and maintenance of target blood pressure, dynamics of modifiable risk factors (smoking, obesity) for a year. Results. Withdrawal in group 1 was 36%, target blood pressure was achieved in 77% patients vs 12% in group 2 (p < 0.001). Conclusion. Introduction of ITMTS technologies into outpatient clinics activity considerably raises efficacy of outpatient treatment of hypertensive patients.

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• 0.12

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  [Outpatient prophylaxis and treatment of arterial hypertension with application of mobile telephone systems and Internet techniques].

  A R Kiselev, V A Shvarts, O M Posnenkova, V I Gridnev, P Ia Dovgalevskiĭ, E V Oshchepkova, S E Evstifeeva

  Terapevticheskiĭ arkhiv. 01/2011; 83(4):46-52.

  To compare clinical efficacy of standard outpatient follow-up of hypertensive patients with efficacy of such follow-up with application of internet techniques and mobile telephone systems (ITMTS). Two groups of hypertensive patients were examined: group 1 (n=97, 45% females, age 49 +/- 11 years) on ... [more] To compare clinical efficacy of standard outpatient follow-up of hypertensive patients with efficacy of such follow-up with application of internet techniques and mobile telephone systems (ITMTS). Two groups of hypertensive patients were examined: group 1 (n=97, 45% females, age 49 +/- 11 years) on one-year ITMTS follow-up; group 2 (n=102, 50% females, age 51 +/- 11 years) on standard one-year follow-up. Clinical efficacy was assessed by the rate of achievement and maintenance of target blood pressure, dynamics of modifiable risk factors (smoking, obesity) for a year. Withdrawal in group 1 was 36%, target blood pressure was achieved in 77% patients vs. 12% in group 2 (p < 0.001). Introduction of ITMTS technologies into outpatient clinics activity considerably raises efficacy of outpatient treatment of hypertensive patients.

• Dynamics of 0.1 Hz Oscillations Synchronization in Cardiovascular System during the Treatment of Acute Myocardial Infarction Patients

  Anton R. KISELEV, Vladimir I. GRIDNEV, Anatoly S. KARAVAEV, Olga M. POSNENKOVA, Mikhail D Prokhorov, Vladimir I Ponomarenko, Boris P. BEZRUCHKO

  Applied Medical Informatics. 01/2011;

  Aim: The aim was the studying of synchronization between 0.1 Hz oscillations in heart rate (HR) and plethysmographic peripheral microcirculation (PM) in acute myocardial infarction (AMI) patients and in healthy subjects. Material and Method: 12 healthy volunteers aged 26±5 years and 125 patients wit... [more] Aim: The aim was the studying of synchronization between 0.1 Hz oscillations in heart rate (HR) and plethysmographic peripheral microcirculation (PM) in acute myocardial infarction (AMI) patients and in healthy subjects. Material and Method: 12 healthy volunteers aged 26±5 years and 125 patients with AMI aged 65±9 years were involved in the study. Simultaneous registration of electrocardiogram and photoplethysmogram were performed during 10 min. In AMI patients the signals were recorded twice: the first record was done during 3-5 days after AMI, the second record was done during the third week after AMI. Phase differences between HR and PM oscillations were used to measure the degree of synchronization (S). Data are submitted as medians with inter-quartile ranges (25%, 75%). Results: S was 65.8% (50.5%; 79.5%) in healthy subjects whereas in AMI patients at the first week after AMI S was 16.3% (9.4%; 24.6%) (p<0.001). In records made at the third week after AMI index S was 18.4% (11.2%; 28.2%). Two groups of AMI patients were identified on the basis of individual S dynamics. In 100 AMI patients no dynamics of S was observed during the observation period and in 25 AMI patients the increase of S was observed. The group of AMI patients with increase of S had greater HR values during the first week after AMI. Conclusion: The index S of synchronization of 0.1 Hz oscillations in HR and PM appears to be a sensitive indicator of autonomic control dynamic disturbances in AMI patients.

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• Using of spectral analysis of heart rate variability for increasing reliability of bicycle ergometry results

  Gridnev V.I., Kiselev A.R., Posnenkova O.M., Shvartz V.A

  Health. 01/2011; 3:477-481.

  The aim was to study the suitability of the heart rate variability (HRV) spectral parameters for evaluations of bicycle ergometry results in coronary heart disease (CHD) patients. Methods. Our study included 243 male CHD patients aged 49±8 years. The coronary atherosclerosis was assessed by coronary... [more] The aim was to study the suitability of the heart rate variability (HRV) spectral parameters for evaluations of bicycle ergometry results in coronary heart disease (CHD) patients. Methods. Our study included 243 male CHD patients aged 49±8 years. The coronary atherosclerosis was assessed by coronary angiography. The results of bicycle ergometry, Doppler echocardio-graphy and HRV spectral analysis were also analyzed. The duration of each stage of bicycle ergometry was 3 min, the initial load value was 25 W. Dynamic load continued until the patient had reached 75% of heart rate from his maximal age level. The maximal level of load achieved (i.e. load tolerance) was taken into consideration. We calculated sensitivity (Se), specificity (Sp), likelihood ratios of positive (LR+) and negative (LR-) bicycle ergometry results. Results. All patients had similar clinical characteristics. LR+ become maximal under the moderate load tolerance. LR- are maximal in the CHD patients with high load tolerance. Thus, the excessiveness of false-negative results of bicycle ergometry is in CHD patients with high load tolerance. Reliability of results of bicycle ergometry increased under using assessments of low-frequency (LF) range power of HRV spectrum. Conclusions. Thus,the using of LF range power of HRV spectrum increases reliability of bicycle ergometry (or other load tests) results in CHD patients.

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• Synchronization of 0.1 Hz oscillations in heart rate and blood pressure: Application to treatment of myocardial infarction patients

  Prokhorov M.D., Kiselev A.R., Karavaev A.S., Posnenkova O.M., Gridnev V.I., Ponomarenko V.I.

  Proceedings of World Academy of Science, Engineering and Technology. 01/2011; 76:367–372.

  Synchronization between 0.1 Hz oscillations in heart rate and blood pressure is studied and its change during vertical tilt is evaluated in 37 myocardial infarction patients. Two groups of patients are identified with decreased and increased, respectively, synchronization of the studied oscillations... [more] Synchronization between 0.1 Hz oscillations in heart rate and blood pressure is studied and its change during vertical tilt is evaluated in 37 myocardial infarction patients. Two groups of patients are identified with decreased and increased, respectively, synchronization of the studied oscillations as a response to a tilt test. It is shown that assessment of synchronization of 0.1 Hz oscillations as a response to vertical tilt can be used as a guideline for selecting optimal dose of beta-blocker treatment in post-myocardial infarction patients. http://www.waset.org/journals/waset/v76/v76-68.pdf

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• Peculiariries of clinical signs in patients with arterial hypertension. The results of primary medical documentation analysis

  Posnenkova O.M., Kiselyov A.R., Gridnev V.I., Dovgalevskiy P.Ya.

  Problemy standartizacii v zdravoohranenii. 01/2011;

  Authors studied the completeness of an examination and representativeness of clinical signs obtained according to the data of out-patient clinics’ cards of patients with arterial hypertension. 12,604 cards of patients with arterial hypertension from 13 regions of Russia were analyzed. Several indice... [more] Authors studied the completeness of an examination and representativeness of clinical signs obtained according to the data of out-patient clinics’ cards of patients with arterial hypertension. 12,604 cards of patients with arterial hypertension from 13 regions of Russia were analyzed. Several indices were studied: the structure according to the sex and age, risk factors, laboratory tests, the presence of associated clinical states and disorders of target organs. The information on diagnostical studies is out-patient clinic’s cards was not sufficient compared to that ones in clinical recommendations for arterial hypertension treatment. Statistic dispersion of systolic blood pressure, common cholesterol and creatinine values were different from normal ones, and it makes the use of median values not reasonable. The absence of representativeness of creatinine values in relation to the whole population of patients with arterial hypertension is shown. Incompleteness and insignificance of data on patient’s clinical status presented in out-patient clinic’s cards made the interpretation of population estimation of health difficult. http://www.zdrav.net/publisher/magazine/prinzdrav/archive/2011/1/08

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• Dynamic evaluation of heart rate variability spectrum in coronary heart disease patients with hemodynamically significant coronary stenoses

  Kiselev A.R., Posnenkova O.M.

  Bulletin of Medical Internet conferences. 01/2011; 1:27-30.

  Aim – to study characteristics of autonomic heart regulation in patients with coronary heart disease (CHD) associated with hemodynamically significant and insignificant coronary stenoses. Methods – 143 patients with CHD aged 49±8 years were enrolled in the study. 88 patients had at list one coronary... [more] Aim – to study characteristics of autonomic heart regulation in patients with coronary heart disease (CHD) associated with hemodynamically significant and insignificant coronary stenoses. Methods – 143 patients with CHD aged 49±8 years were enrolled in the study. 88 patients had at list one coronary artery stenosis of more then 50%. 55 CHD patients had no such stenoses. Rhythmograms at rest and during veloergometric test (VET) with exercise of 25 and 50 Wt were registered during 6 minutes at each stage. The first 3 minutes were registered at spontaneous breathing. The last 3 minutes were registered at controlled breathing with 10 seconds period. Frequency power of heart rate variability (HRV) spectrum in low-frequency (LF) and in high-frequency (HF) ranges was estimated. It was assumed that the power of LF-range in a parametric spectrum determined by the power of 0.1 Hz oscillations in HRV. Results – the dynamic of power of LF- range of HRV spectrum during the stages of VET at spontaneous breathing did not differ reliably in CHD patients with coronary stenoses of more then 50% and without such stenoses. Reliably higher increase of LF-range power under switching from the spontaneous to the controlled breathing was revealed at rest and at exercise of 25 Wt in CHD patients with coronary stenosis of less then 50%. The dynamic of power of HF-range of HRV spectrum during VET repeated the changes in LF-range. Any reliable intergroup differences were not revealed. Conclusions – the evidence of autonomic dysfunction is associated with hemodynamically significant coronary stenoses. http://medconfer.com/node/1147

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• Evaluation of five-year risk of lethal outcome and development of cardiovascular disorders in patients with acute myocardial infarction on basis of 0.1-Hz rhythms synchronization in cardiovascular system

  KiselevA.R, V.I. Gridnev, KaravaevA.S, Posnenkova. O.M, Ponomarenko. V.I, Prokhorov. M.D, Bezruchko. B.P, Shvartz V.A

  Saratov Journal of Medical Scientific Research. 01/2010;

  The research goal is to evaluate the impact of autonomic heart control indices on five-year risk of lethal outcome and development of cardiovascular disorders in patients with acute myocardial infarction (AMI) and to study the dynam¬ics of indices in short- and long-term period. 125 patients with AM... [more] The research goal is to evaluate the impact of autonomic heart control indices on five-year risk of lethal outcome and development of cardiovascular disorders in patients with acute myocardial infarction (AMI) and to study the dynam¬ics of indices in short- and long-term period. 125 patients with AMI (42% female), ages 30 to 83 years, were enrolled in prospective observational study. Observation period lasted 6 years. Control checking was carried out in 1 week, 3 weeks, 6 months, 1 year and then annually. The dynamics of heart rate variability (HRV) and the synchronization of 0.1-Hz rhythms of heart and microcirculation (S) were studied during the first year. Outcomes proved to be death, MI, stroke. Development of acute heart failure Killip 2-4 and indices S < 20% during the first week of AMI (х2 = 10,5, p = 0,005 for the Cox model) played a significant role in evaluation of five-year risk of death after AMI. Sensitivity (Se) and specificity (Sp) of index S < 20% during the first week of AMI were 76% and 43% correspondingly. The Cox model showed that indices of HRV and 0.1-Hz rhythms synchronization were not of great value in evaluation of five-year risk of death after AMI. The article concludes that indices S < 20% in patients with AMI possess better prognostic value than common clinical parameters

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• Comparison of fosinopril and atenolol effect on heart 0.1 Hz-rhythms synchronization and blood microcirculation in patients with arterial hypertension

  Kiselev A.R., Gridnev V.I., Karavaev A.S., Posnenkova O.M., Ponomarenko V.I., Prochorov M.D., Bezruchko B.P.

  Rational Pharmacother. Card. 01/2010; 6:803-811.

  Aim. To compare the effect of fosinopril and atenolol on synchronization of heart 0.1 Hz-rhythms and blood microcirculatory. Material and methods. 63 patients at the age of 47±8 with hypertension (HT) of grade 1-2 were enrolled in the study. 0.1 Hz-oscillations in heart rate variability (HRV) and in... [more] Aim. To compare the effect of fosinopril and atenolol on synchronization of heart 0.1 Hz-rhythms and blood microcirculatory. Material and methods. 63 patients at the age of 47±8 with hypertension (HT) of grade 1-2 were enrolled in the study. 0.1 Hz-oscillations in heart rate variability (HRV) and in filling of microcirculatory bed were registered during passive tilt test under spontaneous breathing. The duration of each stage of test was 10 min. Synchronization was estimated as a phase difference between 0.1 Hz-rhythms of heart rate and filling of microcirculatory bed. Frequency values of HRV spectrum in LF- and HF-ranges were also assessed. Results. Fosinopril and atenolol showed comparable effect on blood pressure (BP) reduction. Atenolol decreased in heart rate significantly. Treatment with either fosinopril or atenolol in patients with significant vegetative dysfunction resulted in repair of functional interaction between heart 0.1 Hz-regulation and microcirculatory bed. Functional dissociation of 0.1 Hz-regulation mechanisms was observed under the treatment with fosinopril or atenolol in patients with initially sufficient interaction. Conclusions. Fosinopril and atenolol influenced similarly on heart 0.1 Hz-mechanisms and microcirculation autonomic regulation in patients with HT. Atenolol is a drug of choice in patients with sympathicotony. Both drugs should be administered in according with an individual level of 0.1-Hz rhythms synchronization assessed before start of the treatment. http://www.rpcardio.com/archive/article.php?ID=3078

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• Comparison of dynamic of autonomic control indices in cardiovascular system under the treatment by ACE inhibitor (Enalapril) and beta-blocker (Metoprolol) in patients with hypertension

  Kiselev A.R, Karavaev A.S, Gridnev V.I, Posnenkova. O.M, Shvartz V.A, Ponomarenko. V.I, Prokhorov. M.D, Bezruchko. B.P

  Saratov Journal of Medical Scientific Research. 01/2010;

  The objective of the present research was to compare the influence of Enalapril and Metoprolol on synchronization of 0.1 Hz-regulation of heart and blood microcirculation. 42 patients aged 49±9 years old with hypertension I, II were included in the study. 0.1 Hz-oscillations in heart rate variabilit... [more] The objective of the present research was to compare the influence of Enalapril and Metoprolol on synchronization of 0.1 Hz-regulation of heart and blood microcirculation. 42 patients aged 49±9 years old with hypertension I, II were included in the study. 0.1 Hz-oscillations in heart rate variability (HRV) and blood microcirculation were registered during the passive orthostatic sign while breathing spontaneously. The duration of each test was 10 minutes. Synchronization was estimated as a phase difference between 0.1 Hz-rhythms in heart rate and in filling of blood microcirculation. Quantitative measures of synchronization were also estimated. In addition frequency values of HRV spectrum in LF- and HF-ranges were assessed. Enalapril and Metoprolol had comparable effect on blood pressure reduction. Treatment with both Enalapril and Metoprolol in patients with significant vegetative dysfunction resulted in repair of functional interaction between 0.1 Hz-regulation of heart and blood microcirculation. Enalapril was preferred in hypertensive patients with prevalence of disorders of vegetative regulation of blood microcirculation. Metoprolol influenced positively on 0,1 Hz-rhythm synchronization in patients with predominance of heart vegetative regulation dysfunction and in patients with sympathicotonia. In patients with hypertension and initially normal level of synchronization of 0.1 Hz-mechanisms treatment with Enalapril or Metoprolol caused functional dissociation. Differentiated approach to the choice of hypertensive therapy should consider individual peculiarities of system vegetative dysfunction. The level of synchronization of 0.1 Hz-rhythms in cardiovascular system should especially be evaluated initially and during the treatment

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• 1.80

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  Synchronization of low-frequency oscillations in the human cardiovascular system.

  A S Karavaev, M D Prokhorov, V I Ponomarenko, A R Kiselev, V I Gridnev, E I Ruban, B.P. Bezruchko

  Chaos (Woodbury, N.Y.). 09/2009; 19(3):033112.

  We investigate synchronization between the low-frequency oscillations of heart rate and blood pressure having in humans a basic frequency close to 0.1 Hz. A method is proposed for quantitative estimation of synchronization between these oscillating processes based on calculation of relative time of ... [more] We investigate synchronization between the low-frequency oscillations of heart rate and blood pressure having in humans a basic frequency close to 0.1 Hz. A method is proposed for quantitative estimation of synchronization between these oscillating processes based on calculation of relative time of phase synchronization of oscillations. It is shown that healthy subjects exhibit on average substantially longer epochs of internal synchronization between the low-frequency oscillations in heart rate and blood pressure than patients after acute myocardial infarction.

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• Synchronization between the slow oscillations in the human cardiovascular system

  Prokhorov M.D., Ponomarenko V.I., Karavaev A.S., Kiselev A.R., Gridnev V.I.

  Proceedings of World Academy of Science, Engineering and Technology, Singapore; 08/2009

  World Academy of Science, Engineering and Technology, 2009, Vol. 56, P.764-768. Synchronization between the slow oscillations of heart rate and blood pressure having in humans a basic frequency close to 0.1 Hz is investigated. A method is proposed for quantitative estimation of synchronization betw... [more] World Academy of Science, Engineering and Technology, 2009, Vol. 56, P.764-768. Synchronization between the slow oscillations of heart rate and blood pressure having in humans a basic frequency close to 0.1 Hz is investigated. A method is proposed for quantitative estimation of synchronization between these oscillating processes based on calculation of relative time of phase synchronization of oscillations. It is shown that healthy subjects exhibit in average substantially longer epochs of synchronization between the slow oscillations in heart rate and blood pressure than patients after acute myocardial infarction.

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• Effects of carvedilol and metoprolol on vegetative regulation of heart and microcirculation in patients with hypertension and high body mass

  A.R. Kiselev, V.I. Gridnev, A.S. Karavaev, O.M. Posnenkova, V.A. Shvarts, V.I. Ponomarenko, M.D. Prokhorov, B.P. Bezruchko

  Rational Pharmacother. Card. [rus]. 01/2009; .:55-61.

  Aim. To study effects of carvedilol and metoprolol on vegetative regulation of heart and microcirculatory vessels in patients with arterial hypertension (HT) of 1-2 degrees and high body mass/obesity. Material and methods. Patients with HT of 1-2 degrees (n=25; aged 51±8 y.o.) were included in the ... [more] Aim. To study effects of carvedilol and metoprolol on vegetative regulation of heart and microcirculatory vessels in patients with arterial hypertension (HT) of 1-2 degrees and high body mass/obesity. Material and methods. Patients with HT of 1-2 degrees (n=25; aged 51±8 y.o.) were included in the study. Registration of 0,1 Hz-fluctuations in heart rhythm variability and microcirculation change was performed during passive orthostatic test at spontaneous breath (duration of each test stage 10 min). Synchronization of 0,1 Hz-rhythms was estimated by calculation of phases difference and a numerical measure of synchronization. Frequency estimations of heart rhythm variability spectrum were performed in high and low frequency ranges additionaly. Results. Carvedilol and metoprolol have the comparable antihypertensive effect and influence on vegetative regulation of cardiovascular system in patients with HT. Both drugs have negative influence on synchronization of 0,1 Hz-rhythms in initially high systolic blood pressure level (>150 mm Hg). Conclusion. Carvedilol and metoprolol have comparable influence on synchronization of 0,1 Hz-rhythms in cardiovascular system.

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• Risk of repeated thrombotic events in patients survived acute coronary syndrome and having laboratory proven resistance to acetylsalicylic acid

  Puchinyan N.F., Furman N.V., Kiselev A.R., Dovgalevsky Ya.P.

  Rational Pharmacother. Card. [rus]. 01/2009; .:41-46.

  Aim. To evaluate risk of repeated atherothrombotic events in patients survived acute coronary syndrome (ACS) and having poorly reduced platelet aggregation (proven by optical aggregometry) in response to acetylsalicylic acid (ASA) therapy. Material and methods. 200 patients with ACS (aged 56,6±9,2 y... [more] Aim. To evaluate risk of repeated atherothrombotic events in patients survived acute coronary syndrome (ACS) and having poorly reduced platelet aggregation (proven by optical aggregometry) in response to acetylsalicylic acid (ASA) therapy. Material and methods. 200 patients with ACS (aged 56,6±9,2 y.o.) were included in the study. Platelet functional activity during ASA therapy was evaluated with laser aggregometer. ASA resistance was defined if the summarizing index of platelet aggregation (induced with ADP, 5 mμml/l) was 50% or higher during ASA therapy. Observation period was 18±6 months. Atherothrombotic events (unstable angina, myocardial infarction, stroke, cardiovascular death) were considered. Results. Lack ASA response rate was about 12%. Totally 22 repeated atherothrombotic events were registered: 5,6% among ASA sensitive patients and 50% - among ASA resistant patients. Repeated atherothrombotic events were registered in ASA resistance patients during first 14 days. ASA sensitive patients showed repeated atherothrombotic events in some months after ACS. The relative risk of cardiovascular event in ASA resistance patients was 8,92 (CI 95% 4,39; 17,84 р=0,05). Conclusion. The high level of the induced platelet aggregation (proven by laser aggregometry) points to high risk of repeated atherothrombotic events in patients with ACS.

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• Clinical Effectiveness Of Dynamic Out-Patient Control Technology Over Hypertensive Patients Based On Computer System And Mobile Phone Connection

  V I Gridnev, A R Kiselev, O M Posnenkova, V.A. Shvartz

  Saratov Journal of Medical Scientific Research. 01/2009;

  A new follow-up technology of dynamic out-patient control based on system of mobile monitoring of patients with arterial hypertension (SMMAH) has been created in Saratov Scientific Research Institute of Cardiology. SMMAH is based on exchange of information between patient and doctor with the help of... [more] A new follow-up technology of dynamic out-patient control based on system of mobile monitoring of patients with arterial hypertension (SMMAH) has been created in Saratov Scientific Research Institute of Cardiology. SMMAH is based on exchange of information between patient and doctor with the help of Internet and standard short mobile messages. The aim of the present work is to study the effectiveness of SMMAH for follow-up control of hypertensive patients for the period of 12 months. 79 patients with hypertension aged 49±11 were included in the investigation. Control period lasted 12 months. Control visits were made in the 1st, 6th and 12th months. The number of patients became out of control, its causes, percentage of patients who achieved and maintained target blood pressure (BP) were analyzed after each visit. Data were presented as M (95% confidence interval). As a result in 1 month period of investigation 88,6% of patients regularly used mobile messages, 11% of patients were out of control. In 6 months period 68,4% of participants were under control, 31,6% of patients dropped out. In 12 months period — 67% and 33% of patients accordingly. Target BP was maintained in 87% (77%-96%) of patients in 1 month period, in 78% (66%-90%) of patients in 6 months period and in 68% of patients (53%-84%) in 12 months period. High clinical effectiveness of SMMAH has been proved during the study: 67% of patients have followed prescribed therapy after the investigation period and 68% of them have maintained target BP level.

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• Clinical audit of medical care quality by computer informational analytical system in patients with hypertension followed in Saratov polyclinic

  V I Gridnev, A R Kiselev, O M Posnenkova, V.A. Shvartz

  Saratov Journal of Medical Scientific Research. 01/2009;

  The research goal is to point out potentiality of clinical audit of care quality carried out by IAS "Register AH" in hypertensive patients followed in Saratov polyclinic. Data of medical cards of 205 hypertensive patients (average age 52,8±9,1 years) followed in Saratov polyclinic have bee... [more] The research goal is to point out potentiality of clinical audit of care quality carried out by IAS "Register AH" in hypertensive patients followed in Saratov polyclinic. Data of medical cards of 205 hypertensive patients (average age 52,8±9,1 years) followed in Saratov polyclinic have been analyzed with the help of IAS "Register AH" indicators set. Implementation of clinical recommendations on diagnosis, treatment and following-up of hypertensive patients from 2007 till 2008 has been assessed. There was no correspondence between statements of recommendations of diagnostic measures for clinical status, treatment and following-up of hypertensive patients. Clinical aim of treatment to support the principal blood pressure has not been achieved in 85% of patients. The main cause has consisted in the patient's clinical status without taking into account the treatment and dynamic follow-up. Clinical audit has allowed the complex evaluation of medical care process in hypertensive patients followed in the studied polyclinic and allowed to reveal a cause of inappropriate results of care. The use of IAS "Register AH" systematizes medical data contained in ambulatory cards, automatizes the process of obtaining indicators results. It increases the reliability assessments

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