Цель. Определить факторы риска и особенности течения ОПП у больных ХБП, подвергнутых аортокоронарному шунтированию (АКШ), а также оценить влия-ние сниженной клубочковой фильтрации почек на ближайший и отдаленный прогноз. Материал и методы. В клиническое исследование было включено 487 боль-ных (294 мужчин и 193 женщин) в возрасте от 45 до 68 лет (средний возраст -58,0±7,6 лет), которым в плановом порядке выполнялось АКШ. до операции у 330 больных (1-я группа) имелась хроническая болезнь почек (ХБП), а у 157 больных (2-я группа) клинико-лабораторных и инструментальных признаков ХБП не выявлено. Острое повреждение почек (ОПП), развившееся первые сутки после АКШ, диагностировали и классифицировали по критериям RIFLE по уровню креатинина сыворотки. динамические наблюдения за больными составляли 3 года после операции. Результаты. В раннем послеоперационном периоде в 1-й группе ОПП раз-вивалось значительно чаще, чем во 2-й группе: 59,4 и 25,1%, соответственно (p<0,001). В 1-й группе основными факторами риска ОПП являлась артери-альная гипертензия (АГ), сахарный диабет 2 типа, застойная хроническая сердечная недостаточность (ХСН), постоянная форма фибрилляции пред-сердий, а во 2-й группе -АГ и застойная ХСН. Также в 1-й группе, по срав-нению со 2-й группой, преобладали случаи умеренного и тяжелого ОПП, персистирующего и стойкого (необратимого) ОПП. Внутрибольничная летальность в 1-й группе была достоверно выше, чем во 2-й группе (16,1 и 6,0%, соответственно; p<0,001), хотя различие внутрибольничной леталь-ности среди больных с ОПП в группах недостоверно: 21,4 и 15,3%, соответ-ственно (p>0,05). У больных с предшествующей ХБП (1-я группа), незави-симо от развития ОПП, 3-летняя выживаемость была достоверно ниже, чем у больных 2-й группы (p<0,001). Выводы. Выявлено, что сниженная клубочковая фильтрация почек усугубляет бли-жайшие и отдаленные результаты операции АКШ, увеличивая риск развития ОПП. REDUCED RENAL GLOMERULAR FILTRATION AND SHORT-AND LONG-TERM PROGNOSIS IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFT SURGERYIskenderov B. G., sisina O. N. Aim.To identify the risk factors and clinical features of acute kidney injury (AKI) in patients with chronic kidney disease (cKd) who underwent coronary artery bypass graft surgery (cABG); to assess the impact of reduced renal glomerular filtration on the short-and long-term prognosis in these patients. Material and methods. The study included 487 patients (294 men and 193 women) aged 45-68 years (mean age 58,0±7,6 years), who underwent planned cABG. Before the intervention, cKd was registered in 330 patients (Group 1), while in 157 patients, no clinical, laboratory, or instrumental evidence of cKd was observed (Group 2). AKI within the first 24 hours after cABG was diagnosed according to the RIFLE criteria (serum creatinine levels). The follow-up period was 3 years after cABG. Results. In the early post-intervention period, Group 1 developed AKI significantly more often than Group 2: 59,4% vs. 25,1%, respectively (p<0,001). The main risk factors of AKI were arterial hypertensio...

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Aim. To study the effectiveness of the fixed-dose combination therapy with perindopril and amlodipine (Prestance 5/5 mg/d) in coronary heart disease (CHD) patients after coronary artery bypass graft (CABG) surgery. Material and methods. The clinical trial included 65 patients (37 men, 28 women aged 45-68 years; mean age 56,3±3,5 years) after CABG. All patients were randomised into two groups: the control group (CG; n=35) and the main group (MG; n=30). Both groups received antiplatelet agents and statins, while the MG patients additionally received Prestance (5/5 mg/d). Prestance therapy started three-four weeks after CABG and lasted for four months. All participants underwent 24-hour monitoring of ECG and blood pressure (BP), Doppler echocardiography, and Doppler ultrasound of brachial and common carotid arteries. Results. Compared to the CG, the MG demonstrated decreased incidence of pain and painless ischemia episodes, reduced maximal ST segment depression and its total duration, and increased rate threshold of myocardial ischemia. In addition, Prestance therapy was associated with improved systolic and diastolic heart function and significantly improved endothelium-dependent vasodilatation. In patients with normal BP, Prestance (5/5 mg/d) did not cause hypotension, but reduced excessive BP variability. In the MG, acute coronary syndrome (ACS) was registered in 1 individual (3,3 %), while in the CG, it was registered in 4 patients (11.4 %), and in 3 cases, coronary artery stenting was performed. Conclusion. In patients with normal BP, Prestance (5/5 mg/d) therapy in the early post-CABG period had a pronounced anti-ischemic, cardio- and vasoprotective effects, and also prevented excessive BP variability.

Widespread implantation of cardiac devices, i.e. cardiac pacemakers, cardioverter-defibrillators and cardiac resynchronisation devices improved patients survival. It has resulted in increase in number of ageing patients with cardiac devices who need physiotherapeutic treatment due to accompanied comorbidities. Hence the study of the interaction between functions of cardiac devices and physiotherapeutic treatment techniques is particularly relevant. The use and safety of physiotherapeutic treatment techniques producing electromagnetic field which in turn eventually cause harm of the cardiac devices are being discussed in present review article. The possible adverse effects of such interaction are abrupt failure to stimulate or triggering of shock therapy with consequent arrhythmic events including cardiac arrest. The technical characteristics particularly associated with electromagnetic interference are discussed here in detail. The attention is also payed to analysis of possible causes and effects of electromagnetic interference and safety measures as well.

Frequency of development of the acute kidney injury (AKI) in patients underwent different cardiac interventions, and its influence on the cardiorenal prognosis depending on initial function of kidneys is analyzed. 1126 patients (595 men and 531 women) aged from 32 till 68 years (62.3±5.2 years) at which at which prosthetics of valves of heart, coronary artery bypass grafting (CABG) and their combination are examined. In 656 patients (the 1st group) before operation the glomerular filtration rate (GFR) was upper than 60 ml/min/1.73 m2 and in 470 patients (the 2nd group) ranged from 59 to 45 ml/min/1.73 m2, determined by a formula CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was diagnosed by level of serum creatinine (sCr) using criteria of AKIN (Acute Kidney Injury Network). In early postoperative period AKI was diagnosed in 23.9% of patients in the 1st group and in 38.7% of patients in the 2nd group ( p