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3CHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN PCHARACTERISTICS OF A 24 HOUR RHYTHM OF BLOOD PRESSURE IN PAAAAATIENTSTIENTSTIENTSTIENTSTIENTSWITH OR WITHOUT THE DIABETIC NEPHROPWITH OR WITHOUT THE DIABETIC NEPHROPWITH OR WITHOUT THE DIABETIC NEPHROPWITH OR WITHOUT THE DIABETIC NEPHROPWITH OR WITHOUT THE DIABETIC NEPHROPAAAAATHYTHYTHYTHYTHY

Abdullaev Sh.S.Tashkent medical academy, Tashkent. Uzbekistan

Aim.Aim.Aim.Aim.Aim. To elicit the peculiarities of 24 hour profile of thearterial blood pressure and compare them withechogeometrical parameters of the heart in patients with IIIstage of CKD with or without the diabetic nephropathy.

Material and methods.Material and methods.Material and methods.Material and methods.Material and methods. The trial enrolled 25 patients (14males and 11 females) with CKD III stage (by classifications ofNKF K/DOQI, 2002) with nephropathy of different genesis:chronic glomerulonephritis 3 8 patients, chronic pyelonephritis 4 patients, diabetic nephropathy 13 patients. The averageages of patients were 368 years. All patients were examinedfor clinical laboratory3biochemical tests. The functional conditionof kidney valued by glomerular filtration rate (GFR) in equationof MDRD (Modification of Diet in Renal Disease) and by urinaryexcretion of albumin. Before beginning of treatments all patientshad arterial hypertension. Herewith systolic arterial pressure(SAP) has formed 158,312,4 mm Hg., diastolic arterial pressure(DAP) 94,17,2 mm Hg. Patients were divided into two groups(1 and 2). 13group has formed patients CKD with diabeticnephropathy, the second group consists of patients CKD withoutdiabetic nephropathy. The control group consists of healthyvolunteers matched by sex and age. 24 hour monitoring of bloodpressure was performed in device of KARDIOTECHNIKA34000AD (Inkart, St. Petersburg) by oscillometric method with intervalof the measurement 15/30 minutes day/night. Estimated theaverage values a SAP, DAP, and night reduction degree of bloodpressure (BP). Hypertension is considered if BP for day hoursformed >140/90 mm Hg, for night 3 >120/70 mm Hg. Intracardialhemodynamics and remodeling of left ventricle valued on 3mode echocardiography. The Results of the study is processedstatistical with using of criterion t Stiyudent. The Differencesconsidered to be reliable if p

431% accordingly), average 47,21,05 years (0,05); mean level of thyroxin in the I group was 7,81,13ng/ml and 7,21,01 ng/ml in the II one (>0,05); meanthyrotropin level in the I and the II groups were 0,0050,06 /ml 0,0040,01 /ml accordingly (>0,05).

Both groups didnt differ in thyroid gland hyperplasiadegree. Average index of thyroid gland volume in the I groupwas 36,41,02 sm?, in the II group 3 38,031,06 sm? (>0,05).

Indices of duration from disease beginning (the

hospitalization date) to treatment beginning were reliablydifferent in comparised groups: in the I group 3 8,30,4 month,in the II group 3 17,00,07 month (

5during 1,532,5 years. All patients had got diastolic dysfunction,but they had not myocardial infarction in anamnesis. Transmitralblood flow was less than 1.0 in according with results (0,74 0,05, while maintaining contractile myocardium ability (LVejection fraction, on average amounted to 66,7 2,03%). Theaverage age of patients was 46,8 7,9 years. Verification ofthe diagnosis of hypertension was performed according to therecommendations Russian Medical Society of ArterialHypertension and Russian Scientific Society of CardiologyDiagnosis and treatment of hypertension, the third revision,2008. All patients from the first day of hospitalization weredivided into two groups (A and B). They did not differ in termsof mean BP. Standard base therapy was in subgroup A (35patients): ?3blocker (Betaloc ZOK in the mean daily dose 37.5mg, aldosterone antagonists (Spironolactone 75 mg / day),diuretics (torasemidi in daily dose 5310 mg) was added aliskiren(Rasilez , Novartis Pharma, Switzerland), 1503300 mg / day,an average of 225 50 mg / day. Combination of aliskiren inthe same daily dose (mean 180 36 mg / day) and losartan(Cozaar , MERCK SHARP & DOHME BV, Switzerland) 50 mg/ day was added in base therapy in subgroup B, submitted 24patients. On the tenth day of hospitalization, all patientsreached target BP: 131 5 3 mmHg and 127 7,2 mmHg forthe subgroup A and subgroup B, respectively, p = 0,673.

Clinical monitoring of symptoms of CHF had surveyed allpatients: dynamic control of blood pressure, daily diuresis,glomerular filtration rate, and echocardiography performed onthe apparatus Ultramarc37 ALT (USA), with the assessment ofsystolic and diastolic heart function in the dynamics, taking intoaccount the results of morphometry cameras heart andanalysis of transmitral blood flow to the second day ofhospitalization, through 15318 day and through one year.Following options of left ventricular diastolic dysfunction wasdistinguishes on based of the ratios of the coefficients of peakvelocities (E / A) transmitral flow:

1. Anomalous the value of E / A was less than 1,0;2. Pseudo the value of E / A was in the range from 1,0

to 1,6;3. Restrictive the ratio E / A spectrogram was 2,0 or more.We continued to titrate patients doses with control of blood

pressure all 12 months. We controlled patients tolerance,identify side effects of therapy and assessment of the functionalclass of CHF on test 63minute walk, as well as monitoring thelevels of blood creatinine and estimated glomerular filtering,ECG record3rest.

Results: Results: Results: Results: Results: a comparative analysis of diastolic function LV andidentification of options for violations of diastolic function LV inpatients of both subgroups revealed that on the second day of

hospitalization abnormal variant occurred respectively in62,4% and 62,9% of patients subgroups A and B (p = 0,944),whereas by 15318 day of hospitalization (before discharge)showed a trend to an increase in this cohort of patients in groupaliskiren therapy (p = 0,058), and a 123month study of theperiod 3 a statistically significant preponderance of thesubgroup combination therapy (p = 0,048). Pseudo versionof the LV diastolic dysfunction was recorded on the second dayof hospitalization in 37,6% and 37,1% of patients respectivelyin groups A and B (p = 0,889) for 15318 days, established atendency to increase the proportion of these patients in thesubgroup A (p = 0,810), which persisted throughout the year(p = 0,097). In addition, 15 to 18 days of hospitalization in onepatient and a year later in two patients with group A therewas a restrictive option left ventricular dysfunction, which isabsent in patients with subgroup B. The study of dynamicchanges options disorders diastolic filling in each patient in asubgroup of the combined aliskiren and losartan treatmentrevealed the presence of anomalous option Stability ispreserved within a specified time of the study, 23 patients(65,6%), and the transformation of the anomalous in thepseudo. There was only one patient (3,5%) at 15318 days ofhospitalization and continued during the year. In six patients(18,3%) of the original pseudo version of diastolicdysfunction in the combined therapy was replaced byabnormal is a 15318 day hospital stay and was maintainedduring the subsequent year. Four patients (12,2%) maintainedstable pseudo version of the dysfunction on the second, 15318 days of hospitalization and within 12 months of follow3up.

Conclusion:Conclusion:Conclusion:Conclusion:Conclusion: Combination aliskiren and losartan therapyin patients with refractory hypertension with chronic heartfailure to NYHA Class II and III, leads to a statistically significantpredominance of patients with prognostically more favorableabnormal type of LV diastolic dysfunction after a year oftherapy. Along with this, in a subgroup of the combined therapyshowed a tendency to increase the number of patients withpseudonormal option dysfunction due to the absence ofpathological evolution of the pseudonormal option in therestrictive that occurred in the subgroup of aliskirenmonotherapy. Study of the nature of the dynamic changesoptions LV diastolic dysfunction in each patient in both groupsshowed a statistically significant increase in the proportion ofpatients with stable to maintain the anomalous option in thesubgroup of combination therapy for a year (p = 0,043),coupled with a significant decrease in its same number ofpatients the transformation of anomalous in the pseudoversion of LV diastolic dysfunction at 15318 days ofhospitalization and within 12 months of observation (p

6and/or stenting of coronary arteries (CA). The presence,character and size of perfusion defects were estimated.

Results.Results.Results.Results.Results. The coronary angioplasty resulted in a 76%decrease of mean size of transitory ischemic zones. Thepresence of reversible perfusion defects after operationcoexisted with the uncomlete revascularization in patients withsignificant multivessel lesions.

In the long3term follow up (336 months and 132 years afterendovascular treatment) the aggravation of coronaryinsufficiency in patients with incomplete revascularizationproceeded mainly due to an increase of the areas of stabledisturbances of coronary microcirculation caused not only byacute myocardial infarction but also by transformation of

transitory ischemic zones to the new stable perfusion defects.As compared to the early terms in the later period (336

months after coronary angioplasty) in patients with restenosisand stenosis de novo the mean size of transitory ischemic zoneswas significantly increased and exceed preoperative level. After132 years the appearance of new irreversible defects in zonesperfused by recanalized CA in 6 of 11 patients was marked. Themicrocirculation of the heart muscle in the group of patientswithout restenosis not undergo remarkable changes.

Conclusion.Conclusion.Conclusion.Conclusion.Conclusion. Myocardium perfusion scintigraphy withthallium3199 chloride allows to evaluate objectively the resultsof endovascular treatment of CAD and to diagnose therestenosis and stenosis de novo with high sensitivity.

ADDITIONAL USE OF A REMOTE MONITADDITIONAL USE OF A REMOTE MONITADDITIONAL USE OF A REMOTE MONITADDITIONAL USE OF A REMOTE MONITADDITIONAL USE OF A REMOTE MONITORING SYSTEMORING SYSTEMORING SYSTEMORING SYSTEMORING SYSTEM(CARELINK, MEDTRONIC) IN P(CARELINK, MEDTRONIC) IN P(CARELINK, MEDTRONIC) IN P(CARELINK, MEDTRONIC) IN P(CARELINK, MEDTRONIC) IN PAAAAATIENTS WITH LONG3TERM IMPLANTED PTIENTS WITH LONG3TERM IMPLANTED PTIENTS WITH LONG3TERM IMPLANTED PTIENTS WITH LONG3TERM IMPLANTED PTIENTS WITH LONG3TERM IMPLANTED PACEMAKER,ACEMAKER,ACEMAKER,ACEMAKER,ACEMAKER,

ICD AND CRT DEVICESICD AND CRT DEVICESICD AND CRT DEVICESICD AND CRT DEVICESICD AND CRT DEVICES

Ritter Yulia, Bastian DirkKlinikum Nrnberg Sd, Nrnberg, Germany

BackgrBackgrBackgrBackgrBackground:ound:ound:ound:ound: The number of patients fitted with new cardiacimplantable electronic devices (CIED) with telemetry options willincrease particularly in regions, where a long journey is necessaryfor follow up and if there is favorable reimbursement. Howeverthere is not enough systematic data available about additional postimplantation equipment of long3term implanted CIED carriers withremote monitoring to start a tele3cardiology network (TKN).

Aim: Aim: Aim: Aim: Aim: To change the follow up of long3term implanted CIEDpatients from out3 patient care in a big cardiology center toremote follow3up (RFU) with cardiology practices with criticalanalysis of patient acceptance and use.

Patients and method: Patients and method: Patients and method: Patients and method: Patients and method: The implantation center initiatedthe setup of a TKN. The effort was deliberately kept to aminimum. 586 non selected patients, that had been equippedwith a CIED (Medtronic) in the years from 2002 to 2009 (meanage 70 13 years) were informed by letter about the possibilityof a voluntary free retrospective equipment with CareLink inJune 2009. Two seminars took place for both patients andcardiologists.

Results: Results: Results: Results: Results: Altogether 289/586 patients (49%) respondedto the letter (Fig 1). The patient response was independent ofpatient age and implantation duration of the CIED, however withdifferences between the device categories (fig. 2). 145/586patients (25%) were equipped with CareLink (70/359pacemaker, 51/182 ICD, 22/43 CRT D, 2/2 implantable looprecorders (ILR)). After 1.5 years, 79 of the 586 patients thatwere addressed in the letters (13%) used the system actively(38 PM, 30 ICD, 10 CRT3 D, 1 ILR) (fig 3). Altogether, 448transmissions (means 3.1/patient) were carried out in this timeperiod with 814 reported events, most frequently with CRTsystems.

Conclusion:Conclusion:Conclusion:Conclusion:Conclusion: If the effort for the initiation is kept minimal,approx. 15% of the attainable CIED carriers use the RFU in anindustrialized urban region. The resulting ratio of effort andusefulness as well as options for more efficient patientrecruitment need to be further analyzed. In rural areas with alower doctor density and longer patient journeys a higheracceptance is to be expected.

Fig. 3 Number of transmissionsfor each CIED3category after 1.5

years

Fig. 1 Patient response to the offer of free CareLinkequipment (n=586) Fig. 2 Patient response for each CIED type

7INTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN INFECTED TRAPPED VENTRICULO3AINTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN INFECTED TRAPPED VENTRICULO3AINTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN INFECTED TRAPPED VENTRICULO3AINTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN INFECTED TRAPPED VENTRICULO3AINTERVENTIONAL LASER3ASSISTED EXTRACTION OF AN INFECTED TRAPPED VENTRICULO3ATRIALTRIALTRIALTRIALTRIALSHUNT BASED ON TECHNIQUES FOR PSHUNT BASED ON TECHNIQUES FOR PSHUNT BASED ON TECHNIQUES FOR PSHUNT BASED ON TECHNIQUES FOR PSHUNT BASED ON TECHNIQUES FOR PACEMAKER LEAD EXPLANTACEMAKER LEAD EXPLANTACEMAKER LEAD EXPLANTACEMAKER LEAD EXPLANTACEMAKER LEAD EXPLANTAAAAATIONTIONTIONTIONTION

Ritter Yulia, Bastian Dirk.Klinikum Nrnberg Sd, Nrnberg, Germany

Aim: Presentation of an alternative interventional methodfor extraction of trapped infected (cerebro3) ventriculo3atrial(VA) shunts.

Case: A 44 year old patient had undergone implantationof a VA3shunt for treatment of a communicating hydrocephalus21 years ago.

After two shunt revisions the patient developed ageneralized infection with staphylococcus aureus. The cerebralventricular part of the shunt could be extracted without anyproblem; the atrial part however could not be removed bysimple traction due to extensive endovascular adhesions.Operative removal was planned using interventional means.

After opening the cervical implantation site we mobilizedthe end of the persisting atrial catheter. A guide wire (Amplatzer0,035 inch, extra stiff) was introduced into the catheter forstabilization and fixed with a solid thread at the end of thecatheter (fig 2). Then a 14 Fr Excimer laser sheath(Spectranetics, Colorado Springs, CO, US) was advanced overthe catheter until the entry to the vein. With low dose energyrelease, careful rotation, traction and counterpressure it waspossible to advance the laser sheath under the clavicle (Fig.3). Extensive local calcifications could be overcome by using a

mechanical sheath (13 Fr, evolution, Cook Vascular) (Fig 4).Adhesions in the superior vena cava (SVC) as well as in theright atrium were loosened without any problems. Finally thewhole remaining systems could be extracted in one piece (fig.5).

Discussion: The procedure is based on techniques andtechnologies which are used for extraction of trapped cardiacpacemaker and ICD electrodes. Necessary preconditions forthis interventional approach include access to an extravascularend of the catheter, sufficient catheter stability to traction andmanipulation and finally3 patency of the catheter lumen. Itseems to be essential to stabilize the catheter by introductionof a stiff guide3wire or a Lead Locking Device. The stiffenedcatheter serves as guidance for the outer sheath, whichdecreases the risk of perforation of the vessel wall significantly.

Conclusion: The safe extraction of intravenous and atrialVA3shunt catheters that have become adherent and trappeddue to the long time since insertion is possible with the use ofmodified techniques for explantation of pacemaker electrodes.This interventional approach can be pursued in specializedcenters to avoid the more invasive primarily vascular surgicalor even cardiosurgical approach.

Fig. 1 Cervical x3ray showing the infected abandoned atrialpart of the ventriculo3atrial shunt (*) and the contralateral

ventriculo3peritoneal shunt()

Fig. 2 Intraoperative site: the mobilized end of the VA3shunt(*) with introduced and fixated guide wire (). Holding

sutures.

Fig. 3 Mobilization of the shunt by advancing the lasersheath (*) down to the clavicle. stiff guide wire inside the

VA3shunt catheter ().

Fig. 4 After passing the stenosis under the clavicle with thenonpowered sheath (*) further adhesions are being

loosened in the SVC. guide wire.

8Fig. 5 Completely removed system (cleaned): * extracted VA3shunt catheter; guide wire for stabilization, fixed to theproximal end of the shunt for traction with a firm suture ().

COMPCOMPCOMPCOMPCOMPARAARAARAARAARATIVE FEATIVE FEATIVE FEATIVE FEATIVE FEATURES OF LIPID3METTURES OF LIPID3METTURES OF LIPID3METTURES OF LIPID3METTURES OF LIPID3METABOLIC DISORDERSABOLIC DISORDERSABOLIC DISORDERSABOLIC DISORDERSABOLIC DISORDERSAMONG INDIGENOUS SMALL IN NUMBERS PEOPLE OF YAMONG INDIGENOUS SMALL IN NUMBERS PEOPLE OF YAMONG INDIGENOUS SMALL IN NUMBERS PEOPLE OF YAMONG INDIGENOUS SMALL IN NUMBERS PEOPLE OF YAMONG INDIGENOUS SMALL IN NUMBERS PEOPLE OF YAKUTIA WITH ARTERIALAKUTIA WITH ARTERIALAKUTIA WITH ARTERIALAKUTIA WITH ARTERIALAKUTIA WITH ARTERIAL

HYPERTENSIONHYPERTENSIONHYPERTENSIONHYPERTENSIONHYPERTENSION

Sofronova S.I., Uvarova T.E., Voevoda M.I.,Yakut Scientific Center of complex medical problems Siberian Branch of RAMS, Yakutsk, Sakha Republic (Yakutia),

Research Institute of Therapy, Siberian Branch of RAMS, Novosibirsk, Russia

Objective of the study: Objective of the study: Objective of the study: Objective of the study: Objective of the study: To study the peculiarities of lipid3metabolic disorders among indigenous people of Yakutia withthe presence of arterial hypertension.

Materials and methods.Materials and methods.Materials and methods.Materials and methods.Materials and methods. A set of material for research iscollected in expedition conditions in places of compactresidence of indigenous small in numbers people of Yakutia inYuryung3Khaya Anabarskiy district (Dolgans), and. EzhantsyUst3Maisky district (Evenks), while conducting complexexamination.

Indigenous small in numbers people of Yakutia (EvenkS andDolgans) of working age from 30 to 59 years who were dividedinto 2 groups were the object of the study. Dolgans and Evenkswith hypertension (80 persons) made up the I, main group.Among them: women 52 (65%), men 28 (35%). The averageage of patients was 44.38 0,82 yrs. II control group wasrepresented by the same ethnic groups without hypertensionand other cardiovascular diseases according to routineinspection and the absence of chronic disease in their medicalhistory (106 persons). Among them: women (62,3%), men 40(37.7%). Average age 39.96 0.7 yrs. For hypertension wastaken BP level 140/90 mmHg. (Russian recommendationsdeveloped by the Committee of Experts All Russiancardiologist's Committee, 2004, 2009). HP I stage 17, HP IIstage 63. Those with secondary symptomatic hypertensionof all forms of CHD are excluded.

Laboratory Methods include: identification of blood lipidprofile (total cholesterol, triglyceride (TG), LDL3cholesterol,HDL3cholesterol) and glucose level.

When estimating the frequency of the blood lipid profiledisorder among the population we used Russianrecommendations III edition of the Committee of Experts of AllRussian cardiologist's Committee 2007, drawn up taking intoaccount the recommendations of the III European edition, 2003[Section atherosclerosis All Russian cardiologist's Committee,2007; European guidelines on cardiovascular disease preventionin clinical practice, 2003 ]. For hypercholesterolemia (HCH) isaccepted cholesterol level 5.0 mmol/l (190 mg/dL),hypercholesterolemia LDL, LDL3 cholesterol 3.0 mmol / l (115mg / dl), hypoalphacholesterolemia (hypo33 cholesterolemia)3 HDL3cholesterol 1.0 mmol / l (40 mg / dL) among men and1.2 mmol / l (46 mg / dL) among women. Hypertriglyceridemia(HTG) is considered when the level of TG 1.7 mmol / l (150mg / dL).

According to the All Russian cardiologist's Committeeclassification (2007) criterion of carbohydrate metabolism

disorder is hyperglycemia (HG), fasting serum 6.1 mmol/l,impaired glucose tolerance (TGT) (plasma glucose 2 hoursafter TSH 7.8 mmol / l 11.1 mmol / l).

Statistical data processing was performed using standardmethods of mathematical statistics, using SPSS softwarepackage (version 17.0). Differences were consideredstatistically significant at p

9When comparing the frequency of Hypo33cholesterolemia in hypertensive women and normotensivealmost the same increase in these parameters in both groups(46.2% in Group I and 47.0% in group II, p> 0,05) is noted. Onother indicators of lipid disorders in women is a similar patternof overall performance. Thus, hypercholesterolemia in GroupI in women made up 73.1% in control 39.4% (p

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: 3 , 30 (71%), 6 24 , 3 40349 50359 3. , 3 , () 18 (43%), 3 15 . : 3 3 3 (7%), 3 10 (24 %), 5 (12)%. , 3 10 (24%) , 3(7%) , 3 5(12%), 2(5%); 3 8(19%) , , 5(12%), 3 3(7 %); 3 . 3 9 (50%), 3 5 (7%). 3 : 15 (35%), 12(29)%, 3 2(4%), 3; 3 3, 4 (10 %), 33 , 6 (14%). , 3

, : 3 3 5(10%); 3 3 2 (5%), 3 32 (5 %); 3 3 3. 31 (74%) (3 1003120). , 3 3. 3 3 3 3. , , 3 3 3 . , 3 . 3 , 3 , . , . 3, , 3 , 3 (3, ), 33. , 3 3 , 3 , 3, , 3 3 . , 3 . 3 , 3 , 3 .

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23

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(4,10,2 2,10,3 ., =0,02, ). 3 (=0,0130,001). 3 3 3 3 (r=0,57, =0,05), 3, (r=0,63, =0,03; r=0,59, =0,05,), 3, 3 (r=30,49, =0,04; (r=30,66,=0,03, ).

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106 5 10 . 42,711,2 .

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24

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26

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::::: 3 : 3 16,7%, 53,8%, 3 3 (21,81,4/%) 61%, III II (21,32,04 17,23,17, =0,04, ), 3 3 . 3 3 (3,40,7/) 537 (2,20,9/). 89,7% 3 3 0,5 1,5/, (95,45,9 (=0,001). 537 (2,033,0). 9 3 3 ( +). 3

3 6. 3 , . 56%, 33,5%, 33% (=2,09); 53%, 26%, 9,9% . 3 19% () 7,6% , 23% 20%, 3 68% 45% . 5,30,3 ( 2,50,02),+ 3,40,3 ( 2,350,07). 3 . , . 3 . 3 4,7% (, ), . 3 (=0,003). (=25,2329,9 42,3% , >30,0 31% ) 3 3 .

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27

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: 270 (129 141 ) 13 83 ( 45,30,9 ), 3 3, . 7 20 (n=22); 20329 (n=32); 30339 (n=38); 40349 (n=54); 50359(n=81); 60369 (n=27); 70 (n=16). 3 3 . 3 . () () 3 / (Sa) 3.

: : : : : 53 3 3

(), 17,00,98, 17,10,6, 18,82,6, 15,10,5,13,90,4, 13,90,4 11,80,8 /, (F=3,53; =0,002). 3 (), , , 43 . 3 10,50,7, 10,80,6, 15,22,3, 14,10,6, 15,40,5,16,20,8 16,31,1 /, (F=4,06;=0,0006). / 1,80,18,1,710,11, 1,320,07, 1,140,05, 0,970,04, 0,860,06 0,740,05 (F=21,14; =0,0000001). / 59% , 81% 94% . 3 3 S 3, 14,41,0315,20,6 /(F=0,18; =0,98). 3 (r=30,23; p=0,018), (r=0,26;p=0,02), / (r=30,56; p=0,0001)

, 3 . 33 .

28

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: : : : : 270 (129 141 ) 13 83 ( 45,30,9 ), 3 3. 7 3 20 (n=22); 20329 (n=32); 30339 (n=38); 40349 (n=54); 50359 (n=81); 60369(n=27); 70 (n=16). 3 3 : 3 (), (), 3 (/), (). 3 (). 3 (, ).

::::: 3 , 65,22,9, 69,52,3, 60,81,6, 54,91,4, 53,21,4, 51,12,1,48,22,3 /, (F=12,54; =0,0000001). / , 3 1,60,06, 1,640,06, 1,440,05, 1,380,04, 1,20,03,1,20,04, 1,10,09 / (F=14,7; =0,0000001). 3

, 42,21,8348,44,5 / (F=1,32; =0,24). 3 3 , 162,77,3 178,64,4 (F=0,67; =0,67). 3 , 3 59,72,2, 52,91,9, 52,52,2, 52,81,8, 44,71,1,45,32,1 40,92,1 /, (F=9,27;=0,0000001). 3 3 49,21,6, 46,61,4, 45,01,7, 43,20,9,39,60,7 38,41,3 /, (F=10,3;=0,0000001). 3 3 (r=0,61; p=0,00001), 3 (r=30,42; p=0,0001) (r=0,34; p=0,002), / (r=30,56; p=0,0001), 3 (r=30,46;p=0,0001), / (r=30,46; p=0,0001), 3 (r=30,38; p=0,0001) (r=30,42;p=0,0001).

, 3 , 33 , 3 3 . 3 .

NT3PROBNP NT3PROBNP NT3PROBNP NT3PROBNP NT3PROBNP

.., .., .. , . ,

: : : : : 3 (), , 3 () 3 , , 3 N3 3 (NT3proBNP), 3 .

: : : : : 3 NT3proBNP 33 .

::::: 3 52 38 3

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: : : : : NT3proBNP ( 3,

29

, NT3proBNP 3 ((r=0,383; p=0,001) 3 (%) (r=30,310; p=0,013). >I . NT3proBNP 112/ 92% 50 % 3, 64%, 87%.

: N3

3 (NT3proBNP) 3 3 3 , 3 .

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3 pNN50 10 (R=0,472, p=0,031), pNN50 3 3 (R=0,449, p=0,031) 30 (R=0,590, p=0,005). 3 HRVti (R=30,691, p=0,001) 3 (R=30,481, p=0,032), 3 HRVti 10 (R=0,468, p=0,037).

. . . . . 3 , 3 .

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30% 3 3 . 82% 3 (30%) 3 (p=0,0678), 59% ( 30%3 39%; =0,0001). 30% ( 42%, 21% 30%, p=0,0048). 30% 2 3 , 0 1 3 (=0,0014). 30% (47%), 30(18%), (p=0,0067). (=0,0382), 3 (=0,0056).

. . . . . 3 , 3 , 3 .

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, 321,6%, 313,5% 3 47,8%. 3 . 3, 322,4% 3 3 334,7%. : 347,8%, 3 32,9%

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R.Virag (2002) 3 , 3 3. 3 100 92% . 3 3 .. .(2005). 3 100 94,5% 3. 3 , .

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2 : 1 (n=61) 2 (n=17). 62,2%, 13 23 12,5% 51,7% 3. 3 3 3 . 3 . 3 3 30%.

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35

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; ; ; 3 . 3 3 ; . 3: 3 ; 3 ; 33 .

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38

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: : : : : 41, 57,81,5 . . (, 3, ) 3 Vitalograph 6800 (Medical GraphicsCorporation, ) 3 . : 7 (17,1%) , 3 (7,3%) 3 10 (24,4%) 3 . 3 , , , II. 3 , 3 : 3, 21(51,2%) , 20 (48,8%), 3. sP sE 3 3 (eBioscience) . 3 3 Statistica 6.0.

:::::

, , sP , (162,833,5 /., 113,558,9 /.=0,002), sE 3 (31,010,7 /., 25,49,4 /.=0,082). 3 3, , , , sP 3 3 (r=30,88; =0,008), sE 3 (r=30,92; =0,002). , 3 3, 3 . sP 3 (r=30,59; =0,033) 3 (r=0,65; =0,02), sE (r=30,63; =0,027) 3 (r=30,67; =0,011).

: : : : : , 3 , sP 3 ; 3 sE , , .

sP sE , sP sE , sP sE , sP sE , sP sE ,

.., .., .., . ., . ., .., .., .., ..

3 , . ,

: : : : : 3 sP sE , 3 (), 3 ().

: : : : : 41 , 3 57,81,5 . ,

7 (17,1%) 3, 3 (7,3%) 10 (24,4%) 3 . , 3 , 3, 3 21(51,2%) 20 (48,8%)

39

. 3 Vitalograph 6800 (MedicalGraphics Corporation, ). sP sE 3 (eBioscience) , 3 . 3 3 Statistica 6.0.

::::: sP 3 , 3 , 134,758,5 /, (211,272,5 / =0,000), (162,833,5 /) =0,01, 3 . sE

, , sE 39,38,5 /, (17,48,8 /)=0,000 (31,010,7/) =0,000. , , sP sE 3 . 3 , , , .

::::: , 3 , 3 , 3 .

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.., .., .., . ., . ., .., .., ..

3 , . ,

: : : : : 3 (Dlco) () 2 , 3 ().

: : : : : 3 49 , 3 3 . 3 , I , 3 2 27 (55,1%) II 22 (44,9%). 3 6,41,5%. 3 (), 3 57,63,0 , 302,4/2. , 3 (II3III 3) , 3 Dlco. 3 . 9 . 3 Dlco 3 Vitalograph 6800

(Medical Graphics Corporation, ). Dlco 3 (Dlco cor). 3 Statistica 6.0.

: : : : : (I Dlco cor 76,25,6%, II Dlco cor 87,68,3%;=0,000), (I 3 Dlco cor 69,88,4%, II Dlco cor 74,57,6%;=0,048) Dlco cor , . 3 Dlco cor , (r=30,52; =0,007), Dlco .

: : : : : , , , Dlco cor, . 3 , 3 .

.., .., .., ..,.. , .. .

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::::: 3 () 3 () 3 ().

: : : : : 36 3 ( 58,39,2

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40

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: : : : : . 3 : >92/. rMSSD>41; >21/ rMSSD>46 3>21/ pNN100>2,1%. rMSSD, rMSSD, rMSSD,pNN100, pNN100, pNN100 , . 3 , SDNN, SDNNi, rMSSD, pNN50, pNN100. 3 4 ., , 3 .

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41

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: : : : : 3 . 3 3 3 , 3 , 3.

sP3 sE3 sP3 sE3 sP3 sE3 sP3 sE3 sP3 sE3 2, 2, 2, 2, 2,

.., .., .., .., .., .., .., ..

, . ,

::::: () 3s3 sE3 () , 3 () 3 ().

: : : : : 22 , 3 , 16 (72,7%), 6 (27,3%). 57,03,2 , 58,01,5 , 57,03,5. 3 . : , 3, . 3 () 2 10 (45,5%), 5 (50%) 5 (50%), 3. 54,5% (12 ). 3 3 3 () 6 (50%). 3 1 . (25%) , 3 73 3 . , 3 2 (17%). (8%) 3, 3. s3 s3 3 3 (eBioscience) , .

::::: s3 3 118,822,0 /, 3

3 156,529,0 / (=0,01), 146,9 21,0 /. , s3 :35,210,2 /, 3 : 18,811,0 /, (=0,0001). s3 . 3 2 , , s3 122,425,1 vs 118,829,1 /, 3 3 : 193,228,3 vs 127,420,0 / (=0,03). sE33 3, , : 44,49,7 vs 31,79,3/ (=0,02). 3 , 3 , , 3 : 24,915,1 vs 18,0 10,2 /;33,611,0 vs 25,19,6 /. 2 , 2 , 3 . , sP3 , 3 , 3 . , 3 , 3 sE33: 20,54,9 vs 11,65,5 / (=0,04); 31,1 4,1 vs 16,3 4,7/ (=0,04). 3 3 sP3

42

. sE3 . , sP3 , :212,569,5 vs 127,424,1 / (=0,04). 3 , . : 3 sE3 13 73

3, 24,912,6 vs 11,65,5(=0,04); 33,68,0 vs 16,34,7 (=0,04).

:::::1. 3

sE3 .

2. , 3 , .

::::: 33 339 (39), 3 : sP3 2 , .

: : : : : 29 , , 22 3 (75,9%), 7 (24,1%). 3 573,25 . 3 () 2 3 12 (41,4%). 3 (). 9, s33, 3 () 3, .

::::: 39 3 258,96197,64 /, 3 3: 52% 537,46375,15 /(=0,0004), 3 508,51431,97/. 3 2 : 2 , 39 3 , , :302,82165,78 vs 228,00216,81 (=0,07) 56%

(=0,004) 302,82165,78 vs 687,43463,61; 47,2% (=0,03): 228,00216,81 vs431,60320,72 /. 39, 13 , 2, , , : 687,43463,61 vs 431,60320,72, (=0,04). 73 , , 13 3 7,1% vs 3,5% (>0,05). , 3 73 39 54,7% (=0,06), , 45,3%(=0,03). 39 sP3, , 3 : R=0,62;p=0,02.

::::: 1.

3 39 3 .

2. , 3 3 , , , 3 3 39 , 73 3 .

3. 3 .

39 39 39 39 39 2 , 2 , 2 , 2 , 2 ,

.., .., .., .., .., .., .., ..

, . ,

39 ,39 ,39 ,39 ,39 ,

.., .., .., .., .., .., .., ..

, . ,

::::: 3 339 (39), : sP sE3 , 3 .

: : : : : 29 ,

, , 22 (75,9%), 7 (24,1%). 573,25 , 3 581,5 573,5. 3 20 (68%). 3 14 (70%).

43

3 8 (89%), (11%). : 3 , 3 1 (5%), 1 (5%), 3 1 (5%), , 4 4 (20%). 4 (20%) , 3 . , , 2 (10%), 3 1 (5%). , 3 , 3 6 (30%) 3 (). 9, s3 s33, 3 () , .

: : : : : 39 3 258,96197,64 /, 3 3: 52% 537,46375,15 /(=0,0004), 3 508,51431,97/. 3 39 , :285,06216,09 vs 176,9192,26 (>0,05) , 42% (=0,02), 74% (=0,02): 490,13412,29 vs686,20477,85 / (>0,05). , 73 , , 3 39 3. 3

9 3 : 240,42210,81 vs 300,15168,55 / (>0,05) 73 3 3 39 , , :553,12429,36 vs 502,64450,75 /; 522,47399,35 vs477,47522,26 / (

44

6 (30%). 3 (). IL31240 () , 3 .

::::: 3 IL31240 3 ( 50 %), : 5,711,56 vs 11,42 8,00 /(=0,0001), . 3 . , IL31240: 16,1412,04 vs 9,925,8 / (>0,05). 3 IL31240 , 3

. , 3 , IL31240 7 3 3 , 3 .

: : : : : 3 IL31240 3 . , 3 , 3. 3 7 , , , , IL31240.

.. , . ,

3 3 , 3 , 3 3. 3 33 , , 3 .

::::: 3 3 3.

: : : : : 81 3 () 18 37, 15 18 35 20 . 3 , 33 , . () 3 () ; 3 () , 3 (L23L4).

. . . . . 3 3 . . 3

. 3 , 3 . 3 3, . , , 3 . 3 18320 , 21329 30337 . 3 , , . 3 3 , 3 , .

. . . . . 3 3 . 3 3 , , , 3, 3 . 3 3 , 3 , 3 , 3 .

45

, , , , ,

.., .., .., .., .., .. . .. ,

, ,. ,

..... 3 () 3 . 3 () 3 (), 3 , 3, 3.

: : : : : 3 If3 3 3 .

: : : : : 21 II3III 3 45 67 ( 58,95,32 ), 17 (81%) 4 (19%) , 3 10 . . 3 33 . 3 303 ( , . ) 3 3, 3 3 . 3 , , , , 3 . 33 2 . 3 13 (n=11) 5/ (, , ) 3 10 / (, , ). 23 (n=10) 5 /. 3 . 3 , 3 , , 3 , , 3 (SDNN, RMSSD, TP). 3 ; .

: : : : : 3 , , , (89,6410,10 13 90,007,16 23 ), (9 ) . 3 : SDNN 13 21 (11,0331,0), 23 25 (13,5333,5). RMSSD TP. : HbA1c 8,621,96%, 5,721,14 / 3 5,961,91 /. 3 , . 3 3 (68,904,68 13 73,004,35 23; =0,0430). 13 < 70 . 3 132 13 234 23, 3 . 3, 3 (SDNN, RMSSD, TP) , 3 . 3 3. 3 3 3 , . 3 < 70 3 13 23 .

::::: , 3 5 / 10 / 3 3 3, .

.., .., .., .., .. , . ,

: : : : : 3 () 3 .

: : : : : 3

5 (, 3, , ) . 20359 . 87% 1320 , 531, 789 . 3

46

. 3 40,10,3 , 40,10,5 , 40,10,4 .

33 , ( , , ), , , 10312 . (), (), 3 ( ) ( ) CardioChekTM PA (PTS).

:1. 3

III 3 2003 .

2. 3 94 , 80 (, 2007).

3. () > 5,6 / (IDF,2005).

3 STATISTICA 8.0. 3 3 3 (253 753 ).

() 5%. , 3 (2001).

::::: 42% ( 59%, 3 23%, p=0,001). (p=0,005). 3 , , , 3 , 3 , (=0,01).

:, 60% ( 37%, p=0,001); 77% ( 43%, p=0,001); 3 61 41% ( p=0,001); 58 30% 3 (p=0,001). 66% , 3 42% (=0,001).

::::: , 3 , 3 .

(IN VIVO) (IN VIVO) (IN VIVO) (IN VIVO) (IN VIVO)

.., .., .., .. , 3 . .. ,

. ,

..... in vivo 3 3 .

. . . . . (2) 3 , 3 , , , . 2 3 3, .. 3. 3 Clark. 3 2, 3, 3 Clark (+3 ). 44. 44 , 3. (PtcO2) 2 20%(), (PtcO2) 2 5315% ( 2 . 1315 ., 45360 . 2 (3

) .(SpO2 2, 90 . .; 703116 ..; 2 150 ..). , 3 , , . 3, 3 3, , in vivo. 3. 3 , 3, 3 576. . 3 3, , 3 . 3 0.04 ; . 0.04 . 3, 3 , , 3

47

. , , 3 3, , , , 3 . , 3, , , 3 : . , 3 3, , 3 , , ,, 3, 3 .

. . . . . 3 , , 3 , 3 . 3 3 , 3 .

. . . . . 3 , 3 , . 3 , 3 , 3 3; , , 3, ., , 3, 3 3 . 3 : ( 3 ); 3; 3 ; 3 592 ( , ).

.., .., .., .., ..3 3 ,

, . ,

: : : : : 3 3 .

: : : : : 3 3 ( , . ). 200632010 . 141 . 3 8 . 336 . 3 : I , 3 3 91 3, II 42 , , 3 (44 ). 3 3 89% I 90,9% II . 3 604,3 I 61,24,8 II. I 34,61,3, II 18,91,1 . 3 2008 . ( 2,5 /), , 3 3 () .

: : : : : 3 . 3 3 3, . 3

: 39 (42,9%) I 6 (13,6%) 3 II . , I ( 33 3) 9 (9,9%) , 3 ( 18 .) 19 (20,9%) 11(12,1%) . II : 3 3 (6,8%) 3(6,8%). 3 II 26 , 18 . .

, 15 (16,5%) I , 8 (8,8%) 3, 7 (7,7%) . II 3 4 (9,1%) 3.

3 , II, , 3 , 3 (54,414,6%/ 42,713,9%/ ; =0,0034), (9,34,8 7,22,3 ; =0,043) 3 (3,81,2 3,21,3 ;=0,014).

::::: 3 3 . 3 3 .

48

.., .. 3 , . ,

3, 3 20 3 . , 3 3 3, .

: : : : : 3 3 3 .

: : : : : 24 3 2503350 . 3 . 3 (n = 6) 303 3 () , 120 . (n = 6) 15 3 303 3 n. vagus. (n = 6) 3 30 , 3 3, 5 5 , 53 . (n = 6)

n. vagus, 3 , . 3 Spike4.

::::: 3 3 . () 3 398%. 3 n.vagus 3 , 3 . 597% (

49

(>0,05). 435%. , n.vagus , 3 3 3597% (

50

(n=6). n. vagus 15 303 (n=6) (n=6) . 3 3 3 , 3 (), (), . () (253; 753 ). 3 (253; 753 3). 3 .

: : : : : 3 27 337 . , 4 9 , . 3 7 . 2 . 3 10 11 , 1 . . 3 4 6 . ;

42 207 . , 5 . , n.vagus. 3 3 . 17, 19 126 . , , 2 , . 3 96,0 (36,5; 277,5) , 3 3 0.0 (0.0;10.25) , 3 n. vagus 3 122.0 (74.25;177.0) , 3 8,5 (0,0;45,75) . 3 3 (0,05). 3 (>0,05).

: : : : : 3 3 n.vagus 3 , 3 .

.. , . ,

..... 3 .

::::: 3 (3 ) Pentaphylloides fruticosa (L). O. Schwarz, Rosaceae ,3 3 3.

: : : : : 3 2,53 , . 3 . 3 . , 0,125 / 1 ( ) 0,25 / 3 1 ( ). , , 3 3 . 3 (), 3 (), ( ); ( 3 , 3 ) (

3 ) . 3 .

..... 3 0,25 / 3 (

51

3 .

. . . . . 3 3 , 3 ( ), , 33

, 3 , 3 3, 3.

,,,,,

. . . . .

. ., .. , . ,

33 , 3 . 3 3 (). .

. . . . . 3 , 3.

. . . . . 122 35 84 ( 52,00,7 ) 33 ( 3 () /(1999 ) () 3 ), 3 . 3 35 , 3 35 63 . 3 : I 35 60 ( 3 49,30,9 ) ; II 3 35 60 ( 46,81,3) ; III 35 60 ( 49,71,1 ) ; IV 3 60 ( 62,61,1 ) ; 35 63 ( 48,21,3 ). () (n=60) () (n=15), . () 3 () 3, () 3 () 3 36. () 3 3 . 3 STATISTICA 6. m, , m . 3

3. t33 . 3

52

III (45,280,92), (

53

.., .., .., .., .., .. 3

, . ,

: : : : : 3 () 2 , 3 (). 3, .

: : : : : 3 , 3 () 2006 2009 . 3 2 (n=303), 3 I ( 57,40,61 ). 3 (II) 535 3, , 1, 2 ( 57,10,58 ). 3 , , , , . ; 33 : , (), 3 MDRD, (3 0,033 /); 3 3 (); .

3 3 , 3 , 3 , (), 3 (), 3 (), 3 , , 3 3, .

3 STATISTICA 6.0. 3 3 3. , 3, , 253 753 3. 3 3. 3 2 . 3 . 3 25 /2) 81% I 79 % II (=0,85). 76% I 74,5% II (=0,4), 3 7,0 5,5% 3 (=0,35), . 3 (95% 87% , p

54

.., .. , . ,

, () 3 . 3 3 3, 3 .

::::: 3 , .

. . . . . 26 , 3 3 . 3. 26 3 34 . 800 2300 . 3. 12 3 . 14 33 . 3 () 3 3 5 . 3 9 . 3 , 3 0438 ( , 3, ). 3 3 V4M, Y, V6M, 3 . 3 . 3 3 Microsoft Excel 7,0.

..... 3 243 3 , 3 . 91,6% 3 , , 3 78,5%, 3. 33,3% 3

3 42,85% , 3 . , 3 , 3 . 3 , 2 8 (57,1%), 3 (25,0%). 3 , 50,0% 3 35,7% 3 3 3 , 3 (16 33 ). 3 . , 3 1 3 (8,3%) 3 (21,42%) . Qc , Qc , (438,5511,52 455,8820,91 , ). 3 8,32% 14,28% . 3 ST ( ) 3 .

. . . . . 3 3 3 , 3 . 3 II 3 , 3 . 3 , 3 3 .

3 3 3 3 3

.. , . ,

::::: 303 3 () 3 .

: : : : : 16 (. =38,158,25 )

. 6 (. = 44,0 10,49 ). 3 12 , , 3, . 3 1/. 3

55

63 () (). (): 1,87 0,29/, 5,831,39/, 3 29,14,18/, , 3 . (, NOBEL3PHARMSANOAT) 45,837,71 /.

::::: 103 3 , , , 3. , 1 (43,6721,37, 62,2520,90, =0,065) 1/ (0,740,27 0,950,19, =0,059). 3 3 . , 3 () 3 25% ( =0,600.15/, =0,750,14 /, =0,033), 3

3 7% ( 43,752.5%, 46,851,91%, =0,006). , 3 3 22% (142,2546,41., 111,0036,77, =0.112) 3 19% ( 29,98,88, 24,322,44, =0,071). . , 1033 3 37% ( 273,6 106,34, 373,831,05.=0,010) () 3 , ( 21,251,89 18,01,63, . 26,253,09 21,01,15, =0,000).

, 303 3 3 , 3 .

.., .. , . ,

3 17% 65 12% . 3 , 3 3 . (), , 3 . 3 , 3 , , 3, .

3 ().

. . . . . 10 . , 3, 3 3.

. . . . . 3 () 3 . 3 7 ST V133, V1,2 QS, V3 QrS. 3 3: V1,2 3 QS, ST , , V3 Q ST 3 (3+), 3 I 436 /( 030,5 /). 3 3 ,

. 3, . 1, 4 5 QRS . 2 3 , 3 , . 2 QRS 1 , 2. 3 3 , 3 QRS 4 . 2,3 QRS 3 , , . QRS , QRS . QRS 1, 2, 3 5 . 3 QRS 1 2,3, . 3 1 4 5 . 3 , 4 3 . 1,531,8 1,4,5 3 2 3 3 3 133. QRS3T . 1, 4 5 , 3 2,3. 3 QRS : 1 0,2230,24 , 2 0,1130,15 , 3 0, 1430,18 , 4 0,2530,28 , 5 0,2130,25 . 3 ST , . , 3 , ; 3 QRS 2 3 3; QRS 1 ; QRS , 3 QRS3T; ST

56

, ; 3 , , 3 333 . 1 . , 1,2 4 5 .

3 , 3 .

. . . . . , 3 , 3 3 .

2 2 2 2 2

.., .., .., .. 3

3 , . ,

() () 2 , , 3. 3 () ST, , . , 3 () 3 3.

: : : : : 3 ST (ST) 2 .

: : : : : 423 ST. . 3 77 (18,20%) . (346) .

: : : : : 3 () 45,45% (n=35) , 3 54,91% (n=190) (>0,05). 33 ,

. 3 (69,57 vs 56,97 ; p=0,02), : 3 3 (42,86% vs 15,26%; p=0,001), (21,95% vs 3,70%; p=0,0001), (11,90% vs 3,16%; p=0,04); 3 TIMI (5,0 vs 2,0; p>0,05), ; 3 40% (54,76% vs 20,0%; p

57

, , 3, ( ).

: : : : : 3 , 3 (p>0,05) : 28,57%, 30,53%.

, 3 : 52,38% 3 42,95% . , 3 3 3.

::::: 2 3 3 .

R3 R3 R3 R3 R3

.., .., .., .. 3

3 ,. 3,

33 . 3 3 ( RR3). 3 R3 . , 3 , ..., , 3 3 .

. . . . . 3 R3 3 ( R3wave trigger). 3 3 , 3 , , , . 3 R3 3. , :

1. o R3 . 3, 3 250 R3 . 3 3 RR3. 3 3 ( R3), 3 .

2. R3 3 3, 3

, , 3 R3.

3. 3 R3 , 3 , 3 ( ), .

4. , 3 , ( 3 ) 3 RR3. , , R3, 3, QRS3. , , 3 .

. . . . . 3 , , . 3 3 3 MicroCap 3 . .

. . . . . 3 R3 16 25. 3 R33 3 , . : 3 R3 3 (), 3 . : , 3

58

. 3

3 . 2010 . 3 . (3 ) 3 . 3 3 , 3 ( ) 3 , 3

. 3 3 , 3 . 3 , 3 28 .

. . . . . 3 3 R3 3 , 3 3 3 . 3 .

2 2 2 2 2

.., .., .., .. , . ,

3 () , 2 ().

3 81 , 30 , 51 3 . 3 8 1,5 3 . 3 () 3 Meditech 02/ ( Meditech, ).

3 3 2 3 ( () =329,1 2,9 .., () =324,00,7 ..,

59

61,61,5), 37 3 () 14 (). 3 3 54 3, 13, 73 14 3 . 14 (52,62,6), 40 (61,11,8): 30 10 . 3 12 3 3 (53,32,2), . () 3 3(). 323 () 313 () 3 .

::::: 3 3 (1,310,11 /, 1,290,11, 1,500,18 1,900,13 /,

60

, 3 .

: : : : : 53 3 : Q3 31 , 3Q 22. 3 38 . 61,2 (41 12 ). 3 , , , . 3 sFas, sICAM31 (CD54) sICAM33 (CD50). 3 3 HLA I (sHLA3I). 3 : ( ), . ELISA c . 3 3 Statsoft Statgraf.

: : : : : sFas. sFas 356,0 7,0 / ( m). sFas Q3 475,8 40,7 /. 20 13 32 .

sICAM31. 3 , 3 , . sICAM31 3 64,0 2,2 /. 3 30% (88,3 6,2 /). sICAM31 Q3 3. 3Q 3 sICAM31. 3

3 Q33 3Q . sFas sICAM31. .

sICAM33. 3 sICAM33 353,6 7,3 /. Q3 364,926,6 /, 3Q 3 373,4 19,7 /. .

sHLA31. 3 sHLA3I 1021,5 156,8 /. Q3 sHLA3I 972,0 468,1 /, 3 3Q , 1342,0973,1 /. HLA I 3 3 3 , CD833 . , 3 sHLA3I, 3 .

: : : : : sFas, , 3 ICAM31, , , 3 . 3 , , 3. 3 ( 4 ), 3 . , , .

.., .., .. ,

, . ,

() 3 3 (). 3 3 () .

: : : : : 3 , 3 , .

: : : : : 69 , 3 2 . : 51 ; ( ): 18 .

. , 3, 3 . 3. 1 3 50,66,2 , 3 25% 44,0 ; 75% 3 57 , 46,097,06, 25% 37,0 ; 75% 59 . 3 . , , 130 / 4,51012/. 33 32000 3 3,5 . 3 3

61

, 1980 . 3 (ASE). 3 .

3 STATISTICA 6,1 (StatSoftware, USA). 3 (3 3, , ). 3 3 < 0,05.

: : : : : 3 28 3 , 23 3 .

, 13 . , (P= 0,05). 13 10, 8%, (P=0,05). 3 13 0,20,12 (P=0,00035). 3 13 27%,(P=0,00002). 3 . (> 110/2) 74 (75%) , 8(10%) 64(86%) . , 112,720,2/2 3 82,119,2/2, , (=0,00001). 3 (R=0,21; =0,00001), ( R= 3 0,19; =0,00035). 6 (8,1%), 5 (6,8%) 3 32 (43,2%). 3 . 3, 58,5% , 3 15,6% , 17,2 % 3 , 8,5% .

3 13 7 % ( r=0,32; =0,0009) 3 , 3. 3 13 23 , 7,3% (=0,03) . 3 13 10,72,7(=0,85). 3 3 () 13 4% (r=0,38;=0,02) . 3 (), 3 13 2% (=0,05). / 3 13 4,9%(=0,00352). 3 (DT) 13 23 . 3 (IVRT ) 3 13 4%(=0,00007), , 3 . 72,6%. 3 13 23 : 56 (68,3%) 24(32,7%) .

::::: , , 3 , , . 3 33 3 , 3 . 33 . 3. 3 3 .

ST ST ST ST ST

.., .., .. ,

, . ,

33 3 () 18,5% 72,7% , 3 . 3 P, R , S, T ( R T V2), P, P3Q, QRS. , 3 () 3 () , , 3 3

. () . 3 ST 3 .

::::: ST 3 .

::::: 98 . 51 , 29 , 18 33 .

62

. 3, , 3 130 / 4,51012/. 34 51 (66%) 125 / 115 /, 70/ 30/. 3 ,, , VI. 3 () ArMaSoft . 200032004 Safe Heart System 24h 2.02. ST 3 3

1, 23 . 3 3 STATISTICA 6,1 (Stat Software, USA). 3 3. < 0,05.

: : : : : , 18,2% 3. ST(.1) , 3, , , (

63

.., .., .., .., .., .., .., .. , . ,

, . , , . ,

() 3 333 . 3 . 3 . , 3 3. , , 3 ( C3344T) .

. . . . . 3 3 ( C3344T) 3 .

. . . . . 226 I3III ( ) (149 77 ) 45 65 ( 3 55,95,8) I3IV NYHA. 3 () 63330% (). 3 136 (63 73 ) 45 65 ( 53,64,8 ) .

, , 3 3 , , 3 . 13 47 (20,8%) I , 23 96 (42,5%) II , 33 83 (36,7%) III3IV .

3 3 : (142 ) 3 (84 ) . 3 : 3, , , () .

( ) 3 3 C3344T. 33 .

. . . . . , , 3 , 3 / (34,5% 18,4%,

64

. . . . . , ,

. / C3344T . / .

.., .., .., .., .., .. , . ,

: : : : : 33 () 3 () () 3 .

: : : : : 55 3 (): G83A 3 (REN), M235T (AGT), I/D 33 (), A1166C 3 II 13 (AGTR1). , 3 . () I/D 3 . 3 . 3 , 3 . : 3 336 , . 3 5 . 15 . 3 150 . 3 3 EEEL, 32, BIOSTAT.

: : : : : 3 3 . G83A (=0,0005, ), (=0,01) G (=0,045) . 3 G83A 3. 3 . 3 32 , , 3 3. , 50% I/D . D3 DD 3 3 . 3 DD D3 , , 3 . , 3

3. 3 3 , 3 . 3. 3 . 16 , , 3 , , 3 3 . 4 . I/D , , 3 3 DD (p

65

, , , , ,

.., .., .., .., .. , ,

. ,

() 3, , 3 , 33 (CC) 2 ( 2). 3 , 3 . , , 3 . , 3 .

: : : : : , .

: : : : : . 3 . 17000 3 127. 3 :, , (), 3 , 3 : 2, (), 3 (), .

3 Microsoft Office Excel 2007

STATISTICA 6.0 (StatSoft, USA). 3 3 2. 3

66

. 3 3 Microsoft Office Excel 2007 3 STATISTICA 6.0 (StatSoft, USA). 3 , 3 . (ME) (253 753). 3 3 Kruskal3Wallis. 3

67

7

8

9

0

0

0

2. CHADS2 CHA2DS2VASc

3 CHADS2, 3

10% , CHA2DS2VASc 6%( 2).

2

35

21

4

0

0

0

0

0

0

0

1

2

3

4

5

6

7

8

9

CHADS2 (n = 29)

0

13

13

3

0

0

0

0

0

0

CHA2DS2VASc (n = 62)

::::: , 3 (n=73), CHADS2, 40% 3 3 . CHA2DS2VASc, , 85%

. 3 3 CHADS2 4 3 CHA2DS2VASc, 3 3 3 .

.., .., .. 3 , . ,

3 3 3 . , 3 , 3 . 3 3 3 , , 3 . 3 , 3 3 . , 3 3 . , 3 3 , 3

33 .

3 3 3 , 3 .

: : : : : 27 40369 , ( 58,51,3 ), 21 6 . ( 3 88,24,3 , 52,62,8 ) . , 13, 73 . 3 , 3 15 , . ; 3 ; . 3

68

3 3. 3 Statistica 7.0, 3 3 .

: : : : : 3 9,07 /, 2,6 3, , 2,6 2,62 6,93. ., 4 1,23 4,81. . 3 : 60% 30% 3. .

3 . 3 3 3 2,42 9,45 . . 3 1,23 8,03 . . 3. 3 () . 1 334 3 2. 334 132 : 21%, 12% 3 3 16%, 20%.

7 . 13 54% 70%, 3 10%. , 3 3 .

3

3 . 3 , . 334 3 . . 3 3 3 . 13 , , . 3 , 3 , 3 . 3 3 .

, , 3 3 , , 3 , 3 , , . 3 , , .

:::::1.

3 , 3 .

2. , 3 3 , 3 .

3. , 3 , 3. 73 .

, , , , , , , , , ,

.., .., ..3 . .. , 3

. .. , . 3,

, , 3 3 64 3 18 65 3 . .. . 30 16, 31340 10 , 41350 14 ,51360 16 , 60 8 .

: : : : : , 3

(), , , , (CoHb). 3 .

, , 3 2, , 3 CoHb. 3 . I 3

69

, II 2 30 37,5 % (9,375 % ), 31340 20 % (3,125 % ), 41350 14,28 %(3,125 % ), 51360 12,5 % (3,125 % ), 60 20 % (3,125 % ). I 4 (6,25 % ), I 3 II 4 (6,25 % ), > 2 2 (3,125 % ). 15,625 %. 3 () . 30 3 (III .. ) Rayan 50 % (12,5% ), 31340 0 %, 41350 57,14 % (12,5 % ),51360 50 % (12,5 % ), 60 100 % (12,5% ). 41350 60 2 3 3 . III .. 16 (25 % ), IVb .. 8 (12,5 % ), V .. 8 (12,5 % ). 50 %. 6 (9,375 % ) .. (3,125 % ) . () 3 : ( IV .. ), QT, 3 ().

100 % 3. 30 25 % (6,25 % ),31340 0%, 41350 42,857 % (9,375 % ), 51360 75% (18,75 % ), 60 50 % (6,25 % ). 40,625 % . 3 43,75 % (21,875% ) 18,75 % I II .., , .. 68,75 % 3. () : 3 (> 100 ), (> 1 ), , . 30 3 25 % (6,25 % ), 31340 20 % (3,125 % ),41350 57,14 % (12,5 % ), 51360 37,5 % (9,375 % ), 60 75 % (9,375 % ). () 60 (3,125 % ). 4 (6,25 % ) 3 ( + ) 3

. 3 1 10 . 46,875 % . 3 30 62,5 %(15,625 % ), 31340 40 % (6,25 % ), 41350 28,57 % (6,25 % ), 51360 12,5 % (3,125 % ), 60 100% (12,5 % ). 3 60 2 3 () 3 (). 3, . 3 , 3 9 182 , , 40 , 3 , , ( ). 3 43,75 % . (, , 3, ) . 10 (15,625 %) 3 . 12 (18,75%) , 22 (34,375 %) , 10(15,625 %) , 6 (9,375 %) 4 (6,25 %) 3. 4 (6,25%) 3 , 4 6 4 5 3 3 .

, 3 3, , 3 3 , , 3 , 3 .

.., .., .., .. , . ,

3 (). 3 . 203 ,

, , 3 .

3 ( ) ().

70

: : : : : 26 (5 21 ), 63,95 +9,54, . 10,61+ 7,26 . 3 3 3 : 13 (n=14) 3 I3II, 23 (n=7) , 33 ( n=5) IV . 3 3 Vivid 3 Expert (General Electric, ). (, ), 3 (, ) , 3 ( ,%) 3 (dS%). 3 ( , /) (/), 3 ( IVRT), 3 (), / 3 , Taniguhi K. . (2000). 3 3 ( ) Celermajer D.S.et.al. (1992) c . 3 7 Vivid 3 Expert (General Electric, 3). , , 3 . 3 200 . . 5 , , 30 . 60390 10% 3 . 3 . 3 3 (2007). , 3, , , 3, . .

: : : : : I3IV

. I3II 48% , 68% , 3 100% . 3 .

3 13 101,8%, 3 9,81%. 3 23 , 86,19%, 3 8,47%. 33 3 3 6,4% 5,08%. 3 3: . , , 3 , 33 . 3 3 , . 3 (r= 30,75 p

71

40 (RMS40)< 20 . 3 . 3 3 3 : RR 3, ; 3 NN (3 RR) (RMSSD), ; NN50 RR, 50 (pNN50%); 3 (0,0030,04) very low frequency (VLF), 2; (0,040,15 ) low frequency (LF),2; (0,150,4 ) high frequency (HF), 2.

. . . . . 3 . , . 3, 3, . 3 , 3 NN50% (9,62,3), RMSSD (26,81,7) (16,31,6 33,72,1 , p

72

.., .., .., .., .. , . ,

. . . . . 3 , , .

. . . . . , .

. . . . . ( 3, 3 ) 3 3 . . ( ) 3 : 3 , , 3, . 3 . 3 3 . 3 , 3 , 3 3. (3 ) , 3, . 3 , 3 3. 3 ( ), 3 , 3. 3 3 3 . 3 ( 3, ) 3 3 3 3 33 . , 2 ., 3 3 .

30 3 . 3

3 . 3 3 .

. . . . . 6 , 6 3 , 3 3 .

3 , , 3 , , .

, 3 , , , 3, . 3 , . . 3 3 . , 3 , 3 , 2 . , . , 3 3 . 3 . 3, , 3 3 . , 3 ( ). , 3 3 . 3 , 3 , , 3 . , . 3, 3. , (, 3 ) , 3 . 70%

73

3 3 . 3 . 3 , 33 , , 3 , . , , 3, 3, 3 . 3

3 3 3 .

. . . . . , 3 3 3 3 .

, , , , ,

.., ., .. , .,

3 , 3 () (). 3 , , 3 , 3 , . , 3 33 13 , 3 .

. . . . . 48 , (40 , 8 ), 3 52,29,2 . 6 3 3 3, , .3 (3, Astra Zeneka, ) 1003150 3 3 . , 3 3 , (, Sanofi Aventis, ).

..... 3 3 (147,712,1 136,910,8 ..; =0,000), 3 (137,417,0 123,012,2 ..; =0,000) (76,38,3 70,96,9 ..; =0,027), 3

(63,520,9 45,021,5%;=0,000) (77,328,7 55,229,5 %; =0,007). , 3 3 , 3 ( 135,98,3 128,86,8 ..; =0,001; 128,311,4 119,17,2 ..; =0,002). 3 3 , , 3 3: ( 131,5 6,1 151,15,2 ..; =0,000; 73,65,5 80,6 5,3 ..;=0,001) ( 154,610,8 175,1 6,5 ..; =0,001; 85,64,0 91,14,9 ..;=0,004), , 3 3 (1009,6 756,2 ; =0,001). 3 , (5,810,5 10,27,1%; =0,024) (1010,2 14,67,7 %; =0,036). 3 (29 5,5%; =0,000) (23 57%; =0,001).

. . . . . , , , . 3 .

33333

.., .., .. , . ,

3 3 , 3 .

3 3

3 () 3.

. . . . . 48 3 3 , 3 () (40 , 8 , 52,29,2 ). 3 3

74

(3, Astrazeneka, 3) 503150 . 3 , 3 ().

. . . . . 2 :1 (22 ) 3 , 3, 2 (16 ) 3 . , 3, , 2 (SDNN 98,0813,2 ms 138,0230,7 ms ; =0,001; pNN503,493,4 % 4,453,7 % ; =0,05). 1 c 3 , 3 , , 3 , 3 , :SDNN 98,0813,2 105,5739,2 ms ;=0,003; pNN50 3,493,4 3,614,0% ;=0,02, rMSSD 20,717,3 25,58,1 ms ;=0,05; HF 69,1450,8 76,2646,0 ms2 ;=0,04; LF/HF 3,62,06 3,01,5 ; =0,01).

2 3 3 : SDANN 155,3564,2 178,5629,2 ms ; =0,02; rMSSD22,657,7 25,144,4 ms ; =0,03; VLF713,77379,13 980,91812,37 ms2 ;=0,005; HF 81,0156,5 98,0129,5 ms2 ;=0,005; LF/HF 4,11,6 3,31,5 ; =0,01).

3 3 , (SDNN 16 7 ms , p=0,001; SDANN 23 11ms , p=0,000; VLF 200 15 3, p=0,000; LF 110 8 , p=0,000; HF 17 7, p=0,001).

. . . . . , , 3 , 3 , 3 . , , 3 , , .

, , , , ,

.., .., .., .., .., .. 2 ,

. ,

3 . 3 3 , 33 .

, 3 3 3. , 3 , 3 33 , .

. . . . . 118 18 70 , 5 : (12 ), () (25 ), 3 () 1 (26 ), 3 233 (28 ), . 3 338/. , 3 , 3, 3 304. 3

, , 3 Vivid 3 Expert. 3 , 3 338/(, ), 3 , .

. . . . . 5,92 / + 1,21; 6,8 / + 1,18; 1 8,72 / + 3,45; 3 233 18,78 / + 11,07; 6,6 + 2,07;

3 3,31 / + 2,47; 5,16 / + 2,84; 1 6,1/ + 3,07; 233 7,39 / + 3,14; 5,38 + 2,18;

3 2,3 ./2 + 2,1; 3 2,7 ./ + 3,3; 1 2,9 ./2 + 3,1 ; 233 5,4 ./2 + 5,07; 3 2,7 ./2 + 2,07;

3 4,6 ./2 +1,93; 3 6,4 ./ + 3,6; 1 9,01 ./2 + 4,6; 233 13,4 ./2 + 7,06; 6,2 ./2 + 5,2;

75

( ) : 800/5; 1200 /5 ; 3 1 1224 /5; 3 233 3101/5; 860 /5;

.....1., 33

3 . 3 .

2. 3 3 3 .

3. 3 , , 3 3 3, 3 , 3 , 3 .

.., .., .. , . ,

3 , 3 3 3 . 3 .

3 3 3 .

. . . . . 3 , , 3, , 3 , . 42 1703320 , 3 . 3 3 40 / .

3 3 .

5 : 3, , 3 ( 40 /), , 0,844 / , 50 / 100 /.

18 , 3

( (), 3 ) 3 ( (), (), 3 ( ).

..... 3 3,6 (

76

, 3 . , , 3 , . 3 80387 % 3 , 3 , 3 536 , 3 , 3 , 3 132 . 3 , 3