Aim. To evaluate the prognosis of patients with myocardial infarction (MI) and chronic kidney disease (CKD) based on the data of the Russian registry REGION-MI, as well as to clarify the disease course and treatment of this group of patients in real-world practice.Material and methods. REGION-MI is a Russian multicenter prospective observational study that included 10884 patients with acute MI. Data on creatinine levels and glomerular filtration rate (GFR) were obtained from 10229 people.Results. Among patients included in the REGION-MI registry, a decrease in GFR <60 ml/min/1,73 m² was diagnosed in 30,5%. Patients with MI and CKD are significantly older than patients with preserved renal function, have a greater number of comorbidities. In addition, they were more often diagnosed with non-ST-elevation MI and were less likely to undergo coronary angiography and percutaneous coronary intervention. Patients with CKD were less likely to receive all groups of drugs prescribed after MI. Mortality of patients with CKD in our study was significantly higher compared to mortality of patients with preserved renal function both at the hospital stage (8,4% and 1,7%, respectively, odds ratio 5,31; 95% confidence interval: 4,25-6,62; p<0,005) and one year after the index event (10,1% and 3,6%, respectively, odds ratio 3,03; 95% confidence interval: 2,54-3,61, p<0,005).Conclusion. A decrease in GFR is a factor influencing an increase in mortality in MI patients. Patients with CKD and MI have a very high risk of cardiovascular events, as well as require intensive care in the acute and late periods of the disease. However, they often do not receive drug therapy in full and are less likely to undergo coronary angiography and invasive treatment. Large clinical trials are needed to study the characteristics of the disease course and choose the optimal treatment tactics for patients with MI and reduced renal function.

Aim. To evaluate effect of therapeutic training and active outpatient management on clinical state and cardiovascular complications (CVC) in patients with chronic heart failure (CHF) during three year follow-up. Material and methods. A total of 211 patients with CHF experienced Q-wave myocardial infarction were enrolled in the study. At admission to the hospital all patients were randomized into two groups. Patients of the first group (group 1; n=106) were managed actively after discharge from the hospital, patients of the second group (group 2; n=105) - managed conventionally after discharge from the hospital. In the hospital patients of the both groups were therapeutically trained and treated according to contemporary guidelines. Patients were observed for three years. Results. Over three year follow-up actively managed patients demonstrated significant (p<0.05) decrease in systolic and diastolic blood pressure, heart rate, blood serum levels of total cholesterol and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), augmentation of 6-minute walk-test distance, deceleration of heart remodeling and left ventricle ejection fraction reduction as compared to those who were conventionally managed. Kaplan-Meier curves revealed that risk of CHF decompensation (р=0.001), mortality (р=0.04), and total number of CVC (р=0.04) was significantly lower in the first group than this in the second one. Conclusion. Therapeutic training and active outpatient management in patients with CHF improves patient compliance to pharmacotherapy , their clinical state and outcomes.

Пациенты с сердечно-сосудистыми заболеваниями и прием НПВП: реальная клиническая практика

Infective endocarditis in patients on maintenance hemodialysis occurs more often than in the population, manifests severe complications and is characterized by high mortality. The management of such patients requires the participation of several specialists. In the presented clinical observation, both typical characteristics of infective endocarditis on maintenance hemodialysis (staphylococcal etiology, association with vascular access devices, metabolic and hemodynamic risk factors) and peculiarities of a particular case (nature of nephropathy that led to maintenance hemodialysis, mechanism of right heart damage, which is uncommon for infective endocarditis on maintenance hemodialysis) are discussed in comparison with literature data. Interdisciplinary interaction of doctors of several specialties contributed to the choice of the right tactics and a favorable outcome of the disease.

Спекл-трекинг эхокардиография — неинвазивный метод, позволяющий исследовать деформацию миокарда, которая тесно связана с его региональной и глобальной функцией. Несмотря на то, что метод еще не внедрен в широкую клиническую практику, активно изучается изменение параметров деформации при различных клинических состояниях, в частности при остром инфаркте миокарда. Многочисленные исследования показывают, что нарушение деформации может иметь важное прогностическое значение у больных острым инфарктом миокарда.