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Особенности кардиологической реабилитации в старших возрастных группах - Научно-практический журнал Cardioсоматика Том 3, №1 (2012)
Особенности кардиологической реабилитации в старших возрастных группах
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Аннотация
В России проблеме кардиологической реабилитации больных пожилого и старческого возраста уделяется недостаточно внимания. Однако вследствие постарения населения доля таких пациентов в практике кардиологов постоянно растет. Проведение реабилитационных мероприятий у больных старших возрастных групп является сложной задачей, учитывая наличие коморбидной патологии, возрастные изменения органов и систем.
В обзоре рассматриваются актуальные вопросы физических тренировок пожилых пациентов, в том числе с использованием собственных данных по электростимуляции скелетных мышц, предлагается дальнейшее развитие исследований по этой проблеме в рамках работы РосОКР.
Ключевые слова: кардиологическая реабилитация, старшие возрастные группы.
Key words: cardiac rehabilitation, older age groups.
В обзоре рассматриваются актуальные вопросы физических тренировок пожилых пациентов, в том числе с использованием собственных данных по электростимуляции скелетных мышц, предлагается дальнейшее развитие исследований по этой проблеме в рамках работы РосОКР.
Ключевые слова: кардиологическая реабилитация, старшие возрастные группы.
________________________________________________
Key words: cardiac rehabilitation, older age groups.
Полный текст
Список литературы
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5. van Domburg RT, Reimer WS, Hoeks SE et al. Three life-years gained from smoking cessation after coronary artery bypass surgery: a 30-year follow-up study. Am Heart J 2008; 156 (3): 473–6.
6. Afilalo J, Duque G, Steele R et al. Statins for secondary prevention in elderly patients: a hierarchical bayesian meta-analysis. JACC 2008; 51 (1): 37–45.
7. Rahilly-Tierney CR, Lawler EV, Scranton RE, Gaziano JM. Cardiovascular benefit of magnitude of low-density lipoprotein cholesterol reduction: a comparison of subgroups by age. Circulation 2009; 120 (15): 1491–7.
8. Gränsbo K, Melander O, Wallentin L et al. Cardiovascular and cancer mortality in very elderly post-myocardial infarction patients receiving statin treatment. JACC 2010; 55 (13): 1362–9.
9. Beckett NS, Peters R, Fletcher AE et al. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358 (18): 1887–98.
10. Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med 2007; 120 (9): 799–806.
11. Suaya JA, Stason WB, Ades PA et al. Cardiac rehabilitation and survival in older coronary patients. JACC 2009; 54 (1): 25–33.
12. Onishi T, Shimada K, Sato H et al. Effects of phase III cardiac rehabilitation on mortality and cardiovascular events in elderly patients with stable coronary artery disease. Circ J 2010; 74 (4): 709–14.
13. Mezzani A, Agostoni P, Cohen-Solal A et al. Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2009; 16 (3): 249–67.
14. De Feo S, Tramarin R, Lorusso R, Faggiano P. Six-minute walking test after cardiac surgery: instructions for an appropriate use. Eur J Cardiovasc Prev Rehabil 2009; 16 (2): 144–9.
15. Fleg JL, Morrell CH, Bos AG et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 2005; 112 (5): 674–82.
16. Hollmann W, Struder HK, Tagarakis CV, King G. Physical activity and the elderly. Eur J Cardiovasc Prev Rehabil 2007; 14 (6): 730–9.
17. Audelin MC, Savage PD, Ades P.A. Exercise-based cardiac rehabilitation for very old patients (> or =75 years): focus on physical function. J Cardiopulm Rehabil Prev 2008; 28 (3): 163–73.
18. Werner C, Furster T, Widmann T et al. Physical exercise prevents cellular senescence in circulating leukocytes and in the vessel wall. Circulation 2009; 120 (24): 2438–47.
19. Albinet CT, Boucard G, Bouquet CA, Audiffren M. Increased heart rate variability and executive performance after aerobic training in the elderly. Eur J Appl Physiol 2010; 109 (4): 617–24.
20. Eder B, Hofmann P, von Duvillard SP et al. Early 4-week cardiac rehabilitation exercise training in elderly patients after heart surgery. J Cardiopulm Rehabil Prev 2010; 30 (2): 85–92.
21. Jünger C, Rauch B, Schneider S et al. Effect of early short-term cardiac rehabilitation after acute ST-elevation and non-ST-elevation myocardial infarction on 1-year mortality. Curr Med Res Opin 2010; 26 (4): 803–11.
22. Сыркин А.Л., Полтавская М.Г., Свет А.В. и др. Интервальные тренировки у больных с хронической сердечной недостаточностью. Кардиология. 2008; 48 (7): 65–71.
23. Konopka AR, Douglass MD, Kaminsky LA et al. Molecular Adaptations to Aerobic Exercise Training in Skeletal Muscle of Older Women. J Gerontol A Biol Sci Med Sci 2010; 65 (11): 1201–7.
24. Jones TE, Stephenson KW, King JG et al. Sarcopenia – mechanisms and treatments. J Geriatr Phys Ther 2009; 32 (2): 39–45.
25. Misic MM, Valentine RJ, Rosengren KS et al. Impact of training modality on strength and physical function in older adults. Gerontology 2009; 55 (4): 411–6.
26. Сумин А.Н. Физические тренировки с использованием электростимуляции скелетных мышц в кардиологии. Кардиология. 2010; 3: 83–90.
27. Sbruzzi G, Ribeiro RA, Schaan BD et al. Functional electrical stimulation in the treatment of patients with chronic heart failure: a meta-analysis of randomized controlled trials. Eur J Cardiovasc Prev Rehabil 2010; 17 (3): 254–60.
28. Fritzsche D, Fruend A, Schenk S et al. Electromyostimulation (EMS) in cardiac patients. Will EMS training be helpful in secondary prevention? Herz 2010; 35 (1): 34–40.
29. Karavidas A, Parissis JT, Matzaraki V et al. Functional electrical stimulation is more effective in severe symptomatic heart failure patients and improves their adherence to rehabilitation programs. J Card Fail 2010; 16 (3): 244–9.
30. Сумин А.Н., Безденежных А.В., Байдина О.М. и др. ПАссивные ТРенировки при Инфаркте миокАРда у пожилыХ (Исследование ПАТРИАРХ): влияние на внутрисердечную гемодинамику и аритмогенный статус. Кардиоваск. тер. и профилакт. 2010; 3: 29–37.
31. Fruend A, Fritzsche D, Cadus M et al. Electromyostimulation and its influence on maximum oxygen consumtion in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil 2010; 17 (Suppl. 2): S24.
32. Maggioni MA, Ce E, Rampichini S et al. Electrical stimulation versus kinesitherapy in improving functional fitness in older women: a randomized controlled trial. Arch Gerontol Geriatr 2010; 50 (3): e19–25.
33. Carvalho VO, Roque JM, Xavier R et al. Hemodynamic response to one session of strength exercise with and without electrostimulation in heart failure patients: A randomized controlled trial. Eur J Cardiovasc Prev Rehabil 2010; 17 (Suppl. 2): S22.
34. Crognale D, Crowe L, Devito G et al. Neuro-muscular electrical stimulation training enhances maximal aerobic capacity in healthy physically active adults. Conf Proc IEEE Eng Med Biol Soc 2009; 2009: 2137–40.
35. Caminiti G, Volterrani M, Arisi A et al. Tai chi added to endurance training vs endurance training alone in elderly patients with chronic heart failure: a randomized pilot study. Eur J Cardiovasc Prev Rehabil 2010; 17 (Suppl. 2): S87.
36. Caminiti G, Volterrani M, Marazzi G et al. Hydrotherapy added to endurance training versus endurance training alone in elderly patients with chronic heart failure: A randomized pilot study. Int J Cardiol 2009 (Epub ahead of print).
37. Buurman BM, Parlevliet JL, van Deelen BA et al. A randomised clinical trial on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: the Transitional Care Bridge. BMC Health Serv Res 2010; 10: 296.
38. Opasich C, Patrignani A, Mazza A et al. An elderly-centered, personalized, physiotherapy program early after cardiac surgery. Eur J Cardiovasc Prev Rehabil 2010; 17 (5): 582–7.
39. Isaac V, Stewart R, Artero S et al. Social activity and improvement in depressive symptoms in older people: a prospective community cohort study. Am J Geriatr Psychiatry 2009; 17 (8): 688–96.
40. Hammill BG, Curtis LH, Schulman KA, Whellan DJ. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation 2010; 121 (1): 63–70.
41. Davidson KW, Mostofsky E, Whang W. Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey. Eur Heart J 2010; 31 (9): 1065–70.
42. Ferri C.P, Prince M, Brayne C et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366 (9503): 2112–7.
43. Kivipelto M, Rovio S, Ngandu T et al. Apolipoprotein E epsilon4 magnifies lifestyle risks for dementia: a population-based study. J Cell Mol Med 2008; 12 (6B): 2762–71.
44. Rovio S, Kåreholt I, Viitanen M et al. Work-related physical activity and the risk of dementia and Alzheimer's disease. Int J Geriatr Psychiatry 2007; 22 (9): 874–82.
45. Singh-Manoux A, Hillsdon M, Brunner E, Marmot M. Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study. Am J Public Health 2005; 95 (12): 2252–8.
46. Abbott RD, White LR, Ross GW et al. Walking and dementia in physically capable elderly men. JAMA 2004; 292 (12): 1447–53.
47. Larson EB, Wang L, Bowen JD et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med 2006; 144 (2): 73–81.
48. Podewils LJ, Guallar E, Kuller LH et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol 2005; 161 (7): 639–51.
49. Taaffe DR, Irie F, Masaki K.H et al. Physical activity, physical function, and incident dementia in elderly men: the Honolulu-Asia Aging Study. J Gerontol A Biol Sci Med Sci 2008; 63 (5): 529–35.
50. Weuve J, Kang JH, Manson JE et al. Physical activity, including walking, and cognitive function in older women. JAMA 2004; 292 (12): 1454–61.
51. Scarmeas N, Luchsinger JA, Brickman AM et al. Physical Activity and Alzheimer Disease Course. Am J Geriatr Psychiatry 2010 (Epub ahead of print).
52. Lautenschlager NT, Cox KL, Flicker L et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008; 300 (9): 1027–37.
53. Williamson JD, Espeland M, Kritchevsky SB et al. LIFE Study Investigators. Changes in cognitive function in a randomized trial of physical activity: results of the lifestyle interventions and independence for elders pilot study. J Gerontol A Biol Sci Med Sci 2009; 64 (6): 688–94.
54. Baker LD, Frank LL, Foster-Schubert K et al. Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Arch Neurol 2010; 67 (1): 71–9.
55. Smith PJ, Blumenthal JA, Hoffman BM et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 2010; 72 (3): 239–52.
56. Hernandez SS, Coelho FG, Gobbi S, Stella F. Effects of physical activity on cognitive functions, balance and risk of falls in elderly patients with Alzheimer's dementia. Rev Bras Fisioter 2010; 14 (1): 68–74.
57. Cerga-Pashoja A, Lowery D, Bhattacharya R et al. Evaluation of exercise on individuals with dementia and their carers: a randomised controlled trial. Trials 2010; 11: 53.
58. Banda JA, Hutto B, Feeney A et al. Comparing Physical Activity Measures in a Diverse Group of Midlife and Older Adults. Med Sci Sports Exerc 2010; 42 (12): 2251–7.
2. Аронов Д.М., Бубнова М.Г. Реальный путь снижения в России смертности от ишемической болезни сердца. Кардиосоматика. 2010; 1: 11–7.
3. Чазов Е.И. Кардиологическая реабилитация. Кардиосоматика. 2010; 1: 9–10.
4. Audelin MC, Savage PD, Ades PA. Changing clinical profile of patients entering cardiac rehabilitation/secondary prevention programs: 1996 to 2006. J Cardiopulm Rehabil Prev 2008; 28 (5): 299–306.
5. van Domburg RT, Reimer WS, Hoeks SE et al. Three life-years gained from smoking cessation after coronary artery bypass surgery: a 30-year follow-up study. Am Heart J 2008; 156 (3): 473–6.
6. Afilalo J, Duque G, Steele R et al. Statins for secondary prevention in elderly patients: a hierarchical bayesian meta-analysis. JACC 2008; 51 (1): 37–45.
7. Rahilly-Tierney CR, Lawler EV, Scranton RE, Gaziano JM. Cardiovascular benefit of magnitude of low-density lipoprotein cholesterol reduction: a comparison of subgroups by age. Circulation 2009; 120 (15): 1491–7.
8. Gränsbo K, Melander O, Wallentin L et al. Cardiovascular and cancer mortality in very elderly post-myocardial infarction patients receiving statin treatment. JACC 2010; 55 (13): 1362–9.
9. Beckett NS, Peters R, Fletcher AE et al. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358 (18): 1887–98.
10. Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med 2007; 120 (9): 799–806.
11. Suaya JA, Stason WB, Ades PA et al. Cardiac rehabilitation and survival in older coronary patients. JACC 2009; 54 (1): 25–33.
12. Onishi T, Shimada K, Sato H et al. Effects of phase III cardiac rehabilitation on mortality and cardiovascular events in elderly patients with stable coronary artery disease. Circ J 2010; 74 (4): 709–14.
13. Mezzani A, Agostoni P, Cohen-Solal A et al. Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2009; 16 (3): 249–67.
14. De Feo S, Tramarin R, Lorusso R, Faggiano P. Six-minute walking test after cardiac surgery: instructions for an appropriate use. Eur J Cardiovasc Prev Rehabil 2009; 16 (2): 144–9.
15. Fleg JL, Morrell CH, Bos AG et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 2005; 112 (5): 674–82.
16. Hollmann W, Struder HK, Tagarakis CV, King G. Physical activity and the elderly. Eur J Cardiovasc Prev Rehabil 2007; 14 (6): 730–9.
17. Audelin MC, Savage PD, Ades P.A. Exercise-based cardiac rehabilitation for very old patients (> or =75 years): focus on physical function. J Cardiopulm Rehabil Prev 2008; 28 (3): 163–73.
18. Werner C, Furster T, Widmann T et al. Physical exercise prevents cellular senescence in circulating leukocytes and in the vessel wall. Circulation 2009; 120 (24): 2438–47.
19. Albinet CT, Boucard G, Bouquet CA, Audiffren M. Increased heart rate variability and executive performance after aerobic training in the elderly. Eur J Appl Physiol 2010; 109 (4): 617–24.
20. Eder B, Hofmann P, von Duvillard SP et al. Early 4-week cardiac rehabilitation exercise training in elderly patients after heart surgery. J Cardiopulm Rehabil Prev 2010; 30 (2): 85–92.
21. Jünger C, Rauch B, Schneider S et al. Effect of early short-term cardiac rehabilitation after acute ST-elevation and non-ST-elevation myocardial infarction on 1-year mortality. Curr Med Res Opin 2010; 26 (4): 803–11.
22. Сыркин А.Л., Полтавская М.Г., Свет А.В. и др. Интервальные тренировки у больных с хронической сердечной недостаточностью. Кардиология. 2008; 48 (7): 65–71.
23. Konopka AR, Douglass MD, Kaminsky LA et al. Molecular Adaptations to Aerobic Exercise Training in Skeletal Muscle of Older Women. J Gerontol A Biol Sci Med Sci 2010; 65 (11): 1201–7.
24. Jones TE, Stephenson KW, King JG et al. Sarcopenia – mechanisms and treatments. J Geriatr Phys Ther 2009; 32 (2): 39–45.
25. Misic MM, Valentine RJ, Rosengren KS et al. Impact of training modality on strength and physical function in older adults. Gerontology 2009; 55 (4): 411–6.
26. Сумин А.Н. Физические тренировки с использованием электростимуляции скелетных мышц в кардиологии. Кардиология. 2010; 3: 83–90.
27. Sbruzzi G, Ribeiro RA, Schaan BD et al. Functional electrical stimulation in the treatment of patients with chronic heart failure: a meta-analysis of randomized controlled trials. Eur J Cardiovasc Prev Rehabil 2010; 17 (3): 254–60.
28. Fritzsche D, Fruend A, Schenk S et al. Electromyostimulation (EMS) in cardiac patients. Will EMS training be helpful in secondary prevention? Herz 2010; 35 (1): 34–40.
29. Karavidas A, Parissis JT, Matzaraki V et al. Functional electrical stimulation is more effective in severe symptomatic heart failure patients and improves their adherence to rehabilitation programs. J Card Fail 2010; 16 (3): 244–9.
30. Сумин А.Н., Безденежных А.В., Байдина О.М. и др. ПАссивные ТРенировки при Инфаркте миокАРда у пожилыХ (Исследование ПАТРИАРХ): влияние на внутрисердечную гемодинамику и аритмогенный статус. Кардиоваск. тер. и профилакт. 2010; 3: 29–37.
31. Fruend A, Fritzsche D, Cadus M et al. Electromyostimulation and its influence on maximum oxygen consumtion in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil 2010; 17 (Suppl. 2): S24.
32. Maggioni MA, Ce E, Rampichini S et al. Electrical stimulation versus kinesitherapy in improving functional fitness in older women: a randomized controlled trial. Arch Gerontol Geriatr 2010; 50 (3): e19–25.
33. Carvalho VO, Roque JM, Xavier R et al. Hemodynamic response to one session of strength exercise with and without electrostimulation in heart failure patients: A randomized controlled trial. Eur J Cardiovasc Prev Rehabil 2010; 17 (Suppl. 2): S22.
34. Crognale D, Crowe L, Devito G et al. Neuro-muscular electrical stimulation training enhances maximal aerobic capacity in healthy physically active adults. Conf Proc IEEE Eng Med Biol Soc 2009; 2009: 2137–40.
35. Caminiti G, Volterrani M, Arisi A et al. Tai chi added to endurance training vs endurance training alone in elderly patients with chronic heart failure: a randomized pilot study. Eur J Cardiovasc Prev Rehabil 2010; 17 (Suppl. 2): S87.
36. Caminiti G, Volterrani M, Marazzi G et al. Hydrotherapy added to endurance training versus endurance training alone in elderly patients with chronic heart failure: A randomized pilot study. Int J Cardiol 2009 (Epub ahead of print).
37. Buurman BM, Parlevliet JL, van Deelen BA et al. A randomised clinical trial on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: the Transitional Care Bridge. BMC Health Serv Res 2010; 10: 296.
38. Opasich C, Patrignani A, Mazza A et al. An elderly-centered, personalized, physiotherapy program early after cardiac surgery. Eur J Cardiovasc Prev Rehabil 2010; 17 (5): 582–7.
39. Isaac V, Stewart R, Artero S et al. Social activity and improvement in depressive symptoms in older people: a prospective community cohort study. Am J Geriatr Psychiatry 2009; 17 (8): 688–96.
40. Hammill BG, Curtis LH, Schulman KA, Whellan DJ. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation 2010; 121 (1): 63–70.
41. Davidson KW, Mostofsky E, Whang W. Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey. Eur Heart J 2010; 31 (9): 1065–70.
42. Ferri C.P, Prince M, Brayne C et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366 (9503): 2112–7.
43. Kivipelto M, Rovio S, Ngandu T et al. Apolipoprotein E epsilon4 magnifies lifestyle risks for dementia: a population-based study. J Cell Mol Med 2008; 12 (6B): 2762–71.
44. Rovio S, Kåreholt I, Viitanen M et al. Work-related physical activity and the risk of dementia and Alzheimer's disease. Int J Geriatr Psychiatry 2007; 22 (9): 874–82.
45. Singh-Manoux A, Hillsdon M, Brunner E, Marmot M. Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study. Am J Public Health 2005; 95 (12): 2252–8.
46. Abbott RD, White LR, Ross GW et al. Walking and dementia in physically capable elderly men. JAMA 2004; 292 (12): 1447–53.
47. Larson EB, Wang L, Bowen JD et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med 2006; 144 (2): 73–81.
48. Podewils LJ, Guallar E, Kuller LH et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol 2005; 161 (7): 639–51.
49. Taaffe DR, Irie F, Masaki K.H et al. Physical activity, physical function, and incident dementia in elderly men: the Honolulu-Asia Aging Study. J Gerontol A Biol Sci Med Sci 2008; 63 (5): 529–35.
50. Weuve J, Kang JH, Manson JE et al. Physical activity, including walking, and cognitive function in older women. JAMA 2004; 292 (12): 1454–61.
51. Scarmeas N, Luchsinger JA, Brickman AM et al. Physical Activity and Alzheimer Disease Course. Am J Geriatr Psychiatry 2010 (Epub ahead of print).
52. Lautenschlager NT, Cox KL, Flicker L et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008; 300 (9): 1027–37.
53. Williamson JD, Espeland M, Kritchevsky SB et al. LIFE Study Investigators. Changes in cognitive function in a randomized trial of physical activity: results of the lifestyle interventions and independence for elders pilot study. J Gerontol A Biol Sci Med Sci 2009; 64 (6): 688–94.
54. Baker LD, Frank LL, Foster-Schubert K et al. Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Arch Neurol 2010; 67 (1): 71–9.
55. Smith PJ, Blumenthal JA, Hoffman BM et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 2010; 72 (3): 239–52.
56. Hernandez SS, Coelho FG, Gobbi S, Stella F. Effects of physical activity on cognitive functions, balance and risk of falls in elderly patients with Alzheimer's dementia. Rev Bras Fisioter 2010; 14 (1): 68–74.
57. Cerga-Pashoja A, Lowery D, Bhattacharya R et al. Evaluation of exercise on individuals with dementia and their carers: a randomised controlled trial. Trials 2010; 11: 53.
58. Banda JA, Hutto B, Feeney A et al. Comparing Physical Activity Measures in a Diverse Group of Midlife and Older Adults. Med Sci Sports Exerc 2010; 42 (12): 2251–7.
Авторы
А.Н.Сумин*, О.Л.Барбараш
УРАМН Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово
*sumian@cardio.kem.ru
URAMS Scientific Research Institute for complex studying of cardiovascular diseases SB RAMS, Kemerovo
*sumian@cardio.kem.ru
УРАМН Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово
*sumian@cardio.kem.ru
________________________________________________
URAMS Scientific Research Institute for complex studying of cardiovascular diseases SB RAMS, Kemerovo
*sumian@cardio.kem.ru
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