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Консенсус экспертов Российского медицинского общества по артериальной гипертонии (РМОАГ) по применению радиочастотной денервации почечных артерий у пациентов с артериальной гипертонией
Консенсус экспертов Российского медицинского общества по артериальной гипертонии (РМОАГ) по применению радиочастотной денервации почечных артерий у пациентов с артериальной гипертонией
Данилов Н.М., Агаева Р.А., Матчин Ю.Г. и др. Консенсус экспертов Российского медицинского общества по артериальной гипертонии (РМОАГ) по применению радиочастотной денервации почечных артерий у пациентов с артериальной гипертонией. Системные гипертензии. 2020; 17 (4): 7–18. DOI: 10.26442/2075082X.2020.4.200398
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Аннотация
Симпатическая гиперактивность нервной системы является одним из основных механизмов в развитии артериальной гипертонии. Транскатетерная денервация почечных артерий предназначена для разрушения почечных симпатических афферентных и эфферентных нервов для достижения устойчивого снижения артериального давления. Начиная с 2017 г. все исследования с применением устройств II поколения продемонстрировали, что ренальная денервация (РДН) обеспечивает клинически значимое снижение артериального давления. Эксперты Российского медицинского общества по артериальной гипертонии (РМОАГ) рассматривают РДН как возможное дополнение к антигипертензивной стратегии у пациентов с неконтролируемой артериальной гипертонией и рекомендуют проведение денервации почечных артерий в рамках регистров и клинических исследований. На основании существующих рандомизированных клинических исследований, а также опыта проведения РДН в России эксперты РМОАГ представляют консенсус и взгляд на современную ситуацию в области РДН.
Ключевые слова: артериальная гипертония, радиочастотные устройства, ренальная денервация, антигипертензивная терапия.
Key words: arterial hypertension, radiofrequency devices, renal denervation, antihypertensive therapy.
Ключевые слова: артериальная гипертония, радиочастотные устройства, ренальная денервация, антигипертензивная терапия.
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Key words: arterial hypertension, radiofrequency devices, renal denervation, antihypertensive therapy.
Полный текст
Список литературы
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4. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021–104.
5. Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension 2011; 57: 911–7.
6. Symplicity HTNI, Esler MD, Krum H et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (the symplicity htn-2 trial): a randomised controlled trial. Lancet 2010; 376: 1903–9.
7. Bhatt DL, Kandzari DE, O’Neill WW et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370: 1393–401. DOI: 10.1056/NEJMoa1402670
8. Townsend RR, Mahfoud F, Kandzari DE et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet 2017; 390: 2160–70.
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10. Azizi M, Schmieder RE, Mahfoud F et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet 2018; 391: 2335–45.
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17. Guyenet PG. The sympathetic control of blood pressure. Nat Rev Neurosci 2006; 7: 335–46.
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19. Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension: results in 1.266 cases. JAMA 1953; 152: 1501–4.
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40. Агаева Р.А., Данилов Н.М., Щелкова Г.В. и др. Радиочастотная денервация почечных артерий моноэлектродным и мультиэлектродным устройствами у пациентов с неконтролируемой артериальной гипертонией: результаты 6-месячного наблюдения Системные гипертензии. 2020; 17 (1): 46–50. DOI: 10.26442/2075082X.2020.1.200077
[Agaeva R.A., Danilov N.M., Shchcelkova G.V. et al. Radiofrequency renal denervation with mono-electrode and multi-electrode device for treatment in patient with uncontrolled hypertension: results of a 6-month follow-up. Systemic Hypertension. 2020; 17 (1): 46–50. DOI: 10.26442/2075082X.2020.1.200077 (in Russian).]
41. Pekarskiy SE, Baev AE, Mordovin VF et al. Denervation of the distal renal arterial branches vs. conventional main renal artery treatment: a randomized controlled trial for treatment of resistant hypertension. J Hypertens 2017; 35: 369–75.
42. Pekarskiy S, Baev A, Mordovin V et al. First-in-man experience of distal renal denervation in segmental branches of renal artery using multi-electrode balloon device. J Hypertens 2018; 6 (36): e167.
43. Böhm M, Mahfoud F, Townsend RR et al. Ambulatory heart rate reduction after catheter-based renal denervation in hypertensive patients not receiving anti-hypertensive medications: data from SPYRAL HTN- OFF MED, a randomized, sham-controlled, proof-of-concept trial. Eur Heart J 2019; 40: 743–51. DOI: 10.1093/eurheartj/ehy871
44. Kario K, Bhatt DL, Kandzari DE et al. Impact of renal denervation on patients with obstructive sleep apnea and resistant hypertension-insights from the symplicity HTN-3 trial. Circ J 2016; 80: 1404–12.
45. Warchol-Celinska E, Prejbisz A, Kadziela J et al. Renal denervation in resistant hypertension and obstructive sleep apnea: randomized proof-of-concept phase II trial. Hypertension 2018; 72: 381–90.
46. Pedrosa RP, Drager LF, Gonzaga CC et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension 2011; 58: 811–7.
47. Muxfeldt ES, Margallo VS, Guimaraes GM, Salles G2. Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension. Am J Hypertens 2014; 27: 1069–78.
48. Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how to screen? Eur Heart J 2014; 35: 1245–54.
49. Linz D, Mancia G, Mahfoud F et al. Renal artery denervation for treatment of patients with self-reported obstructive sleep apnea and resistant hypertension: results from the global SYMPLICITY registry. J Hypertens 2017; 35: 148–53.
50. Logan AG, Perlikowski SM, Mente A et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19: 2271–7.
51. Cooper CJ, Murphy TP, Cutlip DE et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2014; 370: 13–22.
52. Sakakura K, Ladich E, Cheng Q et al. Anatomic assessment of sympathetic peri-arterial renal nerves in man. J Am Coll Cardiol 2014; 64: 635–43.
53. Vink EE, Goldschmeding R, Vink A et al. Limited destruction of renal nerves after catheter-based renal denervation: results of a human case study. Nephrol Dial Transplant 2014; 29: 1608–10.
54. Sanders MF, Blankestijn PJ. Chronic Kidney Disease As a Potential Indication for Renal Denervation. Front Physiol 2016; 7: 220.
55. Rippy MK, Zarins D, Barman NC et al. Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol 2011; 100: 1095–101.
56. Tzafriri AR, Mahfoud F, Keating JH, et al. Innervation patterns may lim it response to endovascular renal denervation. J Am Coll Cardiol 2014;64:1079-87.
57. Mahfoud F, Bhatt DL. Catheter-based renal denervation: the black box procedure. JACC Cardiovasc Interv 2013; 6: 1092–4.
58. Henegar JR, Zhang Y, Hata C et al. Catheter-based radiofrequency renal denervation: location effects on renal norepinephrine. Am J Hypertens 2015; 28: 909–14.
59. Available from: https://clinicaltrials.gov/ct2/show/NCT04311086
60. Bhatt DL. Guide to peripheral and cerebrovascular intervention: remedica; 2004.
61. Hazirolan T, Öz M, Türkbey B et al. CT angiography of the renal arteries and veins: normal anatomy and variants. Diagn Interv Radiol 2011; 17: 67–73.
62. Kawarada O, Yokoi Y, Sakamoto S et al. Impact of aortorenal morphology on renal artery stent procedures: significance of aortic tortuosity and renal artery derivation. J Endovasc Ther 2014; 21: 140–7.
63. Galli M, Tarantino F, Mameli S et al. Transradial approach for renal percutaneous transluminal angioplasty and stenting: a feasibility pilot study. J Invasive Cardiol 2002; 14: 386–90.
64. Alli O, Mathew V, From AM et al. Transradial access for renal artery intervention is feasible and safe. Vasc Endovascular Surg 2011; 45: 738–42.
65. Liu YM, Lin PL, Liao FC et al. Effect of radiofrequency-based renal denervation: the impact of unplanned medication change from a systematic review and meta-analysis. Acta Cardiol Sin 2019; 35: 144–52.
66. Lenski M, Mahfoud F, Razouk A et al. Orthostatic function after renal sympathetic denervation in patients with resistant hypertension. Int J Cardiol 2013; 169: 418–24.
67. Pucci G, Battista F, Lazzari L et al. Progression of renal artery stenosis after renal denervation. Circ J 2014; 78: 767–8.
68. Fink GD, Phelps JT. Can we predict the blood pressure response to renal denervation? Auton Neurosci 2017; 204: 112–8.
69. Persu A, Gordin D, Jacobs L et al. Blood pressure response to renal denervation is correlated with baseline blood pressure variability: a patient-level meta-analysis. J Hypertens 2018; 36: 221–9.
70. Ott C, Schmid A, Toennes SW et al. Central pulse pressure predicts BP reduction after renal denervation in patients with treatment-resistant hypertension. EuroIntervention 2015; 11: 110–6.
71. Peters CD, Mathiassen ON, Vase H et al. The effect of renal denervation on arterial stiffness, central blood pressure and heart rate variability in treatment resistant essential hypertension: a substudy of a randomized sham-controlled doubleblinded trial (the RESET trial). Blood Press 2017; 26: 366–80.
72. Chen W, Du H, Lu J et al. Renal artery vasodilation may be an indicator of successful sympathetic nerve damage during renal denervation procedure. Sci Rep 2016; 6: 37218.
73. Zuern CS, Eick C, Rizas KD et al. Impaired cardiac baroreflex sensitivity predicts response to renal sympathetic denervation in patients with resistant hypertension. J Am Coll Cardiol 2013; 62: 2124–30.
74. Hart EC, McBryde FD, Burchell AE et al. Translational examination of changes in baroreflex function after renal denervation in hypertensive rats and humans. Hypertension 2013; 62: 533–41.
75. Пекарский С.Е., Мордовин В.Ф., Рипп Т.М., Фальковская А.Ю. Ренальная денервация в 2019 году. Сиб. журн. клинической и экспериментальной медицины. 2019; 34 (3): 21–32. DOI: 10.29001/2073-8552-2019-34-3-21-32
[Pekarskiy S.E., Mordovin V.F., Ripp T.M., Falkovskaya A.Yu. Renal denervation in 2019. The Siberian Medical Journal. 2019; 34 (3): 21–32. DOI: 10.29001/2073-8552-2019-34-3-21-32 (in Russian).]
76. Sakaoka A, Terao H, Nakamura S et al. Accurate Depth of Radiofrequency-Induced Lesions in Renal Sympathetic Denervation Based on a Fine Histological Sectioning Approach in a Porcine Model. Circ Cardiovasc Interv 2018; 11: e005779.
77. Pekarskiy S, Baev A, Mordovin V et al. Easy real-time assessment of the procedural success of radiofrequency renal denervation by the impedance drop during energy delivery. Eurointervention 2020; 16 (Suppl. AC): 930. PCR e-Course 2020: 25–7.
78. Singh RR, McArdle ZM, Iudica M et al. Sustained decrease in blood pressure and reduced anatomical and functional reinnervation of renal nerves in hypertensive sheep 30 months after catheter-based renal denervation. Hypertension 2019; 73: 718–27.
79. Doytchinova A, Hassel JL, Yuan Y et al. Simultaneous noninvasive recording of skin sympathetic nerve activity and electrocardiogram. Heart Rhythm 2017; 14: 25–33.
80. Mauriello A, Rovella V, Borri F et al. Hypertension in kidney transplantation is associated with an early renal nerve sprouting. Nephrol Dial Transplant 2017; 32: 1053–60.
81. Kabir RA, Doytchinova A, Liu X et al. Crescendo skin sympathetic nerve activity and ventricular arrhythmia. J Am Coll Cardiol 2017; 70: 3201–2.
82. Booth LC, Nishi EE, Yao ST et al. Reinnervation of renal afferent and efferent nerves at 5.5 and 11 months after catheter-based radiofrequency renal denervation in sheep. Hypertension 2015; 65: 393–400.
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27. Zweiker D, Lambert T, Steinwender C et al. Effects of renal denervation documented in the austrian national multicentre renal denervation registry. PLoS One 2016; 11: e0161250.
28. Volz S, Spaak J, Elf J et al. Renal sympathetic denervation in Sweden: a report from the Swedish registry for renal denervation. J Hypertens 2018; 36: 151–8.
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31. Matchin Iu.G., Grigin V.A., Danilov N.M. et al. Radiochastotnaia denervatsiia pochechnykh arterii v lechenii refrakternoi arterial'noi gipertonii – rezul'taty godichnogo nabliudeniia. Atmosfera. Novosti kardiologii. 2013; 3: 12–8 (in Russian).
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35. Pokushalov E, Romanov A, Corbucci G et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol 2012; 60: 1163–70.
36. Sitkova E.S., Mordovin V.F., Ripp T.M. et al. Positive effects of renal denervation on left ventricular hypertrophy and subendocardial damage. Arterial Hypertension. 2019; 25 (1): 46–59. DOI: 10.18705/1607-419X-2019-25-1-46-59 (in Russian).
37. Ripp T.M. Narusheniia reaktivnosti arterii: kompleksnye metody otsenki i vozmozhnosti korrektsii, organoprotektivnye effekty simpaticheskoi denervatsii pochek u patsientov s arterial'noi gipertenziei. Avtoref. dis. … d-ra med. nauk. Tomsk, 2017 (in Russian).
38. Falkovskaya A.Yu., Mordovin V.F., Pekarskiy S.E. et al. Renal denervation as a new nephroprotective strategy in diabetic patients with resistant hypertension. The Siberian Journal of Clinical and Experimental Medicine. 2020; 35 (1): 80–92. DOI: 10.29001/2073-8552-2020-35-1-80-92 (in Russian).
39. Agaeva R.A., Danilov N.M., Shchelkova G.V. et al. Primenenie metoda radiochastotnoi denervatsii pochechnykh arterii mul'tielektrodnym bipoliarnym ustroistvom pri refrakternoi arterial'noi gipertonii. Kardiologicheskii vestn. 2017; 2: 76–8 (in Russian).
40. Agaeva R.A., Danilov N.M., Shchcelkova G.V. et al. Radiofrequency renal denervation with mono-electrode and multi-electrode device for treatment in patient with uncontrolled hypertension: results of a 6-month follow-up. Systemic Hypertension. 2020; 17 (1): 46–50. DOI: 10.26442/2075082X.2020.1.200077 (in Russian).
41. Pekarskiy SE, Baev AE, Mordovin VF et al. Denervation of the distal renal arterial branches vs. conventional main renal artery treatment: a randomized controlled trial for treatment of resistant hypertension. J Hypertens 2017; 35: 369–75.
42. Pekarskiy S, Baev A, Mordovin V et al. First-in-man experience of distal renal denervation in segmental branches of renal artery using multi-electrode balloon device. J Hypertens 2018; 6 (36): e167.
43. Böhm M, Mahfoud F, Townsend RR et al. Ambulatory heart rate reduction after catheter-based renal denervation in hypertensive patients not receiving anti-hypertensive medications: data from SPYRAL HTN- OFF MED, a randomized, sham-controlled, proof-of-concept trial. Eur Heart J 2019; 40: 743–51. DOI: 10.1093/eurheartj/ehy871
44. Kario K, Bhatt DL, Kandzari DE et al. Impact of renal denervation on patients with obstructive sleep apnea and resistant hypertension-insights from the symplicity HTN-3 trial. Circ J 2016; 80: 1404–12.
45. Warchol-Celinska E, Prejbisz A, Kadziela J et al. Renal denervation in resistant hypertension and obstructive sleep apnea: randomized proof-of-concept phase II trial. Hypertension 2018; 72: 381–90.
46. Pedrosa RP, Drager LF, Gonzaga CC et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension 2011; 58: 811–7.
47. Muxfeldt ES, Margallo VS, Guimaraes GM, Salles G2. Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension. Am J Hypertens 2014; 27: 1069–78.
48. Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how to screen? Eur Heart J 2014; 35: 1245–54.
49. Linz D, Mancia G, Mahfoud F et al. Renal artery denervation for treatment of patients with self-reported obstructive sleep apnea and resistant hypertension: results from the global SYMPLICITY registry. J Hypertens 2017; 35: 148–53.
50. Logan AG, Perlikowski SM, Mente A et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19: 2271–7.
51. Cooper CJ, Murphy TP, Cutlip DE et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2014; 370: 13–22.
52. Sakakura K, Ladich E, Cheng Q et al. Anatomic assessment of sympathetic peri-arterial renal nerves in man. J Am Coll Cardiol 2014; 64: 635–43.
53. Vink EE, Goldschmeding R, Vink A et al. Limited destruction of renal nerves after catheter-based renal denervation: results of a human case study. Nephrol Dial Transplant 2014; 29: 1608–10.
54. Sanders MF, Blankestijn PJ. Chronic Kidney Disease As a Potential Indication for Renal Denervation. Front Physiol 2016; 7: 220.
55. Rippy MK, Zarins D, Barman NC et al. Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol 2011; 100: 1095–101.
56. Tzafriri AR, Mahfoud F, Keating JH, et al. Innervation patterns may lim it response to endovascular renal denervation. J Am Coll Cardiol 2014;64:1079-87.
57. Mahfoud F, Bhatt DL. Catheter-based renal denervation: the black box procedure. JACC Cardiovasc Interv 2013; 6: 1092–4.
58. Henegar JR, Zhang Y, Hata C et al. Catheter-based radiofrequency renal denervation: location effects on renal norepinephrine. Am J Hypertens 2015; 28: 909–14.
59. Available from: https://clinicaltrials.gov/ct2/show/NCT04311086
60. Bhatt DL. Guide to peripheral and cerebrovascular intervention: remedica; 2004.
61. Hazirolan T, Öz M, Türkbey B et al. CT angiography of the renal arteries and veins: normal anatomy and variants. Diagn Interv Radiol 2011; 17: 67–73.
62. Kawarada O, Yokoi Y, Sakamoto S et al. Impact of aortorenal morphology on renal artery stent procedures: significance of aortic tortuosity and renal artery derivation. J Endovasc Ther 2014; 21: 140–7.
63. Galli M, Tarantino F, Mameli S et al. Transradial approach for renal percutaneous transluminal angioplasty and stenting: a feasibility pilot study. J Invasive Cardiol 2002; 14: 386–90.
64. Alli O, Mathew V, From AM et al. Transradial access for renal artery intervention is feasible and safe. Vasc Endovascular Surg 2011; 45: 738–42.
65. Liu YM, Lin PL, Liao FC et al. Effect of radiofrequency-based renal denervation: the impact of unplanned medication change from a systematic review and meta-analysis. Acta Cardiol Sin 2019; 35: 144–52.
66. Lenski M, Mahfoud F, Razouk A et al. Orthostatic function after renal sympathetic denervation in patients with resistant hypertension. Int J Cardiol 2013; 169: 418–24.
67. Pucci G, Battista F, Lazzari L et al. Progression of renal artery stenosis after renal denervation. Circ J 2014; 78: 767–8.
68. Fink GD, Phelps JT. Can we predict the blood pressure response to renal denervation? Auton Neurosci 2017; 204: 112–8.
69. Persu A, Gordin D, Jacobs L et al. Blood pressure response to renal denervation is correlated with baseline blood pressure variability: a patient-level meta-analysis. J Hypertens 2018; 36: 221–9.
70. Ott C, Schmid A, Toennes SW et al. Central pulse pressure predicts BP reduction after renal denervation in patients with treatment-resistant hypertension. EuroIntervention 2015; 11: 110–6.
71. Peters CD, Mathiassen ON, Vase H et al. The effect of renal denervation on arterial stiffness, central blood pressure and heart rate variability in treatment resistant essential hypertension: a substudy of a randomized sham-controlled doubleblinded trial (the RESET trial). Blood Press 2017; 26: 366–80.
72. Chen W, Du H, Lu J et al. Renal artery vasodilation may be an indicator of successful sympathetic nerve damage during renal denervation procedure. Sci Rep 2016; 6: 37218.
73. Zuern CS, Eick C, Rizas KD et al. Impaired cardiac baroreflex sensitivity predicts response to renal sympathetic denervation in patients with resistant hypertension. J Am Coll Cardiol 2013; 62: 2124–30.
74. Hart EC, McBryde FD, Burchell AE et al. Translational examination of changes in baroreflex function after renal denervation in hypertensive rats and humans. Hypertension 2013; 62: 533–41.
75. Pekarskiy S.E., Mordovin V.F., Ripp T.M., Falkovskaya A.Yu. Renal denervation in 2019. The Siberian Medical Journal. 2019; 34 (3): 21–32. DOI: 10.29001/2073-8552-2019-34-3-21-32 (in Russian).
76. Sakaoka A, Terao H, Nakamura S et al. Accurate Depth of Radiofrequency-Induced Lesions in Renal Sympathetic Denervation Based on a Fine Histological Sectioning Approach in a Porcine Model. Circ Cardiovasc Interv 2018; 11: e005779.
77. Pekarskiy S, Baev A, Mordovin V et al. Easy real-time assessment of the procedural success of radiofrequency renal denervation by the impedance drop during energy delivery. Eurointervention 2020; 16 (Suppl. AC): 930. PCR e-Course 2020: 25–7.
78. Singh RR, McArdle ZM, Iudica M et al. Sustained decrease in blood pressure and reduced anatomical and functional reinnervation of renal nerves in hypertensive sheep 30 months after catheter-based renal denervation. Hypertension 2019; 73: 718–27.
79. Doytchinova A, Hassel JL, Yuan Y et al. Simultaneous noninvasive recording of skin sympathetic nerve activity and electrocardiogram. Heart Rhythm 2017; 14: 25–33.
80. Mauriello A, Rovella V, Borri F et al. Hypertension in kidney transplantation is associated with an early renal nerve sprouting. Nephrol Dial Transplant 2017; 32: 1053–60.
81. Kabir RA, Doytchinova A, Liu X et al. Crescendo skin sympathetic nerve activity and ventricular arrhythmia. J Am Coll Cardiol 2017; 70: 3201–2.
82. Booth LC, Nishi EE, Yao ST et al. Reinnervation of renal afferent and efferent nerves at 5.5 and 11 months after catheter-based radiofrequency renal denervation in sheep. Hypertension 2015; 65: 393–400.
Авторы
Н.М. Данилов*1, Р.А. Агаева1, Ю.Г. Матчин1, В.А. Григин1, Г.В. Щелкова1, Т.М. Рипп2,3, С.Е. Пекарский2, А.Е. Баев2, И.Е. Чазова1
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 Научный исследовательский институт кардиологии ФГБУ «Томский национальный исследовательский медицинский центр Российской академии наук», Томск, Россия;
3 ФГБОУ ВО «Сибирский государственный медицинский университет» Минздрава России, Томск, Россия
*ndanilov1@gmail.com
1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia;
3 Siberian State Medical University, Tomsk, Russia
*ndanilov1@gmail.com
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 Научный исследовательский институт кардиологии ФГБУ «Томский национальный исследовательский медицинский центр Российской академии наук», Томск, Россия;
3 ФГБОУ ВО «Сибирский государственный медицинский университет» Минздрава России, Томск, Россия
*ndanilov1@gmail.com
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1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia;
3 Siberian State Medical University, Tomsk, Russia
*ndanilov1@gmail.com
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