Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Features of Risk Stratification, Diagnosis and Secondary Prevention in Patients with Multifocal Arterial Disease. Part 1: Risk Stratification and Diagnosis

https://doi.org/10.20996/1819-6446-2021-02-10

Full Text:

Abstract

Multifocal arterial disease is common in patients with atherosclerotic cardiovascular disease and is associated with an increased risk of cardiovascular complications and death. The possibility of improving the prognosis of patients with multifocal arterial disease is associated with a more efficient diagnosis of both the underlying disease and obstructive atherosclerotic lesions of other localizations and with a more intensive secondary prevention. According to observational studies, the presence of significant stenoses of the carotid arteries and, especially, lower extremities arterial disease can be predictorы of similar lesions in other vascular beds and their detection with screening methods available in clinical practice allows improvement of the diagnosis in patients with suspected coronary artery disease. On the other hand, screening of lower extremities artery diseases in patients with acute coronary syndrome can clarify indications for the use of invasive diagnostic and treatment strategy, in patients with chronic coronary artery disease it can justify more aggressive approaches to secondary prevention.

About the Authors

V. G. Grachev
Urals State Medical University
Russian Federation

Vadim G. Grachev

Yekaterinburg

eLibrary SPIN 3097-0735



S. S. Vedenskaya
Urals State Medical University
Russian Federation

Svetlana S. Vedenskaya

Yekaterinburg

eLibrary SPIN 5248-9958



O. G. Smolenskaya
Urals State Medical University
Russian Federation

Olga G. Smolenskaya

Yekaterinburg

eLibrary SPIN 5443-9382



References

1. Bonaca M.P. Polyvascular disease and risk: When two is not better than one. Vasc Med. 2018;23(6):531-533. DOI:10.1177/1358863X18796936.

2. Desormais I., Vlachopoulos C., Aboyans V. Panvascular disease - epidemiology and prevention. Cor et Vasa. 2018;60(1):e3-e8. DOI:10.1016/j.crvasa.2017.12.004.

3. Aboyans V., Ricco J.B., Bartelink M.E.L., et al. ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816. DOI:10.1093/eurheartj/ehx095.

4. Akberov R.F., Sharafeev A.Z., Mikhaylov M.K., et al. Progressive multifocal atherosclerosis: etiology, clinical and radiological diagnostics, modern treatment strategies. Kazan: Idel-Press; 2008 (In Russ.)

5. Barbarash O.L., Kashtalap V.V. Diagnosis of latent forms of non-coronary atherosclerosis in acute coronary syndrome patients. Is there any practical sense? Complex Issues of Cardiovascular Diseases. 2012;(1):12-6 (In Russ.) DOI:10.17802/2306-1278-2012-1-12-16.

6. Bhatt D.L., Steg P.G., Ohman E.M., et al. REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006;295(2):180-9. DOI:10.1001/jama.295.2.180.

7. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE SteeringCommittee. Lancet. 1996;348(9038):1329-39. DOI:10.1016/s0140-6736(96)09457-3.

8. Bhatt D.L., Peterson E.D., Harrington R.A., et al. CRUSADE Investigators. Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes. Eur Heart J. 2009;30(10):1195-202. DOI:10.1093/eurheartj/ehp099.

9. Subherwal S., Bhatt D.L., Li S., et al. Polyvascular disease and long-term cardiovascular outcomes in older patients with non-ST-segment-elevation myocardial infarction. Circ Cardiovasc Qual Outcomes. 2012;5(4):541-9. DOI:10.1161/CIRCOUTCOMES.111.964379.

10. Vagnarelli F., Corsini A., Lorenzini M., et al. Long-term prognostic role of cerebrovascular disease and peripheral arterial disease across the spectrum of acute coronary syndromes. Atherosclerosis. 2016;245:43-9. DOI:10.1016/j.atherosclerosis.2015.11.014.

11. Heldner M.R, Li L., Lovett N.G., et al. Oxford Vascular Study. Long-Term Prognosis of Patients With Transient Ischemic Attack or Stroke and Symptomatic Vascular Disease in Multiple Arterial Beds. Stroke. 2018;49(7):1639-1646. DOI:10.1161/STROKEAHA.118.020913.

12. Gutierrez J.A., Mulder H., Jones WS., et al. Polyvascular Disease and Risk of Major Adverse Cardiovascular Events in Peripheral Artery Disease: A Secondary Analysis of the EUCLID Trial. JAMA Netw Open. 2018;1(7):e185239. DOI:10.1001/jamanetworkopen.2018.5239.

13. van Kuijk J.P., Flu W.J., Welten G.M., et al. Long-term prognosis of patients with peripheral arterial disease with or without polyvascular atherosclerotic disease. Eur Heart J. 2010;31(8):992-9. DOI:10.1093/eurheartj/ehp553.

14. Steg P.G., Bhatt D.L., Wilson P.W., et al. REACH Registry Investigators. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007;297(11):1197-206. DOI:10.1001/jama.297.11.1197.

15. Alberts M.J., Bhatt D.L., Mas J.L., et al. REduction of Atherothrombosis for Continued Health (REACH) Registry Investigators. Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry. Eur Heart J. 2009;30:2318-26. DOI:10.1093/eurheartj/ehp355.

16. Bhatt D.L., Eagle K.A., Ohman E.M., et al. REACH Registry Investigators. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010;304(12):1350-7. DOI:10.1001/jama.2010.1322.

17. Hirsh J., Bhatt D.L. Comparative benefits of clopidogrel and aspirin in high-risk patient populations: lessons from the CAPRIE and CURE studies. Arch Intern Med. 2004;164(19):2106-10. DOI:10.1001/archinte.164.19.2106.

18. Mukherjee D., Eagle KA., Kline-Rogers E., et al. GRACE Investigators. Impact of prior peripheral arterial disease and stroke on outcomes of acute coronary syndromes and effect of evidence-based therapies (from the Global Registry of Acute Coronary Events). Am J Cardiol. 2007;100(1):1-6. DOI:10.1016/j.amjcard.2007.02.046.

19. Ferreira-González I., Permanyer Miralda G., Heras M., et al. Investigadores del Estudio MASCARA. Prognosis and management of patients with acute coronary syndrome and polyvascular disease. Rev Esp Cardiol. 2009;62(9):1012-21. DOI:10.1016/s1885-5857(09)73267-0.

20. Attar R., Wester A., Koul S., et al. Peripheral artery disease and outcomes in patients with acute myocardial infarction. Open Heart. 2019;6(1):e001004. DOI:10.1136/openhrt-2018-001004.

21. Collet J.P., Cayla G., Ennezat P.V., et al. AMERICA Investigators. Systematic detection of polyvascular disease combined with aggressive secondary prevention in patients presenting with severe coronary artery disease: The randomized AMERICA Study. Int J Cardiol. 2018;254:36-42. DOI:10.1016/j.ijcard.2017.11.081.

22. Knuuti J., Wijns W., Saraste A., et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407-77. DOI:org/10.1093/eurheartj/ehz425.

23. Gallino A., Aboyans V., Diehm C., et al. European Society of Cardiology Working Group on Peripheral Circulation. Non-coronary atherosclerosis. Eur Heart J. 2014;35(17):1112-9. DOI:10.1093/eurheartj/ehu071.

24. Hertzer N.R., Beven E.G., Young J., et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. AnnSurg. 1984;199(2):223-33. DOI:10.1097/00000658-198402000-00016.

25. Duran N.E., Duran I., Gürel E. et al. Coronary artery disease in patients with peripheral artery disease. Heart Lung. 2010;39(2):116-20. DOI:10.1016/j.hrtlng.2009.07.004.

26. Hur D.J., Kizilgul M., Aung W.W., et al. Frequency of coronary artery disease in patients undergoing peripheral artery disease surgery. Am J Cardiol. 2012;110(5):736-40. DOI:10.1016/j.amjcard.2012.04.059.

27. Gutierrez J.A., Bhatt D.L., Banerjee S., et al. Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program. Am Heart J. 2019;213:47-56. DOI:10.1016/j.ahj.2019.04.004.

28. Her K., Choi C., Park Y. Concomitant peripheral artery disease and asymptomatic coronary artery disease: a management strategy. Ann Vasc Surg. 2008;22(5):649-56. DOI:10.1016/j.avsg.2008.01.010.

29. Khandelwal A., Kondo T., Amanuma M., et al. Single injection protocol for coronary and lower extremity CT angiographies in patients suspected for peripheral arterial disease. Medicine (Baltimore). 2016;95(46):e5410. DOI:10.1097/MD.0000000000005410.

30. Krievins D., Zellans E., Erglis A., et al. High prevalence of asymptomatic ischemia-producing coronary stenosis in patients with critical limb ischemia: anatomic and functional assessment with coronary CT-derived fractional flow reserve (FFRCT). Vasc Dis Manag. 2018;15(9):E96-E101.

31. Touzé E., Varenne O., Chatellier G., et al. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005;36(12):2748-55. DOI:10.1161/01.STR.0000190118.02275.33.

32. Mohan K.M., Wolfe C.D., Rudd A.G., et al. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011;42(5):1489-94. DOI:10.1161/STROKEAHA.110.602615.

33. Boulanger M., Béjot Y., Rothwell P.M., et al. Long-Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and MetaAnalysis. J Am Heart Assoc. 2018;7(2):e007267. DOI:10.1161/JAHA.117.007267.

34. Kelly P.J., Crispino G., Sheehan O., et al. Incidence, event rates, and early outcome of stroke in Dublin, Ireland: the North Dublin population stroke study. Stroke. 2012;43(8):2042-7. DOI:10.1161/STROKEAHA.111.645721.

35. Rothwell P.M., Coull A.J., Giles M.F., et al. Oxford Vascular Study. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet. 2004;363(9425):1925-33. DOI:10.1016/S0140-6736(04)16405-2.

36. Venketasubramanian N., Röther J., Bhatt D.L., et al. REACH Investigators. Two-year vascular event rates in patients with symptomatic cerebrovascular disease: the REACH registry. Cerebrovasc Dis. 2011;32(3):254-60. DOI:10.1159/000328650.

37. Adams R.J., Chimowitz M.I., Alpert J.S., et al. American Heart Association/American Stroke Association. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Stroke. 2003;34(9):2310-22. DOI:10.1161/01.STR.0000090125.28466.E2.

38. Amarenco P., Lavallée P.C., Labreuche J., et al. Prevalence of coronary atherosclerosis in patients with cerebral infarction. Stroke. 2011;42(1):22-9. DOI:10.1161/STROKEAHA.110.584086.

39. Hoshino A., Nakamura T., Enomoto S., et al. Clinical utility of evaluating intracranial artery stenosis and silent brain infarction to predict the presence of subclinical coronary artery disease in ischemic stroke patients. Intern Med. 2008;47(20):1775-81. DOI:10.2169/internalmedicine.47.1314.

40. Seo W.K., Yong H.S., Koh S.B., et al. Correlation of coronary artery atherosclerosis with atherosclerosis of the intracranial cerebral artery and the extracranial carotid artery. Eur Neurol. 2008;59(6):292- 8. DOI:10.1159/000121418.

41. Calvet D., Touzé E., Varenne O., et al. Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study. Circulation. 2010;121(14):1623-9. DOI:10.1161/CIRCULATIONAHA.109.906958.

42. Cho H.J., Lee J.H., Kim Y.J., et al. Comprehensive evaluation of coronary artery disease and aortic atherosclerosis in acute ischemic stroke patients: usefulness based on Framingham risk score and stroke subtype. Cerebrovasc Dis. 2011;31(6):592-600. DOI:10.1159/000326075.

43. Yoon Y.E., Chang H.J., Cho I., et al. Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. Int J Cardiovasc Imaging. 2011;27(7):1035-44. DOI:10.1007/s10554-010-9743-8.

44. Kim S.J., Choe Y.H., Park S.J., et al. Routine cardiac evaluation in patients with ischaemic stroke and absence of known atrial fibrillation or coronary heart disease: transthoracic echocardiography vs. multidetector cardiac computed tomography. Eur J Neurol. 2012;19(2):317-23. DOI:10.1111/j.1468-1331.2011.03505.x.

45. Ahn S.S., Nam H.S., Heo J.H., et al. Ischemic stroke: measurement of intracranial artery calcifications can improve prediction of asymptomatic coronary artery disease. Radiology. 2013;268(3):842-9. DOI:10.1148/radiol.13122417.

46. Cha M.J., Lee H.S., Kim Y.D., et al. The association between asymptomatic coronary artery disease and CHADS2 and CHA2DS2-VASc scores in patients with stroke. Eur J Neurol. 2013;20(9):1256- 63. DOI:10.1111/ene.12158.

47. Chimowitz M.I., Poole R.M., Starling MR., et al. Frequency and severity of asymptomatic coronary disease in patients with different causes of stroke. Stroke. 1997;28(5):941-5. DOI:10.1161/01.str.28.5.941.

48. Okin P.M., Roman M.J., Schwartz J.E., et al. Relation of exercise-induced myocardial ischemia to cardiac and carotid structure. Hypertension. 1997;30(6):1382-8. DOI:10.1161/01.hyp.30.6.1382.

49. Hofmann R., Kypta A., Steinwender C., et al. Coronary angiography in patients undergoing carotid artery stenting shows a high incidence of significant coronary artery disease. Heart. 2005;91(11):1438-41. DOI:10.1136/hrt.2004.050906.

50. Chimowitz M.I., Weiss D.G., Cohen S.L., et al. Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167. Stroke. 1994;25(4):759-65. DOI:10.1161/01.str.25.4.759.

51. Giannopoulos A., Kakkos S., Abbott A., et al. Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin Therapy. Eur J VascEndovasc Surg. 2015;50(5):573-82. DOI:10.1016/j.ejvs.2015.06.115.

52. Illuminati G., Ricco J.B., Greco C., et al. Systematic preoperative coronary angiography and stenting improves postoperative results of carotid endarterectomy in patients with asymptomatic coronary artery disease: a randomised controlled trial. Eur J Vasc Endovasc Surg. 2010;39(2):139-45. DOI:10.1016/j.ejvs.2009.11.015.

53. Illuminati G., Schneider F., Greco C., et al. Long-term results of a randomized controlled trial analyzing the role of systematic pre-operative coronary angiography before elective carotid endarterectomy in patients with asymptomatic coronary artery disease. Eur J VascEndovasc Surg. 2015;49(4):366-74. DOI:10.1016/j.ejvs.2014.12.030.

54. Aboyans V., Lacroix P. Indications for carotid screening in patients with coronary artery disease. Presse Med. 2009;38(6):977-86. DOI:10.1016/j.lpm.2009.02.015.

55. Lin J.C., Kabbani L.S., Peterson E.L., et al. Clinical utility of carotid duplex ultrasound prior to cardiac surgery. J Vasc Surg. 2016;63(3):710-4. DOI:10.1016/j.jvs.2015.10.008.

56. Steinvil A., Sadeh B., Arbel Y., et al. Prevalence and predictors of concomitant carotid and coronary artery atherosclerotic disease. J Am Coll Cardiol. 2011;57(7):779-83. DOI:10.1016/j.jacc.2010.09.047.

57. Hirsch A.T., Criqui M.H., Treat-Jacobson D., et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317-24. DOI:10.1001/jama.286.11.1317.

58. Diehm C., Schuster A., Allenberg J.R., et al. High prevalence of peripheral arterial disease and comorbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004;172(1):95- 105. DOI:10.1016/s0021-9150(03)00204-1.

59. RACVS/RSAVS/RSS/RSC/RAE. National Guidelines on the Diagnosis and Treatment of Lower limb arterial disease (2019) [cited by Jan 20, 2021]. Available from: http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (In Russ.)

60. Fowkes F.G., Murray G.D., et al., Ankle Brachial Index Collaboration. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008;300(2):197-208. DOI:10.1001/jama.300.2.197.

61. Hajibandeh S., Hajibandeh S., Shah S., et al. Prognostic significance of ankle brachial pressure index: A systematic review and meta-analysis. Vascular. 2017;25(2):208-24. DOI:10.1177/1708538116658392.

62. Banerjee A., Fowkes F.G., Rothwell P.M. Associations between peripheral artery disease and ischemic stroke: implications for primary and secondary prevention. Stroke. 2010;41(9):2102-7. DOI:10.1161/STROKEAHA.110.582627.

63. Agnelli G., Cimminiello C., Meneghetti G., et al. Polyvascular Atherothrombosis Observational Survey (PATHOS) Investigators. Low ankle-brachial index predicts an adverse 1-year outcome after acute coronary and cerebrovascular events. J Thromb Haemost. 2006;4(12):2599-606. DOI:10.1111/j.1538-7836.2006.02225.x.

64. Serena J., Segura T., Roquer J., et al. ARTICO Study. The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke. BMC Neurol. 2015;15:28. DOI:10.1186/s12883-015-0278-4.

65. Hong J.B., Leonards C.O., Endres M., et al. Ankle-Brachial Index and Recurrent Stroke Risk: MetaAnalysis. Stroke. 2016;47(2):317-22. DOI:10.1161/STROKEAHA.115.011321.

66. Meizels A., Zeitoun D.M., Bataille V., et al. ALLIANCE investigators on behalf of the working group on Epidemiology of the French Society of Cardiology. Impact of polyvascular disease on baseline characteristics, management and mortality in acute myocardial infarction. The Alliance project. Arch Cardiovasc Dis. 2010;103(4):207-14. DOI:10.1016/j.acvd.2010.02.002.

67. Bonaca M.P., Bhatt D.L., Storey R.F., et al. Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease. J Am Coll Cardiol. 2016;67(23):2719-28. DOI:10.1016/j.jacc.2016.03.524.

68. Bonaca M.P., Gutierrez J.A., Cannon C., et al. Polyvascular disease, type 2 diabetes, and long-term vascular risk: a secondary analysis of the IMPROVE-IT trial. Lancet Diabetes Endocrinol. 2018;6(12):934-43. DOI:10.1016/S2213-8587(18)30290-0.

69. Jönelid B., Johnston N., Berglund L., et al. Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction. Eur J Intern Med. 2016;30:55-60. DOI:10.1016/j.ejim.2015.12.016.

70. Kownator S., Cambou J.P., Cacoub P., et al. Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: data in primary care from the IPSILON study. Arch Cardiovasc Dis. 2009;102(8-9):625-31. DOI:10.1016/j.acvd.2009.05.004.

71. Lee J.Y., Lee S.W., Lee W.S., et al. Prevalence and clinical implications of newly revealed, asymptomatic abnormal ankle-brachial index in patients with significant coronary artery disease. JACC Cardiovasc Interv. 2013;6(12):1303-13. DOI:10.1016/j.jcin.2013.08.008.

72. Saleh A., Makhamreh H., Qoussoos T., et al. Prevalence of previously unrecognized peripheral arterial disease in patients undergoing coronary angiography. Medicine (Baltimore). 2018;97(29):e11519. DOI:10.1097/MD.0000000000011519.

73. Barbarash O.L., Zykov M.V., Pecherina T.B., et al. The prognostic value of peripheral artery diseases in patients with ST-segment elevation myocardial infarction. Dis Markers. 2013;35(6):877-82. DOI:10.1155/2013/487807.

74. Falcão F.J., Rodrigues Alves C.M., Caixeta A., et al. Relation between the ankle-brachial index and the complexity of coronary artery disease in older patients. Clin Interv Aging. 2013;8:1611-6. DOI:10.2147/CIA.S52778.

75. Sabedotti M., Sarmento-Leite R., Quadros A. Ankle-Brachial Index as a Predictor of Significant Coronary Artery Disease in Patients Undergoing Coronary Angiography. Rev Bras Cardiol Invasiva. 2014;22(4):359-63. DOI:10.1590/0104-1843000000060.

76. Sadeghi M., Heidari R., Mostanfar B., et al. The Relation Between Ankle-Brachial Index (ABI) and Coronary Artery Disease Severity and Risk Factors: An Angiographic Study. ARYA Atheroscler. 2011;7(2):68-73. PMID: 22577449.

77. Korkmaz L., Adar A., Erkan H., et al. Ankle-brachial index and coronary artery lesion complexity in patients with acute coronary syndromes. Angiology. 2012;63(7):495-9. DOI:10.1177/0003319711429561.

78. Amer M.S., Tawfik H.M., Elmoteleb A.M., et al. Correlation between ankle brachial index and coronary artery disease severity in elderly Egyptians. Angiology. 2014;65(10):891-5. DOI:10.1177/0003319713510594.

79. Bryniarski K.L., Tokarek T., Bryk T., et al. Intima-media thickness and ankle-brachial index are correlated with the extent of coronary artery disease measured by the SYNTAX score. Postepy Kardiol Interwencyjnej. 2018;14(1):52-8. DOI:10.5114/aic.2018.74355.

80. Sebastianski M., Narasimhan S., Graham MM., et al. Usefulness of the ankle-brachial index to predict high coronary SYNTAX scores, myocardium at risk, and incomplete coronary revascularization. Am J Cardiol. 2014;114(11):1745-9. DOI:10.1016/j.amjcard.2014.09.010.


For citation:


Grachev V.G., Vedenskaya S.S., Smolenskaya O.G. Features of Risk Stratification, Diagnosis and Secondary Prevention in Patients with Multifocal Arterial Disease. Part 1: Risk Stratification and Diagnosis. Rational Pharmacotherapy in Cardiology. 2021;17(1):83-91. (In Russ.) https://doi.org/10.20996/1819-6446-2021-02-10

Views: 153


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)