FederalStateBudgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases,Kemerovo,RussiaThe article considers the role of modern non-invasive techniques in the diagnosis of coronary heart disease (CHD), in particular multislice computed tomography (MSCT) and myocardial perfusion scintigraphy (MPS), as well as prospects for the use of hybrid technologies such as SPECT / CT and PET / CT. It provides information about indications for use and features of methods, gives research data on the sensitivity and specificity of each technique and about their changes at the hybrid approach.

Purpose. To assess arterial circulation inflow and venous outflow in extra and intracranial vessels in young patients with initially diagnosed hypertension with or without consistent hypertensive therapy in correlation to degree and stage of hypertensive disease (HD).

Materials and methods. We have examined 82 patients (mean age 36,9±1,5), with HD of the 1-st degree, 63,4 % and 2-nd degree – 36,6 %, HD of the 1-st degree – 61 % and 2-nd degree – 39 %. He control group included – 28 healthy patients of the same age and having normal blood pressure. Circulation in extra and intracranial arteries and veins was studied by ultrasound apparatus Logiq 9 (GEHealthcare,USA).

Results. Patients with hypertension disease reliably demonstrated blood flow decrease in carotid and cerebral arteries depending on the degree and stage of HD compared to healthy people with a normal blood pressure. Venous outflow in patients with AH of the 1-st degree and HD of the first stage was increasing objectively in relevance to the patients with AH of the 2-nd degree and HD of the 20nd stage and healthy patients. Later in patients with AH of the 2-nd degree and HD of the 2-nd stage internal jugular vein elasticity decrease was observed accompanied by diminishing of blood stream velocity.

Conclusion. Patients with HD of 1-st and 20-nd stage and AH of 1-st and 2-nd degree demonstrate blood stream autoregulation in extra and intracranial arteries of the brain. Changes in venous outflow in AH and HD of the 1-st degree and stage are compensatory. Severity of AH and HD results in cerebral venous congestion confirmed by ultrasound signs.

Purpose. To study the dynamics of neurophysiological parameters in patients undergoing on-pump coronary artery bypass grafting 1 year follow-up. Materials and methods. Eighty-one patients with coronary artery disease (CAD) aged 47 to 68 years were included. All the patients underwent neuropsychological and electroencephalographic (EEG) study 3–5 days before, 7–10 days and 1 year after on-pump CABG. The cases of early and long-term postoperative cognitive dysfunction (POCD) were defined by arbitrary criterion, such as 20 % parameters decline in 20 % of tests of all neuropsychological test battery. High-resolution monopolar EEG recordings (62 channels) with closed and open eyes were made using encephalograph «NEUVO», Compumedics, USA. Artifact-free EEG fragments were divided into 2-s epochs and underwent Fourier transformation. EEG spectral power in the frequency band of 4–50 Hz were obtained. The data were log-transformed to normalize the distribution. Statistical processing was performed by using the t-test (Statistica 6.0). Results. The incidence of early POCD was 70 %, long-term POCD – 68 %, of which 51 % were patients with early POCD. The increase of low-frequency theta activity power was found at 7–10 days after CABG in the open and closed eyes, as well as alpha and beta1 activity power with eyes open. One year after CABG the power values of these rhythms decreased, but not reaching the baseline, and were higher than before surgery. Conclusion. The clinical manifestations of early and long-term POCD associated with signs of cortical dysfunction revealed by EEG dynamic changes after on-pump CABG 1 year follow-up.

Purpose. Nowadays it is proved that the use of bivalirudin instead of unfractionated heparin (UFH) during primary percutaneous coronary intervention (PCI) allows to reduce the number of bleeding complications. But at the same time there is no conclusive data on the clinical advantage of the use of bivalirudin over UFH during planned PCI. The purpose of the work was a comparison of shortterm and longterm results of PCI in subjects with stable coronary artery disease (CAD) associated with the infusion of bivalirudin and heparin, depending on the type of vascular access (transradial and transfemoral).

Materials and methods. The study included 127 stable CAD subjects who underwent a planned PCI. By the method of simple randomization the subjects were divided into two groups: «Bivalirudin + transfemoral access» group (n=65) – bivalirudin was used as an anticoagulant during the intervention by femoral access and «Heparin + transradial access» group (n=62). The groups were comparable on major clinical and demographic indicators and risk factors for bleeding complications (14±7 vs. 13±6 scores on «Mehran Score», p=0,451). Endpoints were death, myocardial infarction (MI), repeated myocardial revascularization (RMR), episodes of bleeding during hospitalization and the total number of adverse cardiovascular events during hospitalization and in 1 year after randomization.

Results. After 30 days of observation, the group «bivalirudin» (transfemoral access, n=65) and the group «UFH» (transradial access, n=62) did not differ in the number of fatal outcomes (no cases in both groups), the frequency of RMR (1,5% vs 1,6%, correspondingly, p=0,998), MI (3,1% vs. 1,6%, correspondingly, p=0,899), bleeding episodes during the hospital stay (4,6%, vs. 3,2%, correspondingly, p=0,899). The total number of cardiovascular complications was 4,6% and 3,2%, correspondingly, p=0,675. The results of one year follow-up in both groups also did not differ in the number of fatal outcomes (0% vs. 1,6%, correspondingly, p=0,946), MI (7,7% vs. 6,5%, correspondingly, p=0,656), RMR (7,7% vs. 4,8%, correspondingly, p=0,785), MACE (15,3% vs. 11,3%, correspondingly, p=0,677).

Conclusion. Short-term and long-term results of planned PCI performed by transradial access with UFH anticoagulant support and PCI performed by transfemoral access ) associated with administration of bivalirudin are comparable both in the number of postoperative bleeding complications and in the number of adverse cardiovascular events.

Purpose. To identify demographic and clinical-anatomic and angiographic factors associated with fatal outcome after primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) of coronary arteries within 12 months. Materials and methods. The study included 327 consecutive patients with STEMI and MVD of coronary arteries who received primary PCI. Clinical, demographic and angiographic characteristics of the patients and strategies of revascularization were analyzed. All patients were divided in two groups: (1) Fatal outcome (n=17), and (2) No fatal outcome (n=310). The structure and causes of 30 day and 12 months fatality outcomes were studied. Results. The most significant clinical and demographic factors of fatal outcome after revascularization were: older age 66,6± ±8,2 years (p=0,006); reduction of left ventricular ejection fraction (LVEF) - 46,2±4,5 % (p=0,02); myocardial infarction in past - in 35,3 % of patients (p=0,04); acute heart failure manifestation (Killip 2) - in 29,4 % of patients (p=0,05). Anatomic and angiographic factors of mortality were: unsuccessful PCI (final blood flow in the target artery less than TIMI3 and \ or the presence of significant complications) (p=0,0001) and the initial severity of coronary lesions on the SYNTAX score (p=0,03). Conclusions. Assessment of clinical-demographic, anatomic and angiographic factors allows to identify MVD STEMI patients with a high risk of death after primary PCI to use optimal strategies of revascularization and medical therapy for this high-risk patients.

The article presents the findings of histological analysis of local tissue response to subcutaneous implantation of polyhydroxyalkanoatebased scaffolds and scaffolds with multipotent mesenchymal stromal cells. There were no rejection and acute inflammatory response of the implanted biopolymeric materials. The connective tissue capsule has formed around the implanted materials. Active cell infiltration of the implanted material and its vascularization have been observed. The implanted scaffolds undergo slow biodegradation. The presence of multipotent mesenchymal stromal cells on the scaffold surface slows down the resorption rate of the polymer.

We carried out gistomorphometrical researches of vessels of the small circle of blood circulation in the pulmonary tissue of 17 miners which had worked under dust conditions on the average 14,1±0,5 years. They were considered as healthy according to the results of dynamic observation and they perished due to technogenic catastrophe. The results showed that the thickening of the endothelial layer, the hypertrophy of smooth muscle structures and the development of perivascular sclerosis are happened in the vessels of the lungs of miners. Changes of the structure of the vessel wall lead to its thickening and reduction the lumen of the vessel, that creates conditions for the development of pulmonary hypertension. The hypertrophy of smooth muscle structures is considered as one of the manifestations of systemic coniotic processes which occur in the wall of the pulmonary vessels and consequently causes a further increase in blood pressure that has secondary character. The obtained results dictate the need to develop methods of early monitoring of the cardiovascular system in coal workers to detect latent and the initial stages of pulmonary hypertension.

Coronary artery disease (CAD) is currently a major mortality cause in able-bodied population in industrialized countries including Russia. Despite the success achieved in the recent decades in diagnostics and treatment of myocardial infarction patients, mortality from it remains unacceptably high. Exactly this explains the search for new markers of myocardial infarction development. Recently increasing attention is paid to the factors of inherited predisposition – genetic markers – single nucleotide polymorphisms (SNP) of various genes associated with cardiovascular diseases. The article provides a review of the available data on some genetic polymorphisms of lipid metabolic disorders, in particular АРОА1, АРОА5, АРОЕ, АСЕ, СЕТР, LPL. The perspective of this area is shown. However the accumulated knowledge is highly controversial and requires systematization and continuation of researches including multicenter studies.

Purpose. To study the characteristics of the oscillatory patterns of cardiorhythm during an active orthostatic test in patients with neurogenic syncope using spectral analysis of heart rate variability. Materials and methods. There was carried out the spectral analysis of short five-minute plots of cardiorhythm including the determination of the oscillatory power in the range of high, low and very low frequencies. There were compared the changes in the indicators within the selected ranges during an active orthostatic test in 82 patients with neurogenic syncope. Results. There was disclosed autonomic failure in 70 % of the patients. It declared itself in the reduction of the power of low frequency oscillations by 50 % in average and a more marked decrease of high-frequency oscillations by more than 80 % from baseline in the supine position, which provides the urgent compensatory response to maintain sympathetic vasomotor influence during orthostatic stress. The reduced power of oscillations in the range of very low frequency indicates a failure of the system of a long-term compensation to orthostatic hypotension in patients with neurogenic syncope.

The article presents the standpoint of Russian physicians (obtained by means of survey of 13 expert clinician cardiologists of a Russian clinic) on the recommendations ofAmericanAcademyof Family Physicians based on expert’s opinion. According to the results of the survey it is noted that a consensus was reached in 8 out of 12 recommendations, and upon one of the recommendations all Russian physicians participating in the survey disagreed. Thereby it is shown that the recommendations is only a basis for decision making and in each particular case a physician makes a decision based on the clinical features and the current situation. Moreover, our research testifies that perhaps in the Russian Federation it is also needed to use not just blind copying of even the most advanced recommendations and quite formal (but not formalized) discussion of these recommendations by specialists. It is also necessary to update the recommendations taking into account the new evidences (results of methodologically correct researches) as well as reasonability of participating in discussion and considering the opinions of representatives and scientific communities, practitioners, representatives of different medical organizations, governing bodies of the health care system and insurance companies. 

Pulmonary embolism is a life-threatening condition that requires immediate decision on the choice of the method of reperfusion. Today in the arsenal of multidisciplinary command there are the all methods of restoring circulation: thrombolytic therapy as the gold standard of reperfusion, surgical embolectomy and endovascular therapies. Each of these methods has their advantages and disadvantages. Justification of the choice of the method of reperfusion is the aim of this literature review. 

Presented herein is a clinical case report of successful surgical treatment (open and endovascular operation) of a patient with DeBakey type I aortic dissection. The patient was subjected to a three-stage intervention: the first stage consisted in prosthetic reconstruction of the aortic valve, the ascending portion and the arch of the aorta; the second and third stage included endovascular prosthetic repair of the thoracic aorta with the stent graft. Analysis of early and long term postoperative period showed promising result.

In article key information on the mechanism of effect of direct inhibitor trombina-Bivalirudina, its difference from unfractionated heparin is stated. The main clinical trials with Bivalirudin’s use in cardiovascular surgery and own first experience of application are presented in thesis during coronary shunting with cardiopulmonary-bypass.