Выпуск этого номера приурочен к 25-летнему юбилею Кузбасского кардиологического центра – холдинга, объединяющего специализированные учреждения разных форм собственности, нацеленных на решение одной задачи – профилактики, раннего выявления, высокотехнологичной диагностики и лечения, а также реабилитацию пациентов с сердечно-сосудистой патологией. Важные составляющие деятельности центра – процесс непрерывного профессионального образования и научные разработки в области кардиологии и кардиохирургии.

In this review we highlight the key stages in the development of the bioprosthetic heart valves in the Kemerovo Cardiology Center. We consider new technologies of the preservation and modification of biological material along with tactical approaches to the design and construction of the bioprosthetic frame. The results of the experimental studies led to a mass production of the bioprosthetic heart valves.

The analysis of 23 year-old application of epoxy treated bioprosthesis in mitral position with long-term results of their use, as well as studies of the potential impact of metabolic factors in the rate of development of the recipient calcium degeneration of bioprosthesis.

Purpose. To improve efficiency and safety of anticoagulant therapy in patients with prosthetic heart valves by developing and implementing original approaches: 1) sinus rhythm restoration after simultaneous mitral valve replacement with maze procedure, 2) pharmacogenetics approach for individual choice of anticoagulants, and 3) the implementation of patient education program.

Materials and methods. 525 patients with prosthetic heart valves were included in the study using cluster sampling in the period from 2008–2013. Group 1 (n=118) patients underwent the study aimed at assessing the restoration of sinus rhythm using original approaches, Group 2 (n=249) patients were included in the study aimed at assessing the efficiency of education program, and Group 3 (n=216) patients were included in the study aimed at assessing the efficiency of pharmacogenetics-based warfarin therapy. All patients underwent on-pump heart valve replacement. Genomic methods as well as non-invasive ultrasound monitoring of intracardiac hemodynamic parameters were used in the study.

Results. Simultaneous mitral valve replacement with maze procedure resulted in the restoration of sinus rhythm in 61,8 % of cases; scheduled cardioversion 1,5 months after cardiac surgery ensured sinus rhythm restoration in 84,8 % of patients, and radiofrequency catheter ablation in patients with biological prosthetic heart valves 6 months after cardiac surgery allowed both sinus rthym restoration and warfarin withdrawal. The introduction of pharmacogenetic approach to warfarin dosing in the early postoperative period resulted in a 2-fold reduction in the time of warfarin dose adjustment and a 25,2 % increase of the therapeutic range of anticoagulation level. The implementation of training program based on the continuity of inpatient and outpatient care allowed decreasing 1,8-fold the risk of thrombotic complications and 2,6-fold hemorrhagic complications 2 years after heart valve replacement. The introduction of the strategy aimed at the improvement of efficiency and safety of warfarin therapy demonstrated the benefits of biological heart valve replacement and the feasibility of an integrated approach.

Conclusion. The introduction of the integrated approach composed of the strategies for sinus rhythm restoration, information and motivational approach, and pharmacogenetic approach, ensures a reduction in hemorrhagic and thrombotic complications, improving quality control for warfarin therapy, awareness, and treatment adherence.

We prepared polycaprolactone (PCL) and polyhydroxybutyrate/valerate (PHBV)/polycaprolactone (PCL) 2 mm vascular grafts using electrospinning. The structure of the graft surface along with the physico-mechanical and viscoelastic properties were investigated by scanning electron microscopy, universal testing machine (n=20), and arterial pulsatile flow circuit (n=12), respectively. We also assessed hemocompatibility and thromboresistance of the inner graft surface (n=12). Cell adhesion and viability were investigated using EA.hy 926, an endothelial cell line that was cultured on the cultural plate, PCL, and PHBV/PCL scaffolds during 6 days.

PCL and PHBV/PCL grafts consisted of ≤ 4 μm diameter fibers which were randomly distributed and formed ≤ 40 μm diameter pores. The durability, elasticity, and stiffness of PCL grafts were 2,7-fold lower, 10,7-fold higher, and 2,9-fold higher, respectively, compared to autologous saphenous veins (р<0,001). However, the durability, elasticity, and stiffness of PHBV/PCL grafts were 1,9-fold higher, 1,8-fold lower, and 6,9-fold higher in comparison with PCL grafts (р<0,001). Viscoelastic properties of both PCL and PHBV/PCL grafts differed from native arteries (p<0,001) but were more similar to them then Dacron and ePTFE grafts. After the contact with blood, inner surface of PHBV/PCL grafts contained minimal amount of proteins and blood cells, and there were no signs of platelet activation. However, PCL grafts contained a high amount of proteins and induced platelet activation. After 6 days of culture, the number of EA.hy 926 cells was lower on PCL scaffolds compared to the PHBV/PCL scaffolds and cultural plate; the viability of the cells was similar.

Purpose. The purpose of this study was to create a model and interactive calculator for a differentiated choice of revascularization strategy in patients with ST-elevation myocardial infarction (STEMI) and coronary artery multivessel disease (MVD).

Material and methods. The study included 327 patients with STEMI and MVD undergoing primary percutaneous coronary intervention (PCI). Patients were divided into two groups: 1) Multivessel stenting (MS) (n=91); 2) Staged PCI (SP) (n=236). Study endpoints over 12 months were significant adverse cardiovascular events. Relative frequency of occurrence of an adverse outcome was evaluated and prognostic value for each of 12 demographic, clinical and angiographic factor was calculated for each revascularization strategy.

Results. The negative predictive value for adverse outcome in patients undergoing MS strategy had the following factors: myocardial infarction in past; severe coronary atherosclerosis (SYNTAX Score≥23); Age ≥65 years; female. Negative predictive value for SP strategy had the following factors: stroke in past; myocardial infarction in past; polyvascular atherosclerosis; three-vessel coronary artery disease; using of bare metal stents. The main result of this study was creation of interactive calculator for determine the optimal revascularization strategy for STEMI patients with MVD.

Conclusion. Using the developed model of differentiated choice of the optimal revascularization strategy and created calculator can improve treatment outcomes for STEMI patients with MVD.

Background. Currently, the influence of specific factors on mortality rates for circulatory system disease (CSD) is actively studied by numerous researches. Purpose. To study and compare medical care practitioners’ estimation of the factors affecting the mortality statistics for CSD in different regions of the Russian Federation.

Materials and Methods. Federal State Institution “National Research Centre for Preventive Medicine” compiled a questionnaire submitted to the Public Health Departments of the regions and researchers in preventive medicine and public health care from different regions of Russia. All the interviewees scored the influence of six factors as a leading cause of death (comorbid somatic pathology; comorbid psychopathology; comorbid alcohol and drug use disorders; non-compliance to treatment; ignorance of the major risk factors for CSD or refusal of their prevention; ignorance of the main manifestations (symptoms) of life-threatening diseases or complications) on mortality rates for CSD using a 1-to-5 rating scale. A total of 226 completed questionnaires were received: 37 questionnaires were completed by medical care practitioners from the Kemerovo region, 70 – from the Rostov region and 119 – from other regions of the Russian Federation. Three comparison groups were established.

Results. There were no statistically significant differences in the scores between the comparison groups of medical care practitioners. The average impact of comorbid somatic pathology according to the medical care practitioners’ estimation was 3,5; comorbid psychopathology – 2,7; comorbid alcohol and drug use disorders – 3,5; non-compliance to treatment – 4; ignorance of the major risk factors for CSD or refusal of their prevention – 3,8; ignorance of the main manifestations (symptoms) of life-threatening diseases or complications requiring first aid and emergency medical service – 3,9. Despite certain differences in the medical care practitioners’ estimation of the influence of selected factors on mortality rates for CSD (Kendall’s coefficient of concordance W=0,181) the degree of agreement was statistically significantly (p<0.0001) different from zero.

Conclusion. All these factors, estimated by the medical care practitioners, affect mortality rates for CSD. There were no statistically significant differences between the comparison groups’ estimates of the factors affecting mortality rates for CSD. There was a statistically significant low concordance between medical care practitioners in the use of the 1-to-5 rating scale.

The aim of this study was assessment of link between number of cardiovascular incidents among urban population and environmental conditions (concentration of air pollutants and the values of air temperature).

The analysis of the primary disease incidents, number of hospitalizations and deaths from cardiovascular diseases, as well as levels of air pollutants (mg/m3 ) and the air temperature (in °C) in Novokuznetsk, Kemerovo region for 2007–2012 was conducted. Cardiovascular disease data were adjusted for age (60 years and above 60 years). We analyzed the monthly average daily values of health and environment indicators. We used next statistical methods in our study: Mann-Whitney test, Kruskall-Wallis test and multiple regression analysis.

Indicators of morbidity, hospitalization, and mortality from cardiovascular disease in all age groups, except for hospitalization over the age of 60 years shows trends towards decline. Levels of air pollutants are characterized by multi-directional trend. Air pollutants that most frequently exceeded the maximum allowable concentration in Novokuznetsk in 2007–2012 were: Particulate Matter (6,7 % of samples), hydrogen fluoride (6,6 %), formaldehyde (3,8 %), phenol (2,5 %), carbon black (2,3 %), nitrogen dioxide (1,1 %). Regression analysis showed that rates of cardiovascular disease among Novokuznetsk population in 16–57 % of cases are explained by environmental conditions. The number of registered cases, hospitalizations and deaths from diseases of the cardiovascular system is connected directly with PM, hydrogen fluoride, formaldehyde levels and revesely with the air temperature. The contribution of PM and temperature to number of cardiovascular disease incidents is higher among elderly, compared with persons up to 60 years.

Thus, it is shown the combined influence of pollution levels and air temperature on the cardiovascular pathology of Novokuznetsk population.

The article provides the results of the assessment of mortality parameters from circulatory system disease (CSD) in Russia in the period from 2006 to 2013. The comparative analysis of the nosological structure of causes of death from CSD was performed. Standardized mortality ratio from CSD decreased by 29,1 % in 2013 compared to 2006. Mortality rates caused by CSD prevail in total mortality rates, in particular in the >75 years age group, accounting for 70 % of all deaths. The vast number of deaths was caused by coronary artery disease, i. e. the cases that were not related to acute coronary events. Mortality rates after myocardial infarction (MI) have declined in all age groups < 80 years. Due to the increase in mortality rates after MI in the age groups > 80 years, there was no significant shift in mortality rates after MI in the total population. Recent amendments to the nosological coding of causes of death make difficult to perform the comparative assessment of mortality rates in a number of CSD. However, there was a significant number of deaths from SCD, which clinical interpretation is complicated by the current classification coding, thus, raising problems in the planning and organization of medical and social care, aimed at reducing mortality from SCD.

This article describes the methodological approaches to the diagnosis of cognitive dysfunctions (CD), including postoperative cognitive dysfunction (POCD), accepted and used in everyday practice of Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo. The importance and the need for adequate and timely diagnosis of the pre- and postoperative CD, using both screening neuropsychological scales and specialized tests. The importance of the POCD to choose treatment strategies and evaluate the effectiveness of the therapy was shown. Particular attention in this regard should be given to patients with a planned heart surgery with cardiopulmonary bypass (CPB).

In the review of publications in the «Cardiac Interventions Today» on-line edition (2015; Vol. 9) have been discussed such topical issues in interventional cardiology as treatment of acute myocardial infarction complicated by cardiogenic shock and the strategy of antiplatelet therapy after percutaneous coronary intervention.

Pericarditis have a negative impact on morbidity and mortality in patients with cardiovascular disease. Yet diagnosis of inflammatory diseases of the pericardium is difficult or untimely. Development of modern methods of radiology diagnostics has greatly advance the study of this disease. This review presents the diagnostic aspect of inflammatory diseases of the pericardium by position of multislice computed (CT) and magnetic resonance imaging (MRI). Attempt to determine the role of these methods to optimize the treatment process was performed.

Purpose. Estimation the detection rate of pulmonary embolism (PE) and identifying risk factors for its development and adverse hospital events.

Materials and methods. 55 patients with PE were conducted the standard laboratory and instrumental examination.

Results. About half the patients were hospitalized in the first 24 hours from the time of development symptoms, while 23,6 % of patients had primary PE. The female person with obesity, hypertension, diabetes mellitus and coronary artery disease prevailed in the group of patients. The cancer pathology and thrombosis of deep vein occurred in 21,8 and 18,2 % respectively. The 41,9 % of patients underwent thrombolytic therapy, 52,7 % of patients – conservative treatment by anticoagulants, three patients underwent surgery thrombectomy from the pulmonary artery trunk. The death occurred in 12 (23,6 %) patients. Identified adverse prognostic factors: the low systolic blood pressure, dilatation of the right ventricle, the pulmonary artery trunk thrombosis and elevated levels of troponin-T. The elevated levels of D-dimer was observed in all patients with PE, regardless of the outcome. The frequency of PE was 1,03 % of the patients with pathology of the cardiovascular system have been admitted to the hospital during the year.

Conclusion. The presence of obesity and hypertension in patients with pulmonary embolism was detected most frequently. Adverse hospital events in patients with PE was significantly associated with arterial hypotension (p=0,0016), the presence of right ventricular dilatation (p=0,006), thrombosis of the pulmonary artery trunk (p=0,026) and increased troponin T levels (p=0,0426).

The review article highlights a variety of modern educational technologies, included in the problem-based learning paradigm. A clear distinction between technologies according to their objectives, methods and principles of teaching has been performed. The effective educational technology that may be integrated in the continuing education framework has been determined. The key components for developing positive learning environment in clinical settings has been identified and described.

The report describes the case of electrophysiological study, mapping and catheter ablation of ectopic focus in right ventricular outflow tract. The changes of QRS complex morphology during ablation were analyzed. They were interpreted as characteristics of subepicardial localization of arrhythmogenic substrate.

Aim. Coronary artery bypass grafting (CABG) and tricuspid valve replacement (TVR) are available therapeutic options for cardiac allograft vasculopathy (CAV) and tricuspid regurgitation (TR), respectively after orthotopic heart transplantation (OHT). To our knowledge, these two procedures have never been reported simultaneously in a heart transplant recipient in the literature.

Materials and methods. We present the first incidence of a simultaneous CABG and TVR with a BiocorTMbioprosthetic valve in a heart transplant recipient 25 years after the original transplant operation, the longest reported duration before reoperation after OHT.

Results. Early postoperative course was complicated by complete heart block requiring placement of dual chamber pacemaker. Patient progressed well after this intervention and was eventually discharged to home and remained asymptomatic on follow-up.

Conclusion. Concomitatnt CAV and TVR for severe TR is a safe and effective treatment option with low perioperative mortality and favorable short and long term outcomes in heart transplant recipients.

Aim. Coronary artery bypass grafting (CABG) and tricuspid valve replacement (TVR) are available therapeutic options for cardiac allograft vasculopathy (CAV) and tricuspid regurgitation (TR), respectively after orthotopic heart transplantation (OHT). To our knowledge, these two procedures have never been reported simultaneously in a heart transplant recipient in the literature.

Materials and methods. We present the first incidence of a simultaneous CABG and TVR with a BiocorTMbioprosthetic valve in a heart transplant recipient 25 years after the original transplant operation, the longest reported duration before reoperation after OHT.

Results. Early postoperative course was complicated by complete heart block requiring placement of dual chamber pacemaker. Patient progressed well after this intervention and was eventually discharged to home and remained asymptomatic on follow-up.

Conclusion. Concomitatnt CAV and TVR for severe TR is a safe and effective treatment option with low perioperative mortality and favorable short and long term outcomes in heart transplant recipients.