Aim.. To study clinical and pathogenic relationships between the development of chronic heart failure (CHF) of ischemic genesis associated with type 2 diabetes mellitus (DM) and osteoporosis in postmenopausal women and to evaluate the effects of anti-osteoporotic therapy on CHFMethods

Methods. A total of 178 women were recruited in the study. All patients were assigned to three groups: Group 1 (n = 48) women with CHF and type 2 DM, Group 2 (n = 93) – women with osteoporosis and CHF, Group 3 (n = 37) women with osteoporosis, heart failure and type 2 diabetes mellitus. The control group comprised 35 healthy women in postmenopausal period without clinical signs and symptoms of cardiovascular disease, diabetes and osteoporotic process. 35 patients in Group 2 received bisphosphonates for the treatment of osteoporosis. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and osteoprotegerin were measured with the ELISA.

Results. A significant inverse correlation between levels of total cholesterol, triglycerides and low-density lipoproteins, blood pressure, and bone mineral density has been found. Levels of TNF-α and IL-1β were significantly higher in Group 3 compared with patients in Groups 1 and 2. Women in the control group had significantly lower levels of cytokines compared with patients in all study groups. All women with comorbidities had significantly higher levels of osteoprotegerin compared with the control group. A significant inverse correlation between levels of TNF-α, IL-1β, osteoprotegerin and glycated hemoglobin and bone mineral density has been determined, as well as a direct correlation with the severity of CHF. A significant association between levels of TNF-α and IL-1β, and reduced bone mineral density and unfavorable course of CHF has been established as well. A significant association between bisphosphonates therapy and a favorable course of CHF has been identified.

Conclusion. Increased production of cytokines and osteoprotegerin is of crucial importance for the development of comorbidities, including CHF, type 2 diabetes mellitus and osteoporosis. Understanding of the key mechanisms determining the relationships between these diseases is essential for the development of novel approaches for evaluating risk factors and new methods for prevention and treatment of these diseases.

Aim.. To study the clinical and demographic data and hemodynamic parameters in patients with acute coronary syndrome (ACS) in young adults.

Methods. 299 patients with ACS aged under 45 years admitted to the Department of Acute Myocardial Infarction (AMI) were enrolled in the study. The inclusion criteria were as follows: young adults under 45 years and the confirmed diagnosis of ACS. 53 healthy volunteers were included in the control group.

Results. High risk of early developing ACS was established for young adults who were current smokers, had some form of dyslipidemia, overweight and suffered from arterial hypertension as well as those who had genetic predisposition to early development of cardiovascular disease. The most prevalent outcome of ACS was STEMI. 65.8% of patients underwent percutaneous coronary intervention (PCI). According to coronary angiography (CAG) findings, half patients had single-vessel coronary disease with predominant atherosclerotic lesions of the left anterior descending artery (LAD). Q-wave MI was commonly detected by routine ECG. 80% of patients had one hypokinetic segment. The study group commonly had anterior myocardial infarction. 12% of cases were complicated by left ventricular aneurysms.

Conclusion. 299 young adults with ACS were admitted to the Altai Regional Cardiology Dispensary over 5 years. Most of patients had STEMI by routine ECG. Men suffered from ACS 6 times higher than women. This group of patients had the following traditional risk factors: smoking, arterial hypertension, overweight, and family history of cardiovascular disease. According to the CAG findings, half patients had single-vessel coronary disease, which was commonly associated with atherosclerotic lesion of the LAD. Few patients had atherosclerotic lesions of the right coronary artery and circumflex artery. Q-wave MI was commonly detected by routine ECG. 80% of patients had one hypokinetic segment.

Aim. To assess the effect of epicardial obesity on the development of dyslipidemia and polyvascular subclinical atherosclerosis, and to assess the prognostic significance of various obesity criteria in the development of cardiovascular risk.

Methods. Male patients with arterial hypertension and without clinical symptoms of atherosclerosis of any localization and type 2 diabetes were included in the study. All the patients were enrolled into two groups, depending on the metabolic phenotypes of obesity assessed by epicardial fat thickness and body mass index. Both groups were comparable in waist circumference. All patients in both groups had abdominal obesity (AO≥94 cm). The study groups underwent a comparative assessment of parameters of lipid metabolism and levels of Apo-proteins. Coronary atherosclerosis was measured with multispiral computed tomography. Atherosclerotic lesions of brachiocephalic arteries were assessed by duplex scanning was performed. Epicardial fat thickness was measured by echocardiography.

Results. Significant relationships between epicardial obesity and the development of dyslipidemia and polyvascular subclinical atherosclerosis have been determined. Waist circumference and body mass index have low prognostic significance for developing cardiovascular risk.

 Conclusion. Epicardial obesity significantly affects the development of subclinical atherosclerosis of the coronary and brachiocephalic arteries. The assessment of cardiovascular risk in patients with arterial hypertension and without other diagnosed cardiovascular diseases reported that it is necessary to measure epicardial fat thickness along with traditional risk factors. Epicardial fat thickness is considered to be a criterion for visceral obesity, contributing to the development of cardiometabolic disorders. 

Aim. To assess the effects of high dose atorvastatin loading on the reduction of the rate of myocardial infarction associated with percutaneous coronary interventions and to estimate functional state of myocardium in patients with recanalization of chronic total occlusions in coronary arteries.

Methods. 82 patients who underwent recanalization of chronic total occlusions in coronary arteries were enrolled in the study. The study group included 38 patients who received atorvastatin 80 mg before surgery. The control group consisted of 44 patients who did not receive atorvastatin. Troponin I and CPK-MB fraction were measured in both groups 1 day prior and 24 hours after percutaneous coronary intervention. Functional parameters of the myocardium were estimated with echocardiography 1 day before and 24 hours after percutaneous coronary intervention.

Results. 3 patients (7.9%) in the study group demonstrated moderate elevation of troponin I levels. 11 (25%) patients in the control had over 5-fold increase from the baseline in troponin I levels. 24 hours after percutaneous coronary intervention, elevated CPK-MB was found in 3 (7.9%) patients from the study group and in 16 (36.4%) patients from the control group. There were no statistically significant differences found in echocardiography parameters between the groups.

Conclusion. Atorvastatin 80 mg has a protective effect and prevents periprocedural myocardial ischemia. However, it does not produce any effects on central hemodynamic parameters in the immediate postoperative period. 

Aim. To study the patterns of structural and functional left ventricular dysfunction in men with gout.

Methods. 114 men with gout with either an intermittent course (n = 80, mean age 46.34±6.14 years) or chronic (n = 34, mean age 49.03± 5.66 years) were enrolled in the study. All patients underwent daily monitoring of blood pressure (DMBM), echocardiography (Echo-CG) with the further identification of the architectonic pattern of the left ventricle and estimation of diastolic function with the Doppler Echo-CG.

Results. The main study group consisted of 98 patients (85.9%) with arterial hypertension. The comparison group was composed of 16 (14.1%) patients without elevated blood pressure (BP). Left ventricular dysfunction was found in 67.6% of patients with gout. Importantly, its prevalence increased with the presence of arterial hypertension and its course duration. 52% of men with gout associated with hypertension had concentric left ventricular hypertrophy. Patients with extreme-dipping of nocturnal blood pressure were more frequently found among normotonics (39.2% vs. 13.8%), whereas patients without nocturnal blood pressure dipping and nocturnal BP elevation (nondippers and night-peakers, 41.6% vs. 18.9%) among those suffering from arterial hypertension. Positive correlations between serum uric acid and the LV myocardial mass index (r = 0.32, p<0.05), left ventricular posterior wall thickness (r = 0.42, p<0.001) and interventricular septum thickness (r = 0,38, p<0.001), as well as between the mean daily readings of systolic blood pressure (r = 0.31, p<0.05), diurnal and nocturnal indices of systolic and diastolic blood pressure (r = 0.29; p<0.05 and r = 0.33, p<0.001 and r = 0.29, p<0.05 and r = 0.41, p<0.001, respectively) have been found.

Conclusion. The correlations between severe clinical course of gout, left ventricular remodeling pattern and alterations in its diastolic filling have been established. The presence of arterial hypertension contributes to the development of hemodynamically unfavorable left ventricular pattern, such as concentric hypertrophy, and pathological 24-hour blood pressure profile (nocturnal blood pressure elevation). Alterations of left ventricular diastolic filling interplay with left ventricular myocardial mass, left ventricular architectonic pattern and uric acid levels.

Aim. To study the frequency of mitral regurgitation (MR) detection and the factors associated with its presence in patients with stable coronary heart disease.

Methods. 874 patients with coronary artery disease undergoing preoperative assessment before elective surgical repair of coronary artery disease, carotid artery disease, atherosclerotic lesions of abdominal aorta and lower extremity arteries were included in the study. All patients were enrolled into three groups depending on the presence and severity of mitral regurgitation: Group 1 patients without mitral regurgitation (n = 448), Group 2 – patients with grade I mitral regurgitation (n = 378), Group 3 – patients with grade II-IV mitral regurgitation (n = 48).

Results. The independent predictors of grade II-IV mitral regurgitation according to the multivariate analysis included prior myocardial infarction (p = 0.044), left ventricular aneurysm (p = 0.004), elevated left ventricular end-systolic volume (p<0.001), an increased risk by the EuroSCORE scale (p = 0.004), female gender, the presence of heart failure and angina pectoris.

Conclusion. Mild mitral regurgitation was found in 43.2% of patients with stable coronary artery disease, whereas moderate and severe mitral regurgitation in 5.5% of patients. Independent factors associated with the presence of moderate and severe mitral regurgitation included prior myocardial infarction, left ventricular aneurysm, elevated left ventricular end-systolic volume, the presence of chronic heart failure and angina pectoris, female gender. However, there were no relationships between moderate and severe mitral regurgitation and the localization of coronary stenoses. 

Aim. To study the prognostic role of background EEG activity indicators recorded in patients in the preoperative period of coronary artery bypass grafting (CABG) for the development of cognitive impairment in the early and late postoperative periods.

Methods. A total of 85 patients with coronary artery disease (CAD) who underwent CABG were included in the study. Before CABG (3-5 days) all neuropsychological testing and EEG studies were performed, at the 7-10th days and 1 year after CABG only neuropsychological testing. EEG predictors of early (n = 85) and long-term (n = 65) postoperative cognitive dysfunction were detected using the method of multiple linear regression.

Results. EEG predictors of deterioration of cognitive status in the early postoperative period of CABG were basic higher values of theta-rhythm power in the posterior regions of the cortex of both hemispheres with closed and open eyes. Whereas higher preoperative parameters of beta2-rhythm biopotentials in the left frontal areas with eyes open and lower alpha-rhythm power in the left occipital parts of the cerebral cortex with eyes closed were associated with long-term postoperative cognitive dysfunction.

Conclusion. associations of preoperative eeg indicators with deteriorations of cognitive status in the early and longterm postoperative periods of cabg were revealed. 

Aim. To study peripheral and central ambulatory hemodynamics during the 44-hour interdialytic period in patients with different etiology of end-stage renal disease (ESRD)

Methods. 68 patients with ESRD receiving renal replacement therapy underwent 44-hour interdialytic ambulatory measurement of aortic and brachial artery blood pressure using a validated oscillometric technology Vasotens BPLab (OOO “Petr Telegin”,Nizhny Novgorod). The obtained results were estimated using the Mann-Whitney test depending on the etiology of ESRD (i.e. as a result of primary kidney disease or arterial hypertension (AH) and/or diabetes mellitus (DM). p<0.05 wasconsideredstatistically significant.

Results. Elevated levels of clinical systolic BP (SBP) before (156 [143; 168] and 146 [136; 155] mm Hg) and after the initiation of hemodialysis (154 [140; 169] and 146 [137; 155] mm Hg; p<0.05) were commonly found in patients with ESRD secondary to AH and/or DM compared with those patients with ESRD caused by primary kidney disease. This group of patients demonstrated elevated 44-hour peripheral SBP (149 [138; 160] and 139 [132; 147] mm Hg), pulse BP (PBP) (65 [56; 74] and 60 [54; 66] mm Hg), central nocturnal SBP (132 [122; 143] and 125 [116; 133] mm Hg); p<0.05. Peripheral (152 [141; 163] and 147 [136; 158] mm Hg) and central SBP (137 [125; 148] and 131 [121; 141] mm Hg) were higher in the group of patients with ESRD due to AH and/or DM on day 2 after hemodialysis initiation compared to those on day 1; p<0.05. Peripheral and central daily and nocturnal SBP and pulse BP were also elevated. Patients with primary kidney disease had elevated nocturnal central SBP on day 2 after hemodialysis initiation compared to those on day 1 (131 [121; 142] and 126 [116; 135] mm Hg, p<0.05).

Conclusion. Patients with ESRD secondary to AH and/or DM had higher levels of clinical SBP before and after hemodialysis initiation, as well as ambulatory peripheral and central SBP and pulse BP during both, the 44-hour interdialytic period and on interdialytic days 1-2, compared with patients with primary kidney diseases. In addition, patients in this group demonstrated elevated peripheral and сentral SBP and PBP on day 2 after hemodialysis initiation compared with those on day 1. 

Aim. To compare the clinical significance of the pathological cardio-ankle vascular index (CAVI) and the abnormal ankle-brachial index (ABI) in patients with acute stroke, and to assess the factors associated with the presence of pathological CAVI in these patients.

Methods. 375 patients with stroke (aged 65,0±7,5 years, 200 men and 175 women) were examined in the Department of Neurology at Cardiac Dispensary. All patients were assigned into three groups based on CAVI and ABI: Group 1 - patients with CAVI<9.0 and ABI>0.9 (n= 131), Group 2 - patients with CAVI>9.0 and ABI>0.9 (n = 153), Group 3 - patients with ABI<0.9 (n = 91).Data on rior vascular events and the presence of cardiovascular disease were colledcted. All patients underwent colour Duplex scanning of brachiocephalic arteries, echocardiography, electrocardiography, and laboratory testing (lipid profile, complete blood count, biochemical blood assay, coagulation profile). Arterial stiffness was measured with the VaSera VS-1000.

Results We found that patients with abnormal levels of CAVI (40.8%) were more likely to have concomitant cardiovascular disease (diabetes, chronic heart failure, rhythm disturbances). Patients with abnormal CAVI more often had extracranial artery stenoses (p = 0.001), thickened intima-media complex (p = 0.02), and atrial fibrillation (p = 0.007) compared to patients with normal CAVI.

Conclusion The assessment of cardio-ankle vascular index is preferable in patients with stroke. It allows timely identifying patients with increased arterial stiffness and peripheral artery disease and initiating targeted therapeutic procedures. 

Aim. To assess long-term (1984–2016) trends in the main epidemiological parameters of acute myocardial infarction (AMI) with the World Health Organization Epidemiologic Project “Acute Myocardial Infarction Registry”.

Methods. Epidemiology of AMI was estimated among permanent urban residents aged over 20 years. The study was performed according to the standard research approach using unified diagnostic (clinical, electrocardiographic, biochemical, and pathomorphological) criteria. There was a total of 49,606 subjects with suspected AMI enrolled in the study. Of whom, 30,362 patients (61.2%) got their diagnosis validated.

Results stimated incidence of AMI before 2004 had a wave-like pattern with an overall upward trend. Its rate increased significantly in the period from 2005 to 2010 compared to that in 2004 (p<0.05). In 2011– 2013, the incidence insignificantly increased to 2.23–2.36 cases per 1,000 residents. The incidence rate has been decreasing since that time. Importantly, this decrease was commonly found in male subjects of all ages. However, these changes were less pronounced in women. The changes in the mortality rates virtually followed the incidence rates during the entire period of the study. The overall mortality in AMI patients inTomsk was 35.98% without any changes until 2000s, when it increased due to higher in-hospital mortality among patients who received treatment in the community hospitals. The mean prehospital mortality from AMI was 21.73%. The prehospital mortality rate gradually decreased from 24.8% to 12.3% (p<0.05) in the period from 2001 to 2016. It should be noted that the proportion of elderly subjects died pre-hospitally was the same as those of young adults.

Conclusion The 30-year-follow-up suggests that unfavorable epidemiologic situation of AMI is mainly associated with its incidence rates among patients over 60 years.

The article presents a clinical case of a patient with Erb-Roth’s hereditary neuromuscular dystrophy presented with severe cardiomyopathy.

Metastatic tumours requires further investigation in the cardio-oncology field as they are extremely rare and have a large variety of clinical signs and symptoms, complicating the diagnostic process. Wepresent a clinical case of the delayed diagnosis of primary cutaneous melanoma after cardiovascular complications have developed (myocardial infarction and recurrent paroxysmal heart rhythm disturbances). The complications were caused by the tumor invasion into the left ventricular myocardium.

The wide application of prediction scores requires specific knowledge of their benefits and limitations from physicians. The article discusses the benefits and limitations of the established prediction scores, proposes their new classification as well as the principles of their clinical application. The opportunities and perspectives for developing novel prediction scores using precise mathematic models are highlighted.

The article discusses the use of new biomarkers for assessing the severity of the clinical course and the prognosis of chronic heart failure. In recent decades, prospective possibilities for using biomarkers as the part of early personalized diagnosis of cardiovascular disease have been actively studied to optimize the diagnosis process, patients’ prognosis and increase the effectiveness of therapy for chronic heart failure. New biomarkers are highly sensitive mediators for evaluation of pathogenetic mechanisms of the development and progression of chronic heart failure. Plasma levels of a new biomarker expressed by cardiomyocytes, fibroblasts and endothelial cells, a member of the IL-1 family of soluble isoform ST2 (sST2), which ligand is IL-33 cytokine, is of particular interest. Risk personification using NT-proBNP and ST2 biomarkers allows identifying themostvulnerablepatients for further monitoringand intensification of therapeutic interventions.

Pulmonary arterial hypertension (PAH) is chronic and progressive disease associated with poor prognosis despite advanced therapeutic options. The choice of adequate treatment requires medical examination as a potential misdiagnosis, particularly in patients present with post-capillary pulmonary hypertension, may result in death. Such patients should be followed up by an experienced healthcare specialist.OutpatientCenterwill allow identifying target patients with early-stage disease or minimizing their risk of complications. The article presents the experience of Outpatient Centre for Pulmonary Hypertension at the Regional Cardiology Dispensary in the Samara region.