Aim. To estimate the trends in mortality from circulatory system diseases, including coronary artery disease and cerebrovascular diseases, in the Kemerovo region in the period from 2000 to 2016 and compare it with the national trends.
Methods. Data on national mortality rates, including those among adults of working age (men 16–59 years, women 16–54 years) from circulatory system diseases, coronary artery disease and cerebrovascular diseases in the period from 2000 to 2016 were obtained through the national statistical reports. A linear trend in the regional mortality rate to the national one has been reported.
Results. Mortality rate from circulatory system diseases in the period from 2000 to 2016 tends to a decrease in the Kemerovo region and the Russian Federation. The comparative analysis of mortality rates in the Kemerovo region and the Russian Federation reported lower regional mortality rates in the general population. Despite lower mortality rates from coronary artery disease in the general population and working population, there are higher mortality rates from cerebrovascular diseases.
Conclusion. The trend in mortality from circulatory system diseases in the Kemerovo region is comparable to that in the Russian Federation. Specific regional features related to the interaction of various factors, including regional healthcare system, have been determined. The trends in mortality from coronary artery disease and cerebrovascular diseases in the period from 2000 to 2016 have been presented.

Aim. To assess vitamin D level in patients with acute coronary syndrome and to determine the relationships of vitamin D level with specific patterns of cardiovascular disease in this group of patients.

Methods. 50 patients (35 (70%) males and 15 (30%) females) urgently admitted to the emergency cardiology department of Kaliningrad Regional Hospital were enrolled in the cross-sectional observational study. Patients with diabetes mellitus, autoimmune diseases and cancer were excluded from the study. The mean age of patients was 60 (55; 66) years. Cardiovascular risk factors (obesity, smoking, physical activity, alcohol consumption, genetic predisposition) were assessed in all patients. Total serum cholesterol levels, GFR (CKD-EPI) and troponin levels were measured in all participants. Echocardiography included the measurement of the left ventricular mass index. Coronary angiography with omnipaque contrast was performed in all cases. 25-OH vitamin D was measured with enzyme-linked immunosorbent assay (ELISA).

Results. The majority of patients with acute coronary syndrome had vitamin D deficiency. 3 (6%) patients had severe vitamin D deficiency. The subgroup of patients with marked vitamin D deficiency (n = 39) more often had elevated blood pressure probably related to the left ventricular hypertrophy and left atrial enlargement. Left ventricular systolic dysfunction and occlusive coronary artery disease were more common in patients with lower vitamin D levels. Statistically significant correlations had not been found between vitamin D levels and cardiovascular risk factors as well as laboratory data.

Conclusion. Vitamin D level below normal range was detected in the vast majority of patients with acute coronary syndrome, of them 6 % of patients had critically low vitamin D levels.

Aim. To study the clinical course of atrial fibrillation in patients with arterial hypertension and extracardiac comorbid pathology depending on the administered therapy.

Methods. 207 men aged 45–65 years with atrial fibrillation (paroxysmal and persistent) and arterial hypertension in combination with diabetes mellitus (n = 40), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47) were recruited to a observational cohort study. 56 patients with atrial fibrillation and arterial hypertension but without any extracardiac diseases were included in the comparison group. Clinical and anthropometric parameters were assessed in all patients. Adherence to therapy was estimated with the Morisky-Green test. All patients underwent ECG; electrocardiographic holter monitoring, 24-hour blood pressure monitoring with the Daily Monitoring Systems SCHILLER (Schiller, Switzerland), 2D and M-mode echocardiography using a Vivid 7 device (General Electric, USA). The statistical analysis was performed in the Rstudio software (version 0.99.879, RStudio, Inc., MA, USA).

Results. 66% of patients with atrial fibrillation and arterial hypertension had concomitant extracardiac comorbid pathology, of them 20% of had diabetes mellitus, 22% with chronic obstructive pulmonary disease, and 24% with abdominal obesity. The clinical groups were comparable in electro impulse and drug therapy. Patients who received medical treatment were frequently admitted to hospitals for atrial fibrillation recurrence (p<0.001), compared with those who underwent electro impulse therapy. Adherence to antiarrhythmic therapy was low in the entire cohort of patients. There were no significant differences found between the clinical groups.

Conclusion. Early diagnosis of the factors contributing to the progression of AF, the prescription of additional therapy for the secondary prevention of arrhythmia and the choice of its optimal treatment strategy may slow the progression of arrhythmia and the development of CHF, which will improve not only the clinical status of patients, but also their prognosis.

Aim. To evaluate the pharmacoeconomic analysis of three antihypertensive drugs routinely used to optimize blood pressure in young adults.

Methods. 250 patients were recruited to the study and subdivided into three groups: Group 1 patients (n = 131) received monotherapy with angiotensin-converting enzyme inhibitor, ramipril; Group 2 and 3 patients (n = 119) received combination therapy with perindopril + amlodipine and ramipril + amlodipine.

Results. The group of patients receiving ramipril had the average daily dose of 10 mg, patients taking egipres received 5/10 mg daily, and patients receiving prestans took 5/5 mg daily. Thus, the cost of treatment with ramipril at the dose optimally reducing blood pressure remained the same, while the cost of treatment with prestans decreased up to 37400.00 RUB, and egipres up to 45218.00 RUB. 4.76% of patients who received these antihypertensive medicines experienced side effects, namely cough, dizziness, a sharp decrease in blood pressure, allergic dermatitis, nausea. The least rate of side effects occurred in patients who received perindopril, whereas the highest was recorded in the group of patients receiving ramipril (3.5% vs. 6.5%, respectively).

Conclusion. No significant differences found in the antihypertensive effects between three groups of drugs (ramipril, prestans, egipres). All three medicines included in this study effectively reduced blood pressure. However, prestans was associated with the least rate of side effects. Most side effects were short-term and of mild to moderate severity.

Aim. To assess the effectiveness of endovascular treatment of in-stent restenosis after successful chronic total coronary occlusion (CTO) recanalization.

Methods. 117 patients who underwent successful CTO recanalization in the period from 2009 to 2012 were included in the study. All patients were referred to the elective examination including coronary angiography, intravascular ultrasound and optical coherence tomography within 6.1±0.9 months after the successful recanalization. If in-stent restenosis after CTO recanalization was confirmed and further endovascular treatment was performed, patients underwent repeat endovascular examination after 6.6±0.8 months. Сoronary artery lumen was evaluated at the sites of the performed intervention.

Results. 18.8% of patients had in-stent restenosis, of them 95.5% underwent percutaneous coronary intervention. 76.2% of patients underwent high-pressure balloon predilatation, 4.8% of patients received paclitaxel-eluting balloons, 14.2% of patients – drug-eluting stents (DES), and 4.8% of patients - bare-metal stents. A significant increase of minimum lumen diameter after the percutaneous coronary intervention (from 0.8±0.5 mm to 2.2±0.3 mm, p<0.01) and a decrease of coronary artery lumen stenosis (from 67.9±18.3% to 19.7±8.8%, p<0.01) had been determined. There were no cases of death, acute myocardial infarction, acute strokes and target lesion thrombosis 6.6±0.8 months after the in-stent restenosis treatment. 52.8% of cases had repeat restenosis, including 56.3% of those who underwent high-pressure balloon predilatation and 33.3% of patients after DES implantation. The minimum lumen diameter decreased from 2.2±0.3 mm to 1.6±0.5 mm (p<0.01), and the degree of lumen stenosis increased from 19.7±8.8 mm2 to 41.5±17.3 mm2 (p<0.01).

Conclusion. In-stent restenosis treatment after the successful CTO recanalization by the endovascular methods was effective in 47.2% of cases. DES and drug coated balloons can potentially reduce the rate of repeat restenosis.

Aim. To estimate mechanical function of the right heart chambers after the pulmonary denervation in comparison with the sham procedure using right heart catheterization (RHC) and echocardiography.

Methods. Twelve patients with different clinical types of pulmonary hypertension were included in the study. All patients were randomized into two groups: Group I patients (n = 6) underwent the pulmonary denervation, Group II patients (n = 6) had sham procedure. All the patients had functional class 3 pulmonary hypertension. The patient screening was performed using echocardiography findings, and the final decision was made after RHC. After including in the study the RHC was done three times: before the procedure, immediately after it, and on the 12th months of the follow-up. Echocardiographic measurement of the right heart parameters was performed four times: a day before the procedure, immediately after it, on the 5th day and on the 12th months of the follow-up.

Results. No complications during the procedure and the follow-up were registered. There were no statistically significant differences in any of the RHC parameters between groups at the second and the third control points. The same findings were determined after echocardiographic analysis.

Conclusion. Pulmonary denervation does not have statistically significant effect on the mechanical function of the right heart chambers within the 12-months follow-up.

Aim. To evaluate the in-hospital results of minimally invasive direct coronary artery bypass grafting (MIDCAB) of the left anterior descending artery (LAD) on the beating heart.

Methods. 146 patients with stable coronary artery disease and hemodynamically significant LAD lesions were included in a single-center prospective study. The study endpoints included death, myocardial infarction (MI), stroke, bleedings associated with the CABG, repeated non-elective myocardial revascularization during the in-hospital period. The completeness of the performed revascularization was assessed by estimating the residual SYNTAX score. Additionally, the volume of perioperative blood loss and patients’ ICU and in-hospital length of stay were recorded. Wound complications, heart rhythm and conduction disturbances, respiratory complications were assessed.

Results. The mean patient age was 60±8.9 (36–82) years. The mean EuroScore II was 1.61±1.66%. The SYNTAX score was 11.7±9.5 (5–25.5) scores. After MIDCAB, the residual SYNTAX was 1.8±2.1 (0–12.5). The majority of patients had single-vessel disease (n = 108; 73.9%). More than half of the patients had postinfarction cardiosclerosis (PICS). 17.8% of patients had diabetes mellitus. 19% of patients were present with class 1–2 obesity. The mean left ventricular ejection fraction (LVEF) in the total sample was 61.3±7.5% (37–74%). Eight patients (5.5%) required the conversion of lateral minitracotomy to sternotomy followed by the LAD grafting on the beating heart. The mean volume of intraoperative blood loss was 293.4±117.9 mL. Reasonable incomplete myocardial revascularization was achieved in 24.7% of cases. There were no cases of in-hospital deaths in the study cohort. The incidence of MI, stroke and repeated non-elective myocardial revascularization was within the acceptable range of 0.7%, 0% and 2.7%, respectively. 6.1% of patients (n = 9) had wound complications (deep incisional surgical site infection). The mean length of stay in the intensive care unit was 1±0.2 days. The absolute majority of patients (n = 108) were discharged from the Department of Cardiac Surgery in the period of 10±1.2 days.

Conclusion. Off-pump MIDCAB demonstrated good results, low rate of cardiovascular complications and low volume of perioperative blood loss, lack of deep wound infection and shorter hospital length of stay.

Aim. To determine the role of volume imbalance and alterations in the rheological properties of blood in the pathogenesis of postresuscitation hemocirculatory disorders in dogs after clinical death due to acute myocardial infarction.

Methods. Changes in systemic hemodynamics, volume and dynamic viscosity of circulating blood within a 5-minute period after clinical death due to myocardial infarction were evaluated in a dog model. 152 dogs received pentobarbital anesthesia.

Results. In the early postresuscitation period after myocardial infarction dogs developed phase changes in systemic hemodynamics, volume and dynamic viscosity of circulating blood with an increase in the target indicators, followed by their decrease and final normalization as compared to the baseline. The development of postresuscitation systemic hyperperperfusion (1–3 min) was associated with significantly increased blood volume and its components. The subsequently decreased perfusion volume (5–30 min) was caused by depressed contractile function of the heart. The further progression (1–9 hours) of the hypoperfusion syndrome was mainly attributed to hypovolemia, increased dynamic viscosity of the blood and the viscoelastic properties of the red blood cells. The contribution of heart rhythm disturbances (polytopic ventricular extrasystoles) to the development of circulatory failure 4–5 hours after the successful resuscitation was determined. The subsequent hemodynamic improvements were associated with the normalization of the circulating plasma volume and hemorheological properties of the blood.

Conclusion. Staged disorders of the systemic circulation formed in the recovery period after clinical death following acute myocardial infarction. They were accompanied by the alterations in the volume and dynamic viscosity of the circulating blood. Immediately after the revival, elevated values of the hemodynamic parameters were attributed to the increased blood flow as well as to the increased in plasma and globular components. The initial (5–30 min) decrease in the cardiac output was caused by impaired myocardial contractility. After a recovery period of 1–9 hours, a progressive decrease in the perfusion volume demonstrated a direct linear relationship with a deficit of blood flow and its plasma component. Heart rhythm disturbances contributed to the development of insufficient blood circulation in the 4–5-hour recovery period. Thus, hypovolemia and the hyperviscous syndrome associated with it significantly contributed to the development of insufficient systemic circulation within the 1–9-hour recovery period after clinical death provoked by myocardial infarction.

Aim. To study the frequency distribution of alleles and genotypes of the C421A locus (rs2231142, Q141K) of the ABCG2 gene in patients with gout and to evaluate their association with the risk of the disease development.

Methods. 80 patients (69 men and 11 women) with gout (mean age 54.8±12.4 years) were examined. Gout was diagnosed according to the ACR/EULAR classification criteria, 2015. The material for the study was DNA isolated from leukocytes of the whole peripheral blood. All patients were genotyped to detect polymorphism of the C421A locus (rs2231142, Q141K) of the ABCG2 gene. Statistical data processing was performed using Statistica 10.0 statistical software package.

Results. The results of the study of the C421A polymorphism (rs2231142, Q141K) of the ABCG2 gene demonstrated a high frequency of mutant A (χ2 = 5.58, p = 0.018, OR = 3.5, CI95% = 1.16–10.52) genotypes C/A (χ2 = 5.03, p = 0.024, OR = 3.5, CI95% = 1.11–10.98) among patients with gout compared with the control group. This fact indicates the significance of the ABCG2 gene rs2231142 locus in the development of gout and allows us to consider the carriage of the minor (A) allele and the C/A genotype as a molecular genetic factor in the development of the disease. The carriage of the wild-type allele (C) and the C/C genotype has a protective character, reducing the risk of developing the disease by 3.5 times.

Conclusion. ABCG2 C421A (rs2231142, Q141K) is associated with a high risk of developing gout among population of Zabaikalsky Krai. ABCG2 gene polymorphism can be considered as a genetic predictor of a higher risk of developing gout.

Background. Tissue-engineered vascular grafts can be reinforced by a biostable or biodegradable polymer sheath. A combination of electrospinning, routinely used for fabrication of biodegradable tubular grafts, and the layer-by-layer coating allows forming a polymeric sheath ensuring long-term integrity and high biocompatibility of the vascular grafts after the implantation. Aim To evaluate mechanical properties and in vivo performance of biodegradable small-diameter vascular grafts with a reinforcing sheath.

Methods. Tubular grafts (4 mm diameter) were fabricated from poly(3-hydroxybutyrate-co3-hydroxyvalerate) and poly(ε-caprolactone) by emulsion electrospinning with the incorporation of vascular endothelial growth factor (VEGF) into the inner third of the graft and basic fibroblast growth factor (bFGF) along with stromal cell-derived factor-1α (SDF-1α) into the outer two thirds of the graft wall. Poly(ε-caprolactone) sheath was formed by the layer-by-layer coating. Upon graft fabrication, scanning electron microscopy was performed to assess the grafts’ surface, tensile testing allowed evaluating mechanical properties. The samples were implanted into the ovine carotid artery (n = 5 animals) for 12 months with the subsequent histological examination.

Results. Sintering temperature of 160°C during the extrusion allowed effective and delicate merging of poly(ε-caprolactone) coating with the outer surface of the poly(3hydroxybutyrate-co-3-hydroxyvalerate)/poly(ε-caprolactone) tubular graft. The thickness of poly(ε-caprolactone) fiber was 380–400 μm, the increment of the reinforcing filament was 1 mm. The reinforcing sheath led to a 3-fold increase in durability and elastic modulus of the vascular grafts. At the 12-months follow-up, the grafts reported retained integrity. No signs of inflammation or calcification were found.

Conclusion. The poly(3-hydroxybutyrate-co-3-hydroxyvalerate) and poly(ε-caprolactone) vascular grafts with hierarchically incorporated growth factors and the reinforced poly(ε-caprolactone) spiral sheath demonstrated improved mechanical properties while retaining integrity and high biocompatibility after the long-term implantation into the ovine carotid artery.

Today implantable cardiac devices (ICD) are advanced therapeutic and preventive tools ensuring the collection and transmission of statistical and diagnostic patient data. The information obtained from implanted devices allows analyzing patients’ condition, selecting optimal treatment strategy, predicting and preventing possible complications. The number of ICD recipients is rapidly growing. Over 1,000 devices per 1 million population are implanted in Europe and the US annually. In the Russian Federation this number reaches 300 devices per 1 million population. Routine medical checkups of patients with ICD should be performed 2–4 times a year, with an average length of about 20 minutes. It means that only in the Russian Federation physicians will have to work 20–40 thousand extra hours with a tendency towards its increase as this figure will grow simultaneously with growing patients’ number. Remote monitoring (RM) technologies may solve this problem. In 2000 Biotronik AG developed the world's first system for remote monitoring of anti-arrhythmic devices called the “Home Monitoring” system. It is based on the mobile RM of patients who received ICD. The information collected by the devices is transmitted to a special service center via mobile communication networks and after processing, the information is transferred to a physician’s website along with a text message and a fax. The information is instantly delivered from a patient to a physician. A closed information network "patient-service center-physician" was developed for the hospitals and their patients, providing a novel advanced monitoring and timely treatment of the patient.

The article presents the historical insights into composite coronary artery bypass grafting, current concepts and its different variants. A smaller number of manipulations on the aorta during the procedure has been proved to reduce significantly the risk of ischemic stroke. However, it requires off-pump technology, which is still controversial despite all its advantages. No doubt, composite or compound bypass grafting allows performing myocardial revascularization even if there is a lack of conduits. A particular concern has been paid to the connection between the arterial and venous conduits, therefore emphasizing the relevance of composite coronary artery bypass grafting.

The study of long-term treatment outcomes of patients in the intensive care unit (ICU) is necessary for the rapid recovery of a critically ill patient. Training of ICU staff in basic rehabilitation techniques for early rehabilitation and resocialization of patients allows promoting improvements in postresuscitation immunosuppression, polyneuropathy, polymyopathy, and cognitive dysfunction. The introduction of rehabilitation in the ICU enables avoiding the concept of syndrome-treatment of critically ill patients, solving the problem of “a chronic ICU patient”, reducing the number of complications of the underlying disease and chronic pathologies associated with the patient's critical condition. The algorithms for the recovery of critically ill patients are proposed to be introduced from the first day of the hospitalization, when the first pathophysiological recovery patterns begin to form. The role of resocialization in the framework of this approach to the rehabilitation of critically ill patients, the “open ICU” model and deontological aspects of the communication between medical staff and an ICU patient are put forward. The prevention of delirium after cardiac arrest contributes greatly to the further prevention of post-resuscitation cognitive dysfunction, decreases depression and prevents oversedation. A new phenotype of a chronic critically ill patient, the “patient after a critical condition,” is introduced with the discussion of the pathophysiological patterns involved in its formation. The relevance of this review is confirmed by the growing interest to the integration between ICU staff and patient`s family, thus emerging the role of social aspect of the rehabilitation in critically ill patients. The novelty of this research is imposed by advanced approaches to the early rehabilitation of ICU survivors which are currently neglected from the routine ICU practice.

Venous stroke being “relatively unknown cerebrovascular disease” occurs in 0.55% of all strokes. Specific diagnostic concerns to venous stroke and the expansion of the volume of radiologic examinations from routinely used non-contrast CT to angiographic and perfusion CT- and MRI, diffusion MRI allowed us to increase the number of diagnosed and verified venous ischemic stroke from 0.4% of all strokes treated in our center to 2.4%, resulting in a 6-fold increase within the 5-year period. Symptoms of cerebral venous sinus thrombosis depend on the size and the growth rate of thrombus. In addition, focal neurological symptoms are diverse and largely dependent on thrombus localization and safety of collateral blood flow, as well as patients’ age and severity of cerebral edema. Cerebral symptoms are nonspecific and may occur in varying degrees of severity related to the localization of the pathological process. The routinely used assessment scales such as the National Institutes of Health Stroke Scale (NIHSS), Bartel Index, Rankin Scale do not reliably identify this type of acute ischemic stroke. The leading symptom is headache with the mean visual analogue scale of 7.3±1.6. The tendency towards a less pronounced neurologic deficit at admission and mild disability status at discharge have been found among patients with venous stroke. The clinical course of venous stroke mostly demonstrated a tendency towards rapid regression of focal symptomatology and neurological deficit in comparison with arterial ischemic stroke.

The clinical case reports a personalized expert approach to the management of a patient with myocardial infarction receiving programmed hemodialysis. The challenges facing by cardiologists with antiplatelet therapy, statin therapy, betablockers and renin-angiotensin-aldosterone system blockers as basic therapy have been discussed. The experience of performing coronary angiography with a limited dosage of the contrast agent followed by the stenting in the patient intolerant to unfractionated heparin is presented The complexity of post-puncture hemostasis before dialysis is highlighted. A particular attention has been paid to the existing difficulties in selecting rational loading doses of antiplatelet agents for these patients due to poor evidences on the elimination of clopidogrel metabolites from the blood flow.