The article reports the feasibility of performing coronary angiography to all patients to diagnose type 1 and 2 MI. From the perspective of patient care, the decision should be individual and must be driven by the benefits and risks. The following underlying principles should be taken into account: improvement of a patient’s condition, alleviation of pain, and mortality risk-minimization. However, additional researches are required to obtain new evidences on selecting the target patient group who should be referred to CAG for future decision making, therefore further research is required. A consensual opinion of specialists justifying the need and rational for CAG in specific clinical cases situations is necessary before obtaining reliable evidences. Invasive interventions should not be performed to verify diagnosis for statistical purposes or exclusion of the discrepancies between clinical and pathological anatomical diagnosis.

Highlights. The implantation of cardioverter-defibrillator is the most effective method for preventing sudden cardiac death. However, almost 25% patients have normally functioning CD at the 5-years follow-up. This has necessitated the search for new non-invasive diagnostic methods for detecting patients at high risk of ventricular tachyarrhythmias.

Aim. To evaluate whether the estimated heart rate variability may be used as a predictor for ventricular arrhythmias (VTA) in patients with coronary artery disease.

Methods. 51 patients (mean age of 65.4±8.4 year; 41 male patients (80,3%)) with coronary artery disease (CAD) and indications for cardioverter-defibrillator (ICD) implantation were included to the study. The 6-minute walk distance, echocardiography, heart rate variability (HRV) were assessed and compared between the groups. The statistical analysis was performed using the Statistica 10.0, StatSoft (USA) and MedCalc statistical software (USA).

Results. 43 (84.3%) patients with VTA within the 18-months follow-up were assigned to Group 1, and 8 (15.7%) patients without VTA during the 18-month follow-up were assigned to Group 2. The univariate ROC-analysis showed that a reduction in the average NN interval less than 1130 ms (p = 0.0282), root mean square of successive differences less than 18 ms (p = 0.0037) and high frequency spectral component less than 770 ms (p = 0.0001) contributed to the onset of of VTA. Multivariate ROC-analysis demonstrated that the end-diastolic index (p = 0.0185) and standard deviation of NN interval (p = 0.0370) were independent predictors of VTA. An increase of the VTA predictive index (calculated according to the presented predictive model) by >0.5613 suggested the onset of VTA (AUC = 0.927; p = 0.0001).

Conclusion. Reduced HRV may be a non-invasive VTA predictor in patients with CAD. The combined use of echocardiography and HRV analysis allows identifying a group of patients with high risk of sudden cardiac death.

Background. Prevention of complications in patients after coronary stenting by selection of personalized antiplatelet therapy (PAPT) based on platelet function test and genetic analysis have been actively studied. However, it is still an issue of concern. The article presents a meta-analysis of the recent PAPT studies.

Aim. To evaluate the effectiveness of personalized antiplatelet therapy in patients undergoing coronary stenting.

Methods             Fifteen studies with the total of 9,497 patients were included in the meta-analysis. The PAPT studies were searched using the PubMed, Embase and Cochrane Library.

Results. PAPT reduces the risk of major adverse cardiovascular events (RR 0.58, 95% CI 0.42-0.80, p = 0.001), stent thrombosis (RR 0.60, 95% CI 0.41-0.87, p = 0.008) and myocardial infarction (RR 0.43, 95% CI 0.21-0.88, p = 0.02) compared with patients without PAPT. However, no significant differences were found in cardiovascular mortality (RR 0.77, 95% CI 0.51-1.16, p = 0.21), bleeding (RR 0.96, 95% CI 0.81-1.13, p = 0.59) and ischemic stroke (RR 0.81, 95% CI 0.39-1.66, p = 0.57). The effectiveness of PAPT in reducing major adverse cardiovascular events was mainly in patients with high platelet reactivity during dual antiplatelet therapy (RR 0.46, 95% CI 0.27-0.80, p = 0.006).

Conclusion. Personalized antiplatelet therapy significantly reduces the risk of stent thrombosis, myocardial infarction and other major adverse cardiovascular events in patients with coronary artery stenting.

Aim. To compare the effectiveness of various markers of myocardial injury (creatine phosphokinase MB-fraction (CK-MB), cardiac troponin I, measured by standard and high sensitivity methods (cTnI and hs-TnI), and heart-type fatty acids binding protein (H-FABP)) in predicting the ACS course using the GRACE 2.0 score.

Methods. 183 patients with a verified diagnosis of ACS were included in the study. The levels of CK-MB, cTnl, hs-Tnl and H-FABP were measured at admission. Qualitative assessment of H-FABP was performed by immunochromatographic express-tests “CARD-INFO” and “CardioFABP”. Risk assessment of death in the in-hospital period and within the 12-months follow-up period, as well as death and/or acute myocardial infarction (AMI) within the 12-months follow-up was estimated using the GRACE 2.0 score with alternate inclusion of the various cardiomarkers. The effectiveness of the resultant prognostic scales was evaluated using the ROC-analysis and comparison of the areas under the curve (AUC).

Results. 114 patients (62.3%) were diagnosed with AMI and 69 (37.7%) with unstable angina. 10 patients (5.5%) died during the indexed hospitalization. Four patients died within the follow-up and 8 patients (4.4%) had Ami. 94 patients (51.3%) had elevated hs-Tnl levels at admission, 90 patients (49.2%) - cTnl, 45 patients (24.6%) - CK-MB. H-FABP levels were elevated in 70 (38.3%). The express-test “CARD-INFO” was positive in 86 patients (47.0%), the “CardioFABP” - in 125 (68.3%). There were no significant differences found between the stratification of ACS patients by the GRACE 2.0 score into high and non-high risk groups in terms of complications (p<0.05). Similarly, there were no significant differences found between the AUC values of the cardiomarkers in terms of developing the endpoints using the GRACE 2.0 score (p<0.05).

Conclusion. The introduction of H-FABP in the GRACE 2.0 scale is non-inferior to traditional markers of myocardial damage and may be used to stratify risk in patients with ACS.

Aim. To compare the prognostic value of the PRECISE-DAPT, the GRACE 2.0 and the CRUSADE scores and estimate their potential for detecting ischemic and hemorrhagic events within 2 years after ST-elevated myocardial infarction (MI).

Methods. 680 registry patients enrolled in the Kemerovo Acute Coronary Syndrome Registry in 2015 were retrospectively reviewed. Individual risks were calculated according to the PRECISE-DAPT, the GRACE 2.0 and the CRUSADE scores for each patient. The subgroups with the highest risk were allocated for the subsequent assessment. The following retrospective endpoints (deaths, strokes, MI, unstable angina (UA), heart failure (HF), major bleedings) were collected for two years to perform a comparative analysis of the prognostic value of the PRECISE-DAPT score, the GRACE 2.0 score and the CRUSADE to evaluate their prognostic potential to predict hemorrhagic and ischemic events.

Results. Similar rates of strokes (р = 0.530), MI (р = 0.107), UA (р = 0.099) and major bleedings (р = 0.190) in the outpatient settings were found among patients with calculated PRECISE-DAPT and GRACE 2.0 scores. However, PRECISE-DAPT score predicted a smaller number of deaths (р = 0.001) and HF decompensations (р = 0.048). Similar rates of major bleedings (р = 0.714), UA (р = 0.515), MI (р = 0,522), and strokes (р = 0.230) were found between the PRECISE-DAPT score and the CRUSADE score. However, the former was inferior in terms of the incidence of HF decompensations (р = 0.041).

Conclusion. The retrospective comparative study on the sample of MI patients enrolled in the Kemerovo Acute Coronary Syndrome Registry confirmed similar prognostic potential of the PRECISE-DaPt score, the GRACE 2.0 and the CRUSADE scores for predicting a two-year outcome in the outpatient settings.

Aim. To evaluate the effects of long-term treatment adherence in the post-infarction period, taking into account the clinical and demographic data of patients and the prescribed drug therapies.

Methods. A total of 115 patients who survived after myocardial infarction and recruited in the Acute Myocardial Infarction Registry were enrolled in the study. Patients were followed up for 5 years. Treatment adherence was evaluated with the Moriscos-Green scale. Obtained data were processed using the commercially available software Statistica 10.0 and SPSS Statistics Desktop 22.0.

Results. Only 45% of patients who survived after myocardial infarction, strictly followed the recommendations of the attending physician regarding the prescribed drug therapy. The Kaplan-Mayer estimator reported that adherence to treatment in patients with myocardial infarction had a more significant role than the compliance of drug therapy with the existing guidelines. However, the mean values of the lipid profile did not reach the target levels regardless of patients’ adherence. In addition, one patient out of five who was strictly adhered to the medical recommendations did not reach the target levels of blood pressure.

Conclusion. Adherence to treatment is an independent determinant of the effectiveness of secondary prevention of coronary artery disease. Failure to adhere medical recommendations by patients after myocardial infarction leads to a multiple increase in the likelihood of adverse cardiovascular events. However, failure to achieve the target lipid and blood pressure goals even in those patients who were strictly adhered to treatment may be associated with insufficient doses of drugs, thereby requiring particular attention and concern.

Aim. To evaluate the program of rehabilitation services for patients with ACS over the last six years in the Krasnoyarsk Region.

Methods. Data from the National report on the key performance indicators of the Regional Vascular Centers and Primary Vascular Departments of the Krasnoyarsk Region from 2012 to 2017; National reports on the population health of the Krasnoyarsk Region from 2012 to 2017; reports of the healthcare institutions providing outpatient rehabilitation for patients with ACS in the Krasnoyarsk Region were included in the analysis.

Results. Over the past six years the number of patients with ACS decreased in the Krasnoyarsk Region. There were 15,923 patients suffered from ACS in 2012, in 2013 - 13,119, in 2014 - 11,192, in 2015 - 11,019, in 2016 - 10,985, and in 2017 - 9,903. The number of patients with ACS decreased due to the exclusion of patients with unstable angina (UA), while the number of patients with acute myocardial infarction (AMI) remained constant and varied from 5,000 to 5,500 patients. The majority of ACS patients were treated in the Regional Vascular Centers and Primary Vascular Departments where they successfully underwent Phase 1 of the rehabilitation program. At di, all patients were referred to Phase 2 of the rehabilitation program (in-patient) performed in the sanatorium “Yenissei” and “Krasnoyarsk Zagoije”. Phase 3 of the rehabilitation program was provided in the Center of modern cardiology and Professorial Clinic of Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky. The number of ACS patients who underwent rehabilitation after hospital discharge increased over the last years: 5.9% - in 2012, 8.8% - in 2013, 11.9% - in 2014, 13.1% - in 2015, 14.4% - in 2016, 17.1% in 2017.

Conclusion. The majority of patients with acute coronary syndrome (76.4-81.2%) underwent Phase 1 (early in-patient) rehabilitation in the Regional Vascular Centers and Primary Vascular Departments. The number of ACS patients who underwent Phase 2 rehabilitation had been increasing annually. Over the past 6 years the percentage of patients had increased from 5.9% to 17.1%. However, only one-sixth of patients with ACS underwent Phase 3 rehabilitation after hospital discharge. Therefore, the improvements in the management of Phase 2 (in-patient) and Phase 3 the (outpatient) through the integration with the regional hospitals of the Krasnoyarsk Region, increase in the numbers of government contracts in Krasnoyarsk, and formation of the reliable continuity between Phase 2 and Phase rehabilitation are required.

Aim. To study the factors associated with the development of acute coronary syndrome in young adults.

Methods. 299 patients with acute coronary syndrome (ACS) aged 25 to 44 years admitted to the Cardiology Department at the Regional Government Budgetary Healthcare Institution “Altai Regional Cardiology Dispensary” were enrolled in the study. The mean age of patients was 40.3±0.2 years. The control group included 53 healthy subjects without cardiovascular diseases aged 25 to 44 years (the mean age of 39.9±0.79 years). Traditional risk factors were assessed in all patients. CBC and blood biochemistry were performed in all patients to determine lipid profile and fasting glucose levels. Additionally, height and weight were measured with the subsequent calculation of the body mass index. Patients with ACS underwent electrocardiography, echocardiography, coronary angiography. Gene polymorphisms FII G20210A, FV G1691A, MThFr C677T were evaluated by polymerase chain reaction in 116 young adults present with ACS and 53 healthy volunteers.

Results.Based on the comprehensive assessment of the clinical and demographic data, traditional risk factors and hemostatic and folate metabolism gene polymorphisms assessment in young adults, the most significant risk factors associated with the development of ACS in young patients included smoking, elevated low-density lipoprotein cholesterol with the presence of FV G1691A heterozygous polymorphism. The obtained findings could be effectively used in clinical practice to determine patients at high risk of cardiovascular diseases.

Conclusion. Thus, screening for high risk of cardiovascular diseases among young adults should include genetic testing of FV G1691A and MTHFR C677T gene polymorphisms along with traditional risk factors to introduce additional examinations and employ novel preventive strategies.

Aim. To evaluate the morphological and functional cardiac parameters and to measure markers of myocardial injury in the perioperative period of patients undergoing coronary artery bypass grafting (CABG), depending on the prehabilitation program.

Methods. 60 male patients with stable coronary artery disease (CAD) underwent screening in the preoperative period and were randomized into two groups. Group 1 (n = 30) underwent supervised treadmill exercises at intensity corresponding to 80% of VO2 peak during the preoperative management. Group 2 (n = 30) patients did not undergo any additional trainings. Patients underwent a standard echocardiographic (ECHO-CG) study in the preoperative period and at days 5-7 after CABG. Serum markers of myocardial injury (troponin I, NT-proBNP) were measured in both groups of patients in the preoperative period before training (measurement 1), at the end of exercise training sessions (measurement 2) and at days 5-7 (measurement 3) after CABG.

Results. ECHO-CG findings reported that left ventricular end-systolic dimension (p = 0.039) and left ventricular end-systolic volume (p = 0.039) increased by 8.5% and 18% in patients who underwent supervised exercise trainings as compared to the baseline values. An increase in these parameters was more pronounced in the control group (17% (p = 0.00029) and 41% (p = 0.00028), respectively). NT-proBNP levels showed a downward trend in patients with prehabilitation at the end of the training sessions, while in the control group NT-proBNP levels increased. An increase in NT-proBNP levels was reliable in patients without exercise trainings (p = 0.003) after CABG compared to the preoperative values, while NT-proBNP levels did not differ significantly in patients who underwent prehabilitation (p>0.05).

Conclusion. The safety of high-intensity exercise trainings in the prehabilitation program for CABG had been confirmed by laboratory markers of myocardial damage. The obtained data proved the efficiency of active prehabilitation for optimizing echocardiographic parameters and inducing cardioprotection.

The article focuses on the role of catheter ablation in the treatment of ventricular tachycardias associated with myocardial fibrosis. The optimal treatment strategy has been determined. Particular attention is given to the implantation of cardioverter-defibrillators used for the primary and secondary prevention of sudden cardiac death. Poor quality of life and other main problems generally caused by the Abstract                electropulse therapy are described. The role of catheter radiofrequency ablation has been determined as the main method for treating patients experiencing electrical storm or psychological discomfort due to frequent painful defibrillations. In addition, the article covers issues related to the technical and tactical difficulties of performing catheter ablation, and studies the results of recent large-scale clinical research concerning the analysis of its efficiency and safety, including comparison with other treatment strategies.

Recent literary data reports an increase in the prevalence of orthostatic hypotension (ОН) with age and with the presence of comorbidities. In addition, ОН is associated with a high risk of major adverse cardiovascular and cerebrovascular events and may contribute to cognitive impairment and the onset of dementia. Moreover, OH is one of the main risk factors for falls, especially among elderly patients. The review covers recent national and foreign studies focusing on this problem, and presents an updated definition of ОН, its modern classification, pathophysiology, peculiarities of the ОН course in the elderly, guidelines on OH diagnosis and treatment. Particular attention is given to the secondary ОН, commonly known as drug-induced ОН. Its prevalence increases with increased number of medications taken. A list of drugs that may induce ОН and treatment approaches to polypragmasia are provided.

The review summarizes all recent data on the metabolism of cardiac troponin isoforms. The main mechanisms of troponin release from intact myocardium are described. These mechanisms ensure its baseline levels (less than the 99th percentile) in all healthy individuals. There are various fragments of troponin that circulate in the blood flow as a heterogeneous pool. Their circulation is related to various intracellular and extracellular proteases. In-depth understanding ofthese mechanisms is required to improve the diagnostic process. The article provides new insights into the evaluation of cardiac troponins in other human biological fluids: pericardial, cerebrospinal, amniotic, urine, and oral fluid. The measurements of saliva and urine levels of troponins seem to be promising alternative for non-invasive diagnosis. Recent circadian patterns of high-sensitive cardiac troponin T alterations are reported. These patterns should be taken into account while practicing fast diagnostic algorithms.

Cardiogenic shock is a critical condition characterized by rapid development of multiple organ dysfunction in the absence of intensive care. The article describes Abstract    modern concepts about pathophysiology and approaches to treat intensive care. The concept of phased therapy as well as methods of mechanical circulatory support are discussed. The working algorithm for choosing the optimal method was proposed.

The review reports the role of echocardiography in acute cardiovascular care. Current concepts of the ultrasound examinations and the possibility of their application in routine practice are provided. Clinical syndromes and diagnosticechocardiographic algorithms are discussed. The article would be of particular interest for cardiologists and intensivists providing acute cardiovascular care.

Systemic inflammatory response syndrome (SIRS) is a severe complication in surgical patients associated with increased morbidity and mortality. Anesthetics are known to produce certain effects on the immune system and the manifestation of SIRS. The understanding of these beneficial mechanisms allows selecting optimal anesthetics in order to reduce the manifestation of SIRS and infectious complications in the postoperative period.