Objective. To study associations of I/D polymorphism of the ACE gene with risk of atrial fibrillation (AF) with the aim of detecting groups of patients prone to development of this disease. Materials and methods. We examined 90 probands with confirmed diagnosis of AF and 144 their I, II, III degrees relatives. These families constituted a core group of our study. The control group comprised 100 relatively healthy people without history of cardiovascular diseases. Methods used in all patients included clinical examination, electrocardiography, echocardiography, Holter ECG monitoring, veloergometry, transesophageal left atrial pacing, molecular-genetic tests. Results. We found statistically significant predominance of genotype II homozygous carriers among probands with primary AF compared with the control group (30.0±7.2% and 14.0±3.5%, respectively; p=0.028). Homozygous carriers of DD genotype statistically significantly prevailed in the control group compared with group of probands with primary AF (36.0±4.8% and 15.0%±5.6%; p=0.014). Carriers of homozygous genotype II for common allele statistically significantly prevailed among probands with secondary AF compared with the control group (34.0±6.7% and 14.0±3.5%, respectively; p=0.004). Homozygous carriers of DD genotype for the rare allele statistically significantly prevailed among control subjects compared to probands with secondary AF (36.0±4.8% and 10.0%±4.2%, respectively; p=0.001). Conclusion. Thus, compared with controls statistically significant preponderance of carriers of homozygous genotype II for common allele was found among probands with both primary and secondary AF. At the same time compared with probands there was a statistically significant predominance of homozygous carriers of DD genotype for the rare allele in the control group. Our findings suggest the heterogeneous nature of AF and confirm that DD genotype homozygosity can be protective against the development of AF.

Aim. To investigate the changes of serum nerve growth factor (NGF) level in patients with arterial hypertension (AH) and obesity in dependence on the degree of psycho-emotional stress and physical activity. Materials and methods. We examined 76 male patients with stage I and II AH with mean age 46.75±0.56 years (36 patients with and 40 without obesity). Control group consisted of 26 individuals without AH, obesity, and cardiovascular diseases. All patients underwent ambulatory blood pressure (BP) monitoring. Serum concentrations of NGF β-subunit and cortisol were determined by enzyme linked immunosorbent assay. For assessment of levels of psycho-emotional stress, reactive and personal anxiety, and physical activity we used Psychological Stress Measure (PSM-25), the Spielberger-Khanin questionnaire, and brief International Physical Activity Questionnaire (IPAQ), respectively. Results. Level of NGF in patients with AH and obesity (0.94±0.28 pg/ml) was higher than in non-obese patients with AH (0.21±0.06 pg/ml; p=0.018) with highest figures in patients with insufficient physical activity and high level of psycho-emotional stress. In all groups of patients there was unidirectional reverse correlation between serum NGF and cortisol levels. According to ambulatory BP monitoring, NGF level was inversely proportional to systolic and diastolic BP variability in patients with AH and obesity and in the control group. Reduced serum concentration of NGF was associated with increased levels of reactive and personal anxiety. Conclusion. Obtained data suggests that NGF plays an important role in complex multifactorial interactions between neuropsychic, cardiovascular and metabolic processes.

Purpose: to determine the role of adipokines and vascular remodeling in formation of osteoporosis in idiopathic pulmonary arterial hypertension (IPAH). Materials and methods. Functional and hemodynamic parameters, bone mineral density (BMD) T-score in lumbar spine (LS) and femoral neck (FN), blood serum levels of leptin, adiponectin, visfatin and endothelin-1 were measured in 27 patients with severe IPAH and 30 healthy volunteers. Results. Half of IPAH patients had osteoporosis. Serum levels of leptin, adiponectin, visfatin and endothelin-1 in IPAH group were higher than in healthy volunteers. BMD T-score was directly related to results of 6-minute walk test and inversely related to pulmonary vascular resistance (PVR). Circulating adiponectin and visfatin concentrations correlated with PVR; endothelin-1 concentration was directly related to pulmonary arterial systolic pressure, cardiac index and PVR. Relations between BMD T-score and circulating adiponectin, visfatin, and endothelin-1 were inverse. Positive correlations existed between serum adiponectin, visfatin and endothelin-1 levels. Conclusion. Results of our study confirm the important role of adipokine and endotheline dysregulation in development of hemodynamic disorders in severe IPAH and evidence for their possible involvement in formation of osteopenic syndrome.

Aim : to analyze parameters of vascular stiffness and augmentation index in patients with familial hypercholesterolemia (FH). Materials and methods. We compared parameters of vascular stiffness of 88 normotensive FH patients (mean age 41.95±1.43 years, 43 men [48.9%]) and 68 subjects with normal blood lipid spectrum (mean age 37.58±1.02 years, 21 men [30.9%]). FH was diagnosed according to the criteria of the Dutch Lipid Clinic Network. Examination included lipid profile, 24-hour blood pressure (BP) monitoring with assessment of arterial stiffness. Results. Normotensive FH patients had higher pulse wave velocity (PWV) (7.99±0.17 m/s) in comparison with patients with normal lipid spectrum (6.87±0.10 m/s), p<0.05. In patients with FH significant changes of properties of both direct and reflected waves were also detected with increasing age. Increasing BMI in FH patients was associated with greater changes of the reflected wave and PWV variability. Conclusion. Changes of properties of vascular wall in FH patients even at preclinical stages are more pronounced than in subjects with normal blood lipid profile.

Congenital aneurysms and diverticula of the left ventricle represent a rare group of anomalies in the spectrum of congenital heart disease. Although natural histories of these anomalies are considerably different and characterized by different rates of life-threatening events, similarity of their clinical presentation and diagnostic criteria do not allow to differentiate this anomalies at routine examination. Data on etiology, methods of diagnosis and treatment published by various authors is controversial. In this review we present relevant aspects of etiology, pathophysiology and treatment strategy of patients with left ventricular diverticula and congenital aneurysms.

This review is devoted to the use of antiaggregants. We consider here pathogenesis of intraarterial thrombosis, mechanism of action of antiaggregants, and recommendations on the use of drugs of this class for primary prevention of cardiovascular diseases and prevention of atherothrombotic complications of stable ischemic heart disease. Information on mechanisms of development and causes of resistance to antiaggregants is also presented. Finally we discuss the problem of safety of therapy with antiaggregants, methods of lowering the risk of bleeding, and prevention of aspirin induced gastropathy.

Use of highly concentrated ethyl esters of polyunsaturated fatty acids after myocardial infarction (MI) and in patients with heart failure was associated with lower mortality. ^e goal of this analysis was to perform cost-utility analysis of the use of highly concentrated ethyl esters of polyunsaturated fatty acids after MI (with help of a Markov model) and to find whether its use in some group of patients led to decrease in budget costs. As a result, we have shown that use of highly concentrated ethyl esters of polyunsaturated fatty acids after MI leads to increase in quality-adjusted life expectancy on 0.5 QALY, with incremental cost-effectiveness ratio of 105 thousand rubles per QALY, and net monetary benefit of 780.5 thousand rubles. In the patient subpopulation that receives highly concentrated ethyl esters of polyunsaturated fatty acids for arrhythmia prevention after coronary artery bypass the estimated decrease of budget cost varies between 6 and 50% depending on denominator used.

Coronary artery embolism (CAE) takes an important place among non-atherosclerotic causes of acute myocardial infarction (AMI). The features of embolic AMI are difficulties in diagnostics and absence of evidence-based guidelines for the management of CAE. Purpose of this review - to present synthesis of available data on embolic AMI. We also report here three cases demonstrating new approaches to treatment of CAE.

The article contains an outline of the 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation. This document considers in detail problems of necessity and safety of temporary interrupting of anticoagulation for the period of procedure, main principles of interruption and restarting anticoagulant therapy after procedure, indications to the transitional (bridging) therapy in the periprocedural period, as well as possible strategies of periprocedural management of patients in dependence of risk of bleeding and thromboembolic complications. This Expert Consensus Decision Pathway refer to the periprocedural use of both oral (vitamin K antagonists, new oral anticoagulants) and parenteral (unfractionated and low-molecular-weight heparins) anticoagulants.