It was shown in this retrospective analysis of data from the Russian registry of acute coronary syndromes (ACS) RECORD-3 that compared with patients in whom coronary angiography revealed no hemodynamically significant (>50%) stenosis, patients with such stenosis in one vessel (with single vessel disease - SVD) and especially in multiple vessels (with multi-vessel disease - MVD) had much more anamnestic and clinical factors of unfavorable prognosis. Rates of all cause death as well as composite of death and new myocardial infarction (MI) during hospitalization in patients without significant stenosis and those with SVD were not significantly different but rates of these outcomes among patients with MVD were significantly higher than among patients with SVD or without significant stenosis. Presence of MVD was associated with worse remote outcomes developed after discharge from hospital compared with absence of significant stenosis (rate of death, MI, and urgent revascularization was significantly higher for 6 and 12 months after ACS), and compared with SVD (rate of death, MI, and urgent revascularization was significantly higher for 12 months after ACS). During percutaneous coronary interventions bare metal stents were used 2 times more often than drug eluting stents. Implantation of 2 or more stents compared with implantation of 1 stent was associated with higher rate of unfavorable outcomes (composite of death, MI, and urgent revascularization) developed after hospital discharge during 12 months after onset of ACS.

Background. An important aspect of ischemic heart disease (IHD) diagnosis is the assessment of alterations of regional contractility (ARC) of the left ventricle. Speckle tracking imaging is a relatively new diagnostic method used for this purpose. Aim of this study was to identify optimal parameters of left ventricular (LV) deformation by speckle-tracking echocardiography which can differentiate quantitatively degrees of ARC of all left ventricular segments in patients with acute and chronic forms of IHD. Materials and methods. We compared parameters of LV longitudinal, radial, and circular deformation in 216 patients with IHD in dependence on the presence of ARC. Results. The most sensitive and specific indicator of ARC of LV anterior septal wall was found to be the value of longitudinal systolic deformation of the middle and apical segments (diagnostic thresholds -13.5% and 14.7%, respectively). Such indicator for LV inferior wall was value of circular systolic strain (diagnostic threshold for the basal segment -12.9%, for the middle segment -10.7%).

Objective. This study aimed to assess the cognitive functions and cerebral blood flow measured with arterial spin labeling (ASL) and their possible correlations with vascular age in untreated middle-aged patients with grade 1-2 essential arterial hypertension (EAH). Methods. We examined 73 subjects aged 40-59 years (33 with EAH and 40 healthy volunteers [controls]). Neuropsychological assessment included Montreal Cognitive Assessment (MoCA), Trail Making test (part A and part B), Stroop Color and Word Test, verbal fluency test (phonemic verbal fluency and semantic verbal fluency), 10-item word list learning task. All subjects underwent brain MRI. MRI protocol included ASL. Vascular age was calculated by two techniques - using Framingham Heart Study risk tables and SCORE project scales. Results. Patients with EAH had lower performance on phonemic verbal fluency test and lower mean MoCA score (29.2±1.4 vs. 28.1±1.7 points) compared to controls (13.4±3.2, р=0.002; 29.2±1.4, p=0.001, respectively). White matter hyperintensities (WMH) were present in 7.5% controls and in 51.5% EAH patients (р=0.0002). Cerebral blood flow (CBF) in EAH patients was lower in both right (39.1±5.6 vs. 45.8±3.2 ml/100 g/min) and left frontal lobes of the brain (39.2±6.2 и 45.2±3.6 ml/100 g/min, respectively) compared to controls (р<0.001). EAH patients without WMH had lower CBF compared to controls (right frontal lobe: 39.5±5.1 ml/100 g/min, p=0.0002; left frontal lobe: 38.9±4.3 ml/100 g/min, p=0.00002). In EAH patients vascular age (57.7±7.4 and 64.6±11.0 years as measured by SCORE project scales and Framingham Heart Study risk tables, respectively) was significantly (p<0.001) greater than chronological one (50.2±6.2 years) and was significantly (p<0.001) higher than the corresponding values in the control group. Correlation analysis revealed negative significant associations between vascular age and MoCA score, phonemic verbal fluency test score and CBF. Conclusions. Treatment-naive middle-aged patients with uncomplicated grade 1-2 EAH compared to normotensive controls have lower mean scores in phonemic fluency test and MoCA, lower CBF, even in the absence of WMH, which correlates with vascular age, particularly with the value calculated by Framingham Heart Study risk tables. Early vascular ageing is important factor of brain impairment in hypertension in middle-aged patients even at early stages of EAH.

Objective: to assess in patients with arterial hypertension and type 2 diabetes the effect of perindopril/amlodipine fixed combination on arterial wall stiffness (AWF) and microcirculation, and relationship between AWF parameters and the state microcirculation. Materials and methods. We included in this study 30 patients aged 45-65 years. All patients received fixed perindopril arginine/amlodipine besylate combination for 12 weeks. Examination included measurement of AWF of main arterial blood vessels and evaluation of the state of microcirculation. Results. Target blood pressure was achieved in 100% of patients. Mean values of pulse wave velocity of elastic and muscle-type vessels decreased by 8.5 and 10.3%, respectively; number of patients with paradoxical test also significantly decreased (p>0.05). Shunting index and myogenic tone significantly decreased by 21 and 33.6%, respectively. We also observed significant reduction of endothelium-dependent tone component (Д%=36.3%), significant rise of mean value of perfusion (Д%=19.7%), and significant increase of the respiratory test index (Д%=4.5%). There was a statistically significant redistribution of patients by types of microcirculation: the percentage of patients with hyperemic type increased from 26.7 to 43.3%. Conclusion. In patients with arterial hypertension and type 2 diabetes mellitus perindopril arginine/amlodipine besylate fixed combination demonstrated high antihypertensive efficacy, positive effect on parameters of elasticity of main vessels and microcirculation.

Aim: to compare the percentage of endothelial progenitor cells and exfoliated endothelial cells in the total number of cells of lymphocytic fraction in patients with essential hypertension (EH) and practically healthy persons, and to evaluate expression of vasopressin V2 receptor on the endothelial progenitor cells. Materials and methods. We examined 20 patients with 2-3-degree EH and 10 practically healthy persons. Clinical examination of patients included electrocardiography, echocardiography, biochemical blood analysis/isolation of Endothelial progenitor cells were isolated from blood plasma. Immunocytochemical study was performed by the method of combined staining using primary and secondary antibodies. Microscope Olympus FV10i was used for confocal microscopy of endothelial progenitor cells and exfoliated endothelial cells. Results. The percentage of endothelial progenitor cells (phenotype CD31+СD133+) in the total number of cells of the lymphocytic fraction was significantly higher in patients with EH in comparison with healthy individuals (p=0.013 and p=0.008 for 2 and 3 degrees EH, respectively). The percentage of exfoliated endothelial cells (phenotype СD31+СD133-) in the total number of cells of the lymphocytic fraction was also significantly higher in patients with EH in comparison with healthy individuals (p=0.008 and p=0.019 for 2 and 3 degrees EH, respectively). For the first time we identified the localization of vasopressin V2-receptor on the membrane of endothelial progenitor cells. Conclusion. In patients with 2-3 degrees EH the percentage of endothelial progenitor cells and exfoliated endothelial cells of the total number of cells of the lymphocytic fraction is significantly was found to be increased. Localization of vasopressin V2-receptor on the membrane of endothelial progenitor cells was detected.

Aim: to assess the state of vascular bed, parenchyma, and perfusion of lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using the method of subtraction computed tomography (CT). Methods. CT pulmonary angiography (CTPA) was performed in 45 patients with verified CTEPH (18 men, 27 women, age 26-79 years) by CT scanner using the “Lung subtraction” standard protocol. Parameters analyzed were characteristics of the state of main pulmonary artery (MPA) and the right ventricle (RV), and calculated CT angiographic (CTA) obstruction and perfusion defect scores. Results. Significant correlation was found between CTA obstruction score and perfusion defect score (r=0.34, p=0.02). Mean pulmonary arterial pressure (mPAP) correlated with MPA diameter (r=0.4, p=0.02), RV wall thickness (r=0.6, p=0.0003) and the ratio of MPA diameter to ascending aortic diameter (r=0.5, p=0.002). Significant correlation was also found between RV wall thickness and pulmonary vascular resistance (PVR) (r=0.4, p=0.04). Neither CTA obstruction score nor perfusion defect score correlated with PVR and mPAP. The data of CT did not correlate with results of 6-minute walk test. Conclusion. In patients with CTEPH subtraction CTPA allows carrying out complex diagnostics of the state of vascular bed, parenchyma and perfusion of the lungs.

Aim. To reveal the probability and duration of the onset of remission of anxiety-depressive symptoms in patients with CHF III-IV receiving optimal medicine treatment (OMT ) or (OMT ), supplemented with the education program and active outpatient monitoring (OMT + A). Materials and methods. A secondary analysis of the results of RCT CHANCE, which studied the impact of the training program and active outpatient control (further additional exposure (DV) plus optimal medication (OMT) on mortality and cardiovascular hospitalization in patients with CHF III-IV FC. Therapeutic training and outpatient control performed by the cardiologist after discharge from the hospital (weekly in the first month, every 2 weeks for the next 2 months, and then On the basis of the results of the telephone contact, an additional visit could be scheduled, the CHANCE study control group was made up of patients on OMT who were observed as practiced in regular health care setting. Control group had 4 visits to the cardiologist during the 1 year observation. The present analysis included patients on OMT and OMT + DV who had a clinically significant anxiety at the 0 week of the CHANCE program using the Hospital Anxiety and Depression Scale (HADS) (the sum of scores on the anxiety subscale >11), depression (the sum of scores on the depression subscale >11), or a combination of anxiety and depressive symptoms (scores on anxiety and depression subscales >11). Patients who did not pass HADS or SHOCK testing at 0.24 and 48 weeks were excluded from the analyses. A total of 237 patients were included. Severity of HF symptoms were assessed by “Scale of Heart failure Optimizing Clinical Status (SHOCS)” and compared it with the shares of patients who reached remission (HADS scores <11). Results. The sum of SHOCS scores between 0 and 24 weeks in patients in OMT group decreased by 1.9±3.9 in OMT + DV group by -3.8±3.9 (p=0.00007). These differences persisted even at the end of the CHANCE program (p=0.0002), although between 24 and 48 weeks the rate of decrease in the sum of scores in both subgroups slowed to ≈ 1, 2 points (p=0.90). Against the backdrop of pronounced positive dynamics of clinical manifestations of CHF more than 50% of patients, both in the group of OMT, and the group of OMT + DV achieved a remission of anxious and depressive disorders. The symptomatology of mixed anxiety-depressive disorders significantly decreased only in the OMT + DV group. During the period from 24 to 48 weeks, OMT + DV showed comparable efficacy to HTA in the effect on combined anxiety and depressive symptoms. At the same time, OMT + DV was associated with an increased remission rate in patients with depressive (p = 0.05), but not anxious (p=0.72) symptoms. In addition, OMT + DV often contributed to the preservation of remission, which was achieved by week 24 (p=0.01). As a result, by the end of the CHANCE program, the remission level of all studied somato-psychiatric disorders (anxiety, depression, anxiety and depression) with OMT + DV was significantly higher than with OMT alone (p=0.04). Conclusion. The use of education and active outpatient control in addition to optimal medical therapy allows to reach the remission of anxiety-depressive symptoms after 24th week of treatment and prolong it further, at least for the next 6 months in 89.6% of patients with CHF III-IV FC.

Purpose. To study adherence to therapy with statins and its relation to development of cardio-vascular complications (CVC) in patients with stable angina after elective percutaneous coronary intervention (PCI) at five-year observation. Materials and methods. This study comprised 574 patients with stable angina (81% men, mean age 60.3 years) hospitalized for elective PCI. All patients were prescribed therapy in accordance with recommendations on management of stable angina including statins. Adherence to statin therapy after PCI was assessed in 1 year at telephone interview and in 5 years at ambulatory examination and by filling of an adherence questionnaire. The following CVCs were registered during follow-up after hospital discharge: deaths from all causes, cardiovascular deaths, nonfatal myocardial infarctions and strokes, repetitive myocardial revascularizations. Associations of these events with adherence to hypolipidemic therapy were finally analyzed. Results. Mean duration of follow-up was 53.5 (from 3.4 to 67.6) months. In 1 year 490 patients (84.5%) declared that they continued to take statins. In 5 years number of patients who continued taking statins was 380 (66.2%). Doses of statins were low (mean for simvastatin 17.4, atorvastatin - 15.8, rosuvastatin - 12.1 mg). Only in 8.7% of patients level of low density lipoprotein cholesterol (LDLC) was <1.8 mmol/L. During follow-up CVCs were registered in 24% of cases. Number of deaths was 29 (5.1%) including 4 noncardiac (0.7%). Repeat revascularizations were performed in 84 patients (14.6%). Nonfatal MI or stroke occurred in 17 (3%) and 8 (1.3%), respectively. Patients who reported use of statins at 1 year had lower rate of CVC compared with those who reported discontinuation (9 vs. 16.7%, odds ratio 2.3 [95% confidence interval 1.6 to 3.89], p=0.03). Total number of CVCs in 5 years was not different but among patients who continued statins there were significantly less deaths (2.9 vs. 9.3% among those who discontinued statins, p=0.0178). Conclusions. Adherence to therapy with statins both for first year and in 5 years after PCI despite use of mainly low doses and lack of achievement of target LDLC level was significantly associated with better prognosis.

Calcification of cardiovascular tissues and biological substitutes results in abnormal biomechanics, causing stenosis or tissues ruptures. Therefore, the understanding of calcification pathways will facilitate the development of strategies for calcification risk reduction. Even though calcification pathways have been studied since the mid-80s and are widely described in the medical literature, there is no consensus on the cause-and-effect relationships in this pathological process. The current review covers the composition, structural aspects and specific localization of calcific deposits in native heart valves and blood vessels, bioprosthetic heart valves treated with glutaraldehyde. Moreover, experimental data on the composition of in vivo and in vitro calcification are presented. These characteristics of calcific deposits provide new insights in the calcification pathways. According to the results of the literature review, one may conclude that cell death, microfracture of the surrounding tissues with the overall biochemical imbalance may potentiate the calcification process. Moreover, the progression of calcification process is associated with the accumulation of mechanical stress.

In this review article we discuss the clinical and prognostic value of echocardiographic evaluation methods of the right ventricular function and right ventricular - pulmonary artery coupling, advantages and disadvantages of echocardiography in comparison with other instrumental methods of investigation in patients with chronic heart failure.

We present here a case report of recurring fainting due to orthostatic hypotension in a 45-year-old woman with Hodgkin’s’ disease, treated by radiation therapy and resection of cervical lymph node. We discuss difficulties of identification of etiology and mechanisms of orthostatic hypotension as well as possible role of baroreflex failure at the background of the Hodgkin’s’ disease treatment, and vasovagal syncope of which the patient suffered in her youth.