Purpose: to assess the possibility of the use of ADP induced blood-clotting time measurement in clinical practice prognostication of the course of acute coronary syndrome (ACS) and assessment of effectiveness of antiplatelet therapy (APT). Materials and methods. We enrolled in the study 163 male patients admitted to the coronary unit for acute coronary syndrome (ACS) and 38 male practically healthy volunteers (PHV). ADP induced blood-clotting time (ADP BCT) was measured as time (sec) between addition of ADP (10 μcmol) to recalcificated sample of citrate blood and clot formation. In healthy volunteers ADP BCT was determined before and 45 minutes after oral administration of acetylsalicylic acid (ASA, 250 mg). Risk of cardiovascular death was calculated using the GRACE score. Platelet function tests were performed by optical aggregometry. Follow-up period for patients with ACS was 24 months. The primary end point (PEP) was the composite of cardiovascular death and rehospitalization. Results. In ACS patients ADP BCT was significantly lower than in PHV: 134.8 (109.9; 161.3) vs 85.7 (60.5; 108.7) sec, p=0.015. In PHV ASA increased ADP BCT - 103.2 (95.1; 130.7) vs 133.1 (102.8; 154.3) sec, p=0.041. ADP BCT correlated with age in both PHV and patients (R= -0.431, p<0.05 and R= -0.398, p<0.05). In patients ADP BCT correlated with hematological and coagulation parameters, and with calculated cardiovascular death risk (R= -0.51, р<0.05). 24-months mortality of patients was 10.42%. ADP BCT <80 sec was associated with significant increase in the risk of occurrence of PEP (hazard ratio 2.7, 95% confidence interval 1.1 to 6.4). Conclusion. ADP BCT is a quantitative easily performed test characterizing platelet hemostasis and may be used in clinical practice for monitoring APT. In patients with ACS ADP BCT correlates with cardiovascular death risk. ADP BCT <80 sec (during APT) is a marker of increased 24-months risk of recurrent cardiovascular thrombotic complications.

Purpose: to study structural functional characteristics of the heart in patients with various types of abnormalities of diastolic function (DF) based on data obtained at stress echocardiography (stress EchoCG) and echocardiographic indexes of myocardial deformation. Materials and methods. We included in this study 110 patients with hypertensive disease (HD), clinically manifest chronic heart failure (CHF), and abnormal DF of the left ventricle (LV) in the absence of coronary artery stenosis. All patients underwent standard clinical and laboratory examination, EchoCG with measurement of 3-dimensional global longitudinal strain (GLS), and stress EchoCG on treadmill with evaluation of DF parameters. Results. In the group with abnormal relaxation in patients with Е/e’ >13 left atrial (LA) passive emptying fraction and distensibility index (27.1±14.5 and 127.8±96.1%, respectively) were significantly smaller than in other patients of this group (34.8±14.2 и 207.7±86.8%, respectively; р<0.05). Analogous pattern was observed in the group with transitional type of DF abnormality: patients with Е/e’ >13 during exercise had lower LA passive emptying fraction and distensibility index (р<0.05). In patients with Е/e’ >13 during exercise, degree of reduction of LV contractility was similar irrespective of type of DF abnormality. In patients with different degrees of DF derangements (abnormal relaxation, transitional or restrictive type) Е/e’ >13 during exercise was accompanied by similar lowering of mitral annular systolic velocity at rest (7.1±1.58, 6.9±1.13, and 6.79±0.93 cm/s, respectively). There were also no significant differences between these groups in values of 3-dimensional GLS (-11.2±1.5, -10.4±0.94, and -11.8±1.97%, respectively). Conclusion. Elevation of LV filing pressure during stress EchoCG evidence for non-homogeneity of groups of patients with different degrees of DF abnormalities, presence of deeper structural-functional changes of the cardiovascular system, accompanied by reduction of myocardial contractility as well as LA reservoir and pump function. The use of stress EchoCG for evaluation of parameters of myocardial deformation allows to improve diagnostics of CHF in patients with preserved LV ejection fraction and directs to determination of criteria of preclinical manifestations of CHF.

We included in this study 652 patients with persistent disturbances of heart rhythm and conductiion who attended a cardiologist of the consulting center during 2 years. Analysis of results of examination of these patients was aimed at identification of possible etiologic factors of the appearance of arrhythmias. In 48 patients (8.84%) we did not identify any apparent cause of arrhythmia. This group of patients underwent cardiac magnetic resonance imaging (MRI) for clarifying the nature of arrhythmias. In 32 patients MRI allowed to establish probable cause of a rhythm disturbance. Data of the study draws attention to high rate of detection of MR-signs of myocarditis (in У of patients subjected to MRI).

Objective: to investigate influence of different forms of adiponectin on carotid intima-media thickness (CIMT) in women with abdominal obesity (AO) in St.-Petersburg. It has been recognized before that AO is associated with cardiovascular diseases, including atherosclerosis, but mechanism of this association remains unclear. AO leads to imbalance of adipokines, in particularly decrease of adiponectin, which may lead to atherosclerotic lesion of carotid arteries. Materials and methods. We investigated 81 women with AO (IDF criteria, 2005) and 21 women with normal waist circumference. CIMT was evaluated by an ultrasound scanner. Results. Among patients with AO 54.9% had CIMT >0.9 mm and 38.5% had atherosclerotic plaques in common carotid arteries. The total adiponectin level (TA) was lower in women with CIMT> 0.9 mm, than in women with normal CIMT (23.20 [2.55; 40.65] and 18.09 [1.60; 38.92] μg/ml, respectively; р<0.05). Level of high molecular weight adiponectin (HMWA) was lower in women with CIMT >0.9 mm, than in women with normal CIMT (2.21 [0.50; 6.85] and 2.88 [1.29; 15.45] μg/ml, respectively; р<0.01). Level of HMWA but not of TA was more in women with CIMT >0.9 mm, than in women with CIMT >0.9 mm and atherosclerotic plaques in carotid arteries (3.09 [1.34; 6.85] and1.82 [0.50; 2.94] mcg/ml, respectively; р<0.05). According to logistic regression analysis CIMT >0.9 mm depended on waist circumference, diastolic blood pressure and level of C-reactive protein (CRP), while presence of atherosclerotic plaques was associated with levels of HMWA and CRP. Conclusions. Factors that make the greatest contribution at early stages of atherosclerosis development in carotid arteries in women with AO can be increased waist circumference, high diastolic blood pressure, and high level of CRP. At later stages of atherosclerosis development lowered HMWA level can contribute to the formation of atherosclerotic plaques.

Recently, the notion that in 60-80% of cases the origin of the pulmonary veins (PV) is the place of origin of atrial fibrillation (AF) has become widespread. It has been shown that in this area, under the action of norepinephrine (HA), in the absence of stimulation, an intrinsic rhythm appears. Using two-channel microelectrode leads (from the mouth and distal part of the PV) in rats weighing 350-450 grams, it was found that: 1) in the distal part of PV there are cells with depolarized resting potential (RP) up to -50 mV, which under normal conditions are not excitable; 2) in 17 experiments out of 23, various blocks of excitation conduction along PV were revealed; 3) in 8 experiments out of 23, a reflected excitation wave - echo from PV - was recorded. Myocardium of PV is an extremely heterogeneous medium with a strong variance in the duration of the action potential and variable rate of conduction, which contributes to the occurrence of different types of conduction blocks and causes echoes and other rhythm disturbances.

The main place among cardiovascular diseases takes coronary heart disease. The number of coronary artery bypass surgery increases every year. The large number of coronary artery bypass grafting (CABG) performed worldwide. The need for assessment of grafts patency is enormous. Objective. We are performed analyze of graft patency results, after CABG surgery in our clinic. Materials and Methods. The paper presents the results of a retrospective analysis of angiographic graft patency data depends of TIMI flow, Syntax score, diameter and degree of vascular lesions, as well as the surgery type. Results. According angiographic data of 142 patients, we found that 74 (52.1%) had no graft dysfunction. In the 68 (47.9%) patients had various types graft dysfunction which is 3.0% of the total number of operated patients in our center for coronary heart disease. 31 (46%) patients were operated under Off pump, 19 (28%) - On pump and 18 (26%) - in a parallel bypass technic. According to our data parameters such as Syntax score, the diameter of the vessel and the percentage of lesion, its did not significantly affect the grafts patency in terms of up to 12,7±6,5 months. Preoperative coronary blood flow (assessed by TIMI scale) the significantly affects the grafts patency. Conclusions. In the graft patency for perioperative period and follow-up, significantly affected preoperative coronary blood flow assessed by TIMI. The results of beating heart (off pump and using a parallel IR) and On pump surgery similar in the immediate postoperative period. But there is tend to increase graft dysfunction in up to 30 months in patients after off pump surgery. We don’t found relation between Syntax score, the diameter of the coronary arteries, the percentage of stenosis and graft patency after 12 months follow-up.

Purpose: to identify early markers of development of cardiovascular diseases (CVD) in women. Materials and methods. Female first-degree relatives from 39 families formed 2 groups: families (n=19) containing mothers with arterial hypertension (AH) (group 1) and healthy daughters (group 1a); families (n=20) containing practically heathy mothers (group 2) and healthy daughters (group 2a). We assessed data of anamnesis, including registration of cardiovascular risk factors, and family history of CVD. Examination included registration of anthropometric parameters, automatic and manual measurement of intima-media thickness (IMT) and resistance indexes of brachiocephalic arteries (BCA). We also determined cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), and measured magnitude of ß-adrenoreception of membranes (ß-ARM) of erythrocytes in micro-quantities of venous blood. Results. Mothers in both groups of families had excessive body mass or obesity. Mothers of group 1 had more pronounced signs of abdominal obesity (AO). They also had abnormalities of IMT and sings of subclinical atherosclerosis of BCA. CAVI in this group was significantly higher than in group 2. In group 1a median BMI (25.5 kg/m²) and waist/hip ratio were significantly higher than in group 2a. Daughters of group 1a contrary to group 2a had abnormalities of vascular wall: increased automatically measured IMT of carotid arteries and elevated CAVI. Arterial pressure and heart rate (HR) in group 1a were within limits of physiological norm but significantly higher than in group 2a. All included women had elevated ß-ARM values but in group 1a this parameter was significantly higher than in group 2a and moderately correlated with HR. Conclusions. Risk factors of CVD development in women are AH, AO, high activity of the sympathoadrenal system. These factors provoke changes of vascular wall (elevation of its stiffness and early subclinical atherosclerosis). In daughters of mothers with AH important prognostic components of CVD risk in addition to family history of CVD are AO, systolic blood pressure (BP) >120 mm Hg, diastolic BP >78 mm Hg, HR approaching upper limit of physiological norm, and high CAVI (indicator of vascular wall stiffness).

In this review, modern possibilities of nuclear imaging modalities in cardiology are considered. Perspectives of this branch of radiology are described according to the latest technological and methodological inventions and new clinical data.

Lipoprotein(a) [Lp(a)] consists of an LDL-like particle in which the apolipoprotein B100 is covalently bound to apolipoprotein(a) by a single disulfide bond. Lp(a) is synthesized in the liver and its plasma concentration varies from 0 to 400 mg/dl. Increased level of Lp(a) is considered to be an independent risk factor of cardiovascular diseases and coronary heart disease. Data about the significance of hyperlipoproteinemia(a) in the development of atherosclerosis of peripheral (lower limbs) and carotid arteries remain controversial. This review is devoted to Lp(a), its relationship with atherosclerosis of different vascular beds, as well as modern possibilities of hyperlipoproteinemia(a) correction.

The review analyzes literature data on the phenomenon of chronic heart failure as a clinical syndrome of hypoperfusion of organs and systems of the body due to multiple causes of pumping inadequacy of the circulatory system. Special attention is paid to diastolic heart failure of different origin. Attention is drawn to the fact that integrated quantitative characteristic of CHF of any origin is indexed cardiac output (CO) rather than ejection fraction, and that allocation of systolic and diastolic CHF is a relatively conventional division concept. It has been shown that in heart failure of any origin, cardiac output is reduced, resulting in diminished supply of oxygen and substrates to tissues of the body. The variety of causes of heart failure with preserved ejection fraction makes it impossible to correct hemodynamic disturbances by “standard set" of drugs. Normalization of the balance between delivery of oxygen/substrates and metabolic demands of tissues may be a key approach to the treatment of diastolic heart failure of different origin.

Chronic heart failure with preserved ejection fraction (HFpEF) accounts for about 50% of cases of heart failure, but pharmacotherapy that improves its outcomes has not been developed. The proven principle of improving outcomes in patients with chronic heart failure with a reduced of left ventricular ejection fraction is the decrease in heart rate. The article discusses situations in which treatment with ß-blockers is not effective or negatively affects outcomes. The results of own research and the EDIFY project, in which ivabradine was used in patients with HFpEF, were compared. The importance of phenotyping patients with HFpEF is stated to increase the effectiveness of their therapy.

We present a clinical case of successful correction of aneurismatic dilatation of the anastomosis zone after allotransplant implantation. In 2004 this patient underwent implantation of an arterial allotransplant of “complex architectonics” because of trauma of the iliofemoral arterial segment. After 12 years he reported appearance of discomfort in the left side of the abdomen. Duplex ultrasound scanning revealed aneurism at the site of anastomosis of the prosthesis with internal iliac artery. Therefore, we performed endovascular isolation of the aneurism with the use of a stent-graft and restoration of blood flow down to the extremity periphery has been performed.

A clinical case of apical hypertrophic cardiomyopathy (HCM) in 44-years old man is presented. In this patient exercise ECG testing and 24-hour ECG monitoring revealed exercise-induced ST depression in the angiographically confirmed absence of coronary atherosclerosis. The uncommonness of this observation was the combination of HCM with a rare anomaly of coronary arteries origin.