Aim. To assess frequency and prognostic value of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Materials and methods. We included in this prospective observational study 233 patients with STEMI. Duration of follow-up was 6 months. During this period, we traced development of CI-AKI with subsequent analysis of relation of CI-AKI to STEMI outcomes. Results. CI-AKI was registered in 29.6% of patients. Hospital mortality was 14.5 and 6.1% among patients with and without CI-AKI, respectively (p=0.037). Mortality from cardiovascular causes during the follow-up period was 17.4 and 7.3%, respectively (p=0.021). CI-AKI was associated with increase of risk of death during hospitalization (odds ratio 2.6, 95% confidence interval 1.033-6.592, p=0.042). The development of CI-AKI was associated with glomerular filtration rate <60 mL/min at hospital admission (p<0.001) and female sex (p<0.001). Conclusion. CI-AKI is often found in patients with STEMI and is associated with an unfavorable prognosis.

The aim of the study was to analyze clinical features of patients with premature acute coronary syndrome (ACS) in relation to family history of cardiovascular disease (CVD) and familial hypercholesterolemia (FH). Materials and methods. Of 2832 patients included in ORACUL 1 and ORACUL 2 multicenter observational trials 512 pts who developed premature ACS (≤55 years for men, ≤60 years for women) and had known family history and LDL level were selected for this study. Of these patients 297 had positive family history (51 with FH, 246 no FH), 215 had negative family history. Results. Among patients with positive family history there were more women (31 vs 20.9%), while among patients with negative family history there were more men (79.1 vs 69%). The fact of regular alcohol consumption was significantly more frequently observed among patients with positive family history but without FH, compared to patients with positive family history with FH (69.6 vs 47.1 %). Women with positive family history smoked more frequently than females with negative family history (51.1 vs 31.1%). Among patients with negative family history compared with patients with positive family history there were more people who at admission had hyperglycemia exceeding 11.1 mmol/l (10.3 vs 4.4%). Multiple vessel disease and coronary calcinosis were present in 73.2 and 24.7%, respectively, of patients with positive family history, and in 56.9 and 9.8%, respectively, of those with negative family history. Among patients with positive family history multivessel disease was more frequent in the subgroup with FH, while coronary calcinosis was more frequent in the subgroup without FH. Conclusion. Thus, premature development of ACS might be associated not only with genetic factors but also with family history (“inheritance”) of adverse habits. Herewith coronary calcinosis is more prevalent in patients with FH.

Aim. To assess the dynamics of parameters of myocardial electrical instability in patients with ST-elevation (STE) myocardial infarction (MI) treated with various doses of atorvastatin. Materials and methods. Patients with STEMI (n=70), who received atorvastatin 20 or 80 mg/day for 48 weeks, were divided into two groups: group “Е” - 38 patients (54.3%) in whom by 48-th week target values of low density lipoprotein cholesterol (LDLC) were achieved, and group “NE” - 32 patients (45.7%) in whom these levels were not achieved. On days 7-9, at 24^th and 48^th weeks after onset of MI the patients underwent 24-hour 12-leads ECG monitoring with subsequent analysis of parameters of myocardial electrical inhomogeneity: late ventricular potentials (LVP), dispersion of QT-interval duration, heart rate variability (HRV) and turbulence. Results. After of treatment with atorvastatin target value of LDLC was achieved in 73.5 and 36.1% of patients receiving 80 and 20 mg/day, respectively. In the group “E” we observed positive dynamics of LVP parameters (QRSf - p<0.01, HFLA - p<0.001, RMS - p<0.05), decreases of QTa disp (p<0.05) and sdQTa (p<0.01), favorable transformation of HRV temporal (SDNNi, pNN50 - p<0.05, RMSSD, TINN - p<0.01) and frequency indices (Hfp, L/H -p<0.001). Most striking evolution in this group referred to HRV during night hours. Conclusion. Atorvastatin induced achievement of target LDLC values decreased myocardial arrhythmic readiness what was reflected by reduction of frequency of LVP registration and dispersion of QT duration, increase of activity of the parasympathetic link of vegetative regulation of cardiac activity.

Purpose: to identify factors associated with moderate and severe secondary mitral regurgitation (MR) in ischemic heart disease patients without myocardial infarction depending on gender. Materials and Methods. From the Register of coronary angiography we selected men and women with significant coronary stenosis (≥75% of lumen in at least one epicardial artery) who had no acute or previous myocardial infarction: 1001 men without and 66 men with moderate or severe MR, 183 women without and 20 women with moderate or severe MR. Results. According to mulrivariate analysis irrespective of gender MR was independently associated with disorders of cardiac rhythm and conduction (odds ratio [OR] 7.92, 95% confidence interval [CI] 3.21-19.57, р<0.001, and OR=4.05, 95%CI 1.15-14.35, р=0.030 in men and women, respectively), increased index of left atrial dimension (OR=1.25, 95%CI 1.09-1.43, р=0.002 in men, and OR=1.49, 95%CI 1.15-1.93, р=0.003 in women), decreased left ventricular (LV) ejection fraction (OR=0.82, 95%CI 0.75-0.89, р<0.001 in men, and OR=0.86, 95%CI 0.76-0.96, р=0.008 in women). MR in men was also associated with worse CCS angina class (OR=0.49, 95%CI 0.24-0.98, р=0.044) and older age (OR=1.09, 95% CI 1.03-1.16, р=0.005). Conclusions. Irrespective of gender no association between moderate and severe secondary MR and localization of significant coronary lesions in IHD patients without myocardial infarctions was found. Revealed associations are suggestive of mixed (ischemic and non-ischemic) origin of MR in these patients.

Objectives. To study associations between genes of different functional classes, including fibrogenesis genes, with coronary atherosclerosis and specific features of its course. Methods. We included in this study404 patients with confirmed chronic ischemic heart disease (IHD) who had undergone coronary artery bypass grafting. Two groups of participants were distinguished - those with (n=188) and without (n=216) history of myocardial infarction (MI). Control group consisted of inhabitants of the Siberia region (n=285). Associations were analyzed using 48 single nucleotide polymorphisms (SNP) located in genes earlier determined as associated with diseases of the cardiovascular continuum (diabetes mellitus, MI, atherosclerosis). Multiplex genotyping was performed using mass spectrometry. For statistical analyses we used Statistica v8.0 and R-language with “stats” and “genetics” packages. Results. We identified several genetic markers contributing to susceptibility to development of atherosclerosis. Same markers were identified as determinants of the character ofthe course of atherosclerotic disease. Risk of development of atherosclerosis was higher in carriers of the following genotypes: TT of ITGB5 gene (rs1007856) - by 1.6 times (OR=1.59; р=0.0153); GG of ITGA4 gene - by 1.85 times (OR=1.85; р=0.0016); GG of IGFBP7 gene (rs11133482) - by 2.4 times (OR=2.36; р=0.0031). The following genotypes were identified as protective against MI and determining stable course of the disease: AA of TLR4 gene (rs4986790) (OR=0.47; р=0.0104).; CC of LDLR gene (rs2738446) (OR=0,53; р=0.0041); GG of OAS1 gene (rs1131454) (OR=0.50; р=0.0274). Conclusion. Susceptibility to coronary atherosclerosis and prognosis of disease progression were found to be associated with polymorphism of certain genes, involved in metabolism of the extracellular matrix and processes of fibrogenesis (ADAMDEC1, ITGA4, ITGB5, CDKN2B-AS1, IGFBP7), lipid metabolism (LDLR), immune system functioning (TLR4, OAS1) and DNA repair (LIG1).

Aim: to study the renin-angiotensin-aldosterone-system (RAAS) in patients with polymorphic variants of the vitamin D receptor gene (VDR), arterial hypertension (AH) and obesity. Materials and methods. We included in this study 98 patients with stage II-III AH and obesity (33 men, 65 women, mean age 61.1±9.9 years and BMI 43.3±5.0 kg/m²). The VDR gene study included genotypes TaqI, BsmI, FokI. After identification of TaqI, BsmI, FokI VDR gene sites we carried out measurements of levels of RAAS markers. Results. We revealed an associative relationship between the presence of allele G of the BsmI site, C/C homozygosity of FokI site of VDR gene and presence of AH in patients with obesity. An increase of renin level was noted only in the homozygous T/T genotype of FokI, no differences in the concentration of aldosterone and angiotensin were detected between any of the studied genotypes. Conclusion. Polymorphic alleles and genotypes of the VDR gene can be used as predictors of AH development in obese patients with subsequent characterization of the state of the RAAS system.

Objective: to compare hypotensive and pleiotropic effects of angiotensin II receptor blocker (ARB) azilsartan medoxomil (AM) and angiotensin converting enzyme inhibitor (ACEI) fosinopril in patients with concomitant arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). Materials and methods. We included in this open study 49 patients with concomitant stage I-II AH and COPD. Initially all patients received hydrochlorothiazide (12.5 mg/day) and various ACEI but target blood pressure levels were not achieved, and these ACEI were withdrawn. By method of closed envelopes, the patients were divided into 2 groups. Patients of group 1 were given ARB АМ, of group 2 - ACEI fosinopril. Methods of investigation were repetitive 24-hour ambulatory blood pressure monitoring (ABPM), spirometry, measurement of mean pulmonary artery pressure (mPAP), study of endothelial function by instrumental and laboratory methods. Results. After 4 weeks of treatment with AM target BP level (<140/90 mm Hg) was achieved in 20 patients (87%), by month 2 BP was normalized in all group 1 patients. After 4 weeks ABPM showed significant decrease of variability of systolic and diastolic BP, according to Doppler echocardiography mPAP lowered in 16 patients (70%), endothelium-dependent vasodilatation (EDVD) rose up to 9.5±1.7%. By month 6 EDVD rose up to 11.9±1.1%. Spirometry after 6 months revealed significant increase of forced expiratory volume in the first second (FEV1) up to 69.06±16.18% of predicted value (p<0.05 compared to baseline). After 4 weeks of treatment with fosinopril (20 mg/day) target BP was achieved in 22 patients (85%). In 2 months BP normalized in 23 patients. In 3 remaining patients the dose was increased up to 40 mg/day and on month 3 BP became normal in all patients. After 4 weeks of treatment ABPM showed significant decrease of variability of systolic and diastolic BP, in 15 patients we observed lowering of mPAP. However, no changes of bronchopulmonary system were observed during treatment with fosinopril. Conclusion. Treatment of patients with AH combined with COPD with AM compared with treatment with fosinopril produced greater positive effect on BP profile. In addition, choice of AM was associated with greater degree of realization of pleiotropic effects.

Purpose: to assess effectiveness of algorithms of minimization of right ventricular pacing (MRVP) for prevention of progression of atrial fibrillation (AF), lowering of frequency of hospitalizations due to cardiovascular causes, and mortality in patients with sick sinus syndrome (SSS) and history of paroxysmal AF compared with standard compared with dual-chamber pacing (DDDR). Materials and methods. We included in this single-center prospective study 74 consecutive patients with indications to permanent DDDR pacing be cause of SSS combined with documented history of paroxysmal AF. Patients were randomized in the groups of DDDR pacing (n=36) and with activated algorithms of MRVP (n=38). Pacemaker check up was made after 6 months during 1 year after device implantation. Primary composite endpoint included development of persistent AF, hospitalization due to cardiovascular causes, and all cause death. Results. During follow-up there was no statistically significant difference in achievement of the primary endpoint (27.8 and 18.4% in groups of DDDR pacing and activated algorithms of MRVP respectively (relative risk 1.29% confidence interval 0.43 to 3.86; p=0.25). Rate of development of persistent AF in both groups was comparable (8.6 and 5.3% in DDDR and MRVP groups, respectively; p=0.47). Median AF burden was 6.0 (0;42) and 6.0 (0;42) min/day in DDDR and MRVP groups, respectively (p=0.67). Conclusion. Our study failed to demonstrate advantages of the use of algorithms of decreasing “unmotivated” right ventricular pacing over standard regimen of standard DDDR pacing in patients with SSS and history of paroxysmal AF.

Objective: to study the impact of social, demographic and behavioral factors on 5-year survival rate in persons older than 75 years living in Moscow and the Moscow region. Materials and methods. We included in this prospective observational study 283 patients (25% men, age 75-98, mean 86.8±4.3 years) after stay at the Russian gerontological clinical research center. To study social and behavioral factors we recorded anthropometric parameters and used questionnaires. Duration of follow-up was 5 years. Endpoint was death from any cause. Results. One hundred five patients (37.1%) died during the follow-up (median 3.8 years). Survival analysis using the Kaplan-Meier method revealed a number of parameters that affected 5-year survival: age, deficient and excessive body weight, consumption of less than 1 liter of water per day, start of the night sleep after midnight, nighttime sleep duration >10 h, level of physical activity and history of blood donation. At multivariate analysis adjusted for age and sex the following factors were independently associated with death during follow-up: weight deficiency (hazard ratio [HR] 7.36, 95% confidence interval [CI] 2.15-25.26, p=0.001), second degree obesity (HR 0.47, 95% CI 0.25-0.87, p=0.016), start of night sleep after midnight (HR 2.53, 95% CI 1.32-4.85, p=0.005), nighttime sleep duration ≥10 h (HR 3.89, 95% CI 1.77-8.59, p=0.001), and history of blood donation (HR 0.24, 95% CI 0.09-0.62, p=0.003). Conclusion. In people older than 75 years late sleep initiation and long duration of night sleep, and weight loss increase the risk of death in the next 5 by years, 2.5, 3.9 and 7.4 times, respectively, while overweight and history of blood donation are associated with 53% and 76% reduction of the risk of death.

Objective: comparative assessment of informativity of parameters of arterial wall stiffness - the cardio-ankle vascular index (CAVI), the augmentation index (AI) - for solution of problems of screening patients being under threat of realization of complex impact of metabolic syndrome (MS) and elevated vessel wall stiffness, both creators and markers of high risk of severe cardiovascular complications. Materials and methods. We examined mining industry employees (n=206) with cardiac risk factors (arterial hypertension, abdominal obesity, and smoking). Comparative group comprised 75 employees of the same enterprise without above-mentioned risk factors. Studies of arterial wall stiffness included determination of CAVI and AI. The sensitivity, specificity and accuracy of the screening method were calculated. Results. CAVI and AI parameters had different sensitivity, specificity and accuracy for identifying patients at risk of cardiovascular complications. AI was 2 times more sensitive than CAVI during examination of patients with only clinical and anamnestic cardiovascular risk markers and patients with clinical-anamnestic and laboratory risk markers. Specificity of AI was lower than specificity of CAVI and attained only 34.4% in patients with clinical-anamnestic and laboratory risk factors. At the same time, specificity of CAVI in these patients reached 86.2%. Accuracy of AI for screening study was 1.4 times higher than that of CAVI in patients with only clinical-anamnestic risk markers, and 1.6 times higher in patients with both clinical-anamnestic and laboratory risk markers. Moreover, after comparing patient groups with individually high and normal CAVI and AI, we found the differences in metabolic laboratory risk factors (glucose, total cholesterol, triglycerides and the Atherogenic Index) only for AI.Conclusion. Parameters of arterial stiffness have different informative value for screening of patients with clinical-anamnestic or laboratory risk factors. AI compared with CAVI is 2 times more sensitive and 1.6 times more accurate but has lower specificity for risk factor screening among patients being under threat of realization of complex impact of MS and elevated vessel wall stiffness.

In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlodipine/ perindopril combination for lowering day-by-day BP variability.

The article presents key points of published in March 2017, Guideline for the Evaluation and Management of Patients With Syncope (A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society). This document contains summary and analysis of evidence base and accumulated experience in this field and reflect further development of the problem of the management of adult and pediatric patients with suspected syncope. Traditionally, the basis of diagnostic algorithm of these patients has been primary examination, and in the present guideline one can find strengthening of the importance of anamnestic criteria, and supplementation of ECG criteria of arrhythmic syncope. At the same time, the diagnostic value of provocative tests has been revised, and the class of indications for these tests has been lowered. According to the guideline, along with diagnosis of the cause of fainting, risk stratification of short- and long-term adverse outcomes has a key value. The guideline summarizes latest achievements in the treatment of fainting in sarcoidosis, arrhythmogenic right ventricular dysplasia, primary arrhythmic heart diseases, orthostatic hypotension, and reflex-mediated syncope. Despite orientation on specific properties of medical care in the USA, the guideline can be useful to practical physicians in choice of the best strategy of diagnosis and treatment of syncope in each individual case.