The question of the possibility of MRI scanning in patients with cardiac implantable electronic devices (CIED) appeared simultaneously with the introduction of MRI in clinical practice. A lot of in-vitro, in-vivo and clinical researches were performed to estimate wat going on with CIED in strong magnetic field and is it possible to perform some unified protocol of safe MRI-scanning for these patients. Recommendations were provided, but not for the wide practice. MRI remained strongly contraindicated for CIED patient. To meet the clinical need CIEM manufacturers changed the design of devices to made them MRI-compatible, including reducing of ferromagnetic components, additional filters, new software. Lead coil design was changed as well to minimize lead heating and electrical current induction. Now all leaders of CIED industry have in their portfolio all types of MRI-conditional implanted cardiac rhythm management devices (pacemakers, ICDs, CRTs). “Conditional” means MRI scanning can be done only under specific condition. For MRI device and lead in one system have to be from the same manufacturer. Now, if you need to implant the device, you must proceed from the fact that the patient is more likely to need an MRI in the future and choose the appropriate model, not forgetting that the electrodes should also be MRI-compatible.

Aim. To compare dynamics of biological marker concentrations with echocardiographic data in patients with ST elevation myocardial infarction (STEMI) and preserved LV function during the hospitalization period. Materials and methods. The study successively included 100 patients with diagnosis of STEMI and LV ejection fraction <40%. Revascularization of the symptom-related artery was performed for all patients. Echocardiography was performed for all patients on days 1 and 10-12. Serum concentrations of the following markers were measured for all patients on admission and followed up on days 10-12 of disease onset: matrix metalloprotein-ases 1, 2, and 3 (MMP), tissue inhibitor of matrix metalloproteinases 1 (TIMP1), galectin 3; N-terminal fragment of pro-B natriuretic peptide (NT-proBNP); and soluble IL-1 receptor family member (sST2). Results. The following indexes tended to increase (р<0.05) by days 10-12 of myocardial infarction: LV ejection fraction, stroke volume, E/е’, and early mitral flow propagation velocity (EMFPV). In contrst, end-diastolic volume, end-systolic volume, DT, ET, Em, Em/EMFPV were decreased (р<0.05). The MMP 3 concentration measured on days 10-12 of myocardial infarction was 1.62 times higher than the value obtained on day 1 whereas the soluble ST2 receptor concentration measured on days 10-12 was, in contrast, almost half as high as the values determined on day 1. Also, statistically significant changes during the hospitalization period were observed for galectin-3 (p=0.0001), MMP 2 (p=0.0003), and NT-proBNP (p=0.0361). According to results of the correlation analysis most of the studied markers correlated with indexes of LV systolic and diastolic function both on day 1 and day 10. Conclusion. In the group of patients with STEMI with preserved LV function, consistent dynamics (days 1 and 10-12) of most of the studied markers, including galectine-3, MMP 2, MMP 3, sST2, and NT-proBNP was observed. On day 1 of STEMI, levels of biological markers statistically significantly correlated with echocardio-graphic indexes of systolic and diastolic function.

Aim. To study the role of neutrophil gelatinase-associated lipocalin (NGAL) as a marker for extrarenal complications in patients with acute coronary syndrome (ACS). Materials and methods. For 110 patients with ACS on days 1-3 of hospitalization, concentrations of NGAL, serum (s-NGAL) and urinary (u-NGAL) NGAL, and N-terminal fragment of pro-B natriuretic peptide (NT-proBNP) were measured, and transthoracic echocardiography was performed. Incidence of cardiovascular complications was determined during the stay in the hospital; hemodynamic parameters (systolic and diastolic blood pressure, heart rate) were measured on admission. Results. Concentrations of u-NGAL were significantly higher in acute heart failure (AHF) [10.4 (2.7; 51.2) ng/ ml] than in absence of AHF [3.8 (1.7; 8.6) ng/ml, р=0.03]. Concentrations of u-NGAL and NT-proBNP were higher in patients with [10.17 (4.87; 51.2 ng/ml) and 744.6 (368.7; 2034.9) pg/ml] than without signs of pulmonary hypertension [3.41 (1.72; 7.39) ng/ml; р=0.004 and 431.8 (99.6; 780.1) pg/ml; р=0.012]. The u-NGAL values >9.96 ng/ml were shown to be predictive for AHF, and values >5.81 ng/ml - for pulmonary hypertension. Levels of u-NGAL significantly, directly correlated with values of end-diastolic dimensions and end-systolic dimensions and inversely correlated with values of end-diastolic volume and ejection fraction; levels of s-NGAL positively correlated with cardiac output and heart index. Levels of u-NGAL significantly, directly correlated with NT-proBNP values. Conclusion. Urinary levels of NGAL were significantly higher in ACS patients with than without AHF or signs of pulmonary hypertension. NGAL values >9.96 ng/ml were associated with an increased probability of AHF during stay in the hospital, and NGAL values >5.81 ng/ml - with a higher incidence of ACS patients with signs of pulmonary hypertension. In ACS, direct correlations of blood and urinary levels of NGAL with some echocardiographic parameters reflecting the systolic function and the LV dimensions and geometry were identified. Levels of u-NGAL were found to be positively correlated with blood levels NT-proBNP. NGAL may be used as a supplementary marker not only for acute kidney injury and chronic kidney disease but also for severity of cardiovascular conditions and heart remodeling in patients after exacerbation of ischemic heart disease.

Aim. To study retrospectively the treatment preceding acute coronary syndrome (ACS) in patients with atrial fibrillation (AF) in real-life outpatient practice on the territory of Kirov Region. Materials and methods. The registry included 163 patients with AF who were undergoing rehabilitation following ACS (ACS occurred <1 month ago) in the hospital of Kirov State Medical University. Mean age of patients was 64.9±9.7; 55.8% were men. Results. 92.6% of patients were assigned to group 4 of cardiovascular risk (CVR). Only 26.4% of all patients received hypolipidemic therapy (HLT); only 21.9% of CVR group 4 patients, 66.7% of CVR group 3 patients, and all patients of group 2 achieved the total cholesterol goal. Only 10.6% of group 4 patients, 55.6% of group 3 patients, and 33.3% of group 2 patients achieved the LDL-C goal. Assessment of antithrombotic therapy (ATT ) in AF patients showed that 34.3% of patients received oral anticoagulants (OACs) (vitamin K antagonists (VKAs) - 30.5% and new generation OAKs (NOACs) - 3.8%); 21.5% of patients not taking VKAs monitored their international normalized ratio (MNR) on a regular basis and 9.4% of patients had a target MNR during admission; and 13.3% of patients at high risk of stroke according to the CHA₂DS₂-VASc scale had thromboembolic complications (TEC). 83.6% of patients received a therapy for IHD; 21.88% received a therapy completely consistent with clinical guidelines. 78.2% of patients received a therapy for CHF; 30.08% received a therapy completely consistent with clinical guidelines. Analysis of antihypertensive therapy (AHT) in AF patients showed that 39.3% of patients received a rational combination AHT; 34% received probably rational (considering concurrent conditions) therapy; and 0.7% received a non-rational therapy. 17.33% of AH patients achieved the BP goal; fixed-combination AHTs were administered extremely rarely (4%). Conclusion. The retrospective analysis of treatment quality in patients with AF showed that HLT, ATT, and AHT for IHD and CHF were of very low quality, which suggested that efficacy and safety control for the treatment of major cardiovascular diseases (CVD) administered to this patient cohort before ACS was virtually absent. Generally, approximately the same situation was described in similar registries of Europe, China and Russia.

Aim. To evaluate cost effectiveness of coronary endovascular treatment in patients with stable IHD during “one-night” hospitalization. Materials and methods. Using the cost-minimization analysis direct medical cost of coronary endovascular treatment in patients with stable IHD during the “one-night” hospitalization was compared with the “classic” hospitalization. Results. The most cost-effective strategy for hospitalization of patients for transcutaneous coronary intervention (TCI) with stenting was the “one-night” hospitalization. Differences in direct medical costs (DMC) were statistically significant (p=0.01) in favor of the patient group hospitalized for one night. Conclusion. The “one-night” hospitalization plan for patients with stable IHD to undergo TCI with stenting increases the cost-effectiveness due to the decreased number of days of stay in the hospital and the associated decrease in cost of in-patient maintenance, which resultes in considerable financial savings (А between the hospitalization plans was 21.2% in favor of the “one-might” hospitalization). This А indicates high cost effectiveness of the selected approach.

Background. The low efficiency of recommended therapy for reducing cardiovascular risk (CV) in patients with arterial hypertension even with an effective blood pressure decrease is often due to the persistence of high blood cholesterol and arterial stiffness. Among the effective ways to achieve the goal of therapy is considered the changing to a single-pill combinations (SPCs) of two antihypertensive drugs and statin. Aim. To assess influence of fixed combination consisted of amlodipine, lisinopril and rosuvastatin to the dynamic of lipid spectrum, blood pressure level and elastic properties of arteries in patients with arterial hypertension and high risk of cardio-vascular complications being transferred from their preceding antihypertensive therapy. Materials and methods. 113 patients with atherosclerosis of brachiocephalic arteries (BCA) receiving antihypertensive and partially taking statins therapy were assessed cholesterol, low-density lipoprotein cholesterol (LDL-C), peripheral and central blood pressure, carotid-femoral pulse wave velocity (PWV) initially and after 12 months of taking amlodipine + lisinopril + rosuvastatin (A+L+R) SPCs. Results. The administration ofA+L+R SPCs for 12 months was associated with an increasing of number of patients with the achieved target blood pressure <140/90 mm Hg from 68% to 100%, the target level of LDL-C <2.5 mmol/l from 7% to 88.5%, the PWV <10 m/s from 33% to 67%. In spite of the initial class antihypertensive therapy (the renin-angiotensin-aldosterone system blockers (RAAS) (n = 52), the RASS + diuretic (n = 10), the RAAS + calcium antagonist (CA) (n = 47) the administration of A+L+R SPCs led to a reduction of both central and peripheral blood pressure, as well as PWV. Conclusions: Changing of monotherapy or combined therapy of RAAS, CA, or diuretics to the therapy of A+L+R SPCs in high CV risk patients even with partially normal blood pressure allowed to achieve the target blood pressure, LDL-C level, and PWV in most patients effectively and safely.

Aim. To evaluate preparedness of physicians in real clinical practice to strive for stabilizing the course of CHF by control of clinical and hemodynamic indexes both in prevention of admission for decompensated CHF and following discharge from the hospital. Materials and methods. The study included 750 CHF patients with any NYHA FC who were admitted in emergency for decompensated CHF. All patients with CHF were followed up for a year after discharge from the hospital. Medical records of inpatients (MRIP) and outpatients (MROP) were analyzed including determination of clinical symptoms and administered doses of medicines. Changes in clinical parameters during a year were recorded. Results. CHF decompensation was evident as pulmonary edema in 1.6% of cases and acute left ventricular failure in 18.5% of cases. All the rest of decompensated CHF cases included ascites or hyposarca (21.1%), or increased edema syndrome with unstable hemodynamics (58.5%). In MROPs, weight control was presented for 1.2% of patients. The composite index of effectively achieved control of hemodynamics and body weight was only 0.2%. Treatment effectiveness decreases due to absence of drug titration and switching therapies, which considerably impairs prognosis for patients. Conclusion. Outpatient physicians lack alertness for development of CHF decompensation, and control of hemodynamics and body weight of patients remains ineffective. Physicians are not prepared to achieve recommended doses of medicines, which provokes high risk of fatal outcome and/or rehospitalization.

The clinical case of the Takotsubo syndrome (ТТ) developed in process of treatment pulmonary embolism (PE) in old woman is described. A feature of this observation is the occurrence of TT not in the acute phase of PE, but in a month after the debut of the disease and in a week after the start of successful treatment.