Introduction. Enlargement of the aortic root of occurs in many cases with cardiovascular disease, including congenital connective tissue disorders (CCTD), especially its differentiated and undifferentiated forms (UCCTD). A common deficiency of the generally accepted methods for diagnosing an aortic root dilation may be that persons with CCTD and cardiovascular diseases of potentially having a broader aortic root diameter could be included in the reference groups. The purpose of our study was to develop a modified method for determining the normal aortic root diameter in group of individuals without CCTD and cardiovascular diseases. Materials and methods. The study included 464 apparently healthy people, men and women aged 15 to 65 years. All patients underwent general clinical examination, echocardiography. On the basis of external and internal signs of CCTD, patients with UCCTD were identified - the UCCTD group (n = 208) and without this pathology - the main group (n = 256). The calculation of the normal aortic root diameter (NARD) was made in accordance with the methods of Roman M.J. et al. (1989) and Devereux R. B. et al. (2012). The upper limit values of NARD (UL NARD) were calculated according to the algorithms of Roman M.J. et al. (1989), Devereux R. B. et al. (2012), Campens L. et al. (2014). Results. The data obtained in the main group was used to develop a modified method for the determination of NARD. The mean values by echocardiography and calculated values of the aortic root by modified method of this study were practically the same in the main group, whereas the mean value of NARD calculated by the methods of Roman M.J. et al. and Devereux R. B. et al. in this sample were significantly higher in relation to the listed values. As the NARD values, the UL NARD were significantly higher for all evaluated algorithms in comparison with the modified method. In the group of patients with UCCTD, 13 cases of aortic root dilation were found according to the method of Roman M.J., compared to 19 cases by the modified method. At the same time, 3 patients with aortic root enlargement by the mew method had 7 points of systemic involvement, thus corresponding to the Ghent criteria of Marfan syndrome. The methods of Campens L. and Devereux R. B. were less sensitive, revealing only 5 and 1 patients with aortic root dilatation, respectively. Conclusions. The results of the study demonstrate that, in order to obtain more reliable information on the condition of the root of the aorta and its proper values, the modified method obtained in the course of the study can be used. This method is more sensitive in detecting the enlargement of the aortic root in CCTD and in diagnosing syndromic CCTD.

Aims. Assessment of global longitudinal strain of left ventricle and coronary bloodflow in patients with primary subclinical hypothyroidism. Materials and methods. The study involved 23 women with primary subclinical hypothyroidism of age from 55 to 75 years. Physical examination, transthoracic EchoCG, coronary bloodflow assessment and global LV longitudinal strain by speckle tracking method were performed to all patients. The data obtained were compared to the results of 20 women without any thyroid diseases comparable to the main group by age and concomitant diseases. Results. Patients with primary subclinical hypothyroidism have signs of diastolic dysfunction significantly more frequently than in control group, and increased values of posterior left ventricle wall and interventricular septum thickness. Global longitudinal strain of left ventricle in patients with hypothyroidism was lower than in control group and patients with hypothyroidism had higher FVI values in perforant coronary arteries. Conclusion. Patients with subclinical hypothyroidism demonstrated decrease of global longitudinal strain and increase of volume bloddflow rate in performant coronary arteries.

Aim. To study the relationship between levels of sex hormones and effectiveness of cardiac resynchronisation therapy (CRT) in men with chronic heart failure (CHF). Materials and methods: The best response to CRT (mean time, 38 [19,0;53,7] months) was identified by a maximum decrease in left ventricular end-systolic volume (LVESV) in 58 men (mean age, 54.8±9.6) with CHF (61% IHD). Based on testosterone (TES) level, patients were divided into group 1 (n=28; 48%) - TES < median value (13.8 nmol/l) and group 2 (n=30; 52%) - TES > median value. Exercise tolerance (ET), echocardiography (EchoCG) parameters, plasma levels of NT-proBNP, interleukin (IL) - 1ß, IL-6, IL-10, tumor necrosis factor a (TNF-a), С-reactive peptide (CRP), galectin-3 (Gal-3), matrix metalloprotease-9 (ММР-9), tissue inhibitors of metalloproteinases TIMP-1, TIMP-4, and the indexes MMP-9/TIMP-1 and MMP-9/TIMP-4 were evaluated in dynamics. Levels of TES, progesterone (PGN), dehydroepiandrosterone sulphate (DHEAS), and estradiol (Е2) were measured at baseline. Based on LVESV changes, non-responders (LVESV decrease by <15%), responders (LVESV decrease by >15% but <30%), and super-responders (LVESV decrease by >30%) were identified. Results: In group 2, atrial fibrillation (р=0.064) and radiofrequency ablation of atrioventricular connection (р=0.014) were observed more frequently; incidence of diabetes mellitus was lower (р=0.017); QRS was smaller (р=0.001); ET was higher both at baseline (р=0.022) and in dynamics (р=0.018); numbers of responders and super-responders were greater (р=0.007); levels of PGN (р=0.028), Il-1ß (р=0.020), IL-10 (р=0.013), TNF- a (р=0.006) were higher; and E2/TES was lower (р=0.004). While EchoCG parameters did not differ at baseline, group 2 showed a tendency towards greater changes in LVESV (р=0.069) and LV end systolic dimension (р=0.087), and a greater increase in LV ejection fraction (р=0.007). In dynamics: In group 1, a decrease in NT-proBNP was observed (р=0.015); in group 2, decreases in IL-1ß (р=0.001), IL-6 (р=0.015), IL-10 (р=0.001), TNF-a (р=0.001), TIMP-1 (р=0.046), and Gal-3 (р=0.051) were observed. Levels of sex hormones were correlated with EchoCG parameters, biomarkers of immune inflammation, fibrosis, and NT-proBNP. The ROC analysis showed that a TES level not lower than 13.8 nmol/l was a predictor for a positive response to CRT with a sensitivity of 63.4% and specificity of 76.5% (AUC=0.687; р=0.026). Conclusions: High levels of TES and PGN were associated with better effectivity of CRT, higher ET, greater proportions of responders and super-responders, and reduced immune inflammation activity and fibrosis. A level of TES not lower than 13.8 nmol/l was a predictor for a positive response to CRT.

Objective: To assess the effect of moxonidine on bone metabolism and bone mineral density (BMD) in postmenopausal patients with arterial hypertension (AH) and osteopenia. Materials and methods: A randomized, open, clinical trial included 114 postmenopausal patients with AH. All participants were evaluated bone metabolism), BMD, telomerase activity (TA). Randomization was carried out into 2 groups (moxonidine and bisoprolol therapy) using simple envelopes. After 12 months of therapy, a dynamic examination was performed. Results: Both groups showed a positive effect of both moxonidine and bisoprolol on hypertension during treatment both as monotherapy and in the group of patients receiving combined antihypertensive therapy: a decrease in SBP and DBP in the 1st group was 13.6% and 12.8% respectively, and in the 2nd group - 13.7% and 15% respectively, while achieving normal values. In most patients of group 1, normalization of body weight was noted in comparison with group 2 (23.4% and 17.4%, respectively, p = 0.043), delta of body weight in the moxonidine group was -1.89%. The increase in the processes of bone formation in the form of increased markers of OC and Osteoprotegerin and a statistically significant increase in TA in patients receiving moxonidine were revealed, while in women who took bisoprolol there were no dynamic changes in bone metabolism rates, there was a tendency for a decrease in BMD and a significant decrease in AT. Conclusions: The detected pleiotropic effect of moxonidine on bone metabolism and replicative cell aging processes will reduce the risk of development or progression of osteopenia and osteoporosis in postmenopausal women with AH.

The aim of the study was to evaluate parameters of arterial stiffness (AS) (carotid-femoral pulse wave velocity (cfPWV), central pulse pressure (PP), cardio-ankle vascular index (CAVI) and stiffness gradient between aorta and brachial artery) and subclinical atherosclerosis (carotid intima-media thickness (CIMT) and ankle-brachial index (ABI)) according to inflammatory activity in patients with ВД.. Materials and methods: 85 patients with (EULAR/ACR 2010) were examined (age 59,7±14,3 years, 64,7% with arterial hypertension (AH). Median duration of was 7 years. PWV and central pulse wave were assessed by applanation tonometry. Arterial stiffness gradient was calculated as a ratio between carotid-femoral and carotid-radial PWV: its elevation ≥1 was considered as arterial stiffness mismatch. ABI and CAVI were measured by sphygmometry. CIMT was assessed according to the standard protocol, CIMT>0,9 mm was considered as a subclinical marker of atherosclerosis. p<0.05 was considered significant. Results. Presence of at least 1 marker of atherosclerosis was observed in 32,9%, at least 1 marker of AS - in 63,5%, any marker of arterial damage - in 65,9%. Groups with at least 1 marker of AS or atherosclerosis were characterized by significantly higher hs-CRP level (median 12,6 vs 5,9 mg/l and 11,3 vs 3,9 mg/l respectively). Presence of at least 1 marker of atherosclerosis was associated with age ≥58 (β =0,7) and stiffness gradient ≥1,1 (β =0,9), marker of AS - with GFR <62,1 ml/min/1,73 m² (β = - 0,5), dyslipidemia and NSAIDs intake. Spearmen analysis revealed significant positive correlations between hs-CRP and cfPWV (r=0,35), CAVI (r=0,42), ABI (r= - 0,3). Independent association of cfPWV elevation and hsCRP≥9,6 mg/l was found (β=0,18, р=0,04). Conclusion. In patients with RA markers of AS are more prevalent then markers of atherosclerosis. hsCRP is an independent marker of cfPWV increase as well as age, AH duration and SBP level.

Objective: to analyze patients with first-time developing atrial fibrillation (AF), against acute coronary syndrome (ACS), risk factors for arrhythmia, assessment of patients’ adherence to oral anticoagulant therapy 6-24 months after the ACS episode, according to the total ACS registry for the Krasnodar Territory. Materials and methods: A retrospective analysis of the case histories of 13,244 patients admitted to the infarction departments of all settlements of the Krasnodar Territory without exception and included in the ACS registry for the Krasnodar Territory from November 20, 2015 to January 20, 2018. Results: The study group of ACS with AF included 201 patients, among them 144 men (71.642%), women 57 (28.358%). The average age was 68,084 ± 9,606 years, a maximum of 85 years, a minimum of 25 years. The frequency of the following outcomes was assessed: hospital mortality, frequency of hemorrhagic, thromboembolic complications. The effectiveness of prognostic scales of development of hemorrhage CRUSADE and HAS BLED was evaluated and the expediency of prescribing extended OAT to patients with the first developed AF attack against the background of ACS after discharge from the hospital. Conclusions: Based on the obtained results, based on the data of the total ACS register for the Krasnodar Territory, we can conclude: 1. Patients with a newly developed episode of AF on the background of ACS have demographic, anamnestic data comparable with other types of AF, 2. Patients with a newly developed AF episode on the background of ACS have a more severe course of the disease, which does not affect hospital mortality, hospital complications and lethality after 6-24 months after discharge from the hospital for ACS, 3. Patients with a newly developed episode ofAF on the background of ACS after discharge from the hospital do not have arrhythmia recurrences, they do not have thromboembolic complications. The decision on the duration of oral anticoagulant therapy should be carried out after carrying out a multi-day monitoring of the ECG.

Conducting anticoagulant therapy for atrial fibrillation, combined with diabetes mellitus and/or chronic kidney disease, can create certain difficulties for practicing doctors due to a simultaneous increase in the risk of thromboembolic and hemorrhagic complications. The presence of diabetes mellitus and renal dysfunction can influence the results of antithrombotic therapy in patients with atrial fibrillation. The review provides information on the differences in efficacy and safety of individual oral anticoagulants in the prevention of thromboembolic complications of atrial fibrillation in patients with diabetes mellitus, impaired renal function.