Assessment of perfusion, severity of ischemia and the volume of viable myocardium, including single-photon or positron emission tomography (SPECT and PET ) is one of the most important stages of examination of patients with ischemic heart disease. However, in recent years “perfusion” prefix was added to other cardiologic modalities (echocardiography, magnetic resonance and computed tomography). Such a terminological uncertainty leads cardiologists to an erroneous evaluation of real possibilities of these methods. The review clarifies the definitions of terms “perfusion”, “ischemia”, and “viability” of the myocardium. Imaging modalities are compared from the perspective of compliance with the kinetics of the indicators used and actually visualized myocardial processes.

Aim. To study the possibilities of stress echocardiography (EchoCG) in the assessment of clinical state of patients after percutaneous coronary intervention (PCI). Material and methods. We included into this study 80 patients with stable ischemic heart disease. After preliminary examination, all patients underwent PCI. Stress EchoCG was carried out in 6 and 12 months after PCI. Results. Clinical effect assessed in 12 months after revascularization was good in 90 % of patients. We registered significant increase of exercise capacity (from 97 to 118 W; p=0.001), increase of double product (from 232 to 275; p=0.009), decrease of myocardial ischemia volume (regional contractility impairment index before PCI 1.36, a year after PCI 1.16; p=0.001). The incidence of restenosis was 7.5%. Restenosis was accompanied by a deterioration of clinical status of patients (silent myocardial ischemia, angina recurrence). The accuracy of stress echocardiography in detecting myocardial ischemia in patients after PCI was 94 %. Conclusion. Stress EchoCG has high diagnostic accuracy for detection of myocardial ischemia in patients after PCI during the first 12 months after revascularization.

Purpose. To study prognostic value of left bundle brunch block (LBBB) in patients with verified myocardial infarction in real clinical practice. Material and methods. This analysis has been based on data from the RECORD-3 registry. This registry enrolled consecutive patients hospitalized in participating centers with suspected acute coronary syndrome. Among 2368 included patients 91 (3.84%) had LBBB on admission ECG (“new” in 25 [27.4%], “old” in 28 [30.8%]), and of “undetermined duration” in 38 [41.8%]). Myocardial infarction (MI) was verified in 871 patients, 48 of them (5.5%) had LBBB. Results. MI patients with compared with those without LBBB were significantly older (70.5 vs. 64 years, p=0.011), more often had history of MI and cerebral catastrophes, effort angina, symptoms of chronic heart failure and renal pathology. Patients with LBBB twice more often complained of dyspnea/suffocation and had significantly lower mean ejection fraction (44 vs 52%, p=0.001). At prehospital stage, they less often received aspirin, clopidogrel, в-adrenoblockers. Patients with LBBB more often required artificial pulmonary ventilation (APV ) and temporary cardiac pacing, and were less often subjected to reperfusion strategy (52.1 vs. 85%, p<0.00l). Coronary angiography was carried out in 37.5 and 64.1% (p<0.00l), primary percutaneous coronary intervention was performed in 25 and 46.4% (p=0.0004) of patients in groups with and without LBBB, respectively. Patients with LBBB had more than 2 times higher risk of death during hospitalization (14.6 vs. 6.3%, p<0.027), without significant difference between “new” and “old” block. Multifactorial regression analysis revealed the following independent factors of unfavorable prognosis: necessity of APV, requirement in pressor drugs during first 24 hours and thereafter, heart rate on day two. Conclusion. High hospital mortality of patients with MI with LBBB was due to not simply the presence of LBBB on ECG but older age, severity of condition at admission, and high number of concomitant diseases.

Aim. To assess adherence of patients to antihypertensive therapy, to determine the role of various factors affecting adherence to treatment by outpatients, and to assess clinical efficacy of a calcium antagonist felodipine. Material and methods. We examined 5 474 women and men aged >18 years who at visit to a local internist had office systolic arterial pressure (AP) 140-179 and diastolic AP up to 100 mm Hg both on and without hypotensive therapy. Examination included registration of risk factors and concomitant therapy. All patients self-assessed their state of heath using visual analog scale (VAS). Adherence to therapy was evaluated by the Morisky-Green test. Obtaining by a patient of antihypertensive drugs in the framework of the Programme for Supplementary Pharmaceutical Provision (SPP) was necessarily registered. Results. Among examined ambulatory patients with arterial hypertension (AH) and ischemic heart disease (IHD) more than 60% had low adherence to prescribed medications. Such factors as complicated AH course when AH was combined with IHD or diabetes (D), use of angiotensin converting enzyme inhibitors, calcium antagonists, and angiotensin receptor blockers were associated with high adherence to treatment. Male sex, elderly age, presence of risk factors of cardiovascular complications, and long history of AH were associated with low adherence to therapy. Presence of prescribed drugs in the SSP list was associated with high adherence but multifactorial analysis with inclusion of IHD, D, availability of a tonometer at home made contribution of SSP in high adherence insignificant. The use of felodipine allowed not only to achieve pronounced hypotensive effect in patients with AH but also to improve initially low adherence. Conclusion. During long-term observation of outpatients, it is necessary to regularly assess possibly low adherence to therapy with the aim of its improvement.

Aim. To compare effects of isolated antihypertensive therapy (AHT) and AHT combined with anxiolytic and antidepressant on parameters of 24-hour blood pressure (BP) profile, severity of affective disorders, and quality of life (QL) in patients with uncontrolled arterial hypertension (AH) and anxiety or depressive disorders. Material and methods. We randomized 140 patients (age 48.6±5.9 year, 72 women) into 2 groups. During 1 year patients of each group received 2 variants of pharmacotherapy: isolated AHT and AHT combined with psychotropic medication (PM) - anxiolytic for persons with anxiety disorder and antidepressant for persons with depressive disorder (AHT+PM). Patients of group I received AHT for first 6 months and AHT+PM for remaining 6 months. Group II patients started with AHT+PM and after 6 months switched to AHT. In each group we selected subgroups of patients with prevailing anxiety (I-A, II-A) and prevailing depression (I-D, II-D). In the end of each 6 months period we compared parameters of 24-hour BP monitoring, severity of affective disorders, and QL in subgroups IA vs. II-A and ID vs. IID. Same comparisons were done for each sub-group in the end of the first and second stages of treatment. Results. Starting with combination AHT provided more rapid achievement of low values of average diurnal and nocturnal systolic (S) and diastolic (D) BP, lower parameters of BP variability. In patients with comorbid depression it led to lowering of magnitude and velocity of morning increment of SBP and DBP. Only combination AHT demonstrated adequate reduction of affective disorders. Both combination and isolated AHT in 6 months resulted in significant improvement of QL, however combination AHT provided significantly better estimates of QL. Conclusion. In patients with AH and anxiety or depressive disorders effectiveness of AHT combined with anxiolytic or antidepressant was higher compared with isolated AHT.

Aim. To study relationship between age-associated changes of heart rate variability (HRV), telomere length (TL), and lowering of insulin sensitivity (IS). Material and methods. We included in this study 229 individuals aged 23-91 years without clinical manifestations of cardiovascular and other somatic diseases. In all participants, we analyzed HRV parameters obtained at 24-hour ECG monitoring (24-h ECG) and 5 minutes ECG recordings in the supine and standing positions. Leukocyte TL was estimated on genomic DNA using real time polymerase chain reaction. Insulin sensitivity was characterized by calculation of НОМА-IR and Gutt's insulin sensitivity index (ISI). Results. Elderly people with short telomeres (<9.80 arbitrary units) had lower values of SDNN, RMSSD, TP, VLF compared with people of the same age group with long telomeres (>9.80 arbitrary units). In the group of elderly persons with HOMA-IR >2.5 individuals with short telomeres had lower values of TP in supine and standing positions, LF in supine and HF in standing positions than individuals with long telomeres. Among persons aged >60 years and low ISI (<103.67) HRV parameters (SDNN, SDANN, RMSSD, TP, VLF) obtained from 24-h ECG in groups of short and long telomeres were significantly different. TL was found to be independently related to SDNN and VLF when age, gender and ISI were taken into account. Conclusion. Presumably age-associated changes of vegetative regulation of cardiac rhythm could be related to cellular aging of neurons of the vegetative nervous system (VNS) and cardiomyocytes. However, mechanism of this relationship remains not completely elucidated. Shorter telomeres in individuals aged >60 years without cardiovascular diseases are associated with lowered VNS tone and relative preponderance of sympathetic regulation. At the same time, long telomeres and lowered ISI were found to be associated with higher HRV parameters than short telomeres and lowered ISI.

In this review, we present modern aspects of etiology and pathogenesis of atherosclerosis. We describe the roles played by inflammatory cells, components of cellular response in allergic reactions, disturbances of carbohydrate metabolism, cellular aging, and infection at various stages of formation of atherosclerotic plaques. Special attention is given to the specific characteristics of atherosclerosis and calcification of coronary arteries. We show the influence of age and gender on the disease progression. The review includes information on the importance of myocardial bridges for the change of hemodynamics in segments of coronary arteries. The data presented indicate that differences in localization of atherosclerotic lesions between systems of the right and left coronary arteries depends on their hemodynamic, anatomical and physiological characteristics. According to the literature, anterior descending artery is more vulnerable in this respect.

Clinical-biochemical research of vascular wall hydrated state, water-electrolyte balance has broadened substantially our notions concerning initiation mechanism of vessel damages, methods of their prevention and treatment. Consecutive study of endothelial glycocalyx functioning, computational research of its interaction with oxidative stress, regulation of its state has been aimed at development of novel means of the vascular system protection. Mutual efforts of clinicians and scientists should contribute to the productivity of results of translational cardiology.

Analysis of diagnostic and prognostic possibilities of echocardiography in patients with Takotsubo syndrome is given in this review. Special characteristics of local wall motion abnormalities of the left ventricle are presented and main variants of transitory derangements of local contractility are described. Changes of parameters of deformation of left and right ventricles in acute period and during follow-up are analyzed in detail. A spectrum of complications of the syndrome in detection ofwhich echocardiography plays the leading role is outlined. The review also contains analysis of prognostically unfavorable states and echocardiographic parameters specific for Takotsubo syndrome.