Background. The picture of primary prevention obtained from real-life practice makes possible scheduling measures for prevention improvement. Aim. To analyze features of drug and non-drug therapy aimed at decreasing cardiovascular risk in Russian patients with a high risk (HR) of CVD compared with the study general population. Materials and methods. 14 European countries, including the Russian Federation, participated in this cross-sectional study. The study included patients aged 18-80 without clinical signs of atherosclerosis who have received antihypertensive and/or lipid-lowering therapy and/or therapy for diabetes mellitus (DM) within >6 to <3 years of enrollment in the study. The study protocol included analysis of medical records and an interview focusing on a specially developed, structured questionnaire on major aspects of the life style (smoking, nutrition, physical activity, psychosocial factors), recommendations on drug and non-drug treatment, and patients’ compliance. During the interview, anthropometrics, blood pressure (BP) and CO concentrations were recorded and venous blood was withdrawn for measuring levels of lipids, glucose, and HbA_1c. Oral glucose tolerance test was performed for all patients without fasting hyperglycemia of >11.1 mmol/l. Results. In total, 505 patients with HR were evaluated at Russian study sites and 405 interviews (71.6% females) were taken. Both in the Russian cohort and other countries, the most common recommendations for correction of overweight and obesity concerned diet and physical activity; a drug therapy was administered extremely rarely. Proportion of targeted exercise was approximately similar in the Russian cohort and the study as a whole, 16-18%. Antihypertensive medications were administered to 92.1% of patients in the Russian cohort and 82.7% of patients in the entire study. The most popular classes of antihypertensive drugs were beta-blockers (39.9% and 36.8% respectively), ACEI/ARB (79.6% and 79.8%), calcium antagonists (14.7% and 29.1%), and diuretics (26% and 38.3%). 18% and 35.6% of patients, respectively, received lipid-lowering drugs, and these drugs were statins in 89% and 96.1% of cases. Antihyperglycemic therapy was represented by oral drugs in 70.8% and 75.1% respectively; 16.7% and 18.3% of patients received insulin. Generally, patients estimated their compliance with the drug therapy rather highly. Conclusion. Results of the primary care arm of the EUROASPIRE IV survey indicate considerable room for improvement of CVD prevention.

Aim. To identify factors affecting effective management of patients with myocardial infarction for preventing recurrent coronary events in the outpatient setting. Materials and Methods. The study group consisted of patients (n=11l) with recurrent myocardial infarction. The control group consisted of patients with primary myocardial infarction (n=89) after percutaneous coronary intervention. Social and demographic, clinical and behavioral factors (weight loss, smoking cessation, adherence to therapy, physical and psychological rehabilitation) were evaluated. Results. Risk factors contributing to the development of repeated MI were as follows: patients’ age, concomitant polyvascular and multivessel disease, arterial hypertension, hypercholesterolemia, excess weight and smoking, poor adherence to the recommendations of cardiologists and general physicians. Conclusion. The analysis of the effectiveness of the management of patients with myocardial infarction demonstrated the importance of the outpatient rehabilitation in preventing repeated acute coronary events.

Aim. To study indexes of efficacy, safety and compliance for different ASA forms (Aspirin-Cardio, Cardiomagnyl, Thrombo ASS) used in stable IHD. Materials and methods. An open, cross-sectional study compared three groups of patients consisting of 200 patients each who had stable IHD and a high risk of gastrointestinal disorders and who received a long-term antiaggregant monotherapy with one of ASA drugs (group 1, Aspirin Cardio; group 2, Thrombo ASS; group 3, Cardiomagnyl). Efficacy, safety and compliance with the treatment were evaluated using standard tests and analogue scales; dyspepsia symptoms were evaluated using a special, additionally developed questionnaire. Results. The Aspirin-Cardio treatment reduced the mean score of GI symptom severity from the questionnaire (1.4-1.6 times, р=0.001), requirement for proton pump inhibitors (р=0.002) and endoscopy during the ASA treatment (р=0.001), and proportion of non-compliant patients according to the Morisky test (р=0.0001). The ROC analysis showed that the mean score of GI symptom questionnaire >3 predicted non-compliance or insufficient compliance with a diagnostic sensitivity of 58.9% and specificity of 56.3% (р=0.002), which makes this value a threshold for considering a modification of the treatment. Conclusion. Aspirin-Cardio is characterized by better safety in respect of GI symptoms and better compliance with the treatment during long-term prophylactic therapy. The proposed questionnaire for evaluation of GI symptoms can be used for specifying indications and modifying the treatment tactics.

Aim. To evaluate clinical value copeptin and matrix metalloproteinases in men with acute coronary syndrome (ACS). Materials and methods. the study included 152 men with ACS. After evaluation of the traditional markers of myocardial damage, the patients were divided into 2 groups: the first group included patients with myocardial infarction (MI) - 84 people, the average age was 56.6±1.0 years, the second - with unstable angina (UA) - 68 at the age of 61,4±1.2 years. All patients at admission and after 6 hours and on day 6 of hospitalization were evaluated for the level of CPK MB, troponin I, copeptin, MMP-1, MMP-2, MMP-7, MMP-9 and TIMP-1. Results. Concentration of copeptin at admission in patients with it is 3.5 times higher than in the group with UA and significantly higher than that of control group. To 6-th day of hospitalization, the concentration of copeptin reduced, but nonetheless remains significantly higher than in the control group (0,9±0,1 vs. 0.2±0,0, p=0.000) without significant differences with group UA. The level of MMP-1 and MMP-2 in patients with MI and UA at admission higher than in the control group, and in case of MI these levels are significantly higher than in case of UA. Conclusion. The obtained data indicates the possibility of using copeptin as a marker of myocardial damage. Additionally, it indicates myocardial damage an increase in the level of MMP-1, MMP-2 and MMP-7

Background. Atrial fibrillation (AF) is the most common disorder of heart rhythm. A series of “Maze” surgery was developed, among which the “Maze III” modification is presently a gold standard for surgical treatment of AF. Aim. To study the sinoatrial node (SAN) function before and after the “Maze III” surgery. Materials and methods. The study included 100 patients (48 males) with persistent and long-standing persistent AF and valve abnormality. Mean age of patients was 59 years and mean AF duration - 4 years. Tachysystolic AF prevailed (62%); normosystolic AF was observed in 31% of patients; and bradysystolic - in 7% of patients. Electric cardioversion was performed for all patients according to the standard method. After successful recovery of the sinus rhythm, the endocardial elec-trophysiological study (EPS) of the heart was performed. Correction of valve pathology and the “Maze IIIB” surgery were performed on days 1-2 following EPS. The SAN function was evaluated by the time of function recovery (SAN TFR). Results. Using electric cardioversion, the sinus rhythm was restored in all patients. EPS showed abnormal prolongation of the corrected time for the SAN function recovery (CTSANFR) and sinoatrial conduction time (SACT) in 11% of patients. In 2% of patients, the abnormal prolongation of SACT was an isolated conduction disorder. In total, 13% of patients had SAN dysfunction (SAND). These patients received implantable electric cardioverters after a surgical intervention (correction of valve abnormality and “Maze III”). The sinus rhythm recovered immediately after the surgery. 0n day 7, steady sinus rhythm was observed in 46% of patients. During the postperfusion period and on the first day postsurgery, 62% of patients had replacement atrioventricular nodal rhythm. By the time of discharge from the hospital, the nodal rhythm was observed in 25% of patients. Starting from day 2, the replacement atrial rhythm developed in 13% of patients, and by the time of discharge from the hospital, 24% of patients had a stable atrial rhythm. Conclusion. Effectiveness of the surgical treatment for persistent and long-standing persistent AF (modified “Maze IIIB” surgery with simultaneous correction of the mitral valve (MV) and the tricuspid valve (TV)) in the early postsurgery period was 95%. According to data of preoperative endocardial EPS, SAND was observed in 13% of patients. Following the surgical correction of MV and TV defects and the criomodification of the “Maze IIIB” surgery, signs of SAND requiring implantation of an electric cardioverter were observed in a total of 24% of patients.

Aim. Ventricular tachyarrhythmias (VTs) are often encountered in patients with inflammatory heart diseases. VT can become life-threatening in patients with myocarditis, and the management may vary in different types of myocarditis. Purpose of the study is to describe VT characteristics in patients with verified myocarditis, and to evaluate the efficacy and safety of VT management, when tailored to the type of myocarditis. Materials and methods. Study population comprised: 56 patients with morphologically verified myocarditis; 18 patients with primary cardiomyopathy (control group). All patients underwent full clinical evaluation, endomyocardial biopsy (including immunohistochemical analysis). Forty (54%) patients underwent radiofrequency catheter ablation of VT. An implantable cardioverter-defibrillator (ICD) was inserted in 17 patients. Results. There was no statistically significant difference between myocarditis and primary cardiomyopathy groups by demographic and echocardiographic data. In myocarditis group, nonsustained VT and/or frequent premature ventricular beats were seen in 59% of patients; sustained VT in 12,5% subjects, 1 patient had a history ofventricular fibrillation. VT ablation was associated with a significant decrease in VT recurrence (p=0,0009) during the follow-up period. Active myocarditis was associated with a higher VT recurrence rate (67% in active vs. 19% in borderline myocarditis). Among patients with ICD implantation, only one subject (with active myocarditis at admission) had life-threatening ventricular arrhythmia. Conclusion. In this selected group of patients with verified myocarditis and clinically significant VTs, catheter ablation seems at least partly effective. Patients with borderline myocarditis and symptomatic VTs may benefit from ablation. Therefore, morphological diagnostic of myocarditis can be a key point in choice of treatment.

Aim. To study heart structure and function parameters and hepatolienal blood flow in patients with virus-induced cirrhosis (VIC). Materials and methods. 95 patients with VIC (mean age, 38.6; disease duration, 4.5 years) were evaluated. Doppler EchoCG and Doppler ultrasonic examination of hepatolienal vasculature (VIVID E 95 apparatus) were performed. The control group consisted of 19 healthy individuals. Statistical analysis was performed using the Statistica 6.0 software. Results. The study of hepatolienal blood flow showed that the splanchnic artery blood flow velocity was increased by 25%, the hepatic vein blood flow velocity was increased by 13%, and splanchnic arteries and veins were dilated. 24% of VIC patients had moderate pulmonary hypertension associated with a 20% dilatation of inferior vena cava (p=0.007), a 28% increase in hepatic vein blood flow velocity (p=0.0003), and a 13% decrease in portal vein diameter (p=0.001). Four types of left ventricular (LV) geometry were identified: 40% of VIC patients had normal geometry; 17% of patients had concentric hypertrophy; 23% of patients had concentric remodeling; and 19% had eccentric hypertrophy. Features of hepatolienal blood flow were related with the LV geometry type. LV diastolic filling was impaired in 44.3% and RV diastolic filling - in 33% of patients. In patients with VIC, the disturbed diastolic function was associated with 25% reduced hepatic vein blood flow velocity (p=0.05) whereas development of RV diastolic dysfunction was associated with 6% reduced portal vein diameter (p=0.04), 17% dilated portal vein (p=0.006), and 25% decreased portal vein blood flow velocity (p=0.00l). Anti-viral therapy resulted in improvement of some hepatolienal blood flow parameters. Parameters of splanchnic circulation were correlated with car-diodynamic parameters with correlation coefficients from 0.51 to 0.95 at p<0.05. Conclusion. In patients with VIC, disturbed ventricular diastolic function, LV architectonics, and increased pulmonary artery blood pressure were associated with more pronounced changes in parameters of splanchnic circulation. A course of anti-viral therapy improved some parameters of hepatolienal blood flow. Parameters of splanchnic circulation were interrelated with major ventricular structure and function parameters.

Aim. The current study was aimed at assessing the effectiveness and the impact of a long-term education program, in both inpatient and outpatient treatment settings, on adherence to treatment and the quality of life 5 years after heart valve replacement. Materials and Methods. All the patients were randomly included into two study groups. The study group patients (n=176) underwent the long-term education program in both inpatient and outpatient treatment settings. The control group (n=108) consisted of patients who underwent only an inpatient education program. Adherence to treatment and the quality of life were assessed before education, at the end of the inpatient and outpatient education and 5 years after heart valve replacement. Patients’ treatment adherence was estimated with the Davydov’s questionnaire, and the quality of life - with the 36-Item Short Form Health Survey. Results. After the completion of the education program, the integral index reflecting patients’ adherence to treatment in the study group remained at the same level, but was 1.4-fold higher compared to the control group in the 5-year follow-up. The long-term education program is associated with improved quality of life, mainly due to emotional well-being. The study reported a correlation between physical functioning and emotional well-being and the integral index reflecting patients’ adherence to treatment during the follow-up period. Conclusion. The longterm education program in both inpatient and outpatient treatment settings contributed to improved patients’ adherence to treatment and the quality of life, mainly due to physical functioning. The inpatient education program was associated with poor patients’ adherence to treatment and the quality of life 5 years after heart valve replacement.

Aim. To identify the most significant factor influencing blood levels of cytokines in patients at high and very high cardiovascular risk. Materials and methods. A patient base from the “Management of chronic patients with multiple diseases” project was analyzed. 523 patients (mean age, 87±17.8) were included. Plasma samples were analyzed for concentrations of sodium, creatinine, IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, and NT-proBNP. GFR was calculated using the CKD-EPI formula. Time-related CHF progression was assessed in one year; the time-related progression was considered an increase in CHF stage. Salt consumption was determined using the Charlton: SaltScreener questionnaire at the baseline visit and at one year. Low-salt diet containing 5 g of salt per day was recommended to all patients; 3.5 g of salt per day was recommended to patients with a documented diagnosis of CHF. Statistical analysis was performed using the Statistica 10.0 software. Results. 52.2 % of included patients consumed 6-10 g of salt per day; 43.4 % of patients consumed 10 g of salt or more per day; and only 4.4 % of patients consumed 5 g of salt or less per day. 21 % of included patients were at high risk of cardiovascular complications whereas for the vast majority of patients (79 %), the risk was stratified as very high. Two clusters of patients were formed based on the grade of hypertension, one-year CHF progression, and plasma levels of IL-6, -8, and -18. The one-year progression of CHF most significantly influenced the levels of IL-18, -8, and -6. The IL-6 level was correlated with the NT-proBNP level; an approximately similar degree of correlation was found for NT-proBNP and BP. Conclusion. Therefore, the performed statistical analysis determined correlations between the following factors: IL-6 level, NTproBNP level, and one-year CHF progression.

The article provides a case report of recurrent syncopal episodes in a 57-year old male patient. During a three-month period of recurrent syncope, the patient was managed by the family doctor and at pulmonology and cardiology departments for different diagnoses. Due to an uncertainty in diagnosis, the patient was moved to a hospital where he underwent echocardiographic examination and duplex scanning of right leg veins, which detected a 49.3 mm right leg venous thrombus with a free-floating head in the right common femoral vein. Retrospectively, recurrent pulmonary artery thromboembolism was diagnosed. Thrombectomy and ligation of the right superficial artery were performed; an approximately 17 cm long thrombus was removed; the anticoagulant treatment was administered with a beneficial effect.