Acute myocardial infarction (MI), the most severe complication of coronary artery disease, develops in 2-4% of patients with various malignancies.

Purpose: to explore the specific properties of ST-segment elevation myocardial infarction (STEMI) course in patients with cancer and its effect on short-term outcome.

Materials and methods. We included in this study 45 patients with STEMI and history of cancer hospitalized in the period from 01.01.2015 to 01.01.2017 (group I; 58% men, mean age 69.07±11.60 years). In the comparison group (group II) we selected 90 age and gender matched persons (58% men, mean age 68.16±11.75 years) from patients with STEMI without oncological diseases.

Results. There were no differences between groups in main risk factors of cardiovascular diseases, except greater proportion of patients with damage of peripheral arteries in group 1 (22.2% compared with 5.6% in group 2, p=0.025). There were also no differences between groups in clinical characteristics at admission. However values of the following parameters were significantly lower in group I: concentration of hemoglobin (115.56±23.07 vs. 133.70±16.45 g/l in group 2, р<0.001), red blood cell count (3.95±0.66x10¹²/l vs. 5.57±0.72x10¹²/l in group 2, р<0.001), platelets (93±0.97x10⁹/l vs 186±18.3x10⁹/l in group 2, p<0.001), total cholesterol (4.12±2.17 vs. 6.24±2.56 mmol/L in group 2, р<0.001). There were differences in the frequency of use of antiplatelet drugs: at prehospital stage acetylsalicylic acid was given to 48.9% and 77.8% of patients in groups 1 and 2, respectively (p=0.044); clopidogrel and ticagrelor were also significantly more rarely used in group 1. There was no difference in use of thrombolysis and percutaneous coronary interventions (4.4 and 53.3% vs 5.6 and 56.6% in groups 1 and 2, respectively). In group 2 greater portion of patients was given statins (68.9 vs. 77.8%, p=0.021) and angiotensin-converting enzyme inhibitors (55.6 vs. 82.2%, p=0.008). Inhospital mortality was the same in both groups (4.4%). Occurrence of complications (bleeding, pulmonary edema, cardiogenic shock), and frequency of use of intra-aortic balloon counterpulsation, temporary cardiac pacing were similar. However in group 1 greater portion of patients had ventricular tachyarrhythmias (15.6 vs 2.2% in group 2, р=0.007); the presence of cancer was the only independent predictor of their emergence in multiple logistic regression (OR 8.11 [1.11-40.83], p=0.011).

Conclusions. Rates of application of myocardial reperfusion in STEMI patients with and without history of cancer were the same. Despite similar hospital mortality revealed peculiarities of STEMI course could affect long-term outcomes. Confirmation of this hypothesis requires planned prospective studies.

Erlikh A. D. on Behalf of Participants of the RECORD Registers.

Purpose: to assess changes in the management of patient with Non-ST Elevation (NSTE) Acute Coronary Syndrome (ACS) which occurred in Russian hospitals during recent several years by means of comparing data from a series ofACS registries RECORD - “old” (RECORD and RECORD-2, 2007-2011) and “new” (RECORD-3, 2015).

Results. Numbers of included patients with NSTEACS were 1502 and 1485 in then “new” and “old” registries, respectively. “New” registry compared with “old” comprised more women (44 and 37%, respectively, p=0.0001). Portions of patients aged ≥ 65 years were not statistically different (51 and 47%, respectively, р=0.57). Time from onset of symptoms to hospital admission was longer (7.7 and 4.8 hours, р<0.0001), portion of patients hospitalized in invasive hospitals - higher (67 and 42%, р<0.0001), frequency of troponin level determination - higher (72 and 45%, р<0.00001), frequency of coronary angiography (CA) - higher (48 and 30%, р<0.0001), and of percutaneous coronary interventions (PCI) - higher (21 and 15%, p<0.0001) in the “new” than “old” registries. In invasive hospitals rates of CA, PCI during hospital stay, frequencies of detection of stenoses ≥ 50%, and rates of coronary stenting in the “new” and “old” registries were not statistically different. Rate of PCI during first 72 hours in patients with coronary stenoses ≥ 50% was higher in the “new” registry (48 and 40%, respectively, р=0.013). During hospital stay patients in the «new» registry significantly more rarely received acetylsalicylic acid, parental anticoagulants, nitrates, and more often - dual antiplatelet therapy (DAPT), fondaparinux, statins; while at hospital discharge they were more rarely prescribed β -adrenoblockers, nitrates, and more often - DAPT, statins. Rates of death in “new” and “old” registries were not significantly different (2.5 and 3.4%, respectively, р=0.11) while sum of unfavorable outcomes (deaths + new myocardial infarctions) during hospital stay in the “new” registry was smaller (3.7 and 5.2%, respectively, р=0.042). Median length of inhospital treatment was 10.0 and 13.0 days (p<0.0001), portion of patients transferred from noninvasive hospitals for CA was 12.2 and 1.6% (р<0.0001) in “new” and “old” registries, respectively.

Conclusion. Main changes in management of patients with NSTEACS occurring between conduct of “old” and “new” registries RECORD became more frequent hospitalization in invasive hospitals and transferal from noninvasive hospitals for coronary angiography, more frequent determination of troponin, use of DAPT. With this rate of invasive coronary procedures was not sufficiently increased and remained relatively low.

Purpose: to elucidate independent clinical and laboratory predictors of adverse cardiovascular events (ACVE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with stenting in early inhospital period.

Materials and methods. We included in this prospective single center study 130 patients with ACS who underwent PCI with stenting. All patients prior to and after PCI received dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In 12–48 hours after PCI we measured residual platelet reactivity (RPR) using light aggregometry. In 57 patients simultaneously we performed genotyping of CYP2C19*2 polymorphisms. The following ACVE were used as end­points and were registered during inhospital observation (mean duration 9.7±3.2 days): sudden death, stent thrombosis, arterial thrombosis of other localization, recurrent angina, cardiac rhythm disturbances requiring special therapy.

Results. Repetitive ACVE were observed in 32 patients. According to unifactorial regression analysis risk factors of their development were, ADP F­induced RPR (р<0.001), levels of creatinine (р<0.001), hemoglobin (р<0.001), and glucose (р=0.026), age (р=0.01), iron­deficiency anemia (р=0.01), left ventricular ejection fraction (р=0.004), number of stents (р=0.015). According to results of multifactorial regression analysis independent predictors of ACVE were: ADP­induced RPR >76 % (р=0.003), levels of creatinine >189 µmol / L (р=0.003), and hemoglobin <114 g / L (р=0.004). Significant effect of homozygous carriage of CYP2C19*2 (G681A) (А / А) on development of stent thrombosis was also detected (р=0.028).

Conclusion. ADP­induced RPR, levels of creatinine and hemoglobin were found to be independent predictors of inhospital ACVE after myocardial revascularization with stenting in patients with ACS.

The aim. Evaluates long­term clinical outcomes of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffold (BVS) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of left anterior descending (LAD) lesions.

Methods and Results. In this single­center study were included 130 patients with stable angina and significant (≥ 70 %) LAD disease. Patients were randomly assigned in a 1:1 ratio to PCI with everolimus­eluting BVS (n=65) or MIDCAB (n=65). The primary end­point was major adverse cerebro­cardiovascular events (MACCE) and secondary was scaffold (graft) thrombosis at 1 year. The groups of patients were comparable for all baseline demographic, clinical and angiographic parameters. MACCE at 12 month occurred in 9.2 % of patients in the BVS group and in 4.6 % of patients in the MIDCAB group (p=0.3). There was no significant difference between the groups in rates of all cause death (1.5 % vs 1.5 %, p=1.0), myocardial infarction (3.1 % vs. 6.1 %, p=0.4), any revascularization (1.5 % vs. 6.1 %, p=0.1) and scaffold (graft) thrombosis (1.5 % vs. 1.5 %, p=1.00).

Conclusion. At 12­month follow up, there was no significant difference in the rate of MACCE between PCI by BVS and MIDCAB in patients with isolated LAD lesions.

Aim: to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of follow­up in ambulatory elderly patients with chronic heart failure (CHF).

Materials and methods. We conducted an open, prospective, non­randomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II–IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean follow­up was 26.6±11.0 months.

Results. Bendopnea was present in 38.8 % patients. All these patients complained of shortness of breath during physical exertion and 45.2 % of them had orthopnea.  Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95 % confidence interval [CI] 4.04–34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score)  (OR 1.78, 95 % CI 1.29–2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95 % CI 1.07–1.52, p=0.007), coronary heart disease (OR 26.6, 95 % CI 3.34–21.3, p=0.002), history of myocardial infarction (OR 13.9, 95 % CI 4.2–46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95 % CI 2.69–65.9, p=0.002), increased indexed LV end­systolic diameter (OR 8.2, 95 % CI 1.9–34.1, p=0.004), left atrial size (OR 4.3, 95 % CI 1,4–12.5, p=0.008), indexed LV end­systolic volume (OR 1.32, 95 % CI 1.07–1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95 % 1.03–1.45, p=0.002), high levels of NT­proBNP (OR 1.0, 95 % CI 1.0–1.002, p=0.055), creatinine (OR 1.04, 95 % CI 1.02–1.07, p=0.001), uric acid (OR 1.006, 95 % CI 1.002–1.011, p=0.004); hospitalizations (OR 7.61, 95 % 2.04–28.4, p=0.003), and patient’s mortality (OR 5.63, 95 % CI 1.94–16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95 % CI 1.04–2.8, p=0.033), increased left atrial size (OR 5.67, 95 % CI 2.75–21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95 % CI 1.04–2.80, p=0.050). During follow­up 51.6 and 12.2 % of patients died among those with and without bendopnea, respectively (OR 4.22, 95 % CI 1.85–9.9, p<0.001).

Conclusion. Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

Aim. Lipoprotein(a) [Lp(a)] and low molecular weight (LMW) apolipoprotein(a) [apo(a)] phenotype are risk factors of сoronary heart disease and stroke. Data about the role of Lp(a) and phenotypes apo(a) in the development of lower extremity artery disease (LEAD) is scarce. The aim of our study was to assess the association of Lp(a), apo(a) phenotypes and autoantibodies to apolipoprotein B100 (apoB100) lipoproteins with LEAD.

Materials and methods. The study included 622 patients (386 male and 236 female, average age 61±12 years), examined in the Department of Atherosclerosis of National Medical Research Center of Cardiology. Patients were divided into 2 groups: the main group included 284 patients with LEAD, 338 patients without significant atherosclerosis of coronary, carotid and lower limbs arteries formed the control group. LEAD was diagnosed as atherosclerotic lesions with at least one stenosis of low limb artery ≥50 % and ankle­brachial index ≤0.9. The concentration of Lp(a), lipids was measured in blood serum of all the patients, level of autoantibodies to apoB100 lipoproteins was measured in 247 patients, and apo(a) phenotypes were determined in 389 patients.

Results. Patients with LEAD were older, were more frequently male, and had a greater prevalence of risk factors including hypertension, type 2 diabetes, smoking than the control group patients (p<0.001 in all the cases). The level of Lp(a) was significantly higher in the main group compared to control group: 35 [14; 67] mg / dl vs. 14 [5; 32] mg / dl, p<0,001. ROC analysis demonstrated that the level of Lp(a) ≥26 mg / dl was associated with LEAD (sensitivity 61 %, specificity 70 %). The prevalence of Lp(a) ≥26 mg / dl and LMW apo(a) phenotype were higher in the main group in comparison with the control group: 61 % vs. 30 % and 48 % vs. 26 % respectively (p<0.001 in the both cases). The odds ratio of LEAD in the presence of Lp(a) ≥26 mg / dl was 3.7 (95 % confidence interval (CI), 2.6–5.1, p<0.001) and in the presence of LMW apo(a) phenotype was 2.6 (95 % CI, 1.7–4.0, p<0.001). In logistic regression analysis adjusted for age, sex, hypertension, smoking, diabetes, both Lp(a) and LMW apo(a) phenotype were independent predictors of LEAD when included separately. The level of IgM autoantibodies to Lp(a) was significantly higher in the control group compared to the patients with LEAD (p=0.01). Concentration of IgG autoantobodies to Lp(a) and LDL in the plasma did not differ essentially in the both groups.

Conclusion. The level of Lp(a) ≥26 mg / dl and LMW apo(a) phenotype are independent predictors of LEAD, whereas the contribution of autoantobodies to Lp(a) in LEAD development is controversial.

Purpose: to assess specificities of course of the long­QT syndrome in children before and after implantation of cardioverter­defibrillator (ICD), and optimization of indications to ICD­therapy.

Materials and methods. We included in this study 48 children with long­QT syndrome from 44 unrelated families (28 boys and 20 girls), who underwent ICD implantation at the mean age 11.8±3.8 years. Mean duration of follow­up after implantation was 5.2±2.8 years. Data from these children were compared with those from 59 children of comparable age and gender with long­QT syndrome from 46 unrelated families receiving antiarrhythmic therapy (β­adrenoblockers). We assessed clinical and electrocardiographic characteristics of the disease obtained at initial visit and their dynamics thereafter.

Results. Children with long­QT syndrome and ICD were mainly probands with interval QT longer than 500 ms, recurrent syncope and often history of sudden cardiac arrest requiring high doses of β­adrenoblockers for control of ventricular tachyarrhythmias.

Conclusion. ICD implantation is an effective and safe method both of primary and secondary prevention of sudden cardiac death in children with long­QT syndrome.

Purpose: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE).

Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning.   Examination also included echocardiography.

Results. In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 – 13.70±2.05 days, group 2– 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable – shin veins, popliteal, and common femoral veins, unfavorable – superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, post­infarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

Aim: to investigate clinical properties of course and outcomes of infective endocarditis (IE) depending on source of infection, to find predictors of mortality in a Moscow general hospital.

Materials and methods. We included in this study 176 patients with definite and possible infective endocarditis (the Duke criteria), admitted in our hospital in 2010–2017. Patients were divided in three groups according to source of infection. All patients underwent standard clinical and laboratory assessment, echocardiography, blood culture test combined with blood PCR with sequencing. Inhospital and 1­year outcome were evaluated.

Results. Among 176 patients with IE 65.3 % were men (median age 57 [35–72] years), most patients (n=149, 84.7 %) had native valve IE. Etiological factor was identified in 127 (72.2 %) cases. Gram­positive infective agents prevailed (54 %). Surgery in active phase of the disease was performed in 30 (17 %) patients. Among patients with healthcare­associated IE (n=76, 43.9 %) prevailed those older than 60 years, with high Charlson comorbidity index, with culture­negative IE, and complicated clinical course (mainly progressing heart failure). Patients with intravenous drug use associated IE (n=50, 28.4 %) had low Charlson index, association with hepatitis C viral infection, involvement of tricuspid valve with big vegetations, high frequency of embolic complications, and low inhospital mortality. Group of patients with community acquired IE (n=50, 28.4 %) more often had uncommon causative microorganisms, and had better long­term outcome. In­hospital mortality was 30.1 % (n=53) mostly due to sepsis with multi­organ failure, and heart failure. Risk factors of inhospital death were history of cardiovascular diseases, old age, kidney damage, methicillin­resistant Staphylococcus aureus (MRSA) infection, uncontrolled infection, and embolic events. Risk factors of 1­year mortality were history of stroke, and heart failure as IE complication. Independent predictors of in­hospital death were MRSA infection (odds ratio [OR] 50.32, 95 % confidence interval [CI] 1.66–213.92; p=0.002), persistent infection (OR 18.6, 95 %CI 5.37–64.40; p=0.001), duration of fever >7 days after initiation of antibacterial therapy (OR 13.41, 95 %CI 3.51–51.24; p=0.001); and of death during first year – history of cerebral infarction (OR 4.39, 95 %CI 1.32–14.70; p=0.016)), and heart failure as IE complication (OR 8.1, 95 %CI 1.97–67.09; p=0.016). Among patients subjected to surgery there were no fatal outcomes during 1 year after hospital discharge, while among conservatively treated patients were 21 (14.4 %) deaths (p<0.009).

Conclusion. Main clinical features of IE course in patients urgently admitted to a general hospital was dominance of healthcare­associated  IE among patients, who were older than 60 years with severe comorbidities. These patients had more complications and worse outcome. Modeling of prognosis identified uncontrolled infection as key factor of unfavorable outcome. Surgery significantly reduced long­term mortality.

The article covers the development of the problem of sudden cardiac death prevention with the implantable cardioverter­defibrillators from the moment of creation of these devices to our days. The current concept of primary prevention of sudden cardiac death, based on the severity of manifestation of heart failure and left ventricular dysfunction, is not effective enough. Its practical application is difficult because it requires mass application of implantable defibrillators, with low predictive accuracy of these criteria in terms of development of life­threatening arrhythmias. The development of methods for visualizing the myocardium, allowing to assess the severity of myocardial fibrosis, as well as the possibilities of medical genetics, at the present stage, allows us to clarify indications for implantation of cardioverter­defibrillators and thereby significantly improve the concept of preventing sudden cardiac death with these instruments.

Nowadays an invasive evaluation of fractional flow reserve (FFR) is one of the main methods used for detecting lesions that cause ischemia. Invasively obtained FFR <0.75 has the specificity of 100 %, and FFR >0.80 has the sensitivity >90 %. Recent achievements in computational fluid dynamics and computer simulations allow noninvasive assessment of FFR using data obtained by CT angiography performed according to standard protocol at rest without additional radiation, modification of image acquisition protocols, or added medications for vasodilatation. The present review covers the results of the DISCOVER, the NXT, the DEFACTO and the PLATFORM randomized multicenter studies as well as the prospects of using a noninvasive method for measuring FFR developed by specialists of the Institute of Numerical Mathematics in collaboration with specialists of the I. M. Sechenov First Moscow State Medical University.

The article deals with the modern tactics of pulmonary hypertension therapy, used in case of unsatisfactory clinical response to previous therapy. All classes of pathogenetic therapy of pulmonary hypertension are presented, as well as modern views on the risk stratification of annual mortality of patients. Switching to a more effective drug both within one group of pathogenetic PAH­therapy, and to drugs of other classes is discussed. The latest classification of pulmonary hypertension (Nice, 2018) is presented.