Objective. To examine associations between ischemic heart disease (IHD) and polymorphisms in cytokine genes (IL-1B, IL-4, IL-6, IL-10, TNFA, VEGF) and matrix metalloproteinase genes (MMP2, MMP3, MMP9) in patients with type 2 diabetes. Material and methods. We studied 232 Caucasian diabetic subjects (33 men and 199 women aged 50-70 years). In 93 patients IHD was verified by treadmill test and/or coronary angiography (86 subjects with stable angina, 19 with previous myocardial infarction). Thirteen polymorphisms localized in the promoters of IL-1B (rs1143627), IL-4 (rs2243250), IL-6 (rs1800795), IL-10 (rs1800872, rs1800896), TNFA (rs361525, rs1800629, rs1800630), VEGF (rs699947, rs3025039), MMP2 (rs243865), MMP3 (rs3025058) and MMP9 (rs3918242) were investigated. Results. Prevalence of G-allele and GG-genotype at -308 position of TNFA (rs1800629), as well as C-allele and CC-genotype at position +936 of VEGF (rs3025039) was higher in patients with IHD as compared to patients without IHD (0R=2.0, OR=2.2, OR=2.1, 0R=2.4, respectively, all p=0.02). In logistic regression analysis, TNFA -308 A/ G and VEGF +936 C/T polymorphisms showed associations with IHD (both p=0.009). These polymorphisms along with age, body mass index, duration of diabetes, low density and high density lipoprotein cholesterol were associated with IHD in multivariate models (p=0.0002 and p=0.00008, respectively). Nine combinations of TNFA -308 GG-genotype and variants of other genes demonstrated associations with IHD (p<0.002). Conclusion. The polymorphisms in promoter regions of TNFA (rs1800629) and VEGF (rs3025039) are associated with IHD in patients with type 2 diabetes.

Objective. To compare the diagnostic accuracy of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) with noninvasive methods in assessment of the functional significance of moderate coronary stenoses in patients with chronic ischemic heart disease (IHD). Methods. We included in this study 50 patients with chronic or suspected IHD and moderate coronary stenoses (50-70%; 74 stenoses). Values of iFR and FFR were determined within 10 days after noninvasive stress tests (combination of stress-echo and SPECT). The values of iFR and FFR were compared with the results of noninvasive methods by ROC-analysis. Coronary artery stenosis was considered functionally important if at least one of noninvasive tests (stress-echo or SPECT) demonstrated positive result. Results. The results of noninvasive stress-tests were positive in 14 patients (28 %). ROC area under the curve (AUC) for iFR - 0.961±0.019 (95%CI 0.888-0.992). The best cut-off point for iFR is 0.92 (sensitivity 100, specificity 84 %). ROC AUC for FFR - 0.893±0.041 (95 %CI 0.79-0.96). The best cut-off point for FFR is 0.81 (sensitivity 100 % and specificity 69 %). There was no significant difference between iFR and FFR ROC-curves (р=0.0845). Conclusion. The values of iFR and FFR have equivalent agreement with the results of noninvasive tests commonly used to detect myocardial ischemia in patients with moderate coronary stenoses.

Objective. To assess the association of the lowering of diffusion capacity of the lung and maladaptive remodeling of the heart in a year after myocardial infarction (MI). Materials and Methods. We included into this study 107 patients with ST elevation MI (STEMI). Examination of all patients on 7-12 th days included echocardiography (echoCG), spirography, body plethysmography, and determination of lung diffusion capacity. After one year of observation in 87 patients (81.3%) we performed echocardiogram in dynamics. Results. After 1 year signs of maladaptive remodeling were detected in 25 patients (28.7%). The group of patients with remodeling had clinically significantly lowered parameters of lung diffusion function: diffusion capacity corrected for hemoglobin (DLCOcor) by 30% (p=0.001) and diffusing capacity for carbon monoxide/alveolar volume (DL/VA) by 21% (p=0.001). A mathematical model for prediction of maladaptive cardiac remodeling was obtained by the method of multivariate discriminant analysis. Univariate analysis showed that the reduction of DLCOcor was associated with 3.5-fold elevation of the risk of maladaptive remodeling in one year after STEMI. After adjustment for risk factors this risk rose up to 13.7-fold. Conclusion. Reduction of lung diffusion capacity below 80% of the predicted value on the 12-th day of STEMI was associated with 13.7-fold increase of the risk of detection of maladaptive remodeling of the heart after one year. Independent predictors of cardiac maladaptive remodeling were the number of diseased coronary arteries, reduced DLCO and the presence of myocardial remodeling during acute phases of myocardial infarction.

Aim. Creation of a mathematical nonlinear regression model for prognostication of 1 year outcomes after non-ST elevation acute coronary syndrome (NSTE ACS) for optimization of rehabilitation, secondary prevention, and personalized approach to treatment. Material and methods. We included in this study 135 patients with confirmed NSTE ACS (mean age 59.1±6.1 years, 94 men and 41 women) admitted to hospital № 1 in Novosibirsk during 2010. During hospitalization and 1 year after discharge these patients received standard medical therapy. All patients underwent clinical and instrumental examination which included electrocardiography, echocardiography, Holter ECG monitoring. Program of clinical investigation also included determination of levels of inflammatory cytokines and molecular genetic studies. Effect of each of studied parameters on the probability of unfavorable one year prognosis was assessed by methods of correlation and factor analysis. Results. The constructed mathematical model of multifactor prognostication of 1 year unfavorable or favorable outcomes after NSTE ACS included patient’s age in years, presence of tachycardia at admission, Killip class >II, life-threatening paroxysmal tachyarrhythmias, as well as serum concentration of high-sensitivity C-reactive protein and CT genotype of a polymorphic variant rs1376251 of TAS2R50 gene. Conclusion. The use of the proposed model of multivariate prognostication of 1 year outcomes of NSTE ACS allows to improve the accuracy of events prediction, as it is based on data from Russian patients and takes into account the activity of subclinical inflammation and genotype of the patient. The model is simple to use and allows to personalize secondary prevention, which will facilitate lowering of total cardiovascular risk in these patients.

Aim. To evaluate the effect of cholecalciferol and diuretics as components of combination antihypertensive therapy (CAHT) on plasma renin activity (PRA) and endothelial function in patients with arterial hypertension (AH). Materials and methods. We included in this prospective study 153 patients with II-degree AH. Duration of follow-up was 15.8±1.8 months. Patients were divided into four groups: patients of group 0 received CAHT without cholecalciferol or diuretic; of group 1 - CAHT with cholecalciferol (2000 IU daily); of group 2 - CAHT with diuretic; of group 3 - CAHT with diuretic and cholecalciferol 2000 IU daily. Results. After treatment, the highest level of 25-hydroxy vitamin D (25(OH)D) (48.9 [34.3; 67.9] ng/ml) and its greatest dynamics (Δ) - (27.5 [6.2; 48.8] ng/mL) were observed in group 1. With diuretics blood level of 25(OH)D and its Δ were lower (p<0.05), than without diuretics. Reduction of plasma renin activity (PRA) compared to baseline occurred only in Group 1. It became lower (p=0.0005) than in group 2, in which we observed elevation of PRA. (Д PRA. 0.24 [0.42; 1.54] ng/ml/h). There were no significant changes of PRA in group 3. Lowering of systolic and diastolic BP (SBP and DBP) occurred in all groups. Greatest BP reduction was observed in group 3 (Д SBP -30.0 [-40.0, -10.0] mm Hg, Д DBP -10.0 [-20.0; 0.0] mm Hg). Combined intake of cholecalciferol and diuretic was associated with positive Д of serum nitrate/nitrite levels (p=1.38; p=0.02). Conclusions. Cholecalciferol and diuretics used as components of CAHT promoted greatest lowering of both SBP and DBP, elevated serum levels of nitrates/nitrites, and influenced PRA and serum level of 25(OH)D.

In this article, we present results of the study of blebbing activity of membranes of peripheral blood lymphocytes, concentrations of soluble platelet/endothelial cell adhesion molecule 1, and vascular endothelial growth factor (VEGF) in patients with pulmonary arterial hypertension associated with congenital heart diseases. The research has shown that hypoxia and hemodynamic factors are the initiators of blebbing of membrane of peripheral blood lymphocytes. The activity of blebbing increases in parallel with the severity of the disease. Aberrant leukocyte-endothelial interactions lead to the breach of athrombogenic endothelium function, hypercoagulation and risk of thrombosis. Revealed overexpression of VEGF, aimed at restoration of endothelial cells, has been most pronounced in cyanotic congenital heart defects. We suggest that the potentiating effect of apoptosis and endothelial cells’ proliferation is a key factor of irreversibility of pulmonary arterial hypertension in congenital heart defects.

Mitral valve disease is highly prevalent and quickly leads to development of severe heart failure. Mitral valve disease of degenerative or ischemic etiology affects 7.5 and 9.3% of population older than 65 and 75 years, respectively. “Open” (with cardiopulmonary bypass) surgical repair or valve replacement are not possible in almost half of affected patients because of their complications and concomitant diseases responsible for extremely high risk of these interventions. In the last decade, minimally invasive endovascular technology - transcatheter aortic valve implantation (TAVI) - has been widely introduced for correction of aortic valve disease in similar category of patients. However, transcatheter mitral valve implantation (TMVI) has been developed just during recent couple of years.

The proportion of elderly in the population is growing. The two-thirds of those over the age of 65 has arterial hypertension (AH). There is a significant increase in the incidence of isolated systolic hypertension with age. The relationship between increased pulse pressure, arterial stiffness and aging processes has been repeatedly confirmed in population epidemiological studies. Some evidence has been found that the treatment ofAH in the elderly is accompanied by a reduction in the risk of cardiovascular diseases. Target levels of blood pressure (BP) in elderly people with AH younger than 80 years, as well as over 80 years with a satisfactory physical and cognitive status with systolic BP >160 mm Hg is recommended to be reduce to 140-150 mm Hg. Low doses of thiazide diuretics and long-acting calcium channels blockers (mainly dihydropyridine) are attributed to first-line drugs in order to effectively reduce cardiovascular complications in the treatment of AH in the elderly. Their prescription as a fixed-dose combination appears to be an optimal solution when monotherapy is fails.

The article contains presentation of actual problems of selection of anticoagulant therapy for long term prevention of thromboembolic complications in outpatients with atrial fibrillation, chronic heart failure, and chronic kidney disease.tions in ambulatory Patients with atrial fibrillation, chronic heart failure and chronic kidney disease.