Purpose. To assess and to compare the ventricular myocardium activation patern obtained by non-invasive epi- and endocardial mapping (NIEEM), as well as electrocardiographic (ECG) variants of lef bundle branch block (LBBB) and to estimate the value of these data for the success of cardiac resynchronization therapy (CRT).

Materials and methods. Te study included 23 patients (mean age 59,6±9,9 years) with LBBB, QRS duration ≥ 130 ms, lef ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of LBBB ECG-criteria, proposed by Strauss D.G. et. al, patients were divided into 2 groups: 1group - strict LBBB, proposed by Strauss D.G. et. al. (n=14) and 2 group – other ECG morphologies of LBBB (n=9). NIEEM by the Amycard 01C system with an analysis of epi- and endocardial ventricular electrical activation was performed in all patients and 5 healthy volunteers (mean age 29±1,0years). Response to CRT was estimated by echo and was defned as decrease in lef ventricular (LV) end-systolic volume by > 15% afer 6 months of follow-up.

Results. LBBB ECG-criteria, proposed by Strauss D.G. et. al, was detected in 14 patients (61% of all included). According to the results of NIEEM, these patients had more pronounced ventricular electrical uncoupling (VEU) (р=0,002). Most ofen the line of block was detected in the anteroseptal or posterolateral region of the LV. Te zone of late LV activation, which is the most optimal position for the LV pacing electrode, was located in the basal and middle segments of the lateral and posterior walls. Afer 6 months of CRT 15 patients (65%) were included in the "response" group, the remaining 8 patients (35%) formed the "non-response" group according to echo criteria. In the "response" group the morphology of the QRS complex more frequently met the criteria, proposed by Strauss D.G. et al, than other ECG variants of LBBB (12 vs. 3 respectively, p = 0.023). Initially, VEU was more pronounced in the "response" group (VEU 55 [51, 64] ms in the "response" group vs 22 [8, 38] ms in the "non-response" group).

Сonclusions. LBBB ECG criteria, proposed by Strauss D.G., identify patients with delayed transseptal interventricular conduction due to complete LBBB, what is a good target for CPT. Identifcation of individual ventricular activation properties may help to reveal responders to CRT in patients with LBBB.

Aim. To study effects of gender differences in clinical and epidemiological factors on long-term prognosis for patients with acute decompensated heart failure (ADHF).

Materials and methods. A retrospective, observational analysis of a sample of patients (n=718) hospitalized with signs of ADHF with subsequent collecting information about the endpoint (all-cause death) at four years.

Results. Age was a predictor of unfavorable outcome for both men and women (RR, 1.04, 95% CI, 1.02–1.06, p<0.001 and RR, 1.04, 95% CI, 1.03–1.06, p<0.001). Presence of lower extremity edema increased the risk of fatal outcome for men (RR, 2.03, 95% CI, 1.21-3.39, р=0.007) whereas for women, presence of ascites (RR, 3.43, 95% CI, 2.09-5.64, р<0.001) or orthopneic position on admission (RR, 1.51, 95% CI, 1.03-2.23, p=0.04) resulted in the increased risk. For both sexes, the prediction improved with every 10% increase in systolic BP on admission (RR, 0.87, 95% CI, 0.78–0.97, p=0.01 for men and RR, 0.84, 95% CI, 0.76–0.91, p<0.001 for women). Presence of diabetes mellitus affected the prediction only for women (RR, 1.80, 95% CI, 1.34–2.42, p<0.001). A history of myocardial infarction (RR, 1.40, 95% CI, 1.01–1.95, p=0.04 and RR, 1.44, 95% CI, 1.04–1.98, р=0.03), presence of communityacquired pneumonia (RR, 1.90, 95% CI, 1.32–2.74, p<0.001 and RR, 2.38, 95% CI, 1.55–3.68, p<0.001) adversely affected the prediction for men and women, respectively. At the end of study (4 years), the endpoint (all-cause death) was observed in 65.5% of men and 48.1% of women, median survival was 720 и 1168 days, respectively.

Conclusions. Te long-term prognosis was worse for men hospitalized for ADHF. Presence of congestion signs impaired the prediction for both men and women. Patients with higher systolic BP on admission were characterized with beter survival. A history of diabetes mellitus for women and myocardial infarction or community acquired pneumonia for both sexes worsened the long-term prediction

Te aim of the study was to evaluate the temporal dynamics of brain CD68+ and stabilin-1+ macrophage infltration in patients with fatal myocardial infarction (MI) type 1.

Materials and Methods. Te study included 31 patients with fatal MI type I. Te control group comprised 10 patients of 18–40 age group who died from injuries incompatible with life. Patients with MI were divided into two groups. Group 1 comprised patients who died during the frst 72 hours of MI, group 2 comprised patients who died on days 4‒28. Macrophage infltration in the brain was assessed by immunohistochemical analysis. We used CD68 as a marker for the cells of the macrophage lineage and stabilin-1 as an M2-like macrophage biomarker.

Results. In group 1 the number of brain CD68+ macrophages was signifcantly higher than in the control group. In group 2 the intensity of brain CD68+ cells infltration was lower than in group 1 and higher than in the control group. Tere was a small amount of stabilin-1+ macrophages in the brain of healthy people, as well as of patients who died from MI. Tere were no signifcant differences in the number of stabilin-1+ cells between group 1 and group 2. Correlation analysis revealed the presence of positive correlation between the number of CD68 + macrophages in the infarct, peri-infarct, and non-infarct areas of the myocardium and the number of CD68+ macrophages in the brain in patients with MI. Tere were not correlations between the number of CD68 + and stabilin-1+ cells and the presence of diabetes mellitus, history of stroke, history of MI, and pre-infarction angina.

Conclusion. Te number of brain CD68+ macrophages signifcantly increased during the frst three days of MI. Te number of brain stabilin-1+ macrophages did not increase and did not differ from the control values. We observed a positive correlation between the number of CD68+ macrophages in the brain and myocardium.

Actuality. In the basic therapy of CHF, drugs that reduce the pulse is one of the leading places. Target values of heart rate with sinus rhythm are established. Tere is still no consensus as to which heart rate is ideal in patients with CHF on the background of the rhythm of atrial fbrillation (AF). Te study of the prognosis in patients with CHF and AF depending on the achieved heart rate is relevant.

Objective. To analyze the overall mortality and establish the stratifcation risks of death in patients with CHF and AF depending on the form of AF, functional class of CHF and the presence of tachycardia.

Material and methods. A prospective cohort study was conducted in a group of patients with CHF who were observed at the City Center for CHF treatment (n = 591) during the year. Of these, 47.4% of patients had CHF and AF (n = 280) and 52.6% of patients with CHF without AF (n = 311).

Results. In a year, a permanent AF registered among patients with CHF and AF in 55.4%, persistent – in 36.4%, and paroxysmal – in 8.2% of cases. In 12.2% of patients, the diagnosis of AF was frst diagnosed. According to functional class of CHF, LVEF, assessment of clinical assessment scale, the group with a permanent AF was signifcantly heavier than without AF. Te mortality of patients with tachycardia signifcantly increased as a function of the increase in CHF from I–II to III–IV class: from 3.6% to 14.9% in the group without AF (p=0.04), and in the group with paroxysmal and persistent AF from 6.7% to 25.9% (p = 0.043). Te presence of tachycardia increases the risk of death by 61%, and the transition to a heavier functional class is 4.9 times. With each increase in the clinical assessment scale exponent by 1 point, the mortality rate in the sample is increased by 16%.

Conclusion. Heart rate is not an independent predictor of death, but in combination with functional class III–IV CHF tachycardia signifcantly worsens the prognosis.

Tis review focused on prevalence of anemia and iron defciency (ID) in CHF and their effect on the course and prognosis of this condition. Based on evaluation of numerous laboratory data defnitions of anemia and ID were suggested. Specifcally, a diagnostic value of measuring serum iron, serum ferritin, transferrin saturation, total iron-binding capacity, and concentration of soluble transferrin receptors was discussed. Te review highlighted the importance of measuring bone marrow iron, which is rarely used in everyday clinical practice even though this test is considered a «gold standard» of ID diagnosis. Te review provided an insight into pathogenetic mechanisms of ID in CHF including insufcient iron supply, role of inflammation, erythropoietin, RAS, and effects of some pharmacological therapies. Te authors described physiological consequences of ID and anemia, activation of hemodynamic and non-hemodynamic compensatory mechanisms, which develop in response to anemia and not infrequently aggravate CHF. Special atention was paid to current approaches to treatment of anemia and ID in CHF, including a discussion of efcacy and safety of oral and intravenous dosage forms of iron and hemopoiesis stimulators.

We present a 13-years follow-up results in patient with dilated cardiomyopathy. We performed intracoronary infusion of bone marrow mononuclear fraction in patient with 4th heart failure functional class in 2005. We observed an improvement in symptoms (patient had 1st functional class of heart failure) during 10-years follow-up. In 2015 due to clinical worsening we performed 2nd and 3rd bone marrow mononuclear cells infusion with 9-month interval. We observed a signifcant improvement in symptoms, EF and LV sizes. We continue the follow-up.