Aim: to investigate safety and angiographic efficacy of two-stage revascularization with percutaneous coronary intervention (PCI) with stenting delayed by one day in patients with acute myocardial infarction (MI) and massive coronary thrombosis.

Materials and methods. We included in this study 12 patients with massive infarct related coronary artery thrombus which length was greater than thrice the vessel diameter in the presence of TIMI grade II–III blood flow as detected by coronary angiography (CAG). The emergency PCI was not performed, and conservative antithrombotic therapy continued for 24 hours. After this day, CAG was repeated.

Results. Repeat CAG in all patients showed thrombus regression which visually appeared as complete lysis in 8, and partial lysis – in 4 patients. Stenting of residual stenosis was performed in 11 patients without complications. In 1 patient residual stenosis was considered insignificant (<50 %) therefore stenting was not performed. No-reflowphenomenon and recurrent MI were not observed.

Conclusion. These data suggest that in patients with massive coronary artery thrombosis conservative antithrombotic therapy for 24 hours followed by repeated CAG and, if required, by stenting of residual stenosis, is safe treatment tactics that might reduce the risk of the no-reflow phenomenon.

Purpose: to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention.
Materials and methods. We retrospectively analyzed data from 456 consecutive patients (mean age 59.9±7.1 years, 18.2 % women) who underwent CTO PCI procedures (n=477) during 2014–2016 in the E. N. Meshalkin National Medical Research Center. CTO was localized in the right (61.2 %), left anterior descending (23.2 %) and left circumflex (15.3 %) coronary arteries. In one patient CTO was located in the left main coronary artery. According to the J-CTO score, 30 % of lesions were classified as easy, 36.4 % intermediate, 23.7 % difficult, and 18.9 % very difficult.
Results. Technical and procedural successes were achieved in 374 (78.4 %) and 366 patients (76.7 %), respectively. Antegrade approach was used in 378 (79.2 %), retrograde approach – in 99 (20.7 %) cases. Retrograde approach as primary strategy was used in 27 cases (5.7 %). Most frequent access for CTO PCI was radial artery, contralateral injection was used in 151 cases (31.6 %). Total number of stents per lesion was 1.6±0.98. The mean fluoroscopy time was 36.2±31 min.
Conclusions. The rate of procedural adverse events in our study was low and similar to the non-CTO PCI series. However, despite the large number of CTO PCIs, the procedural success rate was still lower than in centers with dedicated programs for the management of such patients. Thus, further work is required to overcome this difference. Possible solution of this problem might be development and introduction in clinical practice of an algorithm for CTO recanalization.

Aim: to study myocardial function in patients with chronic heart failure (CHF) with preserved left ventricular ejection fraction (PEF) by speckle tracking echocardiography and tissue doppler imaging.
Materials and methods. We examined 80 patients aged 50–70 years with verified NYHA class I–IIa CHF and PEF due to arterial hypertension and ischemic heart disease, and 35 healthy persons. Examination included echocardiography, and speckle-tracking echocardiography.
Results. According to 6-min walk test 26.9 % of patients had functional class (FC) I CHF, 48.3 % – FC II CHF, and 24.8 – FC III CHF. The mean left ventricular ejection fraction (Simpson’s method) was 62.3±5.35 %, mean end systolic left atrial volume index – 45±8.1 ml / m2. All patients had left ventricular diastolic dysfunction: 60 patients – abnormal relaxation pattern, 20 patients – pseudonormal pattern. Other findings were reduced global longitudinal strain (GLS, –16.56±2.61 %) and GLS rate (GLSR, –0.75±0.11 s–1) of the left ventricle and reduced segmental strain and strain rate in basal anteroseptal (–13.62±3.44 % and –0.77±0.04 s–1, respectively) and basal anterolateral (–14.17±3.31 % and –0.81±0.11 s–1, respectively) segments. Lowering of global circular left ventricular strain and strain rate (–15.63±4.8% and –1.4±0.23 s–1, respectively) was found to be smaller than that of GLS (p<0.05). There was positive correlation between left ventricular systolic GLS and left atrial volume (r=0.601, р<0.01).
Conclusions. In patients with CHF and PEF we revealed alterations of diastolic function (abnormal relaxation and pseudonormal patterns), reductions of global and segmental strain and strain rate of the left ventricle. More pronounced lowering of segmental strain and strain rate was registered in left ventricular basal anteroseptal and basal anterolateral segments. Circular strain was found to be slightly reduced, while radial strain was unchanged.

Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.

Purpose: to study blood pressure levels and the prevalence of hypertension in persons aged 25–45 years in Novosibirsk.

Materials and methods. A cross-sectional population study in one of typical areas of Novosibirsk was performed in 2013–2016. The study included 479 men and 612 women aged 25–45 years. Arterial hypertension was defined as blood pressure (BP) ≥140 / 90 mmHg according to Russian recommendations (2004). For analysis two age groups were distinguished: 25–34 years and 35–45 years.

Results. Mean values of systolic and diastolic BP were significantly lower in women than in men in age groups. In men and women, the analyzed indicators were significantly higher in the older than in the younger age group. Mean values of pulse pressure in men were significantly higher than in women in both age groups, there were no differences in the analyzed index between age groups in either men or women. Optimal BP was more often recorded among women than among men in both age groups. The proportion of persons with normal BP among men was grate than among women in both age groups. In the age group 35–45 years compared with the younger group, in men there was a decrease in incidence of category with BP<140 / 90 mmHg, an increase of the proportion of persons with hypertension grades 1 and 2, the appearance of persons with grade 3 hypertension; in women – an increase of the proportion of individuals with normal, high-normal BP, and with grade 1 hypertension, appearance of individuals with grades 2 and 3 hypertension. Frequency of BP categories ≥140 / 90 mmHg in age group 25–34 years among men was 17.6 %, among women 3.1 % (p<0.0001); in age group 35–45 years among men – 34.7 %, among women – 12.5 % (p<0.0001).

Conclusions. Prevalence of hypertension in men was 28 %, in women – 9 %. Favorable tendencies of BP indicators in both sexes were revealed over a 30-year period, while gender differences did not change.

Objective: to study potantial of remote ischemic preconditioning (RIP) as method of cardioprotection during coronary artery bypass surgery with cardiopulmonary bypass (CPB) and anesthesia with propofol.
Materials and methods. We included in this study 87 patients (7 were excluded) with ischemic heart disease, hospitalized in the clinic of aortic and cardiovascular surgery of the I. M. Sechenov First Moscow State Medical University clinical hospital № 1. All patients had indications for direct myocardial revascularization by coronary artery bypass surgery. One day before operation patients were randomly assigned to 2 groups depending on preparation scheme: main group of RIP and the control group. The frequency of complications during surgery and in the postoperative period was assessed. Troponin I level was measured before, and in 2 and 24 hours after surgery. The level of lactate in the venous blood was measured before and after surgery.
Results. Numbers of intraoperative and early postoperative complications in the main and control groups were similar. There were no differences between groups in troponin I and lactate levels after surgery.
Conclusions. Remote ischemic preconditioning has no effect on the outcome of coronary artery bypass surgery with cardiopulmonary bypass and anesthesia with propofol.

Aim: to compare various approaches to estimation of vascular age in patients from sample of citizens of Saint-Petersburg (SPB) with arterial pressure (AP) above 130 / 80 mm Hg without history of cardiovascular events.
Materials and methods. Examination of a population sample of SPB citizens (n=1600) was carried out within framework of the observational epidemiological study ESSE-RF (ЭССЕ-РФ) in 2012–2013. We selected from this sample 477 women and man aged 40–65 years without history of cardiovascular events, diabetes, or chronic kidney disease, and AP >130 / 80 mm Hg. Examination included anthropometry, sampling of fasting blood for measurement of lipids, glucose, creatinine levels, urine sampling for determination of albumin excretion, and AP measurement in ac-cordance with standard methods. The SCORE scale was used of evaluation of 10-year risk of fatal stroke and fatal myocardial infarction. Volume sphygmography (VaSera device) was applied for determination of cardio-ankle vascular index (CAVI) with calculation of vascular age, and ankle-brachial index. ASCORE scale was used for determination of сalculated vascular age was determined with help of the ASCORE scale.
Results. Mean age of participants (182 men [38.2 %], 295 women [61.8 %]) was 52.5±6.2 years. Calculated and instrumental methods of determination of vascular age and early vascular aging had low concordance (κ = 0.099). With elevation of cardiovascular risk early vascular aging was more frequently detected by method of its calculation ASCORE than with instrumental method (VaSera). In the absence of achievement of target AP level signs of early vascular aging were significantly more often detected by the method of vascular age calculation than by the instrumental method VaSera.
Conclusion. Application of the concept of vascular age and early vascular aging syndrome might be an effective tool for stratification of cardiovascular risk by a physician and improvement of adherence of a patient. This is especially actual for young patients with burdened heredity. One can assume that estimation of virtual risk factor load on blood vessels by the ASCORE method of calculation is more sensitive to detection of premature vascular aging, while requiring less financial and organizational efforts.

Aim: to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect.

Materials and methods. Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9.

Results.At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm³, right ventricular volume – from 45.2±5.1 to 33.4±3.8 cm³, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W.

Conclusion. Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.

The article presents modern analysis of the studies and reflects the key problems concerning the feasibility of performing cardiac MRI for assessment of myocardial viability in patients with history of myocardial infarction (with postinfarction cardiosclerosis), as well as the effectiveness of the method for predicting restoration of the function of hibernating myocardium after myocardial revascularization.

Steady increase in the prevalence of chronic kidney disease (CKD) is a serious public health problem, since CKD potentially leads to the development of end-stage renal disease (ESRD) that requires high-cost replacement therapy and is closely associated with increased risk of developing cardiovascular diseases (CVD), which are the cause of death in most patients. Progression of renal dysfunction and development of CVD are significantly affected by hyper- and dyslipidemia. This review contains results of studies evaluating the effect of hypolipidemic therapy on reduction of cardiovascular risk and slowdown of renal dysfunction in patients with CKD at pre-dialysis and dialysis stages of renal failure, as well as in patients with kidney transplant. In addition, recommendations on nutrition and new therapeutic approaches to lipid-lowering therapy in patients with CKD, as well as prospects for the usage of new hypolipidemic drugs are also presented.

A clinical analysis of an elderly patient with medium-high-risk pulmonary thromboembolism and chronic kidney disease is presented. Recommendations on modern principles of diagnosis, choice of treatment tactics in patients with this pathology are given. Much attention is paid to the safety of anticoagulant treatment.