Background. In the recent years, there has been an increasing number of publications postulating that data on left atrial (LA) structure obtained by late gadolinium enhancement magnetic resonance imaging (LGE MRI) can improve the management of patients with atrial fibrillation (AF). At the same time, similar data regarding healthy LA myocardium is limited. Aim. To assess structural and functional properties of LA in healthy volunteers (HV) using cardiac magnetic resonance (CMR) (including LGE MRI); to compare these properties in patients with AF and HV. Materials and methods. We included in this study 53 patients with AF (28 without signs of cardiovascular disease, 28 with hypertension) and 23 HV of similar age. All enrolled persons underwent MRI. Cine-MRI was used to assess end diastolic volume of LA (LA EDV), LA ejection fraction (LA EF), left ventricular diastolic index (LV DI). High resolution LGE MRI was performed 15-20 min after gadoversetamide injection using IR 3D gradient echo pulse sequence with fat saturation (TI 290-340 ms, TE 2.44 ms, TR 610-1100ms). On obtained images LA was segmented semiautomatically. LA fibrosis quantification was performed using developed software LGE Heart Analyzer. The extent of fibrosis was represented as percent of LA myocardium volume. Fibrosis location was determined on reconstructed rotating 3D LA model. Results. Compared with patients HV had lower LA EDV (59 [54; 78] ml and 79 [65.5; 86.6] ml, р=0.043, respectively), higher LA EF (56.1 [49; 63.2] % and 44.5 [34.5, 54.5] %, р=0.03, respectively), and lower extent of LA fibrosis (0.7 [0.05; 3.5] % and 9.1 [1.7; 18] %, р<0.001). In HV sparse foci of fibrosis were located predominately in the inner part of LA posterior wall. In AF predominant fibrosis location was pulmonary vein ostia region. In HV the extent of LA fibrosis correlated with LA EDV (r=0.4, р=0.04), age (r=0.66, p<0.001) and LV DI (r= -0.5, p=0.015). In AF the extent of LA fibrosis correlated with LA EDV (r=0.37, p<0.001), LA EF (r= - 0.4, р<0.001) and grade of hypertension (r=0.35, p=0.01). Conclusions. In HV LA is characterized by normal EDV and EF. Minor LA fibrosis which can be found in HV is located predominantly in inner part of LA posterior wall adjacent to the mitral valve. Patients with AF are characterized by LA dilatation, LA EF reduction and pronounced LA fibrosis (compared to HV ) predominantly located near ostia of pulmonary veins.

Objective. To assess the impact of type 2 diabetes mellitus (T2DM) on prognosis of patients hospitalized because of acute decompensated heart failure (ADHF). Materials and Methods. We analyzed data of the hospital register of ADHF which comprised information on 735 patients (254 [35%] with T2DM) consecutively admitted in 2010-2011. Median follow-up was 1790 days. Results. The presence of T2DM was associated with increased risk of death: during the index hospitalization due to ADHF (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.0-2.8), within 18 months (HR 1.4, 95% CI 1.0-1.8), and within 5 years (HR 1.3, 95% CI 1.0-1.5). Conclusions. T2DM is common among acute decompensated heart failure patients (up to 35% of cases). T2DM is an independent risk factor of death during the index hospitalization and over the next 18 months and 5 years.

Purpose. To assess the suppression of tumorogenicity 2 (ST2) and copeptin significance for risk stratification of patient (pts) with acute decompensated heart failure (ADHF) during long-term follow-up compared with traditional risk factors. Methods. We included in a prospective study 159 pts with ADHF. Blood samples to determine copeptin, sST2, NT-proBNP and hsTnT concentration were collected at admission and at discharge from the hospital. Serial determination of biomarker concentration was performed at 3, 6 and 12 months of follow-up. The combined primary end point of the trial included cardiovascular (CV) death, hospitalization due to HF, episodes of HF deterioration requiring additional intravenous diuretics and CV death with successful resuscitation. Results. During 1-year follow-up (295.3±113.2 days) 56 pts (35.2%) had 78 (49.1%) cardiovascular events. Biomarker concentrations in low risk pts (without CV events) were significantly lower compared with high risk pts (with CV events). Discharge copeptin and NT-proBNP values were comparable for pts risk stratification: AUC=0.727 (95% CI 0.637-0.816), р<0.0001, and AUC=0.735 (0.640;0,830) p<0.0001, but sST2 concentrations had the most predictive capacity relative primary end point during 1-year follow-up: AUC=0.768 (95% CI 0.682-0.854), р<0.0001. Maximally sST2 values were predictive for 180 days period of follow-up: AUC=0.809 (95% CI 0.726-0.921; р<0.0001). Lack of copeptin, NT-proBNP and sST2 concentrations decrease below 28.31pmol/L, 1696 pg/ml and 37.8 ng/ml, respectively, was associated with the highest risk of CV events (HR 5.14 [95% CI (2.204-1198), p<0.0001]; HR 4.41 [95% CI 1.41-9.624], p<0.0001; and HR 6.755 [95% CI 3.026-15.082], p<0.0001, respectively). Value of sST2 at discharge were the most significant predictor of CV events in long-term follow-up combined with standard clinical model (including NT-proBNP) (ß=0.59, p<0.0001; AUC=0.843 [ (0.761-0.925), p<0.0001]). Adding copeptin values decreased model significance. Pts without CV events in the study had sST2, copeptin and NT-proBNP levels below 37.8 ng/ml, 28.31 pmol/L and 1696 pg/ml, respectively, after 3, 6, and 12 months of follow-up. Conclusion. Compared with copeptin, sST2 is more powerful predictor of death/hospitalization due to HF during 1 year follow-up after ADHF. Values of soluble ST2-receptor >37.8 ng/ml, copeptin >28.31pmol/L, and NT-proBNP over 1696 pg/ml at discharge from hospital reflect adverse prognosis in pts with ADHF. Serial copeptin, sST2 and NT-proBNP concentration determination after discharge from the hospital indicates the necessity of reduction the levels of these biomarkers below the cut-off values in long-term follow-up period.

Aim. To investigate the effects of intensive lipid-lowering therapy on cognitive functions and quality of life in patients (pts) with very high cardiovascular risk. Material and methods. In 93 pts (58 men, 63.2±9.5 years old with history of clinically evident cardiovascular disease and fasting low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/l or non-high-density lipoprotein cholesterol (non-HDL-C) >2.6 mmol/l the mental status and quality of life were assessed before and after 6 months of therapy with atorvastatin 80 mg/day. The Montreal Cognitive Assessment (MoCA) scale and Questionnaire SF-36 (russian version) were used to evaluate cognitive functions and quality of life. Results. 59 (63%) pts had cognitive dysfunction (less than 26 scores by MoCA scale). We observed significant difference in cognitive status between pts >65 and <65 years (21.1±3.3 vs 25.6±1.8 points, p<0.05) and between pts with and without stroke (22.4±3.1 vs 24.7±2.78 points, p<0.05). Changes of cognitive function were insignificant in all groups. We observed improvement of mean scores in all sections of SF-36 except vitality: physical functioning (PF) from 57.3±26.7 to 62.9±23.4 points, role-physical functioning (RP) from 40.0±27.9 to 47.1±26.2, bodily pain (BP) from 58.9±30.1 to 70.3±25.4, general health (GH) from 51.9±13.6 to 57.4±14.1, social functioning (SF) from 62.5±23.1 to 70.3±25.4 points, role-emotional (RE) from 53.3±39.4 to 61.4±33.1, mental health (MH) from 66.4±15.1 to 71.3±18.2 points (p<0.05 for all trends). Values of PF, RP, GH and RE grew more in <65 years group. Conclusion. 63% of patients with high cardiovascular risk had cognitive impairment. No association between statin use and cognition was found. Intensive lipid-lowering therapy was association significant improvement of quality of life according to SF-36.

Aim. To perform a randomized, open-label comparison of average time in therapeutic range (TTR) of international normalized ratio (INR) using two approaches to initial warfarin dosing during hospitalization: the standard method and the one using individual patient characteristics (clinical algorithm - the studied approach). Materials and methods. We randomly assigned 60 patients with different indications for vitamin K antagonist therapy to the studied approach (n=31, intervention group) or to the standard method (n=29, control group). А target INR range for all patients was 2.0 to 3.0. Results. The average TTR and portions of INR values within target range during the whole time of drug dosing turned out to be small. TTR was 22.4% with standard method and 21.4% with clinical algorithm, which was well below desired 60%. Conclusion. The opportunities for achieving target INR in inpatient settings, regardless of warfarin dosing regimen, are limited.

The review is dedicated to the new echocardiographic techniques in the assessment of right ventricular (RV) function, such as twodimensional speckle tracking and determining the RV volume by a three-dimensional model. Subclinical changes in RV function are of great importance for the diagnosis and assessment of prognosis of multiple cardiovascular as well as non-cardiac pathologies. Two-dimensional speckle tracking allows to assess longitudinal strain of the RV myocardium and to detect pathological changes before their clinical manifestations. Three-dimensional echocardiography enables calculation of the RV ejection fraction, what was not possible before with the use of ultrasound. Currently, both methods are promising for a comprehensive assessment of RV function.

This review provides modern data on the spectrum and the functional significance of micro-RNAs involved in atherogenesis and on some regulatory mechanisms that ensure the functioning of this class of molecules. We also outline some examples of micro-RNAs use as diagnostic and therapeutic targets.

Despite availability of a wide selection of antihypertensive drugs, only a small portion of patients with arterial hypertension are treated effectively. Angiotensin converting enzyme inhibitors (ACEI) are considered drugs of first choice for starting therapy of uncomplicated arterial hypertension. Among large number of representatives of this class lisinopril deserves special attention as one of best known and well-studied ACEIs. Wide spectrum of activity and proven organoprotective qualities of lisinopril allow to use it a variety of situations.