Aim of this study was to evaluate the impact of direct stenting (DS) strategy on the results of treatment of female patients with STelevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs). Materials and methods. Among 1297 patients with STEMI admitted to the coronary care unit and subjected to PCIs from 2006 to 2015 there were 330 women (25.4 %). Data from 161 women (48.8 %) who underwent DS were compared with those from 169 women who underwent indirect stenting (IS). Among patients of IS group in 148 (87.6 %) stenting was performed after predilation, in 7 (4.1 %) after manual thrombus aspiration, and in 14 (8.3 %) after combination of predilation and thrombus aspiration. Results. The rate of angiographic success was higher in the DS group (97.5 vs. 87.6 %, р<0.001). Rates of deaths (4.3 vs. 11.8 %; p=0.013), major adverse cardiac events (MACE)
(4.3 vs. 13 %; p=0.005), and no-reflow (1.9 % vs. 11.2 %; p=0.013) were significantly lower in the DS group. There were no differences in rates of recurrent myocardial infarction and access site complications. Following propensity score matching, each group contained 78 patients. Rates of MACE (2.6 vs. 14.1 %; p=0.009) and deaths (2.6 vs. 12.8 %; p=0.016) remained significantly lower in the DS group. After multivariate adjustment, DS strategy was independently associated with lower mortality (odds ratio [OR] 0.29; 95 % confidence interval [CI] 0.09–0.97; p=0.04) and MACE (OR=0.28; 95 %CI 0.09–0.087; p=0.03). Conclusion. DS strategy in STEMI female patients turned out to be safe and effective technique.

Purpose: to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical course of ischemic heart disease (IHD) during 3–5 years of follow-up in men after coronary artery bypass grafting (CABG). Materials and methods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwent color duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT) of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels was assessed by the Agatston method. After 3–5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followup was 11.7 % (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcification scores. Results. Significant CA calcification prior to CABG was detected in more than half of the patients (57.6 %). Among all clinical and anamnestic factors only one risk factor – smoking was associated with mortality (odds ratio [OR] 9.8, 95 % confidence interval [CI] 1.2–78.1, χ2=6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenic syndrome and BCA involvement. In the group of patients with baseline coronary calcification index >400 there were more smokers (р=0.026) and patients with lesions in >3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage we revealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= –0.24, р=0.06), Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3–5 years after CABG a medium positive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029). Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoral bone as the only significant predictor of calcium score increase during 3–5 years of follow-up. Conclusion. Dynamics of calcification of CAs in men with IHD during 3–5 years of follow-up after CABG was multidirectional, but in most cases (66 %) it was progressive. There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone prior to CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary  calcification was found. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral density of femoral bone.

Purpose: elaboration of algorithm for selection of patients with resistant arterial hypertension (AH) for Catheter-Based Renal Sympathetic Denervation (CBRSD). Materials and methods. We examined 284 patients with resistant AH. On stage 1 we excluded most frequent causes of secondary AH. In 247 patients (86.9 %) we established secondary character of AH, in 37 patients (13.1 %) AH was found to be essential. On stage 2 patients with essential AH were given 3–5 component hypotensive therapy. At the background of this therapy we conducted 24‑hour ambulatory blood pressure monitoring (ABPM). CBRSD procedure was considered indicated if according to ABPM average 24‑hour blood pressure (BP) was above 150 and 100 mm Hg, and 24‑hour elevated BP load exceeded 60 %. In 13 of 37 patients (35 %) BP level satisfied these conditions. For CBRSD we used high frequency generator. Ablation was performed using the Symplicity Catheter. Results were assessed in 1, 2, 9, 12, and 28 months. Results.Target BP level at the background of minimal doses of hypotensive drugs was achieved in 11 patients (85 %), what was confirmed by ABPM data. Levels of mean 24–4 hour systolic and diastolic BP significantly decreased from 173.9±14.9 to 143±21.3, р<0.05, and from 108.2±8.7 to 91.4±13.8 mm Hg., р<0.05, respectively. Index of elevated systolic BP time decreased from 78.2±14.6 to 49.8±29.6 %, р<0.05. Best effect was achieved in patients with AH duration before the procedure less than 7 years. None of the patients had episodes of cerebral vascular insufficiency or heart failure progression. Conclusion. While determining indications to bilateral CBRSD one should be governed by such criteria as exclusion of symptomatic AH and objective proofs of AH resistance (according to ABPM at the background of hypotensive therapy). 

Purpose: to study frequency of progression of chronic heart failure (CHF), to develop multifactorial models for evaluation of risk of progression, and measures of non-drug secondary prevention of CHF. Materials and methods. We included in this study 531 patients with functional class (FC) I–III CHF (FC I – n=254, FC II – n=255, FC III – n=22). Examination included clinical-instrumental, clinical-functional, and laboratory (with determination of NT-proBNP concentration) investigations, use of the AUDIT and Morisky Green questionnaires. Results. Rate of CHF progression for 24 months was 11.7 % (FC I – 16.1, FC II – 7.8, FC III – 4.5 %). Irrespective of FC significant factors of CHF progression were history of myocardial infarction, and low adherence to treatment. Additional prognostic criteria of increase of CHF FC I to FC II were age >74 years, excessive body mass, disturbance of carbohydrate metabolism, arterial hypertension, and frequent intake of alcohol. FC II CHF progression was associated with such factors as type 2 diabetes, 3‑degree arterial hypertension, permanent atrial fibrillation, and smoking. Using these prognostic criteria, we developed multifactor models, based on which scales for assessing the risk of FC I and II CHF progression were created. These models demonstrated high accuracy of prognosis and good reproducibility (on independent test samples of patients with CHF FC I and FC II prognostic accuracy was 86.3 и 85.5 %, respectively). We also developed a program of secondary non-drug prevention of CHF progression,  with inclusion of structured dynamic education of patients with organization of control and self-control of knowledge quality. After this therapeutic education progression CHF in high risk patients was 2.2 %. Conclusion. Complex application of scores for evaluation of risk of FC I–II CHF progression and the program of secondary non-drug prevention determined lowering of frequency of increases of class of CHF severity from 11.7 to 2.2 %. 

Introduction: A novel cardiac gamma camera utilizes the radiopharmaceutical Iodine-123-Meta-iodobenzylguanidine (₁₂₃I-MIBG) to visualize cardiac sympathetic innervation. Physiological accumulation of ₁₂₃I-mIBG provides an anatomical quantitative determination of the structures of the autonomic nervous system (ANS) with discrete uptake areas (DUA) of sympathetic activity located in the left atrium (LA) corresponding to the main ganglionic plexi (GP) clusters that could not previously be visualized. Aim: to visualize the DUA of the heart in patients with paroxysmal atrial fibrillation (AF) and to assess the effect of radiofrequency ablation (RFA) on DUA in LA. Materials and Methods. Computed tomography (CT) of the heart and radionuclide imaging with ₁₂₃I-mIBG were performed in 15 patients with paroxysmal AF. The results of the study were combined with preliminary taken CT images to create a detailed anatomical map of the sympathetic activity of the heart. The processed images were combined with the 3D reconstruction of the LA, obtained with the navigation system (CARTO 3, CARTO RMT). In DUA, high-frequency stimulation (HFS) followed by RF ablation was performed using the current recommended parameters. Results. Forty-eight DUA (median 3 [3; 3]) were identified. Average activity of DUA was 1315 [1171; 1462] cnt / sec / ml. Positive response to HFS in the DUA was obtained in 8 (53.3 %) patients. Prior to ablation, no response was received to HFS in areas of LA outside the DUA. After ablation, there was no response to HFS in the DUA sites. At repeated scans 3 DUA (median 0 [0; 0]; p<0.001 compared with preoperative data) were observed. Activity of DUA significantly decreased to 819 [684; 955] cnt / sec / ml (p<0.001 as compared with preoperative data). Thirteen of 13 of 15 patients (87 %) had no AF / AT / AFL recurrences for 6 month follow up. Conclusion. In patients with AF, the areas of sympathetic activity in LA can be visualized by physiological localized uptake of ₁₂₃I-mIBG. Radiofrequency catheter ablation can target the identified sympathetic innervation structures in AF patients precisely and effectively.

Decreased heart rate variability (HRV) is associated with increased mortality risk in various diseases. The objective of this investigation:to study HRV in patients with sickle cell anemia (SCA) and to assess the effect of pulmonary arterial hypertension (PAH) on HRV in these patients. Materials and methods. HRV registration and Doppler echocardiographic assessment of systolic pulmonary arterial pressure (PAP) was carried out in 61 stable patients with SCA and 24 healthy subjects. Results. Low frequency power (LFP) and high frequency power (HFP) were decreased in SCA patients compared to healthy subjects. Among SCA patients, PAH patients had lower  LFP and HFP than patients without PAH. In SCA patients, systolic PAP showed significant negative correlation with LFP and HFP. Conclusion. HRV is significantly decreased in SCA patients, especially in those with PAH. HRV may be particularly useful in early detection of PAH patients who may have worse prognosis and higher mortality risk.

The Aim of the study was a detailed investigation of pressure volume-loop (PV-loop) curves in the rat heart during development of doxorubicin cardiomyopathy. Materials and methods. Cardiomyopathy in rats has been developed after 4 weeks doxorubicin administration (2 mg / kg weekly). Results. Echocardiographic study of rats in 8 weeks from onset of doxorubicin administration showed preponderance of systolic dysfunction (67 %) with decrease of left ventricular (LV) ejection fraction (EF) by 30 %. Simultaneous registration of LV pressure and volume showed that diastolic LV volume was preserved in doxorubicin-treated rats due to considerable lengthening of the diastole, the heart rate was reduced by 22 %. These hearts also showed slowing of relaxation, reduced maximal rate of pressure development and stroke work, as well as significant reduction in peripheral arterial resistance. Diastolic dysfunction differed from the systolic one by normal systolic EF and preserved LV contractility index as well as lower diastolic LV pressure throughout the diastole. Conclusions. Based on these data, four compensatory mechanisms associated with cardiomyopathy were distinguished - 1) slowing of myocardial relaxation, prolonging myofibrillar active state, 2) reduction of peripheral arterial resistance for easier LV ejection, 3) heart rate reduction, prolonging diastolic pause and thus facilitating better LV filling and 4) increased pressure in the small circle, also contributing to the LV rapid filling.

Aim: to investigate the functional interaction of α₂-adrenergic and imidazoline receptors recently identified on the sarcolemma of isolated cardiomyocytes for regulation of the intracellular calcium and the production of the signal molecule of nitric oxide (NO). Materials and methods: experiments were performed on isolated left ventricular cardiomyocytes of Wistar rats. Potential-dependent Ca²⁺-currents were measured from the whole-cell by the patch-clamp method in “perforated-patch” configuration. The intracellular calcium and the production of nitric oxide were estimated from the changes in fluorescence intensity of the Ca²⁺-specific and NO-sensitive dyes at fluorescent or confocal microscope. Results: It has been shown that α₂‑adrenergic and imidazoline receptor agonists inhibit L-type Ca²⁺-currents by themselves, but their effects do not develop against each other’s background. The blockade of key effector molecules: protein kinase B (Akt kinase) for α₂‑adrenergic receptors, and protein kinase C for imidazoline receptors causes the action of agonists to become additive. Both the selective α₂‑agonist, guanabenz, and the specific agonist of the first type imidazoline receptors, rilmenidine, show an additional inhibition of Ca²⁺-currents against the basal background already reduced by the activation of one of the two receptor systems. Wherein rilmenidine increases the level of free  Ca²⁺ in the cytosol, and guanabenz, on the contrary, decreases it. The action of guanabenz does not develop against the background of rilmenidine, although it, in turn, effectively increases the intracellular level of calcium in guanabenz-pretreated cardiac cells. Activation of α₂‑adrenergic receptors leads to significant stimulation of the endothelial isoform of NO-synthase, and as a result to an increase in the NO level. Activation of imidazoline receptors itself does not affect NO synthesis but it prevents the production of NO induced by α₂‑agonists. Conclusion: obtained data make it possible to formulate a number of useful recommendations for clinical practice, and also to clarify the non-central peripheral effects arising from the activation of α₂‑adrenergic or imidazoline systems under conditions of endogenous hyperactivation on of the two systems.

Understanding mechanisms of chemotherapy cardiotoxicity is an important problem due to the lack of clear understanding of its occurrence. Development of endothelial dysfunction is considered to be one of possible ways in implementation of these side effects. The analysis of endothelin-1 and e-selectin levels in 26  patients with lymphoproliferative diseases before and after the completion of the treatment program was been performed. The results of the study showed normal values of E-selectin level and increased level of endothelin-1 in the whole group of patients before treatment. After completion of chemotherapy program, in the whole group, there was a decrease of these two markers. However, values of level of endothelin-1 with vasoconstrictor effect remained high even after the end of therapy. It is imp ortant that at detailed analysis the dynamics of investigated markers in patients of older age group (median age 64 years) was associated with worsening of endothelial dysfunction.

Objective: to study myocardial contractile function in patients with liver cirrhosis and ascites in the presence of bacterial overgrowth syndrome (BOS) and pathological bacterial translocation. Materials and methods. We included in this study 59 patients with Child-Pugh class B and C liver cirrhosis (LC) of various etiology and ascites. Control group comprised 12 patients with ischemic heart disease complicated by chronic heart failure (CHF). Examination included history taking and laboratory and instrumental investigation. LC was diagnosed basing on clinical symptoms and instrumental studies. Child-Pugh and MELD scores were used for assessment of LC severity and prognosis. International ascites club grading system was used for evaluation of severity of ascites. Hydrogen breath test was applied for diagnosing BOS. Syndrome of pathological bacterial translocation was established based on blood levels of lipopolysaccharide-binding protein and detection of bacterial DNA in ascitic fluid. Structural-functional parameters of the myocardium and hemodynamics were assessed by echocardiography. Brain natriuretic peptide (BNP) concentration was measured in blood serum and ascitic fluid. Results. In 13 of 59 patients with LC the hydrogen breath test was negative, in 33 positive and in 13 patients the positive hydrogen test was combined with the presence of BOS and pathological bacterial translocation. Blood serum and ascitic fluid BNP concentrations in LC patients were low and within normal limits (62.5±4.1 and 53.3±4.9 rg / ml, respectively), what contrasted with high BNP concentrations in patients with CHF (1820±95.5 and 497.1±39.6 rg / ml, respectively). Total protein level in ascitic fluid also was significantly lower in patients with LC than in patients with CHF (1.77±0.1 and 4.43±0.35 mg / dL, respectively). The serum-ascitic albumin gradient (SAAG) in both groups of patients exceeded 1.1 (1.58±0.13 in patients with CHF and 1.88±0.19 in patients with LC). Conclusions. In patients with liver cirrhosis the presence of BOS and bacterial translocation did not produce a distinct negative impact on contractile function.

Type 2 diabetes mellitus (T2DM) has gone beyond the professional interests of one specialty. T2DM, cardiovascular (CV) diseases and chronic kidney disease, considered from the standpoint of a single cardio-reno-metabolic continuum, place a heavy economic burden on society. At the same time, the improvement of diagnostic methods and medical technologies led to distinct decrease in the frequency and mortality from a number of complications of T2DM, including myocardial infarction and stroke, but other states took their place. Thus, heart failure (HF) has taken the position of one of the most frequent complications with average prevalence of 24–40 % and significant predominance of HF with preserved ejection fraction (HFpEF). According to this paradigm, HFpEF is not a disease of diastolic dysfunction, but a systemic disease, the central element of which is impaired renal function. All this together has a potential value for choosing the optimal therapy. In recent years the results of specially designed studies assessing the CV-safety of antidiabetic drugs from the groups of dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like preptide-1 (GLP-1) receptor agonists and sodium – glucose co-transporter-2 (SGLT2) inhibitors have become known. These drugs, except for SGLT2 inhibitors, by their mechanism of action affecting insulin resistance and hyperglycemia, demonstrated neutral or negative result on the frequency of hospitalizations due to HF. The EMPA-REG OUTCOME study with SGLT2, which has a special insulin-independent mechanism of action, demonstrated not only the efficacy and CV-safety of the drug in the form of a decrease in CV mortality by 38 %, but also a decrease in hospitalizations for HF by 35 %. Further studies with SGLT2 inhibitors confirmed positive effect on HF, indicating a class effect of the drugs. The recently completed study DECLARE-TIMI 58 proved the advantages of using dapagliflozin for the primary and secondary prevention of HF. This review highlights the prevalence of HF in diabetes mellitus, a new concept of the pathophysiology of HF, the main groups of sugar-lowering drugs and their effect on CV outcomes, in particular on HF. 

The modern data on structure and the functional activity of macrophages are presented in the review. It is shown that they are the nonhomogeneous cell population. Two of their main subpopulations are presented as M1 and M2 phenotypes which perform opposite functions at inflammation development. The main attention in the review is paid to a role of macrophages in pathogenesis of atherosclerosis and, first, in formation of unstable atherosclerotic plaques which are the cause of the most severe complications of the disease. It is shown that main subpopulations of macrophages play different roles in formation of unstable and stable atherosclerotic plaques. Macrophages of M1 phenotype in the vascular wall carry out pro-atherogenic role and influence destabilization of an atherosclerotic plaque, while M2 macrophages perform atheroprotective function.

The article presents a clinical case of embolism with bone cement of the right ventricle of the heart and pulmonary artery after percutaneous vertebroplasty in a patient aged 63 years. According to the results of a comprehensive examination using ultrasound and x-ray methods, three foreign bodies were found: in the right ventricle cavity, in the trunk of the pulmonary artery, in the branches of the left pulmonary artery. Considering the stable condition, normal blood oxygen saturation, the lack of influence of formations on intracardiac hemodynamics, it was decided to refrain from surgery, since the risk of intervention exceeded the possible benefit. Conservative treatment tactics and dynamic observation were chosen. The literature data on the frequency of such events and tactics of management of these patients are presented.