Aim. To study parameters of collagen myocardial metabolism in patients with ischemic cardiomyopathy (ICMP) and to assess the effect of concomitant chronic obstructive pulmonary disease (COPD) on their levels.

Materials and methods. We examined 130 patients with ICMP (mean age 55.5 [43; 63] years) and 42 patients with ICMP and COPD (mean age 54.8 [41; 63] years). Determination of serum levels of matrix metalloproteinase-1 (MMP-1), its tissue inhibitor (TIMP-1), transforming growth factor-β1 (TGF-β1), and autoantibodies to collagen types I and III was carried out with the help of commercial test systems based on the method of solidphase enzyme immunoassay. Calculation of the volume fraction of interstitial collagen (VFIC) of the myocardium was carried out by the method of J. Shirani.

Results. In patients with ICMP combined with COPD, as well as in patients with ICMP we found disbalance in the metabolism of collagen of the extracellular matrix. At the same time, in patients with ICMP+COPD, processes of collagen degradation at the background of extracellular matrix fibrosis were found to be even more pronounced than in patients with ICMP. This was evidenced by the absence of statistically significant differences in the myocardial VFIC (p=0.703), and the level of TGF-β1 (p=0.074), as well as statistically significant higher activity of MMP-1 (p=0.037), MMP-1 / TIMP-1 ratio (p=0.045), and production of autoantibodies to collagen types I and III (p=0.042, p=0.039, respectively).

Conclusion. The presence of COPD in patients with ICMP is associated with increased disbalance of the proteolysis-antiproteolysis system in the direction of collagen breakdown that can lead to more pronounced structural changes of the myocardium, and, as consequence, to aggravate functional impairment of the organ.    

Aim: to verify the effect of vegetative nervous system on the silent myocardial ischemia.

Materials and methods. We included in this study 56 patients with functional class II–III effort angina (22 men and 34 women, age 45–49 years) with silent myocardial ischemia (SMI). Examination included 24hour blood pressure and ECG monitoring.

Results. We revealed the interrelation between elevation of parameters of heart rhythm variability reflecting activity of parasympathetic nervous system and ST segment depression depth during episodes of SMI. Also, а significant interrelationship was found between SMI duration and degree of nocturnal diastolic blood pressure decrease which reflected parasympathetic nervous system activity.

Conclusion. Silent myocardial ischemia more often occurred at the background of elevated activation of the parasympathetic nervous system.    

Background. During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11–19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood.

Objective. To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion.

Materials and methods. We included in this study 68 patients with AMI and IMR aged 36–79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV).

Results. Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 – patients who had a decrease in IMR (n=23, 33.8 %), group 2 – patients with increase of IMR (n=28, 41.1 %), group 3 – patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24).

Conclusion. Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.   

Objective: to assess dynamics of diastolic function for detection of development of diastolic dysfunction (DD) and it’s causes, to evaluate the effect of DD on prognosis in the postoperative period in patients with acquired heart diseases.

Materials and methods. We included in this study 112 patients with aortic and mitral valve diseases (90 men, 22 women, median age 51 [35; 57] years). All patients underwent echocardiography (echo), tissue Doppler, speckle tracking echo prior to surgery, in the early postoperative period (8–14 days) and in 12–36 months after surgery. In 28 patients dynamic contrast-enhanced magnetic resonance imaging was also performed. Patients were divided into groups according to prognosis: group 0 – without complications; group 1 – with postoperative heart failure (HF) and preserved left ventricular ejection fraction (EF); group 2 – with HF and EF <45 %. The following parameters were used for identifying left ventricular (LV) DD: septal velocity es <7 cm / sec, lateral el <10 cm / sec, average E / e ratio >14, left atrial (LA) volume index >34 ml / m2, peak tricuspid regurgitation velocity >2.8 m / sec.

Results. Initially diastolicLV function was normal in 34 of 112 patients (30.4 %), in early postoperative period DD emerged in 9 (26.5 %) of these patients. The appearance of LV DD was associated with decrease of septal es immediately after surgery and its subsequent progressive decline in the long-term postoperative period from 8.5±0.71 to 4.6 ±0.53 cm / sec (p=0.005). Worsening of diastolic function and lowering of septal velocity was detected namely in patients with presence of fibrosis. In the group of other patients in whom fibrosis was not studied and the degree of DD increased there was a transient decrease of lateral el (from 10.2±3.1 to 7.5±2.43 cm / sec, p=0.035) and an increase of the E / el (from 10.53±4.07 to 14.5±5.23, p=0.05) in the early period after the operation. There were no correlations between DD and LV EF,LV volumes, and development of arrhythmias. The prognostic model for DD included average longitudinal deformation of LA (global LA longitudinal strain) and E / e ratio on the tricuspid lateral annular velocity.

Conclusions. Appearance of DD in postoperative period after correction of acquired heart defects was due to damage of the septal diastolic function which correlated with fibrosis and was indicative of inadequate myocardial protection. The model of development of heart failure with normal EF after operation was designed.

Purpose. Determination of clinical and instrumental predictors of progressive course of multifocal atherosclerosis (MFA) in patients one year after myocardial infarction (MI), initially having hemodynamically insignificant stenoses of carotid arteries.

Materials and methods. From database of patients with acute coronary syndrome treated in the Kemerovo Regional Clinical Cardiac Dispensary in 2009–2010 we selected for this study 141 patients with verified diagnosis of MI and hemodynamically insignificant lesions in the internal carotid artery (ICA) (stenosis up ≤ 55 %). All patients had coronary atherosclerosis verified on coronary angiography at admission because of MI. A multivariate analysis of possible predictors of the progressive course of multifocal atherosclerosis was made based on assessment of the development of cardiovascular complications (CVC) (death, MI, stroke and transient cerebral circulatory attacks [TIA]), as well as revascularizations and negative dynamics of parameters of color duplex scanning (CDS) of ICA during one year after MI. Results. One year after MI the overall incidence of CVC was 16.3 % (n=23). Structure of registered events was as follows: death from MI 7.1 % (n=10), deaths from stroke 2.1 % (n=3) and other causes 2.1 % (n=3), non-fatal MI 5.0 % (n=7), non-fatal stroke / TIA 2.1 % (n=3), carotid revascularization 2.8 % (n=4), coronary revascularization 14.9 % (n=21). CDC of ICAs was repeated in 125 patients. There were 17 (13.6 %) cases of progression of carotid atherosclerosis in the form of de novo bilateral stenoses in 14 (11.2 %) patients, stenoses in the left and right ICA 1 patient and 2 patients, respectively. The following predictors of progression of atherosclerosis of cerebral arteries were identified: family history of cardiovascular diseases (CVD),ICA stenosis ≥45 %, baseline circular atherosclerotic plaque (ASP). Predictors of high risk of stroke were family history of CVD, history of stroke,ICA stenosis ≥45 %, heterogeneous hypoechoic ASP. As predictors of lethal outcome, we identified history of MI, high functional class of angina preceding the index MI, severe coronary vascular bed involvement (SYNTAX score >23), presence of any bilateral atherosclerotic lesion in ICAs, and heterogeneous hypoechoic ASP. Assessment of the contribution of adherence to therapy in the prognosis 1 year after hospital discharge was fulfilled in 125 alive patients. It allowed to conclude that patients with progression of atherosclerosis and nonfatal CVC were characterized by insufficient adherence to standard therapy.

Conclusion. Predictors of the progressive course of multifocal atherosclerosis during one year after MI were identified in this study. It is necessary to strengthen therapeutic and preventive measures aimed at minimization of the impact of these factors in this category of patients.   

Aim: to assess possibility of the use of carotid wall shear rate (WSR) as a marker of systemic atherosclerosis and atherosclerotic cardiovascular disease (ASCVD).

Materials and methods. We included into this study 200 patients with different cardiovascular risk (142 patients already had one or more ASCVD). All patients underwent ultrasound scanning of carotid and lower limb arteries with measurement of the ankle-brachial index. Carotid WSR was determined during ultrasonic scanning of carotid arteries in accordance with the Hagen-Poiseuille law.

Results. Mean WSR value in this cohort of patients was 434±139 s–1. Based on the results of the ROCanalysis, it was found that WSR below the threshold value of 300 s–1 allowed to predict the presence of ASCVD with sensitivity of 97.1 % and specificity of 84.6 %. WSR <300 s–1 was associated with relative risk (RR) of ASCVD presence 11.2 (95 % CI 1.26–99.3, p=0.03), adjusted for factors such as sex, age, smoking, obesity, hypertension, estimated glomerular filtration rate (eGFR), low density lipoprotein cholesterol, and high sensitivity C-reactive protein, carotid intima-media thickness. The model which included carotid WSR, as well as factors such as the presence of type 2 diabetes, obesity, sex, age, eGFR, allowed to diagnose combined atherosclerotic lesions of peripheral arteries with a sensitivity of 73.1 % and a specificity of 90.3 %.

Conclusion. Evaluation of the carotid WSR allows to diagnose with satisfactory sensitivity and specificity the presence of combined atherosclerosis of peripheral arteries and ASCVD. 

Today, transplantation of stem / progenitor cells is a promising approach for the treatment of heart diseases. The therapeutic potential of transplanted cells directly depends on the method of delivery to the myocardium, which determines their regenerative properties. It is important for the development of effective methods of cell therapy. In this paper, we performed a comparative study of efficacy of cardiac progenitor cell (CPC) transplantation by intramyocardial needle injections and by tissue engineering constructs (TEC) – “cell sheets” consisting of cells and their extracellular matrix. It has been shown, that transplantation of TEC in comparison with the intramyocardial delivery provides more extensive distribution and retains more proliferating cellular elements in the damaged myocardium, attenuates the negative cardiac remodeling of the left ventricle and promotes its vascularization.   

The prevalence of ischemic heart disease (IHD) and diabetes mellitus type 2 (DM type 2) is permanently increasing both worldwide and in theRussian Federation. That is why studies of mechanisms of pathogenesis of both diseases is continuing for prevention of complications and mortality. DM type 2 contributes a lot to deterioration of IHD. One of pathogenetic features these two pathologies share is pronounced blood vessel wall fibrosis. In this review we present analysis of studies devoted to the determination of the role of metalloproteinase-9 and tissue inhibitor of metalloproteinases-1 indevelopment of vascular wall fibrosis.   

Non-vitamin K antagonist oral anticoagulants (NOACs) – direct oral anticoagulants – are getting the ever-broadening use in clinical practice. However, many problems related to optimal use of NOACs in specific clinical situations remain unresolved. European Heart Rhythm Association in April 2018 issued the renovated recommendations on the use of NOACs in patients with atrial fibrillation. The authors of recommendations presented some specific clinical variants for which they formulated practical advices based on the evidence obtained in randomized clinical trials. They also outlined the indications for use of NOACs, formulated practical start-program and scheme of subsequent follow-up management of patients taking NOACs. Recommendations contain information on pharmacokinetics of NOACs and their interactions with other drugs, consideration of feasibility of NOACs use in patients with chronic renal insufficiency or advanced liver disease. Many other practical problems are covered as well.  

The review is devoted to the use of antithrombotic therapy in patients with atrial fibrillation (AF) and chronic ischemic heart disease (IHD). We discuss data of international registries, meta-analyses assessing possibilities of the use of oral anticoagulants for secondary prevention of IHD. We present here results of randomized and observational clinical studies demonstrating advantages of prescription of monotherapy with oral anticoagulants (OAC) in combination of AF and chronic IHD. Modern evidence base of advantages of dual antithrombotic therapy with the use of direct OAC following percutaneous coronary intervention is also presented.  

The review contains results of analysis of clinical studies on the problem of defining the target level of the blood pressure (BP). The rationale for selection the target systolic BP level below120 mmHg was obtained in the SPRINT study comparing the target levels <120 mmHg and <140 mmHg. A considerably lower number of cardiovascular complications and deaths was seen in the group of a stricter BP control. Nevertheless, this study had some limitations related to certain patient populations, and methods of BP measurement. More ambitious target of BP lowering was associated with elevated risk of iatrogenic hypotension and fainting. Moreover, the ACCORD study, exploring the same target levels failed to demonstrate similar risk reduction. Taking into account various literature data, the authors find it reasonable to use personalized approach to determining BP targets, and utilize assessment of central aortic pressure and state of vessels for more accurate risk stratification and selection of treatment.   

Radiofrequency ablation is the “gold standard” in atrial fibrillation treatment. The frequency of complications is about 3.5–3.9 %. The symptomatic pulmonary vein stenosis is one of the most severe complications. In this report we present a clinical case of stenosis of all four pulmonary veins after redo catheter ablation of atrial fibrillation in 61year-old patient, and discussion of possible causes, specific features of diagnosis, and possible approaches to treatment of this complication.