Aim: to find out whether atrial fibrillation (AF) in patients with ischemic heart disease (IHD) is related to some definite localization or extent of coronary artery lesions or type of coronary circulation. Materials and methods. We compared data of clinical, laboratory, and instrumental examination of 178 IHD patients from the Registry of coronary angiography of patients with AF (main group) and 331 patients (comparison group) selected according to propensity score matching with balancing by sex, age, body mass index, severity of chronic heart failure, frequency of myocardial infarctions, detection of arterial hypertension, and thyroid diseases. Results. The groups did not differ in terms of alcohol use, frequency of smoking, and detection of diabetes. Patients with AF compared with those without had higher mean heart rate (105±32 vs. 70±13 bpm, р<0.001), lower level of triglycerides (1.74±1.08 vs. 1.94±1.17 mmol / l, р=0.019). AF patients more rarely had class III–IV effort angina (52.9 % vs. 66.5 %, р=0.041). Rate of detection of left ventricular (LV) dilatation and index of LV asynergy in both groups were similar, but absolute dimensions and indexes of LV, left atrium, right ventricle, LV myocardial mass were higher in the AF group. Hemodynamically significant mitral regurgitation and lowering of LV contractility were more often detected in patients with AF (49.1 % vs. 18.4 %, р<0.001, and 56.2 % vs. 39.5 %, р<0.001, in main and comparison groups, respectively). Analysis of coronary angiography data showed that patients with compared with those without AF more often had right type of coronary circulation (87.5 % vs. 80.4 %, р=0.043) as well as lesions of the right coronary artery (92.1 % vs. 85.8 %, р=0.037), and less often lesions of left coronary artery trunk (16.3 % vs. 24.8 %, р=0.027). Conclusion. AF in patients with IHD is associated with right coronary artery lesions and right type of coronary circulation.

Aim: to assess effect of correction of moderate ischemic mitral regurgitation (IMR) in patients with ischemic cardiomyopathy (IMC) in immediate and remote period. Materials and methods. We included in a single center prospective study 76 patients with IMC, left ventricular ejection fraction ≤35 %, and moderate IMR. Patients with indications to postinfarction aneurism repair were not included. For randomization we used the method of envelopes. Thirty-eight patients were randomized in the group where coronary artery bypass grafting (CABG) was combined with of mitral valve repair (MVR), and 38 patients in the control group of isolated CABG. Mean age of patients was 57±8 (from 30 to 75 лет) years. For IMR correction we used rigid MEDENG ring. Results. Inhospital mortality was 5.4 % (n=2) after isolated CABG and 10.81 % (n=4) after CABG + MVR. Main cause of death was acute heart failure. One- and 2‑year survival was 84 and 78 %, respectively, after CABG+MVR, and 84 and 71 % after isolated CABG. There was significant difference in three-year survival between groups (hazard ratio [HR] of death 0.457, p=0.04). Five-year survival was 45 and 74 % after isolated CABG and CABG+MVR, respectively (р=0.037). Factors associated with inhospital mortality were pulmonary hypertension (HR 2.177, 95 % confidence interval [CI] 2.299 to 9.831; p=0.043), NYHA class IV chronic heart failure (HR 3.027, 95 % CI 1.605 to 5.707; р=0.001), negative result of stress test echocardiography (HR 0.087, 95 %CI 0.041 to 0.186; р<0.001), atrial fibrillation (HR 4.754, 95 %CI 2.299 to 9.831; р<0.001). Conclusion. Correction of moderate IMR in patients with IMC leads to improvement of parameters of survival in remote period. Five-year survival after isolated CABG was 45 %, while after CABG+MVR – 74 % (р=0.037).

Aim: to investigate relationship between arterial hypertension (AH) and risk factors / subclinical damage of target organs in patients with type 2 diabetes mellitus (DM2). Methods. We included into this clinical epidemiological study 528 patients with DM2 (30.5 % men, 69.5 % women; mean age 54.1±0.3 years; 80.3 % with AH, 19.7 % without AH), who answered questions of the ARIC study questionnaire related to risk factors. Also, we studied features of target organ damage and laboratory indicators. Results. In comparison with normotensives patients with AH more frequently had ischemic heart disease (12.7±1.6 % vs. 5.8±2.3 %, p<0.05), chronic heart failure (CHF) (30.9±2.2 % vs. 9.6±2.9 %, p<0.001), atherosclerosis of vessels of lower extremities (69.8±2.2 % vs. 53.8±4.9 %, p<0.01) and cerebral vessels (50.9±2.4 % vs. 28.8±4.4 %, p<0.001), history of stroke (5.0±1.1 % vs. 0 %, p<0.05), hypertonic angiopathy (14.5±1.8 % vs. 6.5±2.5 %, p<0.05), low level of high density lipoprotein (87.3±2.2 % vs. 74.5±6.4 %, p<0.05), electro- and echocardiographic signs of left ventricular hypertrophy (75.6±2.1 % vs. 45.4±5.1 %, p<0.001; 61.1±2.6 % vs. 24.4±4.7 %, p<0.001, respectively), lowering of left ventricular ejection fraction (12.5±1.7 % vs. 7.8±2.8 %, p<0.001), diastolic disfunction of the left ventricle (52.6±2.7 % vs. 23.2±4.7 %, p<0.001), atherosclerosis of the aorta (38.0±2.6 % vs. 20.7±4.5 %, p<0.01), lowering of the ankle-brachial index (left – 29.8±2.3 % vs. 14.9±3.5 %, p<0.01; right – 31.5±2.3 % vs. 9.9±3.0 %, p<0.001, respectively), increased intima-media thickness of the right carotid artery (84.6±5.0 % vs. 60.0±11.0 %, p<0.05). Conclusion. In patients with type 2 diabetes and AH, in order to develop strategy of macro- and microvascular complications prevention, it is necessary to conduct early screening of risk factors and subclinical damage of target organs.

Purpose: to assess efficacy of correction of anxiety states by anxiolytic drug fabomotizole in ambulatory patients with arterial hypertension (AH) and / or ischemic heart disease (IHD).

Materials and methods. In the framework of multicenter cross-sectional study with participation of patients aged ≥55 years with verified AH / IHD we conducted the therapeutic part of the COMETA program in which we included patients with comorbid anxiety state (≥11 points on the Hospital Anxiety and Depression Scale Anxiety [HADS-A] and clinically expressed anxiety state) without clinically expressed depressive symptoms (<11 points on the HADS-Depression). Participants were randomized into main and control groups. Patients in the main group in addition to therapy prescribed because of AH / IHD were given a recommendation to take fabomotizole (10 mg thrice a day), patients of control group received standard therapy. Efficacy of therapy was evaluated by HADS and visual analog scale after 6 and 12 weeks of observation.

Results. We included 182 and 104 in the main and control groups, respectively. Most patients in main and control groups had AH (97.3 and 95.2 %, respectively, about one third had IHD (36.8 and 30.8 %, respectively). Social-demographic, clinical characteristics, and recommended for AH / IHD treatment of participants of both groups were similar. Portion of patients with complete reduction of anxiety symptoms (<8 points on HADS-A) was significantly higher already after 6 weeks of fabomotizole therapy (37.9 and 19.2 %, respectively, p<0.001). Analogous picture was noted by the end of observation (66.9 and 32 %, respectively; p<0.001). Mean estimate of chronic psychoemotional stress in the main group decreased by 25 % after 6 weeks (from 6.45±2.20 to 5.05±1.96 points; р<0.001) and by 40 % after 12 weeks (from 6.45±2.20 to 3.98±1.99 points; р<0.001). In the control group it also decreased but degree of lowering was 2 times less than in the main group (11.1 % vs. 25 % after 6 weeks, р=0.016; and 20 % vs. 40 % after 12 weeks, р<0.001, respectively).

Conclusion. The use of fabomotizole by patients with AH / IHD provided improvement of psychological status (reduction of anxiety symptoms and lowering of the level of chronic psychoemotional stress).

The review covers issues of epidemiology, diagnostics, management strategy, and treatment outcomes in patients with non-ST elevation acute coronary syndrome. Numerous factors affecting the choice of an invasive strategy are analyzed as well as its correspondence to existing recommendations of patient’s management. The stratification of risk of development of adverse coronary events, which is a part of the formation of a treatment strategy, is discussed.

During several recent decades spontaneous coronary artery dissection (SCAD) has been known as one of causes of development of acute coronary syndrome (ACS). It has been assumed that this condition is extremely rarely met and is associated with pregnancy and postpartum period. The use in clinical practice of high sensitivity troponin, coronary angiography (CAG) in early period of ACS, in conjunction with the growing awareness of doctors about this pathology led to a revision of the viewse on prevalence of the disease. At present SCAD is considered as one of the causes of ACS in young and middle-aged women. In this review we present results of studies of pathogenesis, diagnostics, and treatment of SCAD, describe various angiographic types of this disease, and discuss problems of choice of optimal strategy of management of patients with SCAD.

In this review we present analysis the European recommendations on hypertension – what’s new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.

In this article we present discussion of the current state of the problem of surgical treatment of ischemic cardiomyopathy (ICM). The pathophysiological aspects of left ventricular remodeling in patients with ICM are also covered. A detailed characterization of methods for assessing the myocardial viability is given and their role in patients with ICM is shown. The problem of right ventricular dysfunction in ICM is discussed. Main attention is focused on the methods of surgical treatment of ICM. Limitations of the Surgical Treatment for Ischemic Heart Failure (STICH) study are analyzed. The article is intended for cardiologists, general practitioners and cardiac surgeons.

This article describes for the first time in the domestic literature a clinical case of the therapeutic effect of neuromodulation on the permanent form of atrial fibrillation and chronic heart failure in an elderly patient with spinal stenosis which led to the development of pain syndrome and movement disorders. For the treatment of neurological pathology, at the beginning epidural administration of drugs was applied, followed by spinal cord stimulation trial and implantation of permanent neurostimulator. At each stage of treatment conducted by a functional neurosurgeon the patient had a spontaneous restoration of sinus rhythm, and during continuous neurostimulation a stable retention of sinus rhythm and regression of heart failure symptoms have been observed throughout a long observation period. The article also presents the data of a few experimental and clinical studies on the use of neuromodulation in cardiology, describes the method of implantation of spinal electrodes and analyzes possible mechanisms of modulation of the autonomic innervation of the heart, implemented by spinal cord stimulation.

Fulminant myocarditis (FM) is a severe form of inflammatory myocardial injury rapidly developing as acute heart failure, cardiogenic shock, or life-threatening disturbances of cardiac rhythm. FM requires intensive treatment including drug therapy, mechanical circulatory support, and in some cases – heart transplantation. Echocardiography can be used as a screening method of diagnostics. Magnetic resonance imaging of the heart often cannot be performed because of hemodynamic instability of a patient, therefore endomyocardial biopsy with histological and immunohistochemical studies as well as molecular-genetic analysis of obtained samples is required for final diagnosis. Prognosis of the disease is determined by histological picture. In most cases, after cessation of acute stage of the inflammatory process, FM has a favorable long-term prognosis. In this article we present a clinical case of FM and review of current literature on diagnosis and treatment of this disease.

In the conclusion of the council of experts (list of participants see text) the following issues are discussed: regional specifics of diagnostics and therapy of patients with ischemic heart disease (IHD) and / or peripheral arterial disease (PAD), methods of risk assessment in patients with stable course of atherosclerotic disease, pathogenetic validity of simultaneous inhibition of coagulation and platelet thrombus formation, as well as clinical significance of a novel therapeutic approach – combined use of rivaroxaban and acetylsalicylic acid (ASA). Possible problems and ways to their solution at implementation in clinical practice of the novel scheme of antithrombotic therapy are presented. Importance of multidisciplinary approach to management of patients with IHD and concomitant diseases is stressed. Experts have noted that after registration of the corresponding indication therapy with rivaroxaban 2.5 mg twice daily and ASA 75–100 mg once daily might be recommended to majority of patients with atherosclerotic involvement of blood vessels. In real clinical practice prescription of this therapy is appropriate first of all in patients with IHD and high risk of complications – with multifocal atherosclerosis, with history of myocardial infarction after stoppage of dual antiplatelet therapy, – patients with concomitant diabetes, heart failure, and other prognosis worsening comorbid diseases. Experts express hope that in the nearest time combined antithrombotic therapy will be included into corresponding national clinical recommendations.