Aim. To study was to assess in-hospital outcomes of direct coronary stenting (DS) compared with stenting after predilation (PD) in patients with ST-elevation myocardial infarction (STEMI). Material and methods. Data were collected from all patients (n=1103) with STEMI subjected to primary PCI in Tyumen cardiology center from 2006 to 2014. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of no-reflow phenomenon were analyzed. The composite of in-hospital death, myocardial infarction (MI) and stent thrombosis were defined as major adverse cardiac events (MACE). Results. Altogether 563 patients (51%) underwent DS, and in 540 (49%) stents were implanted after PD. Patients in DS group compared with those in PD group were younger (57.9±10.9 vs 60±11.5 years; p=0.001), less often had chronic kidney disease (5.2 vs 8.4%; р=0.034), more often recieved prehospital thrombolysis (25 vs 11.9%; p<0.001). Rates of diabetes mellitus (16.1 vs 17.5%; р=0.522), and history of MI (15.5 vs 18.7%; р=0.162), time from onset symptoms to diagnosis (120 [73; 205] min и 120 [65.5; 239.5] min; р=0.289) were comparable between groups. Patients of DS group less often had occluded culprit arteries (47.4 vs 84.3%; p<0.001) and multivessel coronary artery involvement (23.8 vs 34.4%; p<0.001). There were no differences in rates of stent thrombosis (1.2 vs 2.8%; p=0.068) and repeat MI (1.4 vs 1.9%; p=0.572). Rates of angiographic success (95.7 vs 90%; р<0.001), death (2.5 vs 5.4%; p=0.013), MACE (6.7 vs 11.3%; p=0.008), as well as no-reflow (2.2 vs 7.4%; p<0.001) were significantly lower in the DS group. After multivariate adjustment, PD was associated with no-reflow [odds ratio 3.39; 95% confidence interval 1.83-6.28; p<0.001]. Conclusion. DS in STEMI is safe and effective and should be used in all cases when it is possible. PD is an independent predictor of no-reflow phenomen on during PCI.

Aim. To study effects of a fixed azilsartan medoxomil/chlorthalidone combination (Edarbi Clo) on clinical, ambulatory and central blood pressure (BP) in patients with uncontrolled arterial hypertension (AH)). Materials and methods. Patients (n=25) with uncontrolled AH were given fixed azilsartan medoxomil/chlorthalidone combination (40/12.5 mg/day) for 4 weeks. After 4 weeks, in patients who did not achieve target BP levels the dose was increased up to 40/25 mg/day. Duration of the study was 12 weeks. Results. After 12 weeks of treatment 88% of patients achieved target clinical BP (<140/90 mm Hg without diabetes, <140/85 mm Hg with diabetes). According to 24-hour blood pressure monitoring (ABPM) decline of mean BP was 19.3/11.1 mm Hg, of mean daytime peripheral BP - 20.1/11.4 mm Hg, of mean nocturnal peripheral BP - 19.5/9.1 mm Hg, of central systolic (S), diastolic and pulse BP - 15.8, 10.1, 6.6 mm Hg, respectively. Target values of mean 24-hour BP were achieved in 40% of patients. Improvement of ABPM parameters led to normalization of the daily systolic BP index, associated with increase of the portion of “dippers” (from 60 to 64%) and reduction of that of “night-pickers” at the account of their transition into “non-dipper” and “dipper” categories. There were no adverse events either causing discontinuation after the first dose or serious. Conclusion. In patients with uncontrolled AP with/without diabetes therapy with fixed- azilsartan medoxomil/chlorthalidone combination was accompanied by pronounced antihypertensive effect (lowering of clinical, daily peripheral BP, improvement of the daily SBP profile). For the first time, the effectiveness of azilsartan medoxomil/chlorthalidone combination was demonstrated in relation to the central systolic, diastolic and pulse BP. Significant changes of parameters of carbohydrate or lipid metabolism, adverse events leading to drug discontinuation were not registered.

The article is devoted to the investigation of the mechanisms of the development of arterial hypertension (AH) in patients with atherosclerosis of the abdominal aorta and the formation of chronic lower limb ischemia (Lerish syndrome). With the development of thrombotic occlusion of arteries of the lower extremities, the nature of the course of hypertension worsens. The operational recovery of the main blood flow in the limbs positively influences the course of hypertension in the majority of patients.

Purpose. To compare immediate results of mitral valve surgery in patients with severe pulmonary hypertension with versus without concomitant pulmonary artery denervation. Materials and methods. From January to December 2015 30 patients were randomly assigned into two groups. Patients of one group underwent mitral valve surgery (comparison group), in the other group mitral valve surgery was accompanied by pulmonary artery ablation (ablation group). Both groups had comparable anthropometric, echocardiographic, and hemodynamics characteristics. Results. There were no hospital mortality and specific ablation-related complications. Left ventricular remodeling and decrease of pulmonary artery pressure were observed in both groups at discharge. On the third day after surgery systolic and mean pulmonary artery pressure assessed by right heart catheterization were 48 and 22 versus 59 and 39 mm Hg in ablation and comparison group, respectively (p<0.05). No significant improvement of results of six-minute walk test was registered at discharge in both groups. Conclusions. Concomitant radiofrequency pulmonary artery ablation in patients with mitral valve disease and severe pulmonary artery hypertension was associated with lower pulmonary artery pressure in early postoperative period in comparison with valve surgery alone.

Pulmonary vein (PV) myocardium is characterized by numerous electrophysiological properties which make this tissue highly prone to spontaneous, ectopic activity partially due to resting potential (RP) instability. PV derived ectopy frequently underlies supraventricular arrhythmias, including atrial fibrillation. It has also been demonstrated that adrenergic stimulation causes proarrhythmic alterations in PV. Selective α₁- and β-adrenoreceptors stimulation causes RP depolarization and hyperpolarization, respectively, at least in rats. The intracellular mechanisms of α₁- and β-adrenoreceptors-dependent RP drifts are not investigated. Adenylate cyclase (AC) activator forscolin similarly to selective β-adrenoreceptors agonist isoproterenol (ISO) induced strong hyperpolarization in quiescent isolated perfused multicellular preparations of rat PV. Maximal value of hyperpolarization in PV was equal after application of both compounds. Proteinkinase A (PKA) inhibitors КТ5720, H-89 and Rp-adenosine-cAMP suppressed ISO-induced hyperpolarization in PV. Inhibitors of phospholipase C (U73122) or D (FIPI), similarly to proteinkinase C (PKC) inhibitor chelerythrine, failed to suppress α₁-adrenoreceptors-dependent phenylephrine-induced depolarization in rat PV myocardium. These results allow us to suggest that ß-adrenoreceptors-dependent RP hyperpolarization in quiescent rat PV myocardium is only partially mediated by cAMP-dependent signal transduction pathway and by PKA. Besides, PKA-independent mechanisms also contribute to β-agonists effects in PV. In addition, α-adrenoreceptors-dependent depolarization in rat PV myocardium could be independent on PLC and PKC.

Aim. To assess advantages of integrated approach to improvement of efficiency and safety of warfarin therapy after heart valve replacement. Materials and methods. We included in this study 118 patients who had undergone simultaneous mitral valve replacement and maze procedure. Group 1 patients (n=37) underwent just sinus rhythm restoration, group 2 patients (n=54) underwent sinus rhythm restoration and participated in a patient education program, group 3 patients (n=27) underwent sinus rhythm restoration, participated in a patient education program, and were subjected to pharmacogenetic testing for warfarin sensitivity. In examination of patients we used clinical, demographic, and instrumental methods. Estimation of the time in the therapeutic range (TTR) of an international normalized ratio (INR) was used as a measure of warfarin therapy quality, and the Kaplan-Meier method was applied for analysis of hemorrhagic and thrombotic complications. Results. TTR was 42% in group 1, 68% in group 2 (p=0.0327), and 82% in group 3 (p=0.0019). Application of integrated approach was associated with absence of hemorrhagic and thrombotic complications within one year after heart valve replacement. Conclusion. The integrated approach comprising restoration of sinus rhythm, patient education, and pharmacogenetic testing for warfarin sensitivity was associated with improved anticoagulation control, and prevention of hemorrhagic and thrombotic complications.

In our study urine protein composition of 18 healthy volunteers was compared with that of 18 patients with ischemic heart disease and concomitant hypertension. Liquid chromatography-mass-spectrometry (LC-MS) analysis of the second fraction of morning urine was carried out using nano-line high performance liquid chromatograph and hybrid mass spectrometer. The analysis revealed 23 proteins expressed in the endothelium, according to the information contained in the database Bgee, and 49 proteins, with direct functional link with the processes in the endothelium in the reconstruction of associative networks using ANDSystem program. Comparison of urine proteome of healthy people and patients with postinfarction cardiosclerosis revealed proteins specific for patients with cardiovascular disease. Thus, proteins vitronectin, syndecan-4, a histidine rich glycoprotein, endothelial protein C receptor, colony stimulating factor, cathepsin D and sekretogranin-1 may be considered as potential markers for cardiovascular diseases. Further research in this area should be conducted for clinical and experimental verification of these hypotheses.

The article is devoted to the modern state of the problem of blood pressure variability (BPV). Along with discussion of classification and methods of diagnosis it contains data on prognostic value of visit-to-visit BPV. We have also reviewed effect on BPV of various regimens of antihypertensive therapy and presented evidence base supporting ability of amlodipine/perindopril fixed dose combination to lower visit-to-visit BPV.

Effective control of arterial pressure (AP) is achieved only in У of patients with arterial hypertension. It is especially difficult to achieve control of systolic (S) AP in elderly patients in whom SAP is the strongest prognostic factor of cardiovascular complications. Thiazide and thiazide-like diuretics and calcium antagonists are effective for lowering of elevated SAP and pulse (P) AP including aortic PAP elevation of which is associated with high stiffness of arterial wall and is typical for elderly people. Combination of a thiazide diuretic and a calcium antagonist has been recommended by modern guidelines on arterial hypertension (AH) management but until recently it has not found wide application because of absence of a fixed preparation. Evidence base of indapamide-retard and amlodipine use in AH, their profiles of efficacy and safety are such that their combination can become an alternative variant for treatment of patients with AH. Appearance of a fixed indapamide-retard/amlodipine combination opens new perspectives of effective therapy of AH with high SAP and PAP in elderly and other patients with high stiffness of arterial wall.

In this review we present comparison of pharmacokinetics of novel oral anticoagulants (NOAC) dabigatran, rivaroxaban, apixaban, and edoxaban, principles of selection of a regimen of their dosing for phase III clinical trials in patients with atrial fibrillation. Multiplicity of administration of NOAC depends on required level of anticoagulation, ability to maintain anticoagulation for 24 hours, relationship between minimal and maximal levels of equilibrium concentrations, efficacy and safety. Once a day administration of some drugs of this group is reasonable from positions of clinical pharmacology. It can provide not only better adherence to treatment but greater safety relative to development of bleeding.