Aim: to study carotid plaques structure in patients with acute coronary syndrome by ultrasound duplex scanning. Materials and methods. We included in this study143 patients with acute coronary syndrome (ACS) aged 32-83 years and 28 patients with documented coronary heart disease (CHD) aged 46-83 years. Duplex scanning of carotid arteries was carried out with Philips iU22 ultrasound system and L9-3 linear array transducer. Atherosclerotic plaques in CCA, CCA bifurcation, and ICA from right and left side were investigated. Off-line analysis of B-mode images and plaque gray scale median (GSM) was performed with computer semiautomated workstation MultiVox. Results. 378 plaques of ACS and 59 plaques of CHD patients were studied. We assessed traditional (heterogenous structure, hypoechogenic component, irregular plaque surface) as well as additional (positive remodeling, “layered” structure of plaque, local calcification) criteria of plaque instability. In ACS compared with CHD group there were more plaques with hypoechogenic component (43.4 and 28.8%, p=0.0459), heterogenous structure (77.8 and 64.4%, p=0.0327), irregular surface including irregularities more than 2.0 mm (22.5 and 6.8%, p=0.0048, respectively). There was significant difference in “layered” structure (55.7 and 35.8%, p=0.0011) and insignificant difference in positive remodeling (16.3 and 7.5%, p=0.06, respectively). There were no differences of GSM value (53.1 and 57.2, p=0.24) and local calcification (23.2 and 24.5%, p=0.23, respectively). Conclusion. In our study ultrasound duplex scanning revealed that signs of plaque instability in carotid arteries in patients with ACS were more frequent than in patients with stable CHD. The newly introduced parameter “layered” structure of atherosclerotic plaque was found to be most significant.

The issues of epidemiology and pathophysiology of hypertrophic cardiomyopathy (HCMP), as well as the search for its additional clinical-instrumental and genetic markers, environmental factors capable to influence the formation of its clinical variant and prognosis are subjects of great interest to the modern scientific community. Besides genetic markers of main neurohumoral systems, and morphofunctional parameters of intracardiac hemodynamics clinical course of the disease is influenced by a complex of concomitant pathology including ischemic heart disease (IHD), joining of which is possible in 10% of cases. IHD substantially aggravates course of HCMP and hampers selection of medical therapy. It should be noted that prognosis of primary hypertrophies is affected by episodes of ischemia of complex genesis and addition of IHD significantly increases risk of sudden death in these patients.

Objective: to study medical awareness of cardiovascular risk factors (FR) in hospitalized patients of the cardiac and internal medicine units (CU and IMU). Materials and Methods. A total of 100 patients from CU (n=50) and IMU (n=50) of a Moscow city hospital were included into the survey. The patients were interviewed during the I-II days of hospital stay. A special questionnaire was developed including socio-demographic and clinical indicators, open questions on the knowledge of traditional cardiovascular RFs and their target values. Results. Patients of both units did not differ in gender and age. The survey revealed an extremely low awareness of major cardiovascular RFs of patients in both units: practically none of them indicated as RFs for cardiovascular disease elevated cholesterol (0 and 2%, respectively, p>0.05) and blood pressure (0% and 2%, respectively, p>0.05). The majority of patients in both units (74 and 68%, respectively, p>0.05) reported only 1-2 RFs. Patients in both units often believed that stress is the main cardiovascular RF (66% and 50%, respectively, p>0.05). Conclusion. The survey revealed a low awareness of cardiovascular RFs in different types of medical patients at time of hospital admission.

Aim: to study associations between elevated blood plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), risk factors and cardiovascular diseases (CVD) in samples of adult population of Russian Federation (RF) aged 25-64 years. Materials and Methods. We analyzed data of examination of representative samples of population of 5 regions of RF obtained within the framework of the multicenter ESSE-RF study (2012-2013). Number of examined subjects was 8 077 (3 176 men). Methods included use of standard questionnaire, measurements of height, body mass, blood pressure (BP), and plasma NT-proBNP level. The following CVD were included into analysis: arterial hypertension (AH), ischemic heart disease (IHD), atrial fibrillation (AF), and stroke. Results. Women compared to men had higher NT-proBNT concentration was higher in women compared to men, in both genders it rose with age. Overall 17.9% of examinees had elevated NT-proBNT levels (14.2 and 20.3% among men and women, respectively). Elevated NT-proBNP level was associated in men with age, myocardial infarction, angina pectoris, ischemic ECG changes, left ventricular hypertrophy, AF, bradycardia, smoking, in women with age, IHD, ischemic ECG changes, AF, bradycardia, heart rate >80 bpm, BP >160/95 mm Hg. Conclusion. In studied RF population elevated NT-proBNP level was significantly associated with gender, age, smoking, and CVD.

A new trend in modern experimental cardiology is the development of approaches to correction of reparation after myocardial infarction (MI) with the use of specific effects on immune cells. One of the main targets for such interventions is the process of macrophage’s polarization in the infarction zone. Proinflammatory M1-macrophages contribute to hampered myocardial repair, in contrast to M2-macrophages that promote regeneration. Currently, there are two main ways of targeted delivery of agents necessary for macrophage reprogramming - inlipoid and inglycan-encapsulated particles. As modulating agents, small interfering RNA and other genetic constructions are usually used. Both these approaches are currently awaiting their translation into cardiology. The most physiological approach to reprogramming of immune cells may consist in attempts to switch the metabolism of the immune cell from glycolytic to oxidative, which allows macrophages to switch from M1 to M2 phenotype. Among possible targets for macrophage reprogramming, it is worthwhile to isolate the protein complex mTORC1, the blocking of which promotes oxidative metabolism, and the transcription factor HIF-1a, the blocking of which also facilitates the switching of the metabolism from glycolytic to oxidative one.

We discuss in this article problems of prognostic significance of 24-hour arterial pressure variability (24hAPV), as well as the role of 24hAPV in development and progression of various target organs damage by arterial hypertension. We also present literature data on impact of various regimens of antihypertensive therapy on 24hAPV, and on ability of fixed-dose perindopril / amlodipine to lower 24-hAPV.

Ischemic heart disease (IHD) and acute coronary syndrome are the main cause of sudden cardiac death (SCD). Incidence of SCD in patients after myocardial infarction (MI) is 4-6-fold higher than in general population. The review focuses on electrophysiological changes during acute myocardial ischemia and mechanisms of myocardial electromechanical remodeling in remote period after MI. Current data on arrhythmia substrates and triggers are presented. Nowadays, the main guide for implantable cardioverter-defibrillator (ICD) use for primary prevention of SCD is reduced left ventricular ejection fraction. The significance of this parameter has been repeatedly demonstrated in large randomized studies. However, the use of a single indicator cannot solve the problem. In this review we present analysis of modern additional predictors of fatal arrhythmias which are available in clinical practice, as well as the perspective for further research of this highly important scientific, clinical, and social problem.

Takotsubo cardiomyopathy (TCM) is a well-known complication of many conditions associated with emotional or physical stress. Abnormal catecholamine release has been hypothesized to be the main cause of TCM. Myocardial infarction (MI) is associated with release of large amounts of catecholamines. We present here two cases in which patients simultaneously suffered from acute MI and TCM. In these elderly women without prior history of severe somatic diseases we have not revealed any external stressing factor responsible for the initiation of the disease. Therefore, we have considered primary coronary event (acute MI) to be a triggering factor of TCM manifestation.