Objective: to compare strategies of invasive treatment of patients with non-SТ elevation acute coronary syndrome (NSTEACS) hospitalized in 2014 and 2015. Materials and methods. We have analyzed treatment strategy used in patients with NSTEACS hospitalized in cardio-reanimation department of a city hospital during one month in two successive years (January 2014 and November 2015). We have compared indications to, and timing of coronary angiography, numbers of performed percutaneous coronary interventions (PCI) and coronary artery bypass grafting surgeries. Results. Portion of patients subjected to invasive procedures in 2014 was 26%, in 2015-42%. All 32 primary procedures were PCIs. An increase was due to delayed interventions (24-72 hours), which were not performed in 2014. We also more often used selective multivessel coronary stenting, what facilitated availability of invasive treatment for elderly patients. Hospital mortality of patients with NSTEACS decreased from 16 to 7%.

Objective: to assess the effect of lung hyperinflation (LHI) in patients with chronic obstructive pulmonary disease (COPD) on longterm outcomes of percutaneous coronary intervention (PCI). Materials and methods. Patients with COPD who suffered stable ischemic heart disease and underwent PCI (n=135) were included in a prospective cohort study. LHI was found in 60 patients, while 75 patients had no LHI. Evaluation included comparing the frequency of major adverse cardiac events (MACE) (cardiac death, myocardial infarction [MI], stroke, repeat revascularization) and Kaplan-Mayer curves between groups of patients with and without LHI. Associations of parameters of pulmonary function and plasma levels of high sensitivity C-reactive protein (hsCRP) with occurrence of MACE were also elucidated. Duration of follow-up was up to 3 years (median 20 months). Results. Study groups did not differ significantly by main factors of cardiovascular risk, except plasma level of hsCRP. MACE occurred in 41.7 and 26.7% of patients in groups with and without LHI, respectively (p=0.097). However, divergence of the Kaplan-Meier curves was statistically significant (p=0.04). The main contribution was made by cardiac death, MI and stroke (21.7 and 8.0% among patients with and without LHI; p=0.027). No difference was found regarding repeat revascularization. The correlation between functional residual lung capacity and plasma level of hsCRP was closer than the correlation between forced expiratory volume in 1 second and hsCRP level (r=0.36 and r=0.19; p<0.05). Conclusion. After elective PCI in patients with COPD the presence of LHI increased risk of cardiovascular events (cardiac death, myocardial infarction and stroke) by 2.7 times (95% confidence interval 1.1-6.7). LHI produced no effect on repeat elective PCI.

Aim of the study was assessment of efficiency of lung ventilation and its relationship with quality of life in patients undergoing orthotopic heart transplantation (OHT). Materials and methods. The study involved 40 patients with terminal chronic heart failure (CHF) included in the waiting list for heart transplantation. Before surgery and after OHT all patients underwent cardiopulmonary exercise testing, evaluation of clinical status and quality of life (QL) according to the 36-Item Short Form Survey (SF-36). Results. During the follow-up period (5 years) after OHT there were a significant increase in physical capacity, two-fold increase of peak oxygen consumption (VO₂), normalization of VE/VCO₂ slope level, improvement of the efficiency of the VO₂ recovery within first minute and reduction of the VO₂ recovery time. OHT was associated with significant improvement of physical and mental health components of QL. Among exercise test parameters significantly associated with improved physical health component of QL were increments in exercise capacity, peak VO₂, rate of VO₂ recovery within first minute. There was no relationship between cardiopulmonary parameters of exercise test and mental health component of QL. Conclusion. In patients with terminal CHF OHR led to significant increase of the lung ventilation efficiency and QL. Factors contributing to QL improvement after OHT were augmentation of left ventricular ejection fraction and reduction of CHF NYHA class. Among cardiopulmonary exercise test parameters, a high predictive value relative to improvement of subjective assessment of physical health component of QL showed exercise capacity, peak VO₂, and efficiency of VO₂ recovery within first minute.

Purpose: to study efficacy of various schemes of therapy of patients with chronic heart failure (CHF) and anemia. Materials and methods. We included in this study 208 patients with CHF of ishemic etiology (mean age 60.6±1.4 years, 174 with and 34 without anemia). According to therapeutic regimen of the use of methoxy polyethylene glycol-epoetin beta (MEB, 0.60 mсg/kg) and intravenous (IV) iron hydroxide sucrose complex all patients were divided into 4 groups. In all patients before and after treatment we determined Hb, Ht, plasma levels of ferritin, erythropoietin (EPO), NT-proBNP, IL-1, IL-6, TNF-a, transferrin saturation (TS), total vascular peripheral resistance, and parameters of systolic and diastolic function of left ventricular (LV) myocardium (by echocardiography and doppler echocardiography). Results. In patients with NYHA class I-IV CHF and anemia increases of Hb, Ht, TS, levels of EPO and ferritin occurred during treatment by basic drugs combained with MEB. In subgroups of patients with NYHA class I-II and III-IV the 6-minute walk distance significantly increased by 25.1 and 38.3%, and GFR- by 24.5 and 14.9%, respectively. At the background of therapy with IV iron we observed significant increases of Hb, plasma level of ferritin, and TS. Combined treatment with MEB and IV iron was associated with positive dynamics of Hb, Ht, levels of ferritin, EPO, NT-proBNP, and IL-6. In this group in subgroups of patients with NYHA class I-II and III-IV the 6-minute walk distance significantly increased by 21.6 (p<0.001) and 64.9% (p<0.001), respectively. Conclusion. In the treatment of patients with CHF with anemia there is a need for differentiaion depending on such parameters as plasma levels of ferritin, EPO, and TS. In patients with CHF and anemia combined therapy with MEB and IV iron promotes significant positive dynamics of Hb, ferritin, TS and EPO, as well as of LV myocardial function parameters.

Objective: to examine relationship between anatomical changes of the left ventricle (LV), dynamics of velocity of its volume modification, and blood flows in the LV in patients with mitral regurgitation (MR) before and after surgical treatment. Materials and methods. We included into this study 58 patients with severe 3-4 degree MR (38 men, 20 women aged 24-69 [mean age 51±9] years) in sinus rhythm (96%) or atrial fibrillation (4%). The control group included 86 healthy volunteers, mean age 39±7 years. Transthoracic echocardiographic studies were performed in both groups by standard technique at rest using a high-quality echocardiograph Vivid E9, equipped with a 3.5-4.6 MHz multi frequency transducer (in patients before and after surgical repair - mitral valve [MV] replacement and MV reconstruction with annuloplasty ring). The analysis of files recorded was performed off-line by vector analysis technique including estimation of myocardial deformation velocities and dynamics of LV volume modification, construction of “flow-volume” diagram, calculation of the expended kinetic energy, and registration of intraventricular blood flows. Results. End diastolic volume (EDV), end systolic volume (ESV) and total stroke volume (TSV) (effective + retrograde) were significantly increased in patients with severe LV volume overload before surgery in comparison with the control group (p<0.001). After MV replacement EDV decreased from 157 to 101 ml, which averaged 36% of the initial value. TSV before surgery was about 106 ml, after surgery it decreased 43% down to 61±12 ml. Vector analysis technique and diagram method showed that velocities of LV volume modification and sum of normal velocities both in systole and diastole were significantly higher in patients with MR before surgery compared with the control group; with this the velocity of modification of LV length (dL/dt[s]) in systole and diastole did not differ from values in the control group. The ratio of the velocity amount (Σ Vη) - diastole to systole ratio - differed from values in the control group by 13-15%. Kinetic energy loss (E_kin) in patients with MR before surgery was several times higher in diastole than in systole. After MV replacement E_kin in systole and diastole decreased becoming closer to normal values. MV replacement restored the pattern of LV filling from the left atrium, and the blood flow reached the LV apex virtually without energy loss. Conclusions. Thus, myocardial deformation velocities, LV blood flows allow to quantify cardiac function in patients with MV insufficiency and to assess the effectiveness of surgical treatment in the early and remote postoperative periods. Phenomenological patterns in evaluation of LV myocardial function and valve apparatus are based not only on anatomical changes of heart chambers, but also on the dynamics of myocardial deformation velocities, what allows to get closer to a assessment of global cardiac function, taking into consideration blood flow dynamics and turbulence in the ventricles, characterizing the cardiac performance and particularly the kinetic energy of the myocardium. Evaluation of stagnant areas in the LV based on the velocity of intracardiac blood flow, reconstructed from color Doppler mapping can be used as a method to identify topological structures with the assessment of qualitative and quantitative characteristics of the myocardium and valve apparatus.

Optimal duration of dual antiplatelet therapy (DAPT) after stent implantation is uncertain. Some patients have an extended risk of thrombotic complications including that of very late stent thrombosis after cessation of recommended course of DAPT (6-12 months). On the other hand, there is a real risk of bleeding on DAPT. In this review, we present and discuss results of clinical trials of long-term DAPT and data of their meta-analyses. The review also contains consideration of some aspects of new AHA /ACC recommendations (2016) on duration of DAPT.

The fact that microRNAs play an important role in the development and pathogenesis of cardiovascular disease is beyond doubt. This article provides a brief overview of recent data that relate to microRNA expression in various cardiovascular diseases. Detecting significant changes in the level of expression of these molecules in various diseases means that microRNAs can be considered to be potential biomarkers of human pathologies including heart failure. Studying the relationship between the mechanisms of cardiovascular disease and the level of expression of a variety of microRNAs, as well as establishing their exact relationships with the genes is an urgent problem and requires further research.

Edematous states caused by an excessesive extracellular fluid retention are major components of cardiovascular and renal disorders including chronic kidney disease, nephrotic syndrome, and heart failure. The use of diuretic drugs from various groups including loop duiretics are important means of pharmacological correction of these clinical conditions. Moreover, diuretics used to lower bood pressure as a part of antihypertensive treatment, reduce cardiovascular events. The response of patients to the dose of a diuretic is reflected by a sigmoid dose-response curve which can be affected by changes of sodium content in the body. Loop diuretics may fail to control salt and water retention despite the use of appropriate doses. The main reasons for loop diuretic resistance may be determined by further reduction of glomerular filtration rate and reduced peak concentration of loop diuretics in primary urine. Chronic treatment with loop diuretics can cause compensatory hyperthrophy of epithelial cells along the ascending limb of the loop of Henle and thus decrease of its diuretic effect. The principles of avoiding this phenomenon are the restriction of sodium intake, correction of doses, timing and frequency of drug administration, and use of combination diuretic therapy. Loop diuretic - related adverse events that involve uricaemia and ototoxicity also should be taken into consideration.

Coronary arteries aneurysms with their thrombotic occlusion are known to be detected in young patients who have suffered Kawasaki disease in childhood. The other vascular beds are usually not involved. In the literature one can find not enough information regarding diagnostics of this pathology, as well as no specific treatment algorithm. We present here a clinical case of re-emergence of giant aneurysms of coronary arteries in the young female patient with subsequent immuno-histological confirmation of previous Kawasaki disease.

The article is devoted to the analysis of significance of electrocardiography for assessment of anatomical-functional measurements of the heart in patients with arterial hypertension. Modern methods of calculation of the left ventricular myocardial mass are presented with corresponding recommended normal ranges values. The article contains discussion of variants of left ventricular remodeling, significance of functional indexes characterizing the state of systolic and diastolic function of the heart, parameters of deformation of the left ventricle for diagnosis of causes of left ventricular hypertrophy, as well as for assessment of prognosis.