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Decreased heart rate variability (HRV) is associated with increased mortality risk in various diseases. The objective of this investigation:to study HRV in patients with sickle cell anemia (SCA) and to assess the effect of pulmonary arterial hypertension (PAH) on HRV in these patients. Materials and methods. HRV registration and Doppler echocardiographic assessment of systolic pulmonary arterial pressure (PAP) was carried out in 61 stable patients with SCA and 24 healthy subjects. Results. Low frequency power (LFP) and high frequency power (HFP) were decreased in SCA patients compared to healthy subjects. Among SCA patients, PAH patients had lower  LFP and HFP than patients without PAH. In SCA patients, systolic PAP showed significant negative correlation with LFP and HFP. Conclusion. HRV is significantly decreased in SCA patients, especially in those with PAH. HRV may be particularly useful in early detection of PAH patients who may have worse prognosis and higher mortality risk.

During recent 10-15 years, percutaneous coronary interventions (PCI) have reached a new level of efficacy and safety. Rate of serious coronary complications has decreased. That to a greater degree exposes the problem of peripheral complications at the site of arterial approach. At the same time portion of patients older than 75 years in the total pool of PCI constantly increases. Number of patients with pronounced obesity also grows each year. Radial approach for PCI allows to substantially decrease rate of peripheral complications at the account of lowered rate of bleedings, and to shorten duration of hospitalization. In this literature review we present results of a number of relevant clinical studies including those which contained groups of elderly patients and of patients with obesity. We also have summarized main advantages and disadvantages of radial approach as compared with femoral approach for coronary angiography and PCI.

Ischemic heart disease and acute myocardial infarction (AMI) in particular remain widely spread and contribute seriously in total mortality of population. This literature review is devoted to the right ventricular (RV) AMI as the least studied problem of contemporary cardiology. We present here description of specific characteristics of blood supply to ventricles of the heart, clinical picture, diagnostic criteria and prognosis of RV infarction. We also present current strategy of management of patients with RV AMI including early revascularization with the help of percutaneous coronary intervention.

Resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease is a poor predictor for the development of atherothrombotic complications. In 277 patients with coronary artery disease suffered uncomplicated coronary angioplasty with stent implantation, we was estimated arachidon-induced platelet aggregation during treatment with acetylsalicylic acid by bedside VerifyNow Assay test at 28-90 days after the intervention. It was found that 18.9% of the 144 patients receiving a combination of ASA 75 mg with 15.2 mg of magnesium hydroxide had true (laboratory) resistance to ASA. At the same time on the original enteric coated ASA 100 mg, we can found only 0.8% resistance to ASA among 129 patients. We made switch from combination of ASA 75 mg with 15.2 mg of magnesium hydroxide to original enteric coated ASA 100 mg and repeat VerifyNow Assay test at 2-4 days and found lost of resistance in 92% of 28 patients. Thus, resistance to the ASA is not constant, it depends on the form and the applied dose of ASA, and eliminating more than 92% when ASA changes from ineffective to effective form.

The review is devoted to merits and demerits of a new method of assessment of condition of the heart - speckle-tracking echocardiography. Speckle-tracking echocardiography is a perspective method allowing to register disorders of both global and regional contractile motion.

We compared parameters of the state of myocardium after coronary artery bypass surgery (CABS) performed according to the following techniques - with complete cardiopulmonary bypass (CABS-CBP), beating heart bypass grafting with parallel normothermic perfusion (CABS-BH-NP), and beating heart bypass grafting (CABS-BH). Patients (n=100, 86% men, 14% women, age 56-69 years) were divided into 3 groups with comparable sex, age, state of the myocardium, and EUROSCORE surgical risk. In group 1 patients (n=35) we used CABS-CHB, in group 2 (n=32) - CABS-BH-NP, in group 3 (n=33) - CABS-BH. The following parameters were obtained on day 1 after surgery: left ventricular ejection fraction (EF, echocardiography), blood plasma levels of creatine phosphokinase (CPK), CPK-MB, and cardiac troponin I (TnI). There was no significant difference in parameters studied between groups 1 and 2 with a tendency to their more pronounced positive dynamics in group 2. In group 3 compared with groups 1 and 2 we observed significant lowering of levels of CPK (by 21.2-30.9%, p<0.05), CPK-MB (by 9.1-13.1%, p<0.05), TnI (by 0.6-0.7%, p<0.05), and elevation of EF (by 9.8-11.6%, p<0.05). Rate of development of myocardial infarction in group 3 (6.8%) was lower than in groups 1 and 2 (14.2 and 9.8%, respectively). In all groups we observed close correlation between biochemical parameters and left ventricular EF (r=0.74-0.82, p<0.01).

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiari's network.

Objective: to analyze correspondence between determination of vascular age of patients with cardiovascular diseases by volumetric sphygmography and their chronological age, and to assess the influence of lipid factors and atherosclerotic lesions in carotid arteries (CA) on parameters associated with the cardio-ankle vascular index (CAVI)., Material and Methods: Clinical, laboratory and instrumental examination which included volumetric sphygmography was carried out in 185 patients with various cardiovascular diseases. Calculated vascular age was determined on the basis of graphic conversion of ratio of CAVI and true age of a patient., Results: Calculated vascular age exceeded chronological age in 43 patients (23.4%). Analysis of the data obtained in this subgroup, except natural interrelation between such characteristics as age, ankle-brachial index, CAVI and calculated vascular age revealed statistically significant correlations (p < 0.05) between following parameters: R-CAVI and male gender (r = 0.35), calculated vascular age (based on R-CAVI) and TG (r = -0,34), L-CAVI and BMI (r = -0.36), R-ABI and the presence of atherosclerotic plaques in carotid arteries (r = -9.34). Comparison of influence of lipid factors and CA atherosclerotic lesions on CAVI associated parameters revealed no significant differences between groups., Conclusion: Volumetric sphygmography with calculation of vascular age is an easily reproducible and accessible method of screening of early changes in the vascular wall. Determination of vascular age of patients with cardiovascular diseases by volumetric sphygmography suggests advisability of thorough medical examination at least in a quarter of total number of patients.

This paper contains discussion of application of methods of assessment of vascular stiffness in clinical practice, comparison of such parameters as pulse wave velocity, ankle-brachial and cardio-ankle vascular index (CAVI), as well as analysis of advantages of cardio-ankle CAVI for diagnosis, evaluation of effectiveness of treatment, and prognosis in various cardiovascular diseases.

Coronary stents became an integral part of treatment of ischemic heart disease (IHD). Number of percutaneous coronary interventions (PCI) in patients with IHD in Russia constantly growing. At a certain stage of development of interventional cardiology drug eluting stents (DES) were created and became actively used. Compared with metallic stents (MS) drug eluting stents allow to substantially reduce risk of restenosis. However DES did not replace MS and the latter are still used in about 50% of PCI in Russia. Design of standard MS and thickness of struts might affect extent of neointimal proliferation which develops after stent implantation and eventually determines remote outcomes of IHD treatment. Thereby choice of optimal MS remains an actual problem. In this review we present results of clinical studies which compared MS with different design and thickness of struts.

Aim: To study signs of diabetic cardiomyopathy (DCM) in nondiabetic patients with controlled arterial hypertension (AH) and glycemic response during first hour of glucose tolerance test (GTT)., Material and Methods: Patients (n = 47) with controlled AH were divided into 2 groups according to results of GTT with 75 g of glucose: patients of group 1 (n = 22) had glucose level ≤ 200 mg/dl during 1-st hour of GTT; other patients (n = 25) composed group 2. Examination of all patients included transthoracic echocardiography, ultrasound Dopplerography, tissue Doppler (TD) and 24-hour Holter ECG monitoring. Using data of these methods we calculated left ventricular (LV) mass and the following characteristics of mitral ring: E/A, TD e', TD a', TD s', TD e'/a'/. The following characteristics of heart rate variability were obtained: standard deviation of normal RR intervals (SDNN), low and high frequency (LF, HF) power, LF/HF ratio., Results: Patients of group 2 had higher LV mass (229.5 ± 58.2 vs. 192.1 ± 50.6 g; p = 0.036), more pronounced changes of TD e'/a' (0.71 ± 0.25 vs. 1.06 ± 0.58; p = 0.011), lower SDNN both during day (85.4 ± 14.1 vs. 112.5 ± 31.3 ms, p = 0.007) and night (82.2 ± 22.1 vs. 105.9 ± 28.5 ms, p = 0,004) time, higher nocturnal LF/HF ratio (3.75 ± 4.02 vs. 1.72 ± 0.81, p = 0,029)., Conclusion: In patients with controlled arterial hypertension (AH) and glycemic response during first hour of GCT we revealed various pronounced manifestations of DCM. These data constitute a basis for further studies.

This literature review is devoted to clinical significance of filiform structures (Lambls excrescences) which can be revealed on cusps of cardiac valves by transesophageal echocardiography. The review contains analysis of frequency of detection of these structures at pathomorphological investigation and transesophageal echocardiography as well as consideration of their histological construction and mechanisms of formation. Special emphasis is made on mechanisms of related embolic complications and data on association of Lambls excrescences with strokes. Differential diagnosis of these structures and other pathological elements on heart valves is also presented.

Adequate drug therapy of stable ischemic heart disease directed at reduction and prevention of main clinical symptoms of the disease, increase of exercise tolerance to physical effort, improvement of quality of life and prognosis remains an actual problem. Nicorandil combines properties of an antianginal drug and cardioprotective effects. Its pharmacological action is related to capabilities to be an nitrous oxide donor and to activate ATP-dependent potassium channels. In this review we present data on mechanism of action of nicorandil, on its clinical effectiveness, and on comparison with antianginal drugs of other groups. We have also analyzed experience of the use of nicorandil in patients with acute coronary syndrome and in conjunction with during invasive interventions.

The diagnostic efficiency of the methods of separate and combined registration of oronasal airflow and pulse oximetry in order to identify the obstructive sleep apnea/hypopnea syndrome (OSAHS) is studied in this work. Patients with cardiovascular diseases with complaints on sleep disorders were included in the study. Combined registration of oronasal airflow and pulse oximetry during sleep were performed for all examined patients (diagnostic system ApneaLink with pulse oximetry, ResMed). Registration results of oronasal airflow and pulse oximetry were analyzed separately and together. Apnea/hypopnea index (classic, recommended), desaturation index with a threshold of desaturation of 4% and 3% were evaluated as the diagnostic criteria for the identification of OSAHS. Also, in this paper the "apnea/hypopnea combined index" summarizing hypopnea episodes, which are associated with significant desaturation and without desaturation, was tested. As a method of comparison, polysomnography (Embla N7000, MedCare Flaga), which was carried out simultaneously with the main study, was used. The diagnostic efficiency of test methods and their criteria assessed by ROC-analysis (receiver operator characteristic, the characteristic curve analysis). The results of the study showed that combined registration of respiratory oronasal airflow and pulse oximetry during sleep was most effectively identified OSAHS and can be used as a screening method. The most accurate diagnostic criterion for identification of OSAHS is an "apnea/hypopnea combined index".

Aim of this multicenter retrospective study was assessment of effect of intracoronary administration of tirofiban loading dose in troponin positive patients with acute coronary syndrome (ACS). We analyzed multicenter data base of patients subjected to percutaneous coronary interventions (PCI) because of ST-elevation or non-ST elevation ACS from October 2010 to October 2011. Patients who received loading doses of aspirin (300 mg) and clopidogrel (600 mg) before PCI and tirofiban (10 mg/kg bolus with subsequent infusion 0.15 mg/kg/min for 24 h) were selected for the study (n=133, 89 with intravenous and 44 - intracoronary administration of tirofiban loading dose). We assessed hospital mortality, myocardial reinfarctions (reMI), necessity of target vessel revascularization (TVR) and pronounced bleedings. There were no significant differences in mortality, reMI, and TVR between two groups. However major adverse cardiac events was significantly less in patients who received intracoronary tirofiban (6.8 vs. 21.3% in i.v. group; p=0.046). Hospital stay was significantly shorter in intracoronary compared with i.v. group (3.84+/-0.96 vs. 4.55+/-1.11 days; p=0.001). Rates of bleedings did not differ significantly between groups. Thus compared with i.v. intracoronary administration of tirofiban loading dose allows lower rate of major adverse cardiac events as well as to shorten length of hospital stay of patients with ACS.

Thomboembolism is the most threatening complication in patients with atrial fibrillation. Main source of embolism is the left atrial thrombosis. Mechanisms of development of thromboembolic complications in patients with arrhythmias are far from being deciphered. In this review we discuss possible mechanisms of formation of intracardiac thrombus - abnormalities of functioning of the hemostasis system, endothelial dysfunction, inflammatory reactions, fibrosis of the left atrial wall, genetic traits.

The paper contains description of possibilities and limitations of ultrasound diagnosis in patients with acute coronary syndrome (ACS). Main attention is paid to possibilities of echocardiographic diagnosis of myocardial infarction (MI) and its complications, as well as to differential diagnostics of ACS and nonischemic conditions causing chest pain and infarction-like ECG changes. Data are presented demonstrating substantial lowering of rates of some complications of MI in patients subjected to thrombolytic therapy or interventional procedures of myocardial revascularization.

In order to assess the overall prevalence of sleep apnea of obstructive and central origin in of patients hospital cardiology department we performed continuous pulse oximetry monitoring during sleep in all patients admitted over 2 months. Of the 139 patients reliable results were obtained in 125 (89.9%). In 72% of patients desaturation index was 5 or more, indicating probability of sleep apnea. In 36% of patients oxygen desaturation index was > or = 15, which corresponded to moderate forms of sleep apnea. And only 28% of patients had no pathological changes in the nocturnal oxygen saturation curve. Thus, in patients hospital cardiology department we revealed extremely high prevalence of sleep apnea of various origins. Showed the technical feasibility of the continuous pulse oximetry monitoring for mass screening of apnea during sleep.

There are several stratification scales of major cardiovascular events rate for patients have gone through acute coronary syndrome (ACS). None of them is perfect one. Arterial hypertension is included into some scales for post ACS patients but the features of it and its impact on coronary artery disease after ACS have never studied before. We studied the reasonability of Pulse Wave Velocity (PWV) measurement for fatal events rate in hypertensive patients have gone through ACS. 326 patients were examined. They were enrolled into the study in stable condition on 10th day after ACS has occurred. As a result of two years observation the increase PWV on carotid-femoral segment associated with the most negative (fatal) events in hypertensive patients have gone through ACS.

We included in this study 43 patients chronic total occlusions (CTO) subjected percutaneous coronary interventions (PCI) with the use of penetration catheter (Tornus) in 2009-2010. Penetration catheter was applied only in those cases when it was not possible to introduce low profile coronary dilatation catheter into the site of occlusion. After penetration of CTO by a guide wire a channel was formed by a manually rotated penetration catheter. The Tornus catheter was successfully passed into distal part of an artery in 81.4% of cases. In other.

We carried out prospective cohort study of incidence of new cases of atrial fibrillation (AF) in a sample of Moscow population (patients under observation in our policlinic). Total incidence of AF between 2003 and 2009 was 7.7 per 1000 patient/years, it was higher among men than among women. Incidence of AF progressively increased with age reaching maximum in age group more or equal 85 years. Most frequent baseline disease in patients with first appearance of AF was hypertensive disease (71%). Ischemic heart disease diagnosed according to strict criteria (postinfarction cardiosclerosis, revascularization procedures) was registered in 20.1%, diabetes - in 15.7%, chronic heart failure - in 13%, valvular heart disease - in 5.6%, and history of acute ischemic stroke - in 2.5% of patients.

We carried out clinico-economical analysis of 2 tactics of rhythm restoration in patients with paroxysmal atrial fibrillation (AF) lasting less than 48 hours: cardioversion at prehospital stage with intravenous procainamide and inhospital cardioversion with any method. This retrospective study was based on the data from department of urgent aid of an outpatient clinic. The results showed that within 48 hours inhospital was a was more effective, safe, and more economically profitable compared with administration of procainamide at prehospital stage. Intravenous procainamide resulted in effective cardioversion in 70.6% of patients. It was associated with arterial hypotension and proarrhythmogenic action in 14,7% of cases. Patients with effective cardioversion with procainamide had lesser mean values of left ventricular anterior-posterior dimension (echocardiography) and shorter duration of arrhythmia.

We studied relation between cystatin C level and risk of unfavorable outcome (unstable angina, fatal and nonfatal myocardial infarction [MI], fatal and nonfatal stroke, and death) in patients stabilized after exacerbation of ischemic heart disease. Patients (n=272) were included on day 10 after onset of acute coronary syndrome. No relationship between studied outcomes and cystatin was found in a group as a whole. In patients with normal of slightly reduced renal function (glomerular filtration rate more or equal 60 ml/min/1.73 m2) unfavorable outcomes were independently associated with history of myocardial infarction and stroke, elevated levels of brain natriuretic peptide and cystatin. In subjects with moderately or severely reduced renal function elevation of cystatin level lost its significance. Risk of development of unfavorable outcomes among these subjects was independently related to history of MI and GFR &lt;60 ml/min/1.73 m2 (OR 2.130, 95% CI 1.010-4,489; =0,047). Our data confirm possibility of use of cystatin C level measured early after ACS in patients with normal or slightly lowered renal function as a parameter characterizing risk of cardiovascular complications and death.

We investigated prognostic value of the SCORE scale in working age government employees with 3 or more risk factors (RF) of cardiovascular diseases (CVD) and metabolic syndrome (MS, 2001 criteria) according to results of 10-year prospective observation in a policlinic. The study comprised 268 practically healthy men: 168 patients with 3 or more RF of CVD (mean age 47.76+/-6.9 years) (group 1) and 100 patients with MS (mean age 47.73+/-7.97 years) (group 2). Prospective follow up of group I patients with low or moderate CVD risk calculated with the SCORE scale demonstrated concordance of predicted and actual rates of lethal outcomes. In the group of patients with MS and high CVD risk lowering of number and level of RF took place due to in-depth examination and high compliance to therapy. This resulted in lowering of CVD and postponement rate their later development.

Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain one of most difficult parts of interventional cardiology. Introduction of novel devices and methods of recanalization of CTO have facilitated fulfillment of these interventions and increased number of successful procedures. Howere a number of cases it is impossible to position a balloon in the site of occlusion even after its successful crossing with a guidewere. Penetration catheter Tornus was specifically created for such cases. It allows to form a channel in CTO for subsequent dilation and stent implantation. We present a review of available clinical studies assessing efficacy of the use of Tornus catheter during PCI for CTO, as well as results of its comparison with efficacy of rotational atherectomy. Authors of these studies concluded that Tornus catheter was highly effective in cases when it was not possible to pass a catheter for changing usual "RotaWire" guide with the aim of conducting rotational atherectomy, or in cases of impossibility to pass a balloon along a guidewere for predilation of the occlusion site. At the same time the use of penetration catheter had no advantages over rotational atherectomy.

In this literature review we present analysis of various aspects of the problem of cardiotoxicity of antracyclines used for the treatment of the breast cancer. We consider mechanisms of their cardiotoxic action, role of risk factors, clinical manifestations of acute and chronic cardiotoxicity, and dependence of their severity on treatment duration and drug dose. We give data on contemporary methods of diagnostics of early toxic cardiac effects of antracyclines from the side of cardiovascular system. We also conducted assessment of possibility of prevention of toxic action of antracyclines with the use of combination of different methods including dose sparing regimens and schemes of treatment, combinations of drugs, use of cardioprotectors as well as novel preparations from the antracycline group, possessing lesser cardiotoxicity. Clinical and experimental data on the treatment of manifestations of cardiotoxicity with consideration of pathogenetic mechanisms of their development are given.

Results of the study of clinico-diagnostic value of multispiral computed tomography in patients with suspected ischemic heart disease (IHD) are described in this paper. We have used 64-slice spiral computer tomography in examination of 49 patients with high IHD risk referred to the cardiological hospital for IHD exclusion. We have demonstrated high capacity of this method in diagnosis of early stages of atherosclerotic coronary artery involvement. This will allow timely detection of such patients and to intervene on modifiable IHD risk factors with the aim of lowering risk of development of unfavorable clinical manifestations of IHD, such as acute coronary syndrome and sudden death.

Prognostication of the course of disease in patients with high risk of unfavorable outcome of ischemic heart disease (IHD) is of great importance for creation of individualized strategy of treatment. We have investigated contribution of levels of brain natriuretic peptide (BNP) and genetic factors in the risk of development of complications of atherosclerosis in patients who have had acute coronary syndrome. We started to follow 324 patients on day 10 of stable state after acute coronary syndrome (55.1% with Q-wave myocardial infarction, 18.5% with non-Q myocardial infarction, 25.5% with unstable angina, men BNP level 624.5+/-32.13 mol/ml [70.3 - 4276.6]). Duration of followup was 2 years. Baseline BNP level in patients with unfavorable outcome during followup (fatal and nonfatal myocardial infarction and stroke) was 872.47+/-91.42 compared with 592.45+/-35.97 mol/ml in patients without unfavorable outcome (p=0,001). Multifactorial Cox analysis showed that carriage of T allele of polymorphic marker (--1654) of protein C gene, elevated BNP level, symptomatic atherosclerosis of peripheral arteries, history of MI, and use of thiazide diuretics were independently associated with unfavorable outcomes (p=0.026, &lt;0.0001, &lt;0.0001, =0.001, =0.024, respectively). Thus genetic factors and study of BNP allow to improve prediction of unfavorable outcome after exacerbation of IHD.

Disturbances of respiration during sleep especially those of obstructive character are sufficiently widespread phenomena. In addition to worsening of the quality of sleep itself they facilitate formation and development of concomitant pathology of cardiovascular system, endocrine system, cognitive sphere. This results in lowering of quality of life and its duration. At present standard method of diagnosis of disturbances of respiration during sleep is polysomnographical examination. At the same time more accessible screening methods are also actively used with the aim of detection of subjects with high probability of respiratory disturbances during sleep. Among them cardiorespiratory monitoring, nocturnal pulsoximetry, registration of oro-nasal flow during sleep, are questionnaires most widely-spread.

We consider in this review traditional and novel approaches to drug prevention of pulmonary embolism (PE) which in predominant number of cases is related to deep vein thrombosis of lower extremities. Risk of PE development is especially high in patients after orthopedic hip or knee surgery. Modern recommendations contemplate use of unfractionated and low molecular weight heparins, vitamin K antagonists (warfarin in the first place), fondaparinux. Oral direct anticoagulants related to selective inhibitors of blood coagulation factors IIa (thrombin) and Xa have appeared recently and proved their preventive efficacy and safety in randomized controlled studies. Preventive efficacy and safety of dabigatran among direct selective factor IIa (thrombin) inhibitors and of rivaroxaban, apixaban, and edoxaban among direct selective factor IIa inhibitors have been studied best.

The review is devoted to different aspects of pulmonary arterial hypertension (PAH); new classification of PAH is published in 2010. There are idiopathic PAH and PAH associated with other diseases. Current guidelines recommend to treat PAH only after the verification of diagnosis with right heart catheterization and acute tests with vasodilators. Patients-reactors should be treated with calcium antagonists. The following drugs related to one of three categories should be used in PAH: (1) prostanoids (epoprostenol, iloprost et al.); (2) blockers of endothelin receptors (bosentan, ambrisentan, sitaxsentan); (3) phosphodiesterase 5 type inhibitors (sildenafil, tadalafil et al.) In majority of cases the combined treatment is used, usually the combination of bosentan and sildenafil is used.

Constrictive pericarditis is a rare and severe disease. Timely and correct differential diagnosis of this pathology facilitates choice of necessary tactics of treatment and thus improve prognosis and quality of life. In this paper we present clinical case report of a patient with constrictive pericarditis. The disease was diagnosed on the basis of clinical picture, data of X-ray and echocardiographic investigation, and confirmed by multispiral computed tomography (MSCT). The patient was subjected to pericardioectomy with positive clinical effect and results of repeated echocardiography and MSCT.

We have studied prevalence of risk factors (RF) of cardiovascular diseases (CVD) recorded for statistical purposes in subjects of able bodied age during 10 year period of observation in a policlinic as well as prevalence of early and/or oligosymptomatic CVD manifestations in 11762 subjects of working age with RF of CVD development according to results of complex noninvasive examination of cardiovascular system in ambulatory conditions during the period from 2000 to 2009 year. Numbers of men and women were 45.3 and 54.7%, respectively. The program of examination included analysis of ECG, echocardiography (EchoCG), ultrasound examination of brachiocephalic vessels, 24-hour Holter ECG monitoring, exercise test on treadmill. In 2006 and 2007 complex examination was supplemented with 24-hour monitoring of arterial pressure, stress EchoCG, noninvasive arteriography. Complex ambulatory examination of subjects of working age with FR of CVD development with the use of noninvasive methods of functional diagnostics allowed to diagnose in 56% of studied persons various early and/or oligosymptomatic CVD manifestations which often appeared in combination, including ischemic heart disease (in 15%), hypertensive disease- (in 42%), cerebral atherosclerosis - (in 23.5%).

We implanted 59 paclitaxel eluting Apollo stents to 48 patients with ischemic heart disease (IHD) and long de novo coronary artery lesions in 2007 with 100% immediate success rate without inhospital major cardiac complications. One patient developed hematoma at femoral artery puncture site. There were no cases of restenosis among 18 patients subjected to control angiography after 6 months. One patient had acute myocardial infarction in area supplied by nontarget artery. Control angiography after 12 months was carried out in 81.3% of patients while 14.6% of patients who refused angiography were examined with stress tests. Restenosis of stented segments was found in 3 (5.3%) patients, diameter loss was 0.32+/-0.45 mm. All these patients were subjected to repeat PCI. During follow up myocardial infarctions were registered in 4.2% of patients, overall rate of serious cardiac complications was 11.6%. PCI with implantation of paclitaxel was safe and effective with acceptable rate of major cardiac complications. Our results evidence in favor of further use of these stents.

We compared Dopplerographic methods and invasive assessment of mean pulmonary artery pressure (MPAP) in 20 men with chronic obstructive pulmonary disease (COPD). We demonstrated possibility of evaluation of mean pulmonary artery pressure by Doppler methods of calculation using diastolic gradient of pressure of pulmonary regurgitation and ratio of flow acceleration time in right ventricular outflow tract and ejection time. In patients with COPD overestimation of MPAP is possible especially in patients with pronounced elevation of MPAP. Methods of evaluation of MPAP based on measurements of intervals of pulmonary blood flow do not allow to adequately evaluate MPAP in patients with COPD.

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the fifth communication we consider data of two randomized studies in which efficacy and safety of clopidogrel in combination with acetylsalicylic acid (ASA) has been assessed in comparison with ASA in stable patients with atherothrombotic cardiovascular disease. It has been shown in both studies that in stable patients with atherothrombotic cardiovascular disease long-term therapy with combination of clopidogrel and ASA was no more effective than monotherapy with ASA or clopidogrel but was associated with high risk of hemorrhagic complications. Thus contrary to acute coronary syndromes and percutaneous interventions with stenting combinations of clopidogrel and ASA is not indicated to patients with stable course cardiovascular diseases.

Patients (n=432) subjected to percutaneous coronary interventions (PCI) with implantation of one or more drug eluting stents (DES) in 2005 were included in this study. These patients were divided into 3 groups according to baseline glomerular filtration rate (GFR): group 1 - GFR 60 ml/min/1.73 m2, n=271, group 2 - GFR 30-60 ml/min/1.73 m2, n=132, group 3 - GFR <30 ml/min/1.73 m2, n=29. In all patients only contrast preparation iodixanol was used and prevention of contrast induced nephropathy (CIN) was implemented. Immediate success of PCI was higher and comparable between groups. Rate of development of CIN turned out significantly higher in groups 2 and 3 (6.8 and 17.2% compared with 0.7% in group 1, <0.001). During 12 months of follow up restenosis rate was higher in groups 2 and 3 (15.9 and 27.6% compared with 6.6% in group 1, <0.001). Lowered GFR became predictor of long term (up to 3 years) mortality in patients with CKD as for group 2 compared with group 1 relative risk (RR) of death was 1.77 (95%CI 1.19-3.74, =0.001), and for group 3 compared with group 1 - 3.69 (95%CI 1.58-6.87), =0.001. In addition lowered GFR was predictor of nonfatal myocardial infarction (MI) up to 3 years: for group 2 compared with group 1 RR 1.69 95%CI 1.12-3.07, =0.009, for group 3 compared with group 1 RR 3.44 95%CI 1.37-6.19, =0.001. The conducted study showed that initially lowered GFR after stenting increased risk of development of CIN, led to rise of restenosis rate and repeat revascularizations up to 12 months, and also appears to be predictor of death and nonfatal MI in remote period up to 3 years.

Patients (n=727) who had been subjected to implantation of one or several standard stents in 2004 were included into this study. These patients were divided into 3 groups according to initial level of glomerular filtration rate (GFR, MDRD equation): group 1 - 466 patients with GFR >60 ml/min/1,73 m(2), group 2 - 233 patients with GFR 30 - 60 ml/min/1,73 m(2), group 3 - 38 patients with GFR <30 ml/min/1,73 m(2). In all group 2 and 3 patients prevention of contrast induced nephropathy (CIN) was implemented: hydration before and after angiography, limitation of intake of nephrotoxic drugs, N acetylcysteine 600 mg/day orally. In all group 2 and 3 patients only contrast preparation iodixanol was used. Total amount of contrast did not exceed 350 ml in patients with GFR 45-59 ml/min/1.73 m(2) and 250 ml - with GFR <45 ml/min/1.73 m(2). In all patients with GFR 60 ml/min/1.73 m(2) low osmolar contrast preparations were used (total amount - less then 600 ml per patient). Immediate success of PCI was similar in all groups (99.4%, 98.2% 97.4%, respectively). Rate of CIN rose significantly in groups 2 and 3 (0.4%, 4.9%, 13.2%, respectively, <0.001). Before 6 months after PCI restenosis developed more frequently with lowering of GFR (group 1 - 11%, group 2 - 22%, group 3 - 34%, <0.001). Myocardial infarction developed by 3 years in 6, 10, and 26% of patients in groups 1, 2, and 3, respectively. Lethality during 3 years was 5, 10, and 24% in groups 1, 2, and 3, respectively. Regression analysis showed that as a whole 3 years rate of myocardial infarction rose 1.57 times in group 2 compared with group 1, and 3.91 times in group 3 compared with group 1. Mortality by 3 years rose 1.93 times in group 2 compared with group 1, and 4.52 times in group 3 compared with group 1. Thus, presence of initially lowered GFR increases risk of CIN after elective implantations of standard stents, leads to rise of restenosis rate by 6 months and increase of mortality and rate of nonfatal myocardial infarction by 3 years.

Recommendations on echocardiographic diagnosis of diastolic function of the left ventricle of the heart are analyzed in this paper. Possibilities of echocardiography for early detection of disturbances of left ventricular relaxation and of pronounced derangements of diastolic function are shown. Difficulties of diagnostics of intermediate stages of diastolic dysfunction as well as ways of their solution are also considered. Together with presently existing methods of evaluation of severity of diastolic dysfunction which are based on assessment of transmitral blood flow a row of other Dopplerographic parameters are presented. Differential approach to assessment of diastolic function of the heart in dependence of the state of cardiac pump function is discussed. Prognostic value of abnormalities of diastole is presented too.

Unlabelled: The purpose of the study was to estimate the safety and the efficacy of the use of tirofiban, its influence on the function of the left ventricle of the heart and the clinical outcome of the patients with ST elevation acute coronary syndrome (ACS) during the rescue coronary angioplasty after the unsuccessful thrombolysis. The study included 112 patients who were randomized into two groups: in group I rescue percutaneous coronary intervention (PCI) with stenting was carried out, the patients in group 2 were administered tirofiban and rescue PCI was conducted. Analysis of the immediate events (0-30 days) showed that in the frequency (group I - 13.7%, group II - 19.2%) and intensity of bleeding there were no distinct differences between groups (p>0.05). In the tirofiban group the distinct growth in the ejection fraction LV (6+/-3% versus 3+/-5% in group I, p=0.005) was recorded. Late events (31-180 days) occurred significantly more rarely in group II (5.8% versus 21.6% in group I, p<0.05). Multivariate analysis showed that the development of cardiogenic shock (OR=6.8, 95%CI: 1.8-26, p=0.005) was an independent risk factor of prominent cardiovascular complications and events during 6 months after PCI. Thus only the use of tirofiban during PCI had a significant effect of the decrease of significant cardiovascular complications and events during 6 months after PCI (OR=0.15, 95%CI: 0.04-0.53, p=0.003)., Conclusion: the performance of rescue PCI in combination with glycoprotein IIb/IIIa inhibitors allows to reach optimal results of the treatment of patients with ST elevation ACS after failed thrombolysis. The remote prognosis of patients after rescue PCI improves if during the intervention a patient receives IIb/IIIa inhibitors of glycoprotein receptors but at the same time considerably worsens in case of cardiogenic shock development.

With the aim to investigate association of polymorphisms of candidate genes with clinical peculiarities of hypertensive disease in patients having burdened familial anamnesis we examined 413 (229 men and 184 women, mean age 60.3 +/- 0.59 years) patients with essential arterial hypertension (AH). Determination of alleles and genotypes of polymorphic markers of ACE, AGT, AT2R1, CYP11B2, NOS3, ENDl, GNB3, PPARA, PPARG2, MTHFR, CAT, SOD2, PON1, PON2 sigma APOB, APOE, LPL genes was carried out with the use of polymerase chain reaction. Patient with AH having hereditary load were younger (58.9 +/- 0.75 and 61.3 +/- 0.89 years, respectively, p=0.017) and had significantly lower age of debut of the disease (44.4 +/- 0.84 and 47.5 +/- 1.03 years, respectively; p=0.013), higher values of systolic (204.8 +/- 7.66 and 187.0 +/- 2.04 mm Hg; p=0.032) and diastolic (111.2 +/- 1.05 and 107.3 +/- 1.17 mm Hg, respectively; p=0.025) arterial pressure (AP) compared with patients with AH without hereditary loaded anamnesis. Portion of patients with 3 degree of severity of AH was higher among patients with "familial" AH (53.6 and 44.1%, respectively, p=0.018). Early debut (in the age younger than 45 years in men and 55 years in women) was associated with carriage of genotype TT of polymorphic marker C825 of GNB3 gene (OR 2.65 95CI [1.27-5.54], p=0.005) and genotype AA of polymorphic marker A(A153)G of AT2R1 gene (OR 1.67 95% CI [1.03-2.77], p=0.024). Higher AP level corresponding to 3-rd degree AH in the group of patients with burdened familial anamnesis was associated with carriage of Asn allele of polymorphic marker Lysl98Asn of EDN1 gene (OR 2.24 95% CI [1.20-4.18], p=0.008), 4a allele of polymorphic marker 4a/4b of NOS3 gene (OR 2.23 C/[1.29-3.83], p=0.002), genotype ArgArg of polymorphic marker Glnl92Arg of PON1 gene (OR 6.14 C7[1.46-25.67], p=0.01), T allele of polymorphic marker of C825T gene GNB3 (OR 1.75 C/[1.11-2.76], p=0.01) and genotype AA of polymorphic marker A(A153)G of AT2R1 gene (OR 2.61 C/11.29-5.34], p=0.005). In patients without burdened familial anamnesis 3-rd degree AH was associated with higher frequency of allele Ala of polymorphic marker Pro12A1a of PPARG2 gene.

The study assessed 123 patients with non-ST-elevation acute coronary syndrome who were randomized into two groups: percutaneous coronary intervention (PCI) (62 patients) and PCI against background of tirofiban injection (61 patients). The results of the study were estimated during the early (up to 30 days) and the late (up to 180 days) follow-up. It was stated that the use of tirofiban has led to the increase of minor bleedings (11% versus 4.8%, p<0.05), but the total amount of bleedings between the groups did not differ: 19.7% in the tirofiban group versus 14.5% in group I. The use of tirofiban has led to the significant growth of the LV ejection fraction (5+/-4% versus 2+/-3%, p<0.05) and increment of the LV wall motion index (0.28+/-0.18 versus 0.12+/-0.21, p<0.001). There was no difference in the frequency of the early events: 9.6% versus 8.2% in the groups without and with the use of tirofiban accordingly (p<0.05). The use of tirofiban was associated with the decrease in the frequency of all events during the first 180 days after PCI: 30.7% in group I and 13.1% in the tirofiban group (p<0.005). Absence the main cardiovascular complications according to Kaplan-Meier method for all patients amounted to 77+/-6%, in the group of the patients who received tirofiban 88+/-6%, and 64+/-8% in the group of the patients who did not receive tirofiban (p=0.009). Thereby, the use of tirofiban in the treatment of the patients with non-ST-elevation acute coronary syndrome does not lead to the increase in the frequency and severity of bleedings. At the same time, the use of tirofiban in the treatment of the patients with acute coronary syndrome has a significant influence on the growth of the LV wall motion index and the LV ejection fraction by increasing them. Under these conditions when using tirofiban in the late period the frequency of all events during PCI is 2.3 times lower compared to the patients who did not receive tirofiban.