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Aim To perform a systematic review and meta-analysis of efficacy and safety of direct oral anticoagulants (DOAC) as compared to vitamin K antagonists (VKA) in the treatment of left ventricular (LV) thrombosis.Material and methods A search was performed in PubMed and Google Scholar for studies that compared DOAC and VKA in the treatment of LV thrombosis with respect of thromboembolic events, hemorrhagic complications, and thrombus resolution. The effect was evaluated with the odds ratio (OR) that was computed using a fixed effects model.Results For these systematic review and meta-analysis, 19 studies were selected, including 2 randomized and 17 cohort studies. The articles included into these systematic review and meta-analysis, were published from 2018 through 2021. In total, 2970 patients (mean age, 58.8 years; 1879 (61.2 %) men) with LV thrombus were included into the meta-analysis. Mean follow-up duration was 17.9 months. The meta-analysis showed no significant difference between DOAC and VKA in the incidence of the study outcomes: thromboembolic events (OR, 0.86; 95 % CI: 0.67–1.10; р=0.22), hemorrhagic complications (OR, 0.77; 95 % CI: 0.55–1.07; р=0.12), thrombus resolution (OR, 0.96; 95 % CI: 0.76–1.22; р=0.77). In a subgroup analysis, rivaroxaban compared to VKA significantly (79%) reduced the risk of thromboembolic complications (OR, 0.21; 95 % CI: 0.05–0.83; р=0.03) with no significant differences in hemorrhagic events (OR, 0.60; 95 % CI: 0.21–1.71; р=0.34) or thrombus resolution (OR, 1.44; 95 % CI: 0.83–1.31; р=0.20). The apixaban treatment group had significantly more (4.88 times) cases of thrombus resolution than the VKA treatment group (OR, 4.88; 95 % CI: 1.37–17.30; р=0.01); for apixaban, data on hemorrhagic and thromboembolic complications were not available.Conclusions The therapeutic efficacy and side effects of the DOAC treatment for LV thrombosis were similar to those of VKA with respect of thromboembolic events, hemorrhage, and thrombus resolution.

Until 2021, there were problems with the ability of citizens to receive medical care in organizations subordinate to federal authorities, especially those located in Moscow. Since 2021, the federal centers have been funded by the Federal Compulsory Health Insurance Fund (CHI).Goal. To study the impact of the new system of payment for specialized medical care under the CHI program on its volume in the A. N. Bakulev NMICSSH.Results. Number of outpatient consultations in the first half of 2021 has almost reached the level of 2019, despite the pandemic of a new coronavirus infection. The number of patients hospitalized for receiving high-tech medical care under the CHI program exceeded the indicator of 2019, for residents of the subjects of the Russian Federation, except Moscow, – for all types of specialized care.Discussion. In the regions, measures were taken to limit the referral of patients to medical institutions that are not subordinate to the region. The possibilities of federal clinics were not fully used, citizens were limited in the possibility of receiving timely highly qualified medical care, waiting for it in regional institutions. In the worst situation were federal medical organizations located in Moscow, where payment was carried out at the tariffs of Moscow, which are significantly higher than in the absolute majority of other subjects of the Russian Federation. In this connection, the regions faced the question of paying for medical care for 10 patients in “their” medical organizations or 6–7 patients in federal clinics in Moscow.Conclusion. The transition to the new system of payment for medical care in federal clinics directly from the Federal CHI Fund has significantly improved the implementation of citizens ‘ rights to choose a medical organization, reduced the waiting time for specialized, including high-tech, medical care, increased the efficiency of using the capabilities of federal centers both in terms of the use of modern technologies and personnel potential.

As a result of the Program “Modernization of primary health care in the Russian Federation” medical care has been developed at all levels of its provision, starting from primary health care and up to specialized. Aim. Аanalysis of the current state of the outpatient health care link and the results of its activities in ensuring the availability of medical care to the population in the field of “cardiovascular surgery”. Material and methods. The sources of information were the information provided by the subjects of the Russian Federation at the request of the Bakulev National Medical Research Center for Cardiovascular Surgery (Bakulev NMRCCS), official statistical reporting data, materials obtained during field events in supervised regions of the Russian Federation on the organization of medical care in the field of “cardiovascular surgery” by specialists from Bakulev NMRCCS. The organization of providing medical care in the profile “cardiovascular surgery” at the level of the polyclinic level in 38 regions Russian Federation supervised by the Bakulev NMRCCS was studied. Results. The article presents the current state of staffing of outpatient clinics, their relationships with higher-level medical organizations and measures to improve their work in general. The role of the introduction of registers of patients with diseases of the cardiovascular system and the importance of a unified information system in improving the quality of medical care is noted. The importance of telemedicine technologies in increasing the availability of medical care is shown. Discussion. Most of the subjects of Russia have improved the provision of their residents with cardiologists. Successful modernization of the primary care depends on the introduction of the unified state information system of healthcare at all levels of healthcare, starting from the possibility of making an independent appointment with a doctor in an electronic schedule of outpatient appointments. The high prevalence of cardiovascular diseases mortality requires the decision on a unified form of registers for the main diseases. Also, the modernization program should include provisions on the activation of the use of telemedicine technologies. Conclusion. Thus, the target program “Modernization of primary health care in the Russian Federation” is one of the most relevant events in the domestic health care. One of the criteria for the effectiveness of polyclinic departments can be considered the number of residents of the subjects of the Russian Federation who received highly specialized medical care.

In recent years there has been significant interest in treating iron deficiency (ID) in patients with heart failure (HF) due to its high prevalence and detrimental effects in this population. As stated in the 2020 Russain HF guidelines, Intravenous ferric carboxymaltose remains the only proven therapy for ID.This document was prompted by the results from the recent AFFIRM-AHF trial which demonstrates that treatment of ID after acute HF decompensation reduces the risk of future decompensations. Experts have concluded that in HF patients with acute decompensation, a left ventricular ejection fraction of < 50% and ID, Intravenous ferric carboxymaltose reduces future HF hospitalisations. Patients with stable HF may also benefit from treatment of ID to improve quality of life and alleviate symptoms. It is, therefore, reasonable to screen for and treat ID in patients with HF.

Aims — identification the correlates between parameters of tissue Doppler imaging, EF thickness by MRI and biochemical markers of fibrosis and inflammation in patients with nonvalvular AF. Retrospectively to evaluate clinical and instrumental parameters influencing the development of thromboembolic events. Methods. Data analysis was performed on 151 patients with different type of AF. A retrospective analysis included 112 patients. 15 (13%) had a history of LAA thrombosis and/or thromboembolic events (stroke, TIA). The prospective analysis included 39 patients. We identified groups with idiopathic AF (N = 21), AF with arterial hypertension (N = 18). And also a group with normal or slightly enlarged (

Aim To analyze survival of patients with COVID-19 based on echocardiographic (EchoCG) criteria for evaluation of the right ventricular (RV) systolic function.Material and methods Data of patients were retrospectively evaluated at the Center for Medical Care of Patients with Coronavirus Infection. Among 142 primarily evaluated patients with documented COVID-19, 110 patients (men/women, 63/47; mean age, 62.3 ± 15.3 years) met inclusion/exclusion criteria. More than 30 EchoCG parameters were analyzed, and baseline data (comorbidities, oxygen saturation, laboratory data, complications, outcomes, etc.) were evaluated. ROC-analysis was used for evaluating the diagnostic significance of different EchoCG parameters for prediction of a specific outcome and its probability. Dependence of the overall survival of patients on different EchoCG parameters was analyzed with the Cox proportional hazards model. For assessing the predictive value of EchoCG parameters for patient stratification by risk of an adverse outcome, a predictive model was developed using the CHAID method.Results The in-hospital death rate of patients included into the study was 15.5 %, and the death rate for this period of in-hospital observation was 12 %. Based on the single-factor analysis of EchoCG parameters, a multifactor model was developed using the method of Cox regression. The model included two predictors for an unfavorable outcome, estimated pulmonary artery systolic pressure (EPASP) and maximal indexed right atrial volume (RAi), and a preventive factor, right ventricular global longitudinal strain (LS RV). Base risks for fatal outcome were determined with an account of the follow-up time. According to the obtained values, an increase in EPASP by 1 mm Hg was associated with increases in the risk of fatal outcome by 8.6 % and in the RA(i) volume by 1 ml/5.8 %. LS RV demonstrated an inverse correlation; a 1% increase in LS RV was associated with a 13.4% decrease in the risk for an unfavorable outcome. According to the ROC analysis, the most significant determinants of the outcome were the tricuspid annular plane systolic excursion (TAPSE) (AUC, 0.84 ± 0.06; cut-off, 18 mm) and EPASP (AUC, 0.86 ± 0.05; cut-off, 42 mm Hg). Evaluating the effects of different EchoCG predictors, that characterized the condition of the right heart, provided a classification tree. Six final decisions were determined in the model, two of which were assigned to the category of reduced risk for fatal outcome and four were assigned to the category of increased risk. Sensitivity of the classification tree model was 94.1 % and specificity was 89.2 %. Overall diagnostic significance was 90.0±2.9 %.Conclusion The presented models for statistical treatment of EchoCG parameters reflect the requirement for a comprehensive analysis of EchoCG parameters based on a combination of standard methods for EchoCG evaluation and current technologies of noninvasive visualization. According to the study results, the new EchoCG marker, LS RV, allows identifying the signs of right ventricular dysfunction (particularly in combination with pulmonary hemodynamic indexes), may enhance the early risk stratification in patients with COVID-19, and help making clinical decisions for patients with different acute cardiorespiratory diseases.

Background: The main methods of treating patients with stable coronary artery disease (CAD) are myocardial revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI). These are two fundamentally different in technique and volume of surgical interventions; PCI is associated with rapid rehabilitation of the patient, and only CABG demonstrated effective in survival benefit. Aims: Comparison of the long-term results of myocardial revascularization with CABG and PCI in patients with stable CAD. Methods: The results of a prospective one-center cohort study of 369 patients with stable CAD are presented, the average age is 60.1 5.4 years. Patients were randomized into 2 groups by the Heart Team: CABG (n = 196) and PCI (n = 173). In each group, subgroups were identified depending on the severity of the coronary lesion, and the CABG group was also separately studied in according to CABG technique ― beating-heart (off-pump) and with cardiopulmonary bypass (on-pump). The average follow-up was 54.3 7 months. The main outcomes of the study were major adverse cardiac and cerebral events (MACCE): death from all causes, cardiac mortality, nonfatal myocardial infarction (MI), nonfatal stroke and repeated coronary revascularization. Results: Over the 5-year follow-up period, no differences were found between the CABG and PCI groups with a low complexity of coronary artery lesions (SYNTAX Score 14.2 4.8) in terms of survival, cardiac mortality, nonfatal MI and stroke, and the need for repeated myocardial revascularization. Patients with stenosis of the left main coronary artery (LMCA) and/or multivascular CA disease (SYNTAX Score 25.8 5.0) in the long-term follow-up after CABG and PCI did not differ in MACCE, but the CABG group demonstrated a significant advantage in repeated myocardial revascularization. No significant differences were found in any study endpoint in patients after CABG on-pump versus off-pump. Conclusions: Our study demonstrates the advantage of CABG in patients with stable CAD with stenosis of the LMCA and/or multivascular CA disease, and which CABG technique should depends on the comorbidity of the patient, the experience of the surgeon and the surgical center.

Aim This study was aimed at performing a systematic review and meta-analysis to investigate the prognostic role of left ventricular (LV) myocardial strain variables as determined by magnetic-resonance imaging in non-ischemic dilated cardiomyopathy.Material and methods A search was performed in PubMed (MEDLINE), Google Scholar, and EMBASE databases for studies on the prognostic role of LV myocardial strain based on MR feature-tracking in non-ischemic dilated cardiomyopathy. Uncorrected odds ratio (OR) values reported by the studies where similar evaluation criteria of myocardial strain were available, were combined for a meta-analysis.Results Nine studies were selected from 351 publications for this systematic review and meta-analysis. The analysis included a totality of 2139 patients (mean age, 52.3 years; mean follow-up duration, 42.5 months). The meta-analysis showed that the worsening of the LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) was associated with increased risk of major adverse cardiovascular events (MACE): OR, 1.13 per each % of GLS; 95 % CI: 1.050–1.225; p=0.001; OR, 1.16 per each % of GCS; 95 % CI: 1.107–1.213; pConclusion The LV GLS, GCS, and GRS variables by MR feature-tracking data are powerful predictors for the development of MACE. Evaluation of myocardial strain can be used as an effective instrument for risk stratification in patients with non-ischemic dilated cardiomyopathy.

Aim. To develop and evaluate the effectiveness of models for predicting mortality after coronary bypass surgery, obtained using machine learning analysis of preoperative data.Material and methods. As part of a cohort study, a retrospective prediction of in-hospital mortality after coronary artery bypass grafting (CABG) was performed in 2182 patients with stable coronary artery disease. Patients were divided into 2 following samples: learning (80%, n=1745) and training (20%, n=437). The initial ratio of surviving (n=2153) and deceased (n=29) patients in the total sample indicated a pronounced class imbalance, and therefore the resampling method was used in the training sample. Five machine learning (ML) algorithms were used to build predictive risk models: Logistic regression, Random Forrest, CatBoost, LightGBM, XGBoost. For each of these algorithms, cross-validation and hyperparameter search were performed on the training sample. As a result, five predictive models with the best parameters were obtained. The resulting predictive models were applied to the learning sample, after which their performance was compared in order to determine the most effective model.Results. Predictive models implemented on ensemble classifiers (CatBoost, LightGBM, XGBoost) showed better results compared to models based on logistic regression and random forest. The best quality metrics were obtained for CatBoost and LightGBM based models (Precision — 0,667, Recall — 0,333, F1-score — 0,444, ROC AUC — 0,666 for both models). There were following common high-ranking parameters for deciding on the outcome for both models: creatinine and blood glucose levels, left ventricular ejection fraction, age, critical stenosis (>70%) of carotid arteries and main lower limb arteries.Conclusion. Ensemble machine learning methods demonstrate higher predictive power compared to traditional methods such as logistic regression. The prognostic models obtained in the study for preoperative prediction of in-hospital mortality in patients referred for CABG can serve as a basis for developing systems to support medical decision-making in patients with coronary artery disease.

Aim. To conduct a systematic review and meta-analysis to compare clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) using conventional coronary angiography (CAG) or fractional flow reserve (FFR)-guided PCI. In addition, FFR-guided PCI and PCI guided with instantaneous wave-free ratio (iFR) were compared.Material and methods. PubMed, Google Scholar databases were searched for studies comparing clinical outcomes in patients with CAD undergoing CAG-guided or FFR/iFR-guided PCI. Dichotomous data analysis was presented as odds ratio (OR) with 95% confidence interval (CI). Adjusted hazard ratio (HR) values from studies with similar evaluation criteria were pooled for meta-analysis.Results. Six randomized controlled trials (RCTs) from 184 publications were selected for this systematic review and meta-analysis. A total of 2193 patients (mean age, 64,2 years, mean follow-up, 28,0 months) were included. Analysis of RCTs showed that CAG-guided and FFR-guided PCI did not have a significant difference in the incidence of major adverse cardiovascular events (MACE) (OR: 0,78; 95% CI: 0,61-1,00; p=0,05; I2=0%), all-cause death (OR: 0,86; 95% CI: 0,51-1,44; p=0,57; I2=0%) or emergency revascularization (OR: 0,69, 95% CI: 0,46-1,04, p=0,08, I2=0%). However, FFR-guided PCI was associated with a reduced risk of subsequent MI compared with CAG-guided PCI (OR: 0,70; 95% CI: 0,50-0,99; p=0,04; I2=0%). In addition to the results of previous RCTs, we conducted a metaanalysis of 3 observational studies. In total, the CAG-guided and FFR-guided PCI groups included 165012 and 11450 patients, respectively. A meta-analysis showed that FFR-guided PCI was associated with a reduced risk of all-cause mortality (HR: 0,74; 95% CI: 0,63-0,87; P=0,0003) and MI (HR: 0,75; 95% CI: 0,61-0,94; p=0,01). In addition, there was no significant difference between iFRand FFR-guided PCI in terms of MACE (OR: 0,97; 95% CI: 0,76-1,23; p=0,81), all-cause mortality (OR: 0,66; 95% CI: 0,40-1,10; p=0,11), MI (OR: 0,83; 95% CI: 0,56-1,24; p=0,37) or emergency repeated revascularization (OR: 1,16; 95% CI: 0,85-1,58; p=0,34).Conclusion. FFR-guided PCI is associated with a reduced risk of all-cause mortality and subsequent MI compared with CAG-guided PCI. At the same time, the iFR-guided PCI is not inferior to the FFR-guided method in terms of MACE rate.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Among patients with AF the subgroup posessing AF without traditional risk factors is differentiated. Such patients are commonly referred as having lone AF and comprise 1020% of all cases. A number of studies have demonstrated that the background of AF, and in particular lone AF, have a substantial genetic component. Aims: To evaluate the influence of gene polymorphism to the development of atrial fibrillation in patients without concomitant valvular pathology and coronary artery disease. Materials and methods: The study included 174 patients with atrial fibrillation and 124 controls without any cardiovascular pathology. All patients were divided into two subgroups: with lone AF (n=94) and with concomitant arterial hypertension (n=80). All patients underwent a complex of clinical, instrumental (ECG, echocardiography, computed tomography of the pulmonary veins) and laboratory tests (thyroid hormones, inflammatory markers, fibrosis), as well as genetic analysis (determination of single nucleotide polymorphisms described as AF risk factors in genes AGXT2, PDE4D, SLN, SCN5A, PITX2, PRRX1, ZFHX3, TBX5, CAV1 и HCN4). Results: For the rare polymorphisms rs12291814 (SLN) and rs137854601 (SCN5A) wasnt found anyone carrier of the minor allele (C and A, respectively). In the both patient subgroups the minor allele T of rs2200733 in PITX2 (OR=3.18, p0.0001), minor allele G of rs3903239 in PRRX1, and minor alleles A of 2 polymorphisms rs2106261 and rs7193343 in ZFHX3 gene were revealed as risk factor of AF (OR=2.96, p0.0001, OR=2.02, p=0.0045, OR=1.64, p=0.04, respectively). We also revealed significant difference between AF and control groups for rs3807989 in CAV1: homozygotic state of minor allele A has a protective effect on the development of arrhythmias (OR=0.39). Conclusions: We revealed the association between the polymorphisms in genes regulating transcription and the development of atrial fibrillation. These polymorphisms have already described but their frequencies have never investigated in Russian population. But the polymorphisms influence to gene functions stays unclear, although attempts to investigate relationship between genotype and gene expression have been made. When the relationship will be discovered it can help us to modify our approach in treatment to patients with atrial fibrillation.

Aim. To conduct a systematic review and meta-analysis in order to evaluate the prognostic value of left ventricular global longitudinal strain (LV GLS) and LV mechanical dispersion (LVMD) in ischemic and nonischemic cardiomyopathy.Material and methods. We searched PubMed, Google Scholar and Embase for studies on the prognostic value of LV GLS and LVMD in ischemic and nonischemic cardiomyopathy. Hazard ratios (HR) from included studies were pooled for metaanalysis.Results. Twelve studies were selected from 314 publications for this systematic review and meta-analysis. In total, 2624 patients (mean age, 57,3 years; mean follow-up, 40,8 months) were included in the analysis. Meta-analysis showed that decreased LV GLS was associated with an increased risk of ventricular arrhythmias (VAs) (adjusted HR: 1,10 per 1% of GLS; 95% CI: 1,01-1,19; p=0,03) and major adverse cardiovascular events (MACE): adjusted HR: 1,22 per 1% of GLS; 95% CI: 1,11-1,33; pConclusions. LV GLS and LVMD assessed using speckle tracking provides important predictive value and can be used as an effective tool for stratifying risk in patients with ischemic and nonischemic cardiomyopathy.

Aim. To conduct a systematic review and meta-analysis of the efficacy and safety of combined oral anticoagulant therapy with vitamin K antagonists (VKA) and antiplatelet therapy with aspirin compared with VKA monotherapy in patients after mechanical valve replacement.Material and methods. We searched the PubMed, Google Scholar databases for studies comparing the risk of thromboembolic events, major bleeding, and mortality in VKA monotherapy versus combined aspirin and VKA therapy in patients with mechanical valve replacement.Results. Eight randomized clinical trials were selected for this systematic review and meta-analysis. In total, 4082 patients were included in the analysis (mean age, 50,8 years, men — 2484 (60,9%)). A meta-analysis showed that the addition of aspirin to VKA, compared with VKA monotherapy, significantly reduced the incidence of thromboembolic events (odds ratio (OR) 0,47; 95% confidence interval (CI): 0,33-0,67; pConclusion. The addition of aspirin to VKA, compared with VKA monotherapy, reduces the risk of systemic embolism and death in patients after mechanical valve replacement. At the same time, the risk of major bleeding did not differ between the groups.

Aim To evaluate possible social and economic benefits of correcting preoperative iron deficiency /iron deficiency anemia as a comorbidity in a model population in the process of transition from the routine practice to the optimized preparation of patients to elective surgery (as exemplified by several circulatory diseases: I20 – I25, class IX ICD 10).Material and methods By building imitation models depending on the patient blood management (PBM) practice, changes in years of life lost/saved adjusted for disability were evaluated, including in monetary terms, in relation to the annual number of operations performed for ischemic heart disease (IHD) (I20 – I25) in the age group of 17 years and older, as well as a potential effect of PBM on the applied health economics.Results With implementation of the PBM systemic measures in cardiac surgery, the potentially prevented annual social and economic damage will amount to more than 38 thousand years of life saved and more than 20.2 billion rubles in monetary terms. Furthermore, it will be possible to exclude 9435 hemotransfusion from the cardiosurgical practice, which will annually save more than 2.3 thousand liters of blood with a total cost of 77.7 million rubles in favor of clinical situations that have no alternative.Conclusion The implementation of PBM in cardiac surgery, the discipline with the highest levels of preoperative iron deficiency/anemia and the use of blood components, will not only improve the clinical outcomes and cost-effectiveness of surgical interventions, but will also prevent social and economic damage to the country.

Aim To study the cognitive function (CF) state in patients with chronic ischemic heart disease (IHD) depending on the method of coronary bypass (CB), with extracorporeal circulation (EC) or on beating heart.Material and methods Postoperative cognitive dysfunction (POCD) is a frequent complication of CB, and its development may depend on the method of surgery, with EC or on beating heart. This single-center, prospective, nonrandomized study included 196 patients with chronic IHD aged 61.0±5.1 years. Patients were divided into two groups based on the CB method: an EC group (n=11) and a beating heart surgery group (n=85). Mean follow-up period was 26±2.1 mos. The state of CF was evaluated before and after CB (at the hospital stage, at 3, 6, 12, and 24 mos.).Results The mean duration of CF recovery was 3 mos. only in the group of CB without EC (p7.5 % (p=0.001) and 6.5–7.5 % (p=0.03), smoking (p=0.04), atherosclerotic damage of the internal carotid artery (p5 (p=0.03). The CB surgery either with EC (p=0.04) or on beating heart (p=0.04) was associated with the development of CD.Conclusion The results of the study allow identifying patients with chronic IHD and POCD-predisposing factors to recommend them beathing heart CB surgery.

Functional mitral regurgitation, now better known as secondary mitral regurgitation, is the most common acquired heart disease in the world. In most cases, patients with secondary mitral regurgitation have a rather poor prognosis, for example, about 50% of patients are at high risk of surgery or are inoperable, while mortality within 1 year without surgery is 57%. The tactics of treating these patients is the subject of much debate. According to the American Association for Thoracic Surgery (Ischemic Mitral Regurgitation Consensus Guidelines Writing Committee), mitral valve reconstruction is accompanied by a large number of relapses of mitral insufficiency in the long term after surgery, and mitral valve replacement is characterized by high mortality (≥ 13%). With the optimal selected conservative therapy (Guideline-directed medical therapy), in most patients, there is no significant improvement in their condition. Since the 2000s the development of methods of interventional influence on the mitral valve for the treatment of such patients is underway. In the 2010s, interventional treatment techniques began to be widely used, and recommendations for their use began to be developed. In some cases, the results of using the techniques are superior to open surgery. Is it possible to say that the problem of treating patients with functional mitral insufficiency of high operative risk has been solved? In order to answer this question, a literature review was carried out on the interventional treatment of secondary mitral regurgitation using the "edge-to-edge" technique.We used PICO strategy (Patient, Intervention, Comparison, Outcome) for searching articles. A systematic search for information on the research topic was carried out in the PubMed and Google Scholar databases using search queries, keywords, and logical operators AND, OR. Key words: mitral regurgitation, functional mitral regurgitation, chronic mitral regurgitation, MitraClip, percutaneous mitral repair, mitral insufficiency, mitral valve, Edge-to-Edge repair. In the initial selection, 1,180 publications were received. After analyzing the titles and abstracts, 94 articles were selected, and full-text copies were studied. The final analysis included 43 articles and 2 randomized clinical trials. We have compiled a literature review on the interventional treatment of secondary mitral regurgitation using the "edge-to-edge" technique.Received 13 July 2021. Revised 4 August 2021. Accepted 9 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.

Background. Epicardial adipose tissue (EAT) has certain paracrine functions, which could be associated with proinflammatory and fibrotic changes in myocardium even in patients without structural heart disease but with atrial fibrillation (AF). Purpose: to evaluate interrelationship between clinical data, parameters of tissue Doppler imaging (TDI), EAT thickness estimated by magnetic resonance imaging (MRI), and biochemical markers of fibrosis and inflammation in patients with nonvalvular AF without concomitant ischemic heart disease (IHD). Materials and Methods. We included in this study 39 AF patients without valvular pathology or IHD with normal or moderately increased left atrial (LA) dimension (mean age 50.8±13.9 years, 49% men). The following groups were distinguished for analysis: with idiopathic AF (iAFgroup, n=21); with AF and arterial hypertension (AF+AH group, n=18); with normal ( 4.5cm) LA dimensions (n=10). Besides standard ECG and echocardiography (ECHO), all patients underwent TDI and cardiac MRI with late gadolinium enhancement (LGE). Periventricular EAT thickness and LA fibrosis were calculated by MRI. Examination also included measurement of levels of matrix metalloproteinases (MMP-2, MMP-9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), transforming growth factor β 1 (TGF-β 1 ), and soluble intercellular adhesion molecule (sICAM). Results. Most close correlations were found between EAT thickness and levels of the following biomarkers were found to closest: MMP-9 (τ=0.65; Tcr=0,16), TIMP-1 (τ=0,71; Tcr=0,18) in iAF group; and TGF-β 1 (τ=0.22; Tcr=0.19) in the whole group. The LA fibrosis (%) was associated with TIMP-1 with strongest correlation in iAF group (τ=0.72; Tcr 0.21). Myocardial mass was significantly associated with TGF-β 1 in the group with LA 4.5cm (τ=0.81, Tcr 0.24). E/e’ by TDI correlated with levels of MMP-9 and TIMP-1 (τ=0.65, Tcr=0.16, and τ=0.56, Tcr=0.21, respectively), and with TGF-β 1 being closest in the group with LA 1 in patients with AF without structural heart disease. Elevation of MMP-9 and TIMP-1 levels are associated with LV diastolic dysfunction in these patients, what can reflect initial signs of atrial cardiomyopathy even in patients with nonvalvular “nonischemic” AF with normal or slightly enlarged LA.

Background: High residual platelet reactivity (HRPR) during dual antiplatelet therapy (DAPT) may impact clinical outcomes following percutaneous coronary interventions (PCI). However, whether any biomarkers assessed before PCI at DAPT loading may predict delayed maintenance HRPR is not clear. Objective: The aim of this study was to determine whether conventional clinical or laboratory indices at loading before stenting may predict HRPR at 6 months of maintenance DAPT. Methods: The study was designed on a single-center prospective cohort, and included 94 pre-PCI patients. All patients underwent elective PCI with drug-eluting stent implantation, and received DAPT with aspirin and clopidogrel. Platelet reactivity was assessed with 5 μmol/L of adenosine diphosphate-induced light transmission aggregometry before PCI, but after 24 h of DAPT loading, and repeated at 6 months. Baseline clinical characteristics, CYP2C19 polymorphism, C-reactive protein, soluble P-selectin, CD40L, interleukin-6, PAI-1 levels, and von Willebrand factor activity were analyzed. Results: The incidence (light transmission aggregometry p = 0.02), total cholesterol (p = 0.01), low-density lipoproteins (p = 0.004), CYP2C19*2 allele carriage (p = 0.006), soluble P-selectin (p = 0.009), and von Willebrand factor (p = 0.04) were linked to future HRPR. However, multivariate regression analysis suggested that only BMI and P-selectin were independent predictors of HRPR. Conclusions: Platelet reactivity before elective stenting is associated with numerous biomarkers; however, only BMI and soluble P-selectin were independent predictors of future HRPR during maintenance-phase DAPT. This may be important for future tailored antiplatelet strategies in patients with metabolic syndrome and diabetics.

Aim. To analyze the factors affecting the accuracy of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) in case of suspected prosthetic valve endocarditis (PVE).Material and methods. The results of PET/CT performed in 66 patients after heart valve replacement were analyzed: 55 patients with suspected PVE (≥3 months after surgery) and 11 comparison groups without PVE (2 months after surgery). In the group with suspected PVE (n=55) at the time of the study, 27% (15/55) had a normal body temperature, 85% (47/55) — no leukocytosis. In 16% (9/55), the examination was performed from 3 to 6 months after surgery and in 67% (37/55) — against the background of long-term antibiotic therapy (ABT). The final diagnosis of PVE was made on the basis of clinical (including 6±3 followup), laboratory, instrumental, and intraoperative (n=40) data: confirmed — in 37 patients; ruled out — in 29 patients. In order to determine the influence of factors on obtaining false PET/CT results, the odds ratio was calculated.Results. In the group with suspected PVE (n=55), the PET/CT results made it possible to establish and rule out PVE in 92% (34/37) and 67% (12/18) of patients, respectively. In 16% (9/55) of patients, false positive (n=6) and false negative (n=3) results. Thus, the sensitivity, specificity and diagnostic accuracy of PET/CT in the diagnosis of PVE were 92%, 67% and 84%, respectively; positive and negative predictive values — 85% and 80%. The analysis of the odds ratio did not reveal the relationship of low inflammatory activity, the interval between surgery and PET/CT from 3 to 6 months, and long-term ABT before PET/CT with false PET/CT results (p>0,05). In the comparison group without PVE (n=11), 91% (10/11) received false positive PET/CT results, and one patient received a true negative result.Conclusion. The data obtained indicate the high informative value of PET/CT in the diagnosis of PVE. Interval >2 months between surgery and PET/CT significantly reduces the accuracy of PET/CT results. Other factors analyzed in the presented group did not affect the accuracy of PET/CT results.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

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.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

The absence of consensus regarding the reference values of right ventricular free wall longitudinal strain (RVFWLS) and its predictive value prompted us to conduct a systematic review and meta-analysis of publications on the predictive role of this parameter in patients with pulmonary hypertension (PH).Aim. To study the independent predictive value of RVFWLS in PH patients using 2D/3D speckle tracking echocardiography.Material and methods. Firstly, 317 publications (PubMed) and 857 Google Scholar results were selected. Of the initially identified search results, 12 articles were analyzed. The papers were cohort designed.Results. The total number of patients with PH was 1281. The mean age of patients was 54,7±6,8 years. Four studies compared the RVFWLS with a control group (n=251). The mean RVFWLS were -17,0±2,4% and -24,7±2,2% in the experimental and control groups, respectively. A meta-analysis of the difference between the mean RVFWLS values in experimental and control group patients showed its total increase in PH subjects of 8,06% (95% CI: 5,18-10,94%; pThe total number of deaths was 268 (all-cause — 180, composite endpoint — 88). According to the meta-analysis, with an increase of 1% in RVFWLS, there is an increase in mean all-cause mortality risk by 14% (pConclusion. These results highlight the high independent predictive value of RVFWLS as a predictor of adverse outcomes or events associated with a right ventricular dysfunction progression in PH patients.

Background. Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need. Aim. To triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting. Material and methods. This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented ischemic heart disease (IHD) who underwent PCI with drug-eluting stent implantation. All patients received dual antiplatelet therapy with acetyl salicylic acid and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting, as well as CYP2C19 genotyping after patient’s discharge and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and in-stent restenosis. Results. Twenty-three patients experienced MACE. According to univariate regression analysis we found following MACE predictors after PCI: diabetes mellitus (p=0.049), P2Y12 Reaction Units (PRU) according to VerifyNow® (p=0.01), number of stented arteries more than 2 (p=0.01), number of implanted stents more than 2 (p=0.01), baseline levels of plasminogen activator inhibitor-1 (PAI-1) (p=0.03) and von Willebrand activity (vWF) (p=0.01). Using multivariate analysis we demonstrated that concomitant diabetes mellitus, PRU ≥202, PAI-1 level ≥75.95 ng/ml, von Willebrand factor activity ≥155.15% are independent predictors of adverse cardiac events after PCI in stable IHD patients. Other clinical characteristics and laboratory indices, including CYP2C19*2 carriage, showed no significant impact on outcomes after elective PCI. Conclusions. Background diabetes mellitus, high on-treatment platelet reactivity (according to VerifyNow®), PAI-1 and vWF presenting activity may be useful for MACE prediction over 28 months of follow-up after PCI with drug-eluting stent implantation.

Aim. To determine the predictive role of estimated pulmonary artery systolic pressure (ePASP) in COVID-19 patients.Material and methods. A retrospective study of inpatients with documented COVID-19 infection was carried out. Maximal follow-up period was 63 days. The study included 108 patients (men, 62; women, 46; mean age, 62,9±15,5 years). At admission, mean NEWS score was 6,0, blood oxygen saturation — 92%. Echocardiography was performed according to standard protocol using Vivid E9 ultrasound system (GE Healthcare). Quantitative measurements were performed according to the current ASE and EACVI guidelines. Statistical analysis was performed using the IBM SPSS Statistics v.26 software (developed by IBM Corporation).Results.Using the CHAID technique, a classification tree was developed and the strongest predictor of an unfavorable outcome was determined (ePASP). Threshold ePASP values, associated with an increased mortality risk were established (42 mm Hg and 50 mm Hg). Three groups of patients were selected based on the main predictor (50 mm Hg). The increased mortality risk was noted in groups 2 and 3 compared to group 1 of patients and amounted to 31,8% and 70% versus 3,9%, respectively. There was also a correlation between the severity of CT lung parenchymal lesions according to computed tomography and the study groups of patients (36% [30-49%] — group 1, 50% [36-76%] — group 2, and 84% [56-92%] — group 3, p=0,001). In groups 2 and 3, the following complications were significantly more frequent: acute respiratory distress syndrome, acute heart failure, multiple organ system failure, venous thrombosis, disseminated intravascular coagulation. In group 3, acute renal failure and systemic inflammatory response syndrome developed significantly more often than in group 1.Conclusion.A comprehensive echocardiography has proven its availability and safety in assessing the condition of COVID-19 patients, allowing to obtain relevant information on pulmonary hemodynamics. Transthoracic echocardiography reduced the risk of complications from invasive diagnostic methods and allowed to abandon the use of the Swan-Ganz pulmonary artery catheter in the studied group of patients. As a result, a relationship was noted between the increase of ePASP and the severity of clinical performance and lung tissue damage according to computed tomography, changes in laboratory blood tests, the severity of the comorbid profile, an increase in respiratory support need.

The new coronavirus infection, despite severe respiratory complications, is accompanied by serious cardiovascular manifestations A large proportion of patients have primary cardiovascular disease, which with COVID-19 increases the risk of heart complications Objective To analyze available data on cardiovascular disease and complications in patients with COVID-19 Results Patients with severe inflammatory response syndrome and «cytokine storm», often accompanied by myocardial damage, are in the highest risk group In the absence of proven pathogenetic therapy, supporting the treatment and identification of patients with high risk of heart complications is essential Conclusion The article describes the basic mechanisms of coronavirus SARS-CoV-2 exposure, the main clinical manifestations and possible mechanisms of heart complications in patients with COVID-19 Новая коронавирусная инфекция, несмотря на тяжелые респираторные осложнения, сопровождается серьезными сердечно-сосудистыми проявлениями Значительная часть пациентов первично имеют сердечно-сосудистые заболевания, что при COVID-19 увеличивает риск развития сердечных осложнений Цель исследования Провести анализ имеющихся данных по проблеме кардиоваскулярных заболеваний и осложнений у пациентов с COVID-19 Результаты В группе наиболее высокого риска - пациенты с тяжелым синдромом воспалительного ответа и «цитокиновым штормом», часто сопровождающимися повреждением миокарда Ввиду отсутствия доказанной патогенетической терапии, поддерживающее лечение и выявление пациентов с высоким риском сердечных осложнений крайне важно Заключение В статье рассмотрены базовые механизмы воздействия коронавируса SARS-CoV-2, основные клинические проявления и возможные механизмы сердечных осложнений у пациентов с COVID-19

Epicardial adipose tissue (EAT) has certain paracrine functions, which could be associated with proinflammatory and fibrotic changes in myocardium even in patients without structural heart disease but with atrial fibrillation (AF).to evaluate interrelationship between clinical data, parameters of tissue Doppler imaging (TDI), EAT thickness estimated by magnetic resonance imaging (MRI), and biochemical markers of fibrosis and inflammation in patients with nonvalvular AF without concomitant ischemic heart disease (IHD).We included in this study 39 AF patients without valvular pathology or IHD with normal or moderately increased left atrial (LA) dimension (mean age 50.8±13.9 years, 49 % men). The following groups were distinguished for analysis: with idiopathic AF (iAFgroup, n=21); with AF and arterial hypertension (AF+AH group, n=18); with normal (.

Objective: to determine impact of different laboratory and genetic factors on high on-treatment platelet reactivity (HOPR) during dual antiplatelet therapy (DAPT). Methods. We included in this study 94 patients with stable ischemic heart disease (mean age 59±9.67 years). All patients underwent elective PCI with implantation of drug eluting stents at the background of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. Platelet reactivity was assessed using light transmission aggregometry with 5 μmol/L ADP (LTA 5ADP) and VerifyNow assay before PCI. All patients underwent genotyping to detect CYP2C19 polymorphism. In 74 patients at baseline examination we determined levels of high-sensitivity C-reactive protein (hsCPR), soluble platelet-selectin (sP-selectin), soluble CD40-ligand (sCD40L), interleukin-6 (IL-6), plasminogen activator inhibitor (PAI-1) and activity of von Willebrand factor. Results. Incidence of HOPR according to LTA-5ADP was 16% and VerifyNow - 24.5%. Univariate regression analysis showed that the following factors were significantly associated with HPR determined by LTA-5ADP: body mass index (BMI) (p=0.02), levels of total cholesterol (CH) (p=0.0l), low density lipoprotein CH (p=0.004), and sP-selectin (p=0.009), activity of von Willebrand factor (p=0.04). Carriage of CYP2C19*2 allele was also associated with HOPR (p=0.006). According to multivariate regression analysis body mass index and level of sP-selectin were independent predictors of HOPR during DAPT. Conclusions. HOPR determined by LTA was significantly associated with high BMI, levels of total and LDL CH, carriage of CYP2C19*2 allele, levels of hsCRP and sP-selectin. Independent factors significantly related to HORP were BMI and sP-selectin level.

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.

to assess prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with ischemic heart disease (IHD) during long-term follow-up as well as during myocardial revascularization surgery and early postoperative period.We prospectively enrolled 97 patients (mean age 61+/-10years) with angiographically confirmed coronary artery disease. Most patients (68%) had heart failure NYHA functional class II-III. Mean left ventricular ejection fraction (LVEF) was 50+/-13%; 20% of patients had LVEF less or equal 35%. Sixty two patients had revascularization procedures during follow-up.We used 24-hour Holter monitoring and signal-averaged electrocardiography to obtain the following parameters: microvolt T-wave alternans, QT-interval duration and dynamics, heart rate turbulence (HRT) and variability. Laboratory tests included serum creatinine and creatinine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels.During mean follow-up period of 25+/-11 months life-threatening ventricular arrhythmias were observed in 11 patients (11%). On univariate analysis, history of percutaneous coronary intervention (p0.05), history of malignant arrhythmias or syncope (p0.05), LVEF less or equal 47% (p0.01), left atrium size more or equal 4.7cm (p0.05), left atrium index (p=0.01), filtered QRS duration (p0.05), abnormal heart rate turbulence (HRT) (chi-square test=6.2, p=0.01), abnormal turbulence slope (chi-square test=9.5, p0.01), BNP more or equal 158picogram/ml (p0.01), NT-proBNP more or equal 787 rg/ml (chi-square test=4.4, p0.05) were significantly associated with malignant arrhythmias in long-term follow-up. History of malignant arrhythmias or syncope (OR 11.1, 95% CI 2.8-44.4; p0.01), abnormal HRT (R 13.6, 95% CI 2.8-66.1; p0.01), and plasma BNP more or equal 158 picogram/ml (R 14.3, 95% CI 3.2-65.0; p0.01) were independent predictors of malignant arrhythmias on multivariate Cox regression analysis.History of malignant arrhythmias, pathological HRT and plasma brain natriuretic peptide level more or equal 158 picogram/ml were independent predictors of malignant ventricular arrhythmias during 2 years follow-up of patients with ID.

Objective: Assessment of the role of statin therapy in the prevention of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients without prior atrial fibrillation. Methods: A retrospective analysis of 206 patients, aged 57.2 ± 7.9 years (mean ± SD), who underwent isolated CABG is carried out. All patients are divided into two groups. The first group (nSt-patients) includes the patients who did not receive statin therapy prior to CABG (n = 82). The second group (St-patients) includes the patients who received statin therapy prior to CABG (n = 124). Both groups received the statin therapy from the first day after CABG. The risk of occurrence of POAF is evaluated using the Cox-regression model. Results: The rate of POAF was 25.6% in nSt-patients and 6.5% in St-patients (P = 0.020). On the 4th day after CABG, white blood cells (WBC) count was 11.0 (9.0, 13.0) × 109/mL (medians with inter-quartile ranges) in nSt-patients and 9.0 (7.6, 10.2) × 109/mL in St-patients (P

to assess prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with ischemic heart disease (IHD) during long-term follow-up as well as during myocardial revascularization surgery and early postoperative period.We prospectively enrolled 97 patients (mean age 61 ± 10 years) with angiographically confirmed coronary artery disease. Most patients (68%) had heart failure NYHA functional class II-III. Mean left ventricular ejection fraction (LVEF) was 50 ± 13%; 20% of patients had LVEF ≤ 35%. Sixty two patients had revascularization procedures during follow-up.We used 24-hour Holter monitoring and signal-averaged electrocardiography to obtain the following parameters: microvolt T-wave alternans, QT-interval duration and dynamics, heart rate turbulence (HRT) and variability. Laboratory tests included serum creatinine and creatinine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels. RESULTS. During mean follow-up period of 25 ± 11 months life-threatening ventricular arrhythmias were observed in 11 patients (11%). On univariate analysis, history of percutaneous coronary intervention (p0.05), history of malignant arrhythmias or syncope (p0.05), LVEF ≤ 47% (p0.01), left atrium size 24.7 cm (p0.05), left atrium index (p = 0.01), filtered QRS duration (p0.05), abnormal heart rate turbulence (HRT) (chi-square test = 6.2, p = 0.01), abnormal turbulence slope (chi-square test = 9.5, p0.01), BNP ≥ 158 picogram/ml (p0.01), NT-proBNP ≥ 787 rg/ml (chi-square test = 4.4, p0.05) were significantly associated with malignant arrhythmias in long-term follow-up. History of malignant arrhythmias or syncope (OR 11.1, 95% Cl 2.8-44.4; p0.01), abnormal HRT (OR 13.6, 95% Cl 2.8-66.1; p0.01), and plasma BNP ≥ 158 picogram/ml (OR 14.3, 95% CI 3.2-65.0; p0.01) were independent predictors of malignant arrhythmias on multivariate Cox regression analysis.History of malignant arrhythmias, pathological HRT and plasma brain natriuretic peptide level ≥ 158 picogram/ml were independent predictors of malignant ventricular arrhythmias during 2 years follow-up of patients with IHD.

We evaluated effect of activity of cytochrome P450 CYP2C9 on maintenance doses of warfarin in 33 patients with implanted artificial heart valves. Losartan test was used for measurement of concentration of active metabolite E-3174 in urine. Concentration of E-3174 below 2500 ng/ml in patients with genotype CYP2C981/*1 with sensitivity 87% and specificity 66% predicted requirement of low doses (5 mg/day) of warfarin in the late postoperative period (odds ratio 14, 95% confidence interval 1.135 to 172.75).

Psoriatic and atherosclerotic plaques were examined using the real-time polymerase chain reaction. Expression of the FOSL1 gene proved to substantially increase in both psoriatic lesions of the skin and atherosclerotic lesions of vessels as compared with nonlesion samples.

The study involved 85 patients with coronary heart disease (CHD). The parameters of metabolic status the actual food intake with the help of a new computer program, based on frequency method were investigated from patients with cardiovascular diseases. It was found a disbalanse of intake main food components and low physical activity in of patients.

Aim. To evaluate the influence of gene СYP2C9 activeness via losartan test on the warfarin dosage management in earlier and long-term post-operational periods. Material and methods. Totally 33 patients included with artificial heart valves. All patients underwent assessment of genes carriage by polymorphic marker СYP2C9 by PCR after preparing of DNA from whole blood. The activeness of СYP2C9 was assessed with losartan concentration and its metabolite (E-3174) in urine after single intake of losartan 50 mg. Results. The level of losartan and its active metabolite (E-3174) in urine was a prognostic marker determining therapeutic dose of warfarin in cardiac surgery patients in long-term post-operation period. Conclusion. The СYP2C9 assessment by losartan concentration and E-3174 in“losartan test” might help to determine warfarin treatment dosage in delayed postoperational period that might improve the efficiency and safety of pharmacotherapy in valve prosthesis patients.

The aim of this investigation was assessment of efficacy of stenting in patients with ischemic heart disease with lesions of left coronary artery (LCA) trunk. In the A.N. Bakulev Scientific Center of Cardiovascular Surgery between June 1997 and March 2005 stenting of LCA trunk was carried out in 50 patients (33 with stable effort angina and 17 with acute coronary syndrome). Immediate success rate was 100% in patients with stable angina. In a group of patients with acute coronary syndrome angiographic success rate was 100%. Total lethality in this group was (3 cases) 17.7%. In remote period (6 to 60 months) 33 of 39 patients were examined and recurrence of angina was noted in 7 of them (21.1%). Control angiography was carried out in 16 patients and restenosis of LCA was revealed in 18.75% of cases. The authors believe that stenting of LCA trunk is an effective and safe method of treatment of patients with stable angina and sufficiently safe method in patients with acute coronary syndrome. Roentgenoendovascular treatment may serve as an alternative to aortocoronary bypass surgery especially in isolated lesions of LCA trunk. Application of stents with drug coating allows to cardinally improve long term results of stenting.

The article deals with the problem concerning the use of the term "specific cardiomyopathy", adopted by WHO in 1995, in cases of advanced left ventricle lesion in patients with valvular heart defects. The group of patients with dilated left ventricle cavity, related to acquired heart diseases, is rather heterogeneous and large in number, and includes about 50% of the patients who underwent an operation. In the authors' opinion, it is reasonable to divide them into the following main subgroups: patients with quickly regressing symptomatic left ventricle dilatation, resulting from volume overload; patients with valvular cardiomyopathy (the terminal stage of heart defect); patients with left ventricle dilatational lesion, typical of the intermediate stage with characteristic pathological remodeling and the disturbance of its segmental contractility. The authors consider such a division to be useful for further study of patients with left ventricle dilatation due to valvular heart defects.

The efficacy of endovascular treatment of internal carotid arteries (ICA) stenosis (20 patients) has been compared to that of conventional carotid endarterectomy (25 control cases). ICA stenting was performed in case of stenosis, narrowing arteries toor = 60% in "symptomatic" patients and toor = 80% in "asymptomatic" ones. Angiographic indices revealed favorable outcome after stenting in 100%. Mean extent of residual stenosis was 8.3 +/- 0.8%. Significant complications (stroke/fatal outcome) after 22 procedures developed in 3 (13.6%) cases. Mortality was estimated as 4.5%. Taking stroke and fatal cases into account, the interventions were successful in 86.4% cases. The duration of follow-up study was from 1 to 48 months, with 1 case resulting in death and 2--in development of acute disturbance of cerebral blood circulation of contralateral ICA. Short- and long-term results of the intervention did not significantly differ between the study and control groups thus indicating ICA stenting as an alternative to carotid endarterectomy procedure.

Objective: To evaluate efficacy of one-step and two-step surgery approach in patients with arrhythmias combined with Ebstein’s anomaly. Methods: Fifty-three patients with Ebstein’s anomaly combined with tachyarrhythmias (58.5% men, 41.5% women, mean age 21.6G10.7 years) were operated on. In group A (32 patients), one-step surgical correction (simultaneous intraoperative elimination of arrhythmias and congenital heart defect repair) was performed, whereas in group B (21 patients), two-step surgery was performed with initial elimination of arrhythmogenic substrate by transcatheter radiofrequency ablation (first step) and following surgical repair of congenital heart defect (second step). Results: In group A, total hospital mortality was 3.1% (1 patient) due to initial severe condition of this patient. One-step surgery was effective in 93.5% of cases. Mortality was not observed in group B. Efficacy of transcatheter radiofrequency ablation was 76.2%. Conclusions: one-stage and two-stage surgery of arrhythmias and Ebstein’s anomaly are highly effective. First step of surgery of combined pathology reduces cardiopulmonary bypass time, complications and mortality while performing the second step of congenital heart defect surgery. However, simultaneous approach (one-step surgery) is better in terms of arrhythmia elimination. Q 2005 Published by Elsevier B.V.