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The article presents the ontology of the "Software usability" domain. Authors provides the review of existing ontologies for “user interface” and “software” domains. The article describes the advantages that can give its use in the analysis and evaluation of software products usability, e.g.: opened data structure for more easily data sharing. The paper presents a class diagram of the proposed ontology and a text description for the classes, object properties and data properties. Presented diagrams contains basic classes (device, session, user, region, variation, image) and subclasses for the event class. Examples of questions that can be answered by ontology are given. e.g.: “What commands are made by users in the region?” and “What variations of the region are in the session?”. Also, the article presents the SPARQL queries that may be used for this ontology. The classification of possible methods of analysis and evaluation of usability on the basis of the ontology is proposed and some of them are described. An example of the user activity data in a standard RDF/XML format is demonstrated. Described ontology "Software Usability" designed for the user activity data representation. Experiments have shown that ontology can be used to analyze the usability of desktop applications for Windows operating systems, including the construction of heat maps. Heat map based on the collected user activity data in is shown. In addition, ontology can be used and extended by any researchers involved in the problems of ease of use of software interfaces, in particular in experiments with different types of interfaces. The authors will welcome comments and suggestions on the refinement and development of ontology from experts in the domain and are ready to cooperate.

The aim of this guideline is to assist physicians in the management of patients with cardiovascular pathology and obstructive sleep-disordered breathing. The article consists data on diagnostic tactics for patients with possible sleep-breathing disorders, describes the basic principles of obstructive sleep apnea treatment, and substantiates the clinical significance of obstructive sleep apnea therapy initiating in the management of patients with cardiovascular diseases.

Objective. Assessment of renal artery stenosis significance in patients with resistant arterial hypertension using non-invasive diagnostic methods and to compare them with the results of selective angiography and methods of physiological assessment of renal artery stenoses.Materials and methods. Prospectively, 156 patients with drug-resistant arterial hypertension and signs of renal artery stenosis detected by doppler ultrasonography of renal arteries were included in the study. Subsequently, 25 patients were excluded from the study due to multiple variant renal blood supply and bilateral renal artery stenosis. The remaining patients (n=131) underwent selective angiography of renal arteries, and 66 of them additionally underwent CTA of renal arteries with intravenous contrast. If the artery narrowing was 90% or more (n=27) in diameter, the stenosis was considered hemodynamically significant and further stenting of the affected artery was performed, and in case of 60-90% stenosis (n=52) additional assessment of functional significance of the stenosis was performed by measuring translesional pressure gradient, fractional blood flow reserve, instantaneous blood flow reserve (iFR) and Pd/ Pa ratio. Results. Among all patients (n=131), in whom the doppler ultrasonography of renal arteries showed signs of unilateral renal artery stenosis, after angiography combined with additional methods of functional significance assessment, hemodynamically significant renal artery stenosis was confirmed in 41% of cases (n=54). Thus, the sensitivity of doppler ultrasonography of renal arteries in detection of hemodynamically significant stenoses was 74%, prognostic value of positive 78% and negative result 64% (p90% and 52 patients had stenosis 60-90%. Patients with stenosis

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Modern pathogenetic therapy of idiopathic pulmonary arterial hypertension (IPAH), a severe life-threatening cardiovascular disease of unknown etiology, leads to a positive clinical effect due to reverse remodeling of the vessels of the microvasculature of the lungs. Highly effective drugs of specific therapy that act on the main targets of pathogenesis have now been introduced into clinical practice.The presented clinical case of a patient with diagnosed in 2014 IPAH with an initial functional class III according to the WHO classification demonstrates high long-term efficacy and safety of specific therapy based on the use of the soluble guanylate cyclase stimulator riociguat for 5 years after replacing previous therapy with sildenafil with further implementation of the strategy of sequential combination therapy due to the addition of ambrisentan and selexipag.

Our observation demonstrates a case of a 40-year-old female with idiopathic pulmonary arterial hypertension World Health Organization functional class III, who was admitted to NMRC of Cardiology repeatedly due to disease progression including dyspnea worsening and exercise tolerance decrease after previous COVID-19 infection on riociguat (7.5 mg daily), macitentan (10 mg daily) and selexipag (1600 mcg daily) therapy. Clinical examination demonstrated high-risk status according to the expected 1-year mortality. Due to unreleased treatment goals and high-risk status, we performed transition from selexipag to inhale iloprost. After therapy escalation the patient demonstrated a significant improvement in clinical condition, dyspnea reduction and exercise tolerance increase. The current treatment strategy for pulmonary arterial hypertension is based on regular multiparametric risk stratification approach in PAH patients. The impact of COVID-19 may become an important cause of clinical worsening in PAH patients during COVID-19 pandemic. Directed on vasodilatation and antiproliferation mechanisms of action of PAH-specific drugs are supposed to be protective in COVID-19 patients. However, the probability of clinical worsening in PAH patients despite PAH-specific therapy intake needs to be closely monitored to perform timely treatment correction in order to achieve low-risk status and to improve the prognosis of PAH patients.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Disclaimer The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Aim. To assess the effect of balloon pulmonary angioplasty (BPA) on structural parameters of the pulmonary arteries in inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH).Materials and methods. The study included 21 patients with an inoperable form of CTEPH. Assessment of clinical and hemodynamic parameters, pulmonary arteries diameters according to angiography, and structural parameters of the pulmonary arteries according to intravascular ultrasound (IVUS) in 11 patients was performed initially, immediately after BPA and after a series of BPA.Results. In total 50 BPA were performed – series of 2.3 ± 1.5 BPA per patient. The observation was carried out for 165 (88; 248) days. After series of BPA there were found out positive changes of clinical and hemodynamic parameters, including functional class, distance in the 6-minute walk test, mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR). According to angiography there was observed a continued dilation of the arteries at the level of segmental arteries and the 1st order branches of subsegmental arteries after the first BPA. According IVUS measurements the greatest changes during the observation period were determined at the 1st and 2d order branches of subsegmental pulmonary arteries – increased outer and inner diameters, vessel lumen area, decreased vascular wall area. A statistical relationship was found out between the diameter of the 1st order branches of subsegmental arteries after BPA and mPAP (r = -0.74, p = 0.006), cardiac output (r = 0.71, p = 0.010), PVR (r = -0, 78, p = 0.003).Conclusion. BPA in inoperable patients with CTEPH leads to a persistent enlargement of the ballooned vessel lumen. In the long term, there is a positive remodeling of the pulmonary arteries with the greatest effect at the level more distal than subsegmental arteries. The diameter of the vessels at this level has a strong correlation with the hemodynamic result of BPA.

Takayasu arteritis (TA) is a systemic vasculitis with predominatly lesions of aorta and its large branches. In some cases pulmonary arteries (PA) are involved in the pathological inflammatory process and lead to the formation of pulmonary hypertension and significantly worse the prognosis. Timely development of lesion of PA, appointment of adequate therapy and surgical treatment can prevent irreversible damage of blood vessels and improve the prognosis. Perioperative administration of interleukin-6 inhibitor inhibitor (tocilizumab) in at patients with indications for vascular surgery, including angioplasty PA, should be considered as a promising approach to control the inflammatory activity of TA, reduce the dose of glucocorticoids and the risk of postoperative complications. We present the clinical experience of significant improvement in the patients condition was achieved by using two-stage balloon angioplasty on the background of control of the disease activity with interleukin-6 tocilizumab intravenously and specific therapy with riociguat and iloprost.

Russian Society of Cardiology (RSC)With the participation: Association of Cardiovascular Surgeons of Russia, Russian Respiratory Society, Federation of Anesthesiologists and Resuscitators, Association of Rheumatologists of Russia, National Congress of Radiation Diagnosticians.

Pulmonary arterial hypertension (PAH) is a severe, disabling disease characterized by an increase pressure in the pulmonary artery (PA), an increase pressure in the right atrium, and a decrease of the cardiac output. It combines several diseases: idiopathic pulmonary hypertension, inherited pulmonary hypertension, PAH induced by medication and toxins, PAH associated with systemic diseases of connective tissue, HIV infection, portal hypertension, congenital heart defects, schistosomiasis. In the absence of treatment, PAH quickly leads to insufficiency of the right heart and premature death. An effective PAH therapy did not exist for a long time. However, in 1987 there was established a positive effect of taking large doses of calcium channel blockers in patients, who “responded” to their prescription in the short term, and in recently several groups of specific drugs have been developed and approved for the treatment of this pathology: prostacyclin analogues and prostacyclin receptors agonists, endothelin receptor antagonists, phosphodiesterase type 5 inhibitors and soluble guanylate cyclase stimulators. Modern studies of treatment of PAH are based on the latest data of the molecular transmission mechanisms of intracellular and intercellular signals, the action of hormones and tissue enzymes. The available results of these studies allow to suggest the inclusion to clinical guidelines several new drugs for the pathogenetic treatment of PAH in the near future: receptor tyrosine kinase inhibitors, Rho - kinase inhibitors, immunosuppressants and type 2 activin receptor agonists, protein kinase C inhibitors, aromatase inhibitors and estrogen receptor antagonists, poly-(ADP-ribose)-polymerase inhibitors and bromodomain protein 4, elastase inhibitors. Some of the drugs have already passed the III phase of clinical trials (imatinib), others are at the preclinical stage or at the I-II phase tests (olaparib, enzastaurin, elafin).

Pulmonary hypertension (PH) is a group of diseases with a hemodynamic pattern of progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP), which leads to right ventricular dysfunction and the development of right ventricular heart failure.

Objective. To study the efficacy and safety of radiofrequency renal denervation with mono-electrode and multi-electrode devices in patients with uncontrolled arterial hypertension during follow-up period. Materials and methods. The study included 42 patients with uncontrolled arterial hypertension (mean age 51±12 years), while receiving multicomponent antihypertensive therapy, including diuretic. All patients underwent radiofrequency denervation of the renal arteries with a mono-electrode (n=27; group A) and multi-electrode devices (n=15; group B). The safety of the procedure was assessed using creatinine and glomerular filtration rate (MDRD equation), as well as according to ultrasound of the kidneys and renal arteries. The effectiveness of the procedure was study according to office blood pressure (BP) and ambulatory BP monitoring (ABPM). Results. In the general group, according to office BP after 6 months, there decreased in systolic (SBP)/diastolic BP (DBP) by 28/13 mm Hg (p=0.000001). According to ABPM, there was a decrease in the average daily SBP by 9 mm Hg (p=0.007) and DBP by 6 mm Hg (p=0.03). No significant changes in creatinine and glomerular filtration rate were detected in the general group. According to ABPM, after 6 months in group B, there was a decrease in the average daily SBP/DBP by 13 and 6 mm Hg (p=0.1). In group A, according to the ABPM, after 6 months, there was a decrease in the average daily SBP and DBP by 7 mm Hg (p=0.001) and 4 mm Hg (p=0.03). After 1 year, according to the office BP, there was a decrease in SBP/DBP by 14/11 mm Hg (p=0.002), and after 3 years at 15/17 mm Hg (p=0.3). Conclusion. The results confirm the safety and efficacy of radiofrequency renal denervation. Renal denervation in combination with drug therapy leads to decreasing of BP after 6 months and in the long-term

The clinical case demonstrates the difficulties of differential diagnosis and the determination of treatment tactics in a patient with chronic thromboembolic pulmonary hypertension, recidivous cardiac myxoma and radiographic pattern of dissemination in lung tissue.

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable forms of pulmonary hypertension, in which pulmonary thromboendarterectomy is the gold standard treatment. However, over the last decade, great attention has been given to a combined therapeutic approach including both drug therapy and surgical treatment and the application of endovascular technologies. This clinical case demonstrates the diagnostic difficulties of CTEPH and the opportunities of a comprehensive approach to therapy for the disease with mandatory assessment of preoperative surgical and medical treatment in order to improve the patient status and to prepare for surgery.

Aim. To evaluate the vascular bed and lung perfusion in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by computed tomography (CT) and to compare the severity of pulmonary arterial (PA) thrombotic lesions concurrent with parenchymal perfusion disorders with angiopulmonographic findings and clinical and hemodynamic characteristics. Subjects and methods. In the period from November 2015 to May 2016, 22 patients (7 men, 15 women) aged 27 to 67 years with a verified diagnosis of CTEPH were examined using an Aquilion ONE VISION Edition 640 (Toshiba Medical Systems, Japan) CT scanner with a 320-row detector. Perfusion defect in this study was evaluated with the new software allowing one to combine contrast and contrast-free images by a subtraction method. CT data analysis included visual assessment of the vascular bed and lung parenchyma and quantitative assessment with perfusion map construction and semi-automatic determination of the obstruction index (OI) and perfusion defect index (PDI). OI was compared with PDI and mean LA pressure according to the data of right heart catheterization and 6-minute walk test. Results. A statistically significant correlation was found between OI and PDI in patients with CTEPH (Pearson r=0.56; p=0.0065). There were no relationships between mean LA pressure and vascular perfusion indices (OI and PDI) or between vascular perfusion parameters and 6-minute walk test results. Conclusion. CT angiopulmonography in conjunction with pulmonary perfusion assessment (within one study) allows evaluation of the severity of vascular lesions and perfusion disorders and determination of the efficiency of treatment in patients with CTEPH.

Thromboendarterectomy is undoubtedly the most widely used method in chronic thromboembolic hypertension treatment. Although surgical treatment is highly effective, it is often associated with high risk of complications. One of the main reasons for impossibility of surgery performance is distal pulmonary artery obstruction. In this case medical therapy or staged balloon angioplasty is considered the treatment of choice. This case report discusses if pulmonary artery angioplasty can be used in patients with proximal pulmonary artery obstruction.

Objective. To determine the possibility of radio frequency denervation of the renal arteries (RDN) in the treatment of patients with refractory essential hypertension (GRA). Materials and methods. The study included 57 patients with a diagnosis of the guide RAG. According to the results of surveys conducted by RDA was performed of 25 patients diagnosed with essential RAG. Within 12 months after the procedure was carried out monitoring of clinical blood pressure (BP), BP monitoring (ABPM), and laboratory evaluation of renal function and renal artery ultrasound. Statistical analysis was performed using Statistica 6.1 program, significant differences were recognized when p

Aim: to evaluate the effect of renal denervation (RDN) on the stiffness of the aorta and major arteries, central blood pressure and index augmentation in patients with resistant hypertension. Material and methods. We included 20 patients with systolic blood pressure 178 [170; 180] mm Hg and diastolic blood pressure 100 [94; 100] mm Hg on 5.1±0.7 antihypertensive drugs with diuretic, who underwent bilateral RDN. Blood pressure (BP) was studied before intervention, at 7 days and 6 months after RDN by tree methods: office BP, 24-hour ambulatory blood pressure (ABPM) and aortic BP with applanation tonometry a. radialis (SphygmoCor). All patients were divided into two groups by ABPM in 6 months after RDN: responders (decrease of mean ABPM≥5 mm Hg) and non-responders (decrease of mean ABPM

Objective. To evaluate the dynamics of clinical and functional status, the parameters of central hemodynamics and tolerability of bosentan therapy lasting more than 12 months in patients with idiopathic pulmonary hypertension (IPAH). Materials and methods. In the study we included 20 IPAH non-responders with functional class II-III (WHO). All patients were assigned to treatment with bosentan in the initial dose of 125 mg/ day, which was increased to 250 mg/day after 4 wks. The mean FU duration was 15±3 months. Conducted 5 visits: at baseline and visit 5, all patients underwent a comprehensive examination, including right heart catheterization (RHC). Transthoracic echocardiography was performed additionally at visit 3. 6-minute walking (6MW) test was assessed every 3 months. For safety reasons hepatic transaminases were analyzed monthly. Results. Bosentan therapy resulted to significant improvement of functional class (FC (I/II/III) with 0%/45%/55% to 30%/45%/25%, p

Aim - to analyze functional status and hemodynamic changes in patients who demonstrate vasoreactivity but doesn’t reach the criteria of "positive respond" ("grey zone") and to compare this data with "responders" and "true non-responders". Material and methods. We enrolled 159 patients with pulmonary hypertension. Right heart catheterization with acute vasodilator testing was performed in all cases. Depending on hemodynamic respond during acute vasoreactivity testing patients were divided in to three groups: "responders", "true non-responders" and patients in the "grey zone". The following parameters were analyzed in all included patients: basic clinical parameters, hemodynamic changes, right ventricle size, right atrium area, 6-minute walking test distance and time to clinical worsening. Results. In our study it was shown that patients of "grey zone" had several clinical and hemodynamic parameters that differ significantly from patients "responders" and "true non-responders". Patients in the "grey zone" also have the longest time to clinical worsening.

Clinical and hemodynamic profile and neurohormonal indicators in patients with idiopathic pulmonary hypertension, depending on vasoreactivity reserve of pulmonary arteries. Objective: the main objective of our research work was an evaluation of clinical and hemodynamic profile, neurohormonal indicators in patients with IPH, depending on the results of vasoreactivity testing. Methods: the study included 131 patients with IPH (mean age 32,4±3,2 years. All the patients underwent the routine laboratory tests, 6-minuts walking test (6-MWT), transthoracic echocardiography, thorax organs radiography, right heart catheterization (RHC) with acute pharmacological test (APT) using one or two vasodilators (VD) In order to study neurohumoral status the analysis of the 6-keto-PgF1β, NO, ET-1, norepinephrine, epinephrine levels, NT-proANP, NT-proBNP (NUP), renin activity, AII, aldosterone (RAAS) activity was conducted. Results: significant differences of clinical and hemodynamic profile and neurohormonal indicators in patients with IPH depending on the availability (APT +) and absence (APT-) of the vasoreactivity reserve of pulmonary arteries (PA) were established. Among the APT- patients the number of patients belonging to FC III was significantly greater in comparison with APT+ patients. FC IV refered only to the APT- patients. Significantly more patients with APT+ belonged to FC I and II. The 6-MWT revealed that patients with IPH with intact vasodilation reserve overcame significantly longer distance. Doppler echocardiography showed that in APT-group a greater level of systolic pressure in the pulmonary artery (SPPA). When comparing the RHDC data all the hemodynamic parameters in the groups varied considerably, prognostically better data marked APT+ group. According to thorax organs radiography APT- group had significantly higher leel of KTI. Comparative evaluation of neurohumoral status, regardless of the outcome of the APT, showed a significant difference in the groups. Conclusion: the group of responders in comparison with the APT- patients group indicated more safe clinical-hemodynamic and functional status, and neurohumoral rates in the responders group were closer to the outcome in the control group.

The patient with the verified diagnosis of idiopathic pulmonary hypertension, negative acute vasoreactivity testing by RHC, functional class III (WHO) was treated by phosphodiesterase type 5 inhibitor sildenafil. After one year there was achieved the significant improvement of the functional and hemodynamic status.

Idiopathic pulmonary arterial hypertension (IPAH) is a rare cardiovascular disease of unknown etiology, characterized by pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) increase due to pronounced remodeling of small pulmonary arteries and arterioles, with progressive deterioration and the rapid development of right ventricle failure. The key pathogenetic feature is the endothelial dysfunction, which leads to the development of vasoconstriction, thrombosis in situ, proliferative and inflammatory changes in the lung microvasculature. Optimization of drug therapy is associated with the clinical implementation of highly effective pathogenetic drugs which act on the main disease targets - activation of endothelin-1 (ET-1) system, the lack of endogenous prostacyclin and nitric oxide. The role of ET-1 as a powerful vasoconstrictor that induces cell proliferation and differentiation, production of cytokines, growth factors, biologically active substances. Endothelin receptor antagonists (ERA) represents the important class of PAH-specific therapy, including two non-selective ERAs-nonselective bosentan and selective ambrizentan. Presented clinical case demonstrates the long-term reliable efficacy and safety of ambrizentan for 10 years in the IPAH patient with the baseline functional class III (WHO).

Over the last decade, the interest in the treatment of idiopathic pulmonary hypertension (IPAH) has greatly increased because of the development and implementation of innovative therapeutic approaches. One of the modern drug groups for the treatment of pulmonary arterial hypertension are phosphodiesterase type 5 inhibitors (PDE5), which can cause pulmonary vasodilation via a NO-dependent mechanism.The aim of the research was to study the efficacy and safety of sildenafil treatment in patients with IPAH received 16-week course and to study sildenafil impact on clinical, hemodynamic and functional status.Material and methods: 20 patients with IPAH (mean age 40.9±11.5 years) functional class (FC) II-IV (WHO), who were receiving standard therapy (anticoagulants, diuretics, glycosides, calcium antagonists), were prescribed sildenafil 20 mg three times a day for 16 weeks. Initially, and after 16 weeks of treatment we studied FC, and the results of the six-minute walk test (6MWT), transthoracic echocardiography (ECHO), right heart catheterization (RHC) and laboratory tests to determine the safety of the therapy were carried out, as well.Results: the group of patients had 6MWT distance of 344±116 m at the beginning of the study. For about 90% of the patients suffered from dizziness, 75% - from the pain in the heart, 65% of the patients had edema and 35% - hepatomegaly. The patients suffered from severe pulmonary hypertension according to the functional and hemodynamic status. The estimated pulmonary artery systolic pressure (PASP) according to ECHO results was 89.6±22 mm Hg. According to the data from RHC we noted the elevation of mean pulmonary arterial pressure (mPAP) to 56.3±19 mm Hg, of pulmonary vascular resistance (PVR) to 1218±709 dyne/sec x per x cm-5 and the decrease in cardiac output (CO) - 3.4±0.8 l/min/m2.There were slight increasing in 6MWT distance (+23 m, p>0.05) and a statistically significant improvement in clinical status in comparison with the initial data: dizziness - 71%, heart pain - 38%, edema and hepatomegaly were observed in 15% and 14% (p

Resistant hypertension is an urgent problem in modern cardiology, leading to myocardial infarction, stroke, and, as a consequence, early disability of patients. The emergence of such a method as radiofrequency denervation of the renal arteries in the complex antihypertensive therapy can expect to achieve control of blood pressure and thus reduce the risk of cardiovascular complications. This article presents the current state of the use of this method in clinical practice.

The currentguidelines on chronic thromboembolic pulmonary hypertension (CTEPH) treatment consider pulmonary thrombendarterectomy as the first therapy choice. In case of inoperability due to severe patient's condition, distal lesions of pulmonary vessels, extremely high pulmonary vascular resistance, medical treatment for CTEPH includes life-long anticoagulation therapy and reduction of heart failure symptoms. This clinical case of the 59-y-old patient M. with inoperable CTEPH demonstrates the efficacy of phosphodiеsterase-5 inhibitor Sildenafil usedin high doses. The diagnosis was confirmed by the results of the complete diagnostic process including right heart catheterization and pulmonary angiography. The initial functional class was assessed as III in accordance with WHO classification. Sildenafil 60 mg daily was added tothe standard therapy (anticoagulant, calcium channel blocker) for initial four weeks. To the 4wk visit Sildenafil dose was increased to 240 mgdailytaking into account good tolerance of the treatment.The significant improvement of functional class, positive dynamic ofhemodynamic and echo parameters were found to 4 month of follow-up.

The patient with the verified diagnosis of idiopathic pulmonary hypertension, functional class III (WHO) was treated by anticoagulants, diuretics, calcium channel blocker. After one year of adding endothelin receptor antagonist bosentan there was noticed the negative dynamic with right heart chambers dilation, appearing of heart failure signs. By 11 months of the combined pathogenetic therapy with bosentan and phosphodiesterase type 5 inhibitor sildenafil there was achieved the significant improvement of the functional and hemodynamic status. This positive dynamics remained within the next 3 years of observation.

The research area of the scientific school «Discrete mathematics and mathematical cybernetics» at Kemerovo State University is a wide class of optimization and management problems from different fields of human activity studied by means of mathematical modeling.Since the size of the paper is restricted, it presents only the results of those school’s activity which concern construction and research of mathematical models for so-called conflict controlled processes. In this connection, the main emphasis is put on the results obtained by the members of the school in the last 10–15 years.

Objective: in our study, iloprost was used as a drug for acute tests in patients with pulmonary arterial hypertension (PAH). Design and Method. We included 7 pts with pulmonary arterial hypertension (PAH): 5 females and 2 males, average age 32,0±12,0 years. All patients underwent right heart catheterization including acute tests with both nitric oxide and Iloprost. In addition to hemodynamic changes the intravascular ultrasound (IVUS) parameters were analyzed. We used parameters such as: intima-media thickness, the pulsatility index (PI), the outer and inner diameter of the vessel, the area of the vascular wall. Results. Compared with the action of nitric oxide, the degree of reduction of medium pulmonary arterial pressure (mPAP) after Iloprost was 17,2±5 and 25,37±9 mm Hg respectively, and pulmonary vascular resistance (PVR) 251,4±120 and 276±129 dynes×c×cm-5 respectively (p

Aim. To evaluate the efficiency and safety of intravenous infusion of levosimendan in patients with idiopathic pulmonary hypertension (IPH) and its clinical, hemodynamic, and neurohumoral effects. Subjects and methods. The study included 9 patients (mean age 31.8±8.7 years) with Functional Class III and IV IPH and severe right ventricular failure (RVF). Levosimendan was administered as dropwise intravenous infusion. The patients' general condition, blood pressure, heart rate, and 6-minute walk test results were assessed at baseline and 24 hours after levosimendan infusion, and then following 12 weeks. The time course of changes in blood neurohumoral mediators was determined and transthoracic echocardiography performed. Results. At 24 hours after initiation of levosimendan infusion, there were substantial reductions in pulmonary artery systolic pressure, mean pulmonary artery pressure, mean right atrial pressure, and pulmonary vascular resistance. There was a significant increase in exercise tolerance. The blood exhibited lower norepinephrine and NT-proBNP and higher epinephrine concentrations. At 12 weeks after termination of levosimendan infusion, the improved functional status was preserved in the patients with IPH. There were no noticeable changes in the achieved key hemodynamic parameters. Only one patient needed re-administration of the drug 12 weeks later. The achieved changes in vasoactive mediators were retained 12 weeks following levosimendan infusion. Levosimendan treatment was not followed by clinically relevant adverse reactions requiring infusion termination and therapy discontinuation. Conclusion. 24-hour intravenous levosimendan infusion in patents with FC III-IV IPH and severe RVF causes positive changes in the key hemodynamic parameters and neurohumoral status of the patients and promotes stabilization in those with IPH at 12-week follow-up.

Aim. To study survival of patients with a natural course of pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SS). Material and methods. Twenty SD patients with PAH and 71 SS patients free of PAH were followed up for 10 years (1998-2008) when therapy with specific pulmonary vasodilators was not available. Survival curves for both groups were plotted by Kaplan-Mayer method. Results. One-, 3and 5-year survival were 85, 25 and 5%, respectively, in the SS-PAH group and 99, 82 and 77% in the SS group, respectively. The differences were significant (р < 0,001). Survival median in the group SS-PAH was 32 months. Conclusion. The above evidence is comparable to the results obtained earlier and demonstrate a fatal outcome of the disease in the absence of therapy with specific pulmonary vasodilators.

Objective: to study the efficacy and safety of the endothelin 1 receptor inhibitor traclir in patients with pulmonary hypertension (PH) asso ciated with systemic connective tissue diseases. Subjects and methods. The study included 4 patients: 3 with scleroderma systematica and 1 with exanthematous lupus erythematosus. The diagnosis of PH was established on the basis of right heart catheterization data and after exclusion of all its other causes of HP. In addition to hemodynamic evaluation, the female patients underwent echocardiography (EchoCG), lung function tests, 6-minute walk test, and blood biochemical study (determination of uric acid levels). Traclir was given in a dose of 62.5 mg twice in the first 4 weeks of the study and then in a dose of 125 mg twice for the subsequent 12 weeks. Every 4 weeks, the levels of transaminases were monitored and a pregnancy test was carried out in patients of fertile age. Results. After 16-week intake of the drug, all the female patients were found to have obvious positive changes as a longer 6-min walk test distance and two female patients had improvement in the functional class of PH. Estimation of hemodynamic parameters suggested a posi tive effect in all the female patients, as confirmed primarily by an increase in cardiac index and a reduction in pulmonary vascular resist ance. According to EchoCG data, there was a substantial increase in tricuspid annular plane systolic excursion; other parameters had no informative value. During traclir therapy, there was also an increase in lung diffusion capacity and a reduction in uric acid levels. There were no adverse events throughout the trial. Conclusion. Thus, the experience with traclir used in patients with PH associated with systemic autoimmune diseases suggests its high effi cacy and safety.

Idiopathic (primary) pulmonary hypertension (IPH) is a rare disease of unknown etiology, which is characterized by elevated pulmonary artery pressure, increased total pulmonary vascular resistance, frequently a malignant course with evolving right ventricular decompensation, and a fatal outcome. The diagnosis of IPH is established on the increments in the mean resting and exercise pulmonary artery trunk pressure by more than 25 and more than 30 mm Hg at rest and during exercise, respectively, with a normal pulmonary artery wedge pressure. Endothelin receptor antagonists (ERA) are one of the effective classes of drugs for the treatment of patients with IPH. Bosentan is the first drug from the ERA class that blocks the receptors of both types and that has been recommended by the WHO to treat patients with functional class II-IV pulmonary hypertension. The described case demonstrates the possibility of concomitantly using bosentan in a female patient with IPH shortly after ineffective treatment with a calcium antagonist.

This review is devoted to coronary restenosis after stent implantation in metabolic syndrome (MS) patients. It is known that some clinical factors increase restenosis risk, first of all, diabetes mellitus. Recently, MS has also been regarded as a pathology enhancing coronary restenosis risk. Certain MS features (reduced NO release after oral glucose tolerance test; increased leptin level; hyperinsulinemia, insulin resistance) are important predictors of intra-stent restenosis in coronary heart disease (CHD) patients with normal fasting levels of glucose and glycated hemoglobin. In CHD and MS patients, new, antiproliferative drug-coated stent use could be recommended.

В последнее время появились достаточно убедительные данные, указывающее на то, что такие факторы, как пониженное высвобождение оксида азота (NO) после проведения перорального теста толерантности к глюкозе (ПТТГ), повышенный уровень лептина, гиперинсулинемия и инсулинорезистентность (ИР), являются важными предикторами развития рестеноза внутри стента у больных ишемической болезнью сердца (ИБС) с нормальными уровнями глюкозы натощак и гликированного гемоглобина. Как известно, именно эти факторы являются основополагающими в структуре формирования метаболического синдрома (МС). Настоящий обзор предполагает, что и ИР, и эндотелиальная дисфункция являются независимыми предикторами рестенозов после коронарного стентирования с использованием непокрытых металлических стентов. Оценка толерантности к глюкозе, секреции инсулина и высвобождения NO после стандартного ПТТГ является важным инструментом в попытке выявить пациентов с высоким риском раннего рестеноза среди больных с МС, подвергающихся эндоваскулярным вмешательствам. Более того, изолированное определение ИР и постнагрузочной гиперинсулинемии хотя и служит важным фактором риска ИБС, является слабым предиктором рестенозов после коронарного стентирования, но становится высоко прогностически значимым при повышенном уровне лептина и сниженном уровне высвобождения NO во время ПТТГ.

The results of the study of the dynamics of energy intensity of gross regional product of the Sverdlovsk region for the period 1996 - 2003 years. and projections for the period up to 2015. The principal possibility of growth performance of the regional economy, without a significant increase in the consumption of primary fuel.