The reduction of morbidity and mortality from noncommunicable diseases (NCDs) in young and middle-aged populations leads to an increase in life expectancy (LE) at birth and, consequently, to an increase in the population, to a greater extent, in the older age groups. At the same time, the probability of premature deaths from NCDs is largely related to the household income levels and health care expenditures per person.

With high levels of income and health care expenditures (more than $1,000, per person per year) there is a low (less than 10% probability of premature deaths) from NCDs and high, 80+ years, rates of LE. Reducing the probability of premature deaths from NCDs leads to the preservation of human capital, increasing of government revenues and, consequently, possibility to provide for maintaining of public health, development and use of effective technologies for the prevention and control of NCDs.

Aim. To determine the feasibility of complex approach for the determination of individual tolerance to physical activity based on functional and biochemical markers, in order to choose an effective program of physical rehabilitation for patients with non-ST elevation acute coronary syndrome (NSTEACS) after percutaneous coronary intervention (PCI).

Material and methods. A prospective study included 80 patients with NSTEACS who underwent coronary revascularization. One month after the acute coronary event and conducting PCI, patients were invited to participate in cardiac rehabilitation programs, including with the inclusion of exercise program. In order to select a program of physical rehabilitation, a general clinical examination, an assessment of the risk of cardiovascular complications in NSTEACS, and an individual tolerance to physical activity were carried out. Individual tolerance to physical activity was assessed by the results of a loading test and biochemical markers characterizing metabolic processes during aerobic exercise. A loading test was performed on the Marquette-Hellige 2000 treadmill (Bruse protocol). According to the results of the exercise test and biochemical markers, patients were recommended to controlled walking or prescribed a short course of exercises with an intensity of 60% of the threshold power.

Results. At the end of the short cycle of the exercise program, a significant increase of the minute oxygen consumption (MOC) was observed in 72,5%. In 15,5% of the remaining patients the increase of MOC was insignificant, and in 12% MOC remained at the initial level. The analysis of biochemical markers in the dynamics of these patients showed consistently elevated values. The level of urea and creatinine increased by 16,7% compared with baseline afterload parameters. The level of creatine phosphokinase decreased by 16-24% of the afterload data. Myoglobin level was 106,2+8,4 pig/i vs baseline 90,2±6,2 gg/l. In addition, the total duration of exercise programs in these patients was less than stated.

Conclusion. Thus, focusing on the initial level of the MOC in determining of load is not always possible to obtain the expected increase in physical performance. In this case, the assessment of biochemical blood changes allows to determine signs of overstrain under the influence of physical exertion, which makes it possible to correct the level of load.

Aim. To evaluate patients with acute coronary syndrome (ACS) in combination with atrial fibrillation (AF) according to the total register of ACS in the Krasnodar region of echocardiographic (EchoCG) parameters (left atrial dimension (LAD), left ventricular wall thickness (LVWT), left ventricle end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), as well as coronary substrate assessment according to coronary angiography (CAG) and determination of the relationship between the value of LVEF and the coronary substrate.

Material and methods. From the register of the ACS in the Krasnodar region, patients were successively taken to the cardiology departments of Krasnodar regional clinical hospital № 1 for the period from November 20, 2015 to November 20, 2017 with a diagnosis of ACS, accompanied by one of the types of atrial fibrillation. This group of patients was designated as a group of ACS + AF and amounted to 119 patients. The comparison group was selected with the help of a random number generator from patients admitted to the hospital with ACS and intact sinus rhythm (SR) for the period of time from November 20, 2015 to November 20, 2017 (120). We analyzed the ECHO-CG parameters, the coronary substrate — according to the CAG.

Results. When comparing the cohort of patients with ACS + AF with the cohort of patients with ACS + SR, we determined a significant (p<0,05) difference of LA size, LVEF and values of PASP. During comparing the presence of hemodynamically significant stenosis in the coronary arteries we noticed that in ACS + AF patients with LVEF <40% in significantly higher percentage of cases (p=0,0007) occurs significant hemodynamic stenosis of coronary arteries, in contrast to the group of patients with ACS + SR with LVEF <40%. In patients with EF >40% and ACS + SR we determined a significantly more frequent (p<0,001) stenosis.

Conclusion. The results of the analysis are important for understanding the distinguishing characteristics of patients with ACS that occur on the background of AF, which is important for correct prediction of the course of the disease. The maintenance of the ACS register will provide information on the real clinical course of the disease, as well as improve the effectiveness of treatment in real clinical practice.

Aim. To reveal latent disorders of carbohydrate metabolism (CHM) in conjunction with neurohormonal status in hospitalized patients with chronic heart failure (CHF) of ischemic etiology.

Material and methods. We analyzed 174 patients with NYHA class II-IV CHF of ischemic etiology who received the same standard CHF therapy (P-adrenergic blockers, mineralocorticoid receptor antagonists, angiotensin-converting enzyme inhibitors, diuretics), did not have disorders of CHM and never took hypoglycemic agent. We conducted oral glucose tolerance test (OGTT) and general clinical examination. The levels of brain natriuretic peptide, aldosterone and insulin was determined by enzyme immunoassay. Insulin resistance (IR) is assessed using the HOMA-IR index.

Results. Among 174 hospitalized patients with NYHA class II-IV CHF of ischemic etiology disorders of CHM was detected in 52,3% of patients: 33,9% of those had impaired glucose tolerance (IGT), 1,7% — impaired fasting glucose (IFG), 16,7% — newly diagnosed type 2 diabetes mellitus (DM), in 47,7% of the patients disorders of CHM was not found. In all patients with CHF, along with elevated levels of brain natriuretic peptide and aldosterone, insulin levels were also increased. IR elevated with the increase in the severity of disorders of CHM (in the group without disorders of CHM — 10,78 (8,9-12,2), IGT — 14,6 (11,2-18,2), newly diagnosed type 2 DM — 18,6 (15,19-26,7). Also the concentration of aldosterone was higher in the group with DM, compared with the ITG group (p_2-3<0,01).

Conclusion. The presence and progression of IR in patients with CHF of ischemic etiology in conjunction with neurohormonal status emphasizes the importance of timely detection of latent CHM disorders with its future management.

Aim. To study the prognostic value of Left Ventricular Mass (LVM) with asymptomatic aortic stenosis (AS) in a long-term outpatient study, as well as the effect of the LVM on major cardiovascular events (CVe).

Material and methods. Cox regression analysis was used to evaluate the effect of an echocardiographically detected increased LVM on the frequency of major cardiovascular diseases: a serious cardiovascular event; events related to the aortic valve — combined aortic valve replacement, congestive heart failure due to AS, and ischemic cardiovascular events — nonfatal myocardial infarction, non-hemorrhagic stroke, coronary revascularization, hospitalization due to unstable angina. The study included 165 patients with average age of 67 years; 39,6% of women had asymptomatic form of mild and moderate AS. Patients were selected with asymptomatic, mainly moderate AS, without diabetes, cardiovascular or renal pathologies. Patients were observed for 4 years.

Results. At the beginning of the study, the LVM index was 45,9±14,9 g/ m², and the peak velocity in the aorta was 3,9±0,54 m/s. During the observation, 58 major CVE were indentified. In Cox regression analysis, 1 standard deviation (15 g/m²) above the initial level of the LVM index determines the predicted increase in risk by 12% for major CVE, 28% for ischemic CVE, 34% for cardiovascular mortality and 23% for all cause mortality and hospitalization for heart failure (all p<0,01). A higher LVM index was consistently associated with CVE risk increase from 13% to 61% (all p<0,01) regardless of age, gender, body mass index, LV ejection fraction, concentricity and presence of concomitant hypertension.

Conclusion. A higher LVM index is independently associated with increased cardiovascular morbidity and mortality with progression of AS.

Aim. To develop mathematical models for predicting the risk of gangrene of the lower limb and the algorithm for selecting of treatment strategies for vascular surgeons and angiologists.

Material and methods. The results presented in this work are based on a six-year-old (since 2011) observation of 400 patients with chronic obliterating diseases of the lower limb arteries, some of which had combinations of ischemic damage to the central hemodynamic system, heart and brain. Patients had different stages of the disease, up to critical ischemia and gangrene, which requires amputation of the lower limbs. During the exploratory analysis, we selected 8 informative features, which were used to develop mathematical models that divide patients into classes: low confidence in the development of gangrene; average confidence in the development of gangrene; high confidence in the development of gangrene and very high confidence in the development of gangrene. For each identified class, confidence in the development of gangrene was determined by an individual treatment strategy, implemented in accordance with the intelligent decision support system by a decision-making algorithm.

Results. It was shown that, compared with traditional treatment tactics, using of presented algorithm can increase the speed of positive results achieving by 3,4 times (68,3%), reduce the risk of lower limb gangrene development by 2,8 times (61,6%) and reduce the risk of limb amputation by 4,1 times (68,1%).

Conclusion. The obtained mathematical models should be used in the medical practice of vascular surgeons and angiologists, both in the form of software for smartphones and tablet computers, and as part of decision support systems, including telemedicine systems.

Aim. To study the relationship of polymorphism of APOC3, PON1, AGT, AGTR1 genes and Vascular control parameters (blood pressure — BP and heart rate — HR) when performing an orthostatic test in young individuals.

Material and methods. The study involved 75 relatively healthy Caucasian volunteers aged 20-25 years. The exclusion criterion was the presence of cardiovascular and central nervous pathologies. Vascular control was assessed by conducting an active orthostatic test. Identification of gene polymorphism was carried out by the method of deoxyribonucleic acid pyrosequencing.

Results. Persons with the presence of the risk C allele of the A1666C A>C polymorphism of the AGTR1 gene have a lower heart rate in the prone position. The pulse pressure (PP) of these persons in the first minute after the rise remained at higher values. The highest levels of PP in the first minute as well as heart rate were observed in individuals whose genotype simultaneously contains the risk allele of the A1666C A>C polymorphism of the AGTR1 gene and T207M C>T polymorphism of the AGT gene. After 1 min of orthostasis in individuals carrying the mutant allele of the A1666C A>C polymorphism of the AGTR1 gene diastolic blood pressure (DBP) increased lesser, and the pulse pressure decreased “weaker” in relation to the initial values. The presence of the M268T T>C polymorphism of the AGT gene in the genotype was associated with a less high systolic blood pressure (SBP) at the first minute of orthostasis, as well as a less significant increase in DBP. Persons whose genotype contains the T allele of the L55M A>T polymorphism of the PON1 gene had a lower SBD and PP in the prone position. The presence in the genotype of the T allele of the -482 C>T polymorphism of the APOC3 gene is associated with lower rates of DBP in the prone position and SBP on the first minute after the rise. Also these individuals showed a more pronounced heart rate increase after the rise.

Conclusion. There is a significant relationship between the studied polymorphic variants of the APOC3, PON1, AGT, AGTR1 genes and vascular control parameters in the context of orthostasis. It may be a predictor of early development of arterial hypertension.

Aim. To evaluate the prevalence of prehypertension and its interrelations with other cardiovascular risk factors in Krasnoyarsk Region population.

Material and methods. The present study, conducted in the framework of epidemiological research ESSE-RF, included 1603 people (age 25-64 years) of urban and rural population of the Krasnoyarsk Region. All participants underwent the questionnaire test, office blood pressure measurement, anthropometry, and biochemical blood analysis. Persons with 120-139/80-89 mm Hg blood pressure was subsumed to the prehypertension group. Statistical processing of the results was performed in IBM SPSS v. 22. Differences in prehypertension prevalence were assessed for statistical significance using the Pearson’s chi-squared test. The influence of sociodemographic factors and laboratory parameters was evaluated using logistic regression with the gradual elimination of insignificant factors. Statistical significance was taken into account at p<0,05.

Results. We determined that 29,1% of Krasnoyarsk Region population had prehypertension. It was more prevalent in males compared to females (32,5% vs 27,2% respectively), in younger people compared to older (41,6% in 25-34 vs 16,5% in 55-64), and in urban population compared to rural (30,7% vs 24,7% respectively). Prehypertension prevalence in the Krasnoyarsk Region was lower compared with the average country statistics (35,0%) due to the greater prevalence of arterial hypertension. The significant predictors of prehypertension were higher education, obesity and hypertriglyceridemia.

Conclusion. The prevalence of prehypertension in Krasnoyarsk Region was 29,1%; it is lower than the average data over Russia because of a higher percentage of people with arterial hypertension and a lower percentage of optimal blood pressure in Krasnoyarsk Region population. The percentage of prehypertension decreased with age. Higher education, obesity and hypertriglyceridemia increased the risk of prehypertension.

Aim. To assess the incidence of unfavorable in-hospital outcomes (fatal and non-fatal complications) following coronary artery bypass grafting (CABG), depending on the age of the patient and the presence of comorbidities.

Material and methods. In the period from 2011 to 2012 we included in the study 680 patients for elective CABG (single-site, register, prospective study). Combined clinical endpoint (CCE) included the presence of myocardial infarction (MI), multiple organ dysfunction syndrome (MODS), heart failure (HF), new atrial fibrillation (AF) after CABG, repeat mediastinotomy (of one or more complications) and/or deaths.

Results. There is a high prevalence of comorbidities among the patients referred to CABG. One hundred fifty two (22,40%) patients reached the CCEs. The highest rate of the CCEs was recorded in the group of patients undergoing concomitant CABG, compared to the group of patients after isolated CABG. Patients’ age was associated with the development of CCE in the early postoperative period. The highest number of CCEs was registered in the group of patients with combined surgical interventions.

Conclusion. Factors associated with the probable development of unfavorable nosocomial outcomes either fatal or non-fatal following is the age of patients 61 years and older, concomitant CABG, and the extracorporeal circulation.

The authors express their opinion on the problem of the terminology of the combined pathology in modern clinical practice. The terms “comorbidity”, “multimorbidity”, “dual diagnosis” are considered in terms of conceptual differences. The issues of diagnostics, classification and modern clinical recommendations for patients with combined pathology are also discussed. Given the variety of terminology and the ambiguity of the semantic component in the discussion of the problem of comorbidity/ multimorbidity, it seems justified for the medical community to come a common consensus in terms of terminology, classification and diagnosis. It will help to avoid mistakes and disagreements between physicians of various specialties.

Aim. To study the structure of cardiovascular comorbidities, the quality of outpatient management and the structure of concomitant pathology in patients with cardiovascular continuum. To compare the obtained results with the results of the pilot stage of the REKVAZA register study (Outpatient Polyclinic Register of Cardiovascular Diseases in the Ryazan Region), conducted in 2012 using similar selection criteria. To evaluate the results of preventive measures for this patient population.

Material and methods. We carried out one-stage retrospective analysis of 1 thousand outpatient cards of cardiovascular patients in Ryazan, who visited a general practitioner in 2016.

Results. The overall comorbidity of cardiovascular patients reaches 91% and elevates with age increasing. Since 2012, the frequency of various combinations of cardiovascular diseases has increased from 82% to 89,7%, but the frequency of cerebral stroke and myocardial infarction has not changed. Chronic kidney disease has been found to be significantly associated with coronary artery disease, myocardial infarction and cerebral stroke; type 2 diabetes mellitus — with coronary artery disease and obesity. All patients suffered from hypertension, but only 39,5% reached target blood pressure levels (<140/90 mm Hg) — that is 13,6% more than in 2012. Over the past 4 years, the number of people receiving statins increased from 35,9% to 50,6%, but the proportion of patients who achieved total cholesterol levels <5,0 mmol/l decreased from 51,1% to 31,6%. The frequency of prescription of antiplatelet agents and anticoagulants in the total cohort of the surveyed patients decreased from 64,8% to 40,6%.

Conclusion. Comorbidity levels among cardiovascular patients are high and it increases with age; the most common are various combinations of cardiovascular diseases. Antihypertensive, antiplatelet and lipid-lowering therapy does not fully comply with current clinical guidelines. Insignificant positive changes in the management of patients were noted: compared to 2012, the number of people receiving antihypertensive therapy and the number of patients taking statins increased, but there were no positive changes in case management.

The article is a lecture on modern recommendations of the European Society of Cardiology and the American Heart Association for the diagnosis of syncopal conditions. The article presents the latest information from the 2018 review concerning the definition of syncope, its classification, diagnostics and risk stratification, patient management tactics. The article will be useful both to students, residents, postgraduates of medical universities, and practicing doctors.

Arterial hypertension (AH) is observed in almost every third of adult, and in 15% of cases it can be secondary. Endocrine hypertension as a cause of symptomatic hypertension (SAH) takes the second place after renovascular etiology. Thus, screening of endocrine SAH should be performed on almost every patient with AH. The general practitioner first meets a patient with elevated blood pressure levels, and his aim is to suspect SAH just-in-time, be able to provide its primary diagnostics, interpret the results and know the cases when patient with AH should be referred to a narrowly focused specialist. The article presents modern approaches to screening of endocrine hypertension causes, which allow not only to normalize blood pressure, but also to avoid complications.

The lecture is devoted to the choice of tactics and the rules of reperfusion therapy for ST-elevated myocardial infarction. Since the time of reperfusion is crucial for the survival of these patients and the preservation of a viable myocardium, proper organization of care and strict adherence to the guidelines for drug-induced and non-drug interventions is necessary. The lecture substantiates the tactics of pharmaco-invasive intervention, the choice of thrombolytic agent, provides data on indications and contraindications for thrombolytic therapy, dosing regimen of thrombolytic drugs, other antiplatelet and anticoagulant drugs required for reperfusion. Knowledge of current guidelines should help reduce ischemia time and cases of unjustified refusal to effective interventions.