Aim. To evaluate the prevalence of atherosclerosis, to define the type of atherosclerotic lesion of brachiocephalic arteries in patients with systemic sclerodermia (SSD); to reveal the main factors influencing that process.

Material and methods. Totally 38 patients with SSD studied. We measured vessel stiffness on the area between carotid and femoral arteries; instrumental and laboratory characteristics of endothelial function, morphology of carotid arteries, lipid profile parameters, as glucose, uric acid, N-terminal brain natriuretic peptide (NT-proBNP), antinuclear autoantibodies spectrum, cytokines concentration and chemokines of serum.

Results. The increase of intima-media thickness (IMT) was found in 79% (n=30/38) of the patients studied with SSD. In one of the patients there was occluded carotid artery. Different level of arterial stenosis (20- 70%) — in 52,6% (n=20/38) of patients. We also measured relation of IMT and several classic risk factors (RF) of atherosclerosis (age, glyciemia level). Among non-classical risk factors there was relation of IMT and levels of asymmetrical dimethyl arginine (ADMA), soluble adhesion endothelium molecule (sVCAM), uric acid, NT-proBNP, autoantibodies to centromeres proteines. In multiple regression analysis the most informative predictors of IMT were age, uric acid, sVCAM, granulocytic colony- stimulating factor (G-CSF) and interleucine-1 (IL-1). Conclusion. In SSD patients atherosclerosis develops partially through non-classic factors influence, primarily inflammatory mediators and common for SSD metabolic disruptions (uricemia). This can point on the specific interrelation of pathogenetic mechanisms of arterial wall involvement in SSD, and might require repeated assessment of IMT in SSD, using larger patients selection and additional investigation methods.

Aim. To study the specifics of vessel wall remodeling in arteries of young persons with family history (FH) of arterial hypertension (AH). Material and methods. Totally 95 persons assessed, parents of whom had AH. During the study we selected them into 2 groups: with higher normal and normal BP Controls were healthy persons with FH of AH. All underwent ambulatory blood pressure monitoring (ABPM), ultrasound examination (USE) of carotid arteries, the coefficient of transverse elasticity was measured, elasticity coefficient in transverse section, Jung elasticity module, stiffness index, pulse wave velocity (PWV), integral module of arterial system resilience for the vessels of muscular and elastic type. Results. The significant changes of elasticity were revealed for the vessels, as the increase of PWV and integral module of resilience of the muscular and elastic wall. These were found in patients with higher normal BP having FH of AH. In patients with higher normal BP these parameters did not differ significantly. In USE of carotid arteries in the group of normal

BP persons and with FH of AH family anamnesis there was significant increase of the stiffness index of vessel wall (p<0,005), transverse elasticity coefficient (p=0,0001) and Jung elasticity module (p<0,005). Conclusion. In younger persons with FH of AH the changes of PWV were depended on BP level, and the values of common carotid arteries elasticity (as the coefficient of transverse distension, stiffness index, Jung elasticity index) marked earlier processes of vessel wall remodeling in normal BP, that can be used as screening tool for diagnostics of arterial rigidity onset and prognosis of cardiovascular diseases in younger persons having the relatives of the first line with AH.  

Aim. To study interrelations of cardio-ankle vessel index (CAVI) with annual results of coronary bypass grafting (CBG) in patients with ischemic heart disease (CHD).

Material and methods. On the first stage, we included 356 patients after CBG. All patients underwent CAVI assessment. In a year we analyzed the condition of 341 patient, and selected patients into groups: I (n=221) — CAVI >9,0 and II (n=120) group — CAVI <9,0. Groups were comparable by the prevalence of cardiovascular events: death, myocardial infarction, stroke, hospitalization, angina onset.

Results. In evaluation of the results in long-term period after operation, the mortality was higher in the II group and reached 3,3% relative to I group — 2,3% cases, resp. (p=0,55). In general patients with pathologic CAVI had more common negative prognosis during one year in 34 (28,3%) cases, comparing to patients with normal CAVI — 42 (19,0%) of patients (p=0,048). Probability of combined endpoint occurrence (CEP) increased with the increase of CAVI (p=0,04), with the existence of bilateral carotid stenosis (p=0,01), and in the relation of CBG with therombectomy (p=0,04). In multifactor analysis an independent relation with the risk of CEP was found for bilateral carotid arteries stenosis and increase of CAVI (OR 2,5; 95% CI 1,26-5,08; p-0,008 and OR 1,7; 95% CI 1,0-2,9; p=0,02, resp.).

Conclusion. The pathological CAVI was associated with higher prevalence of CEP during one year. In multifactorial analysis an independent influence on prognosis in this kind of patients had CAVI and presence of bilateral carotid stenosis. The assessment of CAVI is aimfull to perform before CBG to find out the patients with increased risk of cardiovascular events.

Aim. To evaluate the type D personality relation with clinical and instrumental parameters in patients with ischemic heart disease (CHD), underwent percutaneous coronary interventions (PCI). Material and methods. Into prospective study we included all patients after urgent or planned PCI for hemodynamically significant stenosis of coronary arteries in Tyumen cardiological center by the period from 15.10.2012 to 15.11.2013 y. Totally we studied 1018 patients (764 men and 254 women). For type D personality definition we used the questionnaire DS14. Results. Type D personality was found in 32% patients. These did not differ from the others in terms of age, gender, main cardiovascular risk factors (CVD). Patients of D-type had more often the carbohydrate metabolism changes — 28,2% vs 22,1% (p=0,047), also they had tendency to the increase of diabetes diagnosed — 25,3% vs 19,9% (p=0,06). There was no difference in lipid profile of the blood, as by clinical severity of the disease and duration of CHD; same prevalence was for post infarction cardiosclerosis. At the same time D-type patients had more prevalent >2 myocardial infarction in anamnesis — 17% vs 9,6% (p=0,02) among those with post infarction cardiosclerosis. D-type patients did not differ from non-D-type by significance and severity of coronary arteries lesions, short-term outcomes of PCI and echocardiography parameters. Conclusion. Among CHD patients underwent PCI, D-type personality was found in 32%. These had more often carbohydrate metabolism changes and 2 and more MI in anamnesis. There is no link for D-type personality, severity of CHD clinically and for short- term outcomes of PCI.

Aim. To compare the influence of the most informative parameters of inflammatory markers and structural-geometrical parameters of the heart remodeling in patients with different clinical types of atrial fibrillation (AF). Material and methods. We observed 141 patients with ischemic heart disease (CHD) and arterial hypertension (AH) having nonvalvular type of AF. Duration of AF was up to 84 months, mean 13,8±8,0 months. As controls we examined the same by age and gender patients with CHD and AH, however without AF — 18 patients. All patients underwent clinical and instrumental, immunological investigation. Mathematical processing was done with SPSS-13.

Results. By the cluster-analysis method we found that except the remodeling parameters in paroxysmal and persistent AF important role do play the levels of such markers as C-reactive protein (C-r.p.) and inlerleukine-6 (IL-6). In patients with permanent form of atrial fibrillation inflammation markers levels do not play key role. Conclusion. C-r.p. and inflammatory cytokines play some role in pathogenesis of AF, especially in its paroxysmal and persisting types. And as C-r.p., being an acute phase protein, cannot be the specific marker of inflammation in AF, but the increase of C-r.p. might be the predictor of IL-6 level increase, especially in paroxysms and returns of Af.

Treatment of acute heart failure (ACF) remains a strenuous task. Modern treatment methods — diuretics, vasodilators, inotropic drugs — are effective in ACF symptoms reduction, but do not decrease risk of death, that is still very high in this urgent condition. This determines a necessity of novel treatment methods search.

Aim. To assess efficacy of serelaxine in ACF caused by cardiotoxic effect of cytostatic therapy.

Material and methods. Serelaxine is a recombinant human relaxine-2, having hemodynamic and pleiotropic organoprotective effects. The data on the drug efficacy for one or other cause of ACF is non-sufficient. In single-center observational study there is an experience presented of serelaxine in pulmonary oedema, developed as complication of polychemotherapy (PCT) in oncohematological diseases.

Results. The use of serelaxine in addition to the standard treatment led to successful cessation of pulmonary oedema, stabilization of hemodynamics and of blood gases, therefore to completion of full PCT program.

Conclusion. The first clinical experience presented has shown efficacy of serelaxine in ACF due to cardiotoxic action of PCT in oncohematological patients. Further clinical trials are aimfull in this category of patients.  

Aim. To assess the parameters of lipid profile in patients with metabolic syndrome (MS) with respiratory pathology in ethnic cohort of the Yakut. Material and methods. The main group I (MG I) consisted of 88 patients of Yakut nationality with bronchial and pulmonary pathology together with metabolic syndrome. Mean age — 50,9±0,91 y. Comparison group I (CG I) was made up from 60 patients of Yakut ethnicity with lung diseases but without MS. Mean age was comparable to the one of MG I — 48,9±1,35 y. For the comparison study, depending on ethnicity we selected the II group from MG — those of Yakut ethnicity with chronic pulmonary obstructive diseases (COPD), n=39, mean age — 53,4±1,17 y. CG II consisted of 40 patients of Russian ethnicity with COPD and MS. Mean age was comparable to MG II of Yakut: 53,1±1,21 y. Lipids of blood were assessed. Results. Total cholesterol of blood (TC) in MG I was 5,5±0,13 mmol/L vs 4,7±0,17 mmol/L in CG I without MS (р=0,002); triglycerides (TG) — 1,6±0,10 mmol/L vs 1,0±0,06 mmol/L (р=0,000); low density cholesterol (LDL) — 3,5±0,09 mmol/L vs 3,0±0,12 mmol/L (р=0,007); high density cholesterol (HDL) — 1,3±0,05 mmol/L vs 1,4±0,04 (р=0,086); atherogeneity index (AI) — 4,5±0,12 vs 3,8±0,17 (р=0,004), respectively. Depending on ethnicity: TC was 5,3±0,16 mmol/L in Yakut group and 5,5±0,14 mmol/L in Russians; LDL — 3,5±0,16 mmol/L vs 3,5±0,10 mmol/L; HDL — 1,2±0,06 mmol/L vs 1,2±0,05 mmol/L, TG — 1,5±0,16 mmol/L vs 2,1±0,12 mmol/L (р=0,000), respectively. Conclusion. Lipid profile in Yakut ethnicity with COPD and MS has more negative kind in relation to TC, LDL, AI, comparing to the Yakut with the same pathology without MS. Atherogenic dyslipidemia in patients with MS and COPD irrelevant to ethnicity shows higher levels of TC, LDL in both ethnicities and hypertriglyceridemia in Russians. 

Aim. To invent the method of body mass index (BMI) trend evaluation for children and adults for automatic system of overweight and obesity prevention. Material and methods. Into the analysis we included anthropometric data from four population-based studies, differing by the duration of observation period and age diapason. Data processing and statistical analysis were done with multidimensional regression analysis in procedure SAS PROG GLM at the variant with repeated measurements. Results. As a result of the analysis of age-related dynamics of anthropometric parameters we invented a system of BMI (increase) trend (of the Kettle index), that make it to reveal the persons (children and adults) with excessive income of BMI in its upper limits during short time intervals. This information about a child or an adult is a subject for automatic registration and is being reported to the physician. Conclusion. The proposed method makes possible to screen the persons with excessive weight gain. As a result of physician and patients' partnership it is possible to do on-time primary and secondary prevention of excessive body weight and obesity in children as in adults. 

Aim. To evaluate the opportunities for application of pulse wave velocity measurements (PWV) in aorta as prediction instrument as additional method in cardiovascular risk (CVR) stratification in patients with abdominal obesity (AO).

Material and methods. Totally 132 normotensive patients studied with AO and SCORE risk <5%, at the age 31-55 (mean age 45,0±5,3); we measured lipid profile, glycemic profile, glomerular filtration rate, microalbuminuria (MAU), performed triplex scanning of carotid arteries (CA) echocardioscopy, bifunctional 24-hour blood pressure monitoring with assessment of mean daily PWV in aorta. As additional prediction instrument in CVR stratification we meant PWV >75 percentile for the respective age range — 8,0 m/s for persons of 31-45 years old and 8,3 m/s for 46-55 years old.

Results. In patients with PWV in aorta >75th percentile organ damage was found more often — carotid atherosclerosis — 44,1% vs 5,1% (p<0,01); CA wall hypertrophy — 50,0% vs 26,5% (p<0,05); MAU — 32,4% vs 0% (p<0,01). The criteria chosen for vessel wall rigidity made it to reveal 100% of persons with MAU, 42,9% with left ventricle hypertrophy, 39,5% with CA wall hypertrophy, 75,0% with carotid atherosclerosis among all patients with AO, that was comparable with the analogic parameters in case of traditional method application with the same aim in model of metabolic syndrome. At the same time the prevalence of carotid atherosclerosis and MAU in the first subgroup was significantly higher — 44,1% vs 16,2% and 32,4% vs 10,8%, resp. (p<0,01).

Conclusion. For the patients with AO and low and moderate CVR by SCORE in case of PWV in aorta at the range >75 percentile for the respective age diapason it is aimfull to do screening of subclinical atherosclerosis for consequent reclassification of CVR and reconsideration of the necessary prevention events. 

Aim. To assess the risk factors of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) and to evaluate their prognostic value in short- term and long-term periods after aortocoronary bypass grafting (CBG). Material and methods. Totally 733 patients studied (476 men and 257 women) with the age 47-66 y.o. (mean age — 60,3±5,8 y.), underwent planned CBG. According to preoperational level of glomerular filtration rate (GFR) patients were selected into 3 groups: 352 patients with GFR >90 ml/min/1,73 m² (I group); in 311 patients — 89-60 ml/min/1,73 m² (II group) and in 70 patients — 59-45 ml/min/1,73 m² (III group). AKI was diagnosed and classified by the level of serum creatinine (sCr), using AKIN criteria (Acute Kidney Injury Network). Dynamical observation of patients was performed for 12 months after discharge.

Results. During early post-operation period the AKI diagnosed in 32,6% patients, including I group in 23,0%, the II group in 37,9% and the III group in 55,7%. Hospital mortality in the I group was 3,1%, in the II — 9,1% and in the III — 12,9% (p<0,05). In the I group the development of CKD in patients after AKI, was found in 5,6% cases, and progression of CKD in the II group — in 8,6% cases and in the III group — 15,8% cases. Contrary, the regression of CKD in the II group was found in 61,5% cases, including those after AKI, in 55,5% cases and in patients without AKI in 67,2% cases. In the III group the regression of CKD was found in 40,4% cases (p=0,005) and there were no differences related to AKI. Programmed hemodialysis in the I group was performed for 2,1% patients, in the II group — for 5,3% patients and in the III group — for 22,8% patients, significant intergroup differences.

After 12 months of observation total mortality in the I group was 2,6%, in the II — 6,6% and in the III group — 17,5%.

Conclusion. Therefore, presence and severity of CKD, development of postoperational AKI predetermine short- and long-term cardiorenal prognosis in patients after CBG.

Aim. To estimate the relation of the 30-year survival equation and levels of high-density cholesterol (HDL) in almost healthy men 40-59 years old and to define based on this data the optimal level of HDL for that category of persons.

Material and methods. Totally 2177 men studied at the age 40-59 y., that were 72,3% of all inhabitants of Chelyabinsk districts. As healthy were 398 marked, and for further study 174 persons selected (50%), of 40 refused to participate. During 30 years, we followed 134 men. All participants underwent the assessments of total cholesterol, low- density cholesterol, HDL, other biochemical parameters. As endpoint, we regarded the death. Statistics was done with Excel, STATISTICA 10.0, SPSS 17.0 software. We measured mortality rates with 95% confidence intervals. Survival equation by different levels of HDL in the range 0,3-2,0 mmol/l was done by the Kaplan-Meyer method. Confidence rows of survival were built-up with non-parametric criteria of Kolmogorov- Smirnov. The regression dependence was studied for the life duration of an individ and the level of HDL using Cox model. Results. Thirty-year mortality equations in almost healthy men of 40-59 y.o. demonstrate clear dependence on the HDL level. The level of HDL 1,7 mmol/l is associated with the most positive parameters of 30-year survival. The mentioned HDL level is desirable for this category of persons.

Conclusion. The survival equation demonstrates the value of an exposition of the set level of HDL, and the beginning, duration and cessation of statistically relevant increase of survival comparing to lower values of the studied parameter.

Aim. To study the relation of pulse wave velocity (PWV) as arterial stiffness index, and the level of biochemical factors elevation, that are involved in atherothrombogenesis and play role in determination of cardiovascular risk in various age patients.

Material and methods. Totally 202 patients included at the age 30-75 y.o. (M/F 68/134) without clinical signs of atherosclerosis. Stiffness/ elasticity of arteries was assessed by PWV method. Stiff — biologically "old" — we regarded the arteries with PWV more than 10 m/s, elastic — biologically "young" — in PWV <10 m/s. Biochemical parameters of the blood were assessed by standard methods.

Results. In younger age group with stiff arteries comparing to those with elastic arteries there were higher levels of glucose, insulin, C-peptide and HOMA-IR. There was tendency revealed for higher levels of ultrasensitive C-reactive protein (hsC-rp) and fibrinogen. In older age group there were no differences in hsC-rp and fibrinogen, but the higher levels of glucose, C-peptide and HOMA-IR found with the same level of insulin. In comparison of different age groups with elastic arteries in older group we found higher levels of fibrinogen and von Willebrand factor, and tendency for higher level of hsC-rp. In persons with stiffer arteries >45 y.o. von Willebrand factor and fibrinogen also were higher. In comparison of different age groups with elastic and stiff arteries we found higher levels of glucose and glycosylated hemoglobin with the same levels of insulin, C-peptide and HOMA-IR. Conclusion. Increased PWV non-dependent of age is associated with disruptions of carbohydrate metabolism as decreased insulin sensitivity. Accelerated biological ageing (increased PWV in younger age group) is associated not only with significant alterations in glucose utilization processes, but also with initial signs of chronic inflammation of arterial wall and tendency to clot formation.

The review provides the opinions of scientists on the results of pharmaco- economy analysis of antihypertension drugs usage in different countries. The necessity underlined for the concentration of attention on analytic approach and financing of the State sector of healthcare support on the availability of treatment and prevention of the main chronic diseases. The parameters of economic assessment of efficacy of different antihypertension drugs are not only the criterial for rational usage of restricted resources of healthcare system, but also help to choose the exact drug in clinical situation to provide to the patient the best life quality with real economic wealth.

Disorders of arterial elastic properties and endothelial dysfunction are important cardiovascular risk factors and early markers of arterial damage. The review focuses on the results of randomized trials of risk factors influence on taut-elastic arterial properties, modern approaches to the correction and prevention that include life style modification and pharmacological media that are available in broad medical practice. The directions are discussed of the application of novel classes of drugs and potential treatment strategies for the correction of arterial stiffness and endothelial dysfunction.

The second part of the review focuses on the main principles of exercise tests, protocols of exercise tests, prognostic significance of the values obtained in ischemic heart disease. The problems are accounted on how to use the results of exercise tests for pretest probability of ischemic heart disease, to stratify the risk of cardiovascular complications, to evaluate the efficacy and prognosis.

Chronic heart failure (CHF) is common complication of a variety of cardiovascular diseases. In patients with CHF it common to find atrial and ventricular rhythm disorders. Recently the interest to atrial fibrillation (AF) is growing due to its influence on the prognosis of patients with CHF, combination of CHF with AF has worse outcome comparing to isolated AF or CHF. These patients need to be controlled for their ventricular rate by continuous right-ventricular stimulation. However continuous right- ventricular stimulation leads to worsening of the left ventricle function through complicated mechanisms of synchrony impairment. In dyssynchrony with progression of CHF these patients need cardiac resynchronization therapy. Ventricular rhythm disorders are common in these patients and lead to the increase of death risk, hence such patients need to implant cardioverter-defibrillator, and if with biventricular stimulation there is not only a decrease of death from ventricular arrhythmias, but also decrease of the quantity of onsets of these arrhythmias, so cardiac resynchronizing therapy can prevent AF development in CHF.