Aim. To study the influence of nitric oxide (NO) on the types of remodeling of the left ventricle myocardium (LV) and hemodynamics parameters in patients with arterial hypertension (AH), inhabitants of the higher altitudes areas.

Material and methods. In high altitudes of Elbrus areas we studied 170 person at the age 37-68 y.o.: 110 patients with AH of various grade and 60 healthy persons. All patients underwent general clinical, instrumental and laboratory investigations. Production of NO was assessed by nitrite- anion NO₂^- and nitrate-anion NO₃^- concentration in plasma and erythrocytes by spectral method.

Results. Myocardial geometry changes were found in 53% patients with AH, related to the changes of NO metabolites concentration in blood and hemodynamics. NO concentration was decreased by 5% in patients with AH with normal geometry of the LV. Significant decrease of NO was found in the groups of patients with concentric remodeling of the LV and concentric hypertrophy of the LV by 39% and 92%, respectively. Normal production of NO with higher concentration of nitrites in the blood was found in patients with eccentric hypertrophy.

Conclusion. In total, the data shows a significant role of NO for the regulation of blood pressure and course of the LV remodeling in AH patients. Under conditions of chronic hypoxia production of NO increases, and that might influence significantly hemodynamics and types of the left ventricle geometry in higher altitudes inhabitants. 

Aim. To study the impact of 16-week pharmacotherapy with а₁,в- adrenoblocker carvedilol (С) on the parameters of pressure and vascular rigidity in arteries of different size in 1-2 grade arterial hypertension (AH) patients.

Material and methods. Totally 36 patients studied with AH of 1-2 grade at the age 49,9±9,4 y.o. We analyzed structural-functional parameters of the vessel wall, using methods of 24-hour blood pressure monitoring and assessment of the rigidity by Vasera-1000 equipment and current- related vasodilation (CRVD) in test with post occlusion reactive hyperemia by ultrasound device My Lab 90. All patients received С during 16 weeks treatment.

Results. At the background of pharmacotherapy, there was significant dynamic of aortic pressure by the data of 24-hour monitoring. There was a decrease of the mean 24-hour values of the central velocity of pulse wave (PWV) by 5,2% (p<0,01) with the absence of adverse influence on reflected pulse wave. By the data of volume-related sphygmography there was significant decrease of PWV in aorta by 13%, in mostly elastic arteries by 6% and muscular type — by 14% (p<0,05). While studying CRVD in post occlusion reactive hyperemia test the С therapy has also supported the improvement of endothelial function. Conclusion. 16-week С therapy, except BP normalization in various caliber arteries, improved structural-functional properties of the vessel wall.

Aim. To study the influence of the two basic load types, aerobic exercise (AE) and resistant with weights (RW), on the course of atrial fibrillation, on echocardiographic, structural and functional parameters of the left ventricle and left atrium and on the frequency of atrial fibrillation (AF) onsets. Material and methods. We performed controlled study in 102 patients (45 women) with AH at the age 56±9 years with sinus rhythm and at least one known episode of AF. The patients were randomized to three groups for AE on thread-mill (n=34), for RW (n=34), and controls without any load (n=34).

Results. As the study has shown, both types of load significantly improved structural and functional parameters of the left ventricle and atrium, and reduced the frequency of onset of AF comparing to controls. However, in 6 months of regular exercise the RW group had better diastolic function parameters of the left ventricle and the left atrium, and did not have any episodes of AF comparing to AE and controls. Systemic pressure and systolic parameters of the left ventricle did not differ in groups.

Conclusion. Adherence in RW was better than AE group. Aftereffect in patients who stopped training was more significant than in stopped AE patients, which presented with higher peak of oxygen consumption in 9-minute thread-mill test in these patients with RW. 

Aim. To evaluate the influence of antihypertension therapy that includes antidepressants, on the main parameters of structural and functional condition of the left ventricle (LV) myocardium in patients with non- controlled arterial hypertension (NCAH) and depression-spectrum disorder (DD).

Material and methods. Totally 160 patients included, with NCAH and DD, median age 58 (53-64) y.o., who were administered combination therapy that included angiotensin-converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. The patients were randomized into 2 groups: to the 1st group we added escitalopram (Selectra, Abbott Laboratories) as antidepressant, 10 mg/ day; to the 2nd group — calcium channel antagonist (CA) amlodipine 5-10 mg/day. All patients at the baseline and in 6 months underwent ambulatory blood pressure monitoring (ABPM), echocardiography, DD diagnostics with the Tsung and HADS scores.

Results. After 4 weeks of treatment the therapy that included antidepressant led to the decrease of BP to target levels in 52,6% of patients, in CA — in 24,4%, and in 24 weeks of treatment there was comparable number of target reached patients in both groups. Comparative analysis of cardioprotection action of combination antihypertension therapy showed that in the usage oif antidepressant, as in CA usage there was comparable regression of hypertrophy and diastolic function of LV myocardium. With the treatment, in the 1st group there was increase of patients with normal geometry of the LV by 54,7%, and in the 2nd group — by 52,4% (p<0,05). In the 1 and 2 groups we saw the increase of those with normalized diastolic LV function: to 68,8% and to 65,1%, respectively (p<0,05).

Conclusion. Addition of escitalopram as part of combination therapy mediated a significant antihypertensive effect, a little overcoming the treatment with amlodipine addition. Usage of tetracomponent therapy in combination of HADS and DD led to significant and comparable regression of structural and functional changes of the LV myocardium, that can be utilized for optimization of arterial hypertension control in this category of patients.

Aim. To study the specifics of relation between hemostasis parameters and functional activity of neutrophil granulocytes in sensitive and resistant to acetylsalicylic acid (ASA) patients with acute coronary syndrome.

Material and methods. Totally 53 patients included during the first 24 hours of ACS. Controls consisted of 50 relatively healthy individuals. All patients before the treatment and revascularization were assessed for the resistance to ASA, and selected into groups of sensitive (AS) and resistant (AR). Sensitivity test was done in vitro. In all participants the coagulation and platelet clotting systems were studied. With the luminescent method the neutrophil activity was assessed. Results. In AR with ACS there was decrease of platelets in blood, decreased level of ADP- (ADP 5 mcM) and adrenalin-induced aggregation, increases the level of ADP-induced platelets aggregation (PA) with ADP 0,1 mcM, and von Willebrand factor level. In the ASA sensitive patients there was a decrease of adrenalin induced aggregation.

There were no specifics of coagulation hemostasis according to ASA sensitivity. Chemiluminiscence (CL) of neutrophils in ACS has a maximized out time. In AR there was decrease of activation. In AS functional activity of neutrophils more significantly correlates with the parameters of clotting, but in AR — with fibrinolytic and anticoagulation parameters.

Conclusion. In ACS patients depending on ASA sensitivity, there are character specifics of platelet clotting: increase of ADP-induced aggregation in AR, decrease of platelet amount and the level of von Willebrand factor. In ACS patients there is a decreased velocity of "respiratory boost" in neutrophils. In AR there is more prominent dysbalance of coagulation hemostasis and "respiratory boost" of neutrophils, with the decrease of neutrophil reactivity related to clotting activity and appearance of relations with the parameters of fibrinolytic and anticoagulation activity.

Aim. The evaluation of the prominence of subclinical nonspecific inflammation in men and women with ST-elevation myocardial infarction (STEMI) with different one year outcomes.

Material and methods. Totally 223 patients with STEMI included — 56 (25,1%) women, 167 (74,9%) men. At 10-14 day of hospitalization we checked inflammation factors: interleukins (IL) — 1а, 6, 8, 10, 12, С-reactive protein, tumor necrosis factor, neopterin. In the assessment of inflammatory reaction severity in men and women each group was assessed in general, and further was spread by the age: <65 y.o. and >65 y.o.

Results. In assessment of the combination endpoint it was found that more significantly vascular events developed in women and made up 47% cases, but in men just 33% (р=0,001). Selecting the patients by age-relevant subgroups it was shown that in the age <65 y.o. women had more frequent vascular episodes, than men in this age: 50% (n=20) and 26% (n=89), respectively (р=0,000). In analysis of the IL-12 it is shown than women, comparing to men have this parameter higher in negative as in positive outcome: in positive prognosis 1,4 times higher (р=0,019), and negative prognosis — 1,6 times (р=0,045). In neopterine analysis, depending on combination endpoint it was found than in men with negative outcome the level of neopterin was significantly higher — 17,41 (9,52; 20,90) nmoles/L, than in men with positive outcome — 10,80 (6,53; 10,91) nmoles/L (р=0,000).

Conclusion. Negative prognosis in women with STEMI is associated with the increase of IL-12 by 10-14 day, in men — neopterin. Key words: myocardial infarction, pro-inflammatory markers, gender specifics.

Aim. To assess the levels of serum fibrosis marker (galectin-3) in patients with metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD)

Material and methods. Totally 76 patients included, 43 with MS, of those 72,1% had the NAFLD diagnosed; 33 patients without MS and NAFLD (controls), mean age 61±12 y. The complex investigation was done, incl. the levels of galectin-3 measurement. Results. Mean level of galectin-3 in MS group was significantly higher than in controls (р=0,006). Left ventricle myocardium hypertrophy (LVH), chronic heart failure (CHF) were diagnosed significantly more frequently in MS group (р<0,05). Mean values of galectin-3 statistically more significantly higher were in CHF (р<0,05). Mean volumetric fibrosis fraction in interventricular septum was significantly higher in MS group than in non-MS (р<0,001). Of MS patients 72,1% had NAFLD. There were positive correlations of galectin-3 and the following: LVH (r=0,30), CHF (r=0,35), coronary heart disease (r=0,34), heart fibrosis fraction (r=0,24), liver steatosis (r=0,43) pancreas steatosis (r=0,24), NAFLD fibrosis score (r=0,30),— all р<0,05.

Conclusion. The study revealed correlations of the level of galectin-3 and the conditions closely associated with MS — LVH, CHF, fraction of heart fibrosis, liver and pancreas steatosis. In all MS patients the galectin-3 values were significantly higher that can be regarded as the witness of more prominent fibrosis of the heart and the liver. Serum fibrosis marker (galectin-3) might be promising molecule for assessment of the patient condition in MS and be used as an additional criteria for diagnostics of cardiovascular catastrophes and, probably, of liver pathology — NAFLD. 

Aim. To compare, in what extent are the patients with atrial fibrillation (AF), included into three large randomized clinical trials (RCT) of the new oral anticoagulants (NOAC), comparable with Russian patients with AF. Material and methods. We revealed the results of the published Russian registries showing clinical and anamnestic data on the patients with all types of AF. The research done with the contents of journals and the list of Russian epidemiological studies in cardiology. Totally 6 papers selected that match with the requirements of contemporary registry. Results. Patients included into RCT, differ by the severity of the disease. In RELY-AF and ARISTOTLE study patients were quite similar, however ROCKET-AF was significantly different by the severity of included patients diseases. Of 6 selected Russian registries, two were outpatients (RECVAZA-Ryazan and RECVAZA-Yaroslavl), two registries of specialized units (PROFIL and the registry based on the FMSVU), and acute myocardial infarction (LIS-1) and stroke (LIS-2) registries. These patients are the most similar with those included into ROCJET-AF. However, by the range of parameters that characterize the severity of pathology, they even worse comparing to those with ROCKET-AF. The patients included into FSMSU registry and PROFIL are more relevant to those included into RELY-AF and ARISTOTLE.

Conclusion. Currently there are no large registries of AF in Russian Federation. In general, the Russian "portrait" of AF-patient has worse course of the disease, which those included to RCT: ROCKET-AF, RELY- AF and ARISTOTLE, that makes it very important to implement the data obtained in these three large-scale RCT in Russian population with care. 

The article focuses on the modern approaches to evaluation of stress- induced changes in cardiovascular system in young people, regularly participating in sports. The problem of early and achievable diagnostics is highlighted, as by the experience of some abroad experts. Based upon literary data on the risk stratification of life-threatening conditions development in adult athletes and upon our own clinical experience we propose the original approach to diagnostics of desadaptational changes in cardiovascular system of adolescent sportsmen. The fundamentals for more relevant confirmation of stress-induced cardiomyopathy are provided, including non-proved sportsmen withdraw.

Aim. To assess the influence of dynamic and static exercises on the parameters of intracardiac hemodynamics and physical endurance in higher-level sportsmen.

Material and methods. Totally, 136 sportsmen studied all males. Higher- level (qualified) sportsmen (groups of sports perfection and higher sports mastery) — 116 persons (mean age 22,07±4,10 y.; sports experience 5-15 years) depending on the type of activity were selected into groups as following: I (n=30) — wrestling, judo, II (n=27) — ski racing, biathlon, III (n=33) — powerlifting, IV (n=26)—volleyball. Group V (n=20) — controls (age 17,95±1,55 y.), with the experience not higher than 3 years. Investigation methods: electrocardiography, echocardiography (EchoCG), veloergometry. Results. By the data of ECG the parameters of intracardiac hemodynamics in sportsmen of all groups were in the normal range. There were significant differences found for the geometry of the heart between control group and higher-level sportsmen, and the controls had lower morphostructural parameters. In highly dynamic kinds of sports (ski racing, biathlon) the morphostructural changes are related to the increase of volumetric parameters of the left ventricle. Intensive static and low dynamic load in power kinds of sports (powerlifting) lead to the increase of myocardial mass, caused by thickness of the left ventricle walls. The highest values of the level of physical endurance and maximum oxygen consumption were in biathlon and ski racing sportsmen who train endurance. Conclusion. Study of the influence of dynamic and static physical exertion on the parameters of intracardiac hemodynamic, morphostructure of the heart and physical endurance is of definitive importance for the evaluation of cardiovascular adaptation potential in higher-level sportsmen. Depending on the type and intensity of the exertion adaptation mechanisms have their specifics. The obtained data can be used for on-time correction of the training regimens and for management of training-competition process in sportsmen of various kinds. That means, EchoCG and veloergometry must be included into the list of obligatory diagnostic methods that fulfill systemic dynamic control of cardiovascular system parameters in the highest achievement sportsmen, that has special significance for revealing of the signs of desadaptation and overtraining in longtime sports involvement.

Aim. To study the values of cardial-ankle vascular index (CAVI) in healthy persons of various age by the data of multicenter epidemiological study "Epidemiology of cardiovascular diseases and risk factors in Russian Federation" (ESSE-RF) in Kemerovskaya Region (KR). Material and methods. The study was conducted on random population selection of adult males and females, age 25-64 y.o. Study was performed in March-October 2013. Final selection consisted of 1610 persons. In 1595 we did the measurement of peripheral arteries rigidity with CAVI by the device VaSeraVS-1000 (Fukuda Denshi, Japan). For the measurement of normal CAVI we collected a group of healthy volunteers — 190 (11,7%) persons.

Results. Among the whole cohort, CAVI was in reference range: 7,1 (6,4; 8,0). In healthy persons CAVI was lower — 6,7 (6,1; 7,4), than in general population. In analysis of CAVI within different age groups among healthy persons, CAVI was much higher in men than in women. Though different age groups CAVI increased from 6,2 at the age 21-30 y.o. to 7,8 by 61-70 y.o., grade of increase was 25,8%. In older age group, there was more rapid increase of stiffness index. The highest correlation of CAVI among participants was with the age (r=0,402; р<0,001), and with the values of systolic and diastolic arterial pressure (BP) — r=0,348; r=0,368; resp., (р<0,001), smoking duration — r=0,494 (р<0,001) and blood creatinine level — r=0,198 (p=0,006).

Conclusion. The values of CAVI in healthy persons by the data from population study ESSE-RF in KR were 6,2 to 7,8 in various age groups. There was linear increase of CAVI every 10 years by 28%. Except the age, CAVI correlated with BP, smoking duration, cholesterol and creatinine levels. The results of this study can be included into CAVI evaluations in screenings, and for formulation of normal values for Russian population.  

Aim. Analysis of the prevalence of cardiovascular diseases and risk factors depending on occupation.

Material and methods. Under the multicenter epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Russian Federation) the questioning performed and 1627 persons investigated in Kemerovo Region at the age 25-64 y.o. Two comparison groups were created: employed (n=1214), unemployed (n=413). The data obtained on the occupation and cardiovascular risk factors: smoking, alcohol consumption, obesity, cholesterol level, lipoproteids, glucose, anamnesis of cardiovascular diseases and real presence of arterial hypertension, ischemic heart disease (IHD) by Minnesota criteria, and angina pectoris by Rose score. In statistical processing, with the aim to relieve age differences of the groups we standardized by the age via direct method, and in regression analysis there was a parameter "age".

Results. In employed men there was statistically significant lower prevalence of smoking — among workers 40,2%, unemployed 52,6% (p=0,011). CHD in anamnesis in 5,4% and 11,9%, resp. (p=0,0047), arterial hypertension — 47,9% and 57,1%, resp. (p=0,043), angina by Rose score — 5,3% and 13,6%, resp. (p=0,00001), CHD by Minnesota code — 5,0% and 9,2%, resp. (p=0,048), CHD by 3 epidemiological criteria — 9,4% and 20,4%, resp. (p=0,00020). In women employment was related to lower prevalence of smoking — 15,4% among workers, 22,4% — unemployed (p=0,038) and CHD by Minnesota code —5,4% and 9,6%, resp. (p=0,019). Occupational status for men leads to the decrease of arterial pressure by 3,4 mmHg in average (p=0,051), increase of total cholesterol concentration by 0,231 mmol/L (p=0,041), and in women — increase of HDL by 0,135 mmol/L (p=0,0024).

Conclusion. Better cardiovascular health do have employed people comparing to unemployed: tendency is stronger in men. The results reflect common tendency of the higher level of health among employed young inhabitants comparing to unemployed.  

Noncompacted myocardium of the left ventricle (NMLV), or noncompacted cardiomyopathy, according to the World Health Organization classification is a non-classified cardiomyopathy with not fully known origins. This type of cardiomyopathy presents with an increased trabecularity with deep intertrabecular sinuses in the LV. NMLV exists as either isolated or together with other inherited syndromes. Clinical presentation of NMLV varies: there are asymptomatic forms, or those with progression of the disease, with heart failure, angina, thromboembolism, life-threatening ventricular rhythm disorders; in some cases, the disease manifests as sudden cardiac death. At the same time, there is a problem of NMLV decompensation, with significant impact of acute myocarditis comorbidity. The article presents a case of the female patient, whose disease presented with heart failure at the background of acute myocarditis and further onset of everything for NMLV.

The importance of adipose tissue is much greater than it has been expected. Adipose tissue is a large endocrine organ, value of which is difficult to overestimate. Its work influences a lot of metabolic disorders, cardiovascular pathology. Recently, there is active research on the relation of obesity and microbiota contents. It is studied depending on the food type, physical activity, and microbiota itself might influence the absorption of nutrients, permeability of the gut wall, and appetites. The article is focused on several mechanisms of interrelation of gut microbiota and obesity, on the results of last years studies.

Cardiovascular diseases (CVD) play leading roles among the main causes of death around the globe. In 2009 the American Heart Association developed the Model of Cardiovascular Health (CVHealth) and implemented the meaning of an "ideal", "average" and "poor" CVHealth. In assessment of CVHealth there are 7 parameters: glucose level, cholesterol level, blood pressure, smoking cessation, body mass index, physical activity and healthy food. After creation of this model, there were studies of its efficacy, and efficacy of the prevention procedures. It was revealed that the prevalence of an "ideal" CVHealth is very low, <1%, and it is necessary to pay attention to these "ideal" parameters that might be a strong predictor of morbidity as mortality from CVD. Therefore, the implementation of this score can affect positively the morbidity and mortality from CVD, by development of procedures for healthy life style in children, adolescents and youths, as for an increase of sensitivity of the people to the meanings of healthy life style.