Aim. To analyze,  how is, under  the  framework of the  Pilot Project, organized and being conducted  the improvement of work of the known departments in exact medical institutions (MI) of RF for rehabilitation of cardiovascular  diseases (CVD) patients  at the  three  steps  under  the current “Order of medical care and medical rehabilitation”, and how do the scientifically proven and types and methods  of cardiorehabilitation (CR) being implemented,  and to try to elaborate  on an exact algorithm for patients course.

Material and methods. Into the Pilot Project, 17 MI included, from 13 entities of RF. For the analysis of effectiveness of organizational models of CR in MI the unified charts were developed making to assess the equality to the  Order  of the  rehabilitation care  provided to patients  with CVD, of multidisciplinary team  involved in care,  the staff list and MI equipment. Specific charts included the units assessing the efficacy of work on three stages of CR: I stage — in resuscitation and intensive care unit or specialized cardiology department, II — in in-patient department, III — in polyclinics. The article presents data from CR analysis of Jan 2013 to Dec 2015. Results. The CR was organized at the stage I in 10 MI, stage II in 10 MI and stage III in 7 MI. By the year 2015, almost in all MI the multidisciplinary teams   were  shaped,   including  cardiologist,  cardiorehabilitologist, exercise specialist, clinical psychologist, physiotherapist; the rooms for exercise were equipped, as the halls for education of patients. The start of rehabilitation process  from ICU made it to decrease the remaining of patient on the bedside for 0,7 days in average (2013-2015) and for 1 day in cardiovascular department. About 67% myocardial infarction patients in average  were transferred  to the stage  II of CR. In all MI there  were educational  Schools  organized,  and  the  explanatory  talks  with the relatives were done as well. By now, the project is on its way. Conclusion. The analysis of three-staged CR system  for myocardial infarction  patients   according   to  current   laws,  showed  significant improvement  of  rehabilitational  activeness   of  the  newly  created multidisciplinary teams  at all stages  of CR, increase  of the number of methods  of CR and  better  fulfillment of those,  as  demonstrated the safety of proposed  principals of physical rehabilitation according to the Russian  clinical guidelines  “Myocardial infarction with ST elevation: rehabilitation and  secondary  prevention” under  the framework of the organizational model of CR.

Aim. To study the clinical course and outcomes  of myocardial infarction (MI) in diabetes  mellitus patients  (DM) and  non-diabetic,  underwent percutaneous coronary intervention (PCI).

Material and methods. Totally, 99 MI patients included, that underwent PCI with stenting. Patients were selected to 2 groups by absence or presence of DM: group 1 (n=49) — DM type 2; group 2 (n=50) — non-diabetic  and glucose intolerance. We studied the baseline clinical and demographic,  as laboratory and instrumental characteristics of patients, specifics of in-patient stage of treatment and outcomes in 1 year after discharge.

Results.  There  was  predominance   of  women  in DM2 group  and developing MI. It was found, that DM patients  adhered  the preclinical treatment  of ischemic heart disease  in 47% cases  and about 20% DM patients  did not take  glucose  lowering medications.  In patients  from group  1  the  arterial  hypertension  was  diagnosed  significantly more commonly in comparatively lower values of the left ventricle ejection fraction. More commonly than the other complication of MI, the acute heart failure developed (14%). By the end of the 1 year, DM patients nonsignificantly more  commonly  had  recurrent   hospitalizations  for  all cardiovascular causes, as the cases  with fatal outcomes.

Conclusion. The course of MI in DM has its specifics as comparatively lower values of myocardium contractility, significant lesion of coronary vessels, high number of acute period of MI complications with indefinite influence on the one-year prognosis.

Aim. To evaluate the effectiveness of fixed combination of perindopril arginine and amlodipine besilate (Prestans®, Les Laboratoires Servier) in optimal treatment scheme selection of arterial hypertension (AH) in patients with chronic heart failure (CHF) having the signs of chronic kidney disease (CKD).

Material and methods. Totally, 118 patients studied, with essential AH, with CHF. In 53 (44,9%) of those, thre were signs of CKD. The latter presented with a decreased glomerular filtration rate (GFR) and increased cystatin C in the blood plasma (1,4+0,3 mg/L). As the treatment, they were prescribed the fixed combination of perindopril arginine and amlodipine besilate—5/5, 5/10, 10/10 mg. The assessment of treatment was done in 2 months follow-up.

Results. During treatment there was significant decrease of office systolic and diastolic blood pressure (BP). Target BP was reached in 82,6% cases. The mean daily values of systolic and diastolic BP load became lower. During the treatment, there was improvement of clinical condition by functional class of CHF. The score by CAS decreased from 6,2+1,1 to 4,2+1,3 (р<0,01) and exercise tolerance increased: six-minute walking test distance from 160,4+14,5 to 307,14+13,1 m (р<0,01). Also, the level of cystatin C decreased in plasma, and GFR increased, witnessing the improvement of functional capacity of kidneys as a result of treatment.

Conclusion. The fixed combination of perindopril arginine and amlodipine besilate can be successfully applied into treatment of AH and CHF patients with the signs of CKD.

Aim. To compare  efficacy  of bisoprolol  and  nebivolol treatment   in ventricular arrhythmias patients (VA) and arterial hypertension (AH) and/ or  ischemic  heart  disease   (IHD) taken  its  influence  on  regulatoryadaptive state (RAS).

Material and methods. Totally, 60 patients  participated  with VA  of Lown I-IV grades,  Bigger II-III grades,  at the background  of AH II-III stage  and/or  IHD, who were randomized  to 2 groups  of treatment: bisoprolol 6,5±1,8 mg daily or nebivolol 6,5±2,1 mg daily. As combination  therapy,  lisinopril was  used   12,3±4,0  mg  daily and 13,7±4,5   mg/daily,  acetylsalicylic  acid  92,3±18,8   mg/daily  and 92,9±18,2 mg/daily, atorvastatin 16,3±4,8 mg/daily and 16,5±4,7 mg daily together  with bisprolol or nebivolol, respectively. At baseline and in 6 months of therapy we performed: quantitative RAS assessment via the test of cardio-respiratory  synchronicity, echocardiography, triplex scanning of brachocephalic  arteries,  tredmill, six minute walking test, 24-hour blood pressure monitoring and ECG monitoring, self-assessed life quality.

Results. Both  regimens  of  combination  therapy  comparably  same improved structural and functional state  of the heart, decreased blood pressure, effectively suppressed ventricular arrhythmia. However, only nebvolol positively influenced RAS, better improved exercise tolerance and improved life quality.

Conclusion. In VA patients with AH of II-III stages  and/or IHD, usage of nebivolol, comparing  to bisoprolol, as  combination therapy,  might be more preferrable due to positive influence on RAS.

Aim. To assess the factors associated with combination cardio protection therapy intake in patients with atherosclerotic lesion of lower extremities. Material and methods. Totally, 436 patients studied: 372 (82,3%) males and  64 (14,7%) females  at the age  45-81  (mediana  63) year old with obliteration  atherosclerosis of lower extremities  >50%.  Patients  were investigated under the framework of the registry in Kemerovo cardiological center in 2009-2013 y. The study included a dynamic follow-up of vascular surgeon and cardiologist, instrumental and laboratory investigation. Depending on the regularity of cardioprotection  therapy, two groups were shaped:  group 1 (n=226) taking full combination cardioprotection therapy: antiplatelets,  inhibitors of angiotensin-converting  enzyme or angiotensin receptor blockers and statins, group 2 (n=210) did not take at least one of the listed drug groups.

Results. The intake of combination  cardioprotection  therapy  was associated with higher prevalence  of arterial hypertension (95,1%), myocardial infarction (46,5%), coronary bypass  and percutaneous coronary intervention (21,1% and 32,3%, resp.), as interventions on extracranial arteries  (12,8%). Patients  from this group had angina presentation    more   often   and   the   diagnosed    coronary   heart disease  — 68,1%  and  83,2%,  resp.  Almost 60% of patients  with adequately  prescribed  treatment  were followed-up by cardiologist. In laboratory  data  of  this  group  there  was  lower  level  of  total  cholesterol. Patients had significantly larger left ventricle and lower ejection fraction.

Conclusion. The factors associated with optimal medication treatment were ischemic heart disease (p<0,001), cardiologist follow-up (p<0,001), decrease of total cholesterol (p=0,02). To increase the effectiveness of secondary prevention in obliteration atherosclerosis of lower extremities it is worthy to apply novel organizational approaches  during outpatient period, particularly, dispensary follow-up in cardiologist practice.

Aim.  The  research  on  medical  technologies   for  optimization  of complication prevention and of post-surgery management of patients with coronary heart disease  (CHD) with ejection fraction (EF) of the left ventricle (LV) <40% in surgical revascularization of the heart.

Material and methods. In the controlled, randomized study of 103 CHD patients with severe systolic dysfunction of the LV, the effectiveness  of aortic  coronary  bypass  surgery  was  studied.  All  patients  underwent clinical investigations,  where  the  severity of patient’s  condition  was assessed, as the risks of surgery by EuroSCORE, severity of heart failure signs  by the  clinical condition  scale,  echocardiography, clinical and chemistry lab. Aldosterone levels were studied  with immune enzyme assay,  brain natriuretic peptide  — with immune enzyme assay,  redox potential (NAD/NADP) with the Sigma-Aldrich system, procollagen III of N-end peptide — with the test-system USCN, Statistics was done on the software Statistica 8.0.

Results. The inclusion to pre-operation  preparing of patients  of a drug with positive inotropic properties  and decreasing the level of systemic inflammation syndrome, dosage of 2 ampules intravenously during 3 days before operation and with following 7-day post-surgery, in CHD patients with significant LV  dysfunction  influences  positively the  symptoms  of chronic heart failure, initiates the deremodeling of the heart — significantly decreases the end-systolic size and increases EF LV, reduces  pulmonary hypertension, significantly decreases the duration of artificial ventilation, timing of inotropic support, duration of stay in ICU. It is shown that the level of brain  natriuretic  peptide  (NT-proBNP) in plasma  does  negatively correlate  with EF LV (r=-0,69,  p<0,01)  and redox-potential  NAD/NADP (r=-0,89; p=0,0001). At the background of Adenotsin® treatment there is significant decrease of NT-proBNP level by the 7th day after operation by 55%, the level of renin decreases, of aldosterone  and procollagen type III in blood, that confirms the positive prognosis of treatment.  There are no negative events in the drug course of implication for the studied category of patients.

Aim. To assess the relation of obstructive sleep apnea syndrome (OSAS) by the data of Berlin questionnaire and risk of fatal cardiovascular events. Material and methods. Totally, 275 persons  studied (115 males, 160 females)  age  25-64 y.o., with unknown cardiovascular  complications, underwent structured  interview. The risk of sleep-disordered breathing was assessed by Berlin questionnaire, cardiovascular risk — by SCORE. Anthropometric  parameters  were  studied,   as  lipid profile,  fasting glucose, uric acid, creatinine, C-reactive protein, adiponectin, leptin.

Results. The increased  OSAS risk according to Berlin questionnaire was found in 7,3% of the studies. Most (90,0%) common was concomitance of the  components   of OSAS such  as  snoring/stops of respiration  and cardiometabolic disorders. Males more frequently complained on snoring/ stops of breathing — 21,7% vs 6,3% (p=0,001), that determined  higher general risk of OSAS among them comparing to women — 11,3% vs 4,4% (p=0,03).  For males  (1,7%)  and  females  (3,1%)  the  complaints  on daytime sleepiness were less common. Among those 40 y.o. and older the increased  risk of OSAS was found in 9,8%, comparing to 1,2% younger than  40  y.o.  (p=0,01).  In higher  OSAS risk there  was  higher  total cholesterol  — 6,10±0,18  vs 5,53±0,09  mM/L (p=0,05) and low density lipoproteides — 4,17±0,19 vs 3,59±0,08 mM/L (p=0,02); they were more often overweight — body mass  index 31,73±1,19  vs 27,71±0,38  kg/m2 (p=0,001),   and   had   higher  systolic  pressure  —  134,89±4,96   vs 126,72±1,18  mmHg. (p=0,04) and diastolic pressure — 84,26±2,69  vs 78,55±0,80  mmHg (p=0,03).  Respondents with higher  risk of OSAS regardless the  gender,  did not differ by SCORE. While determine  the specific combinations of OSAS components, there was no independent significance of snoring/respiration  pauses  and daytime sleepiness  in the total cardiovascular risk by SCORE.

Aim. To assess the  relation of polymorphism of the  genes  APOC3, PON1, AGT, AGTR1 and psychovegetative disorders in young, relatively healthy persons.

Material and methods. Totally, 75 healthy volunteers included, white race, aged 20-25 y.o. Psychovegetative status was assessed with tests for panic  attacks  revealing,  anxiety level assessment,  as  with the questionnaire  for vegetovascular  dystony. The inclusion criteria was organic  pathology  of  cardiovascular  and  central  nervous  system. Genes polymorphism was identified with the method of pyrosequencing of  desoxyribonucleic  acid  with  the   genetic   analysis  equipment “PyroMark Q24”

Results. The presence of vegetovascular  dystony, panic attacks  and increased  level of anxiety was mostly associated with the presence of T polymorphism -482 C>T gene APOC3, allele М polymorphism L55M А>Т gene PON1 and allele А — polymorphism А1666С А>С gene AGTR1. Conclusion. There is relation of genes  polymorphism playing role in lipids metabolism and arterial pressure regulation, with psychovegetative status of the young, relatively healthy persons.

Aim. To study the nosological structure and mortality dynamics of adult population from cardiovascular diseases (CVD) by nosological and agerelated regards.

Material and methods. The study uses  the data  from Rosstat  on the population in general, mortality in yearly age groups according to the causes of death based on the Brief list of fatal outcomes of Rosstat. During analysis the nosological structure  of fatal cases  from CVD in 2006 and 2014 was assessed, part of the each of cases  of death defined in the total number of adults died and in mortality values from CVD in 5-year age groups.

Results.  The significant decrease of mortality from CVD was found, related to the improvement of organization and of quality of medical care.

Simultaneously  conducted   analysis  of  structure   and  parameters of mortality witness the problems of comparison of mortality from different causes of from combination of causes.

Conclusion. There is necessity in review of clinical and anatomic criteria of cardiological diagnostics.

The review presents with the  literary data  on the  prevalence  of risk factors (RF) of cardiovascular diseases among inhabitants of rural areas comparing  to citizens from the point of view explaining the mortality gradients  between  rural and city inhabitants  in many countries  in the world. It is shown that gradients of RF prevalence among rural inhabitants and  citizens are  oppositely  directed  and  might change  with time. In Russia in general the profile of RF among rural inhabitants is less benign comparing  to citizens, that may explain mortality gradient.  This issue demands  further investigation.

Recently, there is a lot being done for optimization of care in pulmonary embolism (PE), however there is no significant decline in mortality and its structure  within this  pathology.  Epidemiological data  on  PE remain unknown due to difficulties in diagnostics,  however the data has been collected, witness for the low levels of diagnostics of this pathology, but not rareness of its development.

Based on the Regulation of the Ministry of Health from 29.12.2012  № 1706 (ed. from 13.02.2013) in the regions, there are schemes for routing of patients  with one or another  nosology, that are the administratively proven order of direction with a detailed explication of all movements related  to medical care.  Hence,  the  routing of an exact  patient  is a process  of an optimal route of scheduled events for quality medical care with minimal time and financial expenses. Under framework of 3-level system of medical care, the order for PE patients is not yet established. However, it is  known that  in this  category  of  patients  an  on-time verification of  PE  and  start  of  adequate  treatment   do  determine prognosis.  Therefore,  the optimal organization of routing for patients with suspected PE does  determine  a course  of disease  and might, in many cases, prevent fatal outcome. This article focuses  on the optimal routing of patients with suspected PE.

The cumulative impact  of the  so  called  “reversible” risk factors  into development  of chronic heart failure (CHF) is significant even with no significant myocardium injury. According to current view, mechanism of the  complex  multiorgan  involvement does  define  the  high  level of mortality among patients with acute decompensation, demanding of the necessity of holistic approach to prevention and treatment of CHF. Taken that the main expenses on treatment of a one taken patient with CHF are mostly on  in-patient  management, decrease  of hospitalization rates does  have two reasons. It makes to improve not just a stability of the disease, but wil improve life quality of severe condition patients significantly decreasing the expenses on their management.

Arterial hypertension (AH) is a serious medical and social problem due to its complications leading to disability. Recently, there is a lot of attention paid to markers evaluation for cardiovascular pathology — endothelial dysfunction,  arteries  elasticity decline,  increased  pulse  wave velocity (vascular  wall stiffness)  and  studying  of  an  influence  of  various antihypertension  treatments. Current  article  focuses  on  the  modern influences on remodeling of vessel wall in AH and opportunities  of its pharmacological   correction   with  angiotensine   converting  enzyme inhibitors, calcium channel blockers and beta-blockers as monotherapy and combination.