Aim. To assess the effects of external muscular counter-pulsation (MCP) in early post-operation period among coronary heart disease (CHD) patients, who underwent coronary aortic bypass graft (CABG) surgery.
Мaterial and methods. 47 CHD patients (all males, functional class of angina 3.4±0.08), after on-pump CABG, were divided into two groups. In the main group (n=29), starting at Day 1-2 after CABG, standard therapy was combined with MCP course (CardioLa device, Switzerland). Control group (n=18) was observed according to standard protocol. The methods used included echocardiography (EchoCG) and tetrapolar thoracic impedancometry at rest.
Results. MCP facilitated normalization of central and peripheral hemodynamics, disturbed due to on-pump intervention. In main group, stroke volume (р<0.002), stroke index (р<0.003), minute volume (р<0.0001), cardiac index (р<0.0001) and total ejection fraction (р<0.0001) increased, according to EchoCG at rest, and total peripheral resistance decreased, according to tetrapolar thoracic impedancometry results, comparing to control group. The number of post-operation days at the hospital was significantly lower in main group, comparing with controls (р<0.0001).
Conclusion. MCP is highly effective for stabilization and improvement of central and peripheral hemodynamics in early post-CABG period.

Aim. To assess effectiveness of rilmenidine treatment in arterial hypertensive (AH) patients with cerebrovascular transient ischemic attacks (TIA).
Material and methods. The study included 39 patients with Stage I-III AH, combined with TIA: 6 males and 33 females; mean age 47±2.7 years. At baseline and after 4 weeks of rilmenidine monotherapy (1 mg/d), 24-hour blood pressure monitoring (BPM) was performed; beta-adrenoreceptivity of red cell membranes (b-ARM) was measured; psychological status and quality of life (QoL) by DISS (Disability Scale) were assessed.
Results. According to 24-hour BPM results, rilmenidine therapy was associated with statistically significant (р<0.01) antihypertensive effect in Stage III AH patients. In participants with Stage I-II AH, circadian BP profile (BP CP) was normalized without statistically significant BP decline. At baseline, b-ARM was increased in all patients, that could be regarded as a sign of enhanced sympatho-adrenal activity. Rilmenidine (1 mg/d) substantially reduces hypersympathicotony, manifested in b-ARM decrease during the therapy. QoL also significantly improved during rilmenidine therapy (р<0.01).
Conclusion. Rilmenidine reduced BP level, benefited BP CP, decreased sympathicoadrenal system activity, and improved QoL in AH patients with TIA.

Aim. To study the role of cardiovascular disease (CVD) in family history regarding coronary heart disease (CHD) prevalence.
Material and methods. In total, 1131 males and 1015 females aged 40-59 years, selected from non-organized Tashkent population, were examined. All participants had informative family history. The authors used standard survey methods and unified criteria for epidemiology data assessment.
Results. CHD was significantly more prevalent in males (10.6%) and females (12.3%) with CVD in family history, comparing to their peers with no CVD in family anamnesis (5.6% and 7.3%, respectively). In the former, mean blood pressure levels were significantly higher, as well as the prevalence of 3 and more risk factors and/or target organ pathology, than in their peers with no CVD-affected relatives.
Conclusion. In the population studied, people with CVD in family history could be regarded as a CHD risk group.

Aim. To study right ventricular (RV) geometry and analyze clinico-pathophysiological processes, associated with right heart remodeling in coronary heart disease (CHD) patients.
Material and methods. The study included 184 CHD patients, who underwent dobutamine stress echocardiography (EchoCG).
Results. In CHD patients, structural and functional abnormalities of right heart chambers were registered: RV dilatation, dysconfiguration (increased ratio of RV transversal to longitudinal size), right atrium (RA) dilatation, tricuspidal valve fibrotic annulus distention, associated with tricuspidal insufficiency, and RF systolic function decrease. Among pathogenetic factors of right heart remodeling, there were: left heart function, mitral insufficiency, RV ischemic myocardial dysfunction, interventricular septum function.
Conclusion.RV function determinants and right heart remodeling mechanisms are complex and multifactorial. This study analyzed regional RV geometry in various categories of CHD patients, and pathogenesis of right heart remodeling.

Aim. To assess safety and efficacy of minimally invasive myocardial revascularization (MIMR) in coronary heart disease (CHD) patients with left coronary artery (LCA) trunk pathology.
Material and methods. Forty-six CHD patients (41 males, 5 females) with LCA trunk pathology, who underwent offpump coronary aortic bypass graft (CABG) surgery, were examined. Mean age of the patients was 58.7±2.5 years, mean CHD duration – 53.9±11.3 months.
Results. Off-Pump Coronary Artery Bypass surgery is effective in CHD patients with LCA trunk pathology. It provides good results during in-hospital treatment, and is associated with low intra-operational risks.
Conclusion. CHD patients with LCA trunk pathology require special attention at all levels of treatment. MIMR is effective and safe in this category of patients. It gives an opportunity to decrease CABG traumatic effects and is prospective for both patients and surgeons.

Aim. To assess diagnostic potential of contrast stress echocardiography (CS-EchoCG) with dipyridamole in coronary heart disease (CHD) patients.
Material and methods. The study included 22 patients (mean age 56.04±1.8 years) with typical CHD clinics. The results of traditional S-EchoCG and CS-EchoCG with dipyridamole were compared with coronaroangiography (CAG) data.
Results. Both methods of EchoCG visualization were highly informative for topic diagnostics of coronary atherosclerosis – 91%, comparing with CAG results. CS-EchoCG had a number of benefits: sensitivity, specificity, and prognostic value, comparing to traditional S-EchoCG, were 95% and 75%, 95% and 86%, 50% and 91%, respectively. In CS-EchoCG, perfusion abnormalities were registered even with low dipyridamole doses. This allows to diagnose coronary blood flow disturbance before asynergic zones appear.
Conclusion. CS-EchoCG with dipyridamole was highly predictive in coronary insufficiency diagnostics. The results of CS-EchoCG and CAG were comparable.

Aim. To develop effective angiographic criteria for stable effort angina (SEA), caused by coronary atherosclerosis (CA), in patients with myocardial infarction (MI).
Material and methods. The study included 49 patients with proven MI in anamnesis. In 29 participants, SEA was not verified by maximal stress testing (ST). In 20 patients, SEA was registered in ST: transitory myocardial ischemia was manifested in anginal pain and ST depression >200 mV. Selective coronary angiography (CAG) was performed in all patients.
Results. Two complex angiographic criteria for SEA, caused by CA, were developed. For the first one, specificity was 82.8±7.1%, sensitivity - no less than 95.5%: for the second one, specificity was at least 96.8%, sensitivity – 90.0±6.9%.
Conclusion. A system of CAG criteria was created, to diagnose CEA, caused by CA, in patients with MI in anamnesis. The diagnostic efficacy of the system was as high as 95.9±2.9%.

Aim. Clinical and functional prove for using of modified Novocain block of internal thoracic arteries during inpatient coronary heart disease (CHD) treatment.
Material and methods. In total, 117 CHD patients, males and females of 32-78 years, were divided into two groups. Group I consisted of 50 CHD patients receiving antianginal therapy. Group II consisted of 67 CHD patients, who received not only standard antianginal treatment, but also Novocain blocks of internal thoracic arteries (3 procedures with 2-3-day intervals). Treatment effectiveness was assessed by clinical and instrumental methods: electrocardiogram (ECG), late ventricular potential (LVP) registration, Holter monitoring, echocardiography (EchoCG), and color tissue Doppler EchoCG (TDE).
Results. Internal thoracic artery block improved patients’ status: angina episodes’ number and / or intensity decreased, workload tolerance increased, night sleep normalized. Besides, ST depression and LVP disappeared or reduced, autonomous cardiac regulation improved, QT interval and extrasystole number decreased, that cut the risk of fatal arrhythmias. The method improved the velocity of basal LV segment movement, according to TDE. This inexpensive method, included into complex CHD management, reduced mean hospitalization time by 7 days.
Conclusion. Novocain internal thoracic artery block might be a method of choice in complex treatment of resistant angina.

Aim. To study trimetazidine influence, as a part of complex long-term treatment of chronic heart failure (CHF), on functional heart and kidney status, as well as on quality of life (QoL) in elderly CHF patients.
Material and methods. Forty patients with clinically manifested CHF, functional class (FC) II-III, and myocardial infarction (MI) in anamnesis were randomized into two groups. Group I (n=20) received basic CHF therapy and trimetazidine (70 mg/d), Group II (n=20) - basal therapy only. Follow-up period lasted for 12 months. At baseline, 12 weeks later, and after the treatment, QoL was assessed by Minnesota Questionnaire, 6-minute walking test and echocardiography (EchoCG) were performed, CHF FC and functional kidney status were assessed.
Results. Additional trimetazidine therapy was associated with significant decrease in local myocardial contractility (LMC) index by the end of follow-up, comparing with Group II (0.9±0.34 vs 2.8±0.89, р<0.05). In Group I, CHF FC decreased more substantially, QoL, heart diastolic function and renal function were improved.
Conclusion. Adding trimetazidine to standard CHF therapy improved workload tolerance, QoL, systolic and diastolic heart function, LMC, and demonstrated additional nephroprotective effect in the elderly CHF patients.

Aim. To study efficacy and safety of propafenone (450 mg/d per os) in maintaining sinus rhythm among patients with persistent atrial fibrillation (AF).
Material and methods. The study included 200 patients with persistent AF, aged 39-68 (mean age 56.4±4.2 years), from 10 Russian regions. For AF paroxysm prevention, all patients received propafenone (Propanorm, 450 mg per os, 3 times per day) for 9 months.
Results. Propafenone (450 mg/d) restored sinus rhythm in 148 patients (74%) after one month of treatment, in 122 (61%) after 3 months, and in 90 (45%) after 9 months. Propafenone was effective and well tolerated: during 9-month therapy, only 8 patients (4%) complained of dyspepsia, which regressed without additional therapy or treatment discontinuation. Arrhythmogenic effects of propafenone were not registered. In 7 patients (3.5%), PQ interval increased significantly, by 18% comparing to baseline, but the parameter stayed in the normal range. Moderate increase of QT interval (+28%), without being over 460 ms, was observed in 8 patients (4%), and did not require therapy discontinuation.
Conclusion. According to the results of open, multi-center study “PROMETEY”, propafenone (450 mg/d per os) was effective and safe for maintaining sinus rhythm in patients with persistent AF. In patients with normal left ventricular ejection fraction, propafenone did not affect inotropic myocardial function.

The article is devoted to ACE inhibitor treatment in various cardiovascular pathology. The results of the trials on spirapril (Quadropril®) efficacy in blood pressure control among arterial hypertension (AH) patients are presented, as well as comparative efficacy of spirapril, other ACE inhibitors, and calcium antagonists. Resent Russian clinical trials have demonstrated that spirapril, in the daily dose of 6 mg, can be recommended for AH treatment. 

The article focuses on differential treatment of stable angina patients. Effects of main antianginal and anti-ischemic medication groups are discussed. Clinical aspects of nitrate therapy in coronary heart disease (CHD) management are emphasized. Nitrates’ potential in treating various CHD forms is discussed.

Chronic heart failure (CHF) treatment is an important problem of modern cardiology, with only one radical, but not universally possible solution – heart transplantation. Regenerative myocardial therapy, stem cell transplantation, raises increasing interest recently, due to many researchers’ doubts on genetic therapy for coronary heart disease and CHF management.

Due to high prevalence of arterial hypertension (AH) in postmenopausal women, this problem has received much attention recently. Hormonal changes in perimenopause cause neuroendocrine disturbances, facilitating AH development and determining some AH features. In peri- and postmenopausal women, AH often combines with climacteric complaints and menopausal metabolic syndrome, that should be taken into account in antihypertensive therapy choice. One of pathogenetically appropriate medication groups is imidazoline receptor agonists. 

Objectives. Analysis of cardiovascular disease (CVD) risk factors prevalence and their connection with adolescents blood group.
Materials and methods. Prevalence of smoking, high body mass, anxiety, stress – reactions, a type A coronary behavior and hypertensive reactions was determined in 681 adolescents (334 girls and 347 youths) of 17 – 18 year old.
Results. Reliable differences in CVD risk factors prevalence, level and correlations among adolescents with various blood group were revealed.
Conclusion. These appropriatenesses allow to relate persons with certain blood group to CVD risk group by definite factors and carry out earley preventive measures among adolescents.

Fatty acid metabolism (FA) requires 60-70% of O2 coming to myocardium. In O2 deficit, FA and carbohydrate metabolism declines. Reversible and irreversible ischemic damage is caused by unoxydated metabolites’ storage. Medicament therapy-induced carbohydrate metabolism is perspective, due to its less O2 demand.

The article is devoted to a clinical case of recurrent acute myocardial infarction (AMI) in a 35-year-old woman. The patient had several AMI risk factors (RF): long-term, intensive smoking, Chlamydia pneumoniae and Helicobacter pylori infections, medical abortions, dysmenorrhea, uterine myoma, hormonal and hemostatic dysbalance, and psycho-emotional stress. Endothelial dysfunction, pediatric anamnesis, and multiple organ pathology also played their roles in recurrent AMI pathogenesis.