Aim. Disability and Life-Year Loss (DALYs) is an important healthcare indicator. The first step in DALYs estimation is the measurement of lost years of life due to premature death. To explore the age-sex related statistics of cardiovascular (CV) deaths in Russian Federation (RF); lost years of life (LYL) due to premature death; and to compare those in different regions of RF with the parameter by 100 thousands of population.

Material and methods. Russan Statistic Agency (RosStat) data on population and mortality by age intervals and gender for the year 2012.For each age interval the values of CVM and LYL were calculated.

Results. The relative risk of cardiovascular death is much higher in men than in women at the age 30–62; maximum of additional death risk (by 100 thousands) is in age groups of 60–90 years. The portion of those who died from CVD at <60 y. o. is 30% in men and 8,4% in women; at >80 y. o. — 18,8% and 48,2%, respectively. The portion of CVM from total mortality in 2012 is 55,4%; at the same time LYL proportion from the entire premature deaths was 38% (36% for men and 42% for women). LYL due to premature CD death was 9797 by 100 thousands in RF in general (13211,9 in men and 6854,2 in women with the variety in different regions from 2058 to 10889 in women and from 3350 to 22122 in men, by 100 thousands).

Conclusion. Further investigation required to clarify higher risk for men in economically active ages and significant regional variability in LYL.

Aim. To study macro- and microhemodynamics and bioelectrical properties of the brain in younger adults with nonstable blood pressure (BP).

Material and methods. A population of 79 adults at the age of 19–24 (average 19,9±0,9 years) was examined. According to the BP level they were divided into two groups: 1–46 (58,5%) with stable normal BP (SNBP), and 2–33 (41,5%) with high normal BP inside the range for 1^st level arterial hypertension, whose BP was not stable (UsBP), but changing from normal values to 1st level hypertension. All patients undergone investigation of brachiocephal and intracerebral vessels with blood flow velocity measurement along the vessel direction, the blood sectional volumetric flow and specific kinetic energy. Microcirculation in the brain was measured by rheoencephalography including parameters of the velocity, time and volumetric parameters. Bioelectricity studied by electroencephalography.

Results. In patients with UsBP we found the increase of blood flow velocity, blood volume and specific kinetic flow energy in vertebral and general carotid arteries as in basilar and middle cerebral arteries to. In the area of microcirculation in patients with UsBP the blood filling of frontal lobes was decreased comparing to SNBP patients in whom blood filling showed “mosaic” pattern. In UsBP patients we found changes of bioelectrical activity which are related to the functioning of cortical and subcortical portions of the brain.

Conclusion. In younger patients with UsBP there is developed discirculatory encephalopathy with damage of cortex and subcortical portions of the brain due to impaired hemodynamic and microcirculation.

Aim. To estimate the effectiveness of Diltiazem (Dlt) and its combination with nitrates in patients with ischemic heart disease (CHD) and arterial hypertension (AH) according to exercise tolerance by functional class (FC) of stable angina (StA).

Material and methods. 30 CHD male patients at the age of 58,8±7,5 with StA II FC (n=11), III FC (n=19) and 1–2 stage AH were included into open randomized placebo-controlled study. Drug therapy: Dlt 90–180 mg bid, isosorbide 5-mononitrate 50 mg qd, trinitrolong 2 mg bid or tid. Effectiveness of the regular drug intake was controlled by repeated exercise tolerance tests (ETT) by treadmill with the value of threshold effort time (ThT). Total duration of treatment was 4 weeks.

Results. At the beginning the ThT was 249,8±23,4 s for III FC and 368,6±14,4 s for II FC patients (p=0,0001). One dose of Dlt increased ThT in 5 hours to 387,3±37,5 s and 533,7±20,3 s in both groups, respectively (p=0,001), with the difference between groups being held. During regular Dlt intake the ThT in III FC angina patients reached 441,1±26,8 s, but in II FC patients in has not changed: 526,1±22,0 s. Additional nitrate intake to III FC group led to even more increase of ThT; in II FC patients there was no improvement. Combination therapy by Dlt and nitrates has not led to differences between III and II FC groups by achieved exercise tolerance. Hemodynamic parameters in both groups has not differ.

Conclusion. For patients with III FC stable angina it is recommended to prescribe Dlt with nitrates because of additional effectiveness of combination that might be linked to the influence on cardiac hemodynamics and to improvement of myocardium metabolism. In II FC stable angina Dlt alone reaches its maximum antiischemic effect so the addition of nitrates is not helpful.

Aim. To study possibility of using the evidence-based clinical-andmorphological appropriate use criteria for percutaneous coronary interventions (PCIs) for expert evaluation of high-technology procedures implementation in patients with acute coronary syndrome (ACS) in Russia.

Materials and methods. The appropriateness of performed PCI was assessed in patients with ACS, underwent coronary revascularization. The potential need in PCI was determined in ACS patients refused from coronary revascularization. Assessment was performed with the help of ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update (ACCF 2012). Data from 65,912 ACS patients, containing in Russian ACS Registry (2010–2011) were examined.

Results. ACCF 2012 criteria allow to assess the clinical appropriateness of PCI in 79.2% of patients underwent coronary revascularization and to determine the potential need in PCI in 80.6% of patients, refrained from coronary revascularization. Among ACS patients underwent PCI (n=9147), intervention was appropriate in 68.9% of cases. Inappropriate PCI was revealed in 4.6% of cases. Among patients refrained from PCI (n=56765), coronary revascularization was potentially appropriate in 57.9% of cases.

Conclusion. ACCF 2012 clinical-and-morphological criteria allow to judge on appropriateness of performed PCI and to evaluate the potential need in PCI among the most part of Russian ACS patients. In present study coronary revascularization was appropriate in the majority of ACS patients. It was shown possible to use the evidence-based clinical-andmorphological criteria for expert evaluation of high-technology procedures implementation in Russian ACS patients.

Aim. To estimate the impact of glycemia recorded during myocardial infarction (MI) in-patient care on short-term prognosis of patients without 2nd type diabetes mellitus (2DM).

Material and methods. Totally 296 patients were prospectively investigated. According to glucose levels patients were divided into three groups: 1st with ≤4,0 mM/l (7,4%); 2nd with 4,01–7,79 mM/l (69,9%); 3rd with ≥7,8 mM/l (22,6%). The rate of glucose metabolism disorders and complications during in-hospital care were studied.

Results. In 2/3 of patients with glycemia ≥7,8 mM/l at hospitalization, later the changes of glucose metabolism were found by glucosetolerance test: prediabetes (36,9%), 2DM (32,3%). In the patients of 3^rd group significantly higher was the rate of 3-vessel disease (41,8%) anf MI complications: congestive left-ventricular failure — 52,2% vs 27,3% in the 1st group and 34,1% in the second (p=0,017), cardiogenic shock — 26,9% vs 4,5% and 6,8% (p<0,001), conduction disorders — 27,3% vs 9,1% and 11,7% (p=0,006), in-hospital mortality — 13,8% vs 4,5% and 4,4% (p=0,025). The risk of death in subjects with glycemia ≥7,8 mM/l was 3,48 (95% CI: 1,41–8,60) times higher than in normoglycemic (p=0,007). The glycemia was independently linked with complications of MI during in-hospital period: OR = 1,128; 95% CI: 1,005–1,266 (p=0,042), — as also with the age, severity of myocardial damage and systolic pressure at admittance.

Conclusion. There was higher prevalence of MI complications and 3 times higher risk of death in patients without 2DM, but having ≥7,8 mM/l glucose (22,6% of patients) at admittance. The glycemia parameter was an independent predictor for unfavorable prognosis of MI without previous 2DM diagnosis and should be used as part of secondary prevention care.

Aim. To research the prevalence of atrial fibrillation (AF) and to compare the clinical characteristics of the patients to those without AF.

Material and methods. At the moment of cross-section the Profile Study included 671 patients with various cardiovascular diseases, those who consulted at the Preventive pharmacotherapy department of the Centre.

Results. AF was diagnosed in 99 patients (14,7%). There was no difference by gender with those without AF, but they were significantly older. There was no difference in prevalence of the common risk factors, ischemic heart disease and peripheral atherosclerotic disease. Anamnesis of cerebral stroke was more common for the AF group: 9,1% vs 2,8%. Anamnesis of stomach ulcer disease was also more prevalent in AF group: 9,1% vs 4,4%.

Conclusion. The section-study of patients included into Profile Registry showed typical clinical properties for AF and made it to compare with those found in other registries.

Aim. To estimate the prevalence of iatrogenic atrial flutter in patients with coronary heart disease (CHD) and atrial fibrillation (AF) after two types of surgical operations: radiofrequency pulmonary veins isolation and radiofrequency modified mini Maze procedure; and to compare the results with control group of patients undergone aortic-coronary bypass grafting (CABG).

Material and methods. Totally 95 patients included with CHD and persistent AF. Subjects were randomized into three groups: 1st (n=31) — with simultaneous CABG and radiofrequency ablation of pulmonary veins ostiums; 2nd (n=30) — simultaneous CABG and mini Maze procedure; 3rd control (n=34) — CABG only. For prolonged ECG monitoring the implanted devices Reveal XT were used in 53 subjects.

Results. The patients escaped from left-atrial flutter were 90% in the 1^st group. In the 2nd there was 1 case of left-atrial flutter (according to electrophysiological investigation — the leap through the mitral valve line), meaning 96,9% patients free from it. However there was no significant difference between 1st and 2nd groups (p=0,6). In the 3rd group postprocedure flutter developed in one case too, due to the scar on the left atrium wall after mitral valve regurgitation correction; so 97% patients escaped from flutter, but the difference was still not significant (p=0,4).

Conclusion. In patients with CHD and AF it is recommended to perform radiofrequency modified mini Maze procedure combined with CABG due to its lower proarrhythmogenic effect. The rate of iatrogenic flutter is 3,1% after mini Maze and 10% after pulmonary veins ostiums isolation.

Аim. of the study was to assess the effectiveness of carvedilol and eprosartan in addition to the traditional treatment (Nitrosorbid 30mg/day + Digoxin 0.25mg/day + TromboASS 100mg/day + Atorvastatin 20mg/day + Furosemid 40mg/day + Verospiron 50mg/day + Atenolol 12.5–25 mg/day) in patients with metabolic syndrome and chronic heart failure.

Materials and methods. 91 patients with MS and CHF included sharing mentioned criteria. Carvedilol in doses of 6,25 ÷ 25 mg/day and eprosartan in doses of 300 ÷ 600 mg/day were administered in addition to the traditional treatment.

Results. After 12 months of treatment systolic BP decreased by 23.6% and diastolic by 17.2%. Heart rate decreased by 23.1%, and exercise tolerance increased by 22.3%. Dynamics of the presented indicators are statistically significant.

Conclusion. Administration of an alpha-beta blocker carvedilol and angiotensin II receptor blocker eprosartan in the above dosages promote the longest remission of heart failure, improvement in functional class and regression of pathological remodeling.

Aim. To study the signs of kidney dysfunction in chronic heart failure (CHF).

Material and methods. We included 96 patients with postinfarction cardiosclerosis and CHF with the age of 40–60 years. Patients were divided into two groups by functional class (FC) of CHF according to NYHA. In all patients the levels of serum creatinine and MDRD glomerular filtration rate (GFR), urine alanine transferase, aspartat transferase, alkaline phosphatase and cholinaestherase by spectrophotometric method were measured.

Results. In 33,3% of patients with II FC NYHA and in 66,67% with III FC NYHA we found GFR less than 60 ml/min/1,73 sq.m. Investigation of fermenturia levels in those according to renal functioning showed more prevalent increase of urine enzymes in lower GFR, in whom the patients with III FC NYHA consisted 66,67%. The level of ALT was 39% (p<0,01) higher and AP 35% (p<0,001) higher comparing to subjects without renal dysfunction.

Conclusion. In patients with chronic heart failure as the diseases progresses there is kidney dysfunction developing with the decrease of GFR, increase of resdual nitrogen and enzimes in urine. Enzyme levels testing in urine of CHF patients can be a part of diagnostic approach to kidney dysfunction diagnostic at earlier stages.

Aim. To estimate the role of endogenous metabolic factors in formation of vascular endothelium reactivity in patients with different genesis cardiovascular regulation disorders.

Materials and methods. The research included 30 patients with ischemic heart disease (IHD) with stable form of exertional angina (EA) of II–III severity class, 30 patients with I–II stage and 1st–2nd degree essential hypertension (EH), and 15 clinically healthy volunteers. We researched the signs of functional state of vascular endothelium before and after occlusion test. The parameters investigated included: adhesion of thrombocytes, spontaneous aggregation, prostacyclin activity of blood plasma, levels of antithrombine-III, of von Willebrand factor, contents of malonic aldehyde, of nitrites, of endothelin-1, of membrane-connected haemoglobin, of methaemoglobin in erythrocytes, activity of angiotensineconverting enzyme, level of sorption on the membrane of erythrocytes of nucleotides. Research of hemorheology was performed by viscosimetry method.

Results. In healthy volunteers high probability of endothelium sensitivity to transverse strain decrease (in 82%) was determined and 25% increase of activity of peroxide oxidation of lipids. In patients with exertional angina influence of dynamic changes of blood flow on endothelium occurred by 2% decrease of viscosity and more than 120% increase of production von Willebrand factor (in 87%). It was concluded that as higher the production of prostacyclin in response to mechanic stimuli (more than 50%) is, the higher is probability of blood flow dynamic changes influence on endothelium. In patients with essential hypertension 30% increase of level of antithrombine-III in 100% of cases caused increase of sensibility of vascular endothelium to transverse strain.

Conclusion. The most significant factors linked with sensibility of endothelium of vascular wall to dynamic blood flow changes in examined groups of patients were determined. In patients with exertional angina vascular reaction was mostly linked with rheological qualities and adhesive-aggregation characteristics of blood. In patients with essential hypertension the sensitivity of vascular endothelium was implied to be concordant with anticoagulant activity of blood plasma.

According to population studies the prevalence of angina increases with age and is about 4–7% in 65–84 years old men. In drug therapy, except direct action of the medicaments on symptoms and complications of the disease, sexual activity must be taken into account due to its impact on life quality and treatment compliance. Beta-adrenoblockers and sartans are common solution for angina with its usual cardiovascular comorbities. The most selective beta-blocker nebivolol and valsartan do not affect and even increase sexual activity, making them a choice for the treatment of angina in men.

The article is considered on the questions of pathogenesis, clinic and diagnosis of myocardial disorders, first of all in persons with high blood pressure. Preference of ultrasound cardiography (UC) for detection of concentric and eccentric hypertrophy of left heart ventricle as well as concentric remodeling is shown. Authors claim the principle possibility to use UC methods in the plant out-patient department; it has principal significance for economically active persons. 2557 industrial workers 20–60 years (1492 men and 1065 women) were investigated. Hypertension (140/90 mm Hg or antihypertensive treatment) was diagnosed in 20% — 514 persons. Voltage ECG LVH criteria were found in 142 pts (28%); UC signs of LVH were found in 389 pts (76%). Increase of related thickness of heart walls diagnosed in 412 pts (80%) and increase of Mass myocardial index — in 347 pts (67%), diastolic dysfunction was found in 402 pts (78%). So the exclusive value of modern diagnostic methods including UC is proven which gives the possibility of early diagnostic of prevalent heart disorders in hypertensive industrial workers.

The studies of coronary heart disease as a cause of reduced life quality and disability in population led to improved methods of diagnosis and treatment of this disease. To date, accumulated large evidence base supports the use of DAT (dual antiplatelet therapy) in patients with coronary artery disease after PCI. According to the same data some patients still develop severe complications, i. e. stent thrombosis. In this regard, recent years there is increasing importance of the genetic testing for selection of the optimal antiplatelet therapy in patients with coronary artery disease.

A plenty of trials confirm the importance of aortic wall stiffness evaluation during estimation of the cardiovascular risk and the need for novel drugs influencing this parameter. Most of hypotensive medications modify arterial wall siffness by one or another way. So the usage of drug combination might be more effective. Insufficient impact of betaadrenoblockers on central artrial pressure is linked to peripheral vasoconstriction. The drugs within this class having vasodilatory properties significantly reduce central aortic pressure.