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Aim      To study associations between the risk of severe adverse cardiovascular outcomes (SACVO) and all-cause death with psychosocial risk factors (PS RFs), such as stress, anxiety and depressive symptoms, low level of education, low income, social isolation, and type D personality, in patients with arterial hypertension (AH) and ischemic heart disease (IHD) managed in primary health care institutions in a multi-year prospective study.Material and methods  PS RFs were assessed in patients with AH or IHD, who participated in a multi-year prospective COMETA study, using the Hospital Anxiety and Depression Scale (HADS), DS-14 questionnaire, and a visual analogue scale (VAS) for assessment of stress level. Associations of PS FRs with SACVO and all-cause death after a 1.5-year follow-up were analyzed using multivariate Cox regression models.Results At 1.5 years after patients were included in the study, it was possible to obtain data for 2,538 patients (age at baseline, 66.6 ± 7.8 years, 28.1% men), 106 of whom died during that period. The incidence of SACVO was 40.0 per 1000 person-years. According to the results of multivariate regression analysis, a very high level of anxiety symptoms (HADS-A≥14) was significantly associated with SACVO (odds ratio (OR), 1.81; 95% confidence interval (CI), 1.04-3.15; p=0. 02). The composite endpoint that included all-cause death and/or SACVO was significantly associated with a high (VAS score ≥8) stress level (OR, 1.53; 95% CI, 1.00-2.33; p=0.04) and a very high (HADS-D≥14) level of depressive symptoms (OR, 2.11; 95% CI, 1.22-3.62; p=0.02). A low level of education adjusted for gender and age increased the likelihood of SACVO by 1.7 (95% CI, 1.19-2.43) times. No significant associations were found between the analyzed outcomes and type D personality or with social isolation.Conclusion      In patients with AH or IHD, the presence of high-grade stress and severe depressive symptoms increased the likelihoods of all-cause death and SACVO while a low level of education and severe anxiety symptoms were associated with SACVO. The study results showed that PS RFs for cardiovascular diseases keep the PS RF prognostic significance in the conditions of modern treatment of AH and IHD. Due to the negative impact on the prognosis, PS RFs should be taken into account when taking measures for secondary prevention of AH and IHD.

Introduction: Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases., Material and Methods: Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)» (https://static-0.minzdrav.gov.ru/system/attachments/attaches/)., Results and Discussion: The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs., Conclusion: Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.

Aim: To study the effect of oxidative stress and telomere length in the chromosomes of blood leukocytes in patients with coronary heart disease (CHD) on the development of cardiovascular complications., Materials and Methods: In 119 patients with CHD, the level of oxidatively modified low-density lipoproteins (ox-LDL) in blood plasma and the length of telomeres in nuclear blood cells were determined during the examination. After 5 years, a telephone survey of patients (or their relatives) was conducted to obtain data on the presence of cardiovascular complications. Telomere length was determined using quantitative real-time PCR, and the level of ox-LDL was determined by immunochemical method., Results: It was found that reducing the length of telomeres in patients with CHD increases the risk of subsequent development of cardiovascular complications. A strong negative correlation was found between the level of ox-LDL and telomere length in the group of examined CHD patients who had cardiovascular complications after 5 years., Conclusion: CHD patients with short telomere length and high levels of ox-LDL have an increased risk of cardiovascular complications during 5 years.

Purpose - to assess the probability of occurrence of the main cardiovascular events in the patients after revascularization interventions with a combined course of a stable coronary heart disease and non-alcoholic steatohepatitis (NASH) by indicators of fibrogenesis. 164 patients with stable coronary heart disease were observed, including: 54 patients with NASH (a main group); 110 patients without NASH (a comparison group). All patients underwent general clinical examination, electrocardiography, coronary angiography, echocardiography, assessment of liver function, markers of fibrosis and long-term prognosis by the Kaplan-Meier method. It was found that the patients with stable coronary heart disease, combined with NASH, are characterized by the fibrosis progression, that is characterized by a significantly high value of fibrogenesis markers. The presence of NASH in patients with stable coronary heart disease causes a worsening of the disease and forms a negative prognosis in such patients in a two-year term. The prognosis of the patients who underwent coronary artery stenting depends on the course of non-alcoholic fatty liver disease and is the most prognostically unfavorable against the combination of the FIB-4 index ≥2.0 and NASH.

Cardiovascular diseases caused by atherosclerosis, in many countries of the world are one of the most important social and economic problems due to the high morbidity and mortality rate of the working population. Recently, the immunological theory of atherosclerosis and coronary heart disease (CHD) has been actively developed, and the search for markers of inflammation characterizing immuno- and atherogenesis has been conducted. Buccal epithelium (BE) can be used as biological material for in vivo molecular-cellular studies, allowing to diagnose CHD by inflammation markers. The purpose of the work was a comparative study of the expression of IL-1β, IL-6, IL-10, MCP-1 and GDF-15 in BE in patients of different ages with CHD and without cardiovascular disease. The material of BE in healthy donors and patients with 2nd stage CHD was divided into groups according to age classification of the WHO: the 1st - middle-aged people (45-59 years) and the 2nd - elderly people (60-74 years). Control material was obtained from people of middle and old age without cardiovascular disease. According to the immunocytochemical study, the area of IL-1β expression in BE is 3 times higher in middle-aged people with CHD, and in 4,4 times higher in elderly people compared to healthy individuals of the same age group. The area of IL-6 expression in middle-aged and elderly people with CHD was in 7,9 and 7,4 times higher, respectively, than in the control group. In middle-aged and elderly patients with CHD, IL-10 expression was in 1,6 and 2,8 times higher, respectively, compared to healthy donors of the same age group. The expression of MCP-1 in BE of middle-aged and elderly people in normal and ischemic heart disease did not differ. GDF-15 expression is in 6,8 and 6,6 times higher in middle-aged and elderly people with CHD than in healthy people of the same age. The findings showed that the expression of the cytokines IL-1β, IL-6, IL-10 and GDF-15 increase in BE in patients with CHD of middle-aged and elderly people compared with persons of the same age group without cardiovascular disease. Thus, BE can serve as an informative material for noninvasive molecular diagnosis of CHD in people of different ages.

Aim: To study the possibilities of stress echocardiography (EchoCG) in the assessment of clinical state of patients after percutaneous coronary intervention (PCI)., Material and Methods: We included into this study 80 patients with stable ischemic heart disease. After preliminary examination, all patients underwent PCI. Stress EchoCG was carried out in 6 and 12 months after PCI., Results: Clinical effect assessed in 12 months after revascularization was good in 90% of patients. We registered significant increase of exercise capacity (from 97 to 118 W; p=0.001), increase of double product (from 232 to 275; p=0.009), decrease of myocardial ischemia volume (regional contractility impairment index before PCI 1.36, a year after PCI 1.16; p=0.001). The incidence of restenosis was 7.5%. Restenosis was accompanied by a deterioration of clinical status of patients (silent myocardial ischemia, angina recurrence). The accuracy of stress echocardiography in detecting myocardial ischemia in patients after PCI was 94%., Conclusion: Stress EchoCG has high diagnostic accuracy for detection of myocardial ischemia in patients after PCI during the first 12 months after revascularization.

Aim: To investigate the plasma concentrations of cytokines and vasoactive molecules in patients with coronary heart disease (CHD) in the presence of hypertension in relation to the angiotensin-converting-enzyme (ACE) inhibitor level reflecting the degree of renin-angiotensin-aldosterone system (RAAS) inhibition., Subjects and Methods: 72 patients with NYHA functional class (FC) II-III angina pectoris and 40 healthy persons at the age of 47-65 years were examined in a controlled cohort study. Enzyme immunoassay was employed to determine the serum concentrations of interleukins (IL) (IL-2, IL-12, IL-17A, and IL-24), the vasoactive molecules of bradykinin, serotonin, ACE, angiotensin-II (AT-II), NO, and endothelin-1 (ET-1), and plasma renin activity. In addition, the plasma level of the tetrapeptide N-acetyl-Ser-Asp-Lys-Pro was used as a marker for ACE inhibition., Results: The patients with CHD occurring in the presence of hypertension compared with the apparently healthy individuals displayed decreased ET-1 and NO production along with elevated levels of serotonin, AT-II, as well as IL-17A and IL-12. The found changes were accompanied by reduced renin activity. Thus, the individuals with low ACE inhibitor levels showed more pronounced production of the proinflammatory cytokine IL-17A, as well as high plasma concentrations of ACE and NO. The high ACE inhibitor level that reflects patient adherence to appropriate antihypertensive therapy is associated with the reduced production of IL-2 and with the minimum serum levels of ACE, AT-II, and NO, being characterized by the high production of IL-12 and serotonin at the same time., Conclusion: In patients with CHD and hypertension, the high plasma enzyme inhibitor concentration that reflects the activity of appropriate antihypertensive therapy, by contributing to the strengthening of the mechanisms of relaxation of blood vessels, is associated with the risk for proinflammatory activation of whole blood cells and platelets. The mean ACE inhibitor levels that reflect moderate RAAS suppression and are characterized by a relatively low proinflammatory activation of mononuclear cells may be more preferable than the maximum ones, from the point of view of slowing the progression of the subclinical inflammatory process of the vascular wall and preventing possible CHD exacerbations. This determines the feasibility of estimating the plasma level of an ACE inhibitor to control the depth of inhibition of RAAS activity.

Fibrosis is one of the main components in the progression of most cardiovascular diseases, including coronary heart disease, by causing structural changes in the myocardium and vascular wall. The quantitative and qualitative characteristics of fibrosis of the myocardium are responsible for decreasing its elastic properties, developing diastolic dysfunction, impairing myocardial contractility, developing systolic dysfunction and cardiac arrhythmias, and worsening coronary blood flow in patients with heart failure of different etiologies. The important aspect of studying fibrosis is not only its interpretation as a model of the typical pathological process, but also its consideration as a systemic lesion of various organs and tissues. At the same time, the identification of myocardial fibrosis biomarkers that are available for their determination in circulating blood is of particular interest. Since there was evidence for the role of fibrosis in developing dysfunction of various organs and ensuring the systematicity of most diseases, especially at their development stages, the process of fibrosis came to be regarded as a promising therapeutic target. It is relevant to further investigate myocardial fibrosis, which is aimed at increasing the efficiency of its diagnosis and predicting its course and pathogenetically sound therapy.

Aim: To comparatively analyze the clinical efficiency of eradiation therapy (ET) in patients with coronary heart disease (CHD) concurrent with gastroduodenal pathology (GDP)., Subjects and Methods: The study was conducted in three steps. In Step 1, 1588 patients with chronic CHD were examined. In Step 2, the characteristics of the course of CHD concurrent with Helicobacter pylori-associated GDP in 147 patients with these conditions compared to the same number of CHD patients without GDP. In Step 3, the impact of a GDP treatment option on the efficiency of treatment was investigated in the patients with CHD. Group 1 received ET + basic therapy (BT); Group 2 used antisecretory therapy + BT; Group 3 consisted of CHD patients without concomitant GDP who received BT only. The time course of changes in clinical and quality-of-life (QOL) indicators was assessed., Results: The patients with CHD concurrent with GDP have a more severe course of the disease as manifested by deterioration in clinical status and QOL. After ET, anginal attack rates were decreased by 62.6% in Group 1, by 30.7% in Group 2 (during antisecretory therapy), and by 29.5% in Group 3. The level of physical QOL increased by 23.7% in Group 1, which was not observed in Groups 2 and 3., Conclusion: Inclusion of ET in an algorithm for treating CHD patients with GDP promotes the angina stability and normalizes QOL in the patients.

Objective: To evaluate the impact of single-stage selective arterial catheterizations during X-ray endovascular interventions to reduce obtained radiation doses in the treatment of patients., Material and Methods: X-ray endovascular interventions were carried out in the operating room equipped with a flat detector digital angiography system (Axiom Artis dTA, Siemens Medical System). The impact of single-stage selective arterial catheterization procedures was analyzed during endovascular interventions for coronary heart disease and uterine myomas on the time course of changes in the collective effective radiation doses for patients in the period 2013 to 2015., Results: Analysis of the findings showed that single-stage selective coronary angiography using a universal (multipurpose) radial coronary catheter and single-stage X-ray endovascular uterine artery embolization techniques could reduce collective effective doses for patients from 5.86 persons-Sv in 2013 to 1.6 persons-Sv in 2015., Conclusion: Different single-stage selective catheterization procedures used during endovascular interventions into the coronary and uterine arteries can reduce radiation doses for patients.

Aim: To investigate the clinical effectiveness of pioglitazone in the combination treatment of patients with asthma concurrent with coronary heart disease (CHD)., Subjects and Methods: Fifty patients aged 40-75 years with asthma concurrent with CHD were examined. External respiratory function (ERF), electrocardiograms, blood pressure (BP), and anthropometric measurements were assessed in all the patients. Blood and urine laboratory values and high-sensitivity C-reactive protein (hs-CRP) concentrations were estimated; endothelial function was determined measuring endothelium-dependent and endothelium-independent vasodilation (EDVD and EIVD). The patients were randomized into a comparison group receiving only standard therapy and a study group taking pioglitazone as part of combination therapy for 3 months., Results: At the randomization stage prior to pioglitazone combination therapy, the patient groups did not statistically significantly differ in basic clinical and anamnestic data. Three-month standard therapy resulted in stabilization of ERF and endothelial function. During the treatment, there were increases in the frequency of asthma symptoms and the duration of angina attacks, however, there was a decline in hs-CRP levels (p<0.001). Incorporation of pioglitazone into the standard treatment regimen of patients with asthma concurrent with CHD improved clinical disease control, decreased the degree of bronchial obstruction and the frequency of angina pain and asthma attacks using nitroglycerin and salbutamol, lowered systolic and diastolic blood pressure, improved EDVD (increases in the maximum linear velocity of blood flow after a test for reactive hyperemia (RH), index of reactivity (IR), and A% brachial artery (BA) diameter) and EIVD (increases in IR and A% BA diameter), and reduced systemic inflammation from hs-CRP values (p<0.001) and hypercholesterolemia from total cholesterol levels (p<0.02)., Conclusion: The incorporation of pioglitazone in the combination therapy of patients with asthma concurrent with CHD improves the clinical course of the diseases and increases their control, reduces systemic inflammation, and improves endothelial functional activity.

The aim of the study was to estimate arterial stiffness and bone mineral density (BMD) in women with coronary heart disease (CHD) and concomitant osteoporosis. It included 120 patients (mean age 68.5 ± 8.7 years) divided into 2 groups matched for age and CHD duration. Group I was comprised of 74 women with CHD and severe osteoporosis, group 2 consisted of 46 women with isolated CHD. Carotid-femoral pulse wave velocity and central pulse wave were subjected to contour analysis by applanation tonometry using a SphygmoCor AtCor Medical apparatus (Australia). BMD was measured in lumbar vertebrae and proximal part of the femur by X-ray densitometer (XRD). Statistical treatment of the data obtained was performed with the use of Statistica 6.0 package, Wald-Wolfovitz criterion, and multifactorial regressive analysis; differences were considered statistically significant when the calculated P value was less than 0.05. Women with CHD and osteoporosis had higher arterial (diastolic/systolic) pressure, mean aortic pressure, and pulse wave velocity than patients with isolated CHD. The independent determinants of carotid-femoral segment stffness were age (β = 0.3, 95% CI 0.08-0.11, p = 0.027), BMD in the proximal part of the femur based on Z criterion (β = 5.02, 95% CI 8.4-10.6, p = 0.0059), BMD in the Wards area based on T criterion β = 5.07, 95% CI 6.0-8.1, p = 0.005). It is concluded that women with CHD and osteoporosis have elevated parameters of arterial stiffness including carotid-femoral pulse wave velocity, augmentation index, central pulse pressure, BMD in lumbar vertebrae and proximal part of the femur. Age and BMD in the proximal part of the femur are independent factors affecting arterial stiffness.

Objective: To compare the image quality at coronary multidetector computed tomography (MDCT) using low-dose and low-iodine protocol study in comparison with the standard protocol., Material and Methods: In study included 60 patients undergoing coronary computed tomography angiography. All examinations were performed with 64-row MDCT using prospective ECG-gating and ASIR 40%. 30 patients were examined using a low-concentration (Iodixanol, 270 mg I/ml) iodinated contrast medium and low tube voltage (80 kV) (group 1), 30 patients--using of high-concentration (Iodixanol, 320 mg I/ml) iodinated contrast medium and standard tube voltage (120 kV) (group 2). Image quality of coronary arteries was evaluated using a four-point grading scale, images were randomised. Intra-arterial density was measured for the proximal and distal segments of left anterior descending artery (LAD) and right coronary artery (RCA)., Results: Age, heart rate, BMI and scan parameters were not statistically different between the two groups. Analysis of coronaries visualization revealed the same image quality for group 1 and group 2 (image quality scores were 1.28 ± 0.28 vs. 1.34 ± 0.29, p = 0.4). There was no significant difference between mean enhancement values in the distal segments of RCA and LAD for the two groups. Intraarterial density for proximal LAD and proximal RCA for the nazpyara, umepamuenas group 2 were significantly lower (p < 0.05) than those values for the group 1. Conclusion. Theuse of low-dose and low-iodine protocol can be beneficial for patient safety and or image quality ithout loss of diag- stic information.

Aim: To identify risk factors (RFs), to evaluate the impact of systemic inflammation and endothelial dysfunction on the development of asthma concurrent with coronary heart disease (CHD), and to determine the degree of control of the disease., Subjects and Methods: The clinical trial included 50 asthmatics aged 40-75 years with CHD. All the patients underwent external respiratory function (ERF) test, ECG, blood pressure and anthropometric measurements, and bicycle ergometry. Their medical and allergy history data were collected and RFs and basic therapy were assessed. Laboratory blood and urine values and endothelial function were estimated determining the brachial artery diameter and the time-averaged maximal linear velocity (TAMX) of blood flow in endothelium-dependent and endothelium independent vasodilation (VDV and VIDV)., Results: The development of asthma in the presence of CHD was found to be associated with RFs, such as female gender (66%), hereditary asthma (40%) and CHD (76%), hypertension (86%), obesity (42%), smoking (7%), occupational exposures (20%), and dyslipidemia. Laboratory tests in the asthmatic patients with CHD revealed a positive C-reactive protein reaction (CRP) in 16 (32%) patients and increased serum cholesterol levels. Reactive hyperemia and nitroglycerin tests in the patients with asthma concurrent with CHD showed that the BA diameter was significantly increased up to 4.27 +/- 0.3 and 4.54 +/- 0.03 mm, respectively, as compared to the baseline values (p < 0.01). Most patients were observed to have marked and frequent symptoms of the disease, frequent asthma exacerbations, and impaired ERF and to need "rescue" bronchodilators., Conclusion: RFs, such as female gender, family history, hypertension, obesity and dyslipidemia play an important role in the development of asthma concurrent with CHD. Impaired TAMX, VDV, and VIDV, hypercholesterolemia and higher CRP levels were detected. Basic therapy in the patients with asthma concurrent with CHD was not optimal or rather effective since disease control was not achieved in 70% of the patients.

Aim: To evaluate the degree of carotid artery (CA) atherosclerotic lesion and lipid metabolic disturbances in patients with hypertension and in those with hypertension concurrent with coronary heart disease (CHD) in the indigenous and non-indigenous population living in the Yamal-Nenets Autonomic District., Subjects and Methods: Two hundred men and women aged 21 to 55 years (mean age 48.2 ± 0.7 years), who resided in the Far North, were examined. The patients were divided into 4 gender-and age-matched groups of 50 persons in each: 1) natives; 2) newcomers with hypertension only; 3) natives with CHD and hypertension; 4) non-natives with the above conditions. To study CA involvement, all the patients underwent duplex scanning of the brachiocephalic arteries at the extracranial level and blood lipid analysis in an outpatient setting (Salekhard)., Results: In all the patients, common CA intima-media thickness was significantly greater than the upper limit of the normal range defined in the Guidelines, this indicator proved to be highest in the groups of indigenous people (p<0.001). The latter with CHD and hypertension more commonly tended to have atherosclerotic lesion in the left CA (p=0.06) than the non-indigenous people whereas the number of stenosis in other CAs was similar. In the natives versus the newcomers with CHD and hypertension, the atherogenic blood lipid composition was due to the higher levels of total cholesterol and low-density lipoproteins. In the non- indigenous patients with CHD and hypertension, the atherogenicity of the blood lipid composition was characterized by the higher levels of triglycerides (p=0.04) and very low-density lipoproteins (p=0.02) with the lower concentrations of high-density lipoproteins as compared to those in the natives with CHD and hypertension.

Aim: To evaluate the efficacy and safety of a fixed-dose combination of the angiotensin-converting enzyme inhibitor lisinopril 10 mg and the calcium antagonist amlodipine 5 mg (ekvator) in conjunction with rosuvastatin (mertenil)., Subjects and Methods: The investigation enrolled 50 patients (mean age 57.9 years) with essential hypertension. All the patients received the fixed-dose antihypertensive combination. Stable Functional Class I or II exertional angina was in 46% of the patients. The remaining 54% were found to have brachiocephalic atherosclerosis. All the patients had dyslipidemia and were given rosuvastatin., Results: The mean systolic blood pressure (SBP) initially reached 164.26 mm Hg. During the whole follow-up, the reduction in mean SBP generally accounted for 22.6% (p = 0.000). At the study inclusion, the mean diastolic blood pressure (DBP) reached 99.38 mm Hg. The total decline in mean DBP was 19.3% (p = 0.000). The mean level of total cholesterol (TC) decreased significantly by 32.1% (p = 0.000); that of triglycerides (TG) also fell significantly by 31.8% (p = 0.04); that of high-density lipoproteins increased insignificantly by 11.1% (p = 0.599); that of low-density lipoproteins (LDL) dropped significantly by 47.5% (p = 0.000)., Conclusion: Being safe, the fixed-dose lisinopril and amlodipine combination is effective in lowering blood pressure in patients with hypertensive disease (HD) concurrent with coronary heart disease (CHD) or atherosclerotic changes in the carotid artery. The use of rosuvastatin in patients with HD concurrent with CHD during 2 months causes positive changes in the blood lipid composition as a significant reduction in the-levels of (TC), LDL, and TG.

Contrast-enhanced magnetic resonance tomography (1.5 Tl) was used to examine 101 patients with coronary heart disease. It was shown that angina of effort was associated with disturbed myocardial perfusion manifest during the first passage of the contrast agent at sites with a hypointense signal. Patients with acute myocardial infarction exhibited, besides defective perfusion, hyperintense edematous regions on T2-weighted images as well as hyperintense sites of delayed contrast enhancement. The main symptoms of post-infarction cardiosclerosis in hyperintense zones of delayed contrast enhancement related to cicatrical lesions in myocardium. Disturbances of local contractility depending on the severity of ischemia and cicatrical lesions resulted in the impairment of overall left ventricular contractility.

We assessed effect of enhancement of parasympathetic activity by indirect vagal stimulation via sensitive n. vagus-r. auricularis terminals on dynamics of clinical conditions, ejection fraction and global longitudinal left ventricle deformation in patients with chronic cardiac insufficiency (CCI). This comparative placebo-controlled parallel study 3 months in duration included 70 patients with chronic coronary heart disease, signs of IIl-IV FC CCI, and sinus rhythm. Auricular electric vagal stimulation (AEVS) was performed using a device for electric stimulation of sensitive vagus terminals (patent No 2327492 of 27.06.2008). The complex of clinical and instrumental studies included 6 min walk test, echocardiography, and speckle tracking imaging before, immediately and 3 months after AEVS. A course of AEVS improved clinical conditions in 58 (92.06%) of the 63 patients due to one-grade or greater decrease of CCI FC and increase of the walking distance. This effect persisted till month 3. It was absent in 5 (8.33%) patients. Improvement of clinical conditions with the decrease of CCI FC was accompanied by increase of left ventricular ejection fraction due to diminished end-systolic volume. The ejection fraction did not change in 4 patients with HR over 80/min. All patients with lowered HR after AEVS showed improved LV contractility in the longitudinal direction.

Objective: To study the results of stenting the left coronary artery trunk and to determine the possibility of using Empira dilatation balloon catheters for kissing dilatation., Subject and Methods: The left coronary artery trunk was stented in 47 patients, which constituted 1.39% of the total number of the stented patients. Bifurcation stenting was performed in 48.9%. T and crush stenting procedures were used in 4 and 2 patients, respectively. Stenting of the left coronary artery trunk with transition to the orifice of the anterior interventricular artery or the circumflex artery was carried out in 12 and 5 patients, respectively., Results: The angiographic success rate was 100%; there were no fatal outcomes. After endovascular treatment, 20 (42.5%) patients belonged to Functional Class (FC) 0-I angina; 24 (51.1%) and 3 (6.4%) were diagnosed with FC II and III, respectively., Conclusion: It was ascertained that it was expedient to use the Empira dilatation balloon catheters for kissing dilatation. The left coronary artery trunk can be successfully stented if the patent is carefully prepared for the intervention.

With the incessant growth of cardiovascular mortality, mainly due to myocardial infarction makes prognostication of acute coronary syndrome a principal goal of clinical practice. Biochemical markers (creatine phosphokinase-MB and troponins) are extensively used for diagnostics and prediction of acute coronary heart syndrome (ACS). However, drawbacks of necrosis markers necessitate the search for new ones identifiable at early stages of atherosclerotic plaque instability. Lately atherosclerosis has been considered as an immuno-inflammatory reaction involving cytokines, chemokines, C-reactive protein, natriuretic peptide, and tumor necrosis factor-alpha. Their prognostic value has been demonstrated in many clinical studies, but these data are contradictory and need to be confirmed.

Aim: To study the spread of a number of indicators of subclinical atherosclerosis in patients with coronary heart disease (CHD) and the pattern of their relationship to their functional state and muscle mass., Subjects and Methods: Twenty patients with chronic forms of CHD were examined. Vascular wall stiffness was judged from pulse wave velocity (PWV) along elastic-type vessels, by calculating the carotid-femoral index (CFI). Endothelial function was estimated by endothelium-dependent vasodilation (EDV) in a reactive hyperemia test. Ultrasound scanning of the common carotid artery was used to estimate intima-media thickness. All the patients underwent bicycle ergometry; their exercise tolerance (ET) was determined by the amount of consumed oxygen when the metabolic equivalent (MET) was calculated; the percentages of active cell mass (ACM%) and lean mass (LM%) of total body weight were determined; the levels of total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides were estimated. A control group comprised 20 matched persons without CHD., Results: A prognostically unfavorable increase of >12 m/sec in CFI was revealed in 20% of the patients with CHD and in 10% of the controls; endothelial vasomotor dysfunction (EDV < 10%) in 65 and 50%; a more than 0.9-mm increase in 55 and 15%, respectively. A low ET was stated in the majority of patients with abnormal vascular stiffness and endothelial vasomotor dysfunction. The CHD patients with a low ET were found to have significant correlations of CFI with ACM% and LM%, EDV and ACM% and LM%, CFI and EDV. The control patients with a low ET also showed correlations of EDV and ACM% and LM%. There was a correlation of ACM% and LM% with MET in both groups., Conclusion: EDV and PWV reflect a more decrease in physical activity and dysadapted functional status than in the degree of subclinical atherosclerosis.

In the pandemic of diabetes mellitus (DM), there is no unified approach to making the final clinical and postmortem diagnoses of deaths caused by coronary heart disease (CHD), cerebrovascular diseases (CVD), and some other vascular catastrophes. The acute and chronic forms of CHD and CVD and acute and chronic ischemic lesions in other vascular basins, which result in death in DM, should be regard as its complications. Moreover, DM is a peripheral vascular disease.

The review is devoted to exercise tests (ET) potential in patients with different forms of coronary heart disease (CHD) exacerbation and suspected unstable angina. It is well known that unstable angina untreated pharmacologically is a contraindication for ET. Of interest in clinical practice is diagnosis, risk assessment and treatment policy in patients with chest pain. The main focus is on ET conduction in unstable angina suspects with low and intermediate risk, on safety and validity of ET conduction in these patients.

Aim: To investigate the effects of ivabradine in combination with perindopril on cerebral blood flow and endothelial functional activity., Subjects and Methods: Sixty-four patients with coronary heart disease (CHD) and arterial hypertension (AH) were examined. Group 1 (n = 38) patients took ivabradine in combination with perindopril and Group 2 (n = 26) received metoprolol. At baseline and 8 weeks after therapy, 24-hour blood pressure (BP) monitoring and electrocardiography were done, cerebral blood flow was estimated by Doppler ultrasound, reactive hyperemia and nitroglycerin tests were performed, and plasma nitrite levels were determined., Results: With a comparable decrease in BP and heart rate in the internal carotid artery basin in both groups over time, there was a fall in peak systolic blood flow velocity; Group 1 showed a reduction in pulsatility index (PI) and systolic/diastolic ratio (ISP). After 8 weeks, there was an increase in endothelium-independent vasodilation and baseline blood flow velocity in the brachial artery in Group 1 and a rise in endothelium-dependent vasodilation in Group 2; in both groups, reactive hyperemia were higher in the brachial artery basin. No changes in nitrite levels were recorded during therapy. There was an inverse correlation between PG and PI in Group 1 and between PG and ISP in Group 2., Conclusion: By unidirectionally affecting the vasomotor function of the endothelium, ivabradine in combination with perindopril versus metoprolol has a more favorable effect on circulatory resistance and blood flow velocity in the brachiocephalic arteries of patients with CHD and AH.

The aim of the work was to determine predictors of the absence of hemodynamically significant coronary stenosis (HCS) in elderly patients with coronary heart disease (CHD) and typical stable angina. We compared the results of coronary angiography performed in Tyumen Cardiological Centre in 1998-2010 in CHD patients presenting with typical stable angina with and without HSC at the age of above and below 65 yr (n = 100 and 958 respectively). Women comprised 61.0 and 44.5% of the elderly and younger patients respectively, with 18.8 and 33.4% having inherited risk of CHD (p < 0.001). Angina of effort (I-III FC) was documented in 87.9% of the elderly patients compared with 77.6% among the younger ones (p = 0.018), FC III circulatory insufficiency (NYHA) in 24.0 vs 10.0% (p < 0.001), compensated thyroid hypofunction in 41.6 vs 28.0% (p = 0.010), history of myocardial infarction in 15.0 vs 25.9% (p = 0.016). Results of echocardiography suggest higher indices of linear heart dimension including those of aortic root and left auricle (19.2 +/- -2.5 vs 17. +/- -2.2 mm and 2. +/- -2.7 vs 21. +/- -2.4 mm; p < 0.001). Elderly patients more frequently showed echocardiographic signs of atheroscleotic lesions of aorta (92.8 vs 60.6%; p < 0.001) and valvular pathology including aortic stenosis (9.2 vs 2.9%; p= 0.001). The study revealed the independent relationship of aortic stenosis, thyroid hypofunction, echocardiac signs of aortic atherosclerosis, enlarged left auricle and aortic root, and previous myocardial infarction with the age of patients with CHD and typical stable angina without HCS.

Aim: To identify the factors most substantially influencing the quality of life (QL) in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS), by using the principal component method., Subjects and Methods: One hundred and two male patients (mean age 48.6 +/- 1.02 years) with CHD associated with MS, who had experienced large-focal myocardial infarction not earlier than 6 months before, were examined. Estimation of QL (EORTC QLQ CORE 30) and emotional-personal sphere (brief multifactorial personality questionnaire test and Spielberg's trait anxiety inventory) was made along with the complete clinical, laboratory, and instrumental examination accepted in specialized clinical practice of cardiology., Results: A factor analysis of the variables obtained after a thorough examination of the patients could identify 4 common QL determinants, such as postinfarction cardiac remodeling, neurotization, obesity, and the degree of heart and coronary failure., Conclusion: MS in patients with CHD appreciably determines the total score of physical, emotional, and social well-being. In the cluster of MS components, obesity is a major factor that influences QL in patients who have sustained myocardial infarction.

We studied the relationship between anemia and chronic diseases of the upper gastrointestinal tract in patients with CHD. Patients with CHD and gastroesophageal reflux disease (GERD) had the lowest hemoglobin levels and erythrocyte counts in the absence of pronounced independent effect of GERD. This finding suggests common pathogenesis of CHD, GERD and anemia in patients with coronary problems.

To improve differential diagnostics and treatment of coronary heart diseases (CHD) and concomitant climacteric cardiopathy (CCP), we analysed results of clinical examination and laboratory-instrumental studies of 1063 women complaining of chest pain. They were divided in 3 groups: group 1 (817 patients with CHD), group 2 (134 patients with CCP), group 3 (122 patients with CHD+CCP). Peculiarities of laboratory and instrumental diagnostics are described in conjunction with comparative characteristic of multispiral CT coronarography and corononaroangiography.

The aim of the study was to determine the sensitivity and specificity of combined high-dose dipyridamole and dobutamine stress echocardiography (stress EchoCG) in the diagnosis of coronary artery stenotic lesions in coronary heart disease in a group of patients who were unable to perform physical exercise, by using different assessment criteria (local contractile impairments and systolic velocity changes during tissue Doppler imaging). The study enrolled 68 men who had undergone dipyridamole and dobutamine stress EchoCG, longitudinal tissue Doppler imaging, and coronary angiography. Stress EchoCG could bring up to diagnostic criteria in all the patients. Coronary angiography revealed no coronary artery lesion in 18 patients, but showed single and multiple vascular lesions in 31 and 19 patients, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of stress EchoCG examination. The results of combined stress EchoCG allow one to judge to a greater validity (96% sensitivity and 100% specificity) local contractile impairments corresponding to the blood supply area in the atherosclerosis-afflicted coronary artery. Analysis of systolic velocity parameters during tissue Doppler imaging permits the diagnostic value of the technique to be insignificantly improved particularly when the test results are controversial.

Vascular inflammation is a major pathogenetic factor for the progression of an atherosclerotic process and for the development of destructive plaque changes. Now an active search is under way for markers to diagnose acute coronary syndrome at the early stage of development. The paper discusses the role of markers of inflammation and endogenous destruction in the development of atherosclerotic plaque instability. Pregnancy-associated plasma protein A (PAPP-A) is its most promising marker. It may be used to stratify the risk of cardiovascular complications in coronary heart disease and to assess their prognosis.

Over 30 000 cases of acute poisoning with ethyl alcohol and its surrogates are recorded annually in this country. Differential diagnostics between fatal poisoning and death from coronary heart disease encounters serious difficulties. The authors report a comprehensive forensic chemical, morphometric, and pathomorphological study of the activity of ethanol-oxidizing enzyme systems in the internal organs. The results of histochemical examination provide a basis for the extension of diagnostic potential of the available methods and the enhancement of the objective value of expert reports.

The purpose of the study was to define the values of clinical and biochemical (phenotypic) differences in 2 groups of patients: 1) those with moderate (< or =4.5 mmol/l) blood triglyceride (TG) levels and 2) those with high (more than 4.5 mmol/l) blood TG levels and to reveal significant parameters of a diagnostic algorithm for primary and secondary forms of hypertriglyceridemia (HTG). Ninety-six (54%) patients females) with a TG level of more than 2.3 mmol/l were examined. The age was 12 to 71 years (median [quartiles] 50 years [41-61 years]); women accounted for 54%. The patients had the following diseases: coronary heart disease (CHD) (44.89%), myocardial infarction (13.5%), arterial hypertension (87.9%). The diagnosis of HTG included an algorithm for the clinical, biochemical, and clinicogenealogical examination of patients. Biochemical blood analysis involved lipoprotein parameters: cholesterol, triglycerides, low-density lipoprotein cholesterol, lipid electrophoresis, apolipoproteins Al, B-100, E, and C-III. The data were processed using the statistical packages STATISTICA 6.0 and SPSS 17.0. Comparison revealed no age- and gender-related differences in the parameters between Groups 1 and 2 There was a significant correlation between the high levels of TG and the following indicators: total cholesterol, chylomicrones, lipoprotein(a), LP-E , LP B:E, LP C-III4, and LP C-III, smoking (a risk factor) and with the indicators of other metabolic disturbances--total C, chylomicrones, lipoprotein(a), LP-E-total, LP B:E, LP-C3-total, and LP-C3, which determined the impact of nutrition had a hereditary predisposition through the polygenic mechanisms of gene expression under the influence of a number of factors. Pancreatitis was found to be implicated in the development of HTG. Higher TG levels correlated with the parameters, the diagnosis of which reveals additional metabolic disturbances via environmental and polygenic mechanisms

Heart rate is one of widely investigated new risk factors for the progression of coronary heart disease. Aim of this study was to assess association between admission resting heart rate (HR) and one-year survival in patients with coronary heart disease in dependence on gender, age and clinical expression of coronary heart disease (acute or chronic ischemic heart disease). Methods. We randomly selected 3268 patients with acute myocardial infarction (MI), unstable or stable angina admitted to Kaunas University Clinic of Cardiology in 2005. In 1 year we collected data on outcomes of 1824 patients. Statistical analysis was performed using SPSS and MS Office Excel statistical programs. Results. One-year mortality risk was significantly increased in patients with HR more or equal 67 bpm (p=0.017). Significant interaction was found between resting HR, clinical expression of coronary heart disease, and age. Mortality was significantly increased in patients with HR&gt;75 bpm and chronic coronary heart disease (p=0.015) and with HR &gt;71 bpm in patients with acute coronary syndrome (p=0.016). HR more or equal 72 bpm more than doubled risk of death during 1 year in patients younger than 60 and older than 75 years (p=0.047).

This article highlights main pathogenetic links between coronary heart disease and oncological diseases including the role of apoptosis, paraneoplastic manifestations, and psychopathologic conditions as well as the influence of therapy on CHD progression. Relevant clinical observations to illustrate theoretical considerations are presented.

The study was designed to assess clinical efficiency and safety of nebivolol in patients with cardiovascular problems and chronic obstructive pulmonary disease. It included 50 patients of whom 25 were given daily 5 and 25 mg of nebivolol and 80-100 mg of verapamil. Nebivolol was shown to significantly reduce arterial pressure, heart rate, and the number of ventricular extrasystoles. The drug was well tolerated by the patients and had no adverse effect on bronchial patiency.

Unlabelled: The aim of this study is to assess the 1 and 2-year follow-up of treatment with Cypher drug- eluting stents (Cordis, Johnson & Johnson, USA) for chronic symptomatic coronary artery occlusions in CHD patients after coronary artery bypass graft. That was a retrospective study that included 51 patients who had been implanted Cypher stents. A control group comprised 65 symptomatic patients with coronary heart disease (CHD) after coronary artery bypass grafting with occlusive lesions of the coronary artery, who was carried out only conservative treatment (without PTCA). Patients received standard medicamentous treatment. The groups did not differ in clinical characteristics. 79 stenoses in the eluting stent groups were subject to revascularization. The immediate cure rate was 84.3%. During the follow-up, one patient (2.3%) died and 4 (9.3%) underwent coronary bypass surgery in the drug- eluting stent group; there were 3 (4.6%) deaths and 10 (15.4%) patients had coronary bypass surgery in the control group. After stenting we noted a reliable decrease of patients with anginal attacks, of the used nitrates, increase the average physical tolerance by stress- testing (p < 0.05) than by patients in control group., Conclusion: stenting chronic coronary artery occlusions in patients with coronary heart disease (CHD) after coronary artery bypass grafting with the use of Cypher drug- eluting stents (Cordis, Johnson & Johnson, USA) is an effective procedure from the viewpoint of long-term results, with low frequency of recurrent angina and repeated myocardial revascularization.

Aim: To study some particularly inadequately studied mechanisms for the development of coronary artery calcification (CAC), which are unassociated with calcified atheromatous masses of atherosclerotic plaques., Subjects and Methods: . Endarterectomized coronary artery (CA) segments obtained during aortocoronary bypass surgery were pathomorphologically studied in 150 patients aged 49-72 years with coronary heart disease (CHD). CAC was found in 92% of cases. Two types of CAC were identified: one of them was associated with calcified atheromatous masses of atherosclerotic plaques; the other was related to necroses in the fibrous plaque parts. The atheromatous masses exhibited calcareous deposits as fine-grained masses of small extent. In chronic CHD, morphological signs of instability of atherosclerotic plaques were observed in 23.3% of cases, these being associated with lamellar CAC in two thirds., Conclusion: Calcification in the necrotic area of fibrous parts of stenotic plaques is typical of chronic CHD and is frequently attended by the development of large-focal calcareous deposits generally as laminas (lamellar calcification). Impaired transmural perfusion of plasma is noted to be involved in the development of necroses in stenotic CA atherosclerotic plaques.

Unlabelled: The purpose of this investigation is to evaluate the influence of purified highly-concentrated omega-3 polyunsaturated fatty acids (90% omega-3 polyunsaturated fatty acids 1 g/day) on the severe ventricular arrythmias in patients with stable coronary heart disease (CHD) without concomitant left ventricular contractivity impairment., Materials and Methods: 43 patients with stable CHD (26 male and 17 female, aged 66.2 +/- 8.3) with ejection fraction above 45% with unstable paroxysms of ventricular tachycardia detected at Holter ECG monitoring that received 1 g/day omega-3 polyunsaturated fatty acids during 1 month. 23 patients continued treatment for one month extra, while 20 stopped receiving after one month. ECG monitoring was repeated monthly., Results: In one month after started receiving 90% omega-3 polyunsaturated fatty acids the mean heart rate reduced by 2.4%, the number of single extrasystoles reduced by 20.1% (p=0.01), the number of paired extrasystoles reduced by 47% (p=0.0018) and the number of paroxysms reduced by 49% (p=0.0029). In 41.9% patients no paroxysms have been registered after one month. When continuously receiving omega-3 polyunsaturated fatty acids during the second month, the treatment efficiency increases, while the receiving been stopped after one month, the effect is reduced but remains., Conclusion: 1 g/day omega-3 polyunsaturated fatty acids application in patients with stable CHD without myocardium contraction dysfunction suffering from ventricular arrhythmias (4B grade after B.Lown) with no direct indications for implantable cardioverter defibrillator therapy results in significant reduction of arrhythmia.

Local polyclinic therapists' long experience in timely identifying, treating and rehabilitating patients with coronary heart disease (CHD) is analyzed. A local therapist's attention is given to diferent course types--the clinical manifestations of CHD. The principles of continuity in the work of a therapist and a hospital: possibilities of extrahospital treatment are denoted; indications for hospitalization are specified. Rehabilitative measures include psychotherapy sessions in addition to drug, dietary, and exercise therapies. Continuity in the work of a therapeutic unit and a sociomedical expert commission contributes to the elaboration of clearer criteria for determining the degree of working capacity loss.

Analysis of intracardiac hemodynamics is presented in patients with isolated stage II, III and IV chronic obstructive pulmonary disease (COPD) in the period of exacerbation and in those having COPD with concomitant coronary heart disease (stable angina of functional class II). Retrospective evaluation included 100 medical histories. Color Doppler echoCG was performed and parameters of systolic and diastolic function of both ventricles measured. Results of correlation analysis of systolic and diastolic function of left and right ventricles are presented along with the data on blood pressure in the right chambers of the heart.

The study was designed to evaluate the frequency of inapparent and/or unrecorded cases of acute coronary heart disease (CHD) and its influence on overall estimates of CHD mortality and morbidity. A specially developed algorithm was used to identify unrecorded cases in official medical documentation concerning 285,736 subjects. Their fraction was found to be 20.78 and 24.48% among men and women respectively. 89.43% of them died from acute CHD. Addition of the newly identified cases to official statistics increased overall CHD morbidity rates by 26.24 and 32.41% for men and women and mortality rates by 2.13 and 2.28 times respectively. These data indicate that acute CHD is poorly diagnosed in routine clinical practice and the real CHD mortality rate is grossly underestimated.

Ozone therapeutics is one of not medicated methods of treatment of coronary heart disease (CHD). For external application of ozone therapeutics was elaborated an air-ozone bath. Endurance of procedure is 20 minutes, ozone concentration is 8-10 mg/l in ozonized water and temperature of air-ozone mix is 36 degrees C. Course of treatment consisted of 10 daily procedures. Searches are founded on the base of analyze of results of remedial treatment of 160 patients with CHD. Patient--men, aged from 41 to 65 years (average age is 55,6 +/- 5,6). 130 patients of them, underwent an operation of coronary shunting (CS), admitted to unit on 7-18th day after operation (in average--on 14,4 +/- 3,6th) and 30 patients without operational treatment. Program of patient observe consisted of general-clinical, laboratorial, functional and psychological methods of searches. It was established that using of air-ozone bath in complex program of rehabilitation of patients with CHD, after operation of CS, promotes to improvement of oxygen transporting, flow characteristics of blood, microcirculation, lowering of hypoxemia and hypoxia of tissue.

Patients with FC II-IV CHD and angina of effort were divided into 3 groups (compensated, subcompensated, and decompensated types) based on vascular reaction to local ischemic load Serum lipid spectrum, parameters of hemostasis and blood flow were evaluated before and after the load. It was shown that each type of vascular reaction had specific predictors. Vasodilation in "compensated" patients was largely due to hydrodynamic changes in the vascular bed. The "subcompensated" type was characterized by reduced sensitivity to this changes "decompensated" type of reactivity was related to metabolic rather than hydrodynamic disorders accounting for paradoxic vasoconstriction in response to ischemic load.

This study had the purpose to assess relative risk of cardiovascular death in aged and elderly men with coronary heart disease depending on electrical and functional remodeling of myocardium. It included 526 patients aged 18-92 years, with 167 ones of mean age 75.4 years. The control group comprised 113 healthy men 18-65 years of age. General clinical examination was supplemented by measurements of heart electrical activity and ventricular activation rate (VAR), detection of myocardial electrical remodeling stages, parameters of repolarization and their dispersion, assessment of structural and functional state of myocardium from the results of two-dimensional echocardioscopy. The clinical course of disease and its fatal outcomes were monitored for 10 days. The risk of death from all cardiovascular events significantly increased as a result of decreased ejection fraction, increased mass of left ventricle (LV), dilation of its cavity, excentric myocardial remodeling, and reduced VAR. An independent predictor of cardiovascular death was increased dispersion of intervals dQtend > 60 ms, dJTapex > 60 ms. Cardiovascular mortality positively correlated with the terminal stage of electrical remodeling, dispersion of interval QT > 60 ms, LV mass, its index, LV end systolic and diastolic size, and ecccentric LV remodeling. Results of logistic regression analysis indicate that functional class of circulatory insufficiency, increased heterogeneity of repolarization (QT end interval), progress of electrical remodeling of myocardium and LV cavity dilatation are high risk factors that can be used to predict cardiovascular events in elderly men with coronary heart disease. Prospective 10 year-long follow up of such patients showed that progressive circulatory insufficiency, terminal stage of electrical remodeling of myocardium, dilatation of LV cavity, and dispersion of repolarization interval QT end are the major factors that significantly influence the risk of cardiovascular death.

Verification of the diagnosis of coronary artery disease (CAD) is based mostly on instrumental diagnostic techniques. Presently, there are no laboratory tests officially recommended for the diagnostics of myocardial ischemia (MI). Biochemical methods that would be able to verify MI in patients with suspected CAD have been under development since the 1990s. Ischemically modified albumin--IMA (Albumin Cobalt Binding test), glycogen phosphorylase BB, and free fatty acid-binding protein have been proposed as laboratory markers of MI. The article discusses advantages and disadvantages of IMA for diagnostics of MI in patients with acute coronary syndrome.

Coronary artery disease (CAD) remains the leading cause of death in most highly developed countries. According to the WHO, more than 17 million people in the world die of cardiovascular pathology (CVP) annually; of them, more than seven million die of CAD. For the medical service of Russian Federation Armed Forces, CAD and atherosclerosis present an important problem due to their prevalence in military men leading to high levels of morbidity, mortality, labor losses, disability, dismiss rate and disqualification of highly professional officers and generals. Certain factors of military service and extreme factors have been found to increase CAD risk. Until now, the incidence and prevalence of initial forms of CAD in military men of dangerous professions have been studied insufficiently. In order to investigate the prevalence of atherosclerotic cardiosclerosis (ASCS), the effects of risk factors (RF), and prognostication of its development, 267 military men, including 14 men of dangerous professions (pilots, navigators, command post operators), and 153 engineers, technicians and supply officers were examined at Military Hospital No7, Mandryk Military Hospital No 2, and four units of a Space Forces division. The clinico-functional examination revealed ASCS in 53 or 19.8% of the servicemen; its rate increased with age. Only a few cases of ASCS were found in subjects aged less than 30 years; a significant increase in ASCS frequency was noted in 41- to 50-year-old subjects (29.8%); between 51 and 60 years old ASCS was found in 32% of the subjects, which meant only a 2.2% increase vs. the previous age group. Possibly, this could be connected with the fact that at this age initial signs of initial forms of CAD, including ASCS in military men of dangerous professions depended not only on age, conventional RF of CAD, but on occupational hazardous factors as well. Lipid exchange disorder is an important RF for the development and progress of various CVP, CAD in the first place. Timely and correct diagnostics and interpretation of an altered lipid profile as well as assessment of concomitant cardiovascular RF are necessary conditions to organize rational prophylaxis of the most important CVP.

The possibility and use of prolonged epidural anesthesia in terms of preoperative care was studied in 78 patients. Patients with various stages of coronary arteries affection, central haemodynamics state and risk of reconstructive surgical treatment on lower limb arteries were marked out. Patient selection criteria for aortocoronary shunting or reconstructive operation on great lower limb vessels were worked out. It is proved, that prolonged epidural anesthesia allows not only to attain good analgesia but to minimize cardiac complications at reconstructive operations on abdominal aorta and its branches.

Aim: To select optimal methods of coronary heart disease (CHD) diagnosis in patients with different CHD probability using cost-effect analysis., Material and Methods: The trial included 102 patients admitted to hospital because of suspected CHD. The initial CHD probability was determined according to G.A. Diamond table. CHD diagnosis was made with application of Holter ECG monitoring (88 patients), treadmill test (67 patients), dobutamine stress echocardiography (echo-CG, 31 patients), stress single photon emission computed tomography (SPECT, 30 patients), multislice computed tomography (MSCT) with contrast study of coronary arteries (14 patients). Non-invasive tests were followed by coronaroangiography. The cost-effect method was used for analysis of the above methods cost efficacy., Results: MSCT specificity was 96%, specificity of the other methods - 70-75%. SPECT was most sensitive (96%), Holter ECG monitoring was the least sensitive (49%). Efficacy of all the diagnostic tests was maximal in moderate probability of CHD. In spite of its moderate specificity and sensitivity, treadmill test was the cheapest and, therefore, most cost effective in all the groups. Specification of CHD probability by 1% required 17.4 roubles in low risk groups, 9.4 and 24.7 roubles in moderate and high risk, respectively., Conclusion: CHD diagnosis should be started with treadmill test.

The purpose of the research was to study kinds, frequencies and features of heart rhythm disturbances (HRD) in patients with chronic obstructive pulmonary disease (COPD) subject to degree of severity, including presence of coronary heart disease (CHD). 1189 of patients with registered HRD were examined. 315 of them had COPD (group 1), 531--combination of COPD and CHD (group 2), 343 were CHD patients (group 3). The extent of examinations included electrocardiogram (ECG), Halter monitoring (HM), bicycle ergometry (BEM), external respiration function estimation. Supraventricular HRD were registered statistically more frequently in group 1: according to ECG data in rest - in 37.2% patients, by BEM results--in 18.8%, by HM--in 50%. Combined (supraventricular and ventricular) HRD were registered most frequently in group 2: 41.2 24.4, and 45.5% respectively. Ventricular HRD dominated in group 3: 47.6, 29.3 and 48.6% respectively. The results of the study indicate that supraventricular HRDprevaile in patients with COPD, combined HRD - in patients with COPD and CHD. Ventricular HRD, which most informatively reflect changes in intracardiac geometry and left ventricle hemodynamics, dominate in CHD patients. The optimization of therapy correction consists in early diagnostics of HRD subject to features of cardiorespiratory system functional state.