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An approach to increasing the diagnostic accuracy of the ECG stress test for transient myocardial ischemia is considered. It is proposed to modify the decision rule by including an additional procedure for assessing the temporal dynamics of the equivalent cardiac generator in the ST-T segment. The results of evaluating the sensitivity and specificity of diagnosis in a group of subjects are presented.

The aim of the present study is to determine the prognostic value of GFR reduction according to the CKD-EPI formula, taking into account blood creatinine and a formula that simultaneously takes into account creatinine and cystatin C in patients who were hospitalized for the first time due to decompensation of chronic heart failure with a preserved left ventricular ejection fraction (HFSA) observation within 24 months. Materials and methods. The study included 117 patients (women – 65.8%, mean age 71.6 ± 9.1 years) hospitalized due to debugging of CHF and having a preserved left ventricular ejection fraction according to echocardiography. The study was a prospective observation for 2 years after the inclusion of each patient. On the first day of hospitalization, all serum samples were taken to determine the level of cystatin C. The estimated glomerular filtration rate (eGFR) was determined using the CKD-EPI formula, taking into account blood creatinine and the combined formula, including creatinine and cystatin C. The combination was used as an end point death and re-hospitalization within two years of follow-up. To determine the effect of a decrease in eGFR on the forecast, the Kaplan–Maer method and the log-rank test were used. Differences were considered statistically significant at pResults. During the observation period, the mortality rate was almost 12%. At the same time, every third patient was repeatedly hospitalized within two years. In order to determine the effect of reducing GFR on reaching the end points, all patients were divided into groups with eGFR values of more or less than 45 ml/min/1.73 sq.m according to both formulas. When separating patients using the CKD-EPI formula, which includes only creatinine, the groups did not differ in terms of the frequency of reaching the combined end point, as well as its components: death and re-hospitalization. However, patients with eGFR values less than 45 ml/min/1.73 sq. M according to the combined formula data significantly more often reached the combined end point, mainly due to an increase in mortality. Conclusion. The data obtained suggest that adding cystatin C to the CKD-EPI formula and appropriately identifying patients with reduced eGFR has a high prognostic value for stratifying the risk of an unfavorable outcome after the first decompensation of HFSSFV.

Modern strategies of primary prevention of cardiovascular complications of atherosclerotic etiology are presented in this article: traditional approach based on assessment of risk of development of complication and coming to replace it concept of prevention based on direct application of results of prospective clinical studies. The article contains detailed presentation of new opportunities of computer tomography of the heart allowing to substantially elevate precision of assessment of risk of cardiovascular complications of atherosclerotic etiology. Main attention is paid to the coronary artery calcification index, which determination substantially simpli- fies decision making relative to strategy of primary prevention in clinical practice

Aim.To evaluate the diagnostic accuracy of a noninvasive method of fractional flow reserve (FFR) assessment based on a one-dimensional hemodynamic model build on data obtained from the coronary computed tomography angiography (CCTA).Material and methods.The study enrolled 57 patients: 16 of them underwent 64-slice computed tomography — included retrospectively, 34 — prospectively, with a 640-slice CT scan. Specialists from the Laboratory of Mathematical Modeling processed CT images and evaluated noninvasive FFR. Ischemia was confirmed if FFR Results.During data processing, 3 patients of the retrospective and 34 patients of the prospective group were excluded from the study. The sensitivity of our method was 90,91% (95% CI; 58,72-99,77), specificity — 86,67% (95% CI; 59,54-98,34), PConclusion.Our method has quite a high accuracy and can be successfully used in clinical practice in order to enhance the diagnostic efficiency of the CCTA.

Objective:to study potantial of remote ischemic preconditioning (RIP) as method of cardioprotection during coronary artery bypass surgery with cardiopulmonary bypass (CPB) and anesthesia with propofol.Materials and methods.We included in this study 87 patients (7 were excluded) with ischemic heart disease, hospitalized in the clinic of aortic and cardiovascular surgery of the I. M. Sechenov First Moscow State Medical University clinical hospital № 1. All patients had indications for direct myocardial revascularization by coronary artery bypass surgery. One day before operation patients were randomly assigned to 2 groups depending on preparation scheme: main group of RIP and the control group. The frequency of complications during surgery and in the postoperative period was assessed. Troponin I level was measured before, and in 2 and 24 hours after surgery. The level of lactate in the venous blood was measured before and after surgery.Results. Numbers of intraoperative and early postoperative complications in the main and control groups were similar. There were no differences between groups in troponin I and lactate levels after surgery.Conclusions.Remote ischemic preconditioning has no effect on the outcome of coronary artery bypass surgery with cardiopulmonary bypass and anesthesia with propofol.

Objectives. To study the relationship between the immune system and depression, as well as its endophenotypes (neuroticism and trait anxiety), in patients with ischemic heart disease (IHD). Materials and methods. Studies were performed in a group of men with IHD and depression (78 patients) and without depression (91 patients), as well as in healthy male volunteers (127 subjects). Polymorphisms of the interleukin-4 (IL-4 –589C/T), interleukin-6 (IL-6 –174G/C), tumor necrosis factor α (TNF-α –308G/A), and C-reactive protein (CRP –717A/G) genes were studied. Results. An association between the IL-6 –174G/C polymorphism with depression comorbid with IHD was found (p = 0.01, OR = 2.3, 95% CI = 1.2–4.3), which was apparent as an increase in the frequency of the highly expressed G allele in the group of patients with depression. The IL-4 –589C/T polymorphism was associated with IHD: the frequency of the CC IL-4 –589C/T genotype was greater in this group of patients than in the control group regardless of the presence of depression (p = 0.007, OR = 2.1, 95% CI = 1.2–3.4). The TNF-α –308G/A and CRP –717A/G polymorphisms were not associated with depression in IHD. There were no signifi cant differences in the expression of neuroticism or trait anxiety in carriers of different genotypes at the IL-4 –589C/T, IL-6 –174G/C, TNF-α –308G/A, or CRP –717A/G loci. Conclusions. The association between the IL-6 –174G/C polymorphism with depression comorbid with IHD is consistent with published data on the role of IL-6 in the depression of depression in cardiology patients.

Aim. To assess the efficacy of algorithms for minimization of the rightventricular stimulation (MVS) for prevention of atrial fibrillation (AF) progression in patients with sick sinus node syndrome (SSS) and documented AF in anamnesis, comparing to standard bi-chamber electrical stimulation (DDDR). Material and methods. The study was one-center, prospective, randomized trial with consequent 74 patients inclusion, who had indications to permanent DDDR due to SSS and AF in anamnesis. Patients were randomized to DDDR group (n=36) and active MVS (n=38) group. Procedure of electrocardiostimulator (ECS) maintenance was done at 6 months and 1 year. During follow-up visits, information was saved in the ECS memory, as the data on AF burden. Primary endpoints were AF burden and time to persistent AF onset. Results. During the study, there were no significant differences in AF burden between the groups. Median of AF burden was 6,0 min/day (25- 75 percentiles: 0-42 min/day) in DDDR, and 6,0 min/day (25-75 perc.: 0-42 min/day; p=0,67) in MVS group. Persistent AF development was registered in 5 patients, of those 3 (8,6%) in DDDR and in 2 (5,3%) in MVS (HR 1,25; 95% CI 0,2-7,98; p=0,47). Medication or electrocardioversion was done for 9 (25,7%) patients from DDDR and 12 (31,6%) from MVS groups (HR 0,86, 95% CI 0,31-2,38, p=0,39). Conclusion. There was no benefit of MVS algorithms in short term period in decrease of AF burden and in its progression prevention towards persistent AF in SSS patients with the anamnesis of paroxysmal AF, comparing to standard DDDR regimen of ECS.

Hyponatremia is the most common electrolyte metabolic abnormality in clinical practice. The unfavorable course of many diseases is associated with hyponatremia. Acute severe hyponatremia is life-threatening because cerebral edema may develop. Less obvious chronic hyponatremia increases the risk of balance problems, falls and fractures, especially in elderly patients. In any occasion, hyponatremia should not be now regarded only as a laboratory phenomenon in critically ill patients, but it necessitates a thorough clinical analysis of each individual case and appropriate therapy. The paper presents approaches to diagnosing and treating hyponatremia in various clinical situations.Гипонатриемия - самое частое нарушение электролитного обмена в клинической практике. Неблагоприятное течение многих заболеваний ассоциировано с ее возникновением. Остро возникшая глубокая гипонатриемия представляет угрозу для жизни из-за возможности развития отека головного мозга. Менее выраженная хроническая гипонатриемия увеличивает риск нарушения равновесия, падений и переломов, особенно у пациентов пожилого возраста. В любом случае гипонатриемия в настоящее время не должна рассматриваться только как лабораторный феномен у тяжелобольных пациентов, но обусловливает необходимость тщательного клинического анализа каждого конкретного случая и соответствующей терапии. В статье представлены подходы к диагностике и лечению гипонатриемии в различных клинических ситуациях.

Aim. To evaluate the experience of the usage of Pantogam active (PIQ-PHARMA LLC,Russia) under the concept of personalized approach to correction of cognitive and emotional (anxiety and depression) disorders in arterial hypertension (AH) and chronic heart failure (CHF). Material and methods. The analysis has been done, of three recent trials came out with the results showing efficacy of D-,L-Hopanthenic/rac-Hopanthenic acid (Pantogam active compound for non-cardiac pathology (AH and CHF). The endpoints of efficacy control were the grade of cognition reduction, emotional correction (anxiety and depression), life quality improvement. Also, the influence of the drug was evaluated, on the parameters of cardiovascular system. Results. In the 3 studies, totally 232 patients participated, with cardiovascular diseases (CVD), of those 147 were controls. Duration of Pantogam active intake lasted for 4 to 12 weeks. Responders by the parameter of cognitive function were 78-100%, for emotional disorders — to 88%, for life quality improvement — 86%. Tolerance of the therapy was evaluated as good, and minimal side effects were reduced within the first week of treatment. Conclusion. Application of Pantogam active for complex treatment of AH and CHF patients leads to correction of comorbid cognitive and emotional disorders, with the absence of tolerance, hyperstimulation and withdrawal syndrome, improves life quality, contributes to therapy effectiveness of main CVD and improvement of cardiovascular parameters (blood pressure, heart rate variability, exercise tolerance).

Acute cerebrovascular accident (ACVA) and transient ischemic attack are among the leading causes of morbidity, disability, and mortality in the Russian Federation and the world. Ischemic strokes account for 70-80% of all ACVAs, with 20-30% of them being associated with stenotic atherosclerosis of the brachiocephalic arteries (BCA). The paper describes modern views on the problem of asymptomatic BCA atherosclerosis and considers the possibilities of identifying risk groups among the patients with asymptomatic atherosclerosis of the BCA.Острое нарушение мозгового кровообращения (ОНМК) и транзиторная ишемическая атака (ТИА) являются одними из ведущих причин заболеваемости, инвалидности и смертности населения в Российской Федерации и мире. Ишемические инсульты составляют 70-80% от всех ОНМК, при этом 20-30% из них связано со стенозирующим атеросклерозом брахиоцефальных артерий (БЦА). В статье изложены современные представления о проблеме бессимптомного атеросклероза БЦА, рассмотрены возможности для выделения групп риска среди пациентов с бессимптомным атеросклерозом БЦА.

Aim. Hemodynamic shifts in the brain, developing due to carotid surgery (carotid endarterectomy or stenting) might be the cause of perioperation strokes. Assessment for hemodynamic shifts is important. The aim of current study was to develop methodics of cerebral hemodynamics assessment at pre-operation and post-operation periods of carotid endarterectomy. Material and methods. The authors propose a mathematical model for preoperation analysis of hemodynamics changes in extracranial regions of brachiocephalic arteries after carotid endarterctomy. The development of mathematical model was based upon the data from pre- and postsurgery duplex scan and CT-angiography. Results. The results showed good prediction capacity for the shifts in cerebral hemodynamics, using the developed mathematical model. Conclusion. Study results make it to assess cerebral hemodynamis without supplementary investigations. The model includes and represents real anatomy and quantitative hemodynamics parameters by the CT-angiography and duplex scan of the vessels.

Aim. Comparative analysis of the diagnostic effectiveness of onedimensional (1-D) and three-dimensional (3-D) non-invasive methods for coronary fractional flow reserve (FFR) assessment based on the coronary computed tomography angiography (CCTA). Material and methods . We carried out a retrospective analysis of CCTA data for 13 patients (men — 9, mean age — 61,07±9,73). In the original research, coronary FFR of those patients was evaluated using the original 3-D HeartFlow® Analysis followed by a standard invasive FFR assessment. We estimated coronary FFR using the 1-D algorithm of the Laboratory of Mathematical Modeling (Sechenov University) and compared the diagnostic effectiveness of these methods. Results. In per-vessel analysis, the sensitivity and specificity of the 3-D approach were 90,91% (95% confidence interval (CI) 62,26-99,53) and 20% (95% CI 0,01026-62,46, p>0,9999), respectively; in per-patient analysis — 90% (95% CI 59,58-99,49) and 0% (95% CI 0-56,15, p>0,9999), respectively; area under the ROC curve was 93,75% (95% CI 80,26-100), p=2,0431e-10. For the 1-D approach, the same parameters in per-patient analysis were 88,89 % (95% CI 56,50-99,43) and 25% (95% CI 0,01282-69,94, p>0,9999), respectively; in per-vessel analysis — 100% (95% CI 72,25-100) and 33,33% (95% CI 0,05923-70, p=0,1250), respectively; area under the ROC curve was 84,54% (95% CI 63,93-100), p=0,001. Spearman’s rank correlation coefficient between the 3-D and 1-D techniques was 0,7326 (95% CI 0,35810,9041), p=0,0017. Conclusion. Although we have obtained lower values of area under the ROC curve, the sensitivity and specificity of experimental approach, as well as the correlation coefficient between models were rather high. However, further studies with higher statistical power are required.

To describe cardiac involvement in patients with acute thrombotic microangiopathy (TMA).The case histories of 46 patients with proven TMA, including 17 patients diagnosed with atypical hemolytic uremic syndrome (aHUS) and 29 patients with catastrophic antiphospholipid syndrome (CAPS), were analyzed.Different documentarily verified signs of cardiac involvement were revealed in 6 (13%) patients (5 and 1 patients diagnosed as having aHUS and CAPS, respectively). Five patients developed myocardial involvement at disease onset in the presence of multiple organ dysfunction.Cases of cardiac involvement in TMA of various genesis are presented. The exact incidence of myocardial involvement and its prognostic value are unknown so far.Цель исследования. Описать поражение сердца у больных острой тромботической микроангиопатией (ТМА). Материалы и методы. Проанализировали 46 историй болезни пациентов с доказанной острой ТМА, из которых у 17 диагностирован атипичный гемолитико-уремический синдром (аГУС), у 29 - катастрофический антифосфолипидный синдром (КАФС). Результаты. Различные документально подтвержденные признаки поражения сердца выявлены у 6 (13%) больных (5 - с диагнозом аГУС, 1 - с КАФС). У 5 пациентов вовлечение миокарда развилось в дебюте заболевания в рамках полиорганного поражения. Заключение. Представлены наблюдения поражения сердца при ТМА разного генеза. Точная частота вовлечения миокарда и его прогностическое значение у пациентов с ТМА до настоящего времени неизвестны.

Aim. To analyze the influence of pharmacogenetic factors on the risk of clopidogrel resistance and cardiovascular events during 18-months follow-up. Subjects and methods. Two hundred and fifty patients taking clopidogrel were examined. Platelet function was determined by optical aggregometry. Thromboxane A synthase 1 (TBS1) gene polymorphism was investigated in all the patients. The impact of TBS1 gene polymorphism on the risk of clopidogrel resistance and cardiovascular events was analyzed during 18 months of follow-up. Results. The carriage of TBS1 gene polymorphism AA was shown to affect the risk of clopidogrel resistance. Cardiovascular complications significantly less frequently occurred in TBS1 gene polymorphism AA carriers during 18 months. Conclusion. The carriage of a slow AA allele of the TBS1 gene is suggested to be a clinically significant protective factor in the secondary prevention of coronary heart disease

The paper reviews major biomarkers for determining the prognosis in patients with chronic heart failure and preserved ejection fraction. It also considers cystatin C, one of the novel and probably the most practically important biomarkers.Представлен обзор основных биомаркеров, определяющих прогноз у пациентов с хронической сердечной недостаточностью и сохраненной фракцией выброса. В том числе рассмотрен один из новых и, вероятно, наиболее практически значимый биомаркер - цистатин С.

Summary. Asthenic syndrome often occurs in the cardiologist daily practice. Fatigue can develop not only against the background of various cardiovascular diseases, but also be a symptom of mental disorder, which should be considered in the diagnosis and treatment. Treatment of asthenic syndrome based on both the application of various non-drug approaches and the use of pharmacotherapy.

A trial was carried out to study the efficiency and safety of therapy with the new antiasthenic drug Ladasten. The findings suggest its high safety and efficiency and good tolerability of Ladasten in the treatment of asthenia and asthenic spectrum disorders, the development of which is associated with cardiovascular disease.

To explore the relationship of depression and its endophenotypes (neuroticism and trait anxiety) with inflammatory genes in patients with coronary heart disease (CHD).A sample consisted of 78 male CHD patients with depression, 91 CHD patients without depression and 127 healthy men. Polymorphisms of the genes encoding interleukine-4 (IL-4 -589 C/T), interleukine-6 (IL-6 -174 G/C), tumor-necrosis factor alpha (TNF-α -308 G/A) and C-reactive protein (CRP -717A/G) were studied.There was the association between the IL-6 -174 G/C and depression comorbid to CHD (р=0.01; OR=2.3 CI 95% 1.2-4.3). The frequency of the 'high expression' allele G in this group was higher compared to controls. The association between IL-4 -589 C/T and CHD was found. Compared to the control group, the frequency of the IL-4 -589CC genotype was higher in patients regardless of whether they had symptoms of depression (р=0.007; OR=2.1 CI 95% 1.2-3.4). No association between the TNF-α -308G/A and the CRP -717A/G with depression in CHD was observed. There were no differences between neuroticism and anxiety scores in patients with different IL-4 -589 C/T, IL-6 -174 G/C, TNF-α -308 G/A, CRP -717A/G genotypes.The finding of the association between the IL-6 -174G/C and depression, comorbid to CHD, is in line with literature on a role of IL-6 in the development of depression in patients with CHD.Цель исследования. Изучение связи между генами иммунной системы и депрессией, а также ее эндофенотипами (невротизм и личностная тревожность) при ишемической болезни сердца (ИБС). Материал и методы. Исследование проведено в группе мужчин с ИБС с депрессией (78 человек) и без нее (91 человек), а также у здоровых добровольцев мужского пола (127 человек). Изучены полиморфизмы генов интерлейкина-4 (IL-4 –589C/T), интерлейкина-6 (IL-6 –174G/C), фактора некроза опухолей-α (TNF-α –308G/A) и С-реактивного белка (CRP –717A/G). Результаты. Обнаружена ассоциация полиморфизма IL-6 –174 G/C с депрессией, коморбидной ИБС (р=0,01; ОШ=2,3 ДИ 95% 1,2-4,3), которая выражалась в повышении частоты высокоэкспрессивного аллеля G в группе больных с депрессией. Полиморфизм IL-4 –589C/T был ассоциирован с ИБС: частота генотипа СС IL-4 –589C/T была выше в группе больных по сравнению с контрольной группой независимо от наличия депрессии (р=0,007; ОШ=2,1 ДИ 95% 1,2-3,4). Полиморфизмы TNF-α –308G/A и CRP –717A/G не были ассоциированы с депрессией при ИБС. Значимых различий в выраженности невротизма и личностной тревожности у носителей различных генотипов по локусам IL-4 –589 C/T, IL-6 –174 G/C, TNF-α –308 G/A, CRP –717A/G выявлено не было. Заключение. Ассоциация полиморфизма IL-6 –174G/C с депрессией, коморбидной ИБС, согласуется с данными литературы о роли IL-6 в развитии депрессии у кардиологических больных.

Ишемическая болезнь сердца (ИБС) остается одной из ведущих причин смертности и инвалидизации населения во многих развитых странах. По современным данным, психосоциальные аспекты являются третьим по значимости фактором риска развития ИБС. В этой статье мы суммировали данные исследований по связи различных психологических аспектов личности, таких как нейротизм, враждебность, гнев, тревожность и депрессия, с развитием ИБС. Также нами была оценена связь указанных выше психологических характеристик со следующими процессами, ухудшающими течение ишемии: поведенческие особенности личности, отягчающие течение ИБС (низкая приверженность здоровому образу жизни, низкая комплаентность и др.), артериальная гипертензия (АГ), дисбаланс вегетативной нервной системы, активации тромбоцитарного звена и иммунологические процессы. Особенности психики человека обусловлены взаимодействием нейромедиаторов, таких как серотонин, дофамин, норадреналин и др. Поэтому второй нашей задачей стал анализ данных современной литературы о связи полиморфизмов генов серотониновой системы с особенностями психики человека. Оказалось, что несмотря на большие успехи медицины в данной сфере, научные статьи дают противоречивые и неоднозначные данные. Зачастую, казалось бы, очевидные связи не находят подтверждения в крупных выборках и при проведении больших метаанализов. Правильное понимание связи особенностей психики человека с развитием ИБС поможет не только более эффективно лечить пациентов, но и проводить качественные профилактические и реабилитационные мероприятия, а также формировать группы риска с целью своевременной коррекции терапии и тактики лечения. Ключевые слова: ишемическая болезнь сердца, тревога, нейротизм, враждебность, депрессия, серотонин, генетика. Coronary heart disease (CHD) is one of the leading causes of population's death and disability in many developing countries. According to current data the psychosocial aspects are the third of the most important risk factor for coronary heart disease. In this article we summarized the researches data about connection of various personal psychological aspects such as neuroticism, hostility, anger, anxiety and depression with development of coronary artery disease. We have also evaluated relationship of above mentioned psychological characteristics with following processes worsening ischemia: individual behavioral characteristics aggravating CHD course (poor adherence of healthy lifestyle, low compliance, etc.), hypertension, autonomic nervous system imbalance, platelets activation and immunological processes. Mental features are being explained by interaction of neurotransmitters such as serotonin, dopamine, norepinephrine, etc. Therefore, our second objective was to analyze the recent literature data about relations of serotonin system genes polymorphism with the features of the human psyche. It turned out that although great successes in science and medicine in this area, a large number of works gives contradictory and ambiguous data. Often seemingly obvious connections have not been confirmed in large samples and meta-analyses. Proper understanding of the relationship of human psyche features with development of coronary heart disease will not only help to treat patients more effectively, but also to perform quality preventive and rehabilitative arrangements, as well as to form risk groups which require timely correction of therapy and treatment strategies.