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Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing worldwide. Therefore, the assessment of comorbidities based on the age factor in patients with coronary artery disease (CAD) is highly relevant.Aim: To assess the associations between the age factor and comorbidities in patients undergoing CABG. Material and Methods: Data of 680 patients [538 (79.10%) men and 142 (20.90%) women], undergoing elective CABG in the period 2011-2012, included in the CABG Registry were used to detect comorbidities.All patients were enrolled into 4 age groups: below 50 years, 51-60 years, 61-70 years, over 70 years.Results: Aging was associated with an increase in the proportion of women suffering from arterial hypertension (AH), and multivessel disease. Similarly, the proportion of patients with higher func-tional class (FC) of angina, heart failure (CH), and heart rhythm disturbances increased. The number of patients referred to elective CABG with previous myocardial infarction (MI) was the highest among young adults (77%). Aging was associated with an increase in the number of patients with chronic pyelonephritis (44.30%) and thyroid pathology (3.40%).Conclusion: Patients’ aging is associated with an increase in cardiovascular comorbidities, but not MI. Importantly, there was no any increase in the rate of non-cardiovascular comorbidities.

Aim. To evaluate the potential of using factors associated with type 2 myocardial infarction (MI) for its early diagnosis.Material and methods. This prospective study included 204 patients diagnosed with acute coronary syndrome (ACS). At the time of admission, each patient underwent standard examinations for ACS patients. The 1-year stage consisted of telephone survey of patients on the course of long-term postinfarction period. There were following endpoints: death, recurrent coronary events and hospitalization.Result. Patients with type 2 MI accounted for 10,8% (n=22) of the entire analyzed sample. A model for prehospital diagnosis of probable type 2 MI has been developed. The model included clinical and history data that allow to suggest the type 2 MI course without invasive and laboratory studies. The model included signs (body mass index ≥35, kg/m2, atrial fibrillation+Killip I, hemoglobin

Aim. To study the blood coagulation status by various laboratory methods in patients after pulmonary embolism (PE) receiving long-term anticoagulant therapy.Material and methods. The blood of 23 patients with pulmonary embolism, who received long-term anticoagulant therapy, was studied. The study of coagulation profile, D-dimer, thrombodynamics, thromboelastography and thrombin generation test were carried out.Results. The thrombin generation test shows a significant increase in the time of its formation, while the maximum amount of thrombin formed is half that of the reference values. There is a slightly increased median fibrin clot growth rate in the thrombodynamics test — 30,4 gm/min with a normal coagulation rate of 20-29 gm/min. The result of thromboelastography also reflects the blood hypocoagulation, in terms of R, Angle a and CI.Conclusion. Integral methods for assessing the thrombotic readiness in combination with a routine coagulation panel demonstrate a complete picture of blood coagulation potential in patients after pulmonary embolism requiring long-term anticoagulant therapy.

The onset of critical complications (multiple organ dysfunction syndrome, MODS) after coronary artery bypass grafting is the result of severe stress response. The key etiopathological factor of the induction phase of the complex pathological process, which ultimately leads to dysfunction of organs and systems, is the dysfunction of the immune response. The characteristics of reactions of the immune system in a particular individual are genetically determined and realized through innate immunity activation. Aim. To determine the role of TREM-1 gene polymorphism through the changes of sTREM serum levels and their contribution to the development of multiple organ dysfunction syndrome after coronary artery bypass grafting.Materials and Methods. 132 patients with coronary atherosclerosis who had undergone coronary artery bypass grafting were included in the study. Of them, 30 patients had multiple organ dysfunction syndrome in the early postoperative period. sTREM serum levels were measured using enzyme immunoassay. Genotyping of polymorphic loci of the TREM-1 gene was performed with real-time allele-specific PCR using TaqMan system.Results. Significant differences in sTREM levels among patients with and without MODS were found. sTREM levels depend on the carriage of certain allelic variants in the three polymorphic loci of the TREM-1 gene (rs1817537, rs2234246, rs3804277)Conclusion. The relationships of the levels of the circulating soluble form of TREM-1 and the polymorphic variants of the coding TREM-1 gene with the severity of MODS were determined in coronary artery disease patients after coronary artery bypass grafting.

Purpose: to identify the factors associated with the development of death events during the year follow-up after hospitalization for pulmonary embolism (PE). Materials and methods: 93 patients with PE discharged to the outpatient stage of observation were studied. 45 (61,6%) patients were female with an average age of 66 years. The examination of patients at the stage of inclusion in the study consisted of standard methods of examination for this pathology. The diagnosis was confirmed by multislice computed tomography. Follow-up was 12 months. Statistical analysis was performed using the MedCalc Version 16.2.1. Results: during the one-year follow-up period 62 (66,7%) patients with PE were alive but 11 patients (11,8%) died, and no information was obtained about 20 patients. The causes of death were as follows: the development of recurrent PE – 4 (36,4%) patients, cancer – 3 patients (27,3%), stroke – 2 (18,1%), one patient (9,1%) died due to severe heart failure and one – myocardial infarction. A comparative analysis in the groups of alive patients (n = 62) and patients with a fatal events (n = 11) showed that the dead patients were older (78 (68; 81) vs. 65 (49; 75) years; p = 0,003), had a higher PESI score (119,0 (99,7; 137,2) vs. 88,0 (68,0; 108,0); p = 0,016) and were less compliant to prolonged anticoagulant therapy during the one year of observation (45,5% of patients (n = 5) vs. 82,3% ( = 51); p = 0,015). The ROC curve determined that a high risk of death during the one year after PE is associated with age over 70 years (p = 0,0001) and more than 95 points by PESI in the hospital period (p = 0,0001). Conclusion: The death events were developed in 11,8% of cases in patients with pulmonary embolism during the first year of follow-up. The death outcomes were significantly associated with elderly age, intermediate and high risk by PESI in the hospital period and low compliance to anticoagulant therapy extended during the year after pulmonary embolism.

Aim. To assess the incidence of unfavorable in-hospital outcomes (fatal and non-fatal complications) following coronary artery bypass grafting (CABG), depending on the age of the patient and the presence of comorbidities.Material and methods. In the period from 2011 to 2012 we included in the study 680 patients for elective CABG (single-site, register, prospective study). Combined clinical endpoint (CCE) included the presence of myocardial infarction (MI), multiple organ dysfunction syndrome (MODS), heart failure (HF), new atrial fibrillation (AF) after CABG, repeat mediastinotomy (of one or more complications) and/or deaths.Results. There is a high prevalence of comorbidities among the patients referred to CABG. One hundred fifty two (22,40%) patients reached the CCEs. The highest rate of the CCEs was recorded in the group of patients undergoing concomitant CABG, compared to the group of patients after isolated CABG. Patients’ age was associated with the development of CCE in the early postoperative period. The highest number of CCEs was registered in the group of patients with combined surgical interventions.Conclusion. Factors associated with the probable development of unfavorable nosocomial outcomes either fatal or non-fatal following is the age of patients 61 years and older, concomitant CABG, and the extracorporeal circulation.

Aim. To evaluate the impact of age and gender on in-hospital outcomes of coronary artery bypass grafting (CABG) in patients with coronary artery disease. Methods. 538 (79.10 %) men and 142 (20.90 %) women ( n = = 680) in the CABG registry of the Research Institute for Complex Issues of Cardiovascular who were referred to CABG in the period from 2011 to 2012 were retrospectively reviewed to assess the prevalence of comorbidities and estimate the in-hospital outcomes. The mean age of patients was 59.12 ± 7.98 (33 to 78 years). All patients were assigned to 4 age groups: Group 1 - 70 years. The statistical analysis was performed using the software package SPSS 20.0.1. A p value of

Aim. To study the clinical course and management of patients with pulmonary embolism (PE) of various age groups hospitalized in a cardiology hospital.Material and methods. This prospective single-center study in the period from 2016 to 2018 included 154 patients with PE verified by computed tomography. Statistical processing was conducted using the MedCalcVersion 16.2.1 software package (Softwa, Belgium).Results. In all groups, female patients dominated, but the highest number of women (70,7%) belonged to the group of senile patients, while in the group

Aim. Evaluation of the association of cardiac-ankle vascular index and development of adverse outcomes in patients after non-ST elevation acute coronary syndrome (NSTEACS).Material and methods. To the registry of NSTEACS in 2009. Totally, 415 patients had been included. The group of main long term (5-year) follow up consisted of 385 persons. Measurement of cardiac-ankle vascular index (CAVI) was done with the VaSera-1000 (Japan) equipment. As the endpoints, death, non-fatal myocardial infarction, unstable angina hospitalization, ischemic stroke were taken. Combination of the outcomes was labeled as combinatory endpoint. Statistics was done with Statistica v.8.0, MedCalc v.16.2.1. For the risk evaluation, the odds ratio (OR) was calculated with 95% confidence interval (95% CI). Differences in the comparison groups were taken as significant with (р)8,55 was associated with adverse cardiovascular events in NSTEACS patients during 5 years follow-up, and CAVI ≥9,15 was associated with fatal outcomes.Conclusion. The following clinical and instrumental parameters are associated with adverse cardiovascular events in NSTEMI patients during 5 year follow-up: older age, anamnesis of myocardial infarction and coronary bypass surgery, ischemic ECG changes, decreased left ventricle ejection fraction, higher GRACE score at admission and CAVI >8,55 by sphygmomanometry. This makes possible to use these parameters as the predictors of long term adverse outcomes. Value of CAVI ≥9,15 can be used as a marker of general fatal outcomes in NSTEACS.

Lymphotoxin-α (LTA) is a major pro-inflammatory cytokine produced at the early stages of vascular inflammation, taking part in the formation of arterial atherosclerosis and development of coronary heart disease. Functional changes in the gene encoding LTA production may influence the development of coronary heart disease with unfavorable progression. However, studies for associations between rs1041981 (C-804A) LTA gene variant and development of acute cerebrovascular accidents, myocardial infarction, and severity of coronary atherosclerosis have yielded contradictory results. The purpose of our study was to investigate an association of rs1041981 gene LTA with risk of adverse events within five years of follow-up in the patients with acute coronary syndrome without ST elevation ST (nonST-ACS). 178 patients with nonST-ACS from the Kemerovo Cardiology Center Registry were included into the study. Genotyping of rs1041981 site variable LTA gene was performed by TaqMan technique using an “iCycler iQ” device (BIO-RAD, USA). Results: we have found that the A allele and A/A genotype polymorphism in LTA gene (rs1041981) have been associated with development of adverse cardiovascular events over five years of observation (respective p levels were 0.02 and 0.036). In patients with A/A genotype, the rs1041981 polymorphism in LTA gene was associated with 3.8-fold increase in adverse cardiovascular events, compared to patients having A/C or C/C genotype. Carriage of A allele in LTA gene (rs1041981) doubles the risk of adverse cardiovascular events in patients with nonST-ACS at long observation terms. By means of Kaplan-Meier method, we have determined that survival to the first endpoint occurred more often in carriers of the genotype A/A of LTA gene (rs1041981). The A/A genotype of LTA gene (rs1041981) proved to be more significant (p = 0.016) for development of adverse outcomes, when combining the patients with A/C and C/C genotypes. One may draw a conclusion that A allele and A/A genotype of rs1041981 LTA polymorphism is associated with development of adverse cardiovascular events during the five-year period following the index event in patients with nonST-ACS.

Development of atherosclerosis and its clinical manifestations, i.e. unstable angina, myocardial infarction, and ischemic stroke, is largely determined by a genetic inheritance, particularly inherited variation of the genes encoding Toll-like receptors (TLRs), a major effector of innate immune system. Polymorphisms of the TLR genes may affect vascular inflammation, as well as plaque formation and its stability. Miriades of immune cells and bioactive substances are involved into pathogenesis of atherosclerosis. They exert different effects upon vascular wall and participate in development of universal inflammatory response. Local inflammatory reaction underlyes atherosclerotic plaque destabilization and endothelial dysfunction. This response is associated with TLR activation and induced synthesis of proinflammatory cytokines. Here we review the literature on the role of inherited variations within the TLR genes in the development and progression of atherosclerosis and its complications. Moreoxer, we conclude that a search for genomic markers of atherosclerosis, e.g., TLR gene polymorphisms, may be applied in personalized cardiovascular medicine, in order to predict clinical course and evolution of the disorder, like as to perform prophylactic measures aimed for prevention of the disease progression.

Aim. To reveal the association of polymorphic types of Toll-like receptor genes with myocardial infarction (MI), stroke in patients with coronary heart disease (CHD).Material and methods. Totally 292 patients studied, with CHD and anamnesis of stroke and/or MI. The association of 8 polymorphic loci of 4 genes were studied: TLR1 (rs5743551 & rs5743611), TLR2 (rs3804099 & rs5743708), TLR4 (rs4986790 & rs4986791), TLR6 (rs3775073 & rs5743810).Results. The association of allele C of polymorphism rs5743551 gene TLR1 is associated with higher risk of earlier CHD onset (younger than 55 y.o.). Heterozygous (A/G) genotype of polymorphism rs5743810 TLR6 is protective against the risk of earlier CHD onset (younger than 55 y.o.). Heterozygous (C/T) genotype of polymorphism rs5743551 gene TLR1 is associated with higher risk of stroke in CHD patients. The associations revealed with age, gender and cardiovascular complications by polymorphisms of TLR genes: males, having CHD, homozygous by minor allele (С/С) of polymorphism rs3804099 gene TLR2, have reduced risk of of MI development not related to age; heterozygous (C/T) genotype of polymorphism rs5743551 of gene TLR1 is associated with the increased risk of stroke in CHD patients older than 55 y.o. not depending on gender; heterozygous (T/C) genotype of polymorphism rs3775073 gene TLR6 is associated with increased risk of MI in younger than 55 y.o. patients with CHD not related to gender.Conclusion. Some associations of polymorphic Toll-like receptors genes with the development of atherosclerosis complications (MI, stroke) in CHD are revealed.

Study aim: To investigate an association of the Toll-like receptor (TLR) gene polymorphisms with the risk of coronary artery disease (CAD). Materials and Methods: We recruited 702 consecutive Russian patients with CAD and 300 healthy blood donors who were residents of Western Siberia (Kemerovo Region). We investigated eight polymorphisms within four genes: TLR1 (rs5743551, rs5743611), TLR2 (rs3804099, rs5743708), TLR4 (rs4986790, rs4986791), and TLR6 (rs3775073, rs5743810). Sample genotyping was performed in 96-well format using the TaqMan SNP genotyping assay. Results: C/C genotype of rs5743551 polymorphism and C/G genotype of rs5743611 polymorphism within TLR1 gene along with T/C genotype of rs3775073 polymorphism and A/G genotype of rs5743810 polymorphism within TLR6 gene were associated with a high risk of coronary artery disease (OR = 0.41 (95 % CI = 0.20–0.84), OR = 1.56, 95 % CI = 1.04–2.34, OR = 1.68, 95 % CI = 1.03–2.73, and OR = 1.55 (95 % CI = 1.12–2.14, р < 0,05, respectively) independently of age and gender. Conclusions: certain Toll-like receptor gene polymorphisms are associated with the risk of CAD.

Aim of the study. To determine the impact of polymorphisms within the genes encoding Toll-like receptors on the development of carbohydrate metabolism disorders (CMDs) amongst patients with coronary artery disease (CAD). Materials and Methods. We recruited 292 patients with CAD and investigated 8 polymorphisms within 4 genes, namely TLR1 (rs5743551 and rs5743611), TLR2 (rs3804099 and rs5743708), TLR4 (rs4986790 and rs4986791), and TLR6 (rs3775073 and rs5743810). Results. Carriers of G allele of rs5743611 polymorphism within TLR1 gene had an increased risk of CMDs. Moreover, the risk of CMDs was 3-fold higher in carriers of G/G genotype of rs5743611 polymorphism between 50 and 70 years of age. However, carriers of Т allele of rs4986791 (Thr399Ile) polymorphism and G allele of rs4986790 (Asp299Gly) polymorphism within TLR4 gene had decreased risk of CMDs. In addition, A/A genotype of rs5743810 polymorphism within TLR6 gene was associated with reduced risk of CMDs in males. Conclusion. There are certain associations of polymorphisms within genes encoding Toll-like receptors and development of CMDs amongst patients with CAD.