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В экспериментах на 10 мужчинах4добровольцах в возрасте 5060 лет без выраженной сердечно4сосудистой патологии исследовали влияние относительно кратковременных (по 3050 мин. в день) физических упражнений, сопряженных с повышением напряжения сдвига в ПА, на величину эндотелий4зависимой вазодилатации этой артерии, вызываемой увеличением в ней скорости кровотока. В контрольном периоде на обеих руках испытуемых регистрировали эндотелий4зависимую дилатацию ПА, вызываемую увеличением кровотока в период реактивной гиперемии, следующей за окклюзией, длительностью 5 мин. После 4 дней, в течение которых каждый испытуемый периодически увеличивал кровоток в сосудах только левой руки, ритмически сжимая ею в течение 3050 мин. в сутки резиновый кистевой эспандер, вновь измеряли поток4зависимую вазодилатацию (ПЗВД) на обеих руках и сопоставляли результаты с данными контрольных измерений. В контрольных измерениях реакции ПА обеих рук на повышение кровотока, вызванного окклюзией, были практически одинаковы (4,98 0,3 на левой руке и 5,07 0,6 на правой руке). После 44дневного цикла упражнений левой рукой величина ПЗВД на правой руке не изменилась (p 0,5), а на левой руке достоверно выросла у всех испытуемых, в среднем до 7,84 0,82 (p 0,01). Таким образом, показано, что даже кратковременные физические упражнения, сопряженные с увеличением действующего на стенку артерий напряжения сдвига, заметно улуч4 шают способность эндотелия расслаблять сосудистые гладкие мышцы при увеличении кровотока. Этот результат подтверждает представление о том, что трансформация эндотелиального гликокаликса под действием напряжения сдвига улучшает механоцептивную функцию эндотелия.

Purpose: to compare rates of access site complications at early (after 4 hours) and traditional (after 24 hours) removal of a compression bandage after diagnostic transradial (TR) coronary angiography (CA) in patients not receiving anticoagulants.Materials and methods. We included into this study 392 patients (mean age 63±8.7 years, 62.8% men) who underwent transradial coronary angiography. Patients were divided into 2 groups. In group 1 patients (n=221) compression bandage was removed from puncture site in 4 hours after procedure with subsequent control of radial artery patency using presence of pulse metric curve during ulnar artery compression (the reverse Barbeau test with pulse oximeter). In patients of group 2 (n=171) compression band was removed after 24 hours. In both groups control of radial artery patency was carried out after 24 hours using the reverse Barbeau test. Upon detection of radial artery occlusion (RAO) ultrasound imaging of the forearm arteries was performed.Results. No RAO was detected in group 1 while in group 2 number of detected RAO was 15 (8.8%) (р0.05).Conclusion. Compared with traditional method early removal of compression bandage after TR CA was associated with lower rate of RAO.

Aim To determine in a prospective study factors of progressive atherosclerotic lesion of blood vessels in patients with rheumatoid arthritis (RA).Material and methods This prospective study included 124 patients with RA and suspected ischemic heart disease (IHD) and 30 patients with IHD (comparison group) aged 58 [52; 63] years. On enrollment to the study and at 3 years of follow-up, all patients underwent clinical and instrumental examination according to European and Russian guidelines for diagnosis and treatment of stable IHD (2013), including coronography as indicated. For all RA patients of the comparison group, risk factors (RF) were evaluated, including arterial hypertension, smoking, excessive body weight, family history of cardiovascular diseases (CVD), diabetes mellitus, and dyslipidemia. The following laboratory data were evaluated: blood count; biochemistry, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), rheumatoid factor (RhF), cyclic citrullinated peptide antibodies, and high-sensitivity C-reactive protein (hsCRP). Proinflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF- α), were measured in RA patients once, at 3 years of follow-up.Results Incidence of FRs for CVD was similar in RA patients and in the comparison group. Median RA duration before inclusion into the study was 11 years, and median DAS28 index score was 3.8. Incidence of dyslipidemia due to increased TC, LDL-C, and HDL-C was higher for RA patients at baseline. The LDL-C goal (vs. 0.16 mg/dl; pvs. 11.5 mm/h; p50%. Patients with RA frequently had unchanged or slightly changed coronary arteries (CA) (47% of patients), and less frequently they had hemodynamically significant multi-arterial coronary atherosclerotic lesions (7 % vs. 57 % of patients in comparison group). At 37.5 months, 21 (23 %) of 94 RA patients had progressive atherosclerosis in CA and/or CTA; 12 (13 %) RA patients had only progressive CA atherosclerosis; 7 (8 %) had only progressive CTA atherosclerosis; and 2 (2 %) had simultaneous progression of CA and CTA atherosclerosis. Two groups of RA patients were formed, with the progression of atherosclerosis (n=21) and without the progression of atherosclerosis (n=69). RFs for the development/progression of atherosclerosis in RA patients included smoking, family history of CVD, and duration of the disease. Levels of lipids did not differ. Levels of proinflammatory cytokines (IL-1β, IL-6, TNF-α) were higher in RA patients with progressive atherosclerosis. No effects of the anti-rheumatic therapy on the progression of atherosclerosis were observed.Conclusion Progression of atherosclerosis in RA remains in disease with low and moderate activity during the anti-rheumatic and hypolipidemic treatment. The development of atherosclerosis in RA is determined by lipid, inflammatory, and immune disorders.

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

Aim Immune and inflammatory reactions contribute to the progression of atherosclerosis. The walls of the different arteries and segments of the arteries have heterogeneous haemodynamic and histological features. We aimed to explore the relationship between the circulating T-cell subsets and the abundance of carotid atherosclerosis in different segments of carotid arteries. Methods 70 patients underwent ultrasound duplex scanning to determine the degree of stenosis of the common carotid artery (CCA), the CCA bifurcation or the internal carotid artery (ICA). The blood frequencies of T-, B-, NK-cells, regulatory T cells (Treg), activated T-helpers (Th), IL10-producing Th, Th1 and Th17, as well as blood levels of hsCRP, sCD25, IL10 and IL17a were assessed. Results The frequencies of Th17 were increased in patients with ICA stenosis >35% and >50% vs. patients with ICA stenosis 50%). BMI positively correlated with the CCA bifurcation stenosis degree (r = 0.33, p < 0.05). Conclusion The severity of ICA stenosis can be associated with the circulating Th17 level., Cell biology; Immunology; Cardiology; Diagnostics; Atherosclerosis; Inflammation; Carotid arteries; Ultrasound; T-helpers 17.

Aim: to study carotid plaques structure in patients with acute coronary syndrome by ultrasound duplex scanning. Materials and methods. We included in this study143 patients with acute coronary syndrome (ACS) aged 32-83 years and 28 patients with documented coronary heart disease (CHD) aged 46-83 years. Duplex scanning of carotid arteries was carried out with Philips iU22 ultrasound system and L9-3 linear array transducer. Atherosclerotic plaques in CCA, CCA bifurcation, and ICA from right and left side were investigated. Off-line analysis of B-mode images and plaque gray scale median (GSM) was performed with computer semiautomated workstation MultiVox. Results. 378 plaques of ACS and 59 plaques of CHD patients were studied. We assessed traditional (heterogenous structure, hypoechogenic component, irregular plaque surface) as well as additional (positive remodeling, “layered” structure of plaque, local calcification) criteria of plaque instability. In ACS compared with CHD group there were more plaques with hypoechogenic component (43.4 and 28.8%, p=0.0459), heterogenous structure (77.8 and 64.4%, p=0.0327), irregular surface including irregularities more than 2.0 mm (22.5 and 6.8%, p=0.0048, respectively). There was significant difference in “layered” structure (55.7 and 35.8%, p=0.0011) and insignificant difference in positive remodeling (16.3 and 7.5%, p=0.06, respectively). There were no differences of GSM value (53.1 and 57.2, p=0.24) and local calcification (23.2 and 24.5%, p=0.23, respectively). Conclusion. In our study ultrasound duplex scanning revealed that signs of plaque instability in carotid arteries in patients with ACS were more frequent than in patients with stable CHD. The newly introduced parameter “layered” structure of atherosclerotic plaque was found to be most significant.

Background To date, there have been no studies evaluating the effect of isolated lipoprotein(a) (Lp(a)) lowering therapy on carotid atherosclerosis progression. Methods We enrolled 30 patients who had coronary heart disease (CHD) verified by angiography, Lp(a) level ≥50 mg/dL, and low density lipoprotein cholesterol (LDL-C) level ≤2.6 mmol/L (100 mg/dL) on chronic statin therapy. Subjects were allocated in a 1:1 ratio to receive apheresis treatment on a weekly basis with immunoadsorption columns ("Lp(a) Lipopak" ® , POCARD Ltd., Russia) added to atorvastatin, or atorvastatin monotherapy. The primary efficacy end-point was the change from baseline in the mean intima-media thickness (IMT) of the common carotid arteries. Results After one month run-in period with stable atorvastatin dose, LDL-C level was 2.3 ± 0.3 mmol/L and Lp(a) – 105 ± 37 mg/dL. As a result of acute effect of specific Lp(a) apheresis procedures, Lp(a) level decreased by an average of 73 ± 12% to a mean of 29 ± 16 mg/dL, and mean LDL-C decreased by 17 ± 3% to a mean of 1.8 ± 0.2 mmol/L. In the apheresis group, changes in carotid IMT at 9 and 18 months from baseline were −0.03 ± 0.09 mm (p = 0.05) and −0.07 ± 0.15 mm (p = 0.01), respectively. In the atorvastatin group no significant changes in lipid and lipoprotein parameters as well as in carotid IMT were received over 18-month period. Two years after study termination carotid IMT increased by an average of 0.02 ± 0.08 mm in apheresis group and by 0.06 ± 0.10 mm in the control group (p = 0.033). Conclusion Isolated extracorporeal Lp(a) elimination over an 18 months period produced regression of carotid intima–media thickness in stable CHD patients with high Lp(a) levels. This effect was maintained for two years after the end of study. Trial Registration: Clinicaltrials.gov (NCT02133807).

The prognosis of patients with carotid atherosclerosis is determined by the factor of unstable atherosclerotic plaque. Change of longitudinal strain in junction place of healthy artery wall to plaque determined by local artery elasticity and leads to instability. Aim of the study: Comparative investigation of mechanical characteristics of the stable and unstable plaques in a carotid artery. Methods: In the main group (MGr) were studied 16 plaques with stenosis 7090%, and control group (CGr) 33 plaques with stenosis 25-45%. Carotid ultrasound examinations (PHILIPS iU22) were performed for estimated structure and stenosis of plaques. The ”healthy” wall stiffness (free from plaques -bhw) and plaques zone stiffness (in adventitia -badv and in plaques surface -bpl) were estimated using echo-tracking method by ALOKAa7 in B/M mode ultrasound imaging. Results: In the MGr majority of plaques had structure with hypoechogenic area (>50%) and calcification, third plaques had rough or ulcerated surface. In CGr dominated heterogeneous plaques with smooth surface. In both groups bhw was significantly lower, than badv (MGr: 8,95 3,14 vs 22,73 10,43, CGr: 9,43 2,64 vs 14,45 6,7, p