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Aim. To study risk factors for fatal cardiovascular events in patients with non-small cell lung cancer over two years of standard treatment.Material and methods. This pilot retrospective non-randomized cohort study included 179 patients who were consecutively admitted to the chemotherapy department of City Clinical Hospital 1 from January to December 2020 with a confirmed diagnosis of non-small cell lung cancer based on the comprehensive examination and morphological verification according to the 2018 clinical guidelines on bronchial and lung cancer. Diagnosis and treatment of cardiovascular diseases were carried out according to national clinical guidelines. The follow-up period for non-small cell lung cancer and cardiovascular disease was 2 years. Logistic regression models were considered to assess the risk of cardiovascular death. The model accuracy was assessed by a cross-validation.Results. The best model in terms of the sensitivity and specificity sum according to a cross-validation was the model with the following explanatory variables: sex, cancer stage, platinum-based chemotherapy, etoposide, immunotherapy, surgical treatment. This model showed a sensitivity of 70,1% and a specificity of 82,1%.Conclusion. This approach is easy to implement and may optimize treatment for patients with non-small cell lung cancer.

Aim. To compare the blood levels of N-terminal pro-brain natriuretic peptide (NTproBNP), determined using a Russian semi-quantitative point-of-care test and quantitative laboratory tests, depending on the presence and severity of heart failure (HF) and left ventricular (LV) function.Material and methods. This Diagnosis of chRonic hEart fAilure using a NTproBNP test Multicenter study (DREAM) was conducted in 79 patients with HF and 24 healthy individuals. Blood NT-proBNP concentrations assessed using an immunochromatographic semiquantitative rapid test were compared with quantitative laboratory test results, severity of heart failure, and LV function.Results. The study showed that the NT-proBNP rapid test results were highly correlated (correlation coefficient 0,74) with the quantitative test. The NT-proBNP level assessed by the rapid test increases in patients with higher NYHA HF class and does not differ significantly from the quantitative test grades. The sensitivity, specificity, positive predictive value, and negative predictive value of the test result relative to natriuretic peptide quantification were 0,97, 0,78, 0,91, and 0,93, respectively. Sensitivity, specificity, positive and negative predictive value of the test result regarding NYHA classes II-IV were 0,95, 0,85, 0,95 and 0,85, and regarding LV ejection fraction

Aim. To evaluate the association of the nucleotide sequence variant rs1799752 (I/D) of the angiotensin-converting enzyme (ACE) gene with acute coronary syndrome (ACS) in patients after a coronavirus disease 2019 (COVID-19).Material and methods. The study included 100 patients (women — 50, men — 50) with ACS and prior COVID-19, verified by a polymerase chain reaction (PCR), hospitalized in the regional vascular center № 7 of the City Clinical Hospital № 2 city of Novosibirsk. The mean age of women and men was 59,5±7,2 years and 53,5±9,3 years, respectively. The diagnosis of ACS was established according to a set of criteria proposed and established by the Russian Society of Cardiology and in accordance with the updated 2020 guidelines. Patients underwent examinations, coronary angiography with stenting, as provided for in the standards of care and guidelines. In patients, the nucleotide sequence variant rs1799752 of the ACE gene was determined using PCR. The comparison group consisted of 200 patients with ACS without COVID-19 (no positive PCR or antibodies). Statistical analysis was carried out using the SPSS 17.0.5 software package.Results. When comparing the frequencies of rs1799752 genotypes of the ACE gene in groups with ACS with COVID-19 and ACS without COVID-19, significant differences were obtained (p=0,013). In the group with ACS and COVID-19, carriage of the heterozygous genotype was less common (p=0,005) and there was an accumulation of carriers of the homozygous DD genotype (1,6 times higher; 26% vs 16%; p=0,044).Conclusion. The nucleotide sequence variant rs1799752 (I/D) of the ACE gene is associated with ACS in patients after COVID-19.

In the last decade, there has been an increase in the number of survivors of myocardial infarction (MI). However, the risk of developing chronic heart failure (CHF) remains high in this category of patients. Population aging and comorbidity further contribute to adverse outcomes. Optimization of approaches to identify predictors of postinfarction CHF is an important clinical task of modern medicine. The aim of the investigation is to develop a method to assess the risk of CHF development after MI. Material and Methods. The present analysis included 186 patients who underwent MI from January 2019 to January 2020: 86 patients with signs of CHF above functional class (FC) 2 (NYHA) (mean age 64.3 years) and 100 patients without signs of CHF or with CHF 1 (NYHA) (mean age 62.6 years) by day 30 of MI. A mathematical model of CHF risk after MI was built by factor and correlation analysis methods. Results. A method for assessing CHF risk after a previous MI was developed. The proposed formula is programmed in Excel table processor and includes 5 indicators: presence of atrial fibrillation, Killip class of acute heart failure, triglycerides level, ST-segment elevation of electrocardiogram, left ventricular ejection fraction less than 45 %. The authors’ approach allows long-term personalized monitoring, taking into account the ranked contribution of each factor in a particular patient; it is characterized by high sensitivity, specificity, and accuracy. Conclusion. The present study investigated the factors of formation of postinfarct chronic heart failure syndrome. An original mathematical formula for CHF risk estimation, including routine indices of MI patients, has been proposed. The approach allows personalized management of selected cohorts of patients – with increased and standard risk of postinfarction CHF.

The aim of the study is to evaluate the association of some molecular genetic markers with progressive atherosclerosis. Material and methods. In total, the study included 202 patients (147 men and 55 women), who were divided into 2 groups. The 1st (main) group included patients with coronary artery disease (100 people) who had a combination of two or more cardiovascular events during the last 2 years before inclusion: myocardial infarction or unstable angina pectoris, arterial stenting for urgent indications (coronary and peripheral), stroke; acute ischemia, thrombosis or amputation of the lower extremities. The 2nd group (comparisons) included 102 patients with coronary artery disease who did not have any of the above cardiovascular events during the last 2 years before inclusion. DNA was isolated from peripheral blood samples by phenol-chloroform extraction. Results. In the group with progressive atherosclerosis at the age of 55 years and older, the AA rs3746444 genotype of the MIR499A gene was absent in both men and women, while in the control group its frequency reached 8.3 % (p = 0.044). The odds ratio of detecting the carriage of the heterozygous genotype AG of the rs6922269 polymorphism of the MTHFD1L gene in the group with progressive atherosclerosis is 0.5 times lower compared to the control group (95 % confidence interval 0.3–0.9; p = 0.034). Conclusions. Carrying the AA genotype rs3746444 of the MIR499A gene is a conditionally protective factor against the development of progressive atherosclerosis at the age of 55 years and older. Carrying the AG genotype of the rs6922269 polymorphism of the MTHFD1L gene is associated with a reduced likelihood of developing progressive atherosclerosis in patients with CAD.

The aim of the study is to evaluate the association of some molecular genetic markers with progressive atherosclerosis. Material and methods. In total, the study included 202 patients (147 men and 55 women), who were divided into 2 groups. The 1st (main) group included patients with coronary artery disease (100 people) who had a combination of two or more cardiovascular events during the last 2 years before inclusion: myocardial infarction or unstable angina pectoris, arterial stenting for urgent indications (coronary and peripheral), stroke; acute ischemia, thrombosis or amputation of the lower extremities. The 2nd group (comparisons) included 102 patients with coronary artery disease who did not have any of the above cardiovascular events during the last 2 years before inclusion. DNA was isolated from peripheral blood samples by phenol-chloroform extraction. Results. According to the frequencies of genotypes of the I/D polymorphism (rs36232792) of the SOD1 gene, no statistically significant differences were obtained between the group with progressive atherosclerosis and the control, neither in general, nor when divided by sex and age. The odds ratio of developing progressive atherosclerosis in carriers of the rare homozygous DD genotype of the rs3834129 polymorphism of the CASP8 gene is 2.3 ne is 2.3 times higher compared to carriers of the other two genotypes (DD vs II + ID, 95 % CI 1.1–5.1; p = 0.037). In men, the odds ratio is higher than in the general group – 4.4, p = 0.015. Women also tend to accumulate carriers of the DD genotype in the group with progressive atherosclerosis (26.7 % vs 16.0 %), but the differences do not reach the level of statistical significance. Conclusions. The carriage of the DD genotype of the rs3834129 polymorphism of the CASP8 gene is associated with progressive atherosclerosis in patients with CAD. No association of I/D polymorphism (rs36232792) of the SOD1 gene with progressive atherosclerosis was found. Acknowledgments. The molecular genetic fragment of the study was supported by State Budget theme no. 122031700094-5.

Purpose of the study: the aim of this work is to assess the association of 7 SNPs (rs499818 of the PHACTR1 gene, rs619203 of the ROS1 gene, rs10757278 (xr. 9), rs1376251 of the TAS2R50 gene, rs2549513 (xp. 16), rs4804611 of the ZNF627 gene and rs17465637 гена MIA3) with the severity of myocardial infarction. Materials and methods. Three samples were taken as objects of research. A population sample of patients with non-fatal MI (200 people: men – 129, women – 71), a sample of participants in the HAPIEE project with developed MI during the study (94 people: men – 56, women – 38). A sample of patients with myocardial infarction admitted to the intensive care unit of the city clinical hospital № 1. The sample size was 159 people (112 men, 47 women). The following SNPs were taken into the study: rs499818 (xp. 6), rs619203 of the ROS1 gene, rs10757278 (xr. 9), rs1376251 of the TAS2R50 gene, rs2549513 (xr. 16), rs4804611 of the ZNF627 gene and rs174653. To assess the association of SNP and the severity of the disease, we compared a population sample of patients with non-fatal MI versus a joint group from a sample of HAPIEE project participants with developed MI during the study, and a sample of MI patients admitted to the intensive care unit of City Clinical Hospital No 1. Results. For two SNPs, statistically significant differences in genotype frequencies were obtained: rs10757278 AA vs AG + GG OR = 0.61 CI 0.39–0.94; p = 0.027 and rs619203 of the ROS1 gene in a group of men for genotype GG vs CG + CCOS = 0.59 CI 0.37–0.94; p = 0.033. Conclusions. The associations of seven SNPs were studied, which, according to international studies, are associated with the risk of development, poor prognosis and the severity of myocardial infarction in the population of residents of the city of Novosibirsk. Two SNPs (rs10757278 and rs619203) were identified, which are associated with the severity of myocardial infarction.

Aim of the study was to create a method for assessing the probabilistic time of development of acute myocardial infarction (AMI) in patients with a confirmed diagnosis of type 2 diabetes mellitus (DM). Material and methods. The work was carried out on the basis of the Regional Vascular Center No. 1 (Novosibirsk). A retrospective analysis of the data of 115 patients diagnosed with AMI in combination with verified type 2 DM who were hospitalized in the period from 2018 to 2019 was performed. In all patients included in the study, clinical and demographic, anamnestic, physical, functional, and laboratory data were assessed in accordance with the federal standard for the diagnosis and treatment of this pathology. The nature and duration of the course, drug therapy for diabetes mellitus were assessed according to medical documents and databases. Further, a regression model was built for assessing the probabilistic time of development of AMI in patients with type 2 DM. Results. The author’s model for assessing the probabilistic time of development of acute myocardial infarction in patients with type 2 DM included eight indicators that significantly correlated with the dependent variable and weakly correlated with each other: patient gender, chronic kidney disease with a decrease in glomerular filtration rate to 60 ml/min/1.73 m2, diabetic retinopathy, verified peripheral polyneuropathy, cigarette smoking 1 pack or more, the number of hemodynamically significant coronary artery stenoses according to the results of selective coronary angiography, the use of short-acting insulin as part of hypoglycemic therapy, the use of long-acting insulin as part of hypoglycemic therapy. Conclusion. The study demonstrates the high predictive ability of the author’s approach for determining the individual predicted time for the development of AMI in a patient with type 2 DM. The introduction of the developed method into real clinical practice will make it possible to personally manage type 2 DM patients and to reduce the individual risk of such a formidable cardiovascular complication as myocardial infarction.

This article analyzes the problem of postinfarction myocardial remodeling in the current availability of high-tech methods of coronary revascularization in most countries. The authors discuss both wellstudied factors that determine the transformation of acute myocardial injury into chronic heart failure syndrome and new fundamental ones that determine prognosis and treatment. Used information on the topic from publications over the past five years, based on the PubMed, Google Scholar and Russian Science Citation Index databases.

Aim. To study associations of rs2464196 and rs11212617 polymorphisms with the development of myocardial infarction (MI) in combination with type 2 diabetes (T2D).Material and methods. The study included two groups: main group (n=115) — patients with prior myocardial infarction and T2D, comparison group (n=116) — patients with myocardial infarction without T2D, hospitalized from December 1, 2018 to December 31, 2019 at the Regional Vascular Center № 1 of the City Clinical Hospital № 1. Participants were comparable in sex and age. Patients underwent clinical and instrumental investigations, a genetic test for single nucleotide polymorphisms, which showed associations with the development of MI and T2D according to genome-wide association study (GWAS): rs2464196 of the HNF1A gene, rs11212617 of the ATM gene.Results. Carriage of the AA genotype of the HNF1A rs2464196 polymorphism was found to be associated MI in combination with T2D in the general group (odds ratio (OR), 3,180, 95% confidence interval (CI), 1,206-8,387, p=0,015). After division of the group by sex, significant differences remained only in women (OR=9,706, 95% CI, 1,188-79,325, p=0,011).Conclusion. The data obtained can make it possible to identify a priority group of patients for personalized prevention of cardiovascular diseases.

The article analyzes the state of the problem of rapidly progressive atherosclerosis in comparison with the spontaneous or classical course of the disease. The authors have identified the most well-known factors responsible for the accelerated course of atherosclerosis and the prospects for therapeutic intervention. The analysis used data on the topic from publications over the past five years based on databases PubMed, Google Scholar и Russian Science Citation Index.

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia.

Aim. To identify genetic markers of risk for ST-elevated myocardial infarction (STEMI).Material and methods. The study included 210 patients (119 men, 91 women) with STEMI, hospitalized from December 21, 2016 to June 16, 2017 The average age of men was 55,5±9,5 years, women — 57,5±9,1 years. The diagnosis of STEMI was verified according to the criteria of the European Society of Cardiology (2015, 2017). During hospitalization, patients underwent clinical and instrumental examination, stipulated by medical care standards and clinical guidelines We also conducted a genetic study of single nucleotide polymorphisms (SNPs), which showed their association with the risk of coronary artery disease (CAD) and acute myocardial infarction (AMI) according to the GWAS: rs2820315 of the LMOD1 gene (Leiomodin 1, mapped on chromosome 1), rs9349379 of the PHACTR1 gene (regulator 1 of actin and phosphotase, localized on chromosome 6p241), rs867186 of the PROCR gene (Protein C receptor, located on chromosome 20q11.22), rsi1799883 of the FABP2 gene (Fatty acid-binding protein 2, located on chromosome 4q26). Statistical data analysis was performed using the SPSS 170.5 software package and authorial odds ratio (OR) calculator.Results. Carriage of the CC genotype of rs2820315 polymorphism of the LMOD gene is associated with an increased risk of STEMI by 1,87 times (95% CI 1,2862,722, p=0,016). Carriers of the CT genotype of rs2820315 polymorphism have a reduced risk of STEMI (OR 0,633; 95% CI 0,436-0,918, p=0,016).Conclusion. In order to identify risk groups for STEMI development, the study of the rs2820315 polymorphism of the LMOD gene is recommended. This will define the high-risk group for STEMI for developing of personalized programs for primary and secondary prevention of cardiovascular events in practical health care, which will contribute to reducing of STEMI mortality.

Aim. To determine the genetic predictors of five-year outcomes in patients with acute coronary syndrome (ACS).Material and methods. The study included patients admitted to the City clinical hospital № 1 (CCH №1) in Novosibirsk with a diagnosis of ACS in the period 2010-3 2011 (n=280). All patients were examined in accordance with clinical guidelines and standards of care, genetic markers were assessed. Genotyping included determination of single nucleotide polymorphisms (SNPs), confirming its association with the development of the ACS according to the results of an international genomeassociated studies: rs1376251, rs4804611, rs 1333049, rs619203, rs10757278, rs2549513, rs499818, rs17465637. All patients are kept in touch from the moment of initial contact to the present time, with the help of available means of communication and annual examinations in order to assess the end points. “End points” included: repeated nonfatal myocardial infarction (MI), hospitalization for myocardial ischemia, re-revascularization or chronic heart failure (CHF), nonfatal acute cerebrovascular accident (NACA), cardiovascular death.Results. We revealed SNPs, which play a role in predicting long-term outcomes of ACS: rs10757278, rs 4804611, rs 1333049, rs 2549513. The genotype of rs2549513 as 2,9-fold (95% CI 1,06-8,03; p=0,041) increases the risk of unfavorable long-term prognosis in the subgroup of men older than 55 years. The AA genotype rs10757278 and GG genotype rs1333049 are associated with a favorable long-term prognosis (OR=0,47, 95% CI 0,23-0,96; p=0,042 and OR=0,41, 95% CI 0,22-0,78; p=0,049, respectively) in the group of patients older than 55 years. For the GG genotype rs1333049 association was characteristic only for women. The AA genotype rs4804611 is associated with a favorable outcome of ACS at the age of 55 years (OR=0,036, 95% CI 0,14-0,96; p=0,053), significant differences were obtained in the group of men (p=0,36).Conclusion. The use of identified genetic predictors to assess the risk of five-year outcomes will strengthen a personalized approach to patients and, together with conventional prevention measures, will reduce cardiovascular mortality.

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The study included men and women over 18 years of age with an established class II-IV HF and at least one hospitalization due to acute decompensated HF within 12-month follow-up.Results. The final analysis included 888 patients (men, 52,9%; women, 47,1%; mean age, 69 [61; 78] years). The preserved ejection fraction (EF) was detected in 47,86% of patients, mid-range — in 40,54%, reduced — in 11,6%. Only in 16% of patients, there was improved by 1 or more HF. Hypertension and coronary artery disease were predominant in etiology pattern of HF. Preserved EF was more often detected in women over 60 years of age, with HTN and obesity, as well as with HF with mid-range and reduced EF in men in the same age group. There was sufficient follow-up rate, but the extent examinations do not correspond to the recommended one. The prescription rate of renin-angiotensin-aldosterone system (RAAS) inhibitors corresponds to the recommended one, but there is a high frequency of prescribing angiotensin II receptor blockers (ARBs). The prescription rate of β-blockers and loop diuretics (mainly torasemide) increased in comparison with previous studies, while thiazide diuretics — decreased. In patients with reduced EF, the prescription rate of sacubitril/valsartan was only 14,7%, β-blockers — 83,3%, mineralocorticoid receptor antagonists (MCRA) — 72,5%. In patients with midrange EF, there was a sharp decrease in prescription rate of RAAS inhibitors, β-blockers, MCRA.Conclusion. The practical follow-up of patients with HF differs significantly from clinical guidelines. Due to inadequate pharmacotherapy, as well as insufficient noncompliance with the recommended extent of investigations, 1-year HF therapy does not lead to a pronounced improvement in the patients' class.

Aim. To identify the factors of long-term adverse prognosis of patients with acute coronary syndrome as a result of five-year follow-up.Material and methods. The study included 280 patients with ACS hospitalized in the 1st cardiology Department of the Novosibirsk municipal CLINICAL hospital № 1 in 2010-2011. The study cohort included 145 patients with ACS (107 men and 38 women), 135 patients with ACS (93 men and 43 women). The average age of men was 56,3±5,2, women 52,1±5,3 years. The criteria of the European society of cardiology (2015, 2017) were used for the diagnosis of ACS. For five years, all patients included in the study were contacted through communication and annual medical examinations, to which patients were invited to the clinic. The examinations included the following clinical and instrumental examinations: clinical examination, electrocardiography, Holter monitoring of electrocardiogram, echocardiography, lipid profile, inflammatory cytokines and molecular genetic parameters. In the study, a mathematical model for predicting five-year outcomes Oxpt and Oxbt. Results. Five-year observation allowed using the constructed mathematical model to determine not only the place of each factor in the cardiovascular prognosis, but also to assess how the role of these prognostic markers changes over time. Conclusion. The use of a mathematical model for predicting long-term adverse outcomes of ACS allows to assess the value of specific risk factors and predictors, respectively, makes a significant contribution to the optimization of secondary prevention and personalized approach to treatment. At the same time, the influence of the identified predictors weakens in proportion to the increase in the number of years from a vascular accident. Thus, the identified risk factors have the maximum impact in the first year after ACS, in subsequent years, the role of these factors is reduced, which is probably due not only to the importance of the factors themselves, but also to the addition of other risk factors to the overall picture of the disease of patients. Nevertheless, the use of this model is necessary to solve the problem of reducing cardiovascular risk.

The described clinical case illustrates the fifteen years’ advance of the man on classical stages of a cardiovascular continuum caused by extremely low commitment to therapy with a debut of risk factors at 35-year age and the final at a stage of a systolic heart failure after a Q-positive myocardial infarction at the age of 50 years when, even in the conditions of a high compliance, therapeutic opportunities of tertiary prophylaxis of coronary heart disease are extremely limited.

Aim. To evaluate the utilization of complex significance evaluation in Russian population, of genetic markers of myocardial infarction identified in entire-genomic associative studies.Material and methods. Group of MI patients (n=200) and control group (n=420) were created based on populational selection of 45-69 year old citizens of Novosibirsk (9400 persons), collected during the international project HAPIEE; myocardial infarction patients, admitted to intensive care unit of the Hospital № 1 (160 persons); sudden cardiac death victims, post forensic investigation (n=285). Longevity group was collected during home visits and in the nursing houses (n=85). Genomic DNA was extracted from venous blood and myocardial tissue by phenolchlorophorm method. Genes polymorphism was tested with PCR real-time according to the protocol by equipment developer (TaqMan, Applied Biosystems, USA), device ABI 7900HT. For the study, the following MNP were selected: rs499818, rs619203, rs10757278 and rs1333049 (chr. 9), rs1376251, rs2549513, rs4804611, rs17465637.Results. Mononucleotide polymorphisms, that did not show differences at pretest stage, showed significant distinctions in the studied population. Two MNP were closely linked: rs10757278 and rs1333049 (chr. 9) so for further assessment the rs1333049 was retained. Among other seven, only five MNP showed relation with MI of various strength. Some, like the rs1333049 showed association with MI in all groups and subgroups, while the others — only in separate groups, with restriction by sex and gender. The rs2549513 and rs17465637 showed to be not associated with CHD at all, though rs2549513 showed association with lipid and glucose metabolism, as with the severity of coronary atherosclerosis and adverse prognosis for 1 year post-MI. The rs17465637 was just poorly associated with BMI.Conclusion. Complex approach to assessment of polymorphism role is quite demanding, but provides with a high grade of insurance in the significance of the results obtained, of non-random character of the results, and makes it to choose the most credible, that have showed association not only with the main pathological phenotype, but with its risk factors.

Aim: Investigate relations of 8 SNPs with myocardial infarction in groups of up to 55 years and after 55 years. Methods: The group of patients with myocardial infarction, arrived in the intensive care unit City Clinical Hospital № 1 (2009-2010 gg.) 160 people (113 men and 47 women). The control group was formed based on the sample of population 45-69 year old residents of the October and the Kirov district of Novosibirsk (9.400 people), which was collected by Institute of Internal Medicine SB RAMS during the work on the international project HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe). It included 420 people with no signs of myocardial infarction (men 270, women 150). Genomic DNA was isolated from venous blood by phenol-chloroform extraction. SNP of gene were tested by RT-PCR according to the protocol of the manufacturer (TaqMan Probes, Applied Biosystems, USA) on the device ABI 7900HT. In a study following SNPs were taken: rs499818, rs619203, rs1333049, rs1376251, rs2549513, rs4804611, rs17465637. Results: For rs1333049 were shown an association with MI: SS OR = 2.05 (95 % CI 1.35-3.12 p = 0.001, CC vs CT + TT) and PT OR = 0.59 (95 % CI 0.37-0.93; p = 0.023; CT vs CC + TT) in the group. In both age groups, an association has been confirmed: SS OR = 2.92 (95 % CI 1.39-6.16; p = 0.006; CC vs CT + TT) for junior and SS OR = 1.77 (95 % CI 1.05-2.97; p = 0.035; CC vs CT + TT) and senior groups. For rs4804611 shows a predisposing role in relation to MI AA OR = 1.63 (95 % CI, 1.03-2.45; P = 0.04; AA vs AG + GG) in the older age group, for the remaining SNPs statistically valid data has been received. Conclusions: Thus in this study were confirmed by rs1333049 association (hr. 9) with myocardial infarction, regardless of age, as well as shows the association of rs4804611 in the group over 55 years.

Aim. Prediction of long-term (annual) adverse and benefit outcomes of acute coronary syndrome with sustained ST elevation (STEMI) for the improvement of rehabilitation, secondary prevention and personified approach to treatment.Material and methods. Totally 145 patients included with STEMI (106 men, 39 women), hospitalized to the CCH №1 of Novosibirsk during the year 2010. Mean age of the patients was 59,1±6,1 y. Diagnosis of ACS was set by a collection of criteria developed by European Society of Cardiology and American Heart Association (2000). All patients underwent clinical and instrumental investigation as following: clinical examination, electrocardiography, echocardiography, Holter monitoring, measurement of the inflammatory cytokines and molecular-genetic test. By the methods of factor and correlation analysis, the study made it to define the influence of the each of the factors studied on probability of adverse annual prognosis.Results. As the result of the study, we invented a brand new method of multifactor prediction of long-term (annual) adverse and positive outcomes of the acute coronary syndrome with sustained ST elevation. The model includes the check for the absence or existence in the patient of diabetes mellitus (DM), ejection fraction of the left ventricle (EF LV), ultrasensitive C-reactive protein concentration (hsCRP), and genotype for polymorphism rs1376251 of the gene TAS2R50. Sensitivity of the proposed method of prediction for adverse outcomes was 82%, positive outcomes — 80%.Conclusion. The model proposed was created on the basis of the parameters measured in Russian patients and includes the activity of atherosclerotic inflammation and the patient’s genotype. An equation for the probability calculation of an adverse outcome shows, what is the weight multiplier of one or another factor to influence the probability of adverse outcome. The model is simple in use and makes it possible to individualize secondary prevention for this type of patients.

Aim. To evaluate efficacy and safety of rivaroxaban for stroke and systemicembolism prevention in patients with AF of non-valvular cause and concomitantCKD.Material and methods. Totally 16 patients with AF included, having chronic kidneydisease of II-III stages, who during a year were being assessed an efficacy — casesof death, stroke and systemic embolism, and drug safety (clinically significant andnon-significant bleedings).Results. As a result for efficacy — stroke, systemic embolism, death cases were notregistered. In assessment of safety, mild nasal bleedings (not needed medical help)were marked in 3 patients during one month of treatment, and in 2 patients therewere non-persistent petechias. Clinically significant bleedings were not registered.Conclusion. The usage of the oral anticoagulant rivaroxaban in dose 20 mgand 15 mg per day in patients with AF of non-valvular cause with comorbid CKD II-III stage is effective and safe for the prevention of stroke and systemic embolism.

Aim. To evaluate the relationship of 8 mononucleotide polymorphisms (MNP) with negative longterm prognosis of the acute coronary syndrome.Material and methods. Totally 280 patients with acute coronary syndrome included (ACS), who during 1 year follow up were underwent the solid endpoints evaluation (cardiovascular death, hospitalization for recurrent ischemic event and repeated revascularization).Results. In the analysis of rs4804611 in group with negative outcomes there is significantly more prevalent genotype GG (9,1% vs. 1,8%), chances relation 5,57 (95% CI 1,35-22,96); credibility of the differences kept in men (p=0,021). In the analysis rs2549513 in the group with positive prognosis the AA genotype was more prevalent (70,6% vs. 53%), hazard ratio 0,47 (95% CI 0,26-0,85), and in the group with negative prognosis genotype AC, chances relation 2,32 (95% CI 1,28-4,20; р=0,007).While separated by gender credible differences were shown only in men (p=0,008).Conclusion. Evaluation of genetic markers rs4804611 and rs2549513 can significantly increase prognostic value in riskometry of ACS outcomes.

Aim. To compare the serum levels of heart-type fatty acid binding protein (H-FABP), measured with immune-enzyme assay and immunochromatography express test system, in patients with acute coronary syndrome (ACS), such as myocardialinfarction (MI) and unstable angina (UA). Material and methods. The study included 250 ACS patients: 166 with MI and 84 with UA. At Days 1 and 10 of ACS, serum levels of troponin I (immune-enzyme assay), creatine kinase-MB (CK-MB; photometry), and H-FABP (quantitative measurement with immune-enzyme assay, H-FABP-IEA-BEST test system, VectorBest, Russia; qualitative measurement with immunochromatography express test system, BioTest, Russia) were assessed in all participants. Results. At Day 1, serum H-FABP levels were substantially higher in men vs. women with MI, and in men with MI vs. men with UA. This parameter significantly correlated with MI diagnosis, including Q-wave MI, with other ACS biomarkers (troponin I and CK-MB), and with selected inflammatory biomarkers. Conclusion. H-FABP is a significant, sensitive biomarker of myocardial damage and ACS development. Immunochromatography express test system produced qualitatively “positive” results even in serum H-FABP concentrations lower than 15 ng/ml.

Актуальность. Реабилитация и вторичная профилактика пациентов с сочетанной сердечно-сосудистой патологией представляет значительные трудности, так как прогноз, особенно отдалённый у них зависит от множества факторов: клинических, метаболических, функциональных характеристик не только основного, но и сопутствующих заболеваний. На базе отделения неотложной кардиологии ГКБ № 1 г. Новосибирска в течение последних 13-ти лет ведутся работы по индивидуализации реабилитации и вторичной профилактики пациентов после острого коронарного синдрома (ОКС), а также поиск новых прогностических биомаркеров неблагоприятного прогноза. Цель. Определить наиболее значимые биомаркеры ближайшего и отдалённого прогноза у пациентов с ОКС в сочетании с другими сердечно-сосудистыми заболеваниями и факторы, влияющие на реабилитацию и вторичную профилактику. Материалы и методы. В Клинике с 1998 года проводится реабилитация пациентов с ОКС в сочетании с различной сердечно-сосудистой патологией. В целом за это период наблюдалось 600 больных (270 мужчин, 330 женщин), средний возраст 59,3±6,1 лет (у мужчин - 56,2±5,2 лет, у женщин - 62,1±5,3 лет). Q-позитивный инфаркт миокарда (ИМ) диагностирован у 366 больных (61%), Q-негативный ИМ у 66 больных (11%), нестабильнная стенокардия (НС) у 168 человек (28%). У мужчин Q-ИМ отмечался в 68,8% (186 человек), не Q-ИМ в 10,3% (28 человек), НС в 20,9% (56 человек). У женщин Q-ИМ отмечался в 33,9% (112 человек), не Q-ИМ в 30,9% (102 человека), НС в 35,2% (116 человек). Сочетание с артериальной гипертензией (АГ) отмечалось у 510 человек, с сахарным диабетом (СД) у 78 человек, с хронической сердечной недостаточностью (ХСН) у 320 человек, с ожирением по абдоминальному типу у 462 человек. Кроме обще клинического обследования у пациентов оценивались динамика ЭКГ, ЭхоКГ, тест 6-минутной ходьбы, ХМ-ЭКГ, вентрикулокоронарография (ВКГ), липидный спектр и глюкоза крови. У 250 пациентов дополнительно исследовались концентрации С-реактивного протеина (СРП), интерлейкинов (ИЛ-6, ИЛ-8, ИЛ-1-бета), фактора некроза опухоли (ФНО-альфа) в остром (1-3 сутки ОКС), подостром (10-12 сутки ОКС) и «холодном» периоде ОКС (через год после ОКС).В этой же подгруппе оценены биомаркеры некроза миокарда: креатинкиназа (КК), тропонины I и Т, белок, связывающий жирные кислоты (БСЖК). Результаты. Установлено, что у пациентов старше 60 лет и у женщин ОКС чаще сочетается с двумя и более сердечно-сосудистыми патологиями (АГ, СД, ХСН, ИБМ). Также, у пожилых пациентов чаще имеет место многососудистое атеросклеротическое поражение коронарного русла. У лиц женского пола ОКС протекает более тяжело, достоверно чаще осложнения острого периода: разрывы миокарда, постинфарктная стенокардия, нарушения ритма, острая сердечная недостаточность. Женщинам реже проводилась хирургическая коррекция - ангиопластика и аортокоронарное шунтирование из-за наличия у них микрососудистой стенокардии, более тонких и извитых сосудов, склонности к кровотечениям, инфарктам во время процедуры. Наиболее значимыми биомаркерами неблагоприятного ближайшего и отдаленного прогноза ОКС являются повышенный уровень в крови СРП, особенно у женщин, и ИЛ-6. Высокая прогностическая значимость показана для маркеров некроза миокарда - КК, тропонинов I и Т, БСЖК. Последний биомаркер более чувствителен в первые часы ОКС, когда два других традиционных маркера некроза миокарда еще не повышены. Из методов физической реабилитации больных с сочетанной сердечно-сосудистой патологией наиболее эффективной оказалась ходьба по ровной местности со свободным выбором темпа нагрузки. Выводы. Неблагоприятный ближайший и отдаленный прогноз острого коронарного синдрома в сочетании с другими сердечно-сосудистыми заболеваниями достоверно ассоциируется с пожилым возрастом, женским полом, повышенным уровнем маркеров некроза миокарда - КК, тропонинов I и Т, БСЖК и биомаркеров воспаления - СРП и ИЛ-6. Физическую реабилитацию у этой сложной категории пациентов целесообразнее проводить методикой ходьбы по ровной местности со свободным выбором параметров нагрузки.

Цель. Прогнозирование долгосрочных (годовых) благоприятных и неблагоприятных исходов острого коронарного синдрома без стойкого подъема сегмента ST (OКCбпST) для оптимизации реабилитации, вторичной профилактики и персонализированного подхода к лечению. Материал и методы. В исследование были включены 135 пациентов с ОКСбпST (средний возраст 59,1±6,1 года), в том числе 94 мужчины и 41 женщина, госпитализированных в ГКБ №1 г. Новосибирска в течение 2010 г. Всем пациентам в госпитальном периоде и в течение 1 года после выписки проводилась стандартная медикаментозная терапия ОКС согласно рекомендациям РКО, ESC, ACCA. Диагноз ОКС устанавливался по совокупности критериев, разработанных Европейским обществом кардиологов и Американской коллегией кардиологов (2000 г.). Проведено клинико-инструментальное исследование по следующей программе: клинический осмотр, ЭКГ, ЭхоКГ, холтеровское мониторирование ЭКГ, исследование воспалительных цитокинов и молекулярно-генетические исследования. В работе было определено влияние каждого из исследованных показателей на вероятность неблагоприятного годового прогноза методами факторного и корреляционного анализа. Результаты. Получена математическая модель многофакторного прогнозирования отдаленных (годовых) неблагоприятных и благоприятных исходов OКCбпST. Модель включает в себя определение возраста пациента в годах, наличия или отсутствия у пациента: тахикардии при поступлении, Killip более II, жизнеугрожающих пароксизмальных тахиаритмий, а также концентрации высокочувствительного С-реактивного протеина в сыворотке крови и генотипа по полиморфному варианту rs1376251 гена TAS2R50. Методика внедрена в рутинную клиническую практику Регионального сосудистого центра ГБУЗ НО «Городская клиническая больница №1» г. Новосибирска. Заключение. Применение предложенной модели многофакторного прогнозирования отдаленных исходов OКCбпST позволяет повысить точность предсказываемого события, так как она разработана на основе исследования показателей у российских пациентов и учитывает активность субклинического воспаления атеросклероза и генотип пациента. Формула расчета вероятности неблагоприятного исхода показывает, с каким весовым множителем тот или иной фактор влияет на вероятность неблагоприятного исхода. Модель проста в использовании и позволяет персонифицировать вторичную профилактику, что будет способствовать снижению суммарного сердечно-сосудистого риска у этих пациентов.