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Objective. A clinical case of a 38-year-old female patient with STEMI in the early postpartum period describes the complex issues of diff erential diagnosis with imaging methods application. Results. During the patient’s fi rst hospitalization with STEMI, additional intravascular imaging techniques such as intracoronary ultrasound and/or optical coherence tomography, could help to determine the nature and signifi cance of the coronary lesion. Due to the inability to perform IVUS and OCT, we performed a coronary angiography. According to the results, there were no obvious signs of coronary dissection. Using additional intravascular imaging techniques, we might have obtained diff erent results and would have chosen a diff erent tactic of treatment.Conclusion. The case described indicates the need for a comprehensive diagnosis of MI in women in the postpartum period.

Objective. To identify the association of a number of clinical features and structural and functional characteristics of the heart with the progression of chronic heart failure (CHF) in patients one year after ST-segment elevation myocardial infarction (MI) (STEMI) with preserved and reduced left ventricular ejection fraction (EF) (LVEF).Design and methods. 120 patients with STEMI were included in a prospective study. During the study, all patients underwent an echocardiographic study using a Sonos 2500 device (Hewlett Packard, USA) on the 1st day (point I), on the 12th day (point II) of hospitalization, and also after 1 year (point III). Depending on the parameters of EF on the 1st day of the disease, the total sample of patients was divided into two: the 1st group — with preserved LVEF was represented by 86 (71,7 %), the 2nd group — with a reduced LVEF was represented by 34 (28,3 %) patients.Results. A total of 19 (15,8 %) adverse events were registered. In two cases, a fatal outcome (1,7 %) was recorded, the cause of which was repeated MI, in five (4,2 %) patients decompensation of СHF was noted, in eight (6,7 %) patients a clinic of progressive angina was traced, in four (3, 3 %) of patients were diagnosed recurrent MI. Deterioration of systolic and diastolic function was established one year after STEMI with preserved (≥ 50 %) LVEF: 17,6 % of patients began to correspond to the intermediate range of EF (40-49 %), the number of patients with diastolic dysfunction increased by 10 % compared to with acute study.Conclusions. Within a year after a STEMI with initially preserved LVEF, there is a deterioration in myocardial function in the form of a decrease in myocardial contractility and an increase in the number of patients with diastolic dysfunction.

Highlights. Nowadays the only way to prevent a new coronavirus infection is vaccination. Overcoming such problems as a gradual decrease in the effectiveness of post-vaccination immunity and the emergence of new strains of SARS-CoV-2 is possible due to booster vaccination. The review highlights the current data on the effectiveness and immunogenicity of various booster vaccination regimens and prospects for studying this issue in the Russian Federation.Abstract. The COVID-19 pandemic is going on, which makes it crucial to prevent the spread of coronavirus disease. Vaccination is the only way of specific prevention of COVID-19. The SARS-CoV-2 virus is continuously evolving and new variants appear. Moreover, the effectiveness of protective immunity after vaccination tends to decrease over several months. Booster vaccination may be the solution to these problems. The booster is an extra vaccination that helps to reactivate the immunity against COVID-19. Booster doses can be homologous (the same as the primary vaccine) and heterologous (different from the primary vaccine). It is of current interest to study heterologous vaccination as the injection of different vaccines may result in a more intense immune response. Furthermore, the same vaccine may not be available at the time of booster vaccination. This review is aimed at summarizing the key research findings in the field of booster vaccination against COVID-19.

Polycythemia vera is not only a clonal disease that causes hematopoietic stem cells, but also a pathology that often leads to thrombotic complications. Thrombosis can have different localization and is clinically manifested by stroke, myocardial infarction, deep vein thrombosis of the lower extremities, pulmonary embolism, thrombosis of the veins of internal organs and other conditions. One of the most formidable thrombotic complications is acute cerebrovascular accident. The heterogeneity of the possible causes of acute cerebrovascular accident requires a careful approach to differential diagnosis for timely diagnosis and individual, pathogenetically grounded selection of means of long-term antithrombotic therapy. The presented clinical case of the development of cerebrovascular accident in a patient with polycythemia vera demonstrates the importance of an informal approach to diagnosis, as well as interdisciplinary interaction for finding the true cause of the development of acute cerebrovascular accident and the appointment of pathogenetically based treatment, aimed, among other things, at the prevention of repeated episodes of acute cerebrovascular accident and others. thrombotic complications.

Glomerulonephritis associated with antineutrophil cytoplasmic antibodies (ANCA) is one of the causes of renal parenchymal disease, which can lead to secondary hypertension (HTN). Clinical course of HTN in this case is usually mild, however, high blood pressure can become the only reason to refer to a primary care physician. We report a case of a 45-year old woman with renal parenchymal disease due to ANCA-glomerulonephritis and secondary HTN. HTN was the only clinical manifestation of the disease led to the hospital admission. With this clinical case we emphasize that primary care physicians should always attempt to identify secondary causes of HTN.

The review article is devoted to a discussion of the issues of vaccination against a new coronavirus infection in patients with cardiovascular and autoimmune diseases. Presented at the time of this writing are data on domestic vaccines safety in the Russian Federation: combined vector vaccines “Gam-COVID-Vac” and “Gam-COVID-Vac-Lyo”, peptide-based vaccine “EpiVacCorona”, concentrated, purified and inactivated whole-virion “KoviVac” vaccine, and a standalone vaccine/booster shot “Sputnik Light”. The analysis of the main contraindication applicable to the vaccines in different categories of patients has been carried out. A number of consensus documents published by Russian and foreign professional medical associations and communities on the issues of vaccination of patients with cardiovascular and autoimmune diseases are considered in detail.

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery of all vital functions without signs of neurological deficits. Syncope is a multidisciplinary medical problem common in clinical practice. As a rule, syncope occurs due to cardiovascular dysfunction of organic or functional origin, which either develops spontaneously or is induced by a trigger. Due to a various etiology differential diagnosis and prognostic evaluation is difficult. This clinical case demonstrates the features of differential diagnosis of vasovagal syncope in a patient with polymorbid pathology and the features of the choice of an adequate management, including recommendations for lifestyle modifications, specialized education regarding prodromal symptoms recognition methods and timely application of countermeasures.

Aim. To study the features of the use of thrombolytic therapy (TLT) in normotensive patients with pulmonary embolism (PE) in real clinical practice in Russian hospitals.Material and Methods. From 04/1 5/2018 to 04/15/2019 patients hospitalized with a diagnosis of PE consistently were included in the Russian multicenter observational prospective register "SIRENA” (RusSIan REgistry of pulmoNAry embolism).Results. For 12 months in the registry was included 609 patients with a lifetime confirmed diagnosis of PE. TLT was performed in 152 patients with PE (25.0%), of which only 51 (33.8%) were indicated as "high risk" (shock or hypotension). In 101 not high risk patients, the indications for TLT were: severe shortness of breath/respiratory failure - 19 (18.8%), massive venous thrombosis - 7 (6.9%), signs of massive/submassive PE - 10 (9.9%), intermediate-high risk - 14 (13.9%), suspicion of acute coronary syndrome with ST segment elevation - 3 (2.9%), high pulmonary hypertension -2 (2.0%). The other 46 (45.5%) non-high-risk patients had no clear indication of the reasons for TLT in their medical history. To study the features of management of patients with not high-risk PE who received TLT (group 1), a selection of pairs of patients from the "SIRENA” registry, comparable in gender and age, in a ratio of 1:1 of patients with not high-risk PE who did not perform TLT (group 2). Hospital mortality was 4 (4%) patients in the TLT group and 6 (5.9%) patients in group 2 (р=0,748). Logistic regression analysis showed that floating blood clot in the veins of the lower extremities, syncopes in the debut of PE, respiratory rate over 22 per minute were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis, and probability of completion TLT decreased in the presence of a history of bleeding, chronic kidney disease, surgery in the previous 12 months, increase in the size of the right atrium on EchoCG (statistical significance of the model x2=51.574; pConclusion. In real clinical practice, there is a high frequency of TLT in patients with not high-risk PE. Floating blood clot in the veins of the lower extremities, syncope in the debut of PE, respiratory rate over 22 per minute were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis.

Aim To evaluate the frequency of off-label prescription of medicines in practice of clinical specialists and the awareness of respondents of the procedure of justified off-label prescription.Material and methods The sample included 542 clinical specialists who worked in definite medical organizations in 26 entities of the Russian Federation. The respondents were proposed to fill in remotely an anonymous questionnaire to evaluate the experience of prescribing medicines off-label to adult patients.Results Prescribing medicines not in consistence with the officially approved instruction for medical use (off-label or “outside instruction”) is a relevant issue of global medical care since convincing scientific evidence for safety of such use is scarce. Analysis of information about off-label prescription is one of current tasks of national medical research centers according to the Federal Project “Development of a network of national medical research centers and implementation of innovative medical technologies”. According to the responses about the frequency of off-label prescriptions 67.5 % of respondents reported of no experience of off-label prescription, 27.7 % said “rarely” or “sometimes”, and 4.8 % said “frequently” and “very frequently”. Specialties of physicians who have more often used medicines off-label (50% and more) included obstetrics and gynecology, pediatrics, rheumatology, hematology, and pulmonology. Cardiologists, neurologists and clinical pharmacologists use medicines off-label relatively rarely (19.6%, 28.6 %, and 22.2 %, respectively). 40 % of medicines used off-label were those designed for the treatment of coronavirus infection SARS-CoV-2. The medicines most frequently used off-label included metformin, rituximab, and thioctic acid. 65 % of respondents assessed their knowledge of off-label prescription as insufficient. In addition, 75 % of respondents consider it useful to receive additional information about risks and benefits of off-label prescription in clinical practice.Conclusion The survey revealed the need of physicians for information about risks of the off-label use of medicines in clinical practice.

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.

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR) 2. Risk of early (hospital or 30-day) death was stratified in accordance with the current 2019 ESC Clinical Guidelines. During the study, we analyzed inpatient mortality and complication rate.Results. A total of 604 patients (men, 293 (49%); women, 311 (51%)) were in the study. RD was detected in 320 (53%) patients, while severe dysfunction — in 63 (10%) ones. In addition, 71 (12%) patients had high death risk, 364 (61%) — intermediate, 164 (27%) — low. During hospitalization, 107 (18%) patients died, including 32% from the high-risk group, 20% — moderate, and 7% — low. RD in the deceased patients was diagnosed more often, while GFR 2 reliably predicted hospital mortality (sensitivity, 67%; specificity, 72%; AUC=0,72; pConclusion. In patients with PE of the Russian population, there is a high incidence of RD, which is diagnosed in every second patient and is severe in 10% of cases. The presence of RD is associated with a significant increase in in-hospital mortality, while the risk of death increases with a decrease in GFR. The addition of RD, considered as a decrease in the estimated GFR 2, to the sPESI improves risk stratification and allows identification of patients at high risk of in-hospital death.

Aim. To study the association between a positive results of Heart-type fatty acid binding protein (h-FABP) test with the development of adverse outcomes during the year of observation in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) depending on the type 2 diabetes mellitus (DM-2) presence.Material and methods. The study included 153 patients with NSTEACS hospitalized in the department of emergency cardiology in the period from March 2014 to January 2017. In addition to the standard examination, all patients underwent a qualitative analysis on the h-FABP in venous blood. Results. Kaplan–Meier estimator demonstrated a significant probability of a combined end point in patients with positive h-FABP, both with and without DM-2. H-FABP also acts as a marker for the development of adverse outcomes during the year after NSTE-ACS. Patients with adverse outcomes and type 2 diabetes mellitus had the highest frequency (100%) of positive test reactions.Conclusion. H-FABP positive test when admitted to hospital may be considered as a predictor of adverse long-term outcomes in patients with NSTE-ACS. That statistics is most significant for patients with DM-2.

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: Identification of predictors of unfavorable annual prognosis in patients with acute coronary syndrome with ST-segment elevation (STEMI). Material and methods: The study included 69 patients with STEMI who were hospitalized in the period from March 2014 to January 2017 in the hospital named after Zhadkevich. The follow-up period was 12±3 months after the index STEMI Longterm prognosis was established in 62 (89.8%) patients. Results: the fatal outcome was observed in 7 (11.3%) patients. Nonfatal myocardial infarction developed in 10 (16.2%), hospitalization with heart failure decompensation - in 5 (8%), nonfatal acute cerebrovascular accident - in 3 (4.8%) patients. Predictors of adverse prognosis were: age >60 years, level of brain natriuretic peptide (BNP) >29.2 pmol/l, C-reactive protein (CRP) >4.7 mg/l, left ventricular ejection fraction (LVF) 60 years and BNP level >29.2 pmol/l. Conclusion: Adverse factors affecting the long-term outcome of the disease (12±3 months after the STEMI) are: BNP level >29.2 pmol/l, CRP level >4.7 mg/l, LV FV value 60 years.

The ongoing pandemic of coronavirus disease 2019 makes it important to study the immunogenicity, the duration of immune response, and the safety of existing vaccines.Aim. As part of a prospective observational study, to assess associations between levels of anti-Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) S protein IgG antibodies and thrombodynamics parameters in individuals vaccinated with Gam-COVID-Vac and CoviVac vaccines.Material and methods. The study included 137 people who completed the first 3 visits: 30 people received the Gam-COVID-Vac, 107 people — CoviVac. The study participants underwent venous blood sampling before the introduction of the 1st and 2nd vaccine doses, as well as 42 days after the administration of 1st dose in order to quantify the level of IgG antibodies. At each visit, plasma hemostasis parameters were analyzed using a thrombodynamics test.Results. During the follow-up period, there was a clear increase in the level of anti-SARS-CoV-2 S protein IgG antibodies in both groups. At the same time, this increase over time was significantly greater in Gam-COVID-Vac group. There was no correlation detected between thrombodynamics test results and the levels of anti-SARS-CoV-2 S protein IgG antibodies.Conclusion. The data obtained demonstrate the ability of both vaccines to stimulate the production of anti-SARS-CoV-2 antibodies. However, immune response to Gam-COVID-Vac is much higher. The lack of correlation between thrombodynamics and the level of specific antibodies suggests that vaccination for COVID-19 with Gam-COVIDVac and CoviVac does not cause changes in plasma hemostasis and does not increase the risk of thrombosis.

Aim . To create a new prognostic scale for in-hospital mortality risk assessment in patients with pulmonary embolism (PE). Material and methods . The study was carried out on the basis of Russian register of acute pulmonary embolism SIRENA. Results . Based on the Russian register of acute pulmonary embolism SIRENA (n=609; women — 50,7%; mean age — 63,0±1,5 years), independent predictors of in-hospital death were determined: left ventricular ejection fraction

In real clinical practice, back pain in young patients is associated with neurological manifestations of degenerative changes in the lumbosacral spine. However, such complaints may be a manifestation of a lesion of the sacroiliac joint-sacroiliitis, and degenerative changes in the spine may accompany it, but not cause pain. Sacroiliitis is an inflammatory lesion of the sacroiliac joint, which can develop as an independent disease or as a symptom of another nosology. The causes of this pathology are diverse: injuries, long-term overloading of the joint, congenital abnormalities of the joints, infectious or systemic diseases, and tumors. In neurological practice, sacroiliitis is similar to myofascial syndromes and can disguise as degenerative diseases of the spine, so early diagnosis and proper therapy are of particular importance. Awareness of doctors about the features of examination of young patients, the use of neuroimaging techniques (CT, MRI), laboratory diagnostics, will help to improve the results of therapy. Prescription of NSAIDs with a pronounced anti-inflammatory potential will slow down the progression of the inflammatory process.В реальной клинической практике боль в спине у молодых пациентов связывают с неврологическими проявлениями дегенеративных изменений пояснично-крестцового отдела позвоночника. Однако подобные жалобы могут быть проявлением поражения крестцово-подвздошного сочленения — сакроилеита (СИ), а дегенеративные изменения позвоночника — сопровождать его, но не являться причиной боли. СИ — воспалительное поражение крестцово-подвздошного сочленения может развиваться как самостоятельное заболевание или как проявление другой нозологии. Причины возникновения данной патологии разнообразны: травмы, длительные физические перегрузки, врожденные аномалии скелета, инфекционные, системные заболевания, опухоли. В неврологической практике СИ имеет сходство с миофасциальными синдромами, способен походить на дегенеративные заболевания позвоночника, поэтому особое значение имеет ранняя диагностика и правильная терапия СИ. Знания врачей об особенностях обследования молодых пациентов, использовании визуализационных методик (КТ, МРТ), лабораторной диагностики помогут в улучшении результатов терапии. Назначение нестероидных противовоспалительных препаратов с выраженным противовоспалительным действием позволит замедлить прогрессирование воспалительного процесса.

Aim. To evaluate the incidence and severity of acute kidney injury (AKI), as well as its ability to reclassify the risk of premature mortality and association with inhospital mortality in patients with pulmonary embolism (PE) in the Russian population.Material and methods. From April 2018 to April 2019, the SIRENA Russian Multicenter Registry included patients with PE, as well as the deceased, in whom the PE was detected by autopsy. AKI was diagnosed according to current KDIGO guidelines (2012). Creatinine calculated according to the MDRD equation and corresponding to a glomerular filtration rate of 75 ml/min/1,73 m2 (baseline) was taken as the initial one, with subsequent assessment relative to the parameter value upon admission. The risk stratification of early death was carried out in accordance with the current ESC clinical guidelines (2019).Results. A total of 604 patients with PE were examined (men — 293 (49%), women — 311 (51%), mean age — 64±15 years). AKI was diagnosed in 223 (37%) of them. Stage 1 AKI was detected in 146 (65%), 2 — in 55 (25%), 3 — in 22 (10%) patients. Prior chronic kidney disease was recorded in 61 (10%) patients. Seventy-one (12%) patients had a high risk of death, 364 (61%) — intermediate risk, and 164 (27%) — low risk. The AKI incidence increased as the severity of PE increased: at low risk of death — 26%, intermediate — 38%, high — 59% (pConclusion. Thirty-seven percent of Russian patients with PE have AKI diagnosed by baseline creatinine. In 2/3 of the examined patients, stage 1 AKI is observed. The AKI incidence increases as the severity of PE increases. The presence of AKI reclassifies patients into a higher risk category for death and is associated with a significant increase in inhospital mortality.

Introduction. Recently there has been an active growth in disability of the population due to cases of development of acute cerebrovascular accident (ischemic stroke). Therefore, great attention is given to risk factors for the development of ischemic stroke, including in patients after acute coronary syndrome (non-ST-ACS). Objective: to study the contribution of clinico-laboratory factors associated with the development of acute cerebrovascular accident in patients with non-ST-ACS during five years follow-up. Material and methods. 415 patients were included in the register of patients with non-ST-ACS (2009-2010). The follow-up period was 60 months. In addition to the generally accepted clinical and laboratory examination, patients were assessed the factors of nonspecific inflammation and oxidative metabolism of lipids on the 11th -13th day of hospitalization with ASC. Results. In 29 (7.70%) of the patients with OCSUPST included in the study, ischemic stroke developed over a five-year follow-up period. Significantly, ischemic stroke developed in patients with ischemic stroke in anamnesis (p=0.008) and myocardial infarction (p=0.027), rhythm disturbances about the type of atrial fibrillation-flutter (AF/TP) (p = 0.005) and GRACE-score risk on admission (p=0.00015), higher blood levels of interleukin (IL)-6 (p = 0.01), and IL-10 (p = 0.007), as well as a high average heart- ankle index (p = 0.019). Conclusion. Logistic regression results revealed the most significant adverse factors affecting the development of the ischemic stroke in the long-term follow-up period, after an acute coronary syndrome without an ST segment elevation: an elevated blood concentration of IL-6> 8.0 pg/ml, the presence of atrial fibrillation/flutter, the ischemic stroke in the anamnesis.

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.

Aim. To define early echocardiographic markers of cardiovascular risk in women. Material and methods. In 76 females, of 1st degree of kinship, from 61 families, two groups were selected: 26 daughters, whose mothers have arterial hypertension (AH) — group 1; 41 daughters from normotensive mothers — group 2. Anamnesis was assessed, including registration of cardiovascular risk factors, heredity, anthropometry, bidimensional echocardiography (EchoCG), and tissue Doppler. Results. In women from group 1, waist circumference (WC) and waist/hip ratio were significantly higher than in group 2. In bidimensional EchoCG, structural and functional parameters of the left ventricle function (LV) were within the reference values, however left atrium volume index in group 1 was significantly higher in comparison with the daughters from normotensive mothers. Also, in the group 1, there were significant differences od tissue Doppler values that characterize diastolic LV function. Relation E/e’ on lateral and septal areas of the mitral valve did not reach pathological values in both groups, as the in groups almost healthy persons were included; in the group of daughters form hypertensive mothers though, these parameters were significantly higher than in the group 2. Conclusion. Early adverse factors of cardiovascular risk in women are inheritance for cardiovascular diseases and AH, markers of metabolic syndrome (increased WC and waist/hip ratio), and left atrium volume and E/e’ that represent diastolic function of the LV.

Aim. Evaluation of the association of variation sites G-1082A (rs3024491) and C-592A (rs1800872) gene IL10 with one year outcomes of ST elevation acute coronary syndrome (STEACS). Material and methods. Totally, 178 patients included, with STEACS in whom the polymorphisms C-592А (rs1800872) and G-1082А (rs3024491) of the gene IL10 were checked. Genotyping was done with TaqMan “iCycler iQ” (BIO-RAD, USA). To the control group 185 relatively healthy persons included living in Kemerovo city. In 93, the concentration of interleukin-10 (IL-10) was measured by the hard-phase immune-enzyme assay, by BIOSOURCE (Belgium). Reference values of IL-10 were set at 2,98 (1,75-4,31) pg/mL. At the one-year stage, endpoints developed in 42 (23,5%) patients, progressive angina — in 30 (16,8%); cardiovascular mortality for one year reached 1,1% (n=2), nonfatal myocardial infarction developed in 6 (3,4%), ischemic stroke — in 4 (3,2%) patients. Results. While comparing IL-10 concentrations in STEACS with the reference values in Kemerovo city inhabitants, relatively low concentration was revealed in STEACS patients (0,38 vs 2,98 pg/mL; p=0,001). Association analysis of the variation sites of IL-10 with adverse outcomes during one year showed that genotype А/С rs3024491 (G-1082А) of gene IL10 is associated with the development of adverse outcome after NSTEACS. Endowment analysis towards the endpoint during 12 months showed that the most adverse is heterozygous carriage of А/С rs3024491 (G-1082А) gene IL10 (р=0,048). Conclusion. In NSTEACS patients genotype С/С rs1800872 (С-592А) gene IL10 associated with lots of cardiovascular risk factors, but genotype А/А rs3024491 (G-1082А) on the contrary, shows associations with protective factors. Genotype A/C of polymorphic variant rs3024491(G-1082А) gene IL10 is associated with adverse yearly outcomes in STEACS patients.

Cardiovascular diseases (CVD) remain the main cause of mortality in the world. [1] At the same time, arterial hypertension (AH) is one of the most common CV pathologies, which, according to foreign researchers, affects about 30–45% of the general population [2] and about 40–47% of the population according to Russian studies. [3] The experts forecast that by 2030 the prevalence of hypertension will increase by approximately 10%. [4]

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 Conclusion.In the Kemerovo Oblast, PE most often develops in patients aged 60-75 years and is characterized by a more severe clinical course compared with patients younger than 60 years. Patients over the 60 years of age have severe cardiovascular comorbidity status, atrial fibrillation/flutter and recurrent PE. Surgical treatment for senile patients is limited due to the high risk of postoperative complications, which specifies high mortality. Patients

to study the role of clinical factors and treatment tactics in the development of adverse outcomes in patients with non-STelevation acute coronary syndrome (NSTEACS) for five years follow up.The study included 415 patients with NSTEACS observed for 60±4 months from the date of discharge. Adverse events (AE) were unstable angina (UA), myocardial infarction (MI), ischemic stroke or patient's death. The favorable 5-year outcome was identified in 200, adverse outcome - in 178 patients. Statistical processing was performed using STATISTICA 8.0 software package and MedCalc 11.0.Total mortality for 60 months was 16.1% (n=61). Highest mortality, maximal number of hospitalizations due to MI (41.1%) and UA (49.6%) were observed during first 12 months. Greatest impact on the development of AE produced: history of MI, higher GRACE score, age54 years (p=0.0021), stenosis in brachiocephalic arteries, ischemic changes on admission ECG and reduced left ventricular ejection fraction (LVEF) ≤ 52% (p=0.0001). Five-year survival rate was influenced by coronary angiography (p=0.0001) and percutaneous coronary intervention (PCI) during index hospitalization (p=0.0039).Mortality and frequency of AE in this register were close to generally reported. The observed adverse impact on the long-term outcome of such risk factors such as age over 60 years, history of MI, ischemic ECG changes at admission, decreased LVEF corresponded to literature data. Our study proved the need for coronary imaging in patients with NSTEACS to determine treatment strategy in in hospital period as these factors affected the 5-year survival.During five-year follow-up AE occurred in 47.1% of patients with NSTEACS. Maximal number of patients with AE was registered during the first (24.7%) and fifth (13.8%) year of observation. The development of AE was associated with older age, history of MI and coronary artery bypass grafting, ischemic ECG changes, decreased LVEF, higher GRACE score, and brachiocephalic artery stenosis. Carrying out diagnostic coronary angiography and PCI with stenting during hospitalization in patients with NSTEACS was associated with favorable 5-year outcome.

This paper provides a literature review on left ventricular noncompaction (noncompact cardiomyopathy). It details the historical aspects, epidemiology, ethology, pathophysiology, clinical features, diagnosis, treatment, and prognosis of this abnormality.Представлен обзор литературы по некомпактному миокарду левого желудочка (некомпактная кардиомиопатия). Подробно отражены исторические аспекты, эпидемиология, этиология, патофизиология, особенности клинической картины, диагностики, лечения и прогноза данной патологии.

In 141 apparently healthy working men aged 55 years (mean) we assessed body mass index (BMI), states of lipid, carbohydrate and purine metabolism, morphological and functional state of the cardiovascular system (transthoracic echocardiography), carotid artery intima-media complex (IMC) (ultrasound investigation). Ten year risk of fatal heart disease was also evaluated with the SCORE scale. Same examination of all 141 men was repeated in 3 years. At both examinations 50% of subjects had abnormalities of lipid metabolism. Among these subjects 50% had hypercholesterolemia while hypertriglyceridemia was registered in 7 men. In 3 years numbers of patients with hypertriglyceridemia and elevated low density lipoprotein cholesterol significantly decreased. Arterial hypertension (AH) at initial examination was found in about one fifth of men. After 3 years number of patients with AH did not significantly increase, but the structure of the disease changed: number of patients with stage 2 AH increased and of those with stage 1 AH decreased. Cardiovascular risk measured in accordance with the SCORE scale was moderate at initial examination but significantly increased after three years. Thus despite the fact that during 3-year follow-up the subjects maintained relatively stable body mass and parameters of lipid metabolism risk of occurrence of fatal cardiovascular complications increased probably due to the aging and presence of additional risk factors (low high density lipoprotein, IMC thickening). Ultrasound investigation revealed that the AH progression contributed to the development of left ventricular hypertrophy and increase of intima-media thickness of brachiocephalic arteries.