In the article, a role of percutaneous intervention discussed in stable ischemic disease of the heart, and an evolution presented of the perspectives on its influence on prognosis and clinical presentation of the disease. The results provided, of recent trials, including the ORBITA. According to current clinical guidelines, endovascular treatment does improve prognosis in patients with the left coronary artery stem lesion and proximal left descending artery lesion, as in a significant area of damaged myocardium involved in temporary ischemia. Percutaneous coronary intervention should be done in patients with continued clinical presentation of angina and nonsatisfactory life quality regardless the optimal medication treatment.

Aim. To evaluate the prevalence of cardiovascular events and death depending on baseline coronary collateral blood flow (CBF) in five year follow-up of stable coronary heart disease (CHD) patients.

Material and methods. To the study, 579 stable CHD patients included, who during scheduled coronary angiography (CAG) were diagnosed with at least one stenosis in one coronary artery (diameter no less than 1,5 mm), narrowing its lumen by ≥50%. CBF was assessed by Rentrop modified method. In 5 years post index CAG, the cardiovascular events were counted (relapse or worsening of functional class of angina, non-fatal myocardial infarction, coronary bypass surgery, acute stroke) and mortality.

Results. In multifactorial analysis (Cox regression) the association revealed of the good CBF with lower cardiovascular mortality (HR 0,5; р=0,02) and all-cause mortality (HR 0,5; р=0,004). In multifactorial analysis (logistic regression) there was association of good CBF with lower rate of relapse/worsening of angina in long term period — (OR 0,36, p=0,002). There was no relation found for CBF condition and non-fatal myocardial infarction, percutaneous coronary intervention.

Conclusion. By the data from five year follow-up, good CBF correlates with less cardiovascular and all-cause mortality and with the frequency of relapse/worsening of the FC of angina pectoris in chronic CHD patients, including those underwent revascularization, regardless of the severity of disease, coronary flow lesion and other factors associated with cardiovascular complications.

Aim. Analysis of the primary endpoints occurence in male and female cohort of coronary heart disease (CHD) patients comorbid with other somatic pathology, during 5 years.

Material and methods. To the study, 320 patients included (143 males, 177 females, age 46-72 y. o.) with CHD stable angina I-III functional class, and underwent investigations in the year 2012 in three medical centers in the Republic of Ingushetia. In 2017 patients were invited for second investigation or were contacted by phone. As the primary endpoints the following accounted: revascularization surgery (CBG), endovascular surgery in coronary, carotid, peripheral arteries, diagnosed myocardial infarction, ischemic stroke, diabetes and its complications, fatal outcome from cardiovascular diseases (CVD) and death from other causes.

Results. The number of CHD patients with comorbidities was 196, and with no comorbidities — 124. During the follow-up, stroke developed in 17 (5 males, 11 females) patients, myocardial infarction in 37 (20 males, 17 females), diabetes in 38 (15 males, 23 females), fatal CVD outcome in 11 (8 males, 3 females; of those in 5 — acute coronary syndrome, 4 — stroke, 3 — chronic heart failure),
and death from other causes in 8 (5 males, 3 females). We also analyzed the development of composite endpoints in CHD patients depending on the presence and absence of comorbidities. Stroke was registered in 13 comorbid patients vs 3 in CHD with no other diseases. Myocardial infarction found in 33 patients with CHD and three comorbidities vs 4 cases in CHD with no comorbidities. Diabetes was found in 32 vs 6 patients, respectively; CVD death in 10 vs 1, resp.; all-cause death in 5 vs 3, resp.

Conclusion. Comorbid CHD with 2 and more somatic diseases, during the 5-year period of follow-up, does increase the risk of complications and death from CVD.

Aim. In the article, the analysis of the Russian independent registry presented on acute coronary syndrome (ACS) — RECORD-3, aimed for evaluation of adverse outcomes rate by 12 months after ACS, as the long term management of ACS patients.

Material and methods. To analysis, 966 patients included (43% of all discharged). By most anamnesitcal and clinical data, as by management specifics, patients groups that were and those that were not assessed for 12 month outcomes, did not differ significantly.

Results. The rate of fatal outcomes developed post discharge during 12 months after ACS, was 8,4% (4,8% in ACS with ST elevation (STEACS) and 10,5% in ACS non-ST elevation (NSTEACS); р=0,0012), summated events death+myocardial infarction (MI) + stroke was 12,8% (8,4% in STEACS and 15,4% in NSTEACS; р=0,0012). Mortality in 12 months from the onset of ACS was 15,8% (18,3% in STEACS and 14,2% in NSTEACS; р=0,077), summated events death+MI+stroke in 12 months from the onset of ACS was 19,9% (21,4% in STEACS and 18,9% in NSTEACS; р=0.32). The proportion of patients that continued to follow the prescribed at discharge aspirin, clopidogrel, ticagrelor, ACE inhibitor/angiotensine receptor blocker (ARB), beta-blocker and statin was, respectively, 83,4%, 47,8%, 28,1%, 66,8%, 77,3% and 68,7%. The relation was evaluated, of the “completeness of treatment” in 6 months post ACS with the rate of fatal outcomes in 12 months. In patients, who in 6 months post ACS continued to take ≥2 groups of medications (double antiplatelet therapy, beta-blocker, ACE inhibitor/ARB, statin) the rate of fatal outcomes during 12 months was significantly higher comparing to those who were taking ≤1 group (1,4% vs. 4,9%; р=0,01). Multifactorial regression showed the independent predictors of fatal outcomes post discharge in 12 months. These were coronary arteriography in-patient (odds ratio (OR) 0,11; 95% confidence interval (95% CI) 0,02-0,56; р=0,008), age ≥75 y. o. (OR 5,48; 95% CI 1,57-19,30; р=0,008), ST elevation on baseline ECG ≥1 mm (OR 3,43; 95% CI 1,02-11,48; р=0,046).

Conclusion. The analysis of data of the Russian registry RECORD-3 showed that the prevalence of fatal outcomes developed in 12 months after ACS, post discharge from hospital, was 8,4%, and the prevalence of fatal outcomes from the ACS onset — 15,8%. Best adherence to treatment in 12 months was found for aspirin (83,4%), worst — for ticagrelor (28,1%). Independent predictors of fatal outcomes in 12 months post discharge were age ≥75 y. o., not performed coronary arteriography in-patient, and ST elevation on baseline ECG ≥1 mm.

Aim. Evaluation of structural and functional properties of arteries in healthy persons and in coronary heart disease (CHD) patients with various severity of coronary lesion, in different age groups.

Material and methods. To the study, 135 patients included, with various CHD types, and 56 healthy persons at the age 35 to 65 y. o. All participants underwent laboratory testing for glucose level and lipid profile in blood. Applanation tonometry was done, and volumetric sphygmography, ultrasound scanning of common carotid arteries with the technology of high frequency RF signal.

Results. All participants were selected into two cohorts: younger and older than 50 y. o., which included patients with no hemodynamically significant stenoses of coronary arteries, with significant stenosis of one artery and healthy persons. According to the results of traditional risk factors analysis, CHD patients more prevalently had tobacco addiction, arterial hypertension, as well as family anamnesis of lipid disorders. By ultrasound scanning data of common carotid arteries, the parameters of arterial stiffness predominated in patients with coronary lesions. Applanation tonometry showed that CHD patients and healthy persons had comparable levels of central arterial pressure in both age groups. In all healthy persons the carotid-femoral pulse wave velocity was within normal range, and in CHD it was higher by 10 m/s. Volumetric sphygmography showed that severity of coronary lesion correlated with the increase of vascular rigidity parameters.

Conclusion. The results of current study confirm the necessity for development of novel criteria of risk assessment and prevention of cardiovascular diseases early development. Screening for predictors of early vascular ageing syndrome will make it to identify persons with low relative but high absolute risk of coronary events.

Aim. To assess the dynamics of heart rate variability (HRV) during the therapy with trimetazidine instable angina patients comorbid with diabetes.

Material and methods. Totally, 110 stable angina patients studied, of III functional class (FC), comorbid with type 2 diabetes (DM2), that is 53 with diabetic vegetative cardial neuropathy, and other 57 with no diabetes, that is with no vegetative cardial neuropathy, investigated with hardware and software complex.

Results. Usage of trimetazidine instable angina patients of III FC, comorbid with DM2, makes it to improve the myocardial index to normal levels, to restore variability parameters, clinical condition of the patient, and facilitates the improvement of diabetic neuropathy.

Conclusion. Usage of trimetazidine is practically worthy, making it to improve prognosis in coronary heart disease comorbid with DM2.

Aim. To assess the efficacy of torasemide for changes of electrical instability of the heart in patients with ischemic mitral regurgitation during the period after myocardial infarction.

Material and methods. Ninety six patients with mitral regurgitation, with Q-myocardial infarction (Q-MI) had been randomized to two groups. During six months after discharge, in the control group 1, of 46 patients, the standard therapy applied (clopidogrel, acetylsalicylic acid, nebivolol, perindopril). In the study group 2, of 50 patients, additionally torasemide was used. At baseline, in 3 and 6 months Holter ECG monitoring was performed.

Results. In the group 1 patients with mitral regurgitation post Q-MI, with the standard treatment, there was decrease of silent myocardial ischemia (3,6±0,5 — baseline; 3,3±0,5 and 3,1±0,3 — in 3 and 6 months, respectively, p<0,05). They showed decrease of the duration of silent and anginal ischemia, depression of ST segment >1 mm, number of patients with supra- and ventricular extrasystoles (p>0,05) and increase of the number of anginal ischemia (2,1±0,4 — baseline, 2,2±0,2 and 2,3±0,1 — in 3 and 6 months, respectively, p>0,05). In the group 2 patients, in 6 months of treatment there was decrease of number of silent (2,1±0,3) ischemia episodes, duration of anginal (7,3±2,1 min) and silent (4,3±1,2 min) ischemia comparing to baseline (8,8±1,2; 10,6±2,7 and 8,8±1,2 min — respectively, p<0,05). Also, they showed decrease of ST depression >1 mm episodes (1,2±0,2 vs 2,0±0,4 mm at baseline) and relative values of the patients number with the registered supra- and ventricular extrasystoles (38% and 44%, respectively, versus 62% and 84% at baseline, p>0,05).

Conclusion. The usage of torasemide combination with standard treatment decreases the number of episodes, duration of silent and anginal myocardial ischemia, rate of registered supra- and ventricular extrasystoles in mitral regurgitation patients post Q-MI, comparing to separate standard treatment. Also, the rate of anginal ischemia episodes does not change in 3 and 6 months of standard treatment.

Aim. This study aimed to look at the characteristics of the P2Y12 reactivity unit (PRU) in 30 Minang acute coronary syndrome (ACS) patients in Dr. M. Djamil Hospital, Padang, Indonesia.

Material and methods. This research was a cross-sectional study conducted in September 2016. The effectiveness of clopidogrel on platelet reactivity was identified through examination of PRU values using VerifyNow® with a cut-off point of 208. From the PRU values, it can be classified whether patients were resistant or responsive.

Results. This study shows that 30 patients with ACS who received clopidogrel, 24 patients (80%) were male and 6 female patients (20%). Hypertension was the greatest risk factor for the coronary arterial disease. A total of 11 patients (36,77%) were resistant and 19 patients (63,33%) were responsive to clopidogrel. About 46,67% patients were extensive metabolizers. PRU of these patients were lower than intermediate and poor metabolizers.

Conclusion. ACS patients with functional loss of CYP2C19 activity have lower platelet activity when treated with clopidogrel. Routine CYP2C19 and PRU testing may be warranted. Further research is needed with a larger number of patients to investigate the pharmacogenetic profile of CYP2C19 and the cause of clopidogrel resistance in Minang patients.

Barth syndrome is an X-bound inherited recessive disorder with the prevalenсe 1:300000 — 1:400000 of live bornt, caused by mutations in the gene TAZ; manifesting with dilation cardiomyopathy, neutropenia, proxymal myopathy, delayed physical and motoric development. In the article, a clinical case provided of the Barth syndrome, confirmed by target sequencing of TAZ gene in a boy of 1st year of life, presented in 3 months age by an episode of infectious disease and dilation cardiomyopathy, with family anamnesis of sudden death at the moment of infectious disease in the grand uncle of proband. In dynamics, the patient showed delayed motoric development, as the delay in mass and height (<3 percentile), persistent absolute neutropenia, stable high levels of cardiospecific enzymes, NT-proBNP, symptomes of severe heart failure with following fatal outcome at age of 12 months from sudden death during an episode of infectious disease. The multidisciplinarity presented, as the necessity for clear understanding by practitioners of the specifics

The article is focused on the data concerning the influence of ivabradine on myocardial electrophysiology in experimental and clinical studies. It is shown that ivabradine decreases ventricular rate in chronic atrial fibrillation, and prevents the paroxysms of atrial fibrillation. In myocardial hypertrophy patients or in serious chamber dilation, ivabradine shows moderate antiarrhythmic effect on ventricular arrhythmias.

A review presented, of the novel scientific data, mostly the results of large clinical trials, witnessing on clinical efficacy and safety of rivaroxaban — the anticoagulant, selective blocker of Xa factor — in treatment of acute and chronic coronary heart disease. The mechanisms explained, of the drug influence on atherothrombosis, especially the specifics of dosages and its combination with other antithrombotic drugs in various clinical situations.

Aim. Evaluation of influence of the stimulated regeneration abilities of myocardium with non-cellular allogenic material (NAM) on contractility restoration in experimental post-infarction remodelling.

Material and methods. The experiment was done on the Wistar rodents with postinfarction cardiosclerosis (PICS), and PICS rodents post injection of the NAM at the moment of coronary artery stenosing. PICS was being formed during 45 days after coronary occlusion. The assessments were the formation and size of postinfarction scar of the left ventricle in rodents of different groups. Myocardial contractility was assessed by inotropic reaction of isolated papillary muscles on rest periods (4-60 s) with stimulation frequency 0,5 Hz, under conditions of perfusion with oxygnated Krebs-Henseleit solution.

Results. PICS in the rodents after injection of NAM developed only in 56%, and in comparison group 100%. The size of the scar area was 22% smaller in NAM group (p<0,05). Development of an aneurysm was 45% less in NAM group than in PICS group (p<0,05). Potentiation phenomenon for inotropic response on the periods of papillary muscles rest in PICS rodents myocardium was not observed. In increase of the duration of resting period there was increase of potentiation of inotropic response in rodents myocardium, and in this group the amplitude of response was significantly higher than changes in the other group of PICS animals.

Conclusion. Results of the study show possibility of preservation of myocardial functional capacity after stimulation of its regeneration abilities with allogenic noncellular biomaterial, composed with the technology Alloplant® in experimental infarction.

Developed by the Committee of experts of the Russian society of cardiology (RSC). Section of cardiovascular diseases in pregnant women