Aim. To study the contrast enhanced magnetic resonance imaging (CE-MRI) role in assessment of aortic atherosclerosis and its relation to severity of myocardial injury in myocardial infarction (MI) patients which underwent cardiac MRI before coronary artery bypass grafting and Dor or Menicanti procedures.

Material and methods. The study included 42 patients (38 men, 4 women) who underwent CE-MRI (mean age 57,7±8,75 years). In order to analyze the aortic atherosclerosis, axial T1 weighted images before and after 10-15 minutes after CE was evaluated. Along with visual analysis, the diameter, thickness of the aortic wall, and index of enhancement (IE) of T1 weighted image (WI) (TR=400-650 ms, TE=12-20 ms), as the ratio of postand precontrast intensities of the aortic wall: IE=(Intensity T1-WI post-contrast)/ (Intensity T1-WI pre-contrast) were determined. According to the cardiac CEMRI, the proportion of left ventricle (LV) injury as the ratio of the MI injury and theLV mass was estimated.

Results. Depending on aortic IE value, patients were divided into three groups: group 1 (9 people) with IE ≤1,05; group 2 (15 people) with 1,05< IE ≤1,15; group 3 (18 people) with IE >1,15. We compared the descending aortic wall thickness and the diameter among these groups. To identify intergroup differences one-way ANOVA with Bonferroni correction was carried out. There were no significant differences in the descending aortic diameters (F=0,15; p=0,86): group 1 — 2,41±0,33, group 2 — 2,54±0,63, group 3 — 2,53±0,51 cm. The thickness of the aortic wall in groups was 2,05±0,58 mm, 3,34±0,68 mm and 3,80±0,46 mm (F=17,39; p< 0,001), respectively. The first and second, first and third groups were distinguished, and there was no significant difference between the second and third groups. Between groups 1, 2 and 3 were also noted the increase and differences in proportion of LV injury, which amounted to 0,11±0,03 with a minimum IE (group 1), with an intermediate IE (group 2) — 0,19±0,08, and with high IE — 0,25±0,15.

Conclusion. CE-MRI of the aortic wall can be used as a method of visualizing atherosclerosis and predicting the complications of aortic atherosclerosis. Moreover, the assessment of aortic atherosclerosis can be used in combination with conventional heart examination. The increased CE into the aortic wall in patients with advanced atherosclerosis is usually associated with a greater severity of myocardial injury. During cardiac CE-MRI it is advisable to assess the descending aorta state by calculation of IE T1-WI MRI to clarify the atherosclerosis severity and cardiovascular risk.

Aim. Coronary artery calcification is a characteristic of coronary atherosclerosis, which is often detected by chest computed tomography (CT). The aim of this study is to assess the efficiency of low-dose chest CT in calcium score (CS) determining and to compare it with conventional method and results of CT and selective coronary angiography.

Material and methods. A total of 251 patients underwent a low-dose chest CT and a CS determining. Coincidence between the two methods was evaluated by the absolute CS values and by stratification of patients into five risk categories (“zero” CS values were excluded from the analysis). Eighty patients underwent CT or selective coronary angiography and the results were divided into two groups according to the degree of coronary stenosis — ˂50% and ≥50%. The CS values determined by chest CT are compared with the results of coronary angiography.

 Results. In 79 patients (31%), the CS was 0 and they were excluded from further analysis. The absolute CS values comparability between the two scanning methods in other 172 patients was very high (r=0,978, p<0,05). The coincidence in stratification of patients by risk groups was also high (contingency coefficient k=0,846). The CS specificity compared with coronary angiography was 97,5%, but with a low sensitivity of 43,6%, if the CS value is set to 400, above which coronary stenosis will considered significant. In comparing CS values with results of CT, the relationship of high CS values with coronary stenosis, were statistically proved: in 17 patients from 18 with CS >400 significant coronary stenosis was detected, in comparison with 22 patients from 52 patients with a CS more than 400 (p<0,05).

 Conclusion. The research showed that low-dose chest CT can be used to determine CS. Studied values correlate with the results of coronary angiography.

Aim. To assess the effect of the size and pattern of myocardial structural injury, determined by magnetic resonance imaging (MRI), on response to cardiac resynchronization therapy (CRT) in patients with ischemic and non-ischemic heart failure (HF).

Material and methods. Forty seven patients with ischemic and non-ischemic HF (age 62,3±8,9 years (mean±SD), 44,6% females and 55,4% males), left ventricle (LV) ejection fraction <35%, QRS complex >130 ms, and sinus rhythm were included in the study. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) was undertaken to evaluate myocardial scar prior to CRT devices implantation. All CMR analysis was performed on CVI42 software. According to signal intensity, fibrosis zone and “grey zone” were defined for quantitative analysis (proportion and mass) of injury. Scar zone included fibrosis zone and “grey zone”. Scar location was assessed using a 16-segmentLV model. Response was defined as a reduction inLV end systolic volume of >15% at 6 months follow-up and HF functional class amelioration.

Results. In nonresponse group there was significantly higher proportion and mass of total scar (median 4% [2,5; 19] vs 24% [7; 44], p=0,012,6 g [3,5; 32,5] vs41 g [8; 86], p=0,013)), fibrosis zone (median 0% [0; 3,5] vs 8% [0; 19], p=0,01,0 g [0; 6] vs14 g [0; 34], p=0,014) and “grey zone” (4% [2,5; 15] vs 15% [7; 23], p=0,018,6 g [3,5; 27,5] vs23 g [8; 39], p=0,25). Response proportion in non-ischemic HF patients was higher than in ischemic HF patients (78,5% vs 28,5%, p<0,01). Response to CRT was less in patients with posterolateral scar, more specifically in segments 4,5,6,11,12,15,16 (p<0,05). CRT response in ischemic HF did not depend on size of myocardial structural injury, but depend on scar localization. Lateral scar was associated with poor response. In non-ischemic HF, proportion and mass of fibrosis zone was less in responder group (median 0% [0; 1] vs 8,5% [0; 11], p<0,05,0 g [0; 1] vs14,5 g [0; 22], p<0,05.

Conclusion. Response to CRT is significantly higher in non-ischemic than in ischemic HF patients. Nonresponse to CRT is associated with posterolateral scar, regardless of the HF origin. In patients with non-ischemic HF, size of fibrosis zone is lower in the responder group. In patients with ischemic HF, size ofLV structural injury does not affect the CRT efficiency, but lateral scar is associated with CRT nonresponse.

Aim. To determine the inflammation and calcification activity in aortic stenosis (AS) by assessing the accumulation of ¹⁸F-FDG and ¹⁸F-NaF in the aortic valve; to study the relationship of the AS severity, aortic calcification and the accumulation of ¹⁸F-FDG and ¹⁸F-NaF. 

Material and methods. The study included 62 patients with asymptomatic AS (29 patients with tricuspid (TAV) and 33 with bicuspid (BAV) aortic valve), aged 40 to 70 years. The maximum flow rate at the aortic valve (Vmax) differs from 2,4 m/s to 4,5 m/s. The mean age of patients was 59,44±7,33 years, M:W 1:1. Patients with infective endocarditis and chronic rheumatic heart disease were excluded. The AS severity was assessed according to the standard protocol of transthoracic echocardiography with the use of Vivid 7 ultrasound system (GE,USA). All patients underwent combined positron emission tomography/computed tomography (PET/CT) of the aortic valve using the Discovery 710 system. Evaluation of calcification and inflammation activity of the aortic valve was performed using ⁸F-NaF and ¹⁸F-FDG PET/CT. A quantitative assessment of radiopharmaceuticals accumulation was carried out using uptake ratio indices. The calcium score was calculated using SmartScore 4.0 software.

Results. Patients with TAV and BAV were comparable in severity of AS, the median Vmax was 2,9 [2,6; 3,4] m/s and 2,9 [2,3; 3,3] m/s, respectively. Also, TAV and BAV patients did not differ in calcification values (Agatston score 1088 [465; 2192] and 1128 [442; 2391] HU, respectively). The association of ¹⁸F-FDG accumulation and AS severity has not been established. At the same time, the association was found between the aortic valve peak velocity and the calcium score (r=0,57, p< 0,0001), as well as the ¹⁸F-NaF accumulation values — maximum, mean and maximum to mean (r=0,37, p=0,002; r=0,46, p=0,0001 and r=0,41, p=0,0008, respectively). No association between the accumulation of ¹⁸F-FDG and ¹⁸F-NaF (r=0,098, p=0,49) was found.

Conclusion. It was found that the inflammation according to 18F-FDG PET/CT does not play a significant role in AS pathogenesis. At this time, 18F-NaF PET/CT is a reliable method for the AS diagnosis and valve calcification assessment. It can be used to evaluate the prognosis and effectiveness of therapy in TAV and BAV patients. 

Aim. To assess the role of global and selected scintigraphic scores of myocardial perfusion, blood flow and reserve in the anatomical and functional significance of coronary artery (CA) stenosis.

Material and methods. The double-blind comparative study included 23 patients (mean age 61,2±6,8 years, 12 (52%) women, 11 (48%) men). All patients underwent stress dynamic single-photon emission computed tomography (SPECT) with adenosine triphosphate (ATP) (140 µg/kg/min in 6 minutes). Myocardial perfusion disorders were assessed by a semi-quantitative method, the total Summed Stress Score (SSS), the Summed Rest Score (SRS), and the Summed Difference Score (SDS) were determined. Global (g) and regional (r) myocardial perfusion (MP) were evaluated; myocardial perfusion reserve (MPR) was calculated as the ratio of MP at stress and at rest. Coronary angiography (CAG) was performed within 1 week after SPECT, the amount of CA narrowing was evaluated by diameter. Stenoses >50% were considered anatomically significant. The assessment of the fractional flow reserve (FFR) was performed by the ratio of the mean intracoronary pressure at the CA ostia to the pressure distal to the stenosis at the ATP infusion peak. FFR ≤0,80 was considered a sign of hemodynamically significant stenosis.

 Results. Neither regional nor global scintigraphic scores reflecting myocardial perfusion showed statistical significance as markers of CA stenosis >50%. Among perfusion markers, only SSSg (>4) showed good sensitivity and specificity in the diagnosis of hemodynamically significant (FFR ≤0,80) stenoses (AUC 0,76; p=0,002; sensitivity 81,8%, specificity 83,3%). The following regional flow scores allowed identification of hemodynamically significant CA: stress MPr ≤0,54 ml/min/g (AUC 0,8; p=0,0003; sensitivity 57%, specificity 92%) and MPR ≤1,5 (AUC 0,86; p< 0,0001; sensitivity 71,4%, specificity 92,8%).

Conclusion. It is proved that global and regional scintigraphic scores of MP and MPR are sensitive and specific markers of hemodynamically significant (FFR ≤0,80) coronary stenosis. It can be more useful for localization diagnosis of the lesion than standard SPECT.

Aim. To modernize the computed tomography angiography (CTA) protocol with advanced data processing for the diagnosis of ascending aortic (AA) aneurysms, determining the aortic distensibility and compliance.

 Material and methods. We examined 24 patients (14 men) aged 43 to 72 years old with aneurysm or dilatation of ascending aorta (AA). CTA was performed on Siemens Somatom Definition AS and Philips Ingenuity Elite 128-slice scanners with electrocardiographic (ECG) synchronization after a bolus injection of contrast agents (100-120 ml). End-systolic and end-diastolic frames, maximum aortic diameter and cross-sectional area were determined; aortic distensibility and compliance were calculated.

Results. According to AA diameter in end-diastolic frame, patients were divided into 3 groups. Group 1 — 6 patients, d< 45 mm (39 [39; 40] mm), group 2 — 7 patients, d =45-50 mm (48 [46; 49] mm) and group 3 — 11 patients, d >50 mm (51 [51; 54] mm). A correlation between aortic distensibility and compliance and such parameters as age, systolic blood pressure, systolic and was found. Correlation between the aortic compliance and diastolic diameter can be used for predicting of diameter increase rate.

Conclusion. The designed CTA protocol with advanced data processing allows evaluating the AA distensibility and compliance by the diameter and cross-sectional area in patients with AA dilatation. These criteria provide additional information about the aortic elastic properties and can be used for determining the management strategy.

Aim. To develop and test a risk-stratification model for patients with coronary artery disease (CAD) and non-ischemic pathologies based on a computer analysis of electrical instability ECG markers.

Material and methods. In the period from 2011 to 2018, the study included 1014 patients with CAD and non-ischemic pathologies. Depending on ventricular arrhythmia status, the analyzed cohort was divided into 3 groups: 1) 644 patients without lifethreatening ventricular tachyarrhythmias (-VTA), mean age 51,7±16,1 years; 2) 280 patients with clinically significant ventricular arrhythmias (+csVA): ventricular extrasystoles (VES) >1500/24 h, coupled VES >50/24 h or unstable ventricular tachycardia (uVT), mean age 46,7±14,0 years; 3) 90 patients with life-threatening ventricular tachyarrhythmias (+VTA): persistent VT (pVT), successful cardiopulmonary resuscitation (CPR), appropriate discharges by implanted cardioverter defibrillator (CVD), sudden cardiac death (SCD), mean age 46,8±12,7 years.

Using the Intekard 7.3 software, ECG markers of myocardial electrical instability were analyzed: T wave alternation, QT interval and dispersion, fragmented QRS, spatial QRS-T angle, turbulence onset and slope, and heart rate deceleration/acceleration.

Results. Statistically significant differences were found between the values of T wave alternation, QT interval, fragmented QRS and QRS-T angle in groups 1 and 3 (-VTA) and (+VTA), p<0,005.

Personalized model was formed for predicting the risk of life-threatening VTA (primary endpoints: pVT, appropriate CVD discharges, CPR, SCD) in patients with CAD and non-ischemic pathologies (cardiomyopathy, channelopathy) in 5 years follow-up. Integral score of myocardial electrical instability is proposed as new quantitative parameter for risk stratification (sensitivity 75%, specificity 78%, accuracy 77%).

Conclusion. The myocardial electrical instability score provides the individual assessment of the dynamic SCD risk. The Intekard 7.3 software is a simple, economic and accessible ECG tool for arrhythmia monitoring.

Aim. To study the clinical significance of the gradient of narrowing of arterial lumen (GNL) for atherosclerotic stenosis of the internal carotid artery (ICA) as a risk factor for ischemic brain damage.

Material and methods. We proposed a new parameter of hemodynamic severity of ICA atherosclerotic stenosis — GNL. It calculated as ratio of the difference in the ICA cross section areas on the stenotic lesion and the near non-stenotic region to the distance between them: Snorm — Sstenosis)/Dnorm — stenosis, mm2 /mm. We examined 25 patients with advanced atherosclerosis and with uni(n=22) or bilateral (n=3) ICA stenosis >50% according to European Carotid Surgery Trial, and 11 individuals without ICA stenosis. Each participant underwent magnetic resonance angiography (MRA) of the carotid arteries with reconstruction of the arteries from C6-C7 level to the parietal bones, and the GNL was calculated. The thickness of the baseline slice was 0,8-1 mm. Each subject also underwent cerebral magnetic resonance imaging (MRI) in T1-, T2-, PD-, flair-weighted protocols.

 Results. Patients were divided into groups: group 1 (n=12) — without ischemic injury in the ICA system, and group 2 (n=13)  — with MRI signs ischemic injury history. The groups did not differ in proportion of stenosis (74,9±4,25% and 77,8±3,8%, p<0,05), ICA lumen area on the stenotic lesion (1,05±0,18 mm² and 1,14±0,17 mm² , p<0,05) and the ICA diameter at the non-stenotic region (4,30±0,32 mm and 4,9±0,29 mm, p<0,05). In control group, GNL was <0,75 mm² /mm. Groups 1 and 2 significantly differed (2,47±0,41 mm² /mm and 4,60±0,51 mm² /mm, p<0,02). In group 2, 12 out of 13 patients had GNL >3,35 mm² /mm, and, in group 1, 9 out of 12 — less than 3,35 mm² /mm. GNL did not correlate significantly with other parameters of ICA stenosis. Two patients with the highest GNL in each group (5,5 and 8,6 mm² /mm) had a fatal ischemic stroke within six months

Conclusion. Firstly, proposed parameter of stenosis hemodynamic severity GNL is independent, informative and prognostically important indicator for carotid artery atherosclerotic lesion.

Aim. To assess the ultrasonography role for diagnosis of atherosclerotic lesions of the extracranial carotid arteries.

Material and methods. The study was conducted on the basis of the St. Petersburg Mariinsky Hospital. A total of 855 patients who were admitted to the regional vascular center due to ischemic stroke or transient ischemic attack were examined. The mean age of the patients was 68 years (min 18, max 107). All patients underwent ultrasound of the carotid arteries.

Results. In 570 (66,6%) patients with neurological symptoms (according to clinical and neurological examination), hemodynamically insignificant carotid artery lumen stenosis up to 70-75% was revealed. Ultrasound imaging in all patients revealed signs of atherosclerotic plaque (ASP) instability in various combinations, except for hemorrhage. It was not possible to clearly visualize the finished hemorrhage in the ASP structure.

Conclusion. Despite the high informative value of ultrasound, it is not possible to answer all clinical questions with its single use. At the moment, there is no classification of instability signs, reflecting the ASP embolism risk. It needs for paternal change the management of asymptomatic patients. More detailed study of ASP destabilization using various visualization methods is necessary.

Aim. Comparative assessment of the economic results of rivaroxaban/acetylsalicylic acid (ASA) combination and ASA monotherapy use in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD).

Material and methods. Based on the results of a large international multicenter, placebo-controlled, randomized clinical trial COMPASS, a model that evaluated the clinical outcomes of rivaroxaban/ASA combination and ASA monotherapy was formed. The economic results using cost and cost-effectiveness analyses, and budget impact analysis for two years were also calculated. The analysis took into account both direct medical costs (expenses for treatment, hospitalization due to complications, rehabilitation) financed under the compulsory health insurance, as well as indirect costs (loss of GDP due to disability or death). The calculation was made by accounting 100,000 patients with CAD and/or PAD.

Results. Modeling of clinical outcomes per 100,000 patients based on COMPASS results showed a decrease of stroke prevalence by 649 cases, myocardial infarction — 301 cases, amputations — 478 cases, cardiovascular mortality — 476 cases when using rivaroxaban/ASA combination compared with ASA monotherapy. The cost-effectiveness analysis showed that rivaroxaban/ASA combination has greater clinical efficacy and lower costs in comparison with ASA monotherapy. Budget impact analysis showed that the switching of 100,000 patients with CAD and/or PAD from ASA monotherapy to rivaroxaban/ASA combination leads to budget savings of 1,026 million rubles in two years. This is due to a decrease in the incidence of cardiovascular events.

Conclusion. It was found that the use of a rivaroxaban/ASA combination in comparison with ASA monotherapy in patients with CAD and/or PAD can both decrease a number of complications and lead to cost savings, despite the initially higher cost pharmacotherapy.

Aim. To study the effects of fixed-dose indapamide/perindopril combination on endothelial function and arterial stiffness in patients with uncontrolled stage 1-2 hypertension (HTN) and chronic kidney disease (CKD).

Material and methods. Total of 100 patients with uncured or uncontrolled with ≥3 months antihypertensive therapy HTN and CKD G3 (67% females, mean age 59,1±12,5 years) were included in the study. Each patient took indapamide/perindop combination in accordance with 1 of 3 existing regimes (depending on doses) for 3 months. Primary aim was to assess the effects of indapamide/perindopril combination on endothelial function and parameters of arterial stiffness after 12 weeks of treatment (assessment by AngioScan diagnostic complex). Secondary aims were achievement of target blood pressure (BP) after 4 and 12 weeks of therapy and assessment of glomerular filtration rate (GFR) and the albumin-tocreatinine ratio (ACR) changes after 12 weeks.

Results. Initially, there was an increase in arterial stiffness parameters in all patients, and during treatment decrease was observed: central systolic BP (SBP) from 120±10,1 to 112,9±6,3 mm Hg, median augmentation index from 10,9% to 4,6%, stiffness index from 8,1±2,4 to 7,1±0,9, vascular age decreased by 9,6% (р< 0,001 for trend). Significant improvement of endothelial function was observed regardless of diabetes presence: occlusion index increased from 1,5±0,3 to 1,7±0,5, median phase shift — from -4,6 to -2,4 ms (p< 0,01). After 4 weeks, 27% of patients reached target BP, by the end of the study — 90%. A decrease in the median ACR from 16,3 to 15,0 mg/g, GFR increase from 50,2±7,6 to 53,6±8,7 ml/min/1,73 m² were observed (p< 0,01 for trend).

Conclusion. Therapy with a fixed-dose indapamide/perindopril combination in patients with uncontrolled stage 1-2 HTN and G3 CKD leads to a significant improvement in arterial stiffness, endothelial and renal function, and achievement of target BP in 90% of patients.

The article discusses ways to improve medication adherence using electronic devices. Applications for medication monitoring, currently available in the Russianlanguage Internet segment for Android OS devices in the Google Play Store is analyzed. For analysis, the main functional characteristics, determined by representative reviews of applications, and classification are given; selected applications were tested for core functions. The main features of Russian-language segment applications are established: insufficient Russian language support, high application versatility, frequent advertising, and the relative simplicity of most applications. Only a relatively small number of applications have a wide range of specific functions. In addition, research data is provided on the effectiveness of using applications to improve medication adherence and prognosis. A practitioner ability to increase medication adherence is raised with the implementation of functional programs that are consistent with the aims.

Aim. To develop the methodological ware for distance cardiologists’ postgraduate education by virtual patients’ simulations. The article describes the first stage of the project to create a database of virtual patients. It includes the integration of text and multimedia clinical and diagnostic information about patients and software for its presentation. A virtual patient is considered as an informational model of the diagnostic and treatment processes.

Material and methods. To create a database of virtual patients, a description of completed clinical cases in specially designed patterns was used. To provide distance access to information about virtual patients, the JavaScript was used.

 Results. When forming the database of virtual patients, two categories of case histories were used — the most common cases and rare disease variants. From archival case histories and examination data, information has been selected that plays a significant role in the diagnosis and treatment. It was decided to present the information in the form of separate portions-visits. Each visit includes the results of tests and specialty consultations necessary to make a decision on further treatment. In the template developed by doctors and analysts, patient information is broken down into blocks that included complaints; anamnesis; physical examination; provisional diagnosis; diagnostic and treatment plan; tests’ results; administrations; final diagnosis; clinical report. These blocks served as the basis for the development of relational database tables. To visualize information about the virtual patient, prototypes of screen forms were implemented. Information about different visits was placed on different marks, and the user is able to see previously available information.

Conclusion. After testing, this software will be used in education to demonstrate complete clinical cases to students. In addition, by each virtual case, tasks that require students to make medical decisions can be formed. The technology of virtual patients can be used both for postgraduates (doctors) and medical students. 

The aim of the study was to present the performance parameters, their assessment and their predictors in the group of amateur cross-country skiers at the beginning of the preparatory period. For this purpose, incremental exercise tests were carried out on the treadmill. Body composition measurement was performed using impedance analyzer. The main findings of the study were that the most correlated with VO2 relative (max) were percentages of body fat, running speed (maximum) (km/h), running speed (final) (km/h), ventilation (L/min) and physiological cost of running (ml/kg/km). The appointment of the predictors can be an effective tool to assess the efficiency of this group and prepare a proper training plan for them.

Unstable atherosclerotic plaques (ASP) are the cause of acute ischemia in the carotid and coronary systems. Numerous studies have shown a relationship between plaque instability, manifestations, echogenicity, histological findings and its neovascularization. The presence and extent of ASP neovascularization in the carotid arteries can be detected for the first time using contrast-enhanced carotid ultrasound. Contrast-enhanced carotid ultrasound does not have nephrotoxic effect; it also improves the accuracy of plaque ulceration detecting and determining the severity of stenosis. The article presents the opinions of the authors and international experts on contrast ultrasound of peripheral arteries. An analysis of the literature data and our own observations is presented. Significant parameters such as the doses, procedure onset time and duration, methods for the qualitative and quantitative assessment of plaque neovascularization are analyzed. The difficulties of contrast-enhanced ultrasound are described.

The article presents an overview of qualitative and quantitative methods for coronary calcification assessment by computed tomography (CT). Coronary calcium is one of the well-known predictors of coronary artery disease and its complications. Coronary artery calcification is a common significant finding on routine and low-dose CT. In the review, the Coronary Artery Calcium Data and Reporting System (CAC-DRS) and the Coronary Artery Disease Reporting and Data System (CAD-RADS) are analyzed. Recommendations are given for the further management of patients with stable or acute chest pain in accordance with the CAD-RADS classification. The main aim of CAD-RADS is the standardization of accounting for coronary computed tomography angiography (CCTA) results for facilitating the interpretation by clinicians and subsequent management of patients. Such an approach should lead to an increase of healthcare quality.

Imaging techniques currently play a key role in cardiovascular assessing. Cardiac magnetic resonance imaging (MRI) is one the main elements of diagnosis and prognostic significance of hypertrophic cardiomyopathy (HCMP). The article provides a brief overview on both conventional and novel areas of MRI use in HCMP patients. Particular attention is paid to the MRI role in the patient selection for the surgical treatment. 

Reducing of cardiovascular risk, morbidity and mortality is considered as one of the main aims of modern cardiology, which should help increase life expectancy. Oral anticoagulants are the basis for the cardioembolic stroke prevention in patients with atrial fibrillation, which is common in patients with coronary artery disease. According to statistics, about a quarter of patients with atrial fibrillation have to perform percutaneous coronary intervention at some point in their life. This is due to stable angina or acute coronary syndrome, which is accompanied by difficulties with antithrombotic therapy. This article discusses the main clinical data and recommendations on the optimal use of combination antithrombotic therapy in patients after percutaneous coronary intervention.

Biomarkers being used as a laboratory test allow diagnosing the disease at an early stage, confirming diagnostic assumptions or evaluating treatment results. The reveal of biomarkers is inextricably linked to an understanding of the pathogenesis of the disease. As a rule, a biomarker is a soluble molecule participating in the pathological process. The reveal of biomarkers of atherogenesis (BMA) is based on hypotheses of the atherosclerosis development. The formation of atherosclerotic plaques is associated with impaired lipid metabolism, inflammation, fibrosis, calcinosis and oxidative stress. Low-density cholesterol is a recognized BMA in terms of the concept of lipid metabolism disorder. Another concept of atherogenesis is inflammatory theory. To date, a large number of molecules that are involved in the inflammatory process in the formation of atherosclerotic plaques have been studied. For most of these molecules, association with cardiovascular diseases has been proven, but they enter clinical practice very slowly. The most widespread among inflammatory biomarkers of atherogenesis is the highly sensitive C-reactive protein. C-reactive protein is not directly associated with the development of atherosclerosis, however, it is formed in response to the inflammatory reaction, therefore it can be used as a BMA. Its main advantages include stability and well-known reference intervals. Other molecules that can directly participate in the formation of atherosclerotic plaques or lead to their instability are also being studied as BMA. To introduce the use of these markers into routine practice, additional studies are needed to establish reference intervals. In recent years, the role of micro RNA as BMA has been increasingly discussed. Micro RNA molecules have a high stability and indirectly reflect the level of expression of genes involved in the development of atherosclerosis. The determination of BMA directly involved in the formation of plaques will contribute to a more accurate diagnosis and assessment of existing and potential therapy for atherosclerosis.

Coronary artery calcification (CAC) is characteristic of coronary atherosclerosis, which is often detected by chest computed tomography. The standardized method for assessing CAC is the calcium score (CS) using the Agatston scoring system. A semi-quantitative ECG-synchronized assessment of coronary calcium score is considered a strong prognostic factor for coronary events in asymptomatic patients. Zero CS can serve as the strongest unfavorable risk factor for cardiovascular events in 10-15 years. According to international guidelines, CS should be used in patients of intermediate and low risks with a family history of cardiovascular diseases, as well as in patients with diabetes older than 40 years. The aim of this review was to summarize current data on the clinical significance of CS taking into account the results of international multicenter studies, current international guidelines and further prospects for its wider use in cardiology practice. 

Despite treatment advances, the prognosis of patients with both primary and secondary pulmonary hypertension (PH) remains unfavorable. The increased activity of the sympathetic nervous system is one of the universal mechanisms involved in the PH pathogenesis. Pulmonary artery denervation is a novel minimally invasive pathogenetic method of PH treatment. The denervation procedure is mainly implemented by using radiofrequency ablation of the pulmonary trunk, where most sympathetic nerve fibers are located. In this article we present an overview and analysis of the present state, results of various experimental and clinical studies, as well as clinical experience. The results of studies demonstrated the safety of endovascular surgery and its beneficial effect on both hemodynamic and clinical parameters.

Despite the long history of the concept where infection plays a significant role in cardiovascular diseases (atherosclerosis in particular), today it is relevant and represented a significant interest.

This article discusses H. pylori role in mechanisms of cardiovascular homeostasis disturbance. H. pylori involvement in atherogenic damage of arteries, and/or plaque destabilization is no doubt. This vidence is detailed in this review article.