Aim. To study prevalence rates of vital exhaustion and its effects on 14-year risk of cardiovascular disease (CVD) (arterial hypertension (AH), myocardial infarction (MI), and stroke) development and genetic traits in open population of 25–64-yearold men in Russia/Siberia (West Siberia metropolis, Novosibirsk).

Material and methods. Random representative sample of 25–64-year-old men was studied in a framework of WHO MONICA-Psychosocial Program (MOPSY) in 1994. Maastricht Questionnaire (MQ) was used to assess vital exhaustion. Genotyping for variable number of tandem repeats (VNTR) polymorphisms in DRD4 and DAT genes was performed. All new cases of AH, MI, and stroke were registered among people without CVD for 14 years (from 1994 to 2008). Statistical analysis was done by using software package SPSS 11.5. Cox proportional hazards regression model was used for evaluation of risk coefficient (hazard ratio (HR) taking into account time-adjusted control. Х2 test was used to assess statistical significance of differences between the groups.

Results. In the study population, the vital exhaustion rate was 66,8%. Hazard ration was significantly increased (AH: HR=3,2; MI: HR=2,7; stroke: HR=3,2) in men with vital exhaustion compared with vital exhaustion-free individuals in open population during the first five years of observation. Multifactorial modeling showed that vital exhaustion together with concomitant social gradient determined development of AH, MI, and stroke in open population of 25–64-year-old men. Allele 7 of DRD4 and genotype 9/9 of DAT gene were associated with high level of vital exhaustion.

Conclusion: Open population of 25–64-year-old men (Russia/Siberia, Novosibirsk) showed high level of vital exhaustion, a predictor for risk of developing CVD. Vital exhaustion is significantly associated with certain VNTR polymorphisms of DRD4 and DAT gens.

Anxiety is considered as an independent risk factor for cardiovascular diseases (CVD). Relationships between genetic markers of anxiety and risk of developing CVD remain unknown.

Aim. The objectives of the study were to determine trait anxiety prevalence; to find associations between trait anxiety and VNTR polymorphisms in the DRD4 and DAT genes; and to calculate Hazard retio (HR) for developing arterial hypertension (AH), myocardial infarction (MI), and stroke.

Material and methods. Representative sample of 25-64-year-old males (n=2149) was examined in three screening studies in a framework of the WHO MONICA program and MONICA-psychosocial subprogram in Novosibirsk in 1984, 1988, and 1994. All first time MI, AH, and stroke events were registered from 1984 to 2008. Genotyping of VNTR polymorphism was performed for DRD4 and DAT genes. Anxiety levels were evaluated by using the Spielberger’s test. Stratified Cox proportional regression model was used for Hazard ratio (HR) estimation.

Results. High level of anxiety (HLA) in an open male population was 50,9%. The DRD4 genotype 4/6 and DAT genotype 9/9 were significantly associated with HLA. HLA increased CVD risk. HR for developing AH and stroke was maximal during the first five years of the study, whereas maximal risk of developing MI was found for 10-year period.

Conclusion. Prevalence of HLA in an open 25-64-year-old male population in Novosibirsk was high. Rates of HLA were significantly associated with certain VNTR polymorphisms in the DRD4 and DAT genes. HLA were associated with increased risk of developing CVD.

Aim. To study 33-year (1977–2009) dynamics acute cardiovascular accident in general population aged 25-64 years in Russia.

Material and methods. Data of WHO studies (“Acute Myocardial Infarction Register” and “MONICA”) were analyzed in three districts of Novosibirsk.

Results. Myocardial Infarction (MI) morbidity in 25–64-year-old population in Russia was found one of the highest worldwide. MI morbidity rates remained steady for the entire period of study except for 1988, 1994, 1998 (increase), 2002–2004, and 2006 (decrease). Mortality and lethality resembled morbidity except for 1977– 1978 (decrease) and 2002–2005 (increase). Prehospital mortality and lethality significantly exceeded in-hospital deaths. Lethal outcomes after MI exceeded deaths from alcohol abuse by 2-3 times. Mortality and lethality decrease during period of unchanged morbidity suggested improved management of cardiac care; increase in mortality and lethality at a time of decreased morbidity indicated deterioration of medical assistance for cardiac patients. No changes in behavioral and somatic risk factors were found during 1977–2009. Significant increase in levels of psychosocial risk factors was documented.

Conclusion. MI morbidity, mortality, and lethality rates are the markers of increasing social stress in population. Deaths from MI have been the main component of the increase in mortality in Russia.

Aim. To determine the effects of stress at workplace on the risks (HR: hazard ratio) of development of myocardial infarction and stroke in open population of 25-64-yearold women in Russia/Siberia (Novosibirsk).

Material and methods. Random representative sample of 25-64-year-old women (n=870) was examined in a framework of WHO MONICA-Psychosocial program in one of Novosibirsk districts. Stress at workplace was studied by using the Karasek scale; attitudes to work and prophylactic exams were studied by using the scale of “Knowledge and attitude towards one’s own health” of WHO MONICA-Psychosocial program. During 16 years (1994-2010), all first-time cases of myocardial infarction and stroke were studied in the cohort based on the WHO program of Register of Acute Myocardial Infarction and all available documentation. Cox regression model was used for determination of myocardial infarction and stroke risk over 16 years of follow-up.

Results. Prevalence rate of high level of stress in open population of 25-64-yearold women was 31,6%. High levels of stress at work were associated with high levels of responsibility, inability to get rest at the end of workday, frequent professional dissatisfaction, and decreased working ability. For 16 years, HR was by 3,22 times higher for myocardial infarction (p<0,05) and 1,96 times higher for stroke (p<0,05) in women with stress at work. Rates of myocardial infarction and stroke were higher in married women who experienced stress at work, belonged to categories of managers and physical labor, and had high and low level of education.

Conclusion. Prevalence of high level of stress at workplace is significant in open population of 25–64-year-old women in Russia/Siberia (Novosibirsk). In the presence of stress at workplace, HR of myocardial infarction and stroke were 2 to 3 times higher than without it. Social gradient affected HR of infarct and stroke.

Metabolic changes in diabetes mellitus are associated with hemostatic disorders. However, the sequence of hemostatic events in the early stages of disease remains unclear.

Aim. To assess metabolic and hemostatic parameters and their interaction in pre-diabetes and newly diagnosed type 2 diabetes mellitus (ND T2DM).

Material and methods. The study enrolled volunteers of 40 to 65 years who considered themselves healthy and did not get any medication therapy. Of 170 examined individuals, 46 had impaired carbohydrate exchange (ICE) — 13 with impaired fasting glucose, 17 — impaired glucose tolerance and 16 with ND T2DM. The control group comprised healthy volunteers with normal body mass index and without signs of metabolic abnormalities. The metabolic (carbohydrate, lipid, protein exchange, hepatic transaminase), platelet and plasma hemostatic parameters (mean platelet volume, ADP- &collagen-induced platelet aggregation, coagulation profile, fibrinogen, plasminogen) were investigated. We identified the peculiarities initiating impact of changed parameters on different hemostatic components in patients with pre-diabetes and ND T2DM.

Results. Concentration of insulin, C-peptide, Homa-IR, total cholesterol demonstrated increase in groups with ICE. ADP-induced platelet aggregation, fibrinogen increased in ICE, however these changes were not statistically significant. Mean platelet volume and plasminogen had the tendency to be elevated in pre-diabetes and demonstrated significant increase in ND T2DM.

Conclusion. Metabolic disorders in prediabetic stage initiate changes in platelet hemostasis and fibrinolysis. The increase of MPV and higher concentrations of plasminogen are considered to be significant in ND T2DM.

Aim. Ischemic heart disease (IHD) is the result of endothelial dysfunction, which is associated with inflammation, increased oxidative stress and hyperglycemia. The aim of our study was to examine the aetiology, importance and intensity of inflammation and oxidative stress in IHD development in patients with diabetes mellitus (DM) type 2.

Material and methods. We included 60 male patients with IHD of whom 30 with diabetes type 2. Control group comprised of 12 healthy participants. We analyzed the lipid status, quality of glycemic control (daily glycemia profile — MBG and HbA1c), lipid peroxidation (malondialdehyde-MDA) and inflammation: high sensitivity C reactive protein (hsCRP), intercellular and vascular adhesion molecule-1 (ICAM-1, VCAM-1).

Results. Patients with DM type 2 and IHD were obese with higher levels of HbA1c and MBG compared to other two groups. Systolic and diastolic blood pressure, triglycerides, total and LDL cholesterol were significantly higher and HDL was lower in all patients with IHD compared to the control group. CRP levels, ICAM-1, VCAM-1 and MDA were significantly higher in the groups with IHD compared to the control. MDA and VCAM-1 were higher in patients with IHD and type 2 DM than in patients with IHD. There was a significant positive correlation between hsCRP and LDL cholesterol in patients with IHD, regardless of the presence of DM. Significant positive correlation between VCAM-1 and HbA1c values, and between ICAM-1 and hsCRP were shown only in patients with IHD and DM type 2.

Conclusion. Inflammation, increased oxidative stress, lipid and metabolic disorders showed significant correlation and have an important pathogenic role in the development of IHD, particularly in patients with DM type 2. Increased levels of hsCRP, VCAM-1 and products of lipid peroxidation are characteristic markers of endothelial inflammation and indicators of the presence of atherosclerotic plaque in patients with DM type 2.

Aim. In the present study attempts to determine the impact of 1-month Indoor Cycling training on exercise capacity and blood lipid profile were made.

Material and methods. The study group consisted of 50 men under the model A of the 2nd phase of cardiac rehabilitation (20 men of the Indoor Cycling group, IC, 20 men rehabilitated accordingly to the recommendations of the Polish Cardiac Society — a standard group, ST and 10 people who did not participate in any cardiac rehabilitation program — a control group, C). The average age of all subjects was 56,60±8,25 years, the average left ventricular ejection fraction was 56%±4,00.

Results. In the IC group there was a significant increase in the test duration (8,47 vs 10,23 min; p<0,001), a significant increase in the MET value (10,86 vs 12,35; p=0,06) and VO2 max (38,43 vs 48,25 ml/kg/min; p<0,001). Parallel changes were observed in the ST group, where the following parameters improved: the test duration (8,51 vs 9,96; p<0,001), MET value (10,57 vs 12,18; p=0,002) and VO2 max (38,42 vs 46,24; p<0,001). No significant changes in rest and maximum heart rate as well as systolic and diastolic blood pressure parameters were found. In C group no significant changes in treadmill exercise test parameters were observed. Alike in the IC, ST as well as in the C group, positive modification of blood lipid profile was observed. The significant increase in the average value of HDL cholesterol in the control group (41,00 vs 49,52 mg/dl; p<0,05) was only found.

Conclusion. Indoor Cycling training in the second phase of cardiac rehabilitation is a safe form of therapy and therefore may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of an early cardiac rehabilitation.

Aim. Multislice computed tomography (MSCT) is a non-invasive method for the heart and coronary arteries imaging. The aim of the research was to establish the diagnostic exactness of MSCT in the revelation of significant coronary artery disease in patients with angina pectoris, using digital subtraction angiography (DSA) of coronary arteries as the gold standard.

Material and methods. In 78 (56 men, 22 women; average age 64,3±11 years), patients with clinical signs of angina pectoris were done examination of the coronary arteries on 64-slice MSCT in order to detect significant stenoses (>50% luminal narrowing). MSCT of coronary arteries was compared with the invasive coronary angiography.

Results. In 78 patients, 864 segments of coronary arteries were available for evaluation. In all segments of coronary arteries, invasive coronary angiography identified 51 lesions. Forty-five lesions were detected by MSCT. The matching sensitivity and specificity were 88% and 97%. Sensitivity, specificity and positive and negative predictive values in a patient-per-patient analysis were 93%, 93%, 90%, and 96%, respectively.

False-negative results — Seventeen segments of coronary arteries with diameter reduction in range 51% to 75% were missed on the MSCT scan. The major of the missed lesions were located in the left anterior descedenting artery and the left circumflex artery (small side branches). Four segments were missed because of severe calcifications and five because of motion artifacts. False-positive results — Thirty nine segments were incorrectly classified as significantly because of overestimation.

Conclusion. MSCT coronary angiography is an effective, fast, reliable and noninvasive method for the analysis of the coronary arteries. The best results were obtained in patients with healthy coronary arteries (high percentage of negative predictive value), which can significantly reduce the number of invasive coronary angiography. With the improvement of technical characteristics, CT is gaining more importance in the analysis of coronary stenoses and analysis of atherosclerotic plaque.

Aim. Investigate the acute effects of heavy metal musical auditory stimulation on cardiac autonomic regulation.

Material and methods. This is a prospective study conducted on 22 healthy women between 18 and 30 years old. All procedures were performed in the same soundproof room. The volunteers remained at rest for 20 minutes and subsequently were exposed to heavy metal (75-84 dB) music for 20 minutes. We analysed the following HRV indices: SDNN, RMSSD, pNN50, LF, HF and LF/HF ratio, RRTri, TINN, SD1, SD2 and SD1/SD2 ratio.

Results. During exposure to heavy metal music auditory stimulation we observed that the LF (ms2 ) tended to increase (p=0,06) and reduce HF (nu) (p=0,07) and the LF/HF ratio increased (p=0,05). No significant changes were found for SDNN, pNN50, RMSSD, SDNN/RMSSD ratio, TINN, RRTri, SD1, SD2 and SD1/SD2 ratio.

Conclusion. Auditory stimulation with the selected heavy metal musical style acutely decreased HRV.

Aim. To reveal the predictors of renal dysfunction due to surgical revascularization of myocardium in stable angina patients with prediabetes.

Material and methods. Totally, 48 patients with prediabetes studied, having indications for coronary bypass grafting (CBG) at the age 60±7,4 years with coronary heart disease (CHD) anamnesis 6±5,4 years. Multivessel disease of coronary vessels had 68,8% of patients, LCA stem stenosis >50 % had 10,9% of patients. On-pump CBG was done in 87,5% of patients, off-pump — 12,5%. Duration of on-pump period was 95±23 min., number of distal anastomoses for one patient — 2,8±0,8. Baseline, on the first and second days post-CBG, and if needed later, the creatinin concentration was measured in the blood, as glomerular filtration rate (GFR) by CKD-EPI equation. Of the development of renal dysfunction in CBG we decided if GFR decreased below 60 mL/min/1,73 m2 . In statistics we took continuous variables as М±SD and as Me (25%–75%) depending on the type of distribution. Renal dysfunction predictors were defined with the method of staged regression.

Results. In patients with stable angina and prediabetes we found moderate transient decrease of GFR after CBG comparing to the baseline level with Me 89,4 (78-105) to Ме 77,8 (59-96) mL/min/1,73 m2 (р<0,01). Significant decrease of GFR after CBG had the patients with in-hospital complications (introperational myocardial infarction, acute heart failure, atrial fibrillation paroxysm) — Ме 92 (82-107) and Ме 72,4 (56-89) mL/min/1,73 m2 , р=0,000 differ from the patients groups not having complications, р=0,797. The part of persons developing CBG related renal dysfunction was 21,7%. Decrease of GFR <60 mL/min/1,73 m2 after CBG is associated with older age, lower baseline GFR and longer on-pump period.

Conclusion. Among patients with stable angina and pre-diabetes the part of those developing CBG related renal dysfunction was 21,7%. The increase of on-pump time more than Me 105 (86-136) minutes significantly increased the relative risk of renal dysfunction development after CBG.

The diagnosis of myocardial infarction is done by ECG through the observation of Q waves in one or more leads. The paper describes the relationship between Q waves and the propagation time of the Cardiac Action potential and a technique by which this time of propagation itself can be measured. Rather than observing the Q wave pathology in its very small peak of the total QRS complex, a more refined method is thus made available for continuous patient observation. This propagation time rises from 15 ms to 35 ms or more in progressive pathological conditions. A simulation has been done which illustrates how the Q wave is generated from the travelling action potential wave in the ventricle. The authors have utilized the easy to use novel EPIC Microelectrodes from Plessey Electronics, which are jelly free and provide easy attachment by simple skin contact. Multiple sensors were placed on the chest and the propagation time was measured by differential voltages between them. An embedded controller was used to pick these signals in digitized form and calculate the time intervals. The measurement procedure is simple and highly non invasive. Records from outpatients with cardiac pathology were taken and it was verified that this AP time increases with the Q wave width. This AP propagation time is a more refined method of observing pathological changes than the Q wave, since progressive changes in cardiac condition can be indicated by changes in the millisecond values. It has been verified that the values match with to the usual Q wave width timings.

Local expression of rennin-angiotensin system (RAS) components significantly increases in patients with arterial hypertension and atherosclerosis with or without elevation of RAS activity in the blood. Our objectives was to assessment and compare the expression level of angiotensin II type 1 receptor in the smooth muscle cells in arteries of patients with multifocal atherosclerosis and the role of local angiotensin II receptor type 1 (AT1R) expression in the disease progression. The study results suggest that the tissue RAS activity increases inhomogeneously among patients. It was interestly that AT1R expression levels in intact arteries does not differ of those in atherosclerotic arteries. Most of patients had expression of angiotensin II type 1 receptor in smooth muscle of arteries; strong elevation had 43,8% — 50,0%. Our study suggest of role of local RAS activity, but we proposed existence of another than only angiotensin II type 1 receptor mechanisms of low or high susceptibility of arteries to atherosclerosis in patient with multifocal atherosclerosis.

Pathological heart rate turbulence (HRT) after premature ventricular complexes (PVCs) in patients with coronary heart disease (CHD) and myocardial infarction (MI) may predict higher mortality rate. Aim. To estimate the predictive power HRT in 5 year observational study in patients with CHD. Material and methods. 173 patients with CHD and in whom HRT was possible to record, were analyzed from 2010-2011 until 2015 with survival rate and turbulence slope (TS) and turbulence onset (TO) estimation. Results. Pathological TO showed no correlation with survival rate (p>0,05) but pathological TS in 5 years period (p=0,00026) correlated with survival rate with post-MI patients. Moreover, it had a predictive power also with non-MI patients (p=0,0032). The survival (Kaplan-Mayer) curves between normal and pathological TS started to divide from the 36 months of observation. Presence of nTS in post MI patients increased mortality rate in 5,14 times (p=0,00002) and in non-MI — in 4,99 times (p=0,00002). Conclusions. HRT slope parameter showed to be highly effective in mortality risk prediction in patients with CHD.

Qualitative research is an aristocracy among research methods. Being capable to reach the understanding of events so deep and individual that unattainable for quantification, it requires the same level of capacities from an investigator. In cardiology, biomedical in her origins, novel patient-centered paradigm demands new understanding of the relevance: the relation of scientific findings with clinical application, which, from this point of view, involves the person’s biopsychocultural wholeness. Essential controversy originates from the positivistic impossibility of generalization of qualitative findings, and their broadly assumed fallibility. The results of a study depend on the personality of researcher: the interpreter. If such personality, being invited to another person’s realm, is not enough virtuous, the results of research will be vain. This article focuses on the need and possibility of implementation qualitative research to cardiovascular science on the way to patientcentered paradigm of healthcare. Some argumentation provided, as some literary review of recent qualitative trials in cardiovascular field.

The review of literature is devoted to interrelations between atrial fibrillation (AF) and kidney function. The focus is on the most probable mechanisms of renal dysfunction in patients with atrial fibrillation such as fibrosis, inflammation, neurohormonal activation. The impact of central and renal hemodynamics disorders on chronic kidney disease development in atrial fibrillation patients is under consideration. The problem of atrial fibrillation in end-stage renal disease patients also gets the authors’ attention. We identified unresolved issues and the prospects for their further research.

Persistent left superior vena cava (PLSVC) is a rarely occurring congenital anomaly with the incidence of 0.3% in general population. This anomaly results from the persistence of the left anterior cardinal vein. In 90% of cases blood from PLSVC flows into the coronary sinus and then to the right atrium. It may complicate the placement of central vein catheters in the jugular and subclavian veins and, as such, cardiologists should be aware of the existence of this anatomic variant. Here we describe an adult patient with persistence of the left superior vena cava identified during made echocardiography test in a 57-year-old male patient with paroxysmal atrioventricular nodal reentrant tachycardia (AVNRT) who was admitted to a cardiac ward on a regular basis for ablation procedure.