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The analysis is presented, of the three epidemiologic studies (EPOCHA-CHF, EPOCHA-Hospital-CHF, EPOCHA-Decompensation-CHF). In 16 years, prevalence of chronic heart failure (CHF) in Russia increased from 4,9% (1998) to 10,2% (2014), p=0,01. However, number of CHF patients with III-IV FC NYHA increased more dramatically: from 1,2% (1998) to 4,1% (2014), p=0,002. This happened due to significant increse of the age of patients selection from 64,0±11, 9 y.o. (1998) to 69,9±12,2 y.o. (2014), p=0,02; increase of the weight of etiological causes of ischemic heart disease and myocardial infarction. Overall mortality of the patients with any CHF is 6% per year. This value depends on low rate of prescription of RAAS blockers and beta-blockers during outpatient stage, with usage of low dosages of medications that does not control BP and heartrate. Patients with CHF decompensation led to hospitalization are significantly older than in general population (72,9±10,5 y.o.), and gender differences are for benefit of women, as in general population. 58,2% of hospitalized patients were admitted with noncontrolled hypertension, and in 70,5% there was heartrate higher than 80 bpm. Overall mortality of CHF patients was 25,1% (46,4% died in 1 year with the formed hypotension and 22,1% with retained level of BP). Hospital mortality was 6,8%. Mortality risks increased by repeated admittances for decompensation, absence of RAAS blockers and beta-blockers in management.

Aim. To assess reliability and discriminant validity of the Russian version of European Scale of Self-care in patients with heart failure (HF).

Material and methods. European Scale of self-help assessment in CHF was translated in Russian according to Brislin model by three not related translators. After discussion by the workgroup members, professional translator retranslated back it to English, and the result was agreed with the author of the score. Then, 95 patients were included with chronic HF (CHF) of various etiology, who responded the questions at admittance and discharge from cardiological departments. Cronbach alpha was used for analysis of intrinsic consistency of the score. Also discriminant validity was evaluated.

Results. Edication of CHF patients led to decrease of the whole points summ from 27,7±6,6 at admittance to 15,8±4,5 by discharge event. Coefficient of intrinsic consistency Cronbach alpha of the Russian version of European Scale was 0,826. Absence of significant relation of total points summ from Kansas questionnaire for cardiomyopathy patients and Minnessota questionnaire of life quality in HF proved discriminant validity of the Russian version.

Conclusion. Russian version of European Scale of Self-help for patients with HF is easy to use and convenient instrument, which might be helpful for clinical trials as for clinical practice.

Aim. Comparison of diagnostical abilities of tissue Doppler (TD) and speckle tracking (ST) for assessment of segmental diastolic dysfunction in postinfarction focal changes of myocardium (PIFC) of LV.

Material and methods. Totally, 137 CHD patients studied. In analysis of TD and ST we assessed peaks of early and delayed transmitral LV fillings. Assessment of transmitral parameters of diastolic dysfunction was done with common approach.

Results. The study showed that in PIFC persons there is no significant differences by most of transmitral flow parameters and TD. Strain rate assessment of myocardial deformation and ST led to conclusion on mostly delayed filling peak decrease, which is one of the signs of segmental diastolic dysfunction of the LV in PIFC.

Conclusion. TD and ST make it to reveal covert disorders of diastolic LV relaxation in PIFC patients with absence of diastolic dysfunction criteria by TMBF.

Aim. To find out the significance of different signs of electric instability in acute myocardial infarction patients for on time prediction of in-patient course and adverse outcome by the next year.

Material and methods. 98 men studied, with acute Q-infarction. For electrical instability assessment at hospital stage Holter monitoring was done of high resolition ECG on 1st, 7th day and at discharge.

Results. It is found that in-hospital course can be forecasted by the following data from acute phase: presence of dangerous ventricluar extrasystoli, ventricular and atrial tachicardias paroxysms, decrease of circadian index of heart rate <1,06 (risk of complications) and <0,98 (risk of fatal outcome), prolonged QTc >473 ms (complications risk) and >498 ms (fatal outcome risk), onset of delayed ventricular potentials. We developed the probable predictors of the range of adverse events for in-patient period that is important for any patient management. It is proved, that fatal outcome risk in katamnesis does increase if in-patient period is complicated by left ventricle failure, if frequent ventricular extrasystoli develop or frequent paroxysms of ventricular and supraventricular tachicardia, with absence of significant decrease of dangerous ventricular extrasystoli on further monitors, as in absence of positive dynamics at in-patient stage (from the first to the second monitor) of the values of the following parameters of electrical instability of myocardium: increase of low pNN50 and shortening of prolonged QTc and its dispersion.

Conclusion. Prediction of complicated course of acute myocardial infarction and adverse outcome during the first year can be grounded on complex analysis of the parameters of electrical instability and arrhythmic activity of myocardium by the data of triple Holter monitoring of electrocardiogram of high resolution during in-hospital period, and the best predictive value have data from acute period and its dynamics.

Aim. To study the role of volumetric load in assessment of diastolic reserve of the left ventricle (LV) and to reveal informative predictors of transmitral diastolic flow for heart failure development in myocardial infarction patients without systolic LV dysfunction.

Material and methods. Totally, 40 males studied with primary Q-wave myocardial infarction without clinical signs of heart failure with the baseline LV ejection fraction 50-55%. Statistical analysis was performed via Excel 5.0. Standard methods of variational statistics were applied: mean values, standard deviation. Significance of differences was assessed with t-criteria by Student.

Results. In patients with myocardial infarction at volume load there were 2 types of transmitral diastolic flow. 1 group — patients, who had ipsidirectional changes of transmitral diastolic flow, as the healthy: significantly increased Е and А (p<0,05), not changed Е/А, shortened IVRT of LV and Tdec (p<0,002). 2 group — patients, who at the load did not develop increase of Е (p>0,05), had significantly increased А by 12% (p<0,002) and hence decreased Е/А (p<0,05), and significantly prolonged IVRT of LV and Tdec (p<0,05); changes did not return to baseline by 5 minutes of recovery period.

Conclusion. 1) load test of VDLT is safe and informative method for DR of LV estimation and for revealing of high risk congestive HF in MI. 2) in patients with decreased DR of LV in VL there is decrease of E, significant increase of A, decrease of E/A and prolongation of IVRT and Tdec, during postinfarction period in 27,3% cases congestive HF does develop. 3) in patients with MI and remaining DR of LV during postinfarction period the congestive HF does not develop.

Aim. To study in dynamics the specifics of hemostasis and functioning of neutrophilic granulocytes in patients with acute myocardial infarction (MI) sensitive and resistant to acetylsalicylic acid (ASC).

Material and methods. Totally, 53 patients included during first 24 hours from MI onset. Controls were 50 relatively healthy volunteers. All patients before treatment and revascularization were assessed for resistance to ASC and selected to groups as sensitive (SASC) and resistant (RASC). In complex therapy there was double antiplatelet therapy (ASC+clopidogrel). The parameters of vessel-platelet and plasma hemostasis were assessed. Via the chemiluminescent analysis we studied functional activity of neutrophils.

Results. In RASC patients with MI on 1st and 10th day we found increased ADP aggregation of thrombocytes (ADP 0,1 mcM) and increase of von Willebrand factor. On 10th day in SASC patients there was decrease of ADP aggregation (ADP 5 mcM), von Willebrand factor increases. Not related to ASC sensitivity, in MI patients there is increase of SFMC, thrombin time is increased and D-dimer is low. Kinetics of chemiluminescence of neutrophils in MI patients differs from controls only by increased time of reached maximum. In ASC resistant patients on 1st day of evaluation there is decrease of neutrophil activation index, which gets to normal by 10th day of treatment.

Conclusion. In RASC MI patients there is increased ADP aggregation of platelets, decrease of platelets number and increase of von Willebrand factor levels. Thrombosis risk in RASC patients on 10th day of treatment is caused by remaining disordered vessel-platelet hemostasis and increased spontaneous platelets aggregation. Plasmatic hemostasis on 1st and 10th days of MI shows activated onset of clotting with increase of clotting duration and significant decrease of D-dimer. In MI there is slowed velocity of development of “respiratory boost” in neutrophilic granulocytes that is probably related to compensatory processes in organism and double antiplatelet therapy which is antiinflammatory as well.

Aim. To assess microcirculatory reserves and tissue metabolism reactivity in patients with coronary heart disease (CHD) with various stages of chronic heart failure (CHF).

Material and methods. Totally, 112 CHD patients included. First group (45 persons) consisted of those with CHF I-II FC, second (67 persons) — CHF III-IV FC. By the method of laser-doppler flowmetry (LDF) we studied reserves of cutaneous microcirculatory blood flow (MBF) of lower extremities. Reactivity of tissue metabolism of lower extremities was assessed by transcutaneous oxymetry (ТсрО2 ). Using monofactorial logistic regression, we calculated predictors of adverse cardiovascular events in long-term period after coronary bypass operation (CBG).

Results. MBF level between groups did not differ significantly. Reserves of capillary flow (RCF) in the 1st group were higher than 2nd — 169,1±2,25% and 147,3±2,46% from baseline, respectively, (p=0,01). Lowest efficacy of oxygen supply to peripheral tissues was found in 2nd group (p=0,03). Reserves of metabolic activity of tissues during postocclusion hyperemia — RTmО2 in 1st and 2nd groups were 143,2±2,24% and 125,4±2,86% from baseline, respectively, (p=0,01). Monofactorial logistic regression analysis revealed: 1) RCF lower 125% with 2 type diabetes do increase odds for surgically significant stenoses in lower limbs arteries after CBG in long-term perspective (OR 3,8; CI 1,9-6,5; p=0,002); 2) ejection fraction of the LV lower 40%, increased homocysteine >15,5 mcM/L and RTmО2 less than 120% do increase odds for stroke in long-term period after CBG (OR 4,1; CI 2,2-7,8; p=0,001).

Conclusion. Relation of hypoxia in peripheral tissues at the background of LV dysfunction and hyperhomocysteinemia with development of stroke in long-term period after CBG, as baseline low RCF and DM 2 type with the development of lower limb arteries stenoses after CBG points on the necessity of emphasis on the assessment of microcirculatory reserves as one of leading vascular complications components.

Aim. The influence of depression on the performance of education program and active outpatient control (the “influence”) in patients with heart failure of III-IV functional class.

Material and methods. The post-hoc analysis of the SHANS study (School and Ambulatory Observation of Heart Failure Patients), organized by the society of specialists in heart failure (SSHF), was done for the odds estimation for primary endpoints (mortality from any cause, cardiovascular hospitalization, combination endpoint — mortality and hospitalization) in patients from treatment group depending on the presence of depression sympthoms (HADS(d) >11 pts. As the subgroups of depressed and non-depressed differed by functional class and age, the correction was appliaed by the method of Mantel-Hensel for thse two parameters. Values of mean survival rate was calculated, from the moment of baseline assessment to the moment of death with further build-up of Kaplan-Meier curves.

Results. The influence showed effectiveness for the all endpoints in depression subgroups, as in non-depressed. Depressed patients reacted a little worse on the program, but there were no any statistical significance for the risk of primary endpoints. Corrected combination endpoint: non-depressed [OD =0,3806 (95% CI 0,2107-0,6876)], depressed [OR =0,4699 (95% ДИ 0,3128-0,7058)], p=0,5651. In analysis by Kaplan-Meier endowment curves it was shown that patients randomized to influence group had lower risk of death. Decrease of relative risk was higher in non-depressed [(RRR =25% (95% CI 0,61; 0,94), p<0,001)], than in depressed [(RRR =17% (95% CI 0,68; 0,99), p=0,036)]. However the effectiveness of the influence was same in both subgroups.

Conclusion. The educational and active ambulatory control program, by the secondary analysis data, showed effectiveness in patients with sympthoms of depression. For better reproducibility of such studies more precise diagnostic parameters for depression diagnostics are required.

Aim. To assess the function of the right ventricle (RV), its influence on clinical and instrumental presentation of chronic heart failure (CHF) in patients with hypertrophic cardiomyopathy (HCMP).

Material and methods. Totally, 55 patients with HCMP included, males 17 (34%), mean age — 57,0±15,2 y. All patients were taking bisoprolol 5,7±1,2 mg. The study included assessment of clinical status of patients with Minnessota score of life quality in CHF, SQCA, brain natriuretic peptide (BNP) measurement in plasma, echoCG. With the aim to deeper investigate on cardiac function we asessed Tei index of the left ventricle (LV) and RV. As the result of all studies in HCMP there was increase of Tei of LV. Increase of RV Tei was found in 35 patients (63,6%). By Tei RV value, patients were selected to 2 groups: 1 group (n=35) — those with Tei RV higher than normal — ≥0,32 (0,58±0,2), 2 group (n=20) — with Tei RV <0,32 (0,23±0,09).

Results. Patients from group 1 had higher clinical and laboratory markers of CHF: FC CHF by NYHA (p=0,008), summ by SQCA (p=0,03), BNP level in plasma 200 (p=0,01). In 1st group patients there was higher E/A (p=0,04), transmitral flow, lower regional systolic velocity on septal part of mitral annulus (MVFA) (p=0,04), free wall of tricuspid valve fibrous annulus (TVFA) (p=0,01), longer the time of isovolumetric relaxation on lateral (p=0,04) and posterior (p=0,03) regions of MVFA. There was negative correlation of Tei RV index and peak A (p=0,0007) and postitve — with E/A of transmitral flow (p=0,01). There was correlation of FC CHF by NYHA and s’ of free wall of TVFA (p=0,04); positive association of Tei RV and FC level of CHF by NYHA, BNP (p=0,01). There was negative association of BNP and systolic function of RV: s’ TVFA (p=0,01), s’ of basal part of RV free wall (p=0,002), s’ of median part of RV free wall (p=0,02).

Conclusion. Presence of RV dysfunction by Tei index was found in 63,5% of patients with HCMP. RV dysfunction in HCMP is due to severely disordered diastolic dysfunction of LV, is followed by progression of CHF — increase of FC CHF, SQCA points summ, BNP level and decrease of segmental longitudinal function of myocardium by TDI.

Aim. To conduct complex evaluation of MI risk factors in men taking their agespecific qualities, and to invent prediction calculator of MI based upon the data obtained.

Material and methods. Totally, 112 males with Q and non-Q MI included, at the age 45-74 y.o., mean age — 58,9±0,6 y.o. In all patients we assessed clinical and anamnestic data, parameters of lipid, carbohydrate metabolism, sex hormones levels, CRP, levels of hypodynamia, depression and anxiety via questionnaires.

Results. For males of adult age with MI the most significant factors were smoking, lipid disorders (mostly due to LDL increase), overweight and abdominal obesity; for older males — additionally arterial hypertension (AH), hypodynamia, inheritance for coronary heart disease (CHD), carbohydrate metabolism disorders with insulin resistance, and abdominal obesity.

Conclusion. To predict the risk of MI with statistical methods, a calculator was invented, which make it to estimate the probability of MI development in a patient taken their age-specific risks.

The review is focused on the main data about course specifics of myocardial infarction with ST elevation (STEMI) in senile patients that influences rate of performing urgent coronary reperfusion. Analysis of literature data has been done, on the topics of efficacy and safety of the main methods of coronary reperfusion — thrombolysis, primary percutaneous intervention (PCI) and their combinations under the pharmacoinvasive reperfusion — in patients ≥75 y.o. As a result of such analysis it is accused that the Open artery theory (Braunwald E.), according which the main task for STEMI patients is acute coronary reperfusion, is truthful not only for general population, but for ≥75 as well. Advantage of primary PCI over thrombolysis in senile patients is shown in randomized trials, but is not proved by registries data. High rate of comorbidity restricts the abilities for reperfusion actions in randomized trials as in real practice. Hence it is important to study further the indications and contraindications for urgent reperfusion in such cohort. Especially it is important for early routine PCI in stable senile patients after thrombolysis, with secondary signs of coronary reperfusion.

Heart failure (HF) is systemic and multiple organ syndrome, with metabolic insufficiency as one of its main causes. Heart metabolism disorders in HF activate other processes that futher worsens progression of the disease. Recent data shows that correction of energy metabolism in the heart by suppression of fatty acids (FA) oxydation and/or increase of glucose oxydation is one of promising approaches in HF patient’s treatment. Clinical studies showed that addition of trimetazidine to standard medication therapy improves sympthoms, cardiac function and prognosis in HF patients, not influencing negatively hemodynamics. The review is focused on rationale for and clinical benefits of trimetazidine application according to its influence on myocardial metabolism in HF. Also a very high level of preparedness of the drug to inclusion into main guidelines on HF is pointed on.

Resting heart rate is a strong predictor of mortality and cardiovascular outcome in patients with chronic heart failure. А specific inhibitor of the If current in the sinoatrial node ivabradine improves clinical outcome in patients with heart failure and systolic dysfunction with heart rate ≥70 b.p.m in repose and sinus rhythm. In this review we summarized data on the efficacy of ivabradine in different subgroups of patients, including patients with co-morbidities and severe heart failure.

Classic presentation of congestive heart failure do not have enough sensitivity and specificity, which lead to delayed diagnostics and worsening of the disease outcome. The concept of molecular biomarkers received broad development during past decade. Recently, a range of biomarkers has been invented, representing different pathopgysiological processes of chronic heart failure pathogenesis. These are reliable, safe and objective tool for diagnostics and stratification of adverse events risk, which adds to clinical and instrumental data and reflects the specifics of development and progression mechanisms in an exact patient. The review focuses on a synthesis of known evidence data on the role of biomarkers in diagnostics and risk stratification.

Currently the diseases of heart and vessels are the primary cause of disability and mortality. Recent understanding of myocardial angioarchitectonics does not reveal fully the relation of coronary anatomy with their function related to their aim for sufficient blood supply in coronary system at tissue level. Filtration liquid currents in non-homogenic porous mediums are widely spread in nature and technology and highly attractable for researches. Also, there is broadly discussed filtration in multilayered non-homogenic grounds. Myocard and its vessels can be represented as the model of porous medium, towards which the hydrodynamic laws can be applied, that are in use for liquid perfusion assessement in porous mediums perfusion. This has never been applied to circulation of a human organs and tissues. The direction is presented for collaboration of physicians and physicshydrodynamicians to obtain results for better assessment of vascular organization net and hydrodynamical circumstances of the heart circulation, which might further lead to universalized criteria for reference ranges definition and myocardium perfusion levels of disorder; to objectify pathogenetic approaches to cardiovascular patients treatment.

Pathology of cardiovascular and respiratory systems still predominates the structure of morbidity and mortality all over the world. Especially it is important due to continuous senilization of inhabitants and comorbidity, which is characterized by relevant complication of the conditions by each other and serious worsening of prognosis in such patients. Contemporary approaches for therapy of chronic obstructive lung disease and chronic heart failure during last years led to achievement of some success in control of these diseases and improvement of life quality. However in their combinated course there are difficulties in standard therapy application to such kind of patients.

A rare case is described, of myocardial infarction developed in a young male with rare pathology of coronary arteries — multiple ectasies.