.

Aim. To measure the changes in brain natriuretic peptide (NT-proBNP) in patients with acute myocardial infarction with ST segment elevation (STEMI) according to the age and gender Material and methods. Totally 223 patients with STEMI included, of those 167 (74,88%) were men and 56 (25,11%) women. Average age of women was 61,80 (57;68) years, of men — 57,15 (51;63) years (p=0,0003). The follow-up period starting during hospitalization included 12 months of outpatient treatment. After 12 months the endpoints were assessed. The NT-proBNP concentration was measured on 10-14th day after infarction using serum by testing system "BIOMEDICA GRUPPE". Results. In women from older group NT-proBNP concentration was higher than in younger patients by 38%, in men — by 57,31%. In men with poor prognosis level of NT-proBNP was significantly higher (96,35 fM/ml) comparing to those with benign prognosis (63,8), p=0,0108. There were no such differences in women.

Conclusion. Trustworthy differences of the biomarker studied between men and women do not exist, however in men and in women either of older group (more than 65) there are higher levels of NT-proBNP, than in younger group. Also men with poor prognosis in higher age group do have the highest NT-proBNP level.

Aim. To study the blood levels of MMP-9 and TIMP-1 in dynamic in patients with acute transmural anterior myocardial infarction complicated by aneurysm. Material and methods. 46 patients with acute transmural anterior myocardial infarction were included into the study. The blood levels of MMP-9 and TIMP-1 were studied. Results. In 1-3 days the patients with myocardial infarction without aneurysm had a significant increase in MMP- 9 up to 229,8 ng/ml, then to 10-12th days a decrease and then increase again up to 237,3 ng/ml by 18-22th days. In patients with myocardial infarction complicated by an aneurysm at 1-3rd and 10-12th days the level of MMP-9 increased slightly, and only at 18-22th days we observed significant increases of MMP-9 up to 159,2 ng/ml. In patients with myocardial infarction without aneurysm the level of TIMP-1 gradually grew up from 1-3rd days (698,9 ng/ml) to 18-22th days (942,3 ng/ml). In patients with myocardial infarction complicated by an aneurysm at 1-3rd and 10-12th days we observed maximum values of TIMP-1, gradually decreased to 18-22th days. Conclusion. The changes found in MMP-9 and TIMP-1 levels might indicate a delay of reparation processes in patients with myocardial infarction complicated by an aneurysm.

Aim. To study the immediate and long-term outcomes of STEMI in patients with concomitant COPD in Kuzbass. Material and methods. Totally 529 patients with STEMI included. They were divided into 2 groups: 1st — patients with COPD diagnosed before (65 pts., 12,3%), 2nd — patients without COPD (464 pts.— 87,7%). The diagnosis of COPD was verified by anamnesis morbi in outpatient records. At admittance all patients underwent coronary angiography and angioplastic with infarct-depending artery stenting. Laboratory values were assessed by 10-14 days after MI. Results. There was higher prevalence of complicated in-hospital MI course in patients with STEMI and COPD. In-hospital mortality was also higher. After 1 year more endpoints registered for those with COPD. In this group the levels of NT- proBNP at the 10th after MI were higher.

Aim. To study plasma lipid profile, systemic inflammation and endotelial function in patients with acute period of MI with Q-wave and liver steatosis (LS) or non-alcoholic steatohepatits (NASH).

Material and methods. Totally 48 patients with acute MI of the left ventricle were studied (1st group), with average age 66,33±1,66; 53 — with acute MI and LS (2nd group) — average age 63,74±1,87, and 7 — with acute MI and NASH (3rd group) — average age 58,86±4,47. In all groups men dominated. We measured the levels of liver enzymes, bilirubin, total cholesterol, LDP cholesterol, VLDL cholesterol, triglycerides, atrogenity coefficient, cholesterol-accepting properties of HDL, level of nitrite- and nitrate-anions in serum, hsC-reactive protein. Results. The disordered lipid profile in patients of both groups shows the increased levels of total cholesterol, LDL (p<0,001) and VLDL (p<0,01), atherogenity coefficient (p<0,001) and lowering of HDL and their cholesterol-accepting properties (p<0,001). In patients of 2nd and 3rd groups there is an increase of nitrites (p<0,001) and nitrates (p<0,001). Endothelial dysfunction was the worse in acute MI with NASH. In patients with combined pathology there is increase of C-reactive protein (p<0,001). The parameter of systemic inflammation is higher in patients with acute MI with NASH.

Conclusion. In patients with combined MI and LS or NASH there is an increase of atherogenity and decrease of anti-atherogenity in lipid profile, increase of stable NO metabolites with maximally prominent endothelial dysfunction in patients with NASH, due to aseptic inflammation. Marker of inflammation severity is higher in those with NASH comparing to LS.

Aim. To assess safety and effectiveness of combination therapy by simvastatin with ursodezoxycholic acid in treatment of dyslipidemia in coronary heart disease patients.

Material and methods. Totally 30 CHD patients (stable angina, 2nd functional class — 2FC) having metabolic syndrome (MS) had combination therapy by simvastatin (20 mg/day) and ursodezoxycholic acid (Ursosan in daily dose 15 mg per kg) during 30 days. For all included patients the non-alcoholic steatohepatits (NASH) was confirmed. Of them 25 (85%) had clinical predictors of fibrosis and liver cirrhosis. All patients had abnormal bodyweight and arterial hypertension, very high risk of cardiovascular complications (CCC).

Results. After 30 days of therapy there was sugnificant lowering of ALT from 83,61 (1,81, 5,49) to 51,32 (2,41, 5,76) МЕ/l, а AST — from 78,44 (2,02, 4,23) to 42,12 (1,99, 6,32) МЕ/l (mediana). In 7 patients levels of ALT and AST were normal. Also there was significant lowering of dyslipidemia: in 19 (63,3%) there was normalization of some lipid profile components, and in 9 (30%) we reached target LDL cholesterol 1,8 mmol/l. Also there was tendency to bodyweight normalization: BMI decreased by 1,28 kg/m² in men and by 2,35 kg/m² in women. During the study we did not find any significant side effects. All patients completed the course of simvastatin plus UDCA. Conclusion. Combination treatment by simvastatin and UDCA makes possible the achievement of lipid profile parameters significant improvement and the decrease of serum transaminase activity in patients with CHD and NASH. If not contraindicated, statins and UDCA can be recommended in CHD and non-alcoholic liver disease to reduce the risk of CCC.

Coronary heart disease is higly prevalent in many world countries including Russia, and for several decades cardiovascular disease are being the main reason for death and are regarded as serious medico-social problem. Rapid development of cardiosurgery, invention and enhancement of diagnostic and endovascular interventions require not only a perfect knowledge of surgical heart vessels anatomy, but knowledge of antropometric parameters of hemocirculatory angioarchitectonic and morphological changes of myocardium. In the literature we could not find the data on principles of morphometric parameters of coronary vessels and structurally-functional condition of myocardial cells. So to say, the complex scientific studies required in this area to improve the diagnostic value and objectivity of indication to treatment methods, optimization and correction of surgical methods to improve quality of cardiovascular patients' care.

Myocardial bridging (MB) is congenital abnormality of the coronary arteries, which typically does not interfere with long term prognosis, but in some cases can cause myocardial infarction and other life-threatening conditions. This article reviews current knowledge about the anatomy, pathophysiology, clinical relevance, and treatment of MB and demonstrates a case of painless myocardial infarction in patients with MB of the left anterior descending artery.