Aim. To investigate on the clinical, anamnestic and laboratory-instrumental predictors of short term outcomes development in pulmonary thromboembolism (PTE).

Material and methods. To the study, 136 patients included with the high and intermediate risk PTE confirmed by multispiral computed tomography. The endpoints were obstructive shock, fatal relapse, fatal outcome, necessity of resuscitation, urgent thrombolysis and hemodynamic support. Follow-up lasted for 30 days. Patients were selected to groups of complicated (n=44) and noncomplicated (n=92) course.

Results. The predictors of adverse course of PTE were chronic heart failure of II stage (p=0,02), diabetes type 2 (p=000001), atrial fibrillation (p=0,001), permanent risk factor for PTE (p=0,002), syncope (p=0,02), positive test for the fatty acid binding cardiac protein (cFABP) (p=0,00001), troponin I positive test (p=0,02), heart rate ≥110 bpm (p=0,002), systolic BP ≤100 mmHg (p=0,00001), creatinine clearance ≤70 mL/min (p=0,0008). By the method of logistic regression a combination selected showing most predictive power, that includes heart rate ≥110 bpm, BP ≤100 mmHg, positive cFABP and diabetes. Upon the logistic regression coefficients the prediction score was formulated, named ROCky (Risk of Complications) that includes heart rate ≥110 bpm (1,5 points), BP ≤100 mmHg (2,5 pts), positive cFABP test (2 pts), diabetes type 2 (2,5 pts). The threshold estimated for prediction of combination endpoint ≥2,5 (Se 84%, Sp 75%), obstructive shock ≥3,5 (Se 83%, Sp 83%) and fatal outcome within 30 days ≥4,5 (Se 79%, Sp 82%). Combination of ≥2,5 points by ROCky and presence of echocardiographical signs of the right ventricle dysfunction showed more efficacy than the algorithm of European Society of Cardiology (2014) in the studied population of hemodynamically stable patients, for the obstructive shock, fatal relapse of PTE, fatal outcome and combination endpoint.

Conclusion. The ROCky scale has demonstrated high efficacy in prediction of complications among hemodynamically stable patients and can be recommended for further investigation and implementation into clinical practice.

Aim. To evaluate 10-year risk of potential development of type 2 diabetes (DM) in Russian population with the FINDRISC score, and to assess its associations with social, demographic and behavioral factors by the data from epidemiological study ESSE-RF.

 Material and methods. In the work, the data used, from multi-center study (Epidemiology of cardiovascular diseases in various regions of Russian Federation: ESSE-RF). Totally, 21923 persons investigated, age 25-64 y.o., of those 1045 (3,76% males, 5,39% females) had DM. To the final analysis 20878 persons included (8058 males, 12820 females) with no DM, for whom the 10-year risk was assessed with the FINDRISC (The FINnish Diabetes RIsk SCore). Level of risk and probability of DM onset were evaluated by the points summation. Also, associations were analyzed with education, marital status, place of inhabitance, income, smoking and alcohol status.

Results. The threshold for high DM risk in Russian population was set at ≥12 level, with AUC 0,76, that represents good quality of model. The prevalence of the high risk by Russian criteria was 20,4%. Multifactorial analysis demonstrated that after correction for region and age, DM high risk was associated with smoking cessation (odds ratio (OR) 1,34; 95% confidence interval (CI) 1,14-1,58; р=0,0004) and alcohol consumption (OR 2,01; 95% CI 1,48-2,71; р=0,0001), and in women — with low income, low educational level and being married.

Conclusion. Mean score by FINDRISC was 6,5±0,03, and absolute risk 5,3%. There were associations found of higher DM risk (≥12 points) with behavioral factors in males and social-demographic factors in women.

Aim. To analyze clinical specifics of the Russian population of non-valvular atrial fibrillation patients participating in the 2nd phase of international registry Gloria AF.

Material and methods. The data on clinical characteristics presented, of the Russian population of atrial fibrillation patients, gathered in the second phase of Gloria AF study. The study is an international prospective observational program representing the registry of patients with the first time diagnosed atrial fibrillation.

 Results. Most patients included into Russian population of the Gloria AF registry had one or several comorbidities: 93,6% had arterial hypertension, 37,4% — coronary heart disease, 14,4% — myocardial infarction in anamnesis. Nineteen and three percent of patients had diabetes, 56,4% — chronic heart failure, 8,7% had stroke in anamnesis. Stroke risk assessment showed that the average score by CHA2 DS2 -VASc was 3,2 points, and 14,4% had the risk as 1 pt, 86,6% — two and more points. Such profile of risk was comparable with the data from general population of Gloria AF, and close to those from Garfield registry. Antithrombotic therapy profile analysis points on an intensive implementation of the Novel Oral Anticoagulants into real clinical practice of the investigative centers participating in the Gloria AF.

Conclusion. The results witness on comparable with the international data risk profile in Russian Federation population of AF patients included into the second phase of Gloria AF registry, as on an intensive implementation of the new class Novel Oral Anticoagulants into routine clinical practice of research centers participating in the registry.

Risk factors (RF) management is the key component of the primary and secondary prevention of non-communicable diseases. It applies fully to cardiovascular medicine. From biopsychosocial point of view RF can be distinguished to somatic, psychological and social. And management of RF might be framed by such distiction.

Aim. Based upon the data from recent literature and original studies, to formulate the concept of the RF hierarchy related with their position on somatic, psychological and socio-cultural levels.

Material and methods. The study includes systematic literary review and empirical work with myocardial infarction (MI) patients. Systematic review included 430 sources primaly published last year, on psychosomatic aspects of MI and course of postinfarction period. Empirical part consisted of the in-depth interviews study (n=18), semi-structured interview (n=32) and a range of quiestionnaires (n=304) of post-MI patients, during the time frame 4 days to 3 months after event.

Results. Based upon the interdisciplinary data, the relationship constructed, of somatopsychic and psychosomatic processes around the MI. Taking the meanings from the humanities, neurophilosophy, the bottom-up and top-down biopsychocultural processes are considered, in the biopsychocultural interrelation, that describe social and cultural influence on somatic state, and of somatics on behavior of an ill person (MI patient) in the society. Based on the study of MI patients, the specifics studied, of psychological and socio-cultural components of the illness — that preceded the MI and the continuing. Risk factors, traditionally addressed in cardiology and being the target of cardiorehabilitation and secondary prevention, are stratified to 7 levels of hierarchy: morpho-functional, neurohumoral, psychophysiological, cognitiveaffective, phenomenological, sociocultural, and (epi)genetic.

Conclusion. Such theoretical model might be applied to any RF and to help practitioner by stratification of approaches and efforts in modification, and in facilitation of healthy behavior changes.

Aim. To assess the condition of cerebral blood flow and cognitive functions in coronary heart disease (CHD) patients underwent on-pump coronary bypass surgery and to evaluate the influence of citicoline on the condition of higher cerebral functions during early and delayed follow-up after the surgery.

Material and methods. At the Federal Center of Cardiovascular Surgery (Krasnoyarsk city), 66 patients investigated, with CHD. Patients were selected to two groups. In the main group (n=36) as a cerebral protector citicoline was used intravenously pre-operation, dosage 1000 mg on 200 mL 0,9% saline, and then 7 days after operation with further intake 900 mg daily for 2 months. Comparison group (n=30) did not undergo cerebroprotection in perioperational period.

Results. By the 12th month after surgery, the parameters of cognition returned to baseline. In the controls, cognitive function returned to baseline only by the test “visual verbal memory” (direct reproduction).

Conclusion. Neuroprotection by citicoline can be regarded as a method for improvement of cognitive functioning after such harming influences as on-pump surgery, and therefore to reach higher everyday functioning abilities after coronary bypass.

The sinus node (SN) is built predominantly from pacemaking P-cells, transient T-cells, and Purkinje-like cells located on the periphery of the node. P-cells, especially in the center of SN, are surrounded by dense hardfiber fibrous tissue and do not contact with T-cells. We come up with a hypothesis that in the SN there are telocytes that may play role in electrical impulse conduction from pacemaking cells to contracting myocardium.

Aim. Morphological analysis of telocytes in SN.

Material and methods. Histological and immune-histochemical study of SN done on 10 autopsies. The double trace method was used, with combinations of primary antibodies to HCN4/connexin43 and CD34/connexin43. Confocal laser microscopy with 4 cocktails of antibodies to CD34/S100, CD34/connexin43, SMA/connexin43, S100/vimentin was done in 3 among 10 cases. Additional tissue specimens from SN of 3 other patients underwent electronic microscopy and immune cytochemistry analysis with HCN4.

Results. In all studied SN, there were cells with immune phenotype of telocytes. In the center of the node, their number was 2 times more than in periphery (20,3±4,8 versus 10,8±4,4 cells in х400). Telocytes had dense contacts with P-cells, contracting myocardium, vessels, and expressed HCN4. Their ultrastructural characteristics completely resembled telocytes that are found in other organs and other heart tissues.

Conclusion. Another type of cells was found, able to conduct and, probably, generate electrical impulse in the SN. In our opinion, electrical heterogeneity of the SN might be explained by the presence of telocytes.

Aim. To assess clinical signs and characteristics of venous circulation disorders in lower extremities in young women with idiopathic arterial hypotension (IAH).

Material and methods. The comparison was performed, of the prevalence of subjective and objective signs of the chronic vein disease (CVD), and parameters of ultrasound vessel imaging of lower extremities circulation in 105 women with IAH (SBP 98 mmHg and below) and 48 women with normal arterial pressure (SBP 120- 129 mmHg). Mean age in both groups 19 (18-22) y.o.

Results. Young hypotensive women present with complaints associated with CVD: leg pain in 31%, cramps at night in 27%, knee and feet edema by the end of the day — in 12%, trophic disorder of the skin — in 4%. CVD is characterized by a high prevalence of objective early signs of chronic veins diseases — teleangioectasia/reticular varicose (30%) that 2 times more common in low blood pressure. In IAH there is a decline found of structural and functional parameters of the low extremities veins comparing to normal blood pressure: lower diameter and the area of the lumen of the veins; lower thickness of walls and lower the tone; lower velocity of flow and lower the duration and velocity of venous reflux. In IAH there are ultrasound signs of CVD: in 45% — venous failure, varicose veins in 4%. In 78% young women with hypotension and venous reflux with low tone, there are complaints on leg pain 5 times more common than in normal pressure.

Conclusion. In IAH young women more commonly present with CVD that show more prominent clinical picture and venous hemodynamics disorder than in normal blood pressure.

Aim. To assess the life quality and clinical-laboratory parameters of the stable coronary heart disease (CHD) patients comorbid with diabetes type 2 (DM) and chronic obstructive pulmonary disease (COPD).

Material and methods. Totally, 67 patients included, age 39-69 y.o. All patients were selected to 3 groups: CHD (group 1, n=21, mean age 55,4±6,8 y.o., males/ females 16/5), CHD and DM (group 2, n=21, 58,8±8,9 y.o., M/F 18/6), and CHD and COPD (group 3, n=22, 59,2±5,2 y.o., M/F 16/6). Clinical and anamnestic, as biochemical and hemodynamic parameters were evaluated, and the life quality with EQ-5D score.

Results. In the CHD group with or none DM there was high rate of obesity, but in COPD group mean body mass index was lower than 29 kg/m2 . By EQ-5D, life quality decrease in CHD and DM, at most was determined by the units as “dyscomfort”, “everyday activities” and “anxiety/depression”. In CHD patients with comorbid COPD maximum was collected in the points related to “mobility”, “anxiety/ depression”. In the absence of significant dilation of the left ventricle (LV), in the patients of groups 2 and 3 there were relatively low values of ejection fraction (EF) comparing to CHD only patients. Also, in COPD and CHD patients there were signs of the left atrium overload, as the Doppler digns of pulmonary hypertension. Comorbidity of CHD and DM was followed by increased plasma urea and more significant dyslipidemia.

Conclusion. Comorbid DM and COPD contribute on the worsening of CHD patients parameters with following decline in life quality, increased plasma urea and more significant dyslipidemia.

Background: The physiological responses to auditory stimulation with music are relevant to understand and provide additional information regarding complementary and alternative therapies.

Objectives: Investigate the acute effects of auditory stimulation on the globally chaotic parameters of Heart rate Variability (HRV).

Methods: 27 healthy male students. Measurements of the equivalent sound levels were conducted in a soundproof room. The RR-intervals recorded by the portable HR monitor. HRV was analyzed in the following periods: control protocol – the 10-minutes period before the exposure and the 10-minutes period during the exposure to musical auditory stimulation.

Results: We have the values of CFP for seven groups for 27 subjects who are undergoing auditory stimulation; hence a grid of 7 by 27 to be assessed. The First Principal Component has a variance of 4.5282 and accounts for 64.7% of the total variance. The Second Principal Component has an eigenvalue of 2.4631 accounting for 99.9% of total variance. When we observe the results of PCA. CFP3 is very weakly influencial with first principal component (PC1) at 0.012; whereas, CFP1 is much more influencial with PC1 of 0.2288.

Conclusion: Musical auditory stimulation with a specific classic style did not acutely influence the global chaotic parameters of HRV.

Aim. To analyze the relation of alcohol consumption level with cardiovascular diseases and risk factors in the population of Kemerovskaya Oblast.

Material and methods. The study was performed under the framework of multicenter epidemiological trial ESSE-RF in Kemerovskaya Oblast, with 1628 participants with the age 25-64 y.o. The data was analyzed concerning the prevalence, volume and type of alcohol beverages by the respondents, as the prevalence of a range of cardiovascular diseases and risk factors. By original formulae, total volume was calculated of the consumed alcohol in units of the “safe” ethanol dose (24 grams) with further grouping to “non consuming” and consuming “moderately”, “in-between” and “over”.

Results. Overconsumption of alcohol, comparing to non-consumers, is associated with high risk of hypercholestrolemia (OR 1,76; 95% CI: 1,12-2,75), hypertriglyceridemia (OR 2,69: 1,52-4,77), body overweight (OR 1,68: 1,04-2,71), smoking (OR 2,24: 1,48-3,41). The relation of low physical activity with alcohol consumption is found in all grades. Increase of the mean daily ethanol dosage is positively linearly related with the risk of arterial hypertension (OR 1,04: 1,11-2,75), hypercholesterolemia (OR 1,06: 1,01-1,12), increased level of low density lipoproteins (OR 1,09: 1,02-1,16), smoking (OR 1,17: 1,10-1,24), low physical activity (OR 1,09: 1,02-1,16). There is U-shaped and upside-down J-shaped relation for the level of psychological risk factors (stress, anxiety, depression) and volumes of consumed alcohol. By the considered cardiovascular diseases it can be noted only, the existence of statistically non-significant (0,1>р>0,05) tendency to decrease myocardial infarction risk and stroke in anamnesis, with the increase of the consumed alcohol volumes comparing to non-drinkers.

Conclusion. The study shows that overconsumption of alcohol, as the increase of mean daily dosage of ethanol are associated with the range of cardiovascular risk factors. There is U-shaped and upside-down J-shaped relation of psychoemotional risk factors with the volumes of consumed alcohol. By the considered cardiovascular dseases, there are no significant relations for the level of consumed alcohol, however, there is non-significant tendency for myocardial infarction and stroke risk factors diminishing in the anamnesis, with the increase of consumed alcohol volumes.

In the article, an original meaning is proposed for the term “social neurosis”, developed during transdisciplinary research. In the analysis, recent literature was included, on psychosomatic relations in pathogenesis of myocardial infarction, and the results of empirical study (interviews, questionnaires) in myocardial infarction setting. As “social neurosis”, psychosomatic condition should be meant, that is determined by experiencing of social and cultural life with following shifts in neurohumoral reactions that are bidirectionally linked to the phenomenal Self. As the phenomenal, the living through is understood, of the human as conscious, selfidentifying, thinking and emotioning subject. Practically oriented concept, “social neurosis”, being a generalizing term, might be useful for description of the cultural and social influences that lead to undercoping, chronic experiencing of negative socially oriented emotions, self-destructive behavior. Also, the meaning “somatized social neurosis” is presented that is related to the biomedical part of the problem.

Aim. To assess the results of addition of nicorandil to the treatment of ischemic heart disease: clinical course and long-term outcomes, and to evaluate life quality and treatment adherence in stable angina patients. The article provides data on the NIKEA study design and results of antianginal efficacy of the drug.

Material and methods. The design is prospective multicenter observational study. Totally, 14 institutions participated, from different Russia regions. Included 590 patients: 261 women (44,2%) and 329 men (55,8%). Mean age 65,1±9,6 y.o. All patients had inclusion criteria and no exclusion criteria. All participants, in addition to standard antianginal therapy, were recommended to take nicorandil dosage 20 mg daily with titration up to 40 mg daily in 1 month of the observation. By the protocol, three office visits were set (inclusion, in 1 month and in 3 months): V0, V1, V3. During the visits, physical examination was done, anthropometry, hemodynamics measurement. Antianginal efficacy was assessed with patients diaries on angina attacks and demand of short-acting nitrates (SAN). At the visits V0 and V3 patients completed Seattle life quality questionnaire in CHD, and at V0 also an original questionnaire was completed for adherence evaluation.

Results. Among 590 patients included in NIKEA, 582 (98,6%) confirmed their intention to take nicorandil and 6 refused to buy additional medication. On the planned visits V1 and V3552 patients came: of them 402 started taking nicorandil, and in 1 month 383 continued; in 3 months — 327 patients continued. During the visits V1 and V3 a statistically significant decrease in angina attacks frequency and in demand of SAN was noted  (p<0,05).  In comparison analysis of dynamics of these parameters with those refused or having stopped taking the medication (controls) it was found that these parameters declined in both groups, and in nicorandil group — more seriously; in 3 months the difference between groups became significant (p<0,05).  During the first 3 months of the observation there was almost triple increase of those having 1st functional class of angina: from 4% to 11,6%, and decrease of the 3rd class angina patients almost 1,5 times: from 32% to 20%.

Conclusion. The results of observational program demonstrated good antianginal efficacy of the added nicorandil — antianginal medication with proven positive prognostic influence: decrease of angina attacks, decrease of the demand in SAN, increase of the 1st functional class patients and decrease — of the 3rd, respectively

В статье рассматриваются современные представления о нейрогормональном дисбалансе при хронической сердечной недостаточности, в том числе компенсаторной гиперактивации симпатической нервной системы, ренинангиотензин-альдостероновой системы, эндотелиальной системы, системы эндопептидов, а также снижении эффективности системы натрийуретических пептидов (предсердного натрийуретического пептида, мозгового натрийуретического пептида, эндотелиального натрийуретического пептида). В обзоре показано, что хроническая сердечная недостаточность как клинический син- дром характеризуется тесным взаимодействием между гемодинамической дисфункцией миокарда и компенсаторными нейрогуморальными механизмами. Все нейрогуморальные механизмы неразрывно участвуют в компенсации и прогрессировании хронической сердечной недостаточности, при этом многие из них имеют как компенсаторное, так и патологическое значение.

The review is focused on the recent data on the causes of type 2 myocardial infarction and specifics of its diagnostics and management in patients with vasospastic angina. Significance of the problem is based upon the fact that strategies of this sort of patients management are lacking and usually do not fit guidelines. There is absence of agreed princips of long term management of such patients. The selection of strategy (medication therapy, revascularization of the spastic region, prevention of complications and another infarction) is disputable. The case provided, illustrating some of the listed issues from a real practice point of view.

The literary review includes data from recent research on the medication and nonmedication treatment adherence of coronary heart disease patients. The various approaches considered, of the adherence improvement, and psychological models presented, the “information-motivation-strategy” and “transtheoretical model”. The polypill phenomenon is considered. Also three terms on adherence are commented: compliance, concordance and adherence itself, depending on the part of patient’s active role.