Objective: The objectives of the study were to conduct comparative characterization of patients after conservative and surgical treatment of coronary artery disease and to evaluate tactics of management of patients with coronary heart disease with and without surgical treatment in Altai region. Material and methods. Retrospective study included a total of 186 patients: group I comprised 101 patients with chronic ischemic heart disease (CIHD) after coronary artery bypass grafting (CABG) in 2011 and 2012; group II comprised 85 CIHD patients discharged from hospital without surgical treatment in 2011 and 2012. Patients of both groups were registered after 3±0.2-month period after discharge (p>0.05). The experimental observation lasted over two years. A statistical analysis was performed using software Statistica 6.0. Results and discussion. The average age of patients was 60 years (p=0.2). Rural residents (60.4% and 56.5%, p=0.5) and males (88% and 57%, p<0.001) predominated in both groups. Arterial hypertension (AH) was present in 91% and 88% in group I and II, respectivley (p=0.5). Target levels of blood pressure (BP) during registration were achieved in 93% and 71% of patients in groups I and II, respectivley (p<0.001). By the end of the observation period, target BP was achieved in 87% and 52% of patients in group I and II, respectively (p<0.001). At the time of registration, 90% and 56.5% patients in group I and II were without angina (p<0.001); functional class (FC) II and III were more frequent among patients with conservative management tactics (p<0.001). After 2 years of the follow-up, 68.3% and 28.2% of patients in group I and II, respectively, were without angina (p<0.001); patients of group II had FC II and III more frequently (p<0.001). Patients of group I had significantly better compliance with the recommended therapy than patients of group II (p<0.03). During the observation, the number and the reasons for hospitalization did not differ (p=0.5). Conclusions. Males dominated among patients with CIHD in both groups, but significantly more males were present in the group of patients subjected to CABG. The high prevalence of AH among patients with CIHD was found in the Altai region. The achievement of target BP among the operated patients was more frequent. Patients of group I had significantly better compliance with the recommended treatment. Patients after surgical treatment of CIHD rarely had angina. The numbers and the reasons for hospitalization in both groups did not differ.

The aim of this study was to assess the left ventricular (LV) mechanics and dynamics after coronary artery stenting in patients with stable ischemic heart disease and a single damaged coronary artery. Methods: The analysis was performed in 28 stable ischemic heart disease patients (20 men; age 59±6.47 years) with the LV ejection fraction (EF) of 55% and more. Based on the established indications, PCI was performed in all patients. Syntax score did not exceed 22 (10.78±6.12). Two-dimensional echocardiography and speckle tracking imaging were performed for assessment of the LV global rotation, global rotation rate at systole and early diastole at the basal, apical, and papillary muscle levels, twisting, untwisting and torsion before and during the first week after PCI. Results: There were no differences in the values of global rotation, global rotation rate at systole and early diastole, twisting, untwisting and torsion of the left ventricle in patients with the right coronary artery (RCA) and with the left anterior descending artery (LAD) stenosis. The values of global rotation, global rotation rate, twisting, untwisting and torsion of the left ventricle in patients with stable ischemic heart disease and normal LV EF did not depend on the presence of RCA and LAD stenosis. PCI with RCA and LAD stenting did not affect global rotation, global rotation rate, twisting, untwisting and torsion of the left ventricle in patients with stable ischemic heart disease and preserved LV EF. We found the increased rotation rate in systole and early diastole of the apical segments of RCA region after PCI. In LAD PCI, no similar pattern was found.

The pilot randomized prospective comparative study comprised 54 patients with acute coronary syndrome (ACS) with anxiety and depressive disorders. Patients were admitted to the Emergency Department of the Federal State Budgetary Scientific Institution “Research Institute for Cardiology”. Patients were tested for mental status, sleep quality, and quality of life at discharge and after at 6-month follow-up. During conventional therapy of ACS, patients of group 1 (n=27) were administered with Tenoten; patients of group 2 (n=27) were administered with placebo (groups were randomized). Patients had increased level of anxiety and depression at admission. At 6-month follow up, mental status, sleep quality, and quality of life improved in Tenoten group. In placebo group, mental status of patients and sleep quality did not change. The results showed positive effects of Tenoten therapy on mental status, sleep quality, and quality of life.

Postoperative pleural effusion is the most common complication of cardiac surgery. The aim of our work was to evaluate the effects of NSAIDs alone, NSAIDs combined with steroids, and NSAIDs combined with metalloproteinase (MMP) inhibitor on the severity of inflammation in the pleural cavity in patients undergoing coronary artery bypass grafting. The study included 22 patients with coronary artery disease who underwent coronary artery bypass grafting with cardiopulmonary bypass. To determine the activity of MMP-9, venous blood was sampled on days 1, 5, and 10 after the beginning of anti-inflammatory therapy. Patients were randomly assigned into 3 groups: group I consisted of patients who were prescribed monotherapy with NSAIDs (75 mg/day diclofenac; n=8), group II consisted of patients who were prescribed with a combination of anti-inflammatory therapy with NSAIDs + steroids (75 mg/day diclofenac + 0.5 mg/kg/day prednisolone; n=8) and group III included patients who used the combination therapy minocycline + NSAIDs (75 mg/day diclofenac + 100 mg/day minocycline). The main criterion for evaluating the effectiveness of anti-inflammatory treatment was reduction in the activity of pro-MMP-9 in venous blood samples. The additional criteria were formation of effusions in pleural and pericardial cavities and duration of persistence of pleural effusion according to ultrasound examination. The main criterion for the effectiveness of prevention of postpericardiotomy syndrome was the absence of its clinical signs within 30 days after surgery. Combination treatment with NSAIDs with MMP inhibitor exerted the greatest therapeutic effects on pleural effusions after coronary artery bypass grafting. The therapeutic effects began starting from day 5 of therapy. Moreover, transthoracic echocardiography demonstrated significant decrease in the time of detection of the effusions in the pleural cavities.

The aim of this study was to demonstrate the capabilities of the dual-isotope SPECT with 123I-BMIPP and 99mTc-MIBI in the assessment of myocardial perfusion-metabolic relationships. Following 70 min after the intravenous administration of 99mTc-MIBI (296 MBq), 123I-BMIPP (111 MBq) was introduced. The images were recorded using SPECT system equipped with solid-state semiconductor cadmium-zinc-telluride detectors. The energy windows of the differential discriminator for 99mTc and 123I were adjusted to avoid overlapping. This enables to perform the dual-isotope myocardial scintigraphy as a single procedure at the same day. This method allows for the reduction of radiation exposure and procedure duration, improves logistics of in-hospital examination of patients, and makes the procedure for assessment of myocardium metabolism and perfusion more comfortable.

The work is devoted to verification of 99mTc-Pirfotechum SPECT combined with 99mTc-MIBI techniques for the diagnosis of myocarditis. Forty patients with persistent form of idiopathic atrial fibrillation underwent myocardial scintigraphy with 99mTc-Pirfotechum, combined with myocardial perfusion scintigraphy with 99mTc-MIBI. The obtained scintigraphic data were compared with the results of endomyocardial biopsies. In this work, we determined the sensitivity, specificity and diagnostic accuracy of this technique in the diagnosis of inflammatory changes in the myocardium in patients with idiopathic AF.

Exercise tolerance is the main parameter characterizing the state of cardiovascular system. Considering morphofunctional changes and increases in the mental and physical activity of the growing organism, characterization of the functional state of cardiovascular system is relevant. Aim: The aim of the study was to evaluate exercise tolerance in healthy children of different age groups by modified Harvard step test. Materials and Methods: The study comprised 110 healthy children aged 6 to 16 years. Average age was 10.6±3.6 years. Modified Harvard step test was used for evaluation of exercise tolerance. Results: All subjects performed modified Harvard step test according to the entire protocol. Heart rate increased by 15-20% in 79 children (71.8%) where boys constituted a majority (57%). In the rest of children (28.2%), heart rate decreased by 5-10% after physical exercise compared with the initial values. The values of modified Harvard step test index did not significantly differ between groups of healthy girls and boys: 74.3 (IQR: 63.2:85.5) and 70.3 (IQR: 62.2:82.5), respectively, p=0.94. Conclusion. Independently on gender, all study children completed the test suggesting that this test may be used for exercise tolerance study in children of different age groups regardless of gender.

Aim: The aim of the study was to analyze the results of genetic testing of platelet glycoprotein receptors and their aggregation activity in patients with congenital heart diseases (CHD) with single ventricle defect (SVD). The study comprised 50 children referred for planned surgical correction of CHD. In all patients, the value of platelet aggregation activity was assessed in the presence of Cardiomagnyl and was compared with the results of genetic testing of platelet receptors for collagen ITGA2:807С>Т and for fibrinogen ITGB3:1565T>C. In study patients, the average levels of platelet aggregation in the presence of collagen inductor were 52.5% in carriers of СС genotype of ITGA2:807 gene, 49.0% in carriers of СT genotype, and 65.1% in children carrying TT genotype. The average levels of platelet aggregation in the presence of epinephrine-inductor were 56.3% and 65.8% in carriers of ТТ and ТС genotypes, respectivley, and did not significantly differ from aggregation I patients with CC genotype: 75.6% (р=0.506). In group of study patients with CHD, no relationships of allelic variants of platelet glycoprotein receptor genes for collagen ITGA2:807С>Т and for fibrinogen ITGB3:1565T>C with platelet aggregation activity level were found. Meanwhile, the absence of changes in platelet aggregation activity in response to collagen and epinephrine was found in 30% and 38% of children with CHD administered with Cardiomagnyl.

Complex anatomy, diversity of anatomic variants, prevalence of right or left part of the heart, and the particular movements of the single ventricle complicate echocardiographic assessment of ventricular function in children with single ventricle pathology. The purpose of the present investigation was to evaluate the status of intracardiac hemodynamics in children with single ventricle pathology after a total cavopulmonary connection procedure. Methods: A comparative analysis of two groups was performed. The main group included 39 patients with single ventricle pathology six month after a total cavopulmonary connection procedure. The control group included 349 healthy children without cardiovascular system pathology. Age and weight did not differ between two groups. Results: When comparing two groups, a statistically significant correlation was observed in such echocardiographic values as the sphericity index (p<0.001), ejection fraction (EF) (p<0.001), and Tei index (p<0.001). The study showed that normative values of end diastolic volume of the left ventricle were higher in children with single ventricle pathology compared with those in healthy children. Conclusions. Among the indices evaluating myocardial contractility, max dp/dt appears to be the best index in children with single ventricle pathology. The increasing of the common atrium size (dilatation) can lead to single ventricle dysfunction (significant reduction of contractility).

Aim: The aim of the study was (1) to develop efficacious and minimally time-consuming protocol for extensive MRI and MR-angiographic examinations of carotid arteries in order to detect and quantify severity of atherosclerotic stenosis in the carotid arteries and (2) to evaluate the efficiency of this protocol in routine studies of the head in ambulatory patients aged over 45 years with clinical signs of extensive atherosclerosis. The results of MR-tomographic and MR-angiographic examinations were studied in 147 patients referred to the MRI Laboratory. Initially the protocol of MR-tomographic and MR-angiographic studies included MR-angiography of the carotid and cerebral blood vessels with an acquisition of time-of flight MR-angiograms and detailed visualization of the region of common (CCA) and internal carotid artery (ICA) stenosis, as follows: slice thickness of 1 mm, matrix of 256 х 256, voxel size of 0.2 х 0.2 х 1 mm, TR=6 ms, and TE=32 ms. Thereafter the MR-angiograms of the brain were immediately reconstructed, with on-line evaluation of the presence and severity of ICA stenosis. After that, axial sections of the brain were acquired simultaneously with axial slices of the bifurcations of carotid arteries, in T2-weighted spin-echo regime (TE=100-110 ms, TR=4000-7000 ms) and Т1-weighted spin echo regime (TE=15 ms, TR=400-600 ms), with and without fat suppression. For certain acquisition of MRI slices covering the region of CCA bifurcation, centering them at the level of the intervertebral disc С3-4 was usually enough. The study demonstrated that simultaneous acquisition of MR-angiography of the carotid arteries with MR-tomographic study of the vascular wall may be the effective method to detect intraplaque hemorrhage in the presence of carotid artery stenosis. These intraplaque haemorrhages are suggested as indication to carotid endarterectomy with autovenous plasty and for the elimination of the risk of cerebral stroke.

Persistent left superior vena cava may be found in 0.3-0.47% of cases during endocardial pacemaker implantation with left-sided approach. This venous anomaly can complicate lead placement during implantation. Active fixation leads are usually used. We described a new technique for passive fixation J-shaped atrial lead implantation via persistent left superior vena cava using left-sided approach. Stable position, pacing and sensing parameters were unchanged after 12 months of follow-up.

The article presents a clinical case of pseudo-coronary scenario of inflammatory viral cardiomyopathy. Differential diagnostics of acute coronary syndrome and dilated cardiomyopathy was carried out. Verification of diagnosis was accomplished using routine, as well as modern imaging technologies, including cardiac MRI, 2D-speckle tracking echocardiography, and endomyocardial biopsy with immunohistochemical analysis.

The article presents the biography of the famous Russian psychiatrist Bronislav I. Vorotynskiy and his contribution to the development of Russian psychiatry. The author gives a brief review of his scientific, educational, medical, and social activities.

Based on the analysis of the advances in modern (western) medicine, characteristic factors for its development are demonstrated suggesting that they are the basis of the onset of the crisis. Main aspects of the manifestation of crisis in medicine and its consequences are demonstrated. Possible ways for overcoming the crisis are proposed with an emphasis on the development of integrative medicine combining the analytical principles of classic (western) medicine, positive medical tendencies of the East, and some complementary traditions of the West.