Heart arrhythmias may accompany virtually any cardiac disease. The problem of the preprocedure topical diagnostics of various arrhythmias remains fundamentally important and relevant, which is confirmed by numerous algorithms aimed at non-invasive detection of the arrhythmogenic focus location. Today, many different methods are available for non-invasive topical diagnostics of the arrhythmogenic foci in both ventricular and atrial arrhythmias. A non-invasive imaging of cardiac electrophysiology (NICE), based on the solution of the inverse problem of the electrocardiography, is the most advanced new technology. The accuracy of NICE reaches 90%, however, it is still inferior in its capabilities to the “reference” method of the invasive intracardiac electrophysiological examination. Currently, the market presents devices for both invasive mapping and NICE. However, in the context of surgery, an integrated system of non-invasive electrophysiological mapping with invasive three-dimensional electroanatomic mapping is of high demand. The creation of hybrid systems will allow to visualize electrophysiological processes in the epi- and endocardial surface in the real time with very high accuracy and to carry out the radiofrequency catheter ablation of arrhythmias with the simultaneous reduction of the radiation load on the patient and medical personnel.

Cardiac arrhythmias are associated with deterioration in patient’s quality of life, thromboembolic complications, and sudden cardiac death. Coronary atherosclerosis is often the cause of cardiac arrhythmias. Myocardial hypoxia and remodeling lead to impaired formation and conduction of the impulse and the development of ectopic rhythm. The article reviews the main pathogenetic mechanisms for various types of cardiac arrhythmias in patients with atherosclerotic coronary lesions.

This review highlights the preclinical and clinical data about a relatively new electrophysiological method for chronic heart failure (CHF) treatment, cardiac contractility modulation (CCM). The review presents efficacy and safety data. An updated information about the capability of CCM to influence the molecular genetic apparatus of the cardiomyocytes is proposed. In addition, the review assesses prospects for application of CCM as a tool for reverse cardiac remodeling in patients with CHF.

Aim. The first experience of the application of the integration algorithm for computed tomography of the heart with the navigation system “Astrocard” (Russia) when performing radiofrequency ablation in patients with atrial fibrillation and flutter.
Material and Methods. A total of 31 patients with atrial fibrillation and two patients with atypical left atrial flutter were subjected to electroanatomical reconstruction of the left atrium and pulmonary veins with computed tomography of the heart. In patients with atrial fibrillation, an ablation scheme involved for antral isolation of the pulmonary veins. In patients with atypical left atrial flutter, linear ablation was applied in the area of slow conduction. The duration of the operation was 58±14.5 min, and the time of fluoroscopy was 33±8 min.
Conclusion. The merge function of the “Astrocard” navigation mapping system (Russia) provided an accurate comparison of the electroanatomical map with the computed tomography of the heart, which allowed us to minimize the time of fluoroscopy and the time of operation.

Aim. To investigate the relationships between left atrial (LA) fibrosis extent and left ventricular (LV) structural and functional status in patients (pts) with nonvalvular atrial fibrillation (AF).
Material and Methods. The study enrolled 56 pts (mean age 57.1±8.4 years, 25 females), admitted to hospital for primary catheter ablation (CA), including 47 pts with paroxysmal AF and 9 pts with persistent AF. All pts had scheduled transthoracic echocardiography to measure size and volume of cardiac chambers and systolic and diastolic functions of the left ventricle. Based on the calculation of the LV mass index (LVMI) and relative wall thickness (RWT), we categorized all pts into 4 groups: (1) normal geometry (n=27); (2) concentric remodeling (normal LVMI and high RWT, n=13); (3) concentric hypertrophy (high LVMI and high RWT, n=6); and (4) eccentric remodeling (high LVMI and normal RWT, n=10). The assessment of LA fibrosis sizes was based on the allocation of low voltage zones (<0.5 mV) in the process of voltage electroanatomic mapping (VEM) as the first stage of CA. Following indicators were calculated: total square of fibrosis (Sf), % of fibrosis from the total LA square (Sf%), the degree of LA fibrosis (an analog of the UTAH score), and number of LA fibrosis zones. Level of NT-proBNP in blood was determined among other laboratory tests. All pts had preserved LV ejection fraction (LVEF).
Results. Results of the study confirmed positive relationships between Sf, Sf% and LA diameter, LVMI, and NT-proBNP level. Negative relationship was noted between Sf, Sf%, the UTAH degree and LVEF. Such LV geometry type as eccentric hypertrophy was associated with a higher number of LA fibrosis zones compared to the normal LV geometry, while significant differences in other types of geometry were not found.
Conclusion. Thus, LA fibrosis extent was associated with LA size, LV function, and LV geometric remodeling pattern.

Aim. To estimate the efficacy of invasive and non-invasive long-term ECG monitoring in comparison with conventional follow-up for the detection of silent atrial fibrillation (AF)/atrial flutter (AFL)/atrial tachycardia (AT) in patients with a cryptogenic stroke.
Methods. The randomized, prospective, two-center study enrolled 36 patients who suffered cryptogenic stroke (CS) or transient ischemic attack (TIA) without past history of AF/AFL/AT. Patients were randomized in a 1:1:1 ratio to one of the three ECG monitoring strategies: standard arrhythmia monitoring (group I, n=12), ECG-monitoring with implantable loop recorder (group II, n=12), and ambulatory noninvasive ECG monitoring (group III, n=12). The primary endpoint was the time to the first detection of AF/AFL/AT. Patients, assigned to the group I, underwent an assessment at scheduled and unscheduled visits and received ambulatory ECG monitoring 28 days and 1 year after randomization. Patients in the group II underwent implantation of Reveal XT (Medtronic, USA) with the daily remote data transmission to CareLink Network. In the group III, for long-term external monitoring, Spyder system (WEB Biotechnology, Singapore) was used for up to 28 days.
Results. During the first 28 days of observation, there were no significant differences in AF detection rates between groups I, II, and III: 0 (0%), 1 (8%), and 2 (17%) cases, respectively, р=0.537. During the year of observation, AF/AFL/AT episodes were detected in 1 case (8%) in the group I, 6 cases (50%) in the group II, and 2 cases (17%) in the group III, p=0.0486. The mean time from enrollment into the study to detection of the first AF/AFL/AT episode was 67 days (15; 97) in all groups. In the groups II and III, the first arrhythmia episodes were detected by monitoring devices on days 24 and 6, respectively. In most cases, arrhythmia episodes detected by long-term monitoring were asymptomatic. Recurrent stroke or TIA events occurred in group I and III (1 case in each group), but not in the group with implantable cardiac monitors. Subgroup analysis showed that significantly higher AF/AFL/AT detection rate was associated with stroke, CHA2DS2VASc score ≥2, and the presence of hypertension. For the 12 months of follow-up, the mean AF burden in the group II was 0.4 (0.2; 0.5) hours per day (1.6%). In the patients with recurrent stroke, AF burden was 3.2% compared to 0.9% in the rest of patients.
Conclusion. Detection of silent AF with implantable cardiac monitors is superior to standard and long-term external monitoring in cryptogenic stroke patients.

Purpose. To assess the frequency and predictors of appropriate shocks of cardioverter-defibrillators in patients with dilated cardiomyopathy (DCM) syndrome and the impact on the total mortality and sudden cardiac death (SCD).
Material and Methods. A total of 275 patients with DCM syndrome (average age of 46.8 ± 12.5 years; 185 males and 90 females) were observed. Inclusion criteria were left ventricular (LV) end-diastolic diameter (EDD) more than 5.5 cm and LV ejection fraction (EF) less than 50%. Patients with coronary artery stenosis more than 50% were excluded. Implantable cardioverter-defibrillator (ICD) (n=44) and cardiac resynchronization therapy defibrillator (CRT-D) (n=32) were implanted in 76 (27.6%) patients (53 males and 23 females, average age of 48.9±12.9 years, LV EDD of 6.7±0.8 cm, and LV EF of 28.2±9.9%). A comparison group comprised 199 patients (72.4%) without devices (132 males and 67 females, average age of 46.0±12.3 years, LV EDD of 6.5±0.8 cm, and LV EF of 32.0±10.2%). The average follow-up was 27 (24; 30) months.
Results. SCD in patients with DCM syndrome was recorded in 2.9% of cases; the total mortality rate was 18.9%; the rate of death + transplantation was 22.6%. The SCD, total mortality, and death+transplantation rates were 2.6% (4.6/0%), 23.7% (22.7/25.0%), and 32.9% (34.1/31.3%) in patients with devices (ICD/CRT-D) and 3.0%, 17.1%, and 16.6% in patients without devices, respectively. The rate of SCD+appropriate shocks (ASR) was significantly higher in study group: 26.3 vs 3.0% in comparison group (p<0.001). The nature of DCM syndrome was predominantly inflammatory (53%), primary (genetic) (19.6%), and multifactorial (25.1%). Genetic forms of DCM were represented by non-compaction cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (ARVC), myopathies, and amyloidosis. The pathogenic mutations in the genes LMNA (n=1), DES (n=2), DSP (n=2), EMD (n=2), PKP2 (n=1), TTR (n=1), MUH7+MyBPC3 (n=1), and MyBPC3 (n=4) were detected. The ASR (ICD/CRT-D) rate was 23.7% (n=13/5). The only reliable predictor of ASR was the generic nature of DCM syndrome, identified in 100% of patients with shocks (in the presence of myocarditis in 77.8%/isolated in 22.2%) in comparison with 51.7% (29.3/22.4%) in patients without ASR (p<0.002, AUC 0.747, RR 1.66, 95% CI 0.711-3.885). Ventricular tachycardia (VT) was registered in 84% of patients with shocks (stable/unstable VT rates of 17/67%) vs 1.7/72%, in patients without shocks (р=0.06). In patients with shocks, low QRS voltage (39 vs 6.9%, р<0.05) and the absence of LV hypertrophy signs on the ECG (77.6 vs 58.6%, р>0.05) were registered more often. The average LV EF was higher in patients with ASR (34.4±9.7%) in comparison with patients without ASR (25.9±8.8%), р<0.005. 

Conclusions. The genetic nature of DCM syndrome is an important predictor of appropriate shocks and an independent selection criterion for ICD/CRT-D implantation. Age, NYHA class, and LV EF did not show prognostic significance. Additional predictors of appropriate shocks were sustained/unsustained VT, low QRS voltage, and the absence of LV hypertrophy signs on the ECG. 

Purpose. To assess the diagnostic value of scintigraphy parameters of sympathetic activity and mechanical dyssynchrony of the heart for prediction of the results of cardiac resynchronization therapy (CRT).
Material and Methods. The study included 28 patients with functional class III (NYHA) chronic heart failure referred for CRT. Before operation, a set of scintigraphic studies was performed to evaluate mechanical dyssynchrony, the state of cardiac sympathetic innervation, and perfusion. Clinical status, volume indices, and contractility of both cardiac ventricles were evaluated 6 months after CRT. After that, all patients were divided into 2 groups: group 1 included CRT responders (n=15); group 2 comprised non-responders (n=13).
Results. Significant differences between groups were found in the following baseline parameters: early heart-to-mediastinum ratio (H/M) (2.42 and 1.87; p<0.05), delayed H/M (1.89 and 1.78; p<0.05), left ventricular (LV) end-diastolic volume (EDV) (271 mL and 299 mL; p<0.05); LV end-systolic volume (ESV) (206 mL and 227 mL; p<0.05), and interventricular dyssynchrony (109 ms and 62 ms; p<0.05). Responders showed a strong correlation between delayed H/M and LV dyssynchrony (–0.795, p<0.05). According to logistic regression analysis, delayed H/M (OR=4.25; 95% CI 1.4–12.92; p<0.5) and interventricular dyssynchrony (OR=1.01; 95% CI 1.003–1.03; p<0.5) were statistically significant determinants of the response to CRT.
Conclusion. 123I-MIBG myocardial scintigraphy can be used to predict the effectiveness of CRT. Delayed H/M ratio and interventricular dyssynchrony are the independent predictors of response to CRT.

Aim. To study the structural and functional status of coronary blood flow in patients with acute coronary syndrome with nonobstructive coronary arteries using multispiral computed tomography (MSCT) and single photon emission tomography (SPECT) and to compare data of MSCT and invasive coronary angiography (ICA).
Material and Methods. This study is a non-randomized, open-label, controlled clinical trial. The study is registered on ClinicalTrials.gov. The inclusion criteria are listed on the site. All patients underwent CT and SPECT.
Results. The study included 14 patients with MINOCA; the group comprised predominantly women (n=11, 78.6%); the average age was 61.1±14 years. The risk according to GRACE (Global Registry of Acute Coronary Events) risk score was moderate in 8 patients (57%) and high in 5 patients (35.7%). 85.7% of patients were admitted to hospital within the first six hours from onset of diseases. Three patients (21.4%) received thrombolytic therapy and it was effective in two of them (14%). Risk factors included hypertension (64.2%), dyslipidemia (50%), and burdened history (71.4). According to the results of invasive coronary angiography, intact coronary arteries were detected in 9 patients (64.3%); 5 patients (35.7%) had stenosis up to 50%. Coronary slow-flow phenomenon (TIMI 2) was detected in 11 patients (78.6%) including 8 patients (57.1%) who had coronary slow-flow phenomenon and intact coronary arteries. Severe coronary spasm was registered in 1 patient (7.1%) in the group with ST segment elevation acute coronary syndrome (STE ACS). According to MSCT data, the proportion of patients with intact coronary arteries decreased from 7 (50%) to 5 patients (35.7%) whereas the proportion of patients with nonstenosing atherosclerosis increased from 7 (50%) to 9 patients (64.3%). Twenty six atherosclerotic plaques were detected including eccentric (76%), circular (11.5%), and semi-circular plaques (11.5%). In regard to morphological structure, the atherosclerotic plaques were calcified (59.5%), mostly calcified (7.7%), and soft (29%). Normal myocardial perfusion (Summed Stress Score (SSS) and Summed Rest Score (SRS) <4) was detected in two patients (14.3%); 12 patients (85%) had transitory perfusion defects. The median score values were 7.5 (4; 13) for SSS, 4.7 (1.0; 9.0) for SRS, and 4.7 (3.0; 8.0) for SDS.
Conclusion. The introduction of MCTA and SPECT into the algorithm of the examination of patients with acute myocardial infarction and non-obstructive atherosclerosis of the coronary arteries was safe when additionally used during index hospitalization. These approaches provided new information about the structure and function of the coronary arteries. These data provide rationale for further study using a larger group of patients to determine a prognostic significance of detecting the atherosclerotic plaques with the signs of instability in this patient category.

Objective. To identify associations of beta-adrenoreactivity with stage of chronic heart failure (CHF) in patient with previous
myocardial infarction (MI).
Material and Methods. A total of 50 patients with CHF underwent an analysis of adrenoreactivity based on the changes in red blood cell
osmoresistance in the presence of adrenergic blocker to determine the activity of the sympathoadrenal system a year after MI.
Results. Higher levels of beta-adrenoreactivity (β-ARM) were characteristic of patients with CHF of higher gradations: 61.8
(47.5;74.8) с.u. in patients with stage IIA CHF versus 48.7 (39;65.2) с.u. in patients with stage I CHF, p=0.037.
Conclusion. These results may suggest the diagnostic value of the indicator of adrenoreactivity and its possible use as a new
biomarker for assessing the severity of CHF in patients with previous myocardial infarction.

Objective: To compare the long-term results of coronary artery bypass grafting performed in the early period after stenting for acute coronary syndrome by bare-metal stents with the results of coronary artery bypass grafting in patients with coronary heart disease.
Material and Methods. The results of 24-month follow-up of step-by-step treatment of patients with acute coronary syndrome and multivessel lesion who received stenting of clinical-dependent artery with bare-metal stents as the first step and, then, underwent functional myocardial revascularization by aortocoronary bypass surgery within 90 days were analyzed. Results are presented as mean value and standard deviation (M±SD) in case of normal distribution and median with interquartile range in the form of 25 and 75 percentiles in case of non-normal distribution. The type of distribution of quantitative variables was assessed by the Lilliefors-corrected Kolmogorov–Smirnov test. Efficacy and safety assessments were carried out according to the criteria of non-inferiority in comparison with the literature data of myocardial revascularization by stenting. The differences were estimated using a two-way 95% confidence interval of the difference in adverse events based on the selected noninferiority design.
Results. Surgical revascularization of the coronary bed in the early period after stenting of the clinically dependent artery using bare-metal stents in patients with acute coronary syndrome and multivessel lesion was equivalent to coronary artery bypass grafting, except for the rate of repeated revascularization.

Objective. To compare the models of reverse remodeling of the right heart after the tricuspid valve repair with rigid or flexible rings.
Material and Methods. During the period from September, 2016 to February, 2018, 308 patients who had indications for intervention on the mitral valve and concomitant tricuspid insufficiency without significant differences in clinical status were randomized into two groups. Patients of both groups underwent intervention on the mitral valve with concomitant tricuspid valve repair by a rigid ring (Rigid group, n=154) or a flexible ring (Flex group, n=154)
Results. The perioperative mortality rates were 2.0% in the Rigid group and 2.5% in the Flex group (p=0.504). There was no difference in the pacemaker implantation rate (5.1% vs. 2.6%, p=0.238). Freedom from tricuspid insufficiency recurrence at 12 months follow-up was comparable (96.7% in the Rigid group vs 96.1% in the Flex group, p=0.521). The global systolic function of the right ventricle (fractional change in area, FAC; ejection fraction, EF) significantly increased in both groups (p<0.001 for both group) without significant intergroup differences (p=0.231 for FAC; p=0.156 for EF). Intergroup comparison of the regional systolic function (systolic excursion tricuspid valve, TAPSE; longitudinal velocity of the tricuspid valve, S’) showed that patients of the Flex group had significantly higher increases in the parameters (p<0.001 for TAPSE; p=0.002 for S’).
Conclusion. Both types of the devises had low rates of recurrence of tricuspid insufficiency at the midterm follow-up and contributed to the restoration of the global systolic function of the right ventricle. However, the rigid rings due to their design fix the tricuspid valve annulus, which inevitably affects the regional systolic function. In perspective, the flexible rings can function without interfering with the restoration of the natural shape of the tricuspid valve annulus and its uniform contraction during the cardiac cycle, thus ensuring a significant increase in regional systolic function.

The article focuses on the defects of diagnosing atrial fibrillation in clinical practice. A series of clinical cases suggesting ECGbased overdiagnosis of atrial fibrillation and associated unreasonable therapy with oral anticoagulants is presented.

Purpose. Pregnant women, due to physiological changes in the body, are more prone to cardiac arrhythmias, the frequency of which ranges from 5 to 18%. Paroxysmal supraventricular tachycardia (SVT) occurs in 14% of pregnant women with cardiac arrhythmias. In the treatment of cardiac arrhythmias, radiofrequency ablation (RFA) is currently preferred over antiarrhythmic drugs. However, RFA is associated with radiation exposure to the mother and fetus. The current level of development of arrhythmology provides a unique opportunity to eliminate cardiac arrhythmias without the use of fluoroscopic technologies, which completely excludes radiation exposure.

Clinical case. The article presents a clinical case of a 17-year-old patient diagnosed with idiopathic paroxysmal atrial tachycardia successfully treated in Cardiology Research Institute, Tomsk NRMC. When admitted to the hospital, the patient was at 31 weeks of pregnancy.

Conclusion. The described case shows the possibility and necessity of using non-fluoroscopic navigation systems when performing RFA in pregnant women. RFA using electroanatomic mapping allows to remove the burden of receiving antiarrhythmic therapy in pregnant women without the use of X-ray.

The relevance of this topic is due to the difficulties of diagnosis and management of patients with aortic dissection and the need for the interaction between doctors of different specialties whereas exact algorithm with clearly defined time frame for surgical treatment and overall criteria for choosing between conservative and surgical tactics of treatment in these patients are not currently available. This article presents two clinical cases illustrating the differences in clinical and anamnestic parameters and complexity of treatment of patients with aortic dissection as well as the organization of team work of specialists for the purpose of personalized approach to management of patients with extremely high cardiovascular risk.

Aim. The purpose of the experimental study was to determine the functional properties of the case with antibacterial and hemostatic preparations impregnated on it, to assess the biological safety and the effectiveness of using this medical device in an in vivo model on large laboratory animals (pigs).
Material and Methods. The article presents the first results of an experimental study of a domestic extracellular collagen matrix-based biological case “Bio-NEST” for implantable cardiac devices, impregnated with bioactive substances, in an in vivo experiment on large laboratory animals. The experiment was conducted in three chronological stages to analyze and evaluate the safety, efficacy, and histological compatibility of the biological sheath during implantation and reimplantation of cardiac devices using bioactive substances (antibacterial, hemostatic, and their combinations) as well as under the conditions of the established model of infection with pathogenic microflora implant pocket.
Results. Results of the study showed that the use of the experimental cover sample was safe for a laboratory animal. Experimental samples were biocompatible and did not cause inflammatory and immune responses. Implantation of cardiac devices in the sample of the case allowed preventing implant migration and development of infectious inflammation of the implant bed when the experimental cover was impregnated with a solution of rifampicin and aminocaproic acid.

Research goals. To study the effectiveness of RGD-peptide modification of the small-diameter biodegradable vascular grafts depending on the type of a linker and RGD configuration.
Material and Methods. Tubular scaffolds with a diameter of 1.5 and 4.0 mm were produced by electrospinning from polyhydroxybutyrate/valerate (PHBV) and polycaprolactone (PCL). The PHBV/PCL grafts were modified with RGD peptides. In vitro experiments showed the degree of erythrocyte hemolysis and adhesion of the platelets and endothelial cells when in contact with a modified surface. The physico-mechanical properties and the structure of graft surface were studied before and after modification. The PHBV/PCL and PHBV/PCL/RGD vascular grafts were implanted into the abdominal aorta of rats for the periods of 1 and 3 months. Explant samples were studied using confocal microscopy and histological methods.
Results. The results of physical and mechanical tests showed a significant decrease in the strength properties of the PHBV/PCL/RGD grafts relative to the unmodified analogs. A significant increase in platelet aggregation was found in the modified grafts. The level of adhesion of the endothelial cells on the modified surfaces was higher than that on the unmodified surfaces. Shortterm implantation of the grafts for 1 and 3 months showed that the modified grafts had higher patency and a less tendency to calcification compared with the unmodified grafts. Immunofluorescence study demonstrated the significant superiority of the modified vascular grafts in terms of stimulating the formation of a mature endothelial monolayer. A longer linker of 4,7,10-trioxa-1,13-tridecane diamine was found to increase the bioavailability of RGD peptides; the use of RGDK and c[RGDFK] for surface modification of the grafts stimulated early endothelialization of the internal surface of the implants and reduced the prosthetic wall calcification tendency, which together increased the patency of the implanted grafts.
Conclusion. In short-term implantation of biodegradable vascular grafts modified with RGD peptides, the grafts with RGDK and c[RGDFK], attached to the surface of the prostheses through the 4,7,10-triox-1,13-tridecane diamine linker, showed the best results in terms of endothelial adhesion and maintenance of the viability of the endothelial cells in vitro and endothelialization in vivo; these grafts had high patency after implantation into the bloodstream of small laboratory animals and a less tendency to calcification.

Background. The morpho-functional integrity of the structures of the wall of the venous conduit during coronary artery bypass grafting is the guarantor of the functioning of autovenous bypass grafts in the long-term period. Allocating a vein in a flap with surrounding tissues ensures minimal effect on the vein with better results in the long-term, but it increases the risk of wound complications. Endoscopic vein harvesting contributes to a significant reduction in wound complications. However, according to literary data, this technique can negatively affect the bypass grafts passability due to the effects of mechanical manipulations and exposure to carbon dioxide. Previously, we developed a method for the endoscopic vein extraction in a flap with surrounding tissues that does not require carbon dioxide insufflation.
Aim. The aim of the study was to assess the morphological and functional changes in the vein fragments harvested by the new original endoscopic method compared to the traditional open harvesting technique.
Material and Methods. The fragments of the great saphenous vein were studied after endoscopic and open harvesting. From the access in the knee area, a 3–5 cm fragment of the vein was openly harvested and was then used for the biopsy in the control group. Next, the vein was harvested endoscopically and the fragments of this part of the vein comprised the study group. Light microscopy of the sections, stained with hematoxylin and eosin, was performed to assess the structural integrity of the venous walls; the expression of CD 31 and E-Cadherin was determined immunohistochemically to assess the viability and function of the endothelium.
Results. The results of histological study suggested that the endothelium was more intact in the segments harvested endoscopically; moreover, immunohistochemistry data showed that the endothelium was more viable in these segments.

The aim. To determine gender differences in the prevalence of coronary heart disease in an open urban population.
Material and Methods. For a one-stage epidemiological study in an open urban population, a representative sample of 25–64-year-old residents was formed from the electoral lists of the Central Administrative District of Tyumen (n=2000) using a “random” mathematical method. The response rates of the study were 85.0% among men and 70.3% among women. The conclusion about the presence of coronary artery disease was carried out according to strictly standardized epidemiological methods. Definite CHD (strict criteria) and possible CHD (lax criteria) were distinguished based on the extended criteria.
Results. The prevalence rates of CHD in the open 25–64-year-old population were 12.4% in men and 10.0% in women. According to strict epidemiological criteria, the prevalence of painless ischemic heart disease prevailed in men; the prevalence of angina pectoris prevailed in women (predominantly at a young age). According to non-strict criteria, possible myocardial ischemia prevailed in men and women.
Conclusion. The results can serve as a scientific basis for primary prevention of coronary artery disease and also necessitate identification of the gender differences in the study of the profile of conventional and non-conventional risk factors and their relationships with the prevalence of CHD in an open population of the urbanized Siberian city.

The problem of ensuring the necessary level of availability of narcotic drugs (NLP) in the Russian Federation, especially in the framework of palliative medical care for oncological patients is the area of special and constant attention of the Government and civil society. Recently, a number of necessary changes of the legislation aimed at simplifying the procedures for prescribing and issuing NLP have been introduced, and the possibility of optimizing the rules for their storage and accounting as well as improving the methods for calculating the needs for such drugs are being actively discussed.
As part of the import substitution program in Russia, the new dosage forms for NLP are under development. Such process is accompanied by clinical studies with a number of features that take into account the specific chemical composition of finished products.