Chronic heart failure (CHF) is a typical outcome for all pathological processes affecting the cardiovascular system and is diagnosed in 1–2% of the population in developed countries. The strategy for managing patients with CHF involves the prescription of diuretics for the relief of volume retention syndrome in addition to pathogenetic pharmacotherapy. Considering the confl icting data concerning the effects of diuretics on the long-term prognosis and clinical course of CHF, a strict approach to the analysis of risk/benefit ratio is necessary while choosing a specific diuretic and determining its optimal dose and duration of use. The article reviews state-of-theart literature on the assessment of hydration status in patients with CHF. The euvolemia state, in which the optimal volume of fl uid is achieved in the body of a patient with CHF is viewed from the perspective of evaluating the efficacy and relevance of diuretic therapy.

Cardiovascular diseases (CVD) and chronic obstructive pulmonary disease (COPD) often coexist. Comorbidity of CVD and COPD is a serious modern medical and social problem. This article discusses the main risk factors that are common for COPD and CVD: smoking, infl ammation, a sedentary lifestyle, aging, and oxidative stress. Pathogenetic mechanisms underlying the relationship between COPD and CVD are also discussed.

Chronic heart failure (CHF) is an essential medical, economic, and social problem of the 21st century. Acute decompensated heart failure (ADHF) is a common cause of hospitalization and mortality in patients with CHF. The article presents the analysis of frequency, prognostic signifi cance, and features of renal failure onset in ADHF patients, as well as the effects of various groups of drugs used in the treatment of ADHF on the kidney function. Special aspects of administering these drugs are elucidated in the context of deteriorating kidney function.

Cardiovascular diseases (CVD) remain the leading cause of death in the structure of mortality. The methods of high-technology medical care have been developed to eff ectively fi ght the high prevalence of CVD. The achievements in surgical methods of treatment for coronary artery disease (CAD) are currently undeniable. An important social and economic objective of surgical treatment for CAD is to restore the occupational status of patients. According to various national sources, patients undergoing surgery are estimated to have working age. The proportion of elderly patients undergoing coronary artery bypass grafting (CABG) in other countries is higher. Despite the fact that people receiving surgical treatments in Russia are primarily of working age, the rate of return to work and the percentage of disability are higher. Economic damage due to these factors is signifi cant. There are several causes of this situation including the lack of uniform criteria of referring patients for medical and social examination after surgical myocardial revascularization.

Population ageing is a natural process characterized by the increase in life expectancy and by a growth in the absolute number and proportion of elderly and senile persons in the population. These demographic changes increase the need for medical and social care among the people of this age group and require the development and implementation of new public policies.

Objective. To identify the relationships between obesity and prognosis in patients after myocardial infarction within three years of observation, depending on the severity of post-infarction systolic myocardial dysfunction.

Material and Methods. The study design was based on a three-year follow-up retrospective analysis of patients from the register of acute coronary syndrome of Kemerovo city in 2015 (n = 1366). The main clinical outcomes, including death from all causes, recurrent myocardial infarction (RIM), cerebral stroke, hospitalization for unstable angina pectoris (UA), and decompensation of heart failure (HF), were assessed taking into account the initial values of the left ventricular (LV) ejection fraction (EF) in the groups of obese or non-obese patients who suffered from myocardial infarction. Obesity was defined based on body mass index (BMI).

Results. General obesity was detected in 282 patients (32.2%) at the time of myocardial infarction. Obesity did not adversely affect myocardial infarction outcomes in the general group of patients during the three-year follow up, but it was associated, as a protective factor, with the number of hospitalizations for UA only in patients with BMI ≥35 kg/m2 . Additional stratification of patients by LV EF showed a paradox of obesity and a decrease in systolic myocardial function from 41 to 49% in the group of patients with myocardial infarction and BMI-estimated general obesity. There was a significant decrease in the all-cause mortality rate within three years of observation in the obese patients with initially severe systolic dysfunction compared with that in patients with systolic dysfunction and initial BMI of less than 30 kg/m2 .

Conclusion. The presence of general obesity did not affect the development of an unfavorable outcome in the general group of patients within three years after myocardial infarction, with the exception of non-obese patients with severe systolic dysfunction who had the highest rate of total mortality. Regardless of the degree of post-infarction systolic myocardial dysfunction, obesity can be protective in regard to the development of UA in patients with a BMI greater than or equal to 35 kg/m2 . 

Objective. To study the pathogenetic and prognostic role of cytokines (tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β)) in the development of anthracycline-induced chronic heart failure (CHF).

Material and Methods. A total of 176 women with breast cancer who received anthracycline antibiotics as a part of polychemotherapy regimens were examined. Upon examination, the patients in remission were divided into two groups within 12 months after the completion of chemotherapy: patients with the development of cardiotoxic remodeling (group 1, n = 52) and women with preserved cardiac function (group 2, n = 124). All patients received echocardiography study before, during, and after chemotherapy. Biochemical blood tests were done to determine the levels of TNF-α and IL-1β before chemotherapy, immediately after it, and 12 months after chemotherapy completion. Determination of polymorphisms of the TNF-α (–308G/A, rs1800629) and IL-1β genes (+3953, rs1143634) was carried out by polymerization chain reaction.

Results. A higher level of TNF-α and IL-1β in group 1 was associated with the development of heart failure 12 months after the end of chemotherapy. The level of TNF-α over 7.5 pg/mL after the completion of chemotherapy allowed to predict the development of cardiovascular complications in women receiving anthracycline therapy with sensitivity of 44.2% and specificity of 75.8% (AUS = 0.600; 95% CI = 0.524–0.673; p = 0.035). The study did not reveal any significant differences in the frequency distribution for genotypes of 308G/A polymorphism (rs1800629) of the TNF-α gene and +3953 (rs1143634) polymorphism of the IL-1β gene in the studied groups.

Conclusion. Patients with breast cancer who developed anthracycline-induced heart failure 12 months after the end of chemotherapy had the increased levels of TNF-α and IL-1β suggesting the pathogenetic role of proinflammatory cytokines in the development of cardiac injury during anthracycline therapy. 

Determining the clinical course of disease in patients with hypertrophic cardiomyopathy (HCM) with the presence of symptoms of chronic heart failure (CHF) progression remains a complex and unresolved problem.

Objective. The objective of the study was to analyze the variants of clinical course in patients with CHF due to progressive LV dysfunction and to evaluate the prognostic role of myocardial fibrosis volume according to late gadolinium enhancement cardiac magnetic resonance (CMR) as a predictor of CHF progression to NYHA FC III.

Material and Methods. A comprehensive examination including cardiac echocardiography, Holter ECG monitoring, and late gadolinium enhancement CMR, was performed in 124 patients (79 men and 45 women, median age of 46 years) with HCM who were observed in Republican Scientific and Practical Centre “Cardiology”. The median follow-up was 41 months (from 25 to 58 months). The clinical endpoint was progression of CHF symptoms from NYHA FC I–II to class III requiring hospitalization.

Results and Discussion. Among 124 patients with HCM, CHF progression requiring hospitalization during the follow-up period was observed in 24 patients with preserved systolic function (LV EF > 50%). The 5-year survival rate was 83% (95% CI 76.5–90.1). As a new marker aimed at identifying patients at risk of CHF progression, the volume of myocardial fibrosis was analyzed using the late gadolinium enhancement cardiac MR. The level of fibrosis, associated with the progression of heart failure, was 20%. The log-rank test and Kaplan-Meier survival curves showed statistically significant diff erences (p = 0.001) in groups with fibrosis volume less than 20% and more than 20%. Event-free survival was 95.2% (95% CI 89.9–100%) and 32.1% (95% CI 17.9–57.4%), respectively. Multivariate analysis showed that the independent factors associated with CHF progression and associated hospitalization were age over 50 years (HR 5.9; 95% CI 2.3–15.1, p < 0.001), atrial fibrillation (AF) episodes (HR 5.6; 95% CI 2.2–14.2, p < 0.001), and percentage of myocardial fibrosis volume ≥20% according to cardiac MR data (HR 23.3; 95% CI 7.3–74.8, p < 0.001).

Conclusion. Based on the results of a multi-factor analysis, we identified a group of HCM patients at risk of CHF progression requiring hospitalization. These patients were over 50 years of age, had AF episodes, and a myocardial fibrosis volume ≥20%. 

Aim. To study the features of chronic heart failure (CHF) formation in patients with persistent atrial fibrillation (AF) depending on the phenotype of renal dysfunction.

Material and Methods. The study included 60 patients with persistent AF and CHF. To diagnose CHF, echocardiography study was performed and the concentrations of NT-pRoBNP and sST2 in the blood serum were determined. Renal filtration function was assessed by glomerular filtration rate (GFR) calculated based on creatinine and cystatin C. Plasma NGAL concentration was determined to assess tubular dysfunction. Three phenotypes of renal damage were identified. Group 1 included 14 individuals (23.3%) with isolated tubular dysfunction assessed by NGAL; group 2 included 14 patients (23.3%) with isolated glomerular dysfunction assessed by GFR (CKD-EPIcys); group 3 comprised 32 patients (53.3%) with a combination of tubular and glomerular dysfunction.

Results. The GFR value (CKD-EPIcre) below 60 mL/min/1.73 m2 was found in 36.7% of patients from groups 2 and 3. The concentration of cystatin C significantly diff ered between groups and was the highest in group 3. The value of GFR (CKDEPIcys) below 60 mL/min/1.73 m2 was detected in 76.7% of patients from all groups. The value of GFR (CKD-EPIcys) significantly diff ered between groups and was the lowest in group 3. When comparing serum creatinine and cystatin C in group 1, eight patients (57.1%) showed latent glomerular dysfunction, which manifested only in the concentration of cystatin C. A relationship was found between the level of DBP and NGAL (r = 0.44; p < 0.05). The correlations were identified between the parameters of left ventricular (LV) diastolic function and indicators of filtration function and tubular apparatus of the kidneys, namely: between E/e’ and NGAL concentration (r = 0.31; p < 0.05); between E/e’ and cystatin C concentration (r = 0,30; p < 0.05); between E/A and NGAL concentration (r = –0.36; p < 0.05); and between septal e’ and cystatin C concentration (r = –0.30; p < 0.05). Relationships were found between the concentrations of NGAL and sST2 (r = 0.44; p < 0.05) and between the concentrations of cystatin C and TIMP-1 (r = 0.39; p < 0.05).

Conclusion. The use of blood cystatin C to assess kidney filtration function allowed to detect latent glomerular dysfunction in 57.1% of patients with heart failure and persistent AF, which could not be determined by GFR (CKD-EPIcre). Patients with persistent AF developed CHF with preserved LV EF regardless of the phenotype of renal dysfunction. The severities of glomerular filtration and kidney tubular apparatus abnormalities correlated with the severity of diastolic dysfunction. Unlike clinical indicators and blood concentration of NT-proBNP, sST2 levels allowed to detect the diff erences in heart failure severity in patients with persistent AF depending on the phenotype of renal dysfunction: the lowest severity was observed in the presence of glomerular dysfunction; the highest severity was found in the presence of combined dysfunction. Glomerular dysfunction in patients with CHF and persistent AF was associated with the impaired collagen formation and TIMP-1 activation. 

Objective: The objective of this study is to assess the role of soluble ST2 (sST2) in developing adverse cardiovascular events (ACE) and fatal outcomes in patients with chronic heart failure (HF) during 18 [12.5; 35.5]-month follow-up period.

Results. Depending on the median of baseline sST2 levels, all patients were retrospectively divided into two groups: group 1 enrolled patients with sST2 levels < 31.5 ng/mL (n = 22); and group 2 comprised patients with sST2 levels ≥ 31.5 ng/mL (n = 26). In group 1, the sST2 levels were 27.27 [23.94; 29.23] ng/mL, which was 33.9% higher (p < 0.0000001) than in group 2 (41.28 [34.86; 50.17] ng/mL). ACEs were registered in 9 cases (40.9%) in group 1 and in 17 cases (65.4%) in group 2 (p = 0.025). Based on ROC-analysis, baseline ST2 levels ≥ 33.53 ng/mL were considered a biomarker to predict an unfavorable course of ischemic heart failure during 18 [12.5; 35.5] months of follow-up period with sensitivity of 78.9% and specificity of 62.2% (AUC 0.719; 95% CI 0.562–0.845; p = 0.0059).

Conclusion. The baseline sST2 levels may be considered a non-invasive biomarker allowing to predict the development of adverse cardiovascular events (ACE) and fatal outcomes in patients with chronic heart failure (HF) during 18 [12.5; 35.5] months of follow-up in addition to traditional risk factors.

Objective. To determine the risk of developing chronic heart failure (CHF) in patients with hypertension (HTN) depending on the actual arterial stiffness.

Material and Methods. The study included 175 patients with HTN without a verified diagnosis of heart failure. The average age was 48.5 ± 6.8 years. Patients underwent general clinical examination, volume sphygmoplethysmography assessments of cardio-ankle vascular index (CAVI), echocardiography study (left ventricular (LV) ejection fraction, LV diastolic function, LV myocardial mass index, indexed LV volume by echocardiography), and tests for serum N-terminal pro-B-type natriuretic peptide (NT-proBNP). Patients were divided into two groups depending on CAVI. Group 1 included 141 (80.6%) patients with CAVI < 9; group 2 included 34 (19.4%) patients with CAVI > 9.

Results. In patients of group 1, the level of NT-proBNP was 0.008 [0.006; 5.770], which was significantly lower than the corresponding value in group 2, where the level of NT-proBNP was 13.08 [0.01; 350.65] ng/mL (p = 0.041). Indicators of odds ratio (OR) and relative risk (RR) were also significant. The chance of developing CHF with CAVI > 9 increased by almost 7 times (OR = 6.9; 95% CI = 2.8–16.8), and OR of CHF onset was 4.1 (95% CI = 2.2–7.6). Sensitivity and specificity rates were 55.9% and 84.4%, respectively. Correlation analysis revealed a medium degree of dependence and direct relationships between NT-proBNP level and CAVI values (r = 0.35; p <0.05).

Conclusion. Serum level of NT-proBNP depended on the actual arterial stiffness. Patients with CAVI > 9 indicative of an increase in true arterial stiffness had a greater risk of developing heart failure assessed based on the level of NT-proBNP in the blood. Further studies are required to assess the effects of arterial stiffness, registered within the intermediate values of CAVI index, on the risk of heart failure onset. 

Aim. To evaluate factors of unfavorable annual prognosis of myocardial infarction (MI) complicated by heart failure (HF) with reduced ejection fraction (HFrEF) and associated with chronic cerebral ischemia (CCI).

Material and Methods. A total of 182 patients with Q wave myocardial infarction complicated by the left ventricular dysfunction concomitant with CCI were included in the study. Of them, 149 (81.9%) patients were men and 33 (18.1%) were women. The mean age was 60.4 (53; 69) years. All patients underwent echocardiography, color duplex scanning of the carotid arteries and examination by an interventional neurologist. Hard endpoints were collected within one year.

Results. The majority of the patients included in the study suffered from grade 2 CCI. Atherosclerotic plaques in the brachiocephalic arteries were found in 37.4% of patients; the degree of stenosis did not exceed 50% in all cases. 77 (46.1%) patients achieved hard endpoints within one year. Multivariate logistic regression showed that the most unfavorable predictor of poor 1-year survival was the presence of the positive history of ACVA [RR 7.33 (95% CI 1.97–27.32), p = 0.003], and the most unfavorable predictors of risk of adverse cardiovascular events included prior stroke [RR = 1.92 (95% CI 1.09–3.38), p = 0.025] and carotid atherosclerotic plaques [RR = 2.12 (95% CI 1.34–3.37), p = 0.001].

Conclusion. The presence of carotid atherosclerotic plaques and prior stroke affected the long-term prognosis in patients with myocardial infarction complicated by heart failure and chronic cerebral ischemia. 

Aim. To identify the features of the structural-functional state of the cardiovascular system in patients with pulmonary embolism (PE) in the presence of chronic heart failure (CHF) syndrome.

Material and Methods. The study included 231 patients diagnosed with PE at admission to the hospital. Patients were further divided into subgroups depending on the verification of the diagnosis by computed tomography and the presence of CHF syndrome.

Results and discussion. An increase in pressure in the pulmonary artery system contributed to the formation and aggravation of right ventricular systolic dysfunction, which acquired a greater prevalence and severity in the presence of CHF. This was confirmed by the echocardiographic signs of dysfunction of the right heart including increased linear dimensions of right cardiac chambers, right atrium volume index of 32.3 (29.4–37.9) mL/m2 versus 29.1 (26.6–32.3) mL/m2 (U = 1583.00, p < 0.001); greater prevalence of hemodynamic instability (proportion of patients with fainting or presyncope at hospital admission was 32% in the presence of CHF versus 16.7% without CHF; χ2 = 4,49, p < 0.05); and more significant increases in the laboratory markers of right ventricular dysfunction and injury included in the prediction model of adverse PE outcome [brain natriuretic peptide of 395 (204–789) pg/mL versus 104.2 (38.9–212) pg/mL (U = 1162.00, p < 0.001), high-sensitive troponin of 212 (194.5–297.6) ng/mL versus 184.8 (168.0–194.8) ng/mL (U = 279.50, p < 0.01), myocardial fatty acid-binding protein of 0.37 (0.18–1.2) ng/mL versus 0.2 (0.08–0.3) ng/mL (U = 530.00, p < 0.001), copeptin of 0.2 (0.05–0.92) ng/mL versus 0.09 (0.04–0.15) ng/mL (U = 563.00, p < 0.01), and reduced renal function]. 

Respiratory system remodeling plays an important role in the progression of congestive heart failure (CHF). Decreased oxygenation of the respiratory muscles during intense physical exertion in patients with CHF may aggravate respiratory failure and provoke hyperactivation of the inspiratory metaborefl ex, thereby aggravating exercise intolerance due to a decrease in muscular system perfusion. Respiratory muscle training can minimize the eff ects of inspiration metaborefl ex activation and prolong the duration of exercise.

Trial design. This is a prospective randomized trial with a sham control. The trial will include 40 adult patients of both genders with NYHA II-III CHF and with ejection fraction (EF) ≤ 49%. Patients will be randomized in a 1:1 ratio to either Active or Control group. Active group will receive four-week guided respiratory muscles training followed by 12-week guided aerobic training (treadmill walking). Control group will receive four-week sham respiratory muscles training (THRESHOLD® IMT breathing trainer with level slightly above 0), followed by 12 weeks guided aerobic training (treadmill walking). The primary aim is to compare the eff ect of diff erent training modalities on functional capacity (peak VO2 ). Secondary outcome measures include changes in respiratory muscle strength, serum biomarkers (NT-proBNP and ST2) and Angiotensin II. Health-related quality of life (MLwHFQ.23) and psycho-emotional state of patients also will be assessed.The study also planned an additional analysis with a suitable group of patients who were screened but refused to participate in the study.

Conclusion. Heart failure patients often give up exercise due to symptoms of shortness of breath and muscle weakness. We suggest that the training technique based on the inclusion of respiratory muscle training as the fi rst stage of cardiac rehabilitation will positively aff ect the eff ectiveness of subsequent aerobic training in patients with heart failure, by reducing the activity of RAAS and SAS and increasing respiratory effi ciency. 

Purpose. The aim of this study was to identify the signifi cance of myocardial viability indicators calculated based on cardiac magnetic resonance imaging (MRI) with delayed contrast, as predictors of the adverse course of postoperative period in the surgical treatment of patients with ischemic cardiomyopathy.

Material and Methods. A total of 178 patients underwent surgical treatment for ischemic cardiomyopathy from March, 2013 to December, 2017. All patients underwent preoperative cardiac MRI scan with paramagnetic contrast.

Results. The logistic regression analysis showed that the left ventricular volumetric indicators and the amount of residual viable myocardium, calculated using delayed contrast-enhanced MRI, were the essential predictors of favorable and complicated course of postoperative period in ischemic cardiomyopathy patients. In patients with a residual viable left ventricular myocardium amount over 64.5%, surgical ventricular reconstruction procedure may be performed with a low risk of early postoperative complications (OR 8.25, 95% CI 1.45-46.8, p = 0.017).

Conclusion. Cardiac MRI with delayed paramagnetic contrasting is a valuable method contributing to the preoperative identifi cation of a cohort of ischemic cardiomyopathy patients who can benefi t the most from surgical left ventricular reconstruction. 

Objective. To evaluate cerebral blood flow parameters and cerebrovascular reactivity indices based on data of functional tests in patients with Parkinson’s disease (PD) and vascular pathology.

Material and Methods. A total of 148 people were examined, divided into 4 groups: (1) main group comprised 24 patients with idiopathic PD; (2) comparison group 1 included 21 patients with vascular parkinsonism; (3) comparison group 2 included 26 patients with a diagnosis of chronic cerebral ischemia of severity degree 2 with no signs of parkinsonism; and (4) comparison group 3 included 77 patients with PD and cerebrovascular disease. All patients received transcranial duplex scanning of cerebral blood vessels (TCD) through the temporal window (Toshiba Aplio 500, Japan, 2–2.5 MHz sector probe) using standard protocols for the assessment of blood flow velocity characteristics. An assessment of cerebrovascular reactivity (reserve) was performed using the diagnostic and treatment complex “Carbonic”. The range of cerebrovascular and vasomotor hypercapnia reactivity to hypercapnia was evaluated in the “Testing of cerebrovascular reactivity” mode.

Results. A comprehensive study of cerebral blood flow parameters using functional tests suggested that the absence of changes in the cerebrovascular reactivity index (VRhyperCO2 ) observed in patients with idiopathic PD may be considered a differential diagnostic criterion for Parkinson’s disease and cerebrovascular pathology with Parkinson’s symptoms. 

Objective. To study the structural and functional retinal changes developed in cardiac surgery patients as a consequence of cardiopulmonary bypass and to identify the factors aff ecting the nature and extent of changes observed.

Material and Methods. Ten patients who underwent cardiac surgery under cardiopulmonary bypass (CPB) were studied. The ophthalmologic examination was performed before cardiac surgery and 10–14 days after the surgery.

Results. On days 10 to 14, after cardiac surgery, visual acuity was restored to the maximum; the perimetry indicators, the level of intraocular pressure, and the structures of the anterior segment of the eyeballs did not change signifi cantly. The ophthalmoscopy revealed the foci of ischemic edema in the fundus along with the fi rst- and second-order arteries in 30% of cases. The thickness of ganglionic and nerve fi ber layers decreased in one patient (10%), which may be associated with the intraoperative ischemia of orbital artery branches feeding the optic nerve. These changes had direct relationships with the level of maximum mean blood pressure (MBP) during CPB and the fl uctuation of absolute MBP values during CPB: MBP ≥ 90 mmHg during CPB was associated with the occurrence of ischemic foci in the retina in 100% of cases. If the diff erence between the maximum and minimum MBP levels during CPB exceeded 20 mmHg, the changes in the retina occurred more frequently (p = 0.0350) than in the cases where MBP fl uctuations during CPB were less than 20 mmHg.

Conclusions. The most signifi cant changes in the vision organs of patients undergoing cardiac surgery under CPB occur in the retina. Factors associated with the occurrence of pathological ischemic changes in the retina were fl uctuations in MBP during CPB (≥20 mmHg) and the absolute value of maximum MBP during CPB (>90 mmHg). 

The article provides a clinical case of a 58-year-old man with the fi rst clinical manifestation of chronic heart failure in the presence of a signifi cant decrease in the left ventricular ejection fraction. Left ventricular non-compaction cardiomyopathy was diagnosed by echocardiography. After 12 months, a cardiac contractility modulation device was implanted to the patient in the presence of disease progression despite optimal medical therapy. We assessed the course of disease, quality of life, exercise tolerance, and myocardial contractility of the patient before and six months after surgery. The methods of assessment were collection of patient complaints, physical examination, electrocardiography (ECG), fi lling out the Minnesota Living with Heart Failure Questionnaire (MLHFQ), sixminute walk test, spiroergometry, and echocardiography.

Introduction. The pathophysiological mechanisms of cardiac injury in Takotsubo syndrome are currently poorly understood. The role of adrenergic receptor (AR) subtypes in the development of stress-induced myocardial injury (SIMI) remains unclear.

Aim. To assess the role of β-ARs in the development of SIMI.

Material and Methods. The study was performed using female Wistar rats (n = 84). Rats were subject to 24-hour immobilization in the supine position to simulate SIMI. 99mTc-pyrophosphate radiopharmaceutical was used to determine the degree of cardiac injury.

Results. The study showed that β-AR blockade with propranolol reduced the degree of cardiac injury by 38.4%. Selective β1- AR antagonists, atenolol and nebivolol, led to 2.00- and 2.55-fold decreases in 99mTc pyrophosphate accumulation in the heart, respectively. Blockade of β2-ARs by a selective antagonist ICI-118.551 caused an increase in the degree of 99mTc-pyrophosphate accumulation in the heart by 34.6%. A selective β3-AR antagonist L-748337 did not affect 99mTc pyrophosphate accumulation in the heart.

Conclusions. The study showed that β1-ARs are involved in the damaging effects of stress on the heart during immobilization stress. β2-AR had a cardioprotective effect in immobilization. β3-AP did not play a significant role in the stress-induced cardiac injury with a single exposure to the stressor. 

Introduction. Cardiovascular comorbidity is a relevant problem in modern medicine. Comorbid pathology significantly worsens the quality of life and increases the likelihood of death in cardiovascular patients. The combination of diseases requires a comprehensive examination of the patient and the choice of optimal therapy. This work reviews the structure of cardiovascular comorbidity in outpatient patients of Krasnoyarsk, analyzes the most frequently prescribed medications, and makes conclusions about the need to highlight the problems of combined pathologies in outpatient practice.

Aim. To study the structure of cardiovascular comorbidity in outpatient patients in the city of Krasnoyarsk, to assess the frequency of comorbid pathologies in cardiovascular patients, and to analyze the extent of the prescribed therapy.

Material and Methods. A one-stage retrospective study analyzed 1,928 ambulatory medical charts of cardiovascular patients who visited the primary care physicians in the polyclinics of Krasnoyarsk in 2018. The material was statistically processed, and diff erences were considered statistically significant at p < 0.05.

Results. The prevalence of comorbid pathologies in cardiovascular patients reached 87% and tended to rise with the patients’ age. The study showed that coronary heart disease (CHD) and obesity were associated with type 2 diabetes mellitus (T2DM) in agreement with results reported in previous studies. 43.2% of patients achieved a blood pressure level (BP) < 140/80 mm Hg while on antihypertensive therapy. 46.8% of patients achieved total cholesterol (TCh) < 5.0 mmol/L while taking statins. Only 18.5% of T2DM patients and 15.9% of patients with chronic kidney disease (CKD) who were taking statins had TCh < 4.5 mmol/L. Heart rate (HR) < 70 bpm was reached in about 40% of patients taking b-blockers.

Conclusions. Comorbidity prevalence among cardiovascular patients of Krasnoyarsk city was high and tended to increase with the increase in patient age. Arterial hypertension (AH) and T2DM was the most frequent combination among patients with cardiovascular diseases (CVD). Administered antiplatelet, hypolipidemic, and antihypertensive therapies did not fully comply with the current clinical recommendations in regard to the regimen of administration, dosage, and rates of the treatment targets achieved. The study showed that cardiovascular diseases are most frequently combined with T2DM. In this regard, it is necessary to promote the population awareness of the primary and secondary prevention of these comorbid diseases.