The aim of the study was to investigate the effects of bisoprolol and its combination with indapamide on blood pressure and cerebrovascular reactivity (CVR) in patients with arterial hypertension (AH) and rheumatoid arthritis (RA). Twenty five patients with AH and RA (age of 56 [53; 67] years; blood pressure (BP) of 145.5 [137; 157]/86 [82; 96] mm Hg) received bisoprolol or its combination with indapamide in a 6‑month open‑controlled study in parallel groups. Ambulatory BP monitoring and evaluation of CVR were performed twice: initially and at the end of the study. CVR was evaluated using transcranial Doppler ultrasound (TCD) of the middle cerebral arteries (MCA) in hyperoxia (HO) and hypercapnia (HC). Bisoprolol and its combination with indapamide decreased significant systolic and diastolic BP (p<0.05–0.01). Bisoprolol therapy did not affect MCA blood flow velocity during HO and HC. Combination therapy (bisoprolol and indapamide) significantly decreased MCA blood flow velocity by 18.1 and 8.3% during hyperoxia at min 1 and 2, respectively (p<0.05). Bisoprolol and its combination with indapamide had a significant antihypertensive effect in patients with AH and RA. Only combination therapy with bisoprolol and indapamide improved CVR in hyperoxia.

The aim of the study was to evaluate long-term antihypertensive and cardioprotective efficacy of renal denervation in patients with drug(resistant arterial hypertension. The study excluded patients with symptomatic hypertension, multiple renal arteries when the diameter of one or more arteries was less than 3 mm, and patients with severe kidney disease stage 4–5. According to these criteria, 73 people were selected for renal denervation procedure. Comparison of the initial data with the values obtained after 12 months demonstrated the presence of a significant continuous antihypertensive effect with blood pressure decrease by –29.1/–14.8 mm Hg in the office blood pressure levels and by –12.9/–7.8 mm Hg according to 24(h monitoring. The study showed a decrease in the myocardial mass of the left ventricle in individuals who initially had more pronounced left ventricular hypertrophy. 

In recent years, an increasing attention is paid to the development of vascular fibrosis in patients with arterial hypertension (AH). Particular importance is given to changes in the concentrations of matrix metalloproteinases (MMPs), which play a key role in the development of connective tissue disorders. As of today, research data on the levels of the MMP(2 and the MMP(9 in hypertensive patients and their changes due to treatments remain controversial. Data concerning the impact of renal sympathetic denervation on the changes in the MMPs concentrations in patients with resistant hypertension are unavailable. The objectives of the study were (1) to determine the contents of matrix metalloproteinases 2 and 9 and of their tissue inhibitor TIMP(1 in patients with resistant hypertension before and 6 months after the transcatheter renal artery sympathetic denervation; (2) to compare these parameters in cases of effective and ineffective invasive treatment; and (3) to study the interaction between the enzymes concentrations and blood pressure levels, including pulse pressure levels. 

The aim of the study was to evaluate the association of the polymorphism of T(786C of NOS3 gene and the polymorphism of T1565C of ITGB3 gene with the risk of development and progression of coronary artery disease in the population of the West Siberian region. The study included 242 patients with coronary artery disease (CAD), residing in the territory of the West Siberian region. The control group consisted of 162 residents of Tomsk without cardiovascular and chronic diseases. Genetic testing was performed by allele(specific PCR using SNP(express commercial kit (Lytech Company, Russia). Genotype distribution was assessed by a Pearson’s chi(square test (χ2) or Fisher’s exact test. A p(value <0.05 was considered to denote statistical significance. The genotype (786CC and the allele (786C of NOS3 gene were more common among patients with CAD than in the group of healthy volunteers (p=0.017 and p=0.007). The odds ratio for (786C allele was 1.51 [95% CI: 1.12–2.04]. Functional class (FC) III angina was most prevalent among carriers of the genotype (786CC compared with subgroups of (786TT and (786TC genotypes (p=0.044). Patients with genotype (786TC (p=0.033) had the lowest left ventricular ejection fraction. The allele 1565C of ITGB3 gene was more common among patients with CAD (p = 0.025), and the odds ratio developing CAD for 1565C allele is equal to 1.58 [95% CI: 1.06–2.35]. The allele (786C of polymorphism T(786C (NOS3) and the allele 1565C of polymorphism T1565C (ITGB3) were associated with the risk of CAD among the inhabitants of the West Siberian region. Patients with the genotype (786CC of NOS3 gene constitute the group of the risk for angina progression.

The aim of this study was to assess dynamics of left ventricular (LV) mechanics after coronary artery stenting in patients with stable ischemic heart disease. The analysis was performed in 52 stable ischemic heart disease patients (age of 58.16±8.94 years) with left ventricular (LV) ejection fraction (EF) of 55% and more. Percutaneous coronary intervention (PCI) was performed in all patients according to indications. Syntax score did not exceed 22. Two(dimensional echocardiography and Speckle Tracking Imaging were performed to assess the LV global longitudinal strain (GLSLV), global rotation, global rotation rate at systole and early diastole at the basal, apical, and papillary muscle levels, twist, untwist and torsion before and during the first week after PCI. Cardiac(specific enzymes including troponin I and creatine phosphokinase(MB (CPK( MB) were evaluated before, 6 and 24 hours after PCI in all patients. Cut(off value of CPK(MB and Troponin I for acute coronary syndrome were 25 U/L and more and 0.5 ng/mL and more, respectively. Normal GLSLV was found in 22 patients. GLSLV was decreased (less than –18%) in 30 patients. The patients with decreased GLSLV before PCI had delayed peak LV global rotation the levels of papillary muscles and the apex. The worsening of GLSLV after PCI was found in 24 (46.15%) patients and the improvement of GLSLV was detected in 28 (53.85%) patients. The values of the global rotation, global rotation rate at systole and early diastole, twist, untwist and torsion of LV did not differ in patients with positive and negative GLSLV dynamics. In patients with abnormal GLSLV before PCI and with its worsening after PCI, there was a decrease in time to peak of LV global rotation rate in early diastole at the basal level (509.50±68.28 ms, Ме=505.50 ms vs. 479.88±49.54 ms, Ме=488.00 ms; р=0.04), an increase in the time to peak of LV global apical rotation rate in systole (246.13±164.19 ms; Ме=89.50 ms vs 126.14±52.31 ms; Ме=126.00; U=9.50, Zadj=2.09; р=0.03), and a decrease in global apical rotation rate in early diastole (–17.70±22.25; Ме=–23.52 vs –52.65±24.11; Ме=–45.94; U=5.00, Zadj=2.60; р=0.009). We found a significant increase in Troponin I 24 h and CPK(MB 6 and 24 h after PCI in patients who had GLSLV worsening after PCI, but it did not exceed cut(off value for acute coronary syndrome. Conclusions. (1) There is GLSLV worsening in 46.15% patients after PCI. (2) GLSLV worsening after PCI in stable CAD patients is associated with an increase in cardiac( specific enzymes after PCI and GLSLV worsening caused by the coronary microembolization during PCI. (3) An increase in the time to peak of LV global rotation rate in systole at the levels of papillary muscles and the apex is an early marker of worsening of cardiac mechanics. (4) In patients with abnormal GLSLV before PCI and with its worsening after PCI, the time to peak of LV global apical rotation rate in systole was increased and global apical rotation rate in early diastole was decreased. 

The aim of the study was to develop the methodology for collecting and processing the scintigraphic data to determine myocardial reserve on gamma camera with a solid state cadmium zinc tellurium detectors. Sixteen patients with coronary artery disease and 9 healthy volunteers underwent dynamic cardiac SPECT with 99mTc(MIBI at rest and at pharmacological stress(test. The processing of the results included construction of the “activity–time” curves based on the identification of regions of interest in the cavity and the walls of the left ventricular (LV) myocardium. Myocardial blood flow reserve index was determined as a quotient of two ratios of mean values of counts from the myocardial area to the area under the LV cavity curve obtained in stress test and at rest. According to our data, mean value of myocardial blood flow reserve was 1.86 (1.59; 2.2) in group of healthy volunteers and 1.39 (1.12; 1.69) in patients with coronary artery disease. Cardiac dynamic SPECT(based value of myocardial blood flow reserve index <1.77 allows for identification of three-vessel coronary artery disease with sensitivity and specificity of 81.8 and 66.7%, respectively. Thus, we believe that the development of a methodology for the assessment of myocardial blood flow reserve by SPECT is a promising direction requiring further study and verification.

Coronary bypass surgery is the most effective and radical method for treatment of coronary heart disease, and most often performed under cardiopulmonary bypass that leads to numerous neurological complications postoperatively. Objective: to improve the diagnosis of changes in cerebral tissue perfusion by perfusion computed tomography (PCT) in patients with coronary heart disease and hypertension undergoing on-pump CABG. Materials and Methods. The study included 164 male patients, divided into 3 groups depending on the presence and duration of hypertension. PCT was performed before and after on-pump CABG. Results. Differences in perfusion rates of cerebral blood flow, both before and after the operation, depended on the presence and duration of hypertension. The most well preserved cerebral blood flow was determined in patients without history of concomitant hypertension. CBF indicators in zones A (43.8±4.6 mL/100 g * min) and M3 (49.4±5.6 mL/min * 100g) in patients with essential hypertension were below the threshold value of 50 mL/ 100 g * min. Postoperatively, CBF values increased in left M2, right M2, right M3, left L, and right L; CBV values increased in left M2 and right M2 only in patients with a long history of hypertension. 

The aim of our study was to compare the magnetic resonance imaging (MRI)(based structure of atherosclerotic plaques and cerebral vascular reactivity quantified by echocardiography. All patients underwent MRI of the carotid arteries. To assess the cerebrovascular reactivity, transcranial ultrasound of middle cerebral artery was carried out with quantification of blood flow parameters at rest and during stress tests: first with breath holding and then with hyperventilation, with calculation of reactivity index. Data showed a statistically significant association between MRI plaque structure and type of the reaction during breath holding in hypercapnic test, whereas no significant differences were found in hyperventilation test. In breath-holding test, 56% of patients with hypointense plaques on T1( and hyperintense plaques on T2-weighted MRI scans had unidirectional positive response to functional hypercapnic stress. On the contrary, pathologic unidirectional negative or negative response on a side of the stenosis was observed in patients with MRI evidence of hyperintense plaques on T1- and hypointense plaques on T2-weighted scans. Atherosclerotic lesions of the internal carotid artery with intra-plaque hemorrhage were accompanied with critical deterioration of cerebrovascular reactivity. Any hemorrhage to carotid plaque could probably be assumed as critical risk factor requiring removal of the plaque by carotid endarterectomy. High-resolution MRI of carotid arteries may be suggested as screening test for all patients in atherosclerosis risk groups. 

The aim of this study was to assess the early dynamics in parameters of heart biomechanics by standard and by 2 dimensional speckle tracking echocardiography in patients with acute primary anterior STEMI. The study comprised 35 patients aged 58.46±10.2 years. All of them underwent urgent reperfusion therapy delivered within the first 6 hours after onset of STEMI in 72% of the events. Echocardiography with 2D speckle tracking imaging was performed at day 1 (T1), 7 (T2), and 14 (T3) after STEMI onset (Vivid E9). The study did not show significant dynamics in the parameters of standard echocardiography. However, global longitudinal strain improved from T1 to T3 (p<0.05). This improvement occurred as soon as at day 7 after STEMI: from –10.8±3.15 (Т1) to –11.3±3.04% (Т2). Basal rotation and basal rotation rate were elevated and remained unchanged during the first 14 days after STEMI. Apical rotation was attenuated during the entire period of the study. Apical rotational rate at systole increased to day 14 after STEMI [from 53.09±26.2 (Т1) to 71.3±29.2 °/s (Т3)]. Twist did not change, but twist rate at systole increased to day 14 after STEMI [from 83.75±28.02 (Т1) to 101.76±36.89 °/s (Т3)]. Patients with adverse left ventricular remodeling underwent urgent reperfusion therapy later, than others (5.48±3.58 vs. 3.89±2.16 h). Increase in end diastolic volume was accompanied by the dynamics in global longitudinal strain: –10.85±3.46 (T1), –11.39±3.04 (T2), and –11.87±3.16% (T3) and by the changes in wall motion score index: 1.63±0.35 (Т1), 1.55±0.3 (Т2), and 1.44±0.3 (Т3) at day 1, 7, and 14, respectively.

The aim of this study was to investigate the efficacy and safety of percutaneous coronary intervention after thrombolytic reperfusion with indirect reperfusion signs in elderly patients with an acute ST elevation myocardial infarction. Materials and Methods. Patients aged ≥75 years with acute myocardial infarction and successful thrombolysis were included in this study. The criterion of exclusion was death in the first day of admission to hospital. A total of 96 patient charts were used for the analysis. In these patients, 31% of patients were selected for delayed PCI. In comparison, patients, not selected for PCI, were older, more often were women, more often had stroke in anamnesis, and less often presented with cardiogenic shock. Coronary angiography in patients with electrocardiographic signs of reperfusion demonstrated the presence of occlusion of infarct(related artery in 56.7% of cases. The stent implantation was performed in 70% of cases. The rates of recurrent myocardial infarction (ReMI) and lethality in patients aged ≥75 years with acute myocardial infarction (MI) as well as electrocardiographic signs of reperfusion after thrombolysis did not differ between groups of conservative therapy and delayed PCI: ReMI was 9.1% vs 6.7%; lethality rates were 13.6% and 10.0%, accordingly. The routine delayed PCI in elderly patient with acute myocardial infarction after successful thrombolysis is safe but its benefits still remains unclear.

The aim of the study was to determine the efficacy of a 15 mg single bolus of new domestic thrombolytic agent Fortelysin versus Tenecteplase in patients with acute myocardial infarction. A total of 78 patients within 6 hours of ST-elevation acute myocardial infarction (STEMI) were randomized into two groups. We analyzed clinical and medical history of the patients, timelines, and the effectiveness of the reperfusion approaches. It has been found that the application of a 15 mg single bolus Fortelysin was comparable in efficacy and safety with Tenecteplase in a standard dose based on body weight. 

Objective. The objective of the study was to examine the relationships of the paraoxonase 1 (PON1) level with the development of adverse outcomes in patients with non–ST(elevation acute coronary syndromes (NSTE(ACS) during the year of observation. Materials and Methods. The study included 75 patients with NSTE(ACS. The average age of patients in the sample was 61.1±9.5 years. Study patients comprised 31 (41.3%) men and 44 (58.6%) women. At day 10 of hospitalization, all patients produced PON1 determination in serum. Patients were divided into 2 groups: those with a favorable (n=55) and unfavorable (n=20) outcome [death from cardiovascular causes, unstable angina (UA), myocardial infarction (MI), chronic heart failure (CHF) decompensation, and acute cerebrovascular accident (CVA)]. Results. Reduction in the PON1 levels in serum to less than 4.7 ng/mL increased the risk of hospital readmission for UA during the year of observation in patients with NSTE-ACS by eight times (OR=8.3; 95% CI 1.7–42.1; p=0.002) and the risk of common adverse cardiovascular events by four times (OR=4.2; 95% CI 1.3–13.4; p=0.009). In this study, we investigated potential adverse prognostic role of PON1 in patients with NSTE(ACS. Data demonstrated that reduction in the PON1 blood levels to less than 4.7 ng/mL increased the one(year risk of an adverse outcome in patients with NSTE(ACS by four times. 

Despite the presence of multiple biomarkers, no “gold standard” has been identified yet to serve as a reliable tool for pharmacotherapy effectiveness monitoring, early diagnosis, clinical outcome prognosis, and risk stratification of patients with chronic heart failure with preserved ejection fraction (HFpEF) of the left ventricle. Goal: The goal of the study was to investigate correlations of the levels of serum transforming growth factor β (TGF-β1) with clinical, instrumental, and laboratory markers of HFpEF. Materials and Methods. This clinical and pathophysiological study comprised 27 patients with HFpEF. Results. Correlation relationships were found for left ventricular myocardial mass, intraventricular septum thickness, serum level of tissue inhibitor of metalloproteinases(1 (TIMP-1), and serum level of matrix metalloproteinase 3 (MMP-3). Multiple regression analysis demonstrated the presence of a relationship between TGF(β1 and TIMP-1. The study revealed relationships of serum TGF-β level with clinical and instrumental indicators of myocardial hypertrophy and serum levels of TIMP-1 and MMP-3 in patients with HFpEF. 

Risk factors of congenital heart disease (CHD) remain unclear. Here we investigated the association of the polymorphisms within the HLA&DRB1* alleles and CHD. We recruited 97 females and 59 males who had children with CHD. Genotyping was performed by allele-specific polymerase chain reaction. HLA&DRB1*03 and HLA&DRB1*11 were associated with a high risk (р=0.0007 and 0.0036, respectively). We concluded that the polymorphisms of the HLA genes may be associated with CHD. 

The aim of the study was to assess biochemical markers of myocardial injury, endothelial dysfunction, and heart failure (HF) in children with single ventricle (SV) a year after total cavopulmonary connection (TCPC) and to determine correlations of these biochemical markers with hemodynamic data before TCPC. Materials and Methods. A total of 29 patients with SV aged 3 to 16 years were involved in the study a year after TCPC with extracardiac conduit. The average patient age was 7.7 years ± 3.6 months. Patients were divided into two groups depending on HF (according to NYHA). Group 1 (NYHA I) included 13 patients; group 1 (NYHA II) included 16 patients. All patients underwent complete examination: electrocardiography (ECG), 24-hour Holter ECG monitoring, and echocardiography. Biochemical markers such as brain natriuretic peptide (BNP), N-terminal pro(B(type natriuretic peptide (NT(pro BNP), atrial natriuretic peptide (ANP), fatty acid binding protein (FABP), endothelin-1, and nitric oxide metabolite were assessed. Results. Median NT(pro BNP was elevated in group 2 [123.9 pg/mL (IQR: 52.9–370.5)]. Increased BNP level was observed in 27 children (93.1%) after Fontan procedure. Median BNP levels were elevated in both study groups [204 pg/mL (IQR:129–355) and 211 pg/mL (IQR:92–327), correspondingly]. Median endothelian-1 levels were high in both groups (44.4 (IQR: 14–100.3) and 42.3 (IQR: 6.2–155.8)]. Direct correlation relationship between NT-pro BNP level a year after TCPC and average pulmonary artery pressure before TCPC was found (r=0.54; р=0.04). Nitrogen nitrite level exceeded normal values in all patients. Significantly higher median nitrogen nitrate was found in study group 2 [22.52 (IQR: 31.47–28.95) and 27.94 (IQR: 19.84– 45.51), correspondingly], p=0.04. According to the individualized analysis, nitrogen nitrate level corresponded to normal values only in one patient with HF (NYHA II). At the same time, nitrogen nitrite level was elevated in all patients. Conclusions. NT-pro BNP and BNP levels a year after TCPC were elevated in most of the patients with SV (82.8%). The higher pulmonary artery pressure was before TCPC, the higher NT–pro BNP level was a year after the procedure (p=0.04). 

Physical performance is one of the criteria for human health. Evaluation of physical performance has great diagnostic and prognostic significance. The most strict and quantitative parameter useful for standardization of the exercise tests is peak oxygen consumption measured by the ergometry method. Aim: The aim of the study was to evaluate informativeness and safety of the cardiopulmonary exercise test in patients with ischemic cardiomyopathy. The study comprised data of 260 patients with ischemic heart disease and severe left ventricular dysfunction. Patients were operated in accordance with the principle of “Triple V” (ventricle, vessel, valve) during the period from 2012 to 2014. Physical  erformance was evaluated preoperatively and one to two years after surgical treatment. Statistically significant increase in peak oxygen consumption (p<0.05) and, therefore, higher quality of life of patients was found in groups of isolated coronary artery bypass grafting (CABG), CABG and mitral repair, and CABG and surgical ventricular restoration (SVR) of the left ventricle med-term after surgery. In patients with CABG, mitral repair, and SVR, an exercise-induced increase in peak oxygen consumption was insignificant. Cardiorespiratory test is an informative and safe method of study for the evaluation of the results of surgical treatment in patients with ischemic cardiomyopathy. This method involves physical exercise with control of vital signs of the organism. Patients with ischemic cardiomyopathy require surgical treatment based on “triple V” principle. Significant improvement of physical performance was found in groups of isolated CABG, CABG and mitral repair, and CABG and SVR.

The article highlights the problem of treatment for atrial fibrillation (AF) in patients with ischemic heart disease requiring direct myocardial revascularization. Although there is a growing number of surgical interventions for AF correction during coronary artery bypass grafting, two thirds of patients do not receive treatment. The objective of this prospective single center study was to compare a conventional method with combined two-step approach in treatment of this group of patients. The study showed that adding catheter radiofrequency ablation increases the effectiveness and does not affect the perioperative mortality in patients with atrial fibrillation and ischemic heart disease requiring coronary artery bypass grafting. 

The aim of the study was to evaluate the frequency of cardiac arrhythmias and the peak pressure gradient in the superior vena cava in patients after surgical correction of partial anomalous right pulmonary venous connection (PARPVC) in the superior vena cava (SVC). Analysis was performed in 49 patients with PARPVC in SVC. Patients were divided into 3 groups: (1) patients after intraatrial SVC plasty (n=18); (2) patients after Warden procedure (n=22), and (3) patients after modified Warden procedure (n=8). The flow velocity and the peak pressure gradient in SVC were measured before and after surgical correction. The frequency of heart arrhythmias was evaluated by electrocardiogram and Holter monitoring before and after the operation. Significant dynamics in the average heart rates was found in the group of patients who underwent intraatrial SVC plasty. The frequency of cardiac arrhythmias after surgery was 55.6%. The most common complication was sick sinus syndrome. Peak pressure gradient in SVC was 5.94±2.36 mm Hg (Me=6.00) before operation and 7.22±3.07 mm Hg (Me=7.00) after the surgery. There was no significant dynamics of heart rate after surgery in Warden procedure group. Cardiac arrhythmias were detected in 18.1% of patients in this group in early postoperative period. Sick sinus syndrome and pacemaker migration were detected more frequently after Warden procedure as well as in the first group of patients. Peak pressure gradients were 5.13±1.7 mm Hg (Me=5.00) before Warden procedure and 9.76±6.69 mm Hg after surgery (Me=9.00). Cardiac arrhythmias were not detected in patients who underwent the modified Warden correction. Peak pressure gradients were 6.00±1.19 mm Hg (Me=6.50) before the operation and 3.50±1.37 mm Hg (Me=3.00) after the correction in this group of patients. The lowest frequency of cardiac arrhythmias and increase in SVC pressure gradient were observed after surgical correction of PARPVC in SVC by the modified Warden procedure. 

The article is dedicated to the assessment of long(term results on prevention of systolic anterior motion of the mitral valve (SAM(syndrome) by Edge-to-Edge Alfieri technique without support ring and by Carpentier sliding leaflet technique with support ring implantation in patients with hypertrophic cardiomyopathy with obstruction of the left ventricular outflow tract. Materials and Methods. The study comprised 22 patients with clinical signs of obstruction of the left ventricular outflow tract. The median age was 52.81±15.57 years (23–73 years). All patients had signs of obstruction of the left ventricular outflow tract with an average gradient of 85.5±25.7 mm Hg. Surgical treatment was performed due to the ineffectiveness of therapy with β(blockers. Patients were randomly assigned to 3 groups: group 1 included 7 patients who underwent isolated septal myectomy; group 2 included 9 patients who underwent septal myectomy combined with Edge-to-Edge Alfieri technique trough transaortic approach; group 3 included 6 patients who underwent septal myectomy combined with mitral sliding valvuloplasty with annuloplasty ring by Carpentier method. Results. All patients underwent dynamic observation for up to 72 months. In the early postoperative period, one patient in group 1 required the implantation of a dual chamber pacemaker due to complete atrioventricular block. In group 2, 4 patients required implantation of a dual-chamber pacemaker. Patients of group 3 did not require pacemaker implantation. After surgery, mean left ventricular outflow tract gradient was 24.95±12.98 mm Hg in group 1, 16.62±13.06 mm Hg in group 2, and 18.36±15.24 in group 3 (p<0.05). After surgical treatment, residual mitral regurgitation grade was 1±0.81 in group 1 (1.83±0.75 preoperatively), 0.66±0.5 in group 2 (1.55±0.52 before surgery), and 0.82±0.32 in group 3 (1.76±0.62 before surgery) (p<0.05). The thickness of the interventricular septum was 16.33 ± 3.21 mm in group 1, 15±2.23 mm in group 2, and 13±2.14 mm (n. s.) in group 3. End diastolic value was 60.33±1.52 mL in group1, 75.78±7.87 mL in group 2, and 64.38±5.78 mL (n. s.) in group 3. End systolic value was 14.33±4.04 mL in group 1, 24.18±7.66 mL in group 2, and 26.02±4.46 mL in group 3 (n. s.). Conclusions. The results of the study show that the effectiveness of Alfieri technique in the elimination of the dynamic obstruction of the left ventricular outflow tract was comparable to the widely used Carpentier technique in long-term period (72 months) after combined myectomy. The main advantages of Alfieri technique included shorter time of myocardial ischemia necessary for its implementation and the ability to perform the upper part of the J-sternotomy. No differences in hemodynamics were found between groups for the entire observation period. 

Cardiac remodeling following myocardial infarction leads to impaired ventricular function and heart failure which remain a major cause of mortality and morbidity. The need to extend our knowledge about what factors lead to different outcomes of myocardial infarction has led to a research of immune-inflammatory pathways and molecular activities as the basis of post(infarction remodeling. Recently, macrophages, cells of the immune system, became a subject of scientific interest both under normal and pathological conditions. There are two subpopulations of macrophages: inflammatory M1 macrophages and M2 macrophages, which perform adaptive, regenerative, and anti(inflammatory function. One of the M2 macrophage biomarkers is scavenger receptor stabilin-1. M2 macrophages, expressing stabilin-1, mediate degradation of acetylated low-density lipoproteins and glycoprotein SPARC -secreted protein acidic and rich in cysteine), a universal regulator of wound healing, angiogenesis and tissue remodeling. The aim of this study was to show the presence/absence of myocardial stabilin-1-positive macrophages in patients with fatal myocardial infarction by means of immunohistochemistry. Data confirming the presence of stabilin-1-positive macrophages M2 allow for continuing further studies to identify the molecular profile and function of these cells in the development of adverse cardiac remodeling. 

Aim. The aim of the study was to investigate the function of sarcoplasmic reticulum (SR) in cardiomyocytes from patients with ischemic heart disease (IHD) associated with type 2 diabetes mellitus (T2DM). Materials and Methods. The study was performed with right atrial appendage trabeculae from patients with IHD associated with T2DM. SR function was evaluated through changes in the inotropic function of the isolated muscles in isometric contraction regimen during the post(rest test. Ca2+-ATPase (SERCA2a) levels were evaluated by Western blotting. Results. Study showed the existence of two different types of inotropic reaction. The first type was characterized by a preservation of the post(rest twitch amplitude at basal levels in patients with IHD or by an increase in the amplitude in patients with IHD associated with T2DM. The second type was characterized by a significant decrease in the inotropic response in the both groups of patients. Concentration of SERCA2a was higher in the myocardium from patients with the first type of inotropic response, being the highest in patients with T2DM. The myocardium of patients with the second type of inotropic response had low concentration of SERCA2a, without a significant difference between patient groups. Conclusions. Compared with IHD alone, combined development of IHD and short(term T2DM is characterized by preservation of SR Ca2 + transporting function and by higher concentration of SERCA2a, which may be important for defining treatment strategy and prognosis. 

The study examined the ability of к1-opioid receptors (OR) agonist, U(50.488, in doses of 0.1 and 1 mg/kg to simulate ischemic postconditioning of the heart. Duration of ischemia was 10 or 45 min and duration of reperfusion was 10 min or 2 h. Data demonstrated that the introduction of U(50.488 in a dose of 1 mg/kg both before ischemia and 5 min before reperfusion had a pronounced antiarrhythmic effect. Injection of U-50.488 5 min before reperfusion facilitated a decrease in the ratio of infarct area/area at risk by 2 times. Antiarrhythmic effect of к-OR agonists depended on the activation of к- OR. 

The parameters of respiration, the value of the transmembrane potential, and Са2 +-binding capacity of the mitochondria isolated from the Langendorff(perfused hearts of rats adapted to chronic continuous normobaric hypoxia were analyzed. Modeling of ischemia and reperfusion in intact and adapted animals resulted in reduced Са2 +-binding capacity of mitochondria, indicating an increase in the sensitivity of mitochondrial permeability transition pore (MPT(pore) to calcium ions. At the same time, reduction in transmembrane potential, reduction in ADP/O ratio (the ratio of added ADP to oxygen consumption in State 3), and inhibition of mitochondrial state 3 respiration were observed. Along with that, the study demonstrated that the adaptation of animals to chronic hypoxia promotes the resistance of myocardial mitochondria to the negative effects of ischemia and reperfusion. 

The method of laser(induced fluorescence was tested in the model of global ischemia and reperfusion by using isolated rat hearts. The device LAКK(M was used to register integral fluorescence signals. Induced radiation absorption peak and fluorescence intensity were significantly lower in the reperfusion suggesting lower degree, absorption rate, and radiation reflection. These characteristics imply the left shift of NAD+/NADH ratio which is one of key processes in ischemia and reperfusion injury. The method of laser(induced fluorescence is significantly sensitive to changes in this ratio. It allows for real(time registration of myocardial viability and may represent promising in situ diagnostic modality for myocardial diseases. 

The search for polymer compositions for the preparation of biodegradable stents, cardiovascular patches, and other surgical implants is particularly important nowadays. In this study, we assessed the degradation rate of the scaffolds prepared from biodegradable polymers and evaluated the morphological alterations of the tissues surrounding the implant in animal model. We tested polyhydroxybutyrate/valerate (PHBV, molecular mass of 404 kDa), PHBV+poly(D,L-lactide), and PHBV+10% polycaprolactone (PCL). In addition, we compared the scaffolds prepared by either casting or electrospinning. The degradation rate of the scaffolds prepared by casting was significantly lower than that of their electrospun counterparts. In addition, the scaffold degradation rates of PHBV+poly-D,L(lactide) and PHBV+10% PCL compositions were higher and lower rate compared to PHBV alone. 

The aim of the study was to investigate proprotein convertase subtilisin/kexin type 9 (PCSK9) concentration in men of different population subgroups, its associations with cardiovascular risk factors and with unfavorable 7(years long-term prognosis. The study took three subgroups of men from a population sample of residents of Novosibirsk, at the age of 44– 73 years, not using lipid-lowering drugs (including statins): the population subgroup (183 men), the subgroup with a hypercholesterolemia (46 men), and a subgroup with hypocholesterolemia (18 men). PCSK9 blood levels were determined by ELISA using the test-systems “Human Proprotein Convertase 9/PCSK9 Immunoassay” (R&D Systems). Long-term prognosis (myocardial infarction, cardiovascular death) were studied 7 years after the examination of population subgroups of men using data of the Register of Cardiovascular Mortality and Register of Myocardial Infarction. The outcome showed a normal PCSK9 distribution in population subgroups of men with hyper- and hypocholesterolemia and the abnormal distribution shifted to the left in the population group of men. Concentration of PCSK9 protein in the subgroup of men with hypercholesterolemia was by 1.2 times higher than in the population group of men. Statistically significant correlations of PCSK9 protein level with total cholesterol, LDL cholesterol, and glucose were found. PCSK9 variability was due to the influence of other factors only by 15% (R Square=0.155, p<0.001). Significant influences of HDL-cholesterol levels (Beta=0.238, p=0.023), TG (Beta=0.253, p=0.049) and LDL cholesterol (Beta=0.751, p=0.009) to protein PCSK9 blood level were revealed. Multivariate regression analysis showed a significant independent association of PCSK9 protein levels with the fact of cardiovascular death in a 7-year long-term period (p=0.048, OR=1.01). The results indicated that, in men with increasing blood levels of PCSK9 protein (by 1 ng/mL), the relative risk for cardiovascular death increased by 1% within 7 years after the examination independently of other parameters.

The study involved 80 healthy children with risk factors (RF) for hypertension: smoking, family history, and the combination of these risk factors. Control group consisted of 30 healthy adolescents without risk factors. Patients aged from 13 to 17 years (mean age of 15±0.31 years). The following basic indicators of vascular wall stiffness were determined: PWV, CAVI, and SAI. There was a significant increase in the indicators characterizing the rigidity of the vascular wall in all comparison groups relative to the control. In all adolescents included in comparison groups, initial changes in vascular wall stiffness were present requiring assigning them in group of risk for arterial hypertension and administration of preventive measures at pre(clinical stage of diseases. 

This preventive study comprised employees involved in production work of the Siberian Group of Chemical Enterprises (SGCE). The study demonstrated the high rates of the following risk factors for cardiovascular diseases (CVD) as prenosological criteria for pathology of cardiovascular system (CVS): overweight, hypodynamia, dyslipidemia, arterial hypertension, low adaptation potential, and low integrated index of somatic health. Data showed that the integral indexes characterizing CVS state and somatic health were closely associated with the hemodynamic (systolic and diastolic arterial pressure) and the somatometric (body mass index) parameters as well as with SCORE index representing 10(year CVD mortality risk. Leucocyte indices characterizing a degree of endogenous intoxication caused, in part, by adverse environmental factors, were associated with several hemodynamic and somatometric parameters as well as with the indicators of prenosological health. Obtained results provided a background for recommendation to incorporate the parameters aimed at early detection of health deterioration into the program of periodic health examinations. Our data allowed for an identification of the priority directions in developing the preventive measures for nuclear industry personnel. 

Introduction. Extracardiac conduit fenestration, the connection between systemic and pulmonary venous returns, is created to reduce the risk of postoperative complications in patients after total cavopulmonary connection (TCPC) procedure. Materials and Methods. From July 2009 to December 2015, 63 consecutive patients underwent extracardiac conduit TCPC with a fenestration of 4 mm. Six months after TCPC procedure, all patients underwent routine cardiac catheterization to solve the question of fenestration closure. Results. Before fenestration closure, systemic oxygen saturation was 84.9% (median: 85; range: 83–88), mean extracardiac TCPC circuit pressure was 9.27 mm Hg (median: 10; range: 7–11), transpulmonary pressure gradient (TPG) was 4.92 mm Hg (median: 5; range: 4–6). After fenestration closure in all patients, there was an increase of mean extracardiac TCPC circuit pressure less than 3 mm Hg from baseline 11.65 mm Hg (median: 13; range: 9–15). Systemic oxygen saturation was 94.6% (median: 95; range: 94–96), р<0.001. Conclusions. The optimal time for fenestration closure is six months after TCPC. Contraindications to fenestration closure are: baseline mean extracardiac TCPC circuit pressure more than 15 mm Hg, the increase of mean extracardiac TCPC circuit pressure after balloon occlusion more than 5 mm Hg from baseline, and the increase of TPG more than 10 mmHg.

Remote monitoring of patients with implanted cardiac pacemakers (ICP) and with implanted cardioverter defibrillators (ICD) is a reliable alternative to the ambulatory medical exams. It allows for early detection of changes in patient condition and cardiac stimulation system, saves patient time required for unnecessary ambulatory exams, and decreases physician workload. Reduction of time spent for planned visits to a doctor, on the one hand, and early diagnosis of life(threatening complications, on the other hand, provide significant economic effect and result in better quality of patient life. Aim: The aim of the study was to analyze the advantages of mobile telemonitoring for detection of abnormal work of stimulation system, complications, and undiagnosed disorders in heart rhythm in study patients. Materials and Methods. The study included 42 patients aged 65.71±11.30 years (Me)=67.00 years including 21 men (50%) with different diseases requiring implantation of two(chamber ICP. All patients were divided into 2 groups. Follow up period lasted for one year. Results: Follow up based on remote monitoring at early stage allowed for detection of the changes requiring medical intervention. Most patients from two groups did not have any changes in their condition and did not require regular ambulatory examination. Besides, the study found the intergroup differences between the numbers of hospitalizations and ambulatory visits during the year. Conclusions. Remote monitoring allows for detection of changes in patient condition and in ICP system work earlier than standard follow up examinations suggesting the advantages of remote telemonitoring. 

The aricle presents data on incidence and significance of risk factors for venous trombosis as predictors of pulmonary thromboembolism in patients with cardiac pacemakers. 

On the basis of archival material and periodicals the short review of research and practical work of students of the faculty of medicine of Imperial Tomsk University is given. 

A.T. Teplyakov: the 75th anniversary.