Actuality. It is known that each of the factors (arterial hypertension (AH) and age) has a negative effect on the remodeling of both the heart and vessels, while their combined effect has not been sufficiently studied. 

The aim. Assessment of manifestations of cardiac and vascular remodeling (by the example of common carotid arteries (СCA) and vasomotor endothelium function (right brachial artery)) in patients with AH degree I-III in different age groups.

Material and methods. The study involved 124 (86 men and 38 women) patients at the age from 27 to 81 years (average age of patients 55.7+1.01 years) with AH degree I-III. The presence and variant of myocardial remodeling with calculation of criteria of left ventricular hypertrophy (LVH), myocardial mass (MM) and MM index (MMI) of LV by indexation to the patient’s body surface area were studied in all patients by means of echocardiographic investigation (EchoCG) using the Vivid S5 3Sc-RS echocardiograph with a multifrequency sensor 2.0-3.5 MHz. Normal values of MM were considered to be 67-162 grams (g) for women and 88-224 for men, and MMI - not more than 95 and 115 g/m2, respectively. Types of LVH were determined according to recommendations of Pugliese N.R. et al. (2017), being subdivided into concentric (C) and eccentric (E) LVH. Ultrasound scanning was used to investigate CCA on both sides. The results of reactive hyperemia test on the right brachial artery and blood lipid profile were studied with the calculation of atherogenicity coefficient (AC). The data analysis was carried out with the help of Statistica 12 application package with determination of mean values (M), minimum, maximum and mean error (m), median and interquartile range for the CCA intima-media thickness (IMT). The Spearman rank correlation coefficient (r) was used to estimate the relationship between these variables. The significance level of all statistical tests was accepted at p˂0.05.

The results of the study confirmed the presence of cardiac and vascular remodeling in patients with AH of different degrees with the tendency to increase in older age groups. The CCA remodeling parameter values were also significantly higher in the groups of middle-aged and elderly persons, some of which also had atherosclerotic plaques (AP). The number of patients with disturbed endothelial vasomotor function also somewhat increased with age.

Conclusion. Thus, the age of the examined patients with AH had a significant influence on aggravation of the heart and vessel remodeling processes and increasing frequency of endothelial dysfunction development

The goal of research is to study the influence of the initial state of left ventricular myocardium, as well as the technical features of the coronary artery bypass graft (CABG) on the prognosis of the functioning of coronary shunts.

Materials and methods. 46 men, who had CABG for stable angina class III, were examined. 23 of them had 2 type diabetes mellitus (DM2), 23 of them did not have carbohydrate metabolism disorders. On the eve of the surgery, all patients underwent transthoracic echocardiography to determine the indicators of left ventricular function. Information about the technical features of the CABG were taken from the surgical reports. One year after the surgery, all patients underwent a coronary and bypass angiography.

Results. Occlusion of coronary shunts was detected in 10 patients with DM2, and in 6 patients without DM2 (p value for Fisher’s exact test is 0.177). A larger left ventricle end-diastolic and end-systolic diameter (p value for the Mann-Whitney test is 0.004; 0.012), as well as a larger left ventricle end-diastolic and end-systolic volume (p value for the Mann-Whitney test is 0.012; 0.006) were associated with the presence of coronary shunt occlusions in patients with DM2. Also in the group of patients with DM2, sequential venous shunts were significantly more frequently occluded (p value for Fisher’s exact test is 0.004). Dysfunctioning shunts were associated with abovementioned figures among patients without carbohydrate metabolism disorders.

Conclusion. The results of the research confirm the mutual confounding influence of risk factors on the prognosis after CABG

Objective: to conduct a comprehensive analysis of the clinical, functional, hemodynamic profile of patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) according to the Russian Registry.

Materials and methods: The study involved 30 patients with Eisenmenger syndrome, 25 patients with PAH associated with prevalent systemic-to-pulmonary shunts and 26 patients with PAH after defect correction. All patients had been entered in the Russian registry (NCT03707561). A comparative analysis of clinical, functional, hemodynamic parameters was held. The diagnosis was established by the algorithm proposed in the Russian guidelines for the diagnosis and treatment of PH (2016).

Results: The patients of three subgroups of PAH-CHD were comparable in age and sex. The time from the onset of symptoms to the final diagnosis in the first and second PAH-CHD subgroups was significantly longer: on average, it took three years to establish the diagnosis, whereas in patients with PAH after defect correction, on average, after 9 months the correct diagnosis was made (p=0,0006). Patients with Eisenmenger syndrome were characterized by significantly high values of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) according to right heart catheterization (mPAP (81,0 [72,0;92,0] mm Hg against 52,0 [41,0;75,0] mm Hg, p=0,001 and PVR 2329,0 [1333,0;2778,0] dyn*sec*cm-5 vs. 954,5 [591,0;1439,0] dyn*sec*cm-5, p=0,02) compared with the second subgroup of PAH-CHD, and significant decrease in arterial blood oxygen saturation (SpO2) (90,0 [85,0;93,0]% vs. 94,5 [92,5;96,0]% and 96,0 [92,0;98;0]%) compared with patients of the other subgroups (p=0,002).

Conclusions: Patients with PAH-CHD are a heterogeneous population, the division of which is presented in the clinical classification, and therefore have a different course of the disease. Analyzing the data of patients with PAH-CHD, we found various clinical, functional, physical and hemodynamic features of these patients. With comparable 6MWT and FC (WHO), patients with Eisenmenger syndrome have the highest values of PAP and PVR, as well as lower values of arterial blood oxygen saturation compared to other subgroups of PAH-CHD. In the group of patients with PAH associated with prevalent systemic-to-pulmonary PVR was significantly less compared to other groups of PAH-CHD. In patients with PAH after defect closure, the correlation between 6MWT and FC (WHO) and the area of the right atrium was detected. The obtained data can be useful in the choice of management of these patients

The aim of the study was to study the effect of combined chemotherapy in women with breast cancer (BC) on arterial stiffness and pulse wave by ultrasound examination of the common carotid artery (CCA) using echo tracking technology.

Materials and methods. 40 women with triple negative breast cancer aged 27 to 75 years (47.5±12.0) were examined initially and after chemotherapy with the inclusion of anthracyclines (doxorubicin), taxanes (paclitaxel) and platinum derivatives (cisplatin). Arterial stiffness parametres (β-stiffness index, Ep-elastic modulus, AC-arterial compliance, PWV-pulse wave velocity) and AI - augmentation index were studied in the distal CCA at a distance of 2 cm from bifurcation on an Aloka ProSound α7 ultrasound machine using echo tracking technology.

Results. After combined chemotherapy the parameters b, Ep, PWV not significantly changed (9,3±4,3 vs 8,9±4,5, р=0,63 ;128,73±65,9 vs 119,0±69,5 кПа, р=0,29 ; 6,7±1,5 vs 6,3±1,5 m/s, р=0,24 respectively). Statistically significant decrease in AI from 14, 5±11.3 to 11.1±10.6% (p=0.009) and an increase in AC from 0.72±0.25 to 0.87±0.3 mm2 / kPa (p=0.004) were demonstrated as well as decrease in systolic blood pressure (SBP) from 129.5±14.0 to 118.5±14.5 mm Hg (p=0.0001) and an increase in heart rate from 67.9±10.7 to 76.6±12.1 bpm (p=0.0004), lower the level of hemoglobin from 129.6±20.4 to 102.2±16.3 g / l (p=0.00001) and red blood cells from 4.7±0.4 to 3.3±0.6 1012 / l (p=0.00001).

Conclusion: In women with breast cancer in the early period after combined chemotherapy with the inclusion of anthracyclines (doxorubicin), taxanes (paclitaxel) and platinum derivatives (cisplatin), there were no increased stiffness of the common carotid artery. Pseudo-positive changes in the form of an increase in the extensibility of the vascular wall and a decrease in the augmentation index are explained by general hemodynamic changes in the form of a decrease in the SBP, an increase in heart rate, as well as anemia during chemotherapy.

Soluble guanylate cyclase (sGC) is a key signal-transduction enzyme activated by nitric oxide (NO). Binding NO with sGC - enzyme catalyzes the synthesis of a signal molecule of cyclic guanosine monophosphate (cGMP), which plays an important role in the regulation of processes that affect vascular tone, proliferation, fibrosis and inflammation. Impaired bioavailability and/or responsiveness to endogenous NO has been implicated in the pathogenesis of cardiovascular and other diseases. Pulmonary arterial hypertension (PAH) is a well-known complication of systemic connective tissue diseases (CTD) and ranks second among the most common types of PAH after idiopathic PAH (IPAH). The usage of organic nitrates and other NO donors has limitations, including non-specific interactions of NO with various biomolecules, lack of response and the development of tolerance following prolonged administration. Compounds that activate sGC in NO-independent manner might therefore provide considerable therapeutic advantages. The purpose of this article is to provide contemporary data on the management and treatment of patients, as well as the role of specific therapy and the place of riociguat in the treatment of patients with CTD associated PAH

Idiopathic pulmonary arterial hypertension (IPAH) is a rather rare cardiovascular disease of unknown origin and, at the same time, the most common form of pulmonary arterial hypertension (PAH). It is characterized by increased mean pulmonary artery pressure of ≥ 25 mm Hg and increased pulmonary vascular resistance of > 3 Wood units. One of the key components of IPH pathogenesis is the disorder in the prostacyclin pathway leading to hypertrophy of the smooth muscle and endothelial cells, fibrotic changes, inflammatory response and vasoconstriction, which results in small artery and arteriole remodeling. For severe cases of PAH, in Russia only used one drug acting on the prostacyclin pathway, i.e., iloprost for inhalation. However, this therapy has a number of restrictions on the use. Selexipag is the first selective oral prostacyclin IP-receptor agonist intended for the treatment of patients with PAH. The efficacy and safety of Selexipag in patients with PAH were investigated in GRIPHON study, the largest-scale clinical trial ever conducted in patients with pulmonary hypertension. The publication presents a case of successful use of Selexipag as a part of the combination therapy in a patient with IPAH.

Professor Oleg Shevchenko, Doctor of Medical Sciences, Chair of the Cardiology Department of the School of Continuous Medical Education at Pirogov Russian National Research Medical University of the Russian Ministry of Health, is celebrating his 70th anniversary on November 27, 2019.

Eliquis® (apixaban) was associated with a lower rate of major bleeding, stroke and systemic thromboembolic events compared to a vitamin K antagonist. Results show Eliquis was associated with a lower rate of major bleeding and comparable rates of stroke and systemic thromboembolic events versus dabigatran or rivaroxaban. This late-breaking presentation is one of 11 Bristol-Myers Squibb-Pfizer Alliance abstracts being presented at the European Society of Cardiology Congress 2019.