SUMMARY In order to study the dynamics of cardiac arrhythmias in patients with secondary atrial septal defect (ASD) examined 50 patients in the age of from 3 to 68 (mean age 24,2±2,1 years) with secondary defect investigated arrhythmias changes in the nearest (till 3 months) and remote (till 1 year) the periods after transcatheter closings of arial septal defect using the amplatzer septal occluder were examined. Already in 3 day after transcatheter correction marked decrease frequent (67,8 ±29,4 till 62,5±25 in hour) group supraventricular extrasystoles, disappear episodes paroxysmal atrial fibrillation and paroxysmal supraventricular taxycardias. By 6 months the disappearance of the group and reduction of frequent supraventricular extrasystoles. In relation to ventricular arrhythmias on day 3 observations marked deerease in the number of VEs (254,1±171,2 till 32,6±3,6 in hour), the complete disappearance of VEs high grade to 12 months. Thus, after transcatheter closure of ASD in the coming secondary (3 hours) and long-term (6-12 months). Deadlines are not observed occurrence of serious cardiac arrhythmias, and available undergoing a significant improvement towards a significant reduction in the number of premature beats until their complete disappearance. This fact confirms the effectiveness and safety of this method of treatment of secondary ASD. Key words: secondary interatrial septum defect, electrocardiographia, Amplatzer occluder, supraventricular and ventricular extrasystols.

SUMMERY The study included 40 patients with CTEPH of different severity. All patients underwent 2D and 3D echocardiography to assess structure and function of right and left heart chambers, ventricular interaction, and ventricular-vascular coupling. The study showed that patients with CTEPH had right and left ventricle remodeling with systolic and diastolic dysfunction. We also observed impairment of right and left ventricular-vascular coupling. Key words: CTEPH, echocardiography, heart remodeling, ventricular interaction, ventricular-vascular coupling.

SUMMERY According to the Russian data 34% of patients with pulmonary hypertension (PH) have complaints of chest pain. Currently, the cause of this symptoms can be as coronary heart disease, compression of the coronary arteries (usually the left main coronary artery) dilated pulmonary artery, coronary insufficiency due to low cardiac output is relatively weak development of coronary collaterals in the hypertrophy RV wall or a reflex constriction of the coronary arteries due to distension of the pulmonary artery, to the reduction of blood oxygen saturation in the late stages of the disease. Myocardial ischemia and chest pain reduce the quality of life of patients, and to be predictors of adverse outcomes. Therefore, treatment of these patients should be comprehensive and include PAH -specific and additional metabolic therapy. The therapy of the last group - trimetazidine - being actively researched in various pathologies, and shows the positive side in studies: the Cochrane meta-analysis of patients with ischemic heart disease. Trimetazidine has a pronounced anti-anginal efficacy and good tolerability in combination with other treatment, which will improve the quality of life of patients. Keywords: pulmonary hypertension, myocardial ischemia, chest pain, trimetazidine, metabolic modulator.

SUMMARY Objective: to assess the impact of cell plasma hemostasis disorders and the level of biomarkers on clinical outcomes and to develop laboratory diagnostic criteria forecast recurrent coronary events in patients with unstable angina. Material and Methods: the study included 124 patients with unstable angina. All patients were performed: complete blood count, to determine the level for TnI, the determination of inflammatory markers (hs C-reactive protein (CRP)), the level of myeloperoxidase, von Willebrand factor, the level of thrombin, fibrinogen (FG), antithrombin III (AT III), D-dimer, factor Xa), agregatogramm was performed an impedance aggregometer Multiplate and determining platelet activation by flow cytometry. All patients underwent ECG, echocardiogram, 24-hour ECG monitoring, coronary angiography. Results: developed independent predictors of the risk of recurrent coronary events in patients with unstable angina: the threshold values for evaluating platelet aggregation analyzer Multiplate-ASPI-test (AUC) >52 U, ADP-test (AUC) >60 U; the peak concentration of thrombin >294,5 nM, platelet size - MPV >9,6 fl, myeloperoxidase level >316 pmol/l, hsCRP >3.8 g/l, and troponin I >0,07 ng/ml. We created the scale of the prediction of recurrent coronary events after suffering unstable angina. In patients included to the study it was found that 18 patients (14.5%) recorded a decrease of sensitivity to aspirin (ASA)in the standard dose of 75 mg, in 24 patients (19.4%) to clopidogrel 75 mg and in 8 patients (6,5%) - both to ASA and clopidogrel. It was found that the resistance to ASA and/or clopidogrel more than 2.5 [CI, 2.0; 2.8] once increases the relative risk of recurrent ischemic events. Conclusions: developed by independent predictors of the risk of recurrent coronary events in patients with unstable angina: AUC ASPI- test>52 U, AUC ADP- test>60 U; the peak concentration of thrombin>294,5 nM, platelet size - MPV>9,6 fl, myeloperoxidase >316 pmol/l, high-sensitivity CRP >3.8 g/l, the level of troponin I>0,07 ng/ml. Keywords: unstable angina, resistance to ап^рШеШ agents, agregatogramm, cell and plasma hemostasis

ABSTRACT Objective: the aim of our study was to determine the optimal instantaneous wave-free ratio (iFR) cut-off points in assessing the functional significance of intermediate coronary artery stenoses in patients with chronic coronary artery diseases (CAD) using non-invasive methods of myocardial ischemia verification as reference. Methods: 60 patients with chronic CAD or suspected CAD and intermediate coronary stenoses (50-70%) were included in the study. 92 borderline coronary stenoses were investigated. iFR measurement was carried out within 10 days after the non-invasive stress test (a combination of stress echocardiography and SPECT). Results: stress-induced myocardial ischemia was detected in 18 patients (30%). iFR values are in the range 0.68 to 1.0, median of iFR - 0.95 [0.9; 0.99]. Area under iFR ROC-curve - 0.95 ± 0.02 (95%CI: 0.885-0.985). The iFR cut-off point 0.92 is optimal and has a sensitivity of 100%, a specificity of 83% and a negative predictive value (NPV) of 100%. The iFR cut-off point 0.86 is associated with a specificity of 100%, a sensitivity of 33% and a positive predictive value of 100%. The values of iFR «grey» zone ranged from 0.87 to 0.92. Conclusion: using non-invasive methods of verification of myocardial ischemia as a reference, iFR cut-off point 0.92 excludes the functional significance of coronary artery stenosis with a NPV of 100%. iFR cut-off point 0.86 confirms the functional significance of the stenosis with a PPV of 100%. It is recommended to measure the fractional flow reserve in the case of obtaining the iFR values of «grey» zone (0,87-0,92). Key words: iFR, CAD, stress-echo, SPECT.

ABSTRACT Objective. To study the association the aldosterone synthase gene (CYP11B2) C(-344)T polymorphism in ethnic Belarussians with essential hypertension (EH). Materials and methods. Genotyping of polymorphic marker C(-344)T of the CYP11B2 was performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) in 585 people (391 patients with EH and 194 subjects with normal or optimal blood pressure (BP)). Results. The prevalence of C(-344)T polymorphism genotypes of the CYP11B2 gene did not differ between the groups of hypertensive patients - CC, CT, TT genotypes were detected in 105 (26.8%), 182 (46.6%), 104 (26.6%), and healthy people - in 48 (24.7%), 97 (50.0%), 49 (25.3%), respectively. There were not obtained differences in the level of BP, grade of EH depending on the mutant allele T polymorphism C(-344)T of the CYP11B2 gene among the group of 208 patients without the antihypertensive treatment. Conclusions. In patients with EH of Belarusian ethnicity it was observed equilibrium distribution of the C (50.1%) and T (49.9%) alleles polymorphism C(-344)T of the CYP11B2 gene. The genetic polymorphism C(-344)T of the gene CYP11B2 was not associated with the development of EH in the groups as well as under or after 45 years and taking into account gender differences. Key words: essential arterial hypertension, aldosterone synthase gene, genetic polymorphism.

SUMMERY Objective: to evaluate the combination therapy efficacy and safety of bosentan and sildenafil in patients with idiopathic pulmonary hypertension (IPAH) in the case of clinical worsening of the underlying disease. To analyze the dynamics of clinical and functional status, the parameters of central hemodynamics and neurohumoral profile against the background of the appointment of combination of specific therapy. Material and Methods: the study included 50 patients with IPAH nonresponders functional class (FC) II-III (WHO). Patients were randomized into 2 groups of 1: 1 bosentan therapy at the starting dose of 125 mg/day titrated up to 250 mg across 4 weeks and sildenafil 60 mg/day. Of the 50 pts, 11 had marked clinical worsening IPAH to 3-10 months. Conducted 5 visits: within the framework of the initial and final visit, and the visit of clinical deterioration underwent a comprehensive examination, including right heart catheterization and research level neurohumoral status. At visit 2 in addition to test 6-minute walk surveyed the level of NT-proBNP. Results: clinical deterioration is characterized not only by deterioration FC 9% increase of the frequency of clinical symptoms and a decrease in distance in the test 6-minute walk (D6MH) by an average of 10 meters, but also an increase in systolic pulmonary artery pressure (SPAP) by 3,7 mm Hg. .st, right atrium area on 1,5 m².; increase in pulmonary vascular resistance (PVR) to 233 dyn*sec/cm^-5, slight decrease in cardiac output (CO), cardiac index (CI) and stroke volume (SV), according to right heart catheterization (RHC), as well as increase in NT-proBNP levels at 572 pg/ml, Tx B2 - 295 pg/ml, noradrenaline 128 pg/ ml and ET-1 0.4 fmol/l, a reduction of 6-keto pG F1a 82 pg/ml, adrenaline on. 18 pg/ ml, NO 13 pg/ml. Appointment of combination therapy resulted in improved clinical and functional status in the form of reduced weakness and shortness of breath, improve FC and D6MH growth by an average of 18 m., A significant decrease in SPAP by 9,5 mm Hg and PVR 336 din*sek/sm-5, some increasing CO, CI and SV, as well as the positive dynamics of indicators of neurohumoral status: NT-proBNP reduction of 400 pg/mL, Tx B2 to 432 pg/ml, norepinephrine at 115 pg/ml increase in NO metabolites level of 17 pg/ml. Appointment of combination therapy well tolerated. Conclusion: assigning specific combination therapy when the required criteria of clinical deterioration in 20% of patients with primary therapy bosentan±3 to 9 months. In 27% of patients in the group of sildenafil to 8±2 months. Combination therapy with bosentan and sildenafil for 7±2 months. from the beginning of the treatment leads to a significant improvement in functional class, a distance of 6MW test, central hemodynamic parameters; reduction of SPAP, lower NT-proBNP levels and increase levels of NO metabolites, 6-keto-PG F1 a, adrenaline. Key words: idiopathic pulmonary hypertension, bosentan, sildenafil, combination therapy.

SUMMARY Using atomic force microscopy performed morphofunctional state analysis (morphometry, adhesion strength and stiffness of the membrane) of neutrophils in patients with chronic obstructive pulmonary disease, depending on the presence of pulmonary hypertension. In mode power spectroscopy performed quantification of elastic modulus (Young's modulus) and strength of a cell membrane adhesion of neutrophils. The study showed that in patients with chronic obstructive pulmonary disease with pulmonary hypertension observed neutrophil activation (reduction in cell size, cell nucleus, increasing the number and height of the granules in the cytoplasm), a significant increase in the stiffness of the membrane (increase in the Young modulus) and strength of adhesion of neutrophils compared with the control and COPD patients without pulmonary hypertension Keywords: chronic obstructive pulmonary disease, pulmonary hypertension, atomic force microscopy, neutrophils, morphometry, the stiffness of the membrane, the adhesive force.

SUMMERY The main objective of the management of patients with atrial fibrillation (AF) is an effective prevention of ischemic stroke. For this purpose indirect and direct oral anticoagulants may be used. The choice of anticoagulant should be based on a comprehensive assessment of a number of factors - the presence of significant valvular disease, kidney function, potential drug interactions, risk of complications of anticoagulant therapy. Individual assessment of the profile of thromboembolic and hemorrhagic risks are largely determined by the age, can help choose an efficient anticoagulant with minimal risk of complications. In patients younger than 75 years, in the absence of contraindications to the use of direct oral anticoagulants, the drug of choice can be dabigatran, administered at a dose of 150 mg 2 b.i.d. Keywords: prevention of stroke, atrial fibrillation, cardiovascular disease, new oral anticoagulants.

SUMMERY It is estimated, that more than 140 million people reside at altitudes above 2500 m in 35 countries worldwide. High altitude residents display moderate erythrocytosis and mild-to-moderate elevation in pulmonary artery pressure. Howevere, in some indivudals, severe pulmonary hypertension develop with ensuing right ventricular hypertrophy and failure and thus representing a major public health problem in mountainous regions around the world. In this review, we discuss the history of discovery, clinical findings, diagnostic, treatment and prevention of the disease. Key words: hypoxia, high altitude, pulmonary artery pressure, pulmonary hypertension, right ventricular hypertrophy.

SUMMERY The patient with diagnosis of idiopathic pulmonary hypertension, functional class III (WHO) was treated by anticoagulants, diuretics. After 6 months of treatment with phosphodiesterase type 5-inhibitor sildenafil, there was observed the negative dynamic with systolic pulmonary arterial pressure, intolerance to exercises. The treatment goals were not achieved with sildenafil therapy. The transitioning from sildenafil to riociguat therapy was done. By 6 months of the riociguat therapy there was achieved the significant improvement of the functional and hemodynamic status. Ам^^ to the stratification risk scale the treatment goals were reached. Keywords: idiopathic pulmonary hypertension, phosphodiester-ase type 5 inhibitor, sildenafil, soluble guanylate cyclase stimulators, riociguat, risk assessment.