Aim. The aim of the study was to assess the incidence of CI-AKI in patients with stable CAD in 2012 and 2017 respectively.

Materials and methods. 1023 patients with stable CAD and indications to the interventions with intraarterial contrast media administration were included in the study. 561 patients were enrolled in the study in 2012 and 462 in 2017 respectively& We conducted a prospective open cohort study (ClinicalTrials.gov NCT04014153). Preventive measures included the administration of 0,9% saline with the speed 1 ml/kg/h intravenously and 0,5 kg/ml/h for the patients with heart failure before and after the procedure. The patients enrolled in 2017 were older, had higher BMI and more risk factors of CI-AKI development. The primary endpoint was the development of CI-AKI.

Results. The rate of CI-AKI decreased by more than 3 times in 2017 in comparison with 2012 (6% vs. 18,5% respectively), in spite of the increase of the age of patients, increased use of metformin and higher number of risk factors. The difference was statistically significant (р<0,0001).

Conclusion. The prevalence of CI-AKI decreased 3 times in 2017 in comparison with 2012 (6% vs. 18,5% respectively), in spite of the increase of the age of patients and the number of their comorbidities. These results were obtained due to higher level of education of the doctors about the syndrome, preventive measures and methods of treatment.

Aim. To assess the effect of balloon pulmonary angioplasty (BPA) on structural parameters of the pulmonary arteries in inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Materials and methods. The study included 21 patients with an inoperable form of CTEPH. Assessment of clinical and hemodynamic parameters, pulmonary arteries diameters according to angiography, and structural parameters of the pulmonary arteries according to intravascular ultrasound (IVUS) in 11 patients was performed initially, immediately after BPA and after a series of BPA.

Results. In total 50 BPA were performed – series of 2.3 ± 1.5 BPA per patient. The observation was carried out for 165 (88; 248) days. After series of BPA there were found out positive changes of clinical and hemodynamic parameters, including functional class, distance in the 6-minute walk test, mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR). According to angiography there was observed a continued dilation of the arteries at the level of segmental arteries and the 1st order branches of subsegmental arteries after the first BPA. According IVUS measurements the greatest changes during the observation period were determined at the 1st and 2d order branches of subsegmental pulmonary arteries – increased outer and inner diameters, vessel lumen area, decreased vascular wall area. A statistical relationship was found out between the diameter of the 1st order branches of subsegmental arteries after BPA and mPAP (r = -0.74, p = 0.006), cardiac output (r = 0.71, p = 0.010), PVR (r = -0, 78, p = 0.003).

Conclusion. BPA in inoperable patients with CTEPH leads to a persistent enlargement of the ballooned vessel lumen. In the long term, there is a positive remodeling of the pulmonary arteries with the greatest effect at the level more distal than subsegmental arteries. The diameter of the vessels at this level has a strong correlation with the hemodynamic result of BPA. 

Objective: to study the relationship of behavioral RF of CVD with arterial stiffness and daily dynamics of central aortic pressure in women of different age groups.

Materials and methods: 161 women were examined, which were divided into 3 groups: 1st group – 52 young women from 18 to 30 years old (23.8±5.3 years old); 2nd group – 54 women from 31 years old until menopause (41±5.9 years); Group 3 – 55 women in the postmenopausal period (55.4±5.8 years). All volunteers underwent questionnaires, anthropometry, the study of arterial stiffness with the Doppler method and the method of volume sphygmography, daily monitoring of blood pressure with an assessment of vascular stiffness and central aortic pressure.

Results: the strongest relationship between smoking and arterial stiffness was detected in the 3rd group, with the number of cigarettes per day being more important. Moderate alcohol consumption in group 1 is associated with an increase in the rate of increase in blood pressure in the aorta (dp / dt) max (R = 0.35, p = 0.01) and an improvement in the daily dynamics of central and peripheral pressure. A strict limitation of the caloric content of the consumed products is associated with a decrease in the carotidfemoral velocity of the  cfSPV pulse wave (R = -0.2, p = 0.01) and an improvement in the characteristics of the reflected wave in all groups. Only in the 1st group, the use of 400 grams or more vegetables and fruits per day is associated with an improvement in rigidity. Low physical activity in the 3rd group is associated with an increase in the Weissler coefficient (R = 0.28, p = 0.04) and AASI (R = 0.29, p = 0.03).

Conclusion: behavioral RF of CVDs are interrelated with various indicators of arterial stiffness and changes in central and peripheral pressure in women of different ages. The most significant indicators can be used as markers for the development of subclinical changes in the vascular wall in women, depending on their risk factors in order to start preventive measures in a timely manner.

Aim: to study the association of rs2200733 polymorphism with antiarrhythmic efficacy of amiodarone, propafenone and allapinin in the prevention of atrial fibrillation (AF) progression.

Material and methods. In order to comparatively evaluate the effectiveness of antiarrhythmic drugs in the prevention of AF progression the analysis included 163 patients (54 (33.1%) – with persistent AF and 109 (66,9%) with paroxysmal) in age from 31 to 77 years (average age 52.16±12.64 years) with an initially restored sinus rhythm (pharmacological or electric cardioversion). To prevent relapse of AF one of the antiarrhythmic drugs (amiodarone, propafenone or allapinin) was recommended to patients. In order to identify the association of rs2200733 polymorphism in ATFB5 gene with AF the study included 69 patients who were initially diagnosed with paroxysmal (n=20) and persistent AF (n=49). The control group (n=30) consisted of individuals of Uzbek nationality without AF in age from 30 years to 77 years. Genotyping of samples for the allelic carriage of rs2200733 polymorphism was performed by PCR-RFLP. The results are presented as M ± SD.

Results. It was shown that a persistent form of AF is prognostically unfavorable for AF progression. Moreover, in patients with AF progression the initial body mass index was significantly higher and a higher risk of  developing heart failure was observed in the dynamics. The results indicate the predominance of the CC genotype and C allele of rs2200733 polymorphism in Uzbek patients with AF. A similar analysis performed in the control group (without AF) also showed a significant prevalence of the C allele and CC genotype. The association of TT genotype with a risk of AF was shown, since AF was more common among TT genotype carriers compared with CT and CC genotypes carriers (90% versus 67%, p<0.001). The limiting effect of TT carriage on the antiarrhythmic efficacy of the reference drug, amiodarone, in patients with AF was also noted.

Conclusion. Thus, our study showed that the TT genotype of rs2200733 polymorphism is a genetic marker of the AF risk in Uzbek population. Carriers of TT genotype of rs2200733 polymorphism also have the most unfavorable prognosis for AF progression. Genotyping of the rs2200733 polymorphism in Uzbek patients with AF will allow differentially prescribing antiarrhythmic drugs and timely conduct procedure for radical elimination of arrhythmogenic substrate using radiofrequency ablation.

Purpose. To evaluate the association of clinical factors of cardiovascular risk with an increased heart rate (HR) in the population of Mountain Shoria, depending on ethnicity.

Material and Methods. The study involved residents of the villages of Mountain Shoria aged 18 years and older. Included are 901 people – representatives of indigenous nationality (Shors), 408 people – of  nonindigenous nationality. The groups did not differ by gender and age. The analysis was carried out depending on the increased level of heart rate (over 80 beats/min). As markers, we analyzed the factors used to stratify the overall cardiovascular risk.

Results. In the population of Mountain Shoria, the prevalence of tachycardia was 21.1%: 19.3% among Shors and 24.2% among non-indigenous people (p = 0.030). Interethnic differences in increased heart rate were determined by the following cardiovascular risk factors: male gender, smoking, hypertriglyceridemia, low levels of high density lipoprotein cholesterol and high low-density lipoprotein cholesterol. The risk of this pathology, both in the group of Shors and non-indigenous people, was increased in individuals with arterial hypertension [OR = 3.50; 95% CI (2.31-5.32) and OR = 4.06; 95% CI (2.37-6.95)] and diabetes mellitus [OR = 2.10; 95% CI (1.19-3.72) and OR = 2.64; 95% CI (1.33-5.27)], respectively. In addition, the odds ratio for tachycardia increased among indigenous people who abuse alcohol [OR = 1.60; 95% CI (1.01-2.60)]; among representatives of an indigenous ethnic group with hypertriglyceridemia [OR = 1.86; 95% CI (1.19-2.93)].

Conclusions. Ethnic features of associative relationships between tachycardia and cardiovascular risk factors have been established. A wide range of markers associated with increased heart rate suggests a further more detailed study of these relationships.  

Purpose of the study: to assess the role of educational programs on anticoagulant therapy in patients with atrial fibrillation in increasing adherence to warfarin treatment.

Material and methods: the study included patients with atrial fibrillation, divided into two groups: the main group (n=125) - patients who completed the training program, and the control group (n=216), randomized for routine care, without training sessions. Comparison of the groups were comparable in sex (55.8% of men and 44.2% of women – in main group and 62.4% of men (p<0.3) and 37.6% (p<0.3) - in the control group) and age (64.0±10.4 and 62.0±11.4 years, respectively, p<0.1). Stroke risk was assessed using the CHA2DS2-VASc scale.

Results: the average CHA2DS2-VASc score in the main group was 2.4±1.2 for men and 3.4±1.2 for women. In the control group, this indicator was 2.5±1.3 for men, and 3.5±1.2 for women. Although the number of patients who regularly took warfarin in the main and control groups did not differ significantly (61.4% and 54.9%, respectively, p=0.2), the number of patients who took oral anticoagulants (warfarin + rivaroxaban) in the main group was 85.5%, which turned out to be significantly higher than the data of the control group - 61.5% (p=0.002). Among the patients who underwent training, there were significantly more people who regularly monitor INR, comparing to control group (80.4% versus 44.0%, p=0.005). At the same time, the number of patients who achieved the target INR in the main group was also significantly higher in comparison with the control group (66.7% versus 36.0%, p=0.04).

Conclusion: conducting a course of educational programs among patients with atrial fibrillation increases adherence to the prescribed treatment with warfarin. This is manifested by increased number of patients, who regularly take the drug and monitor INR, as well as a significant increased number of patients who have reached the target INR levels.  

It is known that the frequency of orthostatic hypotensive reactions (OHR) increases with age and is often found in elderly and senile people with arterial hypertension (AH), negatively affecting their quality of life. A large number of studies indicate an association of OHR with an increased risk of cardiovascular complications, cognitive impairment and mortality, especially for middle-aged and elderly people (up to 65 years). The prognostic role of OHR for older patients with AH is currently uncertain. In addition, there are still a number of unresolved issues regarding the detection of OHR in this category of patients and the determination of treatment tactics. This review presents a modern classification of orthostatic hypotensive reactions and features of their clinical manifestations in elderly patients with AH. Particular attention is paid to the analysis of the results of studies on the prognostic role of OHR in hypertension patients in increasing the risk of developing coronary and cerebrovascular complications and cognitive impairments. The features of antihypertensive therapy in hypertensive patients with OHR are considered, as well as modern recommendations on drug and non-drug methods of treatment of OHR are presented.

A comparative analysis of the effectiveness of two classes of drugs – angiotensin converting enzyme inhibitors (ACEI) and angiotensin II type 1 receptor blockers (ARBS II) in the prevention of cardiovascular diseases is presented. The advantage of ACEI over ARB II in reducing total and cardiovascular mortality, myocardial infarction, brain stroke, chronic heart failure, and chronic kidney disease is shown. The reasons for the different effects of inhibitors of the renin-angiotensin-aldosterone system on the course of cardiovascular pathology are explained by the mechanisms of therapeutic effects of ACEI and ARB II. The antihypertensive  effect of ARB II is provided by selective blockade of AT1 receptors for angiotensin II (at II). As a result of the blockade, an additional amount of at II accumulates in the blood, which binds to AT2 receptors, contributes to the appearance of a number of negative phenomena. Stimulation of AT2-receptors (possibly also AT3-, AT4-receptors) unutilized at II leads to apoptosis of the structural elements of the arterial wall, its fibrosis, sclerosis and hypertrophy, inhibition of coronary remodeling with impaired neovascularization of the myocardium, as well as increased proatherogenic and inflammatory processes in the endothelium, possibly in the heart tissue. Stimulation of AT2 receptors also promotes leukocyte-dependent release of matrix metalloproteinase I, which leads to the destruction of extracellular matrix proteins, thereby destabilizing the atherosclerotic plaque,  leading to its rupture, which is a possible reason for increasing the risk of myocardial infarction during treatment with sartans. The cascade of these negative effects may be the main mechanism of IHD destabilization in the appointment of ARB II. Unlike sartans, the therapeutic potential of ACEI is realized through the blockade of at II synthesis, without affecting the work of the receptor apparatus, so the above adverse effects associated with the accumulation of at II do not occur. An important physiological feature of ACEI is their ability to increase the level of bradykinin, which has a positive effect on the vascular wall, reduces their stiffness by increasing prostaglandin synthesis, demonstrates antioxidant and anti-apoptotic effects, leads to a decrease in afterload and stimulation of angiogenesis. It is these mechanisms that underlie the more pronounced cardioprotective effect of ACEI in contrast to ARB II.