Study aim. To investigate whether the shape of calcium phosphate bions (CPB) affects their endothelial toxicity via evaluating the cytokine secretion profile of endothelial cells upon the exposure to either spherical or spindle-shaped CPB.

Material and methods. For the experiments, we used an immortalized human vein endothelial cell line EA.hy 926. Cells were seeded into 6-well plates (3*105 cells) with the further: 1) addition of 100 |jL either spherical CPB, spindle-shaped CPB, or 1x phosphate buffered saline (PBS) upon 1 h following culture for 24 h (non-confluent cell culture); 2) culture for 44 h and subsequent addition of 100 jL either spherical CPB, spindle-shaped CPB, or PBS following culture for 4 h (confluent cell culture). Upon the collection of cell culture supernatant (n=11 wells per group), the levels of proatherosclerotic cytokines (interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, IL-23, tumor necrosis factor (TNF)-a, interferon (IFN)-y, and soluble vascular cell adhesion molecule (sVCAM)-1) were measured utilizing an enzyme-linked immunosorbent assay.

Results. In a non-confluent cell culture, exposure to spindleshaped CPB increased the secretion of several proatherosclerotic cytokines (IL-1 ß, IL-10, IL-12, IL-23, IFN-y) compared to either spherical CPB-treated or control cells. In a confluent cell culture, exposure to either of CPB types decreased the release of IL-1 ß, IL- 10, and IFN-y; however, their concentration was still higher upon the exposure to spindle-shaped CPB in comparison with exposure to spherical CPB. Discriminant analysis and principal component analysis demonstrated that the cytokine secretion profile of spindle-shaped CPB-treated endothelial cells significantly differed from those of either spherical CPB-treated or control cells.

Conclusion. Spindle-shaped CPB induce the secretion of proatherosclerotic cytokines by endothelial cells compared to spherical CPB; this suggests higher endothelial toxicity of spindleshaped CPB.

Objective: the aim of the study was evaluation of the clinical significance of high residual platelet reactivity in patients with unstable angina and coronary arteries stenting in the inpatient and outpatient monitoring and development of optimal ways of correction of this condition.

Material and Methods: the study included 131 patients with unstable angina after coronary stenting. The main group represented 78 patients (UA) underwent dynamic observation of platelet aggregation (Multiplate aggregometer) on the inpatient and outpatient observations (7 day, 1 month, 6 months, 12 months, 18 months) to identify primary and secondary resistance to antiplatelet agents with subsequent correction of antiplatelet therapy. The control group consisted of 53 patients with standard therapy with antiplatelet agents without control of platelet aggregation. All patients were performed: general blood analysis, biochemical blood analysis with determination of the level of TnI, C-reactive protein, myeloperoxidase, von Willebrand factor, and fibrinogen; the test of thrombin generation, also ECG, EchoCG, 24-hour ECG monitoring, coronary angiography. The Republican Scientific and Practical Center Cardiology, Minsk, Belarus

Results: the results of our study showed a reduction in sensitivity to clopidogrel at 24,4% of patients with UA and stenting of the coronary arteries, of which the original clopidogrel in 7,7% of patients, generic clopidogrel 16,7% pts. Reduced sensitivity to acetylsalicylic acid was detected in 17,9% of individuals with UA. Laboratory resistance to ASA and/or clopidogrel increased the relative risk of recurrent cardiovascular events more than 4 times [CI 2,9; 5,6] during the 18 months of observation in comparison with a group of pts with no signs of resistance to antiplatelet agents.

Conclusions: execution of aggregatogram to patients with unstable angina and stenting of the coronary arteries allows to identify patients with high residual platelet reactivity, to correct of antiplatelet therapy and to reduce the number of repeat cardiovascular events in patients with signs of laboratory resistance to antiplatelet agents.

Pulmonary arterial hypertension (PAH), associated with congenital heart disease (CHD) (PAH-CHD), despite the similarities of histological lesions, is а different from other forms of PAH. PAH-CHD is represented by a heterogeneous patient population with varying defect locations, concomitant diseases, indications and contraindications to surgical correction; also, some patients have a history of a defect closure. According to the European guidelines for the diagnosis and treatment of pulmonary hypertension 2015, there are four main groups in the clinical classification of PAH-CHD: 1) Eisenmenger’s syndrome, 2) PAH associated with prevalent systemic-to-pulmonary shunts, 3) PAH with small/concidental defects, 4) PAH after defects correction. The evolution of the guidelines for the surgical correction of CHD has seen in recent years. Risk stratification has a great importance for further prognosis, response to treatment and timing of surgical correction. For optimal treatment carefulness and expertise in diagnosis and differential diagnosis should be exercised. A better understanding of clinical features, risk stratification and the assessment of the impact of a genetic background will help to determine the best clinical management, which is associated with better quality of life and improved survival in patients with PAH-CHD.

The register is an organized system for collecting information about patients with specific diseases. Functions of registers on acute coronary diseases allow using them to characterize therapeutic approaches and assess their quality. It is with the help of registers that help to identify the status and deficiencies in the management of patients at individual stages of specialized care, you can see the most optimal ways to improve the quality of treatment. Carrying out registers and estimation of their dynamics for today are poorly covered in the literature, and in this connection we conducted a comparative analysis of the database of two independent registers (in 2009 and 2015) in one of the districts of Tashkent (a total of 894 patients with acute coronary syndrome and acute myocardial infarction). The analysis revealed that the incidence of ACSAMI in the 2nd register among men younger than 40 years decreased, but the number of obese individuals increased. In the 2nd register, the number of men with HR> 90 beats/min decreased, but the mean values of blood pressure increased. Among men with ACS/ АMI, an increase in the level of triglycerides of blood was registered in the 2nd register, but the percentage of men with hypertriglyceridemia was less. In the 2nd register, the number of troponin determinations has increased, which indicates an increase in the coverage of laboratory studies. The results of the 2nd register on ACS/ АMI among males revealed a significant increase in the groups of drugs used in the treatment, not only those included in the basic therapy of IHD, but also the main ones in the treatment of ACS/ АMI, which indicates positive qualitative shifts in treatment acute cardiac pathology. Thus, the use of the population methodologies of the Registers allows the creation of a program for predicting the outcome of the disease, and also to improve the volume and quality of medical care, taking into account individual risk factors and the potential of their interrelationships

The aim of the present study was to investigate clinical and medical history features of the onset, course, and short-term outcomes of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM). Original data were obtained from analytical information database of the World Health Organization epidemiology program “Acute Myocardial Infarction Register” for 2014 to 2015. A total of 1157 cases of AMI, registered in Tomsk in 2014-2015 except prehospital death episodes, were analyzed. Type 2 diabetes mellitus was present in medical history of 259 (22.4%) patients with AMI. Age-gender structure of patients with diabetes mellitus showed that women (60.2% and 35.4%, respectively; p<0.001) and individuals older than 60 years (76.1% and 57.8%, respectively; p<0.001) prevailed. Obtained results demonstrated that AMI in the presence of T2DM was characterized with more severe cardiovascular medical history, severe AMI course with frequent atypical onset, a few electrocardiographic findings, and very high lethality. The vast majority of fatal AMI cases were registered when patients were in general hospitals. The presence of significant number of women and older individuals among T2DM patients as well as high frequency of cases with atypical clinical onset of the disease and complicated medical history hampered AMI diagnosis. All above-said suggests the necessity of increase awareness of physicians working in general hospitals and emergency departments in regard to individuals with T2DM as potentially vulnerable to AMI development.

Objective. Study of the possibility of predicting atherosclerosis of carotid arteries on the basis of the augmentation index in patients with essential hypertension.

Material and methods. A total of 155 patients with EH in the age range 30-70 years. A physical examination, identification of a number of biochemical parameters: glucose and creatinine and blood lipid (LDL, HDL and triglycerides), duplex scanning of carotid arteries, the definition of arterial stiffness by pulse wave contour analysis.

Results. The augmentation index, along with age, was an independent risk factor for atherosclerosis carotid arteries in patients with EH, as well as the severity of its symptoms.

Aim. To study the arterial hypotension influence to the progress of combined inferior and right ventricle myocardial infarction.

Material and methods. There were studied 66 patients with the primary inferior and right ventricle myocardial infarction. Patients were divided into 2 groups: 1st group - patients with inferior and right ventricle myocardial infarction with stable hemodynamics (n=34); 2nd group - patients with inferior and right ventricle myocardial infarction complicated by arterial hypotension in early period (n=32). Electrocardiography (ECG) and echocardiography (EchoCG) were performed in patients 1, 3, 30 days and 6 months after.

Results. On the 6th month of the disease, despite adequate conservative therapy, there was a significant increase of LV volume index in patients from the 2nd group, thus EDV LV was 164.2±4.2 ml³, ESV 94.1±2.8 ml³ (p<0.028). It was positive dynamics in rehabilitationof systolic function of RV in two groups. Thus EDS RV in patients from the 2nd group was 31.4±2.0 sm³, and in patients from the 1st group 25.1±2.2 cm³ (p<0.05), ESS RV in 2nd group became 19.8±2.0 cm³, and in the 1st group 14.4±1.9 cm³ (p<0.05). To the 6th month of disease FIP LV in the 1st group 40.3±3.2%, in the 2nd group 39.4% (p<0.05 in the group). To the 6th month of disease in the 1st group: ACS repeated episodes were in 6 patients (18%), 4 patients with heart failure FC III (12%), death was in 6% (2 patients). In the 2nd group: ACS repeated episodes were in 10 patients (30%) (OR 2.167; 95% CI 0.674-6.967), 7 patients with heart failure fC III (21%), death was in 10% (3 patients) (OR 2.2; 95% CI 0.190-25.517).

Conclusion. The patients with transitory arterial hypotension at the beginning of disease, have the singes of pathological LV remodeling, which complicate the course of disease, but the RV function becomes better.

In recent years the information about relevance of cardiopulmonary exercise testing (CPET) in complex assessment of pulmonary arterial hypertension (PAH) patients and chronic thromboembolic pulmonary hypertension (CTEPH) patients have been accumulating. Parameters of CPET, such as peak oxygen consumption (Vo2 peak) and ventilation equivalents (VE/Vco2) are very important in risk stratification in patients with PAH, also as distance in 6-minute walking test, the echocardiography and right heart catheterization results, N-terminal prohormone of natriuretic peptide according to the European Society of Cardiology and European Respiratory Society guidelines on diagnosis and treatment of pulmonary hypertension. However, there are no parameters, which can be used in clinical practice to reflect the risk of mortality during 1 year in patients with CTEPH. The aim of our study was to assess the role of CPET in risk stratification, achieving therapy goals and making decision about therapy escalation in patients with PAH and CTEPH. Results of our pilot study demonstrated, that CPET parameters are the reliable markers to reflect the PAH and CTEPH progression. The CPET is necessary for pathogenic therapy efficacy assessment and for making decision of therapy escalation in patients with PAH, also as in CTEPH patients. The critical role of CPET in risk stratification in PAH and CTEPH patients should be emphasized.

Objective. Percutaneous coronary interventions (PCI) have long been an effective tool in the treatment of acute coronary syndromes (ACS), and timely interventions in such patients have great importance. However, due to socio-economic difficulties, it is not always possible to treat adequately this acute condition, in accordance with established international criteria. This gives an opportunity to investigate the results of the practical approach to delayed percutaneous coronary interventions in patients with acute coronary syndrome.

Purpose. Evaluate the immediate results of delayed percutaneous coronary interventions in patients with acute coronary syndrome.

Methods. In this study were included patients with ACS who received coronary angiography with stenting of coronary arteries («acute» PCI group, 42 patients), patients who were treated by medical therapy for ACS in the hospital without possibility of PCI (50 patients), and medically stabilized patients after ACS, which were given for angiography and PCI. (average, 30 days after ACS, 49 patients). The groups did not differ in basic demographic and clinical characteristics. Standard clinical, electrocardiographic (ECG) and echocardiographic (ECH0) data were evaluated.

Results. In the PCI groups, angiographic success was achieved in 100%. The average time from the symptoms onset to PCI in the «acute» group was 89.4 hours. In the «acute» group, mortality was 3 patients (7.1%), and in the medical therapy group, mortality was 18% (p <0,05). In the «acute» group two patients had cardiac adverse events, and at presented they had a cardiogenic shock symptoms, one patient died from complications due to major bleeding. The positive dynamics of ST segment recovery on the ECG and ECH0 parameters was more pronounced in the «acute» PCI group.

Conclusions. Despite on the time delay, PCI in ACS is more effective method of restoring myocardial function even in comparison with patients who received early thrombolysis.

This article makes a retrospective analysis of the prevalence of the use of oral anticoagulants in patients with atrial fibrillation at the outpatient level. The frequency of the sex-age structure of patients with AF, the risk of thromboembolic complications, the risk of bleeding, and the appointment of various groups of anticoagulants after hospitalization are investigated. A retrospective analysis of the data of patients with a history of AF and CHA2DS2-VASc >1 points hospitalized in the Moscow hospital for the next paroxysm of AF showed that slightly more than 2/3 of them in the pre-hospital stage were taken by the oral anticoagulants (OAC) and about / by the (new oral anticoagulants) NOACs . The proportion of patients with the value of the scale CHA2DS2-VASc >4 was 49.3%, the proportion of patients with the HAS-BLED >3 scale was 17.9%. Among all OAK patients, 96 people (68.6%) were admitted prior to admission. Among the remaining 44 patients, 22 received an antiaggregant (aspirin, clopidogrel or a combination thereof), and 22 more did not take any antithrombotic drugs.

The article discusses stroke prevention in elderly patients with atrial fibrillation. The principles of choosing anticoagulant therapy in this group of patients are discussed. The importance of the safety profile of the selected anticoagulant is emphasized considering the high prevalence of comorbidities in elderly patients. The efficacy and profile of dabigatran etexilate demonstrated in randomized clinical trials and in real clinical practice is analyzed in detail. Based on the data discussed, the authors are coming to conclusion that dabigatran can be considered the preferred anticoagulant for long-term treatment in elderly patients with atrial fibrillation.

The use of direct oral anticoagulants in patients with pulmonary arterial hypertension (PAH) has remained a controversial issue for a decade. Despite the lack of solid evidence from well-controlled prospective trials, anticoagulation has been recommended for patients with idiopathic pulmonary arterial hypertension (IPAH), but it is unclear whether this recommendation should be extrapolated to patients with other forms of PAH. In this review, we discuss the current opportunities and problematic aspects of oral anticoagulation therapy in different forms of PAH, the influence on disease course and prognosis..