Aim. To study serum aldosterone level dynamics and cardiac remodeling characteristics in myocardial infarction (MI) patients with undifferentiated connective tissue dysplasia (UCTD) treated with selective aldosterone receptors antagonist eplerenone.

Study population and methods. A total of 110 MI patients with and without UCTD and 32 healthy controls without cardiovascular pathology and without signs of UCTD were enrolled in the study. Clinical examination, phenotyping, echocardiography and serum aldosterone levels evaluation were performed. MI patients were divided into 3 groups: I (n=20) - patients with UCTD who was treated by eplerenone additionally to basic therapy of MI; II (n=60) - patients without UCTD treated by basic therapy of MI; III (n=30) -patients with UCTD treated by basic therapy of MI only.

Results. All MI patients regardless of UCTD presence had increased serum aldosterone in the first day of MI. In 28 days the significant increase of serum aldosterone level in group I in comparison with groups II, III and control group was observed. Analysis of structural and functional characteristics of the heart in MI patients in a 6 month after MI had shown more significant left ventricle enlargement and decrease of cardiac pump function in group III compared to group I.

Conclusion. Presence of UCTD in MI patients does not affect serum aldosterone levels dynamics. Inclusion of eplerenone in the treatment of MI patients with UCTD during 6 months inhibits left ventricular dilatation and attenuates reduction of its ejection fraction.

Introduction. Since 2000^th CHD morbidity in Russia is growing constantly, especially, angina pectoris morbidity. Increasing workload on physicians due to high number of patients makes us find the ways to optimize human resource applying. One of the possible ways is development of clinical decision support systems, particularly, ontology-based systems. These ontologies must adopt semantic interoperability for the concepts included, to be clearly interpreted by physicians of different medical schools.

Research target. Develop the concepts nomenclature for building of angina pectoris ontology. Methods. For primary concepts extraction we used state clinical recommendations “Stable coronary heart disease” issued in 2016. Development and filling of the nomenclature were performed in MS Excel and MS Excel Online. The work through the primarily extracted concepts was performed with expert-cardiologists by cross-validation method and common voting on final inclusion of the concept in the nomenclature. The final nomenclature validation was performed by semi-automatic method on anonymized 610 electronic health records of the patients.

Results. After primary extraction of the concepts without experts, we could extract 336 basic concepts and 144 synonyms, keeping in mind the aspects of this nomenclature development. The shared work through this nomenclature with the expert-cardiologists let us increase the number of the basic concepts up to 409 and the number of the synonyms up to 619. The nomenclature validation on electronic health records showed compliance of the concepts in aspects of diagnostics methods and medicine prescriptions and 92% compliance in diagnostic signs, which doctors evaluate in diagnostics results. Percentages of primarily extracted concepts in draft nomenclature and after being worked through by the experts and also validation results based on electronic health records, let us make a conclusion that clinical recommendations can be used as a basic data source for concepts extraction, but the draft result must be evaluated by the experts and also filled up with the usage of additional knowledge sources about angina pectoris, and after that the nomenclature can be used for angina pectoris ontology development.

Conclusion. The usage of clinical recommendations is proved to be the basic data source for concepts of subject area extraction. However, the draft nomenclature must be evaluated and filled up with additional synonyms and validated on electronic health records. After that, the extracted concepts and their synonyms can be used for ontology development.

Objective: to study the pulmonary hemodynamics and kidney function in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary thromboendarterectomy (PTE). To analyze the main results of PTE.

Material and methods: among 51 patients with CTEPH undergoing PTE, the group with chronic kidney disease (CKD) was identified. The main parameters of hemodynamics, such as cardiac output (CO), cardiac index (d), pulmonary arterial pressure (PAP), pulmonary vascular resistance (PVR), were determined. The cases of acute kidney injury (AKI) after PTE were identified. The correlation between hemodynamics and renal function was analyzed.

Results: there was decrease of mean PAP, PVR and increase of CO and CI after PTE. In cases of AKI 1-2, the complete recovery of renal function were observed. Glomerular filtration rate (GFR) increased before discharge in patients with CKD and in other patients.

Conclusion: the positive dynamics of renal function in patients with CTEPH after PTE is more probably associated with an increase in the С and renal perfusion.

The aim of the work was to compare the integral parameters of the vectorcardiogram (VCG) - spatial QRS-T angle and electrocardiographic ventricular gradient (VG) - with clinical data in patients with chronic coronary heart disease (CHD). The study included 213 patients with CHD (165 men and 48 women, mean age 62.1±9.8 years) who underwent a comprehensive clinical and instrumental examination. The control group consisted of 50 practically healthy persons (30 women and 20 men, mean age 56.5±8.8 years). The QRS-T angle and VG were calculated on the VCG, derived from the 12-lead digital ECG. In patients with CHD, the VG module and VG-X, VG-Y, VG-Z components were significantly smaller, and the QRS-T angle was significantly higher than in healthy individuals of the same sex. The presence of arterial hypertension, hyperlipidemia, diabetes mellitus, chronic heart failure and obesity was associated with increased QRS-T angle. In patients who had a history of anterior myocardial infarction, compared to patients without myocardial infarctions, the VG module and its components VG-X and VG-Z were significantly decreased and the QRS-T angle was increased. In patients who had a history of inferior-posterior myocardial infarction, the VG-Y component was significantly decreased and the VG-Z component was increased. The threshold value VG-Y<10 ms allowed to detect the old inferior-posterior myocardial infarction with a sensitivity of 63% and a specificity of 75%; threshold values of VG-X<14 ms and VG-Z<10 ms allowed to diagnose old anterior myocardial infarction with a sensitivity of 67-77% and specificity of 85-79%, respectively. In CHD patients, higher QRS-T angle values were associated with the presence of traditional risk factors - arterial hypertension, hyperlipidemia, diabetes and obesity. Changes in VG in myocardial infarctions of different localizations were different.

In recent decades, developed countries of the world have made progress in the treatment of breast cancer, both because of the early detection of cancer and the use of modern methods of treatment (target therapy and chemotherapy, radiation therapy and surgical treatment). Due to this, the time of disease-free course of cancer and the duration of life of patients have increased. However, a number of antitumor drugs have cardiotoxicity [1]. It is shown that cardiovascular diseases are the second leading cause of death among women who have undergone breast cancer [27]. Reduction of systolic function of the heart is the most common manifestation of cardiotoxicity of antitumor therapy [7]. Other manifestations of cardiotoxicity include arterial hypertension (AH), acute coronary syndrome, arrhythmias and thromboses. In recent years, methods such as electrocardiography (ECG); echocardiography (EchoCG) with the classical definition of the left ventricular ejection fraction (LVEF) by the method of Simpson's biplane and the global longitudinal strain of the left ventricular (GLS) using data from the 2D Speckle Tracking Imaging; determination of the level of biomarkers of myocardial damage and magnetic resonance imaging (MRI) of the heart have been used to detect the cardiotoxicity of antitumor therapy. Thus, the early diagnosis and timely detection of cardiotoxic effects of antitumor drugs are among the tasks of cardiooncology - an area in medicine formed in recent years [1].

The article considers modern approaches to analyzing the effectiveness of interventions in relation to time, that is, the length of the period after the beginning of their application. The role of the analysis of the Kaplan-Meier curves for the evaluation of the effects of compared interventions depending on the time is discussed. Various options of the relative layout of the Kaplan-Meier curves in the course of the study are examined. The results of a recent analysis of the duration of the period between the onset of statin use and the development of clinical benefits of therapy are presented. In particular, the possibility of using the TTB indicator of intervention and TTH indicator, caused by the intervention, is discussed in making a clinical decision about the validity of the choice of a particular treatment method, in particular the indicator of number of patients Analysis of the Kaplan-Meier curves as an approach to assessing the effectiveness of therapy Modern effective clinical practice largely depends not only on the clinical experience of the physician, but also on the skills of searching and evaluating the evidence-based information that allows to choose the optimal treatment strategy. Such tactics can be determined only in the course of large and well-planned randomized clinical trials (RCTS). Analysis of the survival curves constructed using the Kaplan-Meier method has become one of the main approaches to assessing the incidence of adverse outcomes in modern clinical trials. There may be several variants of the "behavior" of such curves [1]. Such curves may not diverge throughout the study period (Figure 1A), indicating that there is no difference between the efficacy and / or safety of the interventions compared. Such curves may diverge, which will indicate a difference between the who need to be treated with a particular drug. Opinions that emphasize the importance of evaluating the effectiveness of interventions with absolute rather than relative risk of adverse clinical outcomes are mentioned. Clinical situations in which the duration of the TTB is of particular importance, in particular, in patients with a very high risk of developing complications of cardiovascular diseases (for example, after an acute coronary syndrome) and in patients who in most cases have limited life expectancy are considered. The role of atorvastatin in clinical situations is emphasized, in which the earlier achievement of the clinical advantages of lipid-lowering therapy is important. Data on the role of statins, in particular atorvastatin, are given in the early stages after the development of acute coronary syndrome.

Resistant hypertension is defined as a lack to lower 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) values of ambulatory blood pressure (BP) response using 3 antihypertensive agents of different classes, one of which should be a diuretic in patients fully adherent to antihypertensive therapy. Prevalence of resistant hypertension is ranging from about 5 to 50 % in various cohorts. Initial management requires identification of true treatment resistance by out-of-office BP measurements, assessment of adherence and screening for treatable causes of uncontrolled BP. Recent studies try to indicate possible biomarkers of resistance hypertension. Treatment include lifestyle changes, enhancing treatment adherence and optimization of the doses. An invasive approach to resistant hypertension should be kept for persistently severe cases managed in a specialized hypertension center. This article aims to familiarize readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.

The basis for the successful treatment of any disease is a clear understanding of its cause, the mechanisms of its development, and their relationship to symptoms. The article considers one of the links in the pathogenesis of arterial hypertension - an increase in the activity of the sympathetic nervous system, describes the main methods for detecting hypersympathicotonia, approaches to the selection of drug therapy.