Aim. The aim of this study is to compare hospital and long-term outcomes in patients with low surgical risk after aortic stenosis correction in surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).

Materials and methods. Patients with aortic stenosis (AS) were included in the study. The main criterion for inclusion - the presence of indications for surgical correction of an isolated aortic valve defect. The first group included patients after TAVI (n = 11). As a control group, patients who underwent surgical correction aortic stenosis (n = 23). The TAVI group used non-repositories CoreValve (Medtronic) and repositioned Lotus (Boston Scientific) valves. Biological prosthesis Uniline (KemKor) was used in the group of surgical patients. The efficacy of the interventions was evaluated at the hospital and annual follow-up, based on the analysis of the combined endpoint, and major adverse cardiovascular events.

Results. The mean age of the patients was 66.9±5.7 years in the SAVR group and 75.3±4.1 years in the TAVI group (р=0,003). The average score for EuroSCORE II was 3.49±0.3 in the SAVR group and 3.93±1.2 in the TAVI group (р=0,31). Repositionable and non-repositionable valves were implanted in 2 and 9 cases, respectively. The combined endpoint was noted in one patient in the TAVI group and in four patients in the SAVR group according to the annual observation results. There are three (13%) fatal outcomes in the surgical prosthesis group.

Conclusion. The possibility of using TAVI in low-risk patients with aortic stenosis was demonstrated on the basis of comparable results of evaluating efficacy and safety with SAVR in 1-year follow-up.

Objective: to study the relationship between erectile dysfunction and obesity parameters and the severity of obstructive sleep apnea in patients with arterial hypertension.

Material and methods: 71 patients with different severity of erectile dysfunction, overweight and obesity of grade 1, mild and severe obstructive sleep apnea and arterial hypertension were included in the study. The data of cardiorespiratory monitoring, anthropometric parameters of obesity were analyzed and the severity of erectile dysfunction was assessed by intracavernous pharmacodopplerography, the results were compared with the subjective opinion of patients on the degree of severity of erectile dysfunction according to the IIEF-5 questionnaire. All patients underwent psychosomatic status analysis according to the questionnaire scales: assessment of daytime drowsiness on the Epworth scale, severity of personal and situational anxiety on the Spielberger scale and depression level on the Beck scale.

Results: comparative analysis revealed statistically significant links between anthropometric data of obesity with OSA parameters (apnea/hypopnea index, desaturation index) (p<0.05), as well as the severity of erectile dysfunction (in terms of erection and dopplerography with evaluation of the of penile blood flow) (p<0.05). A statistically significant negative relationship between the quality of penile blood flow and the degree of arterial hypertension was revealed too (p=0.02). In a comparative analysis of the subjective state of erectile function and objective examination, no statistically significant association was revealed (p=0.07). As a result of the multifactorial linear regression, we have shown that with an increase of the waist circumference to the hip circumference ratio and a higher apnea/hypopnea index, the condition of penile arterial blood flow worsens, namely, a decrease in the peak systolic blood flow velocity (β=-0.39, p=0.05; β=-0.44, p=0.03, respectively). When assessing the psychosomatic state of patients, a significant correlation has been found between the severity of depression in the Beck scale and the level of personal and situational anxiety according to the Spielberger scale (p<0.05). The relationship between depression level on the Beck scale and the degree of situational anxiety with the severity of erectile dysfunction on the Juname scale has been also shown (p<0.05).

Conclusion: the combination of overweight or obesity with obstructive sleep apnea and arterial hypertension gives ground to suspect the presence of different severity of erectile dysfunction. The severity of ED is directly proportional to the level of anxiety and depression according to the questionnaire scales.

Introduction. Basing on the data of the “RACSMI-UZ” register, the article provides comparative analysis of the structure and transformation of diagnoses during acute coronary conditions in the dynamics (at admission and discharge), assesses patients' adherence to drug therapy depending on gender and also describes analysis of its effect on the short-term prognosis.

Material and methods. The study material included 449 patients with ACS/AMI hospitalized to relevant health care facilities of the experimental district of Tashkent. Two groups of patients were distinguished depending on the gender: group 1 included 243 male patients, and group 2 consisted of 206 female patients.

Results. The registration showed that ACS/AMI was more often observed in men than in women (54.1% vs. 45.9%, respectively). Male patients proved to be younger than female ones (p <0.05); obesity of different degree prevailed in women (48.0% in women vs. 29.6% in men, p <0.05). In the male population, AMI at admission was registered in 43 (17.7%) patients but the number of patients with this diagnosis increased at discharge (61 subjects, or 25.1%). Out of 243 men, 3.7% died and the largest number of deaths occurred in patients with initial diagnosis of unstable angina. In the female population, the incidence of AMI both with and without Q at admission was recorded 2 times less frequent than that at discharge from the hospital (8.7% of cases at admission and 17.5% of cases at discharge), which shows low vigilance of healthcare professionals in diagnostics of AMI in women. Mortality from ACS/ AMI in women was 3.4% with the largest number of deaths being associated with the initial diagnosis of AMI without Q. Compliance in females was somewhat higher than in males; men were prone to taking more medications (Mc’s), though there were no significant differences between men and women by the proportion of Mc’s taken. The direct correlation was found between the patients’ compliance level and the time interval: from admission to death of the respondent (p> 0.05).

Conclusion. ACS / AMI was more often recorded in men than in women, while the age of men was younger (p<0.05). Alertness of primary care physicians in ACS / AMI was low, especially for women. Compliance in women was higher than in men. Thus, the higher was the patient adherence to therapy, the more stable the body appeared to cardio stress.

The aim of the study was to identify individuals with increased frequency of early symptoms of stenosing atherosclerosis of the coronary arteries with consideration of the peculiarities of comorbid abnormalities in CHD patients high risk with the presence of MFA.

Materials and methods. Patients of middle age were divided into 3 clusters by the method of hierarchical analysis of categorical variables according to the clinical manifestation of atherosclerotic lesions of the heart, brain and arteries of the lower extremities. Patients evaluated the clinical status, ECG, CAG, echodopplerography carotid and lower limb arteries. According to the indications, magnetic resonance imaging of the chest and abdomen, spirography, fibro-gastroduodenoscopy, ultrasound of the abdominal cavity and kidneys, if necessary, ultrasound of the pelvis were performed.

Results. It was found that one of the manifestations of coronary artery disease was ACS with hemodynamically significant PKA stenosis (76-90%), which developed in 50% of women with primary lesion of the 3rd segment of PKA, belonging to the 3rd cluster of the examined. The structure of hemodynamically significant changes in LCA branches was dominated by men of the 1st cluster with lesions of the 6th segment of PHA, DV, 15 segment of OA, while unstable angina was established in 54,2% of them, in the anamnesis - in 51,1%. Frequency of the level of the border of stenosis (50-75%) branches LKA showed a male predominance of the 1-St cluster with a lesion of the 6th segment PMRA involving DV and 15 of the OA segment, coupled with clinic stable angina.

Conclusion. The nature of coronary vessels lesions in men and women of the middle age category revealed persons with an increased frequency of signs of stenotic remodeling, taking into account the clinical symptoms and features of vascular comorbid burden in patients with high-risk IHD with the presence of MFA.

Purpose of the study. To study the significance of cystatin C of blood plasma and its relationship with central arterial pressure and carotid intima-media thickness (CIMT) in the stratification of cardiovascular risk.

Materials and methods. A general clinical and laboratory examination of 206 patients aged 16 to 88 years was performed, of which men were 101 (49%), women - 105 (51%). The mean age of the examined subjects was 51.8±14.3 years. Lipid spectrum parameters [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C)], cystatin C, plasma uric acid and fibrinogen were studied. Glomerular filtration rate (GFR) was calculated using the F.J. Hoek et al. (2003) formula. To assess the central blood pressure, all patients underwent a contour analysis of the pulse wave on the AngioScan-01 (AngioScan-Electronics, Russia) and ultrasound examination of carotid artery (CA) on Vivid Q (USA). The type of research was single-step cross-sectional. Depending on the content of cystatin C of the blood plasma, all the examined subjects were divided into three groups. Group 1 (n=62) consisted of patients with cystatin C concentration of up to 0.99 mg/l; group 2 (n=91) - from 1.0 mg/l to 1.5 mg/l; group 3 (n=53) - over 1.51 mg/l.

Results. Patients with excessive body weight, stable angina, type 2 diabetes, cerebrovascular diseases (CVD) and chronic glomerulonephritis (CGN) significantly prevailed in group 3, in comparison with groups 1 and 2 (p<0.5). Mean levels of systolic and central blood pressure (BP) were significantly higher in patients from group 3 (p<0.05). In the same group, there was a significant decrease in HDL cholesterol level (p<0.05), an increase in TG concentration (p<0.05), and blood plasma uric acid (p<0.05), as well as CIMT. Statistically and clinically significant decrease in GFR and an increase in the level of cystatin C in blood plasma was noted both in groups 2 and 3 (p<0.05). Positive correlation between CIMT and the level of cystatin C of blood plasma (r=0.578, p<0.05) and negative correlation with the value of GFR (r=-0.556, p<0.05) were recorded among the patients of group 1. In group 2, strong correlation was observed between CIMT and the content of HDL cholesterol plasma (r=-0.343; p<0.05). A significant direct relationship between CIMT and systolic level (r=0.482, p<0.05) and central arterial pressure (r=0.479, p<0.05) was found in individuals from group 3.

Conclusion. Studying the content of cystatin C of blood plasma in conjunction with determination of GFR is a priority for early diagnosis of renal dysfunction and assessment of cardiovascular disorders, providing stratification of groups of cardiovascular risk and subsequent implementation of preventive measures to reduce the level of total cardiovascular risk.

Purpose. The aim of the trial was to study the importance of immuno-inflammatory processes and hemo-rheological changes in patients suffering from stable coronary heart disease after coronary angioplasty and stenting, as well as establishing the clinical effect of treatment optimized with anti-inflammatory drugs and immune-correctors.

Material and methods. The study included 103 patients in total and 64 patients with an implanted stent. Within 2-28 months after stent implantation, an angiographic study was performed with the definition of a coagulogram, C-reactive protein (CRP), fibrinogen, and pro-inflammatory cytokines - tumor necrosis factor (FNA-α), interleukins (IL), IL-6, IL-8 in the serum of patients with coronary artery disease.

Results. After coronary angioplasty and stenting in patients with coronary artery disease, the average concentrations of CRP and cytokines were significantly higher compared with both the control group and the group without restenosis. This indicator in the groups with and without restenosis was 16.4±1.2 (intragroup variation 6-36) mg/L and 6.8±0.4 (intragroup variation 5-10) mg/L, respectively; p<0.001. And from cytokines, the concentration of IL-6 in groups with and without restenosis was respectively 3.5+0.2 and 18.7+3.1 (p<0.01). In the correlative analysis in the group with restenosis, the expected close relationship between TNF-alpha and IL-6 is equal to r = 0.707, p<0.01, between CRB and IL-6, equal to r = 0.575, p<0.01, and between TNF-alpha and IL-8, equal to r = 0.610, p<0.05.

The initiation of PAH-specific therapy in this case of IPAH was preceded by atrial septostomy. The chosen treatment plan put the patient at an unacceptable risk and did not contribute to the improvement of her clinical condition. The clinical case described in the paper demonstrates the importance of a reasonable approach to the implementation of palliative surgical interventions in patients with pulmonary hypertension in accordance with modern guidelines, as well as the possibility of optimizing drug therapy with endothelin receptor antagonists.

Chest pain remains a common complaint in patients with pulmonary arterial hypertension (PAH). Compression of the coronary arteries is rare and probably underestimated syndrome being a typical cause of angina pectoris in patients with severe pulmonary arterial hypertension. Compression of the left main coronary artery (LMCA) by an enlarged pulmonary trunk is oftentimes associated with angina pectoris, but appropriate approaches to diagnosis and treatment remain poorly defined. This is a clinical case of a 38 years-old woman with idiopathic pulmonary arterial hypertension (IPAH) who has suffered from myocardial ischemia due to compression of the LMCA by a pulmonary artery aneurysm. The diagnosis of LMCA compression was made by coronary angiography (CA) and multispiral computed tomography (MSCT), which confirmed the pulmonary artery aneurysm as a source of external compression. LMCA stenting and changing in the PAH-specific therapy led to a significant improvement in angina, heart function and quality of life. Percutaneous coronary intervention appears to be feasible, safe and effective treatment for patients with external compression of the left coronary artery from pulmonary artery enlargement.