Abnormalities in cardiomyocyte energy metabolism underlie ischemic injury of the heart. However, traditional medicine does not usually set an objective to directly influence energy processes in the myocardium. Therefore, the prospects of developing drug therapy that involves metabolic agents able to successfully eliminate abnormalities in cell metabolism, ionic hemostasis, and membranes functions of the cardiomyocytes thereby preventing or reducing the development of irreversible processes in disease are quite promising.

Aim. The purpose of the study was to elucidate the relationships between the levels of lipoprotein associated phospholipase A2 (LP  PLA2), and the risk of cardiovascular events and to evaluate the  efficacy of preventive therapy with statins. The study comprised a  total of 60 patients with coronary artery disease (CAD) associated  with type 2 diabetes mellitus who underwent endovascular  revascularization. The twelve month follow up study documented the  following events: death, myocardial infarction (MI), acute  cerebrovascular event, repeated coronary revascularization, and  recurrence of angina. Patients were assigned to two groups based on  the absence or the presence of end points: group 1 comprised  patients with unfavorable course of disease (n=30); group 2  comprised patients with favorable course (n=30). In all patients, the  study determined parameters of LP PLA2, glycemic profile, glycated hemoglobin, insulin, ApoB, Apo A1, Lp (a), and lipid profile. Homeostasis model assessment (HOMA) of insulin resistance  was determined. All patients received atorvastatin at a dose of 20– 40 mg/day. The 12 month follow up study showed that, in the  presence of atorvastatin therapy at a dose of 30 mg/day in group 1,  the levels of total cholesterol (TC), triglycerides (TG), and low density lipoprotein (LDL) cholesterol decreased by 20.71%,  26.21%, and 25.84%, respectively. In group 2, TC decreased by  30.52%, LDL cholesterol decreased by 31.41%, and ApoB decreased by 45.2%. The LP PLA2 levels decreased by 21.28% and 26.63% in  group 1 and in group 2, respectively (р=0.004). In group 1, one  patient died (3.3%). Angina reoccurred in 96.7% of subjects. Based  on coronary angiography data, 16.7% of patients had stent  restenosis; 63.3% of patients had progression of atherosclerosis.  Myocardial infarction and acute cerebrovascular event reoccurred in  10% and 3.3% of patients, respectively. Repeated revascularization  was performed in 70% of patients. LP PLA2 level may be considered a prognostic marker of unfavorable cardiovascular events in patients with CAD associated with type 2  diabetes mellitus allowing for selection of special patient cohort for more aggressive lipid correction therapy aimed at achieving  target level of LDL cholesterol.

Aim. The aim of the study was to investigate the effects of blood pressure and its circadian rhythm on cerebrovascular reactivity (CVR). Transcranial duplex scanning (TKDS) of the middle cerebral artery (MCA) and the measurement of blood pressure (BP) (ambulatory BP monitoring and office BP control) were performed in 124 patients with essential hypertension aged 55.2±12.3 years. TKDS was performed with hyperoxia and hypercapnia tests. In patients with abnormal reverse reaction in the presence of hyperoxia, BP was higher (average daily BP: 142.2±12.6/87.4±10.1 mm Hg), and the daily index of SBP was lower (6.0±1.2%) compared with those in patients in whom only hyperoxic reaction was impared (average daily BP: 136.2±7.6/83.4±10.3 mm Hg, p=0.011/0.016; SBP day/night index: 14.2±2.6%, p=0.0007). Patients with abnormal circadian BP rhythm (non dippers and night pickers) with high indexes at night had statistically significant differences in the following CVR parameters: the rate of blood flow velocity change, blood flow velocity in the presence of hyperoxia and hypercapnia, and time index of linear blood flow velocity in the presence of hypercapnia. Patients with reverse reaction during hyperoxia had higher office BP, higher values of ABPM, and lower daily index; there was a statistically significant correlation between the levels of blood pressure and parameters of CVR. Patients with reverse CVR reactions (non dippers and night picker) had three fold rate of abnormal BP circadian rhythm  compared with patients who had normal type of CVR reactions.

The aim of the study was to examine abnormalities in the function of vascular endothelium in young patients with essential hypertension and stable angina. The study included 136 young patients with essential hypertension and stable angina and 30 healthy persons. In young patients with essential hypertension and stable angina, the study revealed the signs of endothelial dysfunction characterized by low levels of endothelin 1 and thromboxane in the presence of reduced synthesis of NO, prostaglandin E2, and guanylate monophosphate. Standard medical treatment and treatment with liposomal drugs did not affect the levels of vasoactive substances. Combined treatment with hypoxytherapy contributed to improvement of endothelial function, namely: statistically significant reduction of endothelin 1 production and increased excretion of nitric oxide.

The aim of this study was to assess dyslipidemia in teenagers with essential arterial hypertension (EAH) at different stages of the disease and its correlation with cardiovascular risk factors and arterial pressure (AP) daily profile. A total of 230 teenagers with EAH aged from 12 to 18 years (mean age of 14.9±2.0 years) were examined. All patients underwent 24 hour blood pressure monitoring. According to monitoring results, the following study groups were formed: group 1 comprised 68 patients with phenomenon of “white coat hypertension”; group 2 comprised 82 patients with labile arterial hypertension; group 3 comprised 80 patients with stable arterial hypertension. Control group included 27 healthy teenagers whose age and sex were similar to those in study groups. Blood lipids study was performed according to practical standards. To detect hyperlipidemias, the National Cholesterol Educational Program (NCEP peds) criteria revised in 1992 were used. Triglycerides (TC) level over 100 mg/dL (1.1 mmol/L) was criterion for hypertriglyceridemia in teenagers. Only teenagers with stable AH had clinically significant difference in the average values of TC and very low density lipoprotein cholesterol compared with control group adjusted for sex and age (р=0.027 and р=0.029 correspondingly). The covariance analysis showed that overweight, family history of hypertensive disease, smoking, and mean values of diastolic AP for all time intervals contribute to blood lipids disorders. Conclusions. Blood lipid disorders in teenagers with EAH can manifest at early stages of the disease and are the early markers of both metabolic syndrome and atherosclerosis requiring appropriate preventive measures.

Present article is devoted to MRI assessment of the status of the left atrium (LA) in patients with resistant hypertension (RH) and left ventricular (LV) hypertrophy in the dynamics of treatment with transcatheter renal denervation (TRD). To achieve this the dynamics of the state of the LA during treatment was assessed; the relationship between the LV mass and the degree of dilation of the LA was analyzed. We studied 40 patients (mean age 56.6±8.4 years) with RH and LV hypertrophy who underwent TRD treatment. All patients received MRI study before TRD and after 6 and 12 months after the treatment. Based on MRI data, we quantified LA volume and LV mass. LA volume statistically significantly decreased 12 months after treatment (from initial 57.95 (47.28; 65.16) cm3 to 54 (44.58; 64.73) cm3 (p<0.05)). The LV mass also statistically significantly decreased (from initial 224.15 (185.79; 296.87) g to 218.84 (181.98; 290.44) g (p=0.002) and to 183.67 (163.76; 254.5) g (p<0.001)) 6 and 12 months after treatment, respectively. Analysis of LA volume demonstrated that all but one of the patients with frequent paroxysmal supraventricular tachyarrhythmias had the volume significantly over of 70 cm3 ranging from 74 cm3 to 89 cm3. TRD significantly decreased LA volume and also suppressed supraventricular tachyarrhythmias. We conclude that TRD exerted a statistically significant antiarrhythmic effect, first of all, due to decreases in mechanical stress and in volume of the atria in these patients as a result of treatment.

The aim of this retrospective study was to evaluate the dynamics of left ventricular (LV) ejection fraction (EF) and end diastolic volume  (EDV) within one year after acute myocardial infarction (AMI) in  patients with early and long term sustained ventricular arrhythmias  (VA); to identify the predictors of these arrhythmias; and to  elucidate the relationships between VA, severity of coronary artery  (CA) lesions, and parameters of LV systolic function. The study  included 36 patients (33 men) aged 57.7±9.8 years with AMI  complicated by early episodes of primary ventricular fibrillation (VF)  or monomorphic ventricular tachycardia (VT). Patients were divided  into two groups depending on whether they developed long term VA  within one year after AMI. In the VA group, there was a trend to an  increase in EF and EDV. In the study group, changes in EF were not present, but EDV decreased by 30 mL relative to the baseline value. Correlation analysis did not show any associations of the number  and the time of long term VA occurrence with LV EF and EDV. The  degree of correlation between VA dynamics and CA lesion severity  was very high. The number of diseased CAs strongly correlated with  the number of VA episodes (r=0.93; p=0.003) as well as with the  time of the first arrhythmic episode onset (r=–0.83; p=0.039).  Revascularization completeness correlated with the number of  episodes (r=–0.83, p=0.009). Predictors of long term VA after AMI,  complicated by early arrhythmic episodes, comprised LV aneurysm, NSTEMI, type 2 diabetes, EDV, and EF≤35%. Left ventricular  aneurysm was an independent predictor of both long term VA and  early VT.

Transposition of the great arteries (TGA) is “cyanotic” congenital heart disease, which leads to certain death in 100% of patients. The modern standard of treatment is radical correction – arterial switch. One of the most important aspects of successful arterial switch is the anatomy of coronary arteries and its influence on the reimplantation technique. Many complex classifications of coronary anatomy during transposition were offered, however, we can see the tendency to their simplicity in practical work. Coronary anatomy of 120 consecutive patients with simple transposition of great vessels TGA and TGA with ventricular septal defect was evaluated. In the most cases (n=105, 93.1%) we observed 3 variants of coronary anatomy: usual (1LAD,Cx,2R – 65.9%), circumflex artery from RCA (1LAD,2R,Сх – 20.4%), separate origin of circumflex artery from aortic sinus (1LAD,R,2Сх – 6.8%). In 65 patients we used classical “open” methods of reimplantation of coronary arteries (U shaped with “buttons”, J shaped “trap door” or their combination), the median time of myocardial ischemia was 83±22.5 min (78–126 min), and median blood loss 120±30 ml (75–245 ml). We used “close” technique in 52 patients. The median time of myocardial ischemia was 34±9.3 min (31–62 min), median intraoperative blood loss 20±20 ml (10–50 ml). The necessity in postponed approximation of sternum decreased from 60% (2010) to 6% (2015). It resulted in reduced time of inotropic myocardial support, reduced frequency of adrenaline usage and combined inotropic support up to 5.6% in 2015. Postoperative mortality reduced from 18% (2010) up to 6% in 2015. Coronary anatomy does not influence on the method of reimplantaion of the coronary arteries. The only real exception is an intramural coronary artery, the way of its reimplantation may differ in each individual case. “Close” technique of reimplantation reduces the period of myocardial ischemia and artificial circulation. The sinotubular zone is formed by means of circular anastomosis while creating of neoaorta, it may reduce the risk of neoaortal valve insufficiency. Continuous locking stitch of coronary anastomosis is haemostatic, this fact was proved by more than twice reduced blood loss.

The article presents the analysis of reinterventions and risk factors for development of restenosis after surgical correction of discrete subaortic stenoses. From 2003 to 2013, 163 patients (age ranging from 3 months to 18 years) with discrete subaortic obstruction underwent primary surgical treatment. The hospital mortality was 1.2%. The follow up period lasted for 62.2±48.1 months and was documented in 134 patients of 161 (83.2%). Residual obstruction was observed in 12.7% (n=17) of patients. Reoperations were required in 13 children (9.7%). Median from initial surgery to reintervention was 52 (interquartile range of 31–98) months. The rate of freedom for restenosis was 80% at 98 months postoperatively (standard error of 0.05). Risk factors for restenosis included the younger age of patients and smaller surface area of a body at the time of primary operation, adhesion of subaortic membrane to the aortic valve, and high pressure gradient at the left ventricle outflow tract immediately after surgery when using various statistical tests.

The aim of this study was to test the accuracy of the noninvasively obtained ventricular activation (isolated epicardial vs. combined endo epicardial mapping) as compared with that of standard invasive  mapping in patients with atrial arrhythmias. A total of 16  patients (5 male and 11 female) aged 21 to 65 years (mean age of  48.8 years) with atrial arrhythmias were examined. All patients  underwent noninvasive electrophysiological examination, which was  performed with Amycard System, and subsequent intracardiac  mapping and radiofrequency catheter ablation. Comparison of the  results obtained from the noninvasive combined epi endocardial  electrophysiological examination and the intracardiac electrophysiology study demonstrated that the arrhythmogenic focus  localizations coincided in 15 cases. Thereby, the accuracy of  the noninvasive mapping was 93.7%.

The purpose of this study was to assess relationships between metabolic syndrome (MS) and depressive disorders (DD) among adult population in Krasnoyarsk taking into account gender identity. Materials and Methods. We analyzed data of 1123 subjects aged 25–34 years who participated in the study titled “Epidemiology of Cardio
Vascular Diseases in Russian Federation – 2012”. We studied the levels of depression according to hospital anxiety and depression scale (HADS); indicators of metabolic syndrome (MS) were assessed according to the criteria of Adult Treatment Panel III (ATP III); the relationships between depressive disorders and MS were evaluated. Results. The frequency of MS among adult population of Krasnoyarsk was 23% (20.5% among men and 24.4% among women). Men with and without MS equally often had subclinical depression and clinical depression (15.5% vs. 13.3% for subclinical depression and 3.6% vs. 4.0% for clinical depression). In women with MS, depressive disorders were diagnosed significantly more often in comparison with women without MS (23.3% vs. 16.3% for higher level of depression, p=0.038 and 7.6% vs 3.7% for clinical depression, p=0.039). In addition, among women with components of MS such as abdominal obesity (AO) and increased blood pressure (IBP), the prevalence of subclinical depression was significantly higher in comparison with women without AO and IBP. Conclusions. General practitioners should give special attention to women with MS, since depressive disorders are more common in this group of patients. In women, such MS components as AO and IBP are associated with depressive disorders. Timely diagnosis of depressive disorders among women with MS can have a positive impact on adherence to MS therapy, thereby reducing overall cardiovascular risk.

The objective of the scientific work was to study the prevalence of increased carotid intima media thickness (cIMT) in the general  employable population of Tomsk and to determine cardiovascular risk  factors, explaining its variation to the greatest extent. With the  currently recommended criteria and measuring technique, there was  established, that the prevalence of increased cIMT in the population  did not exceed 10%, showed quite rare occurrence among the  individuals younger than 50 years old, whereas in the older ones it  was characterized by the further increase with age, emerging in the  every forth man and the every seventh woman. Beyond the age,  variation of the prevalence in the population was explained by such  risk factors as obesity, pulse blood pressure (BP), high density  lipoproteins (HDL), regular smoking, and the role of the factors was not the same between men and women. The leading associative factor in men was obesity, whereas in women the independent  associations were found with respect to pulse BP and HDL. In men  with HDL levels below 0.95 mmol/l the effect of obesity was  significantly higher in magnitude than the average effect in men. The  association of pulse BP in women showed stepwise decrease in  its magnitude as the age increased. The independent role of regular  smoking was not so prominent and showed a limited significance only. Our main findings confirm some reproducible tendencies, demonstrated by the modern epidemiologic data, and  evidence that in the employable population increased cIMT is prevalent only starting up with the sixth decade of life and the  probability of its occurrence is mainly influenced by the major  cardiovascular metabolic risk factors – obesity, HDL, as well as  systolic and pulse BP.

The aim of the study was to investigate the parameters of stress in the workplace depending on the nature of work in women aged 25–64 years in open population of moderately urbanized city of Western Siberia. The study was conducted in the framework of cardiac screening of the urban population among women aged 25–64 years. A representative sample was formed from the lists of citizens residing in one of the administrative districts of Tyumen. According to professional status the respondents were divided into 4 categories: (1) non working, (2) physical labor, (3) experts and engineering technical workers, and (4) managers. The survey was carried out based on the algorithms of the World Health Organization Program “Monica Psychosocial”. The study of the urban population of working age women showed that parameters of stress in the workplace were associated with nature of work. Female managers were often in conflict with their subordinates. At the same time, they were able to relax and to have rest after usual working day in contrast to the women engaged in physical labor. Meanwhile, the women of physical labor categories mostly did not enjoy their work. Experts and engineers had higher responsibility in the workplace and more often experienced changes of supervisors compared with women of other labor categories.

A criterion for the best promising outlook is a research study which is carried out with a method that lies out of the bounds of the current paradigm. Obtaining new knowledge with the help of a new theory, a candidate for a new paradigm, is the most promising line of research. A scientific team working on a new line of research is the most promising school of thought for a scientist who managed to push the limits of the current paradigm and create their own school of thought. A developed school of thought that managed to create a new line of research combines researchers’ high worldview potential, sufficient level of scientific equipment, unity of command and democratic evaluation and analysis of research findings. Two types of schools described are first class schools of thought. Other types of schools are engaged in training practical specialists, whereas students and specialists’ education and training with the simultaneous development of their knowledge and skills should be paradigmal.

The biography of distinguished obstetrician gynaecologist Anna A. Radionchenko is presented in the article. Contribution of A.A. Radionchenko into the development of Tomsk, Siberian and Russian school of obstetrics and gynecology is also reflected in this article. Short review of her scientific, educational, medical and social activity is given.