The article features personal memories, brief biography, and main landmarks of the creative path in medicine of Professor Vikenty V. Pekarsky, MD, PhD, Member of the Academy of Medical Sciences, an outstanding contemporary, brilliant surgeon, scientistinnovator, and talented teacher. Brief characteristics of his scientific legacy are given. His contribution in the development of national cardiac surgery and interventional arrhythmology is reported. The aspects of his innovative, teaching, clinical, and public activities are presented.

The article is devoted to the study of the left ventricular (LV) rotation at the level of the mitral valve, papillary muscles, and the apex in healthy children and adolescents using Two-Dimensional (2D) Speckle Tracking Imaging. Four types of LV twist were identified in children and adolescents. Adult type (I) of the LV twist was observed in 67.06% of cases. Child types (II, III) were found in 23.52%. Type of negative LV rotation was observed in 9.41%.

In recent years, the method of renal arteries transcatheter sympathetic denervation for treating patients with resistant hypertension has been used worldwide. At the same time, many questions about the procedure of hypotensive mechanisms and therapeutic effect duration still remain without answers. The effects of radiofrequency ablation of renal arteries are considered to occur through downregulation of sympathetic effects on the kidneys and decrease in renin–angiotensin–aldosterone system activity. Preclinical animal studies confirmed significant decreases in the renin and aldosterone levels after renal denervation along with lowering blood pressure. However, no data are available regarding the changes in the levels of these hormones in patients after the operative treatment. Long-term effects of catheter renal denervation remain also insufficiently explored.

Aim: To investigate the effects of lisinopril on blood pressure and cerebrovascular reactivity (CVR) in patients with arterial hypertension (AH) and rheumatoid arthritis (RA). Materials and Methods. Fifteen patients with AH and RA (age of 61 (52; 64) years; blood pressure (BP) of 147.0 (142; 156)/87.0 (82; 90) mmHg) received lisinopril during a sixmonth open controlled study. Ambulatory BP monitoring and evaluation of CVR were performed twice: initially and at the end of the study. CVR was evaluated using transcranial Doppler ultrasound (TCD) of the middle cerebral arteries (MCA) in hyperoxia and hypercapnia. Results. Treatment with Lisinopril significantly decreased CVR parameters in hyperoxia test as follows: the MCA coefficient of blood flow velocity change and the reactivity index significantly decreased by –28.6% (–39.32; 2.90) (р=0.037) and by –39% (“77; 7) (р=0.010), respectively, after lisinopril treatment. Conclusions. Lisinopril exerted a significant antihypertensive effect and improved CVR during hyperoxia in patients with AH and RA.

Aim. The aim of the study was to investigate the changes in the balance of fatty acids in patients with coronary heart disease (CHD). Material and Methods. A comparative study of balance of 10 fatty acids was carried out in 40 men, including 30 patients with coronary artery disease and verified coronary angiographic coronary atherosclerosis without acute coronary syndrome and in 10 individuals without CHD. Fatty acids were determined using high performance gas-liquid chromatography. Results. Patients with CHD had a statistically significant increase in the content of palmitic (88.5+3.1mg/DL, which is 2.2 times more), stearic (25.4 mm+0.8 mg/DL, which is 1.6 more), and myristic (3.7 V+0.3 mg/DL, 2.8 times) acids compared with the control group. The levels of monounsaturated fatty acids (MUFAs) changed as follows: the levels of palmitoleic and oleic acids were 2.6 and 1.95 times higher compared with control. The decrease in the fraction of polyunsaturated fatty acids (PUFA) in this group was mainly due to the expense of arachidonic acid (9.07+0.7 mg/DL; by 1.4 times lower in comparison with the corresponding value in the control group). The differences were significant, p<0.01. Conclusion. The study showed that, in coronary atherosclerosis, changes in fatty acid balance consist in a statistically significant increase in palmitic acid, stearic acid, myristic acid, and monounsaturated fatty acids, as well as in a statistically significant decrease in arachidonic acid.

The aim of this study was to assess the changes in serum levels of matrix metalloproteases (MMP-2, 3, 9), ST2, NTproBNP, IL1β, and hCRP and their impact on the adverse left ventricular remodeling (LVR) in patients with acute primary anterior STEMI. The study included 21 patients aged 60.5±7.4 years. All of them received urgent reperfusion therapy; one third of patients received the treatment during the first 3 h. Echocardiography with 2D speckle tracking imaging was performed at day 3 (T2), 7 (T3), and 14 (T4) after STEMI and after 6 months (T5) after AMI (Vivid E9, GE Healthcare). The concentrations of ММP-2, ММP-3, ММP-9, ST2, IL1β, hCRP, and NTproBNP were determined at the same time point and at a day of admission (T1) by the method of quantitative enzyme-linked immunosorbent assay. After that, patients were divided into 2 groups: group 1 comprised patients with the level of ST2 > 35 ng/mL; group 2 comprised patients with ST2 < 35 ng/mL at T1. The study showed that changes in the markers were multidirectional. The level of ММP-2 did not significantly change. The level of MМP-3 increased to T3 and continued to increase to T5; the changes in levels of ММP-9 were reverse over the same period. The level of IL1β decreased to T4 though this parameter as well as the levels of ST2, NTproBNP, and hCRP exceeded the normal range during the entire observation period. The levels of ST2, NTproBNP, and hCRP were changing to T3 and significantly decreased to T5. Marker ST2 demonstrated the best predictive value for the development of adverse left ventricular remodeling. ST2 level of more than 35 ng/mL at a time of admission was associated with the presence of systolic dysfunction, increased wall motion score index, increased end-systolic volume, increased 2D global longitudinal strain, and reduced ejection fraction in the early post-infarction period.

Clinical course of myocardial infarction was analyzed in 190 patients with an emphasis on the genetic predictors of complications of acute myocardial infarction. These associations provide additional opportunities to evaluate the prognosis in this group of patients.

The aim of the study was to evaluate the capabilities of cardiac MRI in the differential diagnosis of acute coronary syndrome (ACS) in patients with nonobstructive coronary atherosclerosis. Material and Methods. This nonrandomized open controlled study was registered on ClinicalTrials.gov: NCT02655718. This article presents the results of the subanalysis of the study. Analysis included data of ACS patients admitted to the Emergency Department of Cardiology Research Institute in 2015–2016. Inclusion criteria were nonobstructive coronary atherosclerosis (normal coronary arteries / plaques <50%), confirmed by invasive coronary angiography, age e”18 years at the time of randomization. The exclusion criteria were previous revascularization of the coronary arteries. 22 patients underwent cardiac MRI. Results. Among 604 individuals who were hospitalized with ACS to the Emergency Department of Cardiology Research Institute in 2015–2016, 3.8% (23) patients had nonobstructive coronary atherosclerosis confirmed by coronary angiography. 22 patients underwent cardiac MRI. Acute myocardial infarction was diagnosed in 56% (13) of cases; unstable angina was diagnosed in 13% (3) of cases; and 1/3 of cases had pseudocoronary scenario of myocarditis. Conclusions. The proportion of patients with nonobstructive coronary atherosclerosis was 3.8%. Cardiac MRI can be used for differential diagnosis of ACS in patients with nonobstructive coronary atherosclerosis.

This article presents the results of examination and treatment of 12 patients with decompensated chronic heart failure (CHF). The heart cellular composition and profile of viruses in the myocardial tissue were studied in patients hospitalized to the Cardiology Research Institute in Tomsk during the period from 2015 to 2016. Study showed the frequencies of inflammation and the presence of viruses in the myocardium in patients with coronary heart disease (CHD) and decompensated CHF.

At present, special attention is given to studying the role of genetic factors in the development of cardiovascular diseases. Wide implementation of the genetic and cellular technologies in the future may contribute to solving the problem of prevention and treatment of cardiac arrhythmias. Ion transport systems in the cardiomyocytes play an important role in the regulation of homeostasis of myocardial cells. The literature describes polymorphic variants in the calsequestrin gene associated with arrhythmias, sudden cardiac death, and development of heart failure in patients with ischemic heart disease. Objective: The objective of the study was to analyze the role of polymorphism in the calsequestrin 1 gene in the development of atrial fibrillation (AF) and sick sinus syndrome (SSS). The study included 47 patients aged 67.0±15.4 years (38 men (80.8%)). Among these patients, 15 individuals (31.9%) had AF; 11 patients (23.4%) had SSS; and 21 patients (44.6%) had combination of these pathologies. These patients had coronary artery disease (n=27 (57.4%)), hypertension (n=10 (21.2%)), myocarditis (n=3 (6.4%)), and idiopathic heart rhythm disturbances (n=7 (14.9%)). Only 35 patients had C/C genotype and 12 patients had C/T genotype. The frequencies of the C and T alleles in patients with a combination of AF and SSS were 88% and 12%, respectively. The frequencies of the C and T alleles in AF group were 93% and 7%, respectively. The frequencies of the C and T alleles in SSS group were 77% and 23%, respectively. Conclusion. The findings showed no significant associations of AF and SSS with the polymorphisms in the calsequestrin gene.

The article is devoted to surgical treatment of the coronary artery disease in combination with atrial fibrillation. Despite the growing number of surgical atrial fibrillation ablation procedures during coronary artery bypass grafting surgery, only 27.5% of patients receive intervention for atrial fibrillation correction in addition to CABG. Article comprises long-term results of the prospective, singlecenter trial on clinical efficacy of combined stepwise approach in treatment of patients with atrial fibrillation and CABG in comparison with surgical ablation alone.

Aim: The aim of the study was to elucidate the peculiarities of pulmonary thromboembolism among patients with atrial fibrillation who died in hospitals in Tomsk during the period from 2013 to 2015 and to conduct clinical and pathological comparison in regard to the analysis of embolic sources. Materials and Methods: The records of autopsies and medical records of 134 patients aged 18 years and older diagnosed in vivo and/or post mortem with pulmonary embolism who died in the hospitals of the city of Tomsk during the period from January 01, 2013 to December 31, 2015. Results. Cardiovascular diseases which occurred in 86.5% represented the leading pathology in patients with pulmonary embolism. According to autopsy reports, pulmonary embolism was the main cause of death in 63.4% of cases. Thrombi in the right heart were found in 29% of patients: 21.6% in the right atrial appendage and 7.4% in atria and ventricles (mural thrombi). In the entire group, atrial fibrillation was found in 48 (33.5%) of patients. Thrombi in the right heart were found in 54.1% of patients with atrial fibrillation.

Retrospective analysis of case histories and protocols of postmortem autopsies of patients in the period from 1.01.2008 until 31.12.2015 is presented. The diagnosis, according to medical records, was established in vivo on the basis of complaints, anamnesis, results of laboratory and instrumental methods, and was confirmed at autopsy. In patients with arterial emboli, the following metabolic disorders were detected: obesity, diabetes mellitus type 2, and dyslipidemia in combination with atherosclerotic plaques in the vascular wall. Obesity was diagnosed in 26% of patients and degree 1 obesity prevailed (54.9%). Diabetes mellitus type 2 occurred in 35% patients and 78% of them had severe decompensated in 69.1% of cases. At the time of admission, blood glucose levels averaged 9.7 mmol/L. It should be emphasized that polyvascular disease with the presence of atherosclerotic plaques at the different stages of their development was observed in all persons with arterial emboli. At the time of admission, the level of total cholesterol was 4.55 mmol/L on average.

Introduction. Earlier research revealed that the decrease in anklebrachial index (ABI) indicates the presence of atherosclerosis of the arteries of the lower extremities and the increased risk of cardiovascular events, including stroke risk. In Russia, prevalence of risk factors for multifocal atherosclerosis is increased, but the problem of the relationship between pathological ABI levels and cerebrovascular diseases has not yet attracted attention. Materials and Methods. The study included 345 patients after stroke. All patients underwent examination of the state of their peripheral arteries using the device VaSera VS1000 (Fukuda Denshi, Japan). In patients, the presence of cardiovascular disease and previous vascular events was evaluated. Results. The study found that patients with abnormal levels of ABI (1.3 <ABI <0.9) often have concomitant cardiovascular disease (angina, chronic heart failure, arrhythmias). The study showed that the speech disorders, central paresis of muscles of the face and the tongue, and paresis of the extremities are more common in patients with pathological ABI. We found that the stenosis of extracranial arteries, thickened intimamedia complex, stenosis of the arteries of the lower extremities are most common in patients with abnormal ABI (p=0.02). Conclusions. Data of our study suggest that ABI assessment is a reasonable approach for patients with ischemic stroke to identify individuals with peripheral atherosclerosis and to administer them with targeted preventive treatments.

Aim. To study the associations of borderline CAVI values with clinical medical history and laboratory-instrumental data in patients with stroke. Materials and Methods. A total of 284 stroke patients aged 63.1±7.2 years (157 men and 127 women) were admitted to the Department of Neurology of Cardiology Clinic. Three groups of patients were identified: patients in group 1 (n=81) had a value of CAVI <8.0; group 2 (n=50) comprised patients with a value of CAVI ranging from 8.0 to 9.0; and group 3 (n=153) included patients with CAVI value >9.0. All patients underwent standard neurological examination, brain MSCT, color duplex scanning (CDS) of brachiocephalic arteries (BCA), echocardiography (echocardiogram), and laboratory tests (lipidogram, blood chemistry). Results. In patients with stroke, normal values of CAVI were identified in 28.5% of cases; borderline values of CAVI were found in 17.6% of cases; and pathological CAVI values were observed in 53.9% of cases. Prevalence of stroke risk factors in stroke patients with borderline values of CAVI was intermediate. Patients with borderline and abnormal values of CAVI more frequently had such factors as the absence of higher education diploma, the presence of angina, heart failure, peripheral atherosclerosis, thickening of intimamedia complex, BCA stenosis, 30%–49% BCA stenosis, decrease in ejection fraction, and increase in total cholesterol. Conclusion. Identification of patients with borderline values of CAVI is reasonable for dynamic follow-up of medicalpreventive measures.

The purpose of the study was to track the frequency of occurrence of cardiovascular diseases in patients with newly diagnosed tuberculosis, and tuberculosis in combination with chronic obstructive pulmonary disease. A comparative retrospective study comprised a total of 232 patients including 116 patients with TB and 116 patients with TB in combination with COPD. Cardiovascular diseases (CVD) were diagnosed in 28 people (24.1%) in group 1. Cardiovascular disease occurred statistically significantly more frequently in women: 25 women (22%) versus 3 men (2%) (p<0.05). In group 2, 44 individuals (37.9%) had CVD. Hypertension was found in 21 individuals (17%); ischemic heart disease was observed in 12 individuals (10%); and chronic heart failure was found in 11 people (9%). In this group, CVD incidence rate was significantly higher in men (34%) than in women (3%) (p<0.05). In tuberculosis group, lower incidence rate and later peak (from 61 to 90 years) of CVD development were observed which was possibly due to less exposure to risk factors (smoking, etc.). In group 1, 32 individuals (27.6%) were smokers and, among then, five patients (15.6%) had CVD. In group 2, 111 (95.1%) individuals were smokers and 40 (36%) of them had CVD (χ2=8.928; р=0.05). In group 1, 13 (11.2%) individuals showed alcohol abuse; one patient (7.7%) had CVD. In group 2, 71 (62.1%) individuals showed alcohol abuse; 22 patients (31%) had CVD (χ2=6,446; p=0.05). Mortality rates were 3.4% in tuberculosis group and 15.5% in group of TB and COPD; half of deceased individuals had history of cardiovascular events (χ2=6.465; p=0.005). The lack of treatment efficacy in the presence of CVD was documented in 37% and 33% (χ2=3,769; p=0.165), respectively. The presence of COPD and tuberculosis increase the frequency of CVD; combination of CVD with COPD and tuberculosis significantly aggravate the course of the main and the concomitant disease.

This singlecenter prospective study included 391 patients with hemodynamically significant coronary artery and internal carotid artery (ICA) stenoses. All patients were divided into four groups depending on the revascularization strategy: group 1 underwent staged surgery: coronary bypass grafting (CABG) followed by carotid endarterectomy (CE) (CABG–CE, n=151, 38.6%); group 2 underwent simultaneous surgery of CABG and CE (CABG+CE, n=141, 36%); group 3 underwent hybrid revascularization: percutaneous coronary intervention (PCI) and CE (PCI–CE, n=28, 7.2%); and group 4 received staged surgery: CE followed by CABG (CE–CABG, n=71, 18.2%). Patients with concomitant coronary artery disease and ICA stenoses had high clinical and instrumental concentration of unfavorable factors, associated with poor prognosis and required the implementation of various surgical revascularization strategies. Maximum severity of complications was recorded in patients with CE–CABG or CABG+CE revascularization strategy. Despite this, the results of simultaneous surgery are very promising. Having evaluated the short- and long-term results of distinct surgery strategies, we designed the algorithm for selection of the revascularization strategy.

The aim of the study was to evaluate the frequency of cardiac arrhythmias and superior vena cava (SVC) stenosis in early and late period after surgical correction of partial anomalous right pulmonary venous connection (PARPVC) to the SVC. Materials and Methods. Analysis was performed in 48 patients with PARPVC to SVC and atrial septal defect (ASD) at age ranging from 1 month to 58 years (6.30±11.23 years; Ме=3.00 years); 26 patients were male (54%). Three types of operations were performed: intraatrial SVC plasty (group 1, n=18), Warden procedure (group 2, n=22), and modified Warden procedure (group 3, n=8). Clinical assessment, electrocardiogram (ECG), Holter monitoring, echocardiography (Echo) with the evaluation of the flow velocity and the peak pressure gradient in SVC were provided before, 10 days and 1 year after surgical correction. Results. The patients of three groups did not differ in baseline clinical and echocardiographic parameters. During the first 10 days after surgery, significant reduction in the size of the right chambers of the heart was found in all groups; in the late period, the right atrium (RA) volume and the size of the right ventricle (RV) remained normal in all three groups. In group 2, peak and mean gradients in the SVC were increased, which did not change in the long term. The incidence rates of cardiac arrhythmias after surgery were 55.6% in group 1 and 18.1% in group 2. In group 3, cardiac arrhythmias were absent in the early and late postoperative period. Conclusions: current methods of PARPVC correction are effective; the lowest frequency of cardiac arrhythmias in the early and late period was observed when PARPVC was corrected using a modified Warden procedure; PARPVC correction by Warden procedure was associated with an increase in peak and average gradients of SVC in the early postoperative period, which did not change in the long term.

Remote monitoring systems (RMS) are the necessary attribute of effective ambulatory follow-up of patients with cardiac implantable electronic devices. Meanwhile, many specialists consider RMS as an addition to traditional in-clinic interrogating. In this research we compared these strategies in patients with ICDs. No differences in verification of leads failure or arrhythmias were shown. Timely notification of a physician about clinical events is an indisputable advantage of RMS.

The article examines the diversity of clinical-psychological and psychopathological phenomena observed in patients with coronary heart disease that reflect the characteristics of their individual responses to the development and course of the underlying disease. It is proposed to consider these characteristics for selection of treatment tactics and strategies, as well as for greater use of clinicalpsychological and psychotherapeutic approaches in integrated treatment and rehabilitation of patients with coronary heart disease.

This research was conducted to assess the informative value of morphological analysis of myocardium biopsy material in patients with ischemic cardiomyopathy (ICMP). Biopsy and autopsy from both left ventricle (LV) and right atrium (RA) were taken. Microscopy analysis of RA and LV biopsies compared with autopsy material showed that, apart from the changes caused by ICMP and post mortem remodeling, the latter had differences caused by insufficient representativeness of small fragment of the myocardium sampled intra vitam.

Tissueengineered vascular grafts are the perfect candidates as vascular conduits for cardiovascular bypass or arterial replacement surgery. Aim: To compare efficiency of the grafts blended of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) with poly(е-caprolactone) and optionally modified with either vascular endothelial growth factor (VEGF) or RGD peptides. Materials and Methods. Electrospun, 2 mm diameter grafts optionally modified with either VEGF or RGD peptides were implanted into rat abdominal aorta (n=20 per each group). In 1, 3, 6, 9, or 12 months, onefifth of rats in each group were sacrificed (n=4 per each time point) for the following histological and immunofluorescence examination of the explanted grafts. Results. At 12 months postimplantation, modification with either VEGF or RGD peptides induced formation of endothelial cell monolayer and a basement membrane-like structure in three-fourths of the grafts, which was three-fold higher compared to unmodified grafts. Furthermore, we detected CD34-positive cells, i.e. endothelial progenitor cells, as early as 1 month postimplantation in both VEGF- and RGD-treated grafts.

It was found that an intravenous administration of the nonselective of opioid receptor (OR) antagonists naltrexone (5 mg/kg) and also the selective antagonist δ1-OR BNTX (0.7 mg/kg), the selective δ2-OR blocker naltriben (0.3 mg/kg), the κ-selective antagonist nor-binaltorphimine (2 mg/kg), do not affect cardiac reperfusion injury in vivo. It is established that the мselective antagonist CTAP limits infarct size.

This research aimed to study the myocardial viability as a marker of a favorable postoperative outcome in patients with ischemic cardiomyopathy (ICMP) with anterior apical aneurysm. An effort was made to describe the state of a ‘viable’ myocardium according to the energy exchange (EE) of the left ventricular (LV) myocardium and the varying degrees of its contractile activity. The object of the study was the myocardium in patients with ICMP with anterior apical aneurysm. MRI study was performed in all patients to determine the kinesis; scintigraphy was used to assess perfusion of the LV walls. The enzymes activities of the main metabolic pathway of the myocardium were detected with the tetrazolium method proposed by Lojda. The evaluation of enzymatic activities was performed based on the intensity of myocardial structure staining using ImageJ software. As a result, we proposed the hypothesis that functional activity of the myocardium largely determined changes in the myocardial contractility rather than in the morphological state. Evaluation of the enzymatic activities allowed to reveal heterogeneity of cardiomyocytes (CMC) in regard to their activities of EE enzymes (lactate dehydrogenase, succinate dehydrogenase, and 3hydroxybutyrate dehydrogenase). Therefore, in this study, CMC population with reduced contractile activity and with increased activity of 3GBDG and LDH is considered viable myocardium.

In the paper we presented the first results of an experimental study of the efficacy of a new topical hemostatic vancomycin-containing agent based on oxidized cellulose as a hemostatic agent for preventing median sternotomy complications. The study showed that the use of the new hemostatic agent lowered the intraoperative blood loss in laboratory animals (mini-pigs) in comparison with bone wax; it did not cause clinical and histological signs of inflammation; and it did not inhibit bone regeneration for three weeks after surgery.

Here we performed a physicomechanical and biocompatibility testing of pericardial adhesion barriers prepared from either blend of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) with poly(lactide-co-glycolide) or collagen. Collagen adhesion barriers had higher durability while synthetic barriers were more prone to deformation. No significant differences in serum levels of proinflammatory cytokines (TNF-б, IL-1в, IL-6, and MCP-1) were found between rats with either collagen or synthetic adhesion barriers implanted to anterior pericardium compared to mock-treated rats. We conclude that both natural and synthetic pericardial adhesion barriers do not cause any systemic inflammation and have high biocompatibility.

Preventive examination of the employees of the Siberian Integrated Chemical Plant showed high frequency of risk factors for cardiovascular diseases (CVD) and poor cardiovascular health estimated using the model of ideal cardiovascular health. Ideal cardiovascular health, characterized by normal values of all major components, was not found in the surveyed workers cohort. Assessment of 10-year fatal risk with the SCORE scale provided a more optimistic prediction: low risk of death from CVD (<1%) was found in 12.3% of workers. Assessment of high-sensitivity C-reactive peptide and non-HDL cholesterol as criteria for effectiveness of health-promoting measures was non-informative in the present study. Therefore, the use of the ideal cardiovascular health model according to AHA allowed to identify abnormalities lost on the evaluation of total cardiovascular risk with the SCORE scale. Timely administration of health-promoting treatments to individuals of high-risk groups who has poor and moderate cardiovascular health allows to decrease the frequency and the severity of cardiovascular risk factors and to improve long-term prognosis of life.