Aim: to study the cardioprotective efficacy of renal denervation in patients with normal and increased blood pressure variability.

Material and Methods. Initially, at 6 and 12 months after renal denervation 84 patients were evaluated by 24-h blood pressure, Doppler echocardiogram and cardiac contrast-enhanced magnetic resonance imaging. Retrospectively, all patients were divided into two groups: the 1^st — with normal (SSD<15 mm Hg, n=28) and the 2nd — with high 24-h blood pressure variability (SSD≥15 mm Hg, n=56).

Results. Left ventricular mass reduced in the 2^nd group at 6 month by 6.9% (p=0.036), at 12 month by 9.6% (р=0.029). By magnetic resonance imaging in the 2^nd group left ventricular mass reduced at 12 month by 15.2% (р=0.010), volume of subendocardial damage — by 28.8% (р=0.039). There were no changes in the 1st group.

By researches it is proved that the phenomenon of no-reflow is an independent predictor of remodeling of the left ventricle at the moment. Particular importance in formation of this phenomenon is the fragmentation of a thrombus with distal embolization of small vessels, which often arise as a complication of the percutaneous coronary intervention during the destruction of a thrombus. Attempts to prevent the development of microvascular obstruction led to the creation of delayed stenting.

The Purpose: assessing the efficacy and safety of deferred stent implantation in patients with ST-segment elevation myocardial infarction and massive coronary thrombosis.

Material and Methods. 12 patients with STEMI are included in a research. In the course of emergency coronary angiography was performed a massive thrombosis of the infarct-related coronary artery was observed with TIMI 2–3 blood flow. The emergency stenting wasn’t carried out to these patients, but continued anti-thrombotic therapy within 24 hours. After one day, repeated the coronary angiography was performed and, according to the indications, performed stenting of residual stenosis.

Results. Development of the phenomenon of no-reflow, deaths and coronary events due to reocclusion of the infarctrelated coronary artery at all patients wasn’t observed. Also, all patients had a positive angiographic result in the form of regurgitation of the thrombus as a result of repeated the coronary angiography.

Conclusion. Two-stage revascularization with delayed-on-day stenting with massive thrombosis of the infarct-related coronary artery in patients with acute myocardial infarction combined with aggressive antithrombotic therapy may be use in clinical practice to reduce the risk of developing the no-reflow phenomenon.

The article shows the results of the study using drug Ropren in the patients with acute coronary syndrome. Ropren is  a plant drug containing polyprenols — dolichol precursors which take part in dolichol phosphate pathway. The pathology in this pathway leads to disbalance and glycoprotein deficiency. This is the reason of large group of diseases. This study is randomized double blind placebo controlled (No. NCT03122340 at ClinicalTrials.gov). Patients (n=68) with ACS taking standard therapy including atorvastatin 40 mg/day were randomized into to 2 groups: group 1 (n=34) took Ropren  8 drops 3 times per day for 3 week, then 5 drops 3 times per day for 5 weeks; group 2 (n=34) took placebo in the same dose regimen. After two — month therapy there was a positive dynamic (decreasing) in the level of interleukin-6 in the study group whereas in the control group there was no statistically significant change: 4.36 (2.61, 8.95) and 5.5 (3.3; 8.4) pg/ml, respectively (p<0.05). In the group of patients taking Ropren the reduction or cessation of statin was required significantly less than in the placebo group: 3 (8.8%) vs 9 (26.5%), respectively. One patient from the first group had a side effect in the form of gravity in the right hypochondrium. That is why the administration of Ropren in addition to standard therapy is reasonable in patients with ACS.

The aim was to study the clinical course of CHF decompensation and the structural and functional state of the left ventricle in patients with ischemic CHF with systolic dysfunction and myocardial inflammation.

Material and Methods. This study is open, non-randomized, prospective, registered on the ClinicalTrials.gov website, identification number: NCT02649517. The analysis included 25 patients (84% men, LVEF 29.17±9.4%) with ADHF of ischemic etiology. The average age of the patients was 60.12±9.3 years. All the patients underwent an echocardiography including 2D-speckle tracking technique to assess LV deformation. All patients underwent invasive coronary angiography to exclude the progression of coronary atherosclerosis, as a cause of CHC decompensation. An endomyocardial biopsy was performed to diagnose the presence of myocardial inflammation. We performed a comparative analysis of clinical, laboratory, instrumental indicators depending on the fact of diagnosis of inflammation in the myocardium.

Results. There were no specific features of the clinical course of decompensation of ischemic CHF with systolic LV dysfunction depending on the inflammation in the myocardial tissue. However, in patients with inflammation, aortocoronary bypass surgery was more often performed (p=0.00650). In addition, in patients with inflammation, there was a decrease in apical rotation (p=0.0313), its systolic velocity (p=0.0157 with decompensation of CHF. A year later, improvement in LV biomechanics, but a continuing decrease in the absolute modulus of global longitudinal LV deformation (p=0.0431) after the anti-inflammatory treatment. Also a year later, in both groups there was an increase in the LV end-diastolic volume index (p=0.0180 and p=0.0280, respectively), a decrease in the interventricular septum of the LV (p=0.0491) in the group with inflammation, and an increase in the myocardial mass index of the LV (p=0.04995) in patients with inflammation.

Conclusion. Decreased apical LV rotation and its systolic velocity in patients with ischemic CHF and LV systolic dysfunction, in view of the lack of clinical improvement after optimal myocardial revascularization, may be an additional criterion of concomitant inflammation in the myocardium. Among patients with ischemic CHF and LV systolic dysfunction, more pronounced cardiac remodeling, manifested by LV dilatation and thinning of LV wall, was observed in the group with inflammation.

Purpose: to assess the cardiac sympathetic activity, perfusion and contractility in ischemic and nonischemic chronic heart failure patients by using a radionuclide methods.

Material and Methods. The study included 33 heart failure patients with NYHA class III and ischemic (n=13.39%) and non-ischemic (n=20.61%) heart failure. All patients underwent ¹²³I-MIBG imaging, myocardial perfusion imaging with  99mTc-MIBI and gated blood-pool single-photon emission computed tomography. Based on ¹²³I-MIBG study heart to mediastinum ratio as well as ¹²³I-MIBG washout rate were calculated. According to the myocardial perfusion imaging, Summed Rest Score was evaluated. Systolic and diastolic functions and ejection fraction as well as mechanical intraventricular dyssynchrony of both ventricles were analyzed by gated blood-pool single-photon emission computed tomography.

Results. There was no statistically significant difference of hemodynamic parameters between the groups. In the first group, which include patients with ischemic heart failure, there were found the following correlations: washout rate and left ventricular end-diastolic volume (0.75; p<0.05), washout rate and left ventricular end-systolic volume (0.68; p<0.05), heart to mediastinum ratio and right ventricular ejection fraction (–0.57; p<0.05). In the group of patients with non-ischemic heart failure there were the following correlation: heart to mediastinum ratio and left ventricular end-systolic volume (–0.77; p<0.05), heart to mediastinum ratio and left ventricular ejection fraction (0.77, p<0.05), heart to mediastinum ratio and right ventricular ejection fraction (0.62, p<0.05), washout rate and left ventricular interventricular dyssynchrony (0.6; p<0.05).

Conclusion. It was found out that heart failure patients were characterized by a correlation between sympathetic activity and volumes, hemodynamics and contractility of heart ventricles. The relationship between the cardiac sympathetic activity and myocardial perfusion as well as contractility depend on the etiology of chronic heart failure.

Aim. The aim is to assess clinical features of organism and morpho-functional properties of heart and to study the dynamics of mechanical dyssynchrony in patients with congestive heart failure and superresponse to cardiac resynchronization therapy.

Material and Methods. 72 patients were examined (mean age 54.3±8.9 years) at baseline and during follow-up visits: 10.5±3.7 months, 52.0±21.4 months. Patients were divided into groups: I group (n=31) with decrease of left ventricle endsystolic volume ≥30% (superresponders) and II group (n=41) — decrease of left ventricle endsystolic volume <30% (nonsuperresponders).

Results. At baseline there were differences in the presence of myocardial infarction (22.5% in I group vs 46.3% in II group; p=0.038), the groups were comparable in severity of electrical and mechanical dyssynchrony. Left ventricle pre-ejection period in I group was statistically significantly decreased at both control visits, in group II there was no significant change. Right ventricular pre-ejection period significantly increased only in I group at the second control visit compared to baseline values. The mechanical interventricular delay significantly decreased in I group at both control visits compared to baseline values, in II group only at first control visit. The Intraventricular dyssynchrony assessed by tissue doppler imaging significantly decreased in both groups compared to baseline values. The survival rate in I group was 87.1%, in group II was 65.9% (Log-Rank test p=0.038).

Discussion. Based on the results of the subanalysis of the Echo-CRT study, it was shown that a decrease in mechanical dyssynchrony in patients with cardiac resynchronization therapy is associated with a lower incidence of hospitalization due to heart failure or death. Persistent or worsening dyssynchrony according to echocardiography may be a marker of a severity of the disease in patients with congestive heart failure and has a prognostic value. It is important to note that in our study the described facts confirm the preservation of cardiac resynchronization therapy effect with long follow-up in superresponders and limited cardiac resynchronization therapy effect with short follow-up in nonsuperresponders.

Conclusion. Superresponse is associated with a decrease of mechanical dyssynchrony with a long-term follow-up also with a higher survival rate.

Evaluating the effectiveness of diuretic therapy in the small circle of blood circulation is difficult for clinicians, as distinct from that in the large circle, where it can be assessed by dynamics of peripheral edema and liver size.

The aim of the study is to develop non-invasive diagnostics of venous pulmonary hypertension in order to determine the effectiveness of diuretic therapy.

In addition to the standard protocol of transthoracic echocardiography, we have investigated the minimum and the maximum pulmonary vein diameter in 30 chronic heart failure patients with III functional class (NYHA) before and after 4 months of standart treatment for chronic heart failure with individual selection of torasemid. All patients received  a written consent to participate in the study. After four months of therapy, a significant improvement of the following echocardiographic parameters was revealed (р<0.05): left atrium dimension (from 42±0.88 to 37.9±0.61 mm); left atrium area (from 28.9±0.91 to 24.2±0.83 sm²); maximum pulmonary vein diameter (from 22.4±0.39 to 17.9±0.62 mm); minimum pulmonary vein diameter (from 11.9±0.27 to 8.4±0.6 mm).

Thus, the transthoracic echocardiography measurement of the pulmonary vein diameter is a non-invasive objective diagnostic of venous pulmonary hypertension for evaluation diuretic therapy effectiveness.

Aim: changes in the main cardiometabolic risk factors in women of the climacteric period in early and long-term use of combined drospirenone-containing menopausal hormone therapy.

Material and Methods. The study included 210 menopausal women divided into 3 groups: 1 group (n=48) included women who, after reaching menopause, switched from a drospirenone-containing hormonal contraceptive to taking menopausal hormone therapy; in the second group (n=84) — women who started taking hormone therapy in the period of early postmenopause. Menopausal hormone therapy was used for 1 mg of 17β-estradiol and 2 mg of drospirenone-“Angeliq®”. The control group (n=78) included women in early postmenopausal women who did not take hormonal therapy. The duration of follow-up is 5.2 (4.8, 5.7) years. Lipid metabolism, uric acid, immunoreactive insulin and C-peptide, oral glucose tolerance test, HOMA-IR index were calculated. The waist circumference and waist circumference/thigh circumference were determined.

Results. Against the backdrop of prolonged menopausal hormonal therapy, a decrease in the atherogenicity of blood plasma was noted. In women of the control group, an increase in atherogenic lipid fractions was revealed by the end of the study. Patients of the first group of significant changes in the circumference of the waist and the ratio of waist circumference/thigh circumference were not detected. In women of the second group with initially higher values of the waist circumference and the ratio of the waist circumference/thigh circumference than in the patients of the 1st group, a decrease in the severity of abdominal obesity was established. Women of the control group noted an increase in the value of these indicators by the end of the study. In women receiving menopausal hormone therapy, there was a significant decrease in immunoreactive insulin and C-peptide, a decrease in the HOMA-IR index, combined with a decrease in basal and postprandial blood glucose levels. In women of the control group, as the abdominal obesity progresses, the increase in the studied indicators is noted.

Conclusion. The study suggests the possibility of using a combination of 1 mg of 17β-estradiol and 2 mg of drospirenone for prolonged menopausal hormone therapy in patients with early postmenopausal metabolic disorders. Early and longterm use of menopausal hormone therapy has some additional advantages before prescribing hormone therapy in the early postmenopausal period with more favorable changes in the lipid spectrum of the blood, less pronounced abdominal obesity and insulin resistance.

Irritable bowel syndrome belongs to the category of heavy, hard to treat diseases, which often lead to disability, therefore, the relevance of the restoration of the functional activity of the intestine is not in doubt. We carried out an evaluation of the results of sanatorium-resort treatment of 135 patients with different types of Irritable bowel syndrome (constipation, diarrhea). Age of patients ranged from 18 to 40 years, disease duration from 6 months to 5 years. High effectiveness of complex rehabilitation program in the form of recourse or relief of patient complaints, laboratory remission of the disease and stabilization of the psychological state of patients was proved. It is shown that application in complex rehabilitation of patients of Irritable bowel syndrome amplipuls therapy and millimeter therapy, contributes to more evident improvement in indices of nonspecific resistance and adaptive capacity of the organism, normalization of the intestine’s microflora, and hence increase of the colon the immune protection.

Purpose. Myocardial regeneration is one of the most ambitious goals in prevention of adverse cardiac remodeling. Macrophages play a key role in transition from inflammatory to regenerative phase during wound healing following myocardial infarction (MI). We have accumulated data on macrophage properties ex vivo and in cell culture. However, there is no clear information about phenotypic heterogeneity of cardiac macrophages in patients with MI. The purpose of the project was to assess cardiac macrophage infiltration during wound healing following myocardial infarction in clinical settings taking into consideration experimental knowledge.

Material and Methods. The study included 41 patients with fatal MI type 1. In addition to routine analysis, macrophages infiltration was assessed by immunohistochemistry. We used CD68 as a marker for the cells of the macrophage lineage, while CD163, CD206, and stabilin-1 were considered as M2 macrophage biomarkers. Nine patients who died from noncardiovascular causes comprised the control group.

Results. The intensity of cardiac macrophage infiltration was higher during the regenerative phase than during the inflammatory phase. Results of immunohistochemical analysis demonstrated the presence of phenotypic heterogeneity of cardiac macrophages in patients with MI. We noticed that numbers of CD68⁺, CD163⁺, CD206⁺, and stabilin-1⁺ macrophages depended on MI phase.

Conclusion. Our study supports prospects for implementation of macrophage phenotyping in clinic practice. Improved understanding of phenotypic heterogeneity might become the basis of a method to predict adverse cardiac remodeling and the first step in developing myocardial regeneration target therapy.

Complications of atherosclerosis remain the leading cause of morbidity and mortality worldwide. MiRNAs are short regulatory molecules that are involved in all processes of pathogenesis. Expression of miRNAs is regulated by DNA methylation. Methylation and/or expression of MIR10B and MIR21 genes are known to vary in atherosclerotic tissues of the arteries, but there is no data about the changes in the methylation levels of these genes in blood leukocytes and their association with atherosclerosis risk factors.

Objective. To evaluate the association of methylation levels of MIR10B and MIR21 genes in the blood leukocytes with risk factors and pathogenetically significant traits of carotid atherosclerosis.

Material and Methods. DNA for the study was extracted from the samples of blood leukocytes of 122 patients with advanced carotid atherosclerosis as well as from blood leukocytes of 135 individuals in the control group. The DNA methylation level was analyzed by bisulfite pyrosequencing.

Results. The methylation level of the MIR10B and MIR21 genes in leukocytes of patients with atherosclerosis is higher than in the leukocytes of the control group. In leukocytes of patients with carotid atherosclerosis the methylation level of the MIR21 gene promoter was correlated with type 2 diabetes and serum cholesterol level, and the methylation level of the coding region of the MIR10B gene was correlated with smoking.

Conclusions. The level of DNA methylation in the regions of MIR10B and MIR21 genes in blood leukocytes is associated with the risk of advanced atherosclerosis of the carotid arteries.

The aim of the work was to establish the association of the prevalence of somatic risk factors of coronary heart disease and levels of hostility in an open urban population in men 25–64 years.

Material and Methods. The one-time cross-sectional study was conducted among males (1000 people, 250 people in the age groups of 25–34, 35–44, 45–54, 55–64 years) on a representative sample formed by a “random” mathematical method from electoral administrative lists of the Central District of Tyumen. The response was 85.0%. The analysis of the study included the prevalence of somatic risk factors for coronary heart disease according to the unified evaluation criteria (arterial hypertension, body mass index, HCS, HTG, hypoCS LHD) and the prevalence of low, medium, high levels of hostility on the WHO MONICA-psychosocial questionnaire. The results of the study showed that 70.3% of men aged 25-64 with hostility were identified in the open population, with a high level of hostility in theTyumen population prevailing and amounted to 46.6%, the medium hostility level was 23.7%.Tyumen population is characterized by a high prevalence of such somatic risk factors for coronary heart disease, such as arterial hypertension, HCS, body mass index, which increases significantly from a young age and with the highest values in the older age group. In the open population in men aged 25–64 in groups with the presence of somatic risk factors of coronary heart disease, high levels of hostility predominate.

Discussion. An analysis of the results suggests that the epidemiological criteria for the psychosocial risk factors of cardiovascular disease, including hostility, will be used in conducting preventive examinations of the population, mainly in conjunction with somatic risk factors for cardiovascular disease, to form “risk groups” among men of working age who are subject to follow-up and in-depth examination.

Aim. Identification of the relationship between the state of physical development and the peculiarity of nutrition of students of theAzerbaijanMedicalUniversity.

Material and Methods. Measurement of anthropometric indicators of the students of the 2nd and 5th courses was carried out by the currently known methods. Calculation methods were used to determine sigma deviation, Broca index, body mass index, vital index. The features of student nutrition are studied using the questionnaire-method. Based on the collected questionnaires, the number of macronutrients (proteins, fats and carbohydrates) in the daily ration and its energy value are calculated from the table of the chemical composition of the products.

Results. The gender difference in the actual indicators of physical development and the number of macronutrients used in the diets is stated. The largest number of students with normal mass-scale indicators are defined among the girls of the 2nd year and boys of the 5th year. The content of macronutrients in the diets of these students corresponded to the standards and was confirmed by the values of the body mass index.Comparison of the physical development and the chemical composition of the daily ration indicates that the nutritional status of students, in particular, for young men of the 2nd year (25%) and girls of the 5th year (more than 30%), is inefficient. Excessive fat content in the daily ration and the scarce supply of other macronutrients to the body of students gives grounds for developing recommendations on dietary nutrition.

The article represents the biography of the famous Siberian dermatologist and venereologist Aleksandr Lindstrem and his contribution to the development of Siberian dermatology and venereology. The author gives a brief review of his scientific and educational activities.