Stress echocardiography is a technique that allows to evaluate myocardial contractility and intracardiac hemodynamics under conditions of physical exercise or reaction to a pharmacological drug. Evaluation of systolic function of the left ventricle plays an important role in establishing the prognosis and choosing a treatment strategy for various cardiovascular diseases. Speckle tracking technique is one of the most promising methods for determining values of left ventricular deformation, due to which not only visual, but also quantitative assessment of left ventricular myocardial contractility is possible at rest and during stress tests. In this review, we analyzed the possibility of using speckle tracking stress echocardiography with physical exercise or with the pharmacological drug, in order to diagnose various diseases, such as ischemic heart disease, valvular heart disease, diabetes mellitus, and microvascular damage. Along with this, differences between the values of the longitudinal systolic deformation depending on age were considered. We also compared diagnostic values of the data of speckle-tracking stress echocardiography and coronary angiography and values of the data of speckle-tracking stress echocardiography and computed tomography of the coronary arteries.

This article reviews the issues of cognitive disorders common in cardiac surgery patients as they contribute to the structure of postoperative complications and the long-term prognosis of cardiovascular diseases. Attention is drawn to the fact that the diagnostic capabilities to assess the changes in cognitive status of cardiac surgery patients are limited; and the authors emphasize the need to search for objective and sensitive criteria for diagnosis of cognitive disorders in patients, candidates to direct myocardial revascularization. Relevance of the modern methods for brain electrical activity mapping to study neurophysiological status of patients with coronary artery disease undergoing cardiac surgery interventions is evaluated.

The introduction of autovenous coronary artery bypass grafting (CABG) marked the era of surgical revascularization in patients with coronary artery disease. It provided effective treatment for angina and significantly improved the long-term prognosis. Venous transplants today remain the most popular conduits in coronary surgery due to their availability, ease of harvesting, and the absence of length restrictions. Despite the advantages of autovenous CABG, the main disadvantage is the high incidence of venous graft failure, which represents an important and unresolved problem in cardiac and cardiovascular surgery. On the other hand, the traditional allocation of a large saphenous vein implies the dissection of soft tissues throughout the length of the isolated conduit. Traumatic dissection causes a long-lasting persistent pain syndrome after surgery, frequent abnormalities in  skin sensitivity, and a high incidence of wound complications in the lower extremities. These complications lengthen the period of rehabilitation of patients and worsen the quality of life. There is an approach of isolating the vein in a block with surrounding tissues to optimize the long-term functioning of the venous shunt, however, this technique is even more traumatic than the traditional method, and therefore its use is limited in practice. On the other hand, the introduction of minimally invasive methods of isolation allowed to reduce the incidence of wound complications and to improve the cosmetic result, but there is no convincing data regarding the effect on the consistency of shunts in the long-term postoperative period. The problems associated with the use of venous conduits in CABG are multifaceted, and their solutions are necessary to improve the effectiveness of surgical revascularization.

Background. A 5-year sudden cardiac death risk model in line with ESC-2014 (HCM Risk-SCD score) Guidelines assesses the risk of sudden cardiac death in individuals with hypertrophic cardiomyopathy using clinical parameters without taking into account magnetic resonance imaging indices including myocardial fibrosis.

Aim. To compare subjects with low, moderate, and high sudden cardiac death risks, identified based on HCM Risk-SCD score, with delayed enhancement magnetic resonance imaging-evidenced fibrosis and to assess the role of fibrosis in identification of patients with sudden cardiac death risk.

Material and Methods. A total of 98 patients with hypertrophic cardiomyopathy underwent an integrative examination including cardiac echocardiography, 24-h electrocardiography monitoring, delayed gadolinium-enhanced magnetic resonance imaging, and an assessment of a 5-year sudden cardiac death risk by HCM Risk-SCD score.

Results and Discussion. Out of 98 patients, 45 (46%) patients had low risk of sudden cardiac death, 26 (26%) patients had intermediate risk, and 27 (28%) patients had high sudden cardiac death risk by HCM Risk-SCD score. During the follow-up period, (mean 41 months; 25 to 58 months), 16 adverse events were registered: sudden cardiac death occurred in 9 patients while 7 patients had been successfully resuscitated and implanted with implantable cardioverter defibrillator for secondary prevention of sudden cardiac death. The risk assessment using HCM Risk-SCD score showed high risk in 8 out of 16 (50%) patients; 2 (12.5%) patients had moderate risk, while 6 (37.5%) patients had low risk. High-risk patients demonstrated significantly (p<0.001) larger fibrosis (mean 28.5%; quartiles 21.9%; 44.1%) compared to those with moderate risk (mean 17.6%; quartiles 8.0%; 22.5%) and low risk of sudden cardiac death (mean 11.7%; quartiles 5.8%; 17.6%). The volume of fibrosis by delayed contrast-enhanced magnetic resonance imaging was associated with the adverse outcomes rate, which was 15%. A Log rank test in the KaplanMeier survival analysis showed statistically significant differences (p=0,002) in groups with fibrosis <15% and≥15%. The regression analysis showed that myocardial fibrosis was more significant factor associated with sudden cardiac death (OR 12; 95% CI 1.6–91) compared to SCD ESC-2014 score (OR 2.8 95% CI 1.1–7.5).

Conclusion. Therefore, based on regression analysis, patients with hypertrophic cardiomyopathy who had myocardial fibrosis volume ≥15% were identified as a group with risk of sudden cardiac death and adverse arrhythmic events.

Objective: to identify the features of myocardial fibrosis and ventricular repolarization disorders associated with malignant ventricular tachyarrhythmias (VT) in patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM).

Material and Methods. Fifty consecutive patients (41 men and 9 women aged 60±13 years; 30 patients with ICM and 20 patients with NICM) underwent contrast magnetic resonance imaging (MRI) of the heart, QT dispersion analysis of 12-lead Holter ECG followed by implantation of cardioverter-defibrillator (ICD) or resynchronizing device with defibrillator (CRTD) to prevent sudden cardiac death.

Results. According to data of 32 (28–43)-month follow up, VT paroxysms were registered in 20 of 30 patients (67%) with ICM and in 5 of 20 patients (25%) with NICM on follow-up. Data of successive univariate and ROC analyses of MRI indices differed between patients with and without recurrence of VTs in ICM and NICM patient groups. In ICM patients, VTs were associated with the values of QT (peak) interval dispersion over 80 mc according to data of Holter ECG monitoring and higher gray zone in the left ventricle (≥27%) according to contrast-enhanced MRI. Similar analyses in NICM patients showed that the most valuable diagnostic signs associated with the right ventricular tachycardias were the values of QT (peak) interval dispersion over 90 mc according to data of Holter ECG monitoring and the presence of non-transmural fibrosis of the left ventricle (≥27%) according to contrast-enhanced MRI.

Conclusion. The features of structural remodeling of the left ventricle predisposing to VTs significantly differ in patients with ICM and NICM. Nevertheless, the presence of ventricular repolarization disorders, associated with onset of VTs, is universal in patients with ischemic and non-ischemic cardiomyopathies.

Objective: To study the effect of intense physical exertion on the normal physiology of the left ventricle (LV).

Material and Methods. 146 professional athletes underwent a non-invasive assessment of LV systolic deformity in various directions. As a control group, 22 bowling athletes were surveyed.

Results. In cyclists, eccentric hypertrophy of the LV myocardium was detected in 31.7% of men and in 29.5% of women. The values of global longitudinal strain were below 18% in male athletes from the cycling-BMX and cycling-highway groups (17.70±2.40% and 17.50±2.39%, respectively). Indicators of circular apical and circular global deformation were significantly lower in the group of cycling-BMX (men) compared with the corresponding values in the bowling group (14.50±6.23% and 14.70±6.42%; 18.40±6.32% and 16.90±6.43%, respectively, p<0.01).

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.

Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.

Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.

Conclusions:

1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.

2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.

3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

Aim. To evaluate the informational and diagnostic significance of the myocardial Tei index.

Patients and methods. The study assessed data of echocardiographic studies of 9,256 patients aged 1 month to 60 years, 1,350 healthy individuals, and 7,906 patients with various cardiovascular diseases with abnormal volume-capacitive characteristics of the heart (congenital heart defects, different types of cardiopathy, and hypertensive disease).

Results. The cutting points of the normal values of the indicator were established. Data showed that the Tei index did not reflect changes in the pumping function of the left ventricle and did not depend on the contractility of the left ventricle (LV), but it had direct significant correlation with the left ventricular filling pressure, both in normal and pathological conditions. Correlation was more significant in adult patients.

Conclusion. Normal values of the Tei index less than 0.5 were observed in more than 95% of practically healthy individuals of any age. The maximum sensitivity and specificity of the myocardial performance index was found in patients with restrictive and dilated cardiopathy and common atrioventricular connection.

Aim. To evaluate structural features of the mitral valve (MV) in patients with left ventricular hypertrophy (LVH) and to identify characteristics of MV structural remodeling in hypertrophic obstructive cardiomyopathy (HOCM) patients using three-dimensional MV quantification analysis.

Material and Methods. The study included 48 patients with HOCM and 15 patients with arterial hypertension and LVH. All patients underwent standard echocardiography and real-time 3D transesophageal echocardiography, followed by MV reconstruction with quantitative analysis. Quantitative analysis of MV included assessment of the mitral annulus and cusps.

Results. Differences in characteristics of three-dimensional MV model between patients with HOCM and arterial hypertension and LVH were identified. In patients with HOCM, the height of the fibrous ring of the MV was increased compared to that in patients with arterial hypertension (8.00±1.72 mm vs. 5.99±1.95 mm; p=0.02). Mitral annular height (r=-0.55; p=0.02) and area(3D) (r=-0.30; p=0.04) correlated with peak LV outflow tract (LVOT) gradient. MV nonplanarity index was higher in HOCM patients (2.37±0.47 units vs. 1.73±0.62 units; p=0.02). Mitral annular maximal velocity correlated with peak (r=0.48, p=0.002) and mean (r=0.47, p=0.01) LVOT gradients. Anterior (6.40±2.04 sm2 vs. 5.07±1.04 sm2 ; p<0.05) and posterior (6.61±2.01 см2 vs. 5.27±1.23 см2 ; p=0.006) cusp areas, total cusp area (13.01±3.54 sm2 vs. 10.34±1.82 sm2 ; p=0.008), and total cusp area to annular area ratio (1.31±0.2 units vs. 1.15±0.09 units; р=0.01) had higher values in patients with HOCM. Correlation existed between anterior leaflet length and peak LVOT gradient (r=-0.45; p=0.01). Patients with HOCM had increased anterior leaflet angle compared to patients with arterial hypertension and LVH (32.13±9.21° vs. 24.86±4.45°; р=0.04).

Conclusion. Compared to patients with arterial hypertension and LVH, patients with HOCM experienced more pronounced MV annular remodeling presented as an increase in the annular height, which was accompanied by an increase in the cusp areas and the anterior leaflet angle. In patients with HOCM, the annular area and the maximum mitral annular velocity correlated with LVOT gradient.

Aim. In order to optimize the diagnosis of pneumonia by including lung ultrasonography in the diagnostic algorithm for pneumonia, the main ultrasound signs of inflammatory infiltration of the lungs were identified, depending on the form of morphological substrate, and the capabilities of ultrasound examination in monitoring pneumonia were evaluated.

Material and Methods. A total of 96 patients were admitted to hospital by emergency to rule out/to confirm pneumonia based on X-ray diagnosis of this pathology in 81 persons. Ultrasonic examination was performed in all patients at a day of admission to hospital. Dynamics in inflammatory infiltrate was evaluated in 55 patients at days 3–4, 7, and 10–14 of hospital stay.

Results. The ultrasonic signs of inflammatory infiltrate were found in 55 of 96 patients with prevalent ultrasound pattern of pleuropneumonia (n=48; 50%) and bronchopneumonia in a smaller number of patients (n=7; 8.6%). The results of ultrasonography showed the low sensitivity (69.7%) and significantly high specificity (100%) rates of the method in detecting pneumonia. Positive dynamics in ultrasonic monitoring of pneumonia was detected in the overwhelming number of patients (n=45; 81.8%) at day 3 of hospitalization. Negative dynamics (n=3; 5.5%) was observed at days 3 and 7 of the study.

Conclusion. Ultrasonic study may be considered a useful step in the diagnostic algorithm for patients with pneumonia as this method provides additional information for an attending physician and does not involve adverse effects of ionizing radiation on patient’s body. Since the ultrasonic data on positive and negative dynamics of pneumonia were received ahead of the results of standard control radiography and were verified by further clinical and radiological observations, the role of ultrasonic monitoring of the inflammatory infiltrate was essential for evaluation of the efficacy of antibiotic therapy at earlier time.

Aim. To evaluate the effect of simultaneous surgical intervention on regional cerebral blood flow (CBF) based on single photon emission computed tomography (SPECT).

Material and Methods. The study included 14 patients with hemodynamically significant stenoses of the coronary and carotid arteries that underwent coronary artery bypass grafting concomitant with carotid endarterectomy. Brain SPECT with 99mTcHMPAO was performed twice: before surgery and in the postoperative period at days 5–7.

Results. Overall, the group showed a statistically significant increase in regional cerebral blood flow in comparison with preoperative indicators in the area of the right caudate nucleus from 54.14±6.84 mL/100 g/min in the preoperative stage to 61.43±13.35 mL/100 g/min after surgery, p=0.037634, and in the left temporal lobe from 41.64±2.73 mL/100 g/min in the preoperative stage to 44.57±4.91 mL/100 g/min after surgery, p=0.019224. There were deviations of CBF less than 5 mL/100 g/min in 11 cases (79%) in most of the analyzed regions; the changes in cerebral blood flow were more pronounced in 3 cases: there was a diffuse increase in cerebral blood flow in 2 cases (14%) and а diffuse reduction of cerebral blood flow in 1 case (7%).

Conclusion. Data obtained in a small sample of patients with combined atherosclerotic lesions of the carotid and coronary arteries preliminary suggest the absence of a statistically significant negative effect of simultaneous surgical intervention on the regional cerebral blood flow in all major basins of the cerebral arteries of the brain. Observed increase in the perfusion indices in the isolated analyzed zones, not exceeding 34%, may correspond to reactive benign postischemic hyperperfusion within the concept of reperfusion syndrome.

Aim. To assess the preoperative morphological state of the brain and the state of cerebral circulation in patients referred for coronary bypass surgery to identify predictors of long-term cerebral disorders.

Material and Methods. The study included 33 male patients, divided into 2 groups according to the presence or the absence of distant neurological complications 5 years after surgery. All patients underwent non-contrast computed tomography of the brain and perfusion computed tomography. Computed tomography was repeated 5 years after surgery.

Results. The perfusion indices in all measurement zones in patients of the two groups did not significantly differ. Significant differences in width of the third ventricle and ventricular-cranial index between patients of groups 1 and 2 were not identified. The incidence rates of leukoaraiosis significantly differed: leukoaraiosis was detected significantly more frequently in group 2 (78% of cases) than in patients of group 1 (31%), p=0.0455.

Discussion. The dimensions of the brain cavity system and the preoperative state of the microcirculatory blood flow were not predictors of long-term postoperative neurological disorders. Five years after surgery, patients of group 2 showed clinical and morphological signs of past ischemic changes, which were not detected in patients of group 1 suggesting that leukoaraiosis was an unfavorable prognostic indicator of postoperative cerebrovascular disorders in the long-term period.

Conclusion. When referring a patient with the presence of morphological manifestations of cerebral microangiopathy in the form of the leukoaraiosis phenomenon for cardiac surgery, these patients should be considered at risk requiring administration of the necessary set of measures for the prevention of long-term cerebral disorders.

Aim. To evaluate standard 12-lead electrocardiogram (ECG) indices for the differential diagnosis of left bundle branch block (LBBB) tachycardias.

Material and Methods. The study analyses 244 ECG indices in 63 retrospective patients (85 males and 39 females aged 50±12 years) with LBBB type tachycardias. The electrophysiological study identified ventricular tachycardias (VT) (VT group, n=20), supraventricular tachycardias (SVT) with LBBB (SVT+LBBB group, n=23) or antidromic SVTs (WPW group, n=20). Unifactorial, multifactorial, and ROC analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated in a prospective group of patients with LBBB tachycardias (n=57).

Results. ECG signs of LBBB VTs were as follows: 1) the presence of the initial R wave in the lead aVL; 2) the absence of a split (M-shaped) R wave in the lead I; and 3) the S wave duration in the lead V1≤100 ms. For antidromic LBBB tachycardias, the ECG signs were as follows: 1) the duration of the R waves in the lead V2≥45 ms; 2) the absence of a split R waves (M-shaped) in the lead I; and 3) the duration of the R wave in the lead aVL>30 ms. The accuracy of the algorithm for diagnosis of VT with LBBB was 95% (sensitivity of 97%, specificity of 92%). The accuracy of the algorithm for diagnosis of antidromic tachycardias was 84% (sensitivity rate of 65%, specificity rate of 100%).

Conclusion. Our data showed new very powerful criteria for differential diagnosis between various LBBB tachycardias even in comparison with well-known ECG algorithms of Wellens, Brugada, Griffith, Scheinman, Vereckei, Sasaki, et al.

Introduction. Cardiovascular complications are more often observed in patients with rheumatoid arthritis. Available cardiovascular risk scales were developed for general population and provide in sufficiently adequate assessment of the cardiovascular event likelihood. Studying the risk factors in rheumatoid arthritis patients is necessary for timely diagnosis and prevention.

Objective: To analyze the incidence of atherosclerotic lesions in the brachiocephalic arteries in patients with rheumatoid arthritis and associations of this pathology with cardiovascular risk factors.

Material and Methods. Two hundred and twelve Caucasian patients with rheumatoid arthritis (age of 58.0 years [48.3; 65.0]; Disease Activity Score-28 of 4.96 [3.86; 5.85]) were included in our study. Patients had American College of Rheumatology-defined rheumatoid arthritis (1987 classification criteria). The ratio of women to men was 5.8 to 1. General clinical examination of patients, the identification of traditional cardiovascular risk factors, and the determination of disease activity were performed. The atherosclerotic progression was assessed by ultrasonography with carotid intima-media thickness measurement and atherosclerotic plaque detection. All patients gave written informed consent before enrollment into the study.

Results. Atherosclerotic plaques were found in 59 patients (27.8%), predominantly in older individuals (66.0 [59.0; 73.0] versus 55.0 years [42.0; 61.0], p<0.001) and in men (51.6 versus 23.8% in women, p=0.001). Atherosclerotic plaques were detected in 46.3% of smokers versus 23.4% of non-smokers (p=0.003). Atherosclerotic plaques were more frequently detected in patients with type 2 diabetes mellitus (58.3 versus 26.0%, p=0.036), arterial hypertension (41.7 versus 5.0%, p<0.001), angina pectoris (73.1 versus 21.5%, p<0.001), past history of acute cerebrovascular event (83.3 versus 25.9%, p=0.008), and the presence of post-infarction cardiosclerosis (100.0 versus 26.6%, p=0.03). No atherosclerotic plaques were found in 48 non-climacteric women. Except for the level of rheumatoid factor, all parameters of rheumatoid arthritis activity did not demonstrate statistically significant differences between groups with and without atherosclerotic plaques. The intima-media thickness mainly correlated with age (rs=0.633, p<0.001) and was not associated with rheumatoid arthritis activity. After the use of age- and sex-specific ultrasound criteria, the proportion of patients with intima-media thickening increased from 34.9 to 58.0% (p<0.001). Prevalence rates of most cardiovascular risk factors were associated with age and gender.

Conclusion. The present study identified the differences between the incidence rates of traditional risk factors in patients with rheumatoid arthritis compared with the corresponding values in world studies and generated comparable results with REMARKA study confirming a significance of studying this question in the context of the Russian population. The results, obtained in this study, improve understanding of the structure of risk factors in patients with rheumatoid arthritis and may provide the basis for the algorithm of curation of patient with high cardiovascular risk.

Aim. To analyze the changes in the aerobic-hemodynamic parameters during physical exercise in patients with effort angina administered with reference non-selective beta-blocker propranolol (Obsidan) with positive antianginal action and the absence of clinical effect after the drug intake.

Material and Methods. A total of 58 patients (mean age of 54.2 [48.5; 59.5] years) with effort angina of functional class II–IV were examined with spiro-veloergometry tests before and after administration of propranolol (Obsidan: manufactured by Isis Pharma GmbH, Germany) at a dose of 40 mg. At threshold physical activity the following parameters were assessed: oxygen consumption (VO2 ), specific oxygen consumption, cardiac index (CI), rate pressure product (RPP); total peripheral vascular resistance (TPVR), arteriovenous oxygen difference (a-vDО2 ) and mechanical work of the heart (HW).

Results. The efficacy of single-dose obsidian was observed in 58.6% of patients with angina (group 1); in this, tolerance to physical exercise increased from 50.0 [25.0; 75.0] W to 75.0 [50.0; 100.0] W. In the rest of patients (group 2), no antianginal effect was registered. At the first stage (at initial threshold physical activity level), administration of propranolol was characterized by saving pattern of heart function: statistically significant decrease in the heart rate, mean arterial pressure, CI and HW. This naturally resulted in reduction of myocardial oxygen demand (decrease in RPP from 163.0 [134.5; 218.5] U to 102.0 [90.0; 142.5] U; p<0.001) and predetermined the drug anti-ischemic action. At the second stage (maximum physical effort), an increase in the physical activity, caused by increase in VO2 from 738.0 [604.5; 1148.0] mL/min to 972.0 [774.5; 1458.0] mL/min, occurred due to higher oxygen extraction from peripheral blood (a-vDО2 increase; p<0.002). In group 2, despite the absence of an increase in tolerance to physical exercise, administration of propranolol was characterized by low RPP threshold i.e. the physical effort similar to the initial level was performed at a lower cardiac energy consumption.

Conclusion. Therefore, anti-ischemic effect of Obsidan was due to a decrease in theenergy expenditure of the cardiac function along with a limitation in the hemodynamic productivity efficiently compensated by an increase in the oxygen extraction from circulating blood during physical activity.

Aim. To study significance of platelet count and values of aspartate aminotransferase and tumor necrosis factor-α in the evaluation of the severity of liver fibrosis in chronic hepatitis C and for the development of fibrosis index calculation formula.

Material and Methods. The study included 70 patients with chronic hepatitis C end 30 healthy persons. Liver density was estimated by ultrasound elastography.

Results. The correlation analysis revealed strong relationships between the ultrasound elastography findings of fibrosis stage and the platelet count (r=0.83), aspartate aminotransferase (r=0.83), and tumor necrosis factor-α (r=0.81). The optimal separation points of laboratory tests for fibrosis exclusion were identified as follows: platelet count>270×109 /L (test sensitivity=96.2%), aspartate aminotransferase level<44 E/L (sensitivity=96.2%), and tumor necrosis factor-α concentration below 1.9 pg/mL (sensitivity=92.3%). The obtained values of laboratory parameters were used for calculation of the liver fibrosis index. The value of the fibrosis index ranging between 0 and 0.5 indicated the absence of fibrosis (stage F0), the value of the fibrosis index ranging between 0.6 and 2.5 corresponded to the moderate stage of fibrosis (F1-2), and the value of the fibrosis index>2.5 corresponded to the severe fibrosis/cirrhosis of the liver (F3-4) with diagnostic sensitivity of 83% and specificity of 78%.

Conclusion. Platelet count, the values of aspartate aminotransferase and tumor necrosis factor-α levels, fibrosis index, and laboratory test data can be used for ruling out fibrosis in chronic hepatitis C patients as well as for stratification of liver fibrosis stages.

We present two clinical cases of the late primary diagnosis of cardiac sarcoma with an unusual intracavitary growth in the left atrium with the left atrioventricular orifice obstruction requiring an emergency surgical intervention. A variety of concomitant clinical symptoms that mask the underlying pathological process and impede differential diagnosis has been described.

The presence of the intermediate stenosis (30 to 50% of arterial diameter) according to coronary angiography in patients with premature ventricular complexes often represents a complicated clinical task and requires additional confirmation of myocardial ischemia. The present clinical case demonstrates the opportunities and potential benefits of contrast-enhanced stress echocardiography with assessment of myocardial perfusion in diagnosing the hemodynamic significance of the intermediate lesion of the left anterior descending artery in patient with premature ventricular complexes.

Objective. To study the gender- and age-specific percentile distribution of carotid intima-media thickness (cIMT) in the unorganized urban working-age population.

Material and Methods. Presented data were obtained in the ESSE-RF study in the city of Tomsk (1,412 participants, 25–64 years old without cardiovascular diseases, 59% women). All the surveyed signed voluntary informed consent form to participate in the study. We studied distributions of the mean and maximum cIMT obtained by the automatic and manual measurements, respectively. An error probability of less than 5% was considered statistically significant.

Results. Both indicators of cIMT consistently increased with age in both gender groups. Maximum cIMT (max-cIMT) increased stronger than the mean cIMT (mean-cIMT). Compared with data obtained in other studies, the mean-cIMT estimates were distributed closer to the upper pole of the spectrum presented and increased stronger in 35–55-year-old men compared with those in the populations of Central and Southwestern Europe; the mean-cIMT estimates showed the most pronounced gender effect. Similar trends were identified in relation to the max-cIMT distribution.

Conclusion. Obtained data allowed for specific assessment of the individual cIMT values by gender and age within the framework of risk stratification among people of working age without cardiovascular diseases. Further studies aimed at clarifying the prognostic role of high cIMT values in general population, taking into account the influence of traditional and new cardiovascular risk factors, can broaden the understanding of the significance of vascular state assessment as one of the key points, linking risk factors to clinical events, for primary prevention of cardiovascular diseases in population.

Aim: To study the structural and functional parameters of echocardiography in healthy representatives of the urban Shor population, including men and women.

Material and Methods. The study included 96 indigenous and 66 non-indigenous urbanized residents of Gornaya Shoria, matched by age and divided according to ethnic and gender characteristics into 4 groups: indigenous men (n=40), indigenous women (n=56), non-indigenous men (n=32), and non-indigenous women (n=34). All individuals underwent echocardiographic study. Body surface area-indexed left and right heart structural parameters, pulse wave Doppler data, data on propagation atrioventricular flow rates, and spectral Doppler tissue data were studied.

Results. According to the results of anthropometry, men and women of Shor nationality had a lower body mass and body surface area compared with the corresponding values in men and women of non-indigenous nationality (p<0.0001 in all cases). However, the indices of the thickness of the interventricular septum, the posterior wall of the left ventricle, left ventricular mass and stroke volume, the diameter of the aorta, and the anterior-posterior dimension of the right ventricle were significantly higher in the group of indigenous women compared to non-indigenous ethnic groups. (p<0.01 in all cases). The values of the left ventricular end-diastolic volume, left atrial volume, pulmonary artery diameter were significantly higher in both men and women of indigenous nationality relative to the corresponding female and male comparison groups (p<0.01 in both cases). The tricuspid flow propagation velocity in male Shors was significantly higher than that in non-indigenous men (p<0.01). The Shor nationality was associated with a decrease in body surface area and increases in aortic diameter indices, pulmonary artery, left ventricular posterior wall, left ventricular myocardial mass index, pulmonary artery index, right atrial area index, and tricuspid flow propagation velocity; only a decrease in body surface area was associated with the female sex.

Conclusion. In healthy representatives of the indigenous population of Gornaya Shoria, ethnic differences in the structural and functional parameters of echocardiography prevailed over gender-related differences.

Aim. To study the attitudes towards smoking in working-age men and women with different nature of work and marital status in Tyumen city.

Material and Methods. The cross-sectional epidemiological study was carried out as part of the cardiac screening in open urban male and female population. The study included 850 men (response rate 85.0%) and 704 women (response rate of 70.4%) aged 25–64 years. A self-report questionnaire of the World Health Organization titled «Knowledge and Attitude to Health» with a fixed list of answer options was used to analyze attitudes to smoking. Social status was assessed according to the nature of work (four categories: «unemployed and pensioners», «manual labour», «specialists and technical/engineering employees», and «leaders»), and marital status (have or do not have a life partner). Statistical analysis of the results was conducted using SPSS (11.5) and Statistica 7.0 software packages and Microsoft Excel spreadsheet software. Values were considered statistically significant when p was <0.05.

Results. The prevalence of smoking among single men was higher than the corresponding value in men who had a life partner (63.4 vs. 46.6%, р<0.001); the opposite trend was observed in women (13.1 vs. 17.0%, р>0.05). In regard to the nature of work, the highest smoking rate was found among men who were engaged in manual labour (m/f: 60.8/19.8%). Men from the categories of «specialists and technical/engineering employees» and «leaders» (40.7 and 41%) as well as women from the «unemployed and pensioners» category smoked less often (11.6%), (р<0.001). Gender differences in attitudes to smoking depended on marital status and the nature of work. Correlations between the nature of work and attempts to change something in smoking pattern were observed in men (R=0.35, p=0.05) and women (R=0.18, p=0.01).

Conclusion. According to the study of open urban population, significant differences were detected between men and women in regard to their attitudes towards smoking. Gender-related differences in the associations of smoking with marital status and the nature of work were identified.