Chronic heart failure (CHF) is an important medical, social, and economic problem. Incidence, prevalence, and mortality from CHF remain high and prognosis still remains unfavorable. According to the American Heart Association (AHA), CHF has been named the leading cause of death among 283,000 people in 2008. According to European studies, the risk of developing CHF particularly high in the presence of such pathological conditions as coronary heart disease and diabetes. Studies revealed gender differences in CHF etiology. The presence of coronary artery disease, acute myocardial infarction, and stroke in men are the primary etiological factors of the CHF development. On the contrary, hypertension, diabetes mellitus, heart diseases, and myocarditis in the past medical history were more often verified as etiological causes in women. The relevance of HF becomes more significant with age: the reported prevalence is 0.3% among 20-29-year-old people, whereas in the group of patients older than 90 years, the average rate was about 70%. From the beginning of 1990s, researchers began to pay attention to patients with a preserved ejection fraction of the left ventricle (LV EF) and HF apart from patients with the traditional HF with reduced systolic function. Nowadays, large pool of factual data is accumulated arguing against generally accepted opinion that systolic dysfunction is the only hemodynamic cause responsible for onset and manifestation of HF. International studies show that the percentage of patients with preserved systolic function is approximately 40% to 70% (about 50% on average). Prognosis for patients with heart failure remains unfavorable. Only a comprehensive approach that includes widespread prevention, lifestyle changes, and the use of appropriate drugs, will provide an opportunity to overcome cardiological epidemic of the century - chronic heart failure.

The article present the analysis of current methods for treatment of patients with acute coronary syndrome without ST segment elevation with emphasis on identification of the optimal approach improving survival of patients after the intervention. The authors demonstrate that there is no unified algorithm of pharmaceutical and surgical management of the patients.

The results of clinical and epidemiological studies indicate a high risk of cardiovascular complications in the psychoemotional stress. The prevalence of depressive disorders among patients with pathology of the cardiovascular system is much higher than for other forms of somatic pathology. Anxiety-depressive disorders are independent risk factors for coronary heart disease and arterial hypertension. The study showed correlations between the psychoemotional factors, abnormal endothelial function, and the development of myocardial ischemia. Mental stress leads to activation of the hypothalamic-pituitary-adrenal axis, sympathoadrenal system, and hypersecretion of proinflammatory cytokines contributing to the development of endothelial dysfunction and atherosclerosis, increasing the frequency of severe complications of the disease, including myocardial infarction, and worsening the quality of life of patients.

Purpose of the study was to elucidate the effects of treatment with calcium antagonists and beta-blockers on the dynamics of circadian blood pressure profile and changes of the severity of hypertensive encephalopathy according to magnetic resonance imaging (mRI) and dynamic x-ray computed tomography of the brain (DRKT). The study involved 100 patients with essential hypertension stage II, the average age of 51.0+9.5 years. Forty seven patients received Metoprolol (egilok retard, Egis, Hungary) at a dose of 25-100 mg; 29 patients received felodipine (felodip, IVAX, Czech Republic) 2.5-15 mg; and 24 patients were administered with verapamil (Isoptin SR 240, Knoll, Germany) 120-480 mg. At baseline and 6 months after the treatment, all patients underwent ABPM, MRI, and DRKT of the brain with the calculation of indicators of cerebral blood flow. The treatment with felodipine and verapamil led to a significant decrease in the periventricular and subcortical edema; treatment with metoprolol significantly decreased subcortical edema. The treatment with felodipine significantly improved cerebral perfusion; therapy with metoprolol and verapamil was associated with a tendency to increase cerebral blood flow in the area of periventricular edema. The maximum increase in cerebral blood flow was observed when systolic blood pressure decreased by 16-25 mm Hg compared with baseline. Felodipine exerted the best effects changing cerebral blood flow and decreasing the severity of the structural changes in hypertensive encephalopathy. The drug is indicated in patients with the initially reduced rates of cerebral blood flow and severe periventricular and subcortical cerebral edema. In patients with normal rates of cerebral blood flow and the presence of periventricular and subcortical edema, verapamil may be used. In patients with normal baseline blood flow and small subcortical edema, administration of metoprolol is justified.

The aim of the study was to investigate the long-term results of autologous bone marrow mononuclear cell transplantation in patients with acute myocardial infarction. A total of 62 patients with primary acute myocardial infarction who were admitted to the hospital from 2003 to 2006 were included in the open randomized study registered under the title ESTABOMA. Inclusion criteria were primary ST segment elevation acute myocardial infarction and time to reperfusion of the infarct-related coronary artery from acute myocardial infarction onset not shorter than 4 h. All patients were randomized to two groups: group 1 (main group) included patients who received infarct-related coronary artery stenting and cellular cardiomyoplasty at 20±10 days after onset of acute myocardial infarction (n=28); group 2 (control group) included patients with infarct-related coronary artery stenting at 20±10 days after onset of acute myocardial infarction (n=34). Follow-up study was performed 8.23±0.72 years after acute myocardial infarction and consisted in the evaluation of clinical course of coronary artery disease, physical examination, exercise tolerance assessment by 6-min walking test, and serum BNP test. Adherence of patients to recommended drug treatment was assessed via the Morisky-Green test. Information about vital status of 58 patients (93%) including 26 patients of main group and 32 patients of control group was obtained. In main group, both total and cardiovascular lethality rates were higher compared with those in control group: 10 (36%) versus 4 (12%) (p=0.01) and 8 (29%) vs. 2 (6%), (p=0.03), respectively. Chronic heart failure of functional class II and higher was found more often in second group: 6 (31%) vs. 10 (21%), (р=0.05). In accordance with this, diagnoses of chronic heart failure of functional classes IIA and IIB were established more often in the second group: 8 (29%) vs. 3 (9%), (р=0.05). During eight-year follow-up period, control group had higher frequency of hospitalizations due to cardiovascular disease including unstable angina: 12 (37.5%) vs. 5 (19%), (p=0.035). The study found intergroup difference in the following combined end point: lethal outcomes due to cardiovascular disease + second acute myocardial infarction + chronic heart failure of functional class II and higher; these clinical events were significantly more frequent and occurred significantly earlier in main group (p=0.04). However, no differences in exercise tolerance and BNP levels were found. The study did not show positive effects of autologous bone marrow mononuclear cell transplantation on the long-term survival of patients. However, clinically significant chronic heart failure and diagnosed unstable angina were detected less frequently among patients of the main group who underwent follow-up examination.

The article presents the results of examination and treatment of 105 patients with decompensated chronic heart failure. Immune status and clinical course of disease were studied in patients hospitalized to the SPb RIEMC in 2010-2013. Activation of systemic inflammation and its negative impact on the course and prognosis of disease are demonstrated.

Angiotensin-converting enzyme (ACE) inhibitors are recommended as the first-line drugs for the prevention of cardiovascular diseases. There is evidence that new class of angiotensin receptor blockers (ARBs) have at least the same efficacy for the prevention of cardiovascular disease as ACE inhibitors in patients with heart failure due to the attenuation of excessive renin-angiotensin system activity. Data on efficacy of aldosterone synthesis blockage for the prevention of chronic heart failure have been accumulated in large randomized clinical trials. The aim of the study was to investigate efficacy of combination blockage of angiotensin II receptor, type 1 (AT₁ receptors) and aldosterone receptors for correction of arterial stiffness and neurohormonal abnormalities in chronic heart failure. We analyzed long-term (6-month) efficacy and safety of combination therapy with ARB (valsakor) and aldosterone receptor blocker (spironolactone) in 34 patients (age 62.3±3.9 years) mainly with NYHA class III heart failure and reduced ejection fraction (EF) - 33%. Quantification of left ventricular stiffness and ventricular-arterial coupling was performed by using three-dimensional echocardiography. We tested blood NT-proBNP level by BNP-assay and serum aldosterone by the direct radioimmunoassay. During 6 months of the study, all patients received pathogenetic therapy. Data showed favorable clinical dynamics in general condition of patients, regression of left ventricular remodeling, improvement in indexes of arterial stiffness and cardiac inotropic function resulting in reliable increase in EF (р=0.003). Serum levels of neuromediators, NT-proBNP and aldosterone, showed clear tendency to decrease compared with the initial values. Therefore, the long-term pathogenetic combination therapy of NYHA class III heart failure with valsakor and spironolactone is safe and efficacious. It results in the regression of heart failure, moderate reversal of left ventricular remodeling and increased arterial stiffness, and improvement of the prognosis for the disease.

The aim: To assess the dynamics of N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with congestive heart failure (CHF) and different response to cardiac resynchronization therapy (CRT). A total of 37 patients (mean age of 55.1±7.1 years, 81.1% men) with CHF (67.6% ischemic and 32.4% non-ischemic etiology) were examined at baseline, 1 month, and 6 months after CRT: NT-proBNP, tumor necrosis factor-α, interleukin-1β, interleukin-6, C-reactive protein and an echocardiogram. According to the dynamics of left ventricular end-systolic volume, patients were divided into responders (>15%; n=23) and non-responders (<15%; n=14). In responders, NT-proBNP decreased from 2402.4±1483.5 to 1131.1±547.8 pg/mL after 1 month (p=0.007) and to 871.1±556.7 pg/mL after 6 months (р=0.002). In non-responders, the levels of NT-proBNP did not change significantly. Responders demonstrated a tendency to reduction of all inflammatory markers: tumor necrosis factor-α (p=0.094), interleukin-6 (p=0.074), interleukin-1β (p=0.081), and C-reactive protein (p=0.072) after 6 months of CRT. In non-responders, inflammatory markers did not change significantly. Decrease of NT-proBNP and probably the reduction of inflammatory markers can be used for the assessment of CRT effect.

Aim: to evaluate myocardial perfusion and metabolism of the left ventricle (LV) in patients with dilated cardiomyopathy (DCMP) and to use these data for development of gamma-scintigraphic predictors of cardiac resynchronization therapy (CRT) efficacy. The study included DCMP patients (n=51) who received CRT. Before treatment, all patients underwent examination of the myocardial metabolism and perfusion by using ß-methyl-p-[123I] iodophenyl-pentadecanoic acid (¹²³I-BMIPP) and^99mTc-methoxyisobutylisonitrile, respectively. The 17-segment model of the LV myocardium was used to evaluate metabolic and perfusion deficits as well as perfusion-metabolism mismatch. After 6 months of CRT, patients whose end-systolic volume (ESV) decreased by 15% and more were qualified as “responders” whereas those with ESV decrease by less than 15% were considered “nonresponders”. Groups of “responders” (n=36) and “nonresponders” (n=15) significantly differed by the sizes of perfusion defects (8.70+2.94% vs. 13.73±1.92%, p<0.00005) and metabolic defects seen in the early images (7.97+4.39% vs. 13.23±3.32%, p<0.01). These results of perfusion-metabolic SPECT correlated with post-CRT LV ESV and post-CRT LV ejection fraction. Results of myocardial perfusion-metabolism scintigraphy with¹²³I-BMIPP may be used as additional diagnostic criteria for selection of patients for CRT and for prediction of efficacy of this interventional method of treatment in patients with DCMP.

The aim of the study was to assess left ventricular (LV) global longitudinal Strain/Strain rate, global circumferential Strain/ Strain rate, rotation, twist and untwist in patients with asymmetric LV hypertrophy (LVH) who had gradient of obstruction in the LV outflow tract of 50 mm Hg and more. Thirty one patients with asymmetric LVH and gradient obstruction in the LV outflow were included in the study: 11 patients had arterial hypertension (AH) and 21 patients had normal range of blood pressure values. Criteria for inclusion in this study were gradient of obstruction in Lv outflow of 50 mm Hg and more, intraventricular septum (IVS) thickness of 13 mm and more, and parameters of IVS/LV posterior wall thickness ratio of 1.3 and more. Parameters of global longitudinal Strain/strain rate, global circumferential Strain/Strain rate, rotation, and LV twist were estimated as indicators of the LV systolic function. Left ventricular global longitudinal Strain was significantly lower in patients with AH in comparison with patients with normal range of blood pressures (12.317+2.175% vs. -15.891+5.145%, р=0.04). Left ventricular rotation at the level of basal segments was significantly increased in AH patients (11.164+3.938° vs. -5.915+3.492°, р=0.01) compared with patients with normal blood pressure; rotations at the levels of apex and papillary muscles did not differ between patients’ groups. Twist rate was higher in AH patients (129.302+24.973°/с^-1 vs. 76.836+22.830°/с^-1, р=0.008). In summary, patients with asymmetrical LVH and AH had lower global Strain as compared with patients with normal blood pressure whereas the LV rotation rate and twist at the level basal segments were higher in these patients.

The aim of the study was to adopt and optimise the technique of contrast-enhanced magnetic resonance tomography for evaluation of non-transmural damage of myocardium in patients with drug-resistant arterial hypertension in the course of treatment using intravascular technique of radiofrequency ablation of the renal arteries. ECG-gated contrast-enhanced MRI of the heart was employed for these purposes in ten patients with drug-resistant hypertension and prominent left ventricular hypertrophy twice: before the treatment and six months after radiofrequency ablation of the renal arteries. The index of enhancement (IE) of T1-weighted spin-echo images, volume of uptake of the contrast to the myocardium, and left ventricular myocardial mass were shown as most useful indices for the MRI follow-up of condition of the heart in the patients. The study showed that contrast-enhanced MRI is an adequate technique of diagnosis and follow-up of the non-transmural damage of myocardium in patients with left ventricular hypertrophy and drug-resistant arterial hypertension. Results of the MRI studies in these patients with drug-resistant hypertension provide evidence for significant regress of left ventricular hypertrophy and subendocardial myocardial damage after radiofrequency ablation of the renal arteries.

Incidence of cardiovascular diseases (CVD) in children is currently increasing and arterial hypertension is ranking number one among them. Changes in blood vessels can be detected in the developing arterial hypertension at the preclinical stage. Detection of these changes enables to prevent further progression of increased arterial blood pressure via the package of preventive measures.

The aim of the study was to develop and implement the patient selection algorithm for surgical treatment of long-lasting persistent atrial fibrillation. The algorithm enabled to decrease probability of permanent cardiac pacing in postoperative period and was based on the initial sinus node function by using the originally designed method in these patients. The results showed that the use of this algorithm for selection of patients provides a way to significantly reduce the probability of pacemaker implantation in the postoperative period.

Seventy years passed from the day of the first successful surgical correction of aortic coarctation, but the incidence of recoarctation remains fairly high. One of the main causes of recoarctation is accompanying hypoplasia of the aortic arch, which is present in 60-81% of newborn patients. This review focuses on the challenges of diagnosing concomitant hypoplastic arch, diagnostic criteria for this condition as well as surgical and endovascular methods of its correction.

The aim of the study was to evaluate influence of the dihydroquercetin (DQ) and arabinogalactan (AG) composition on the contraction of murine portal vein smooth muscle cells (SMC). The contractile activity of the rat portal vein segments was investigated by the mechanographic method by using a device with mechano-electrical transducer (FT10g, World Precision Instruments, Inc. USA). The SMC contractile responses to 40-mM KCl and 10-мМ phenylephrine were evaluated after 20 min pre-incubation with DQ (0.001%), AG (0.005%), and their composition with ratio of 1:5 (0.006%). The amplitude of KCl-induced contraction after pre-incubation with DQ was 61.0+5.2% of the initial contraction. Treatment with the composition of DQ and AG reduced the inhibitory effect of DQ on the KCl-induced contraction. Studied substances and their composition suppressed SMC contractions induced by phenylephrine.

The artic1e presents the comparative study of the protective effects of modified nanodiamonds (MND), obtained by detonation synthesis, on nicke1 and chromium ion-induced a11ergic contact dermatitis (ACD) in guinea pigs. Treatment with MND exerted protective effects on guinea pig skin exposed to systematic app1ication of nicke1 ions. No MND-mediated protective effects were found in case of systematic app1ication of chromium ions on the skin of experimenta1 anima1s. The differences in the effects were caused by the differentia1 adsorption properties of MND for nicke1 and chromium ions. Resu1ts of atomic-adsorption spectroscopy of the skin samp1es showed that MND effective1y bound nicke1 ions and did not adsorb chromium ions. The authors discuss prospects of the use of МНА as the new adsorbent agent for prevention ACD caused by nicke1 ions.

The article presents the analysis of medical-demographic situation in Tomsk, typical city of West Siberia, for 21 years. The study demonstrated demographic disadvantages characterized by the development of regressive type of population; loss of population growth potential; population aging; the low life expectancy that had not reached its initial rate of 69.1 years to 2010 when it was only 68.3 years; unprecedented 12.1 year gap between the lifespans of men and women older than 45 years. At the same time, drastic decline in the population older than 45 years confirmed the necessity of prevention of premature death not only at the individual and group levels, but, most important, at the population level.

In this paper, we analyzed health attitudes, their parameters, and self-rated health in participants of the preventive effort “World Heart Day”. We studied prevalence of hypertension, smoking, overweight, consumption of fruits and vegetables as well as the factors related to high self-rated health and needs for training in the program “Health School for Patients with CVD”. The results are discussed in a comparative perspective with respect to the correspondent population rates. We found that high self-rated health and trust in preventive potential of modern medicine were more common in women participating in the effort than in the general population. The prevalence of main risk factors for CVD and other health attitude parameters in effort participants did not significantly differ compared with the population rates. Half of participants were interested in attending the training in the Health School. The most important objective markers of high self-rated health were normal blood pressure, number of cardiovascular risk factors, and body mass index < 30. Predictors of need for learning in the program “Health School for Patients with CVD” were low self-reported health rate, obesity, and awareness of elevated blood pressure and cholesterol. The most unfavorable situation in regard to health attitudes in prevention perspective was found in the age group of 35-44 years.

The study was carried out according to the algorithms of the World Health Organization “MONICA-Psychosocial” program by using the representative population sample of male residents (n=1000) of Tyumen. The aim of the study was to elucidate the attitudes to tobacco smoking in men of employable age in Tyumen depending on their education levels and character of labor. Obtained results suggested that 65.0% of 25-64-year-old men in Tyumen population attempted to change their smoking habits with various degrees of success. The study showed that Tyumen men of employable age working manual labor had the most prominent smoking habits; an increase in education level was associated with the development of negative attitudes to tobacco smoking.

The article presents the health-related problems of candidates entering the Military Institute of Internal Troops of the Russian Ministry of Internal Affairs. Methodology of the work was based on the studies in the fields of medicine, pedagogy, and psychology. The main methods of the project included the analysis, synthesis, comparison, analogy, deduction method, induction method, dialectical approach, generalization, and others. Results of the study are represented with theoretical ideas that can be used in modern medicine and education.

This paper presents a retrospective analysis of endovascular treatment of coronary artery disease (CAD) in patients with stable CAD in the Cardiac Rehabilitation Department (Research Institute for Cardiology, Tomsk) from 2010 to 2011. Data showed that the presence of concomitant multifocal atherosclerosis (MFA) was associated with more severe clinical condition of patients, larger baseline number of risk factors and comorbidities, and the absence of clinical signs of regression of coronary insufficiency and heart failure long-term after coronary intervention. The study showed that the presence of MFA did not increase the length of hospital stay and the rates of complication after endovascular treatment for stable coronary artery disease. Long-term outcomes of planned coronary stenting in patients with CAD associated with MFA were significantly worse in respect to such important events as all-cause mortality and stroke. One of the causes for the unfavorable course of the disease in this group of patients was the presence of significantly higher activity of the inflammatory processes.

The study presents data on clinical evaluation of the likelihood and frequency of “silent” strokes in ambulatory hypertensive patients with or without type 2 diabetes mellitus (T2DM). The results of the study showed that “silent” strokes occurred 8 times more often in hypertensive patients with T2DM compared with patients without T2DM. Results of the clinical evaluation of the likelihood and frequency of “silent” strokes showed that 10%, 40%, and 50% of T2DM-free hypertensive patients had high, moderate, and low chances of past “silent” strokes, respectively, whereas 60%, 30%, and 10% of hypertensive patients with T2DM had high, moderate, and low probabilities of past silent strokes, respectively. Our data suggested that the presence of T2DM contributed to more frequent development of “silent” strokes. Evaluation of clinical probability of the ambulatory “silent” strokes by the proposed method will contribute to timely referral of ambulatory patients with moderate or high stroke likelihood to the most appropriate diagnostic, medical, and preventive services.

The article presents clinical case illustrating diagnosis, treatment, and dynamic follow-up of a young patient with the left anterior descending coronary artery muscular bridge. The authors demonstrate and discuss the development of complications with further successful surgical treatment.

This article explores the links between science and practical medicine in Tomsk during the Great Patriotic War based on the materials of archival documents and periodicals. The authors emphasize the significance of the Tomsk Committee of Scientists for coordination of the collaboration between scientists from the educational and academic research institutions in providing the replacement of imported medicines with homeland pharmaceuticals based on local medical raw materials, controlling epidemics, and improving diagnostic, surgical, and therapeutic approaches. The article describes the great contribution of the Tomsk universities and evacuee research institutions to saving lives and improving health of sick and wounded soldiers staying in military hospitals.

The article reviews the process of establishment of the interregional association “Healthcare of Siberia” as a response of the regional healthcare services to the management crisis in the context of the liberal reforms in 1990s. The authors concluded that the structural and functional fundamentals of the association provided a way for solving the ongoing problems in the public healthcare system of the Siberian region and to establish a constructive dialogue with the Federal authorities during the transformation period.