The article is devoted to the modern aspects of the interventional arrhythmology. The first aim of this study was to test the accuracy of the noninvasively obtained ventricular activation (isolated epicardial vs combined endo-epicardial mapping) as compared with that of standard invasive mapping in patients with ventricular arrhythmias. It was 88.3%. The second aim was to evaluate the patients’ state of health by EQ-5D questionnaire and the appearance of cardiovascular events in the remote period after “MAZE” radiofrequency endocardial catheter ablation procedure, according to the efficacy of the interventional treatment. We also estimated the influence of the inflammation on the results of the atrial fibrillation catheter treatment. The results of the method for the selection and effectiveness of the treatment of severe heart failure are presented.

This article presents results of implementation of new ultrasound technologies in clinical practice. The use of speckle tracking imaging allowed for evaluation of contractile function of the left ventricle and diagnosis of early subclinical signs of cardiac injury in the presence of normal systolic and diastolic function of the left ventricle in patients with arterial hypertension without left ventricular hypertrophy (LVH). Deformations of endocardial and epicardial layers of the left ventricle were studied in regard to the form of LVH and 24-hour profile of arterial blood pressure. Associations of indicators of cardiac mechanics with 24-hour arterial blood pressure profile were demonstrated depending on the presence orabsence of LVH. Phenomenon of rigid left ventricular rotation in patients with chronic heart failure with the narrow QRS complex was discovered. Transthoracic imaging of large coronary arteries is an adequate method of visualization of the left main coronary artery, left anterior descending artery, and right coronary artery. The method may be useful for noninvasive one-time and serial diagnosis of stenosis of the left main coronary artery and the left anterior descending artery as well as of chronic occlusions of the left anterior descending artery and the right coronary artery. The study showed relationship between the coronary reserve values and 24-hour arterial blood pressure profile in patients with arterial hypertension.

This article describes main research directions of nuclear cardiology in the world and in Russia. The distinctive feature of nuclear cardiology is functionality of the techniques. Without providing a high spatial resolution, scintigrams reflect physiological and pathophysiological changes occurring in the body. This work mainly focuses on the characteristics of trends in modern nuclear medicine and cardiology. These trends comprise the development of new radiodiagnostic agents; studies of the processes of impaired myocardial blood perfusion, innervation, and metabolism; development of the methods for verification of inflammatory processes in the heart; generation of new approaches for prediction of the results of hightech interventional treatment and cardiac surgery; and the studies of relationships between the abnormalities of the heart and other organs (brain, lungs, kidneys, etc.).

The work was done by using a complex of the modern clinical and instrumental methods. The authors present a new method that they developed for the distal renal sympathetic denervation. Data demonstrated that the effective renal denervation leads to a stable antihypertensive effect, reduction of the left ventricular mass, improvement of diastolic function, normalization of the cerebral arterial autoregulation, decrease in the severity of the structural changes in the brain, and improvement of carbohydrate metabolism in the presence of resistant hypertension associated with diabetes mellitus.

In Russia, in-hospital lethality after acute myocardial infarction is 13.8%. The part of patients perishes even after recanalization of the infarct-related coronary artery as a result of myocardial reperfusion injury. Experimental data indicate that opioid receptor agonists can prevent reperfusion damage of the heart mimicking postconditioning phenomena. Agonists of k₁-and δ₂-opioid receptors exhibit the most pronounced infarct-limiting effects. Clinical data indicate that morphine is able to prevent cardiac reperfusion injury in humans. Therefore, the analysis of published data suggests that opioid receptor agonists can be prototype for development of drugs for prophylaxis of reperfusion heart injury.

The aim of this study was to investigate the efficacy and safety of pharmacoinvasive reperfusion in elderly patients (>75 years) with acute myocardial infarction. The criterion of exclusion was death in the first day of admission to hospital. A total of 68 patient charts were used for the analysis. The rate of electrocardiographic signs of reperfusion (resolution of ST-segment elevation >50%) was 44% 90 min after thrombolysis. In patients with electrocardiographic signs of reperfusion, the occlusion of infarct-related artery was found in 56.7% of cases. PCI was performed as delayed PCI in 70% and as recue PCI in 76.3% of patients. In other cases, PCI was not performed due to severe coronary disease.

The article presents material of studying the fundamental aspects of morphological and functional changes of the myocardium in heart failure (HF). Authors describe results of electrophysiological, biochemical, genetic, and morphological studies performed by using material from the laboratory animals with modeling of cardiovascular pathologies and from patients with ischemic heart disease (IHD) admitted to clinic of RI Cardiology (Tomsk). Based on presented data, the associations of morphological, functional, and biochemical changes in the cardiomyocytes in the process of pathological remodeling of the myocardium are shown. Data suggest the possible association of these changes with genetic polymorphism.

In structure of mortality, the leading cause of death of adults in economically developed countries is heart disease with heart failure. Early risk stratification before clinical manifestation of decompensated heart failure is relevant and extremely important task. Aim. The study was aimed at searching for new diagnostic biomarkers and predictors of high risk of adverse cardiovascular events and mortality in patients with decompensated heart failure. A total of 206 patients, enrolled in the study, were assigned into 3 groups: group 1 comprised 94 patients with postmyocardial infarction or ischemic remodeling where the prognostic importance of growth factors of VEGf, PDGF-AB, and FGF basic was studied; the diagnostic importance of TIMP-1 was studied in 52 patients with HF NYHA classes II- IV (group 2); and the predictive value of Lp-FLA2 was analyzed in 60 patients with diabetes mellitus type 2 associated with HF NYHA class II (group 3). Receiver operating characteristic (ROC) curves used for assessing the accuracy of predictions revealed high positive predictive values for growth factors VEGF (the area under a curve 0.71+0.05; r=0.000) and FGF basic (0.71+0.05; r=0.000), for PDGF-AB (0.66+0.06; r=0.009). Plasma level of TIMP-1>485.7 ng/mL was found to be an independent, highly sensitive prognostic factor of progression of HF and mortality (specificity of 100%; sensitivity of 80.4%). We found high correlation (r=0.66; p=0.000) between concentration of Lp-FLA2 and a frequency of a stenosis of coronary arteries in patients with type 2 diabetes mellitus (cutoff level of Lp-FLA2 983 ng/mL, sensitivity of 80%; specificity of 100%). Prognostic value of TIMP-1 as an independent marker of risk for progressing of HF and mortality is great and it should be used more widely in cardiology practice. Our study suggests that the levels of growth factors and Lp-FLA2 can be used as candidate markers associated with ischemic dysfunction of the heart, atherosclerosis of coronary arteries, and metabolic disorders. Larger studies are required to verify these findings.

The aim of the study was to extend the indications for the E-vita open plus hybrid stent graft. Surgical treatment of thoracic aorta with the E-vita open plus hybrid stent graft demonstrates the good results in patients with acute and chronic aortic dissection, posttraumatic false aneurysm, and “shaggy aorta” syndrome. Implantation of the E-vita open plus hybrid stent graft is indicated in aortic dissection, aortic aneurisms, “shaggy aorta” syndrome, and posttraumatic false aneurysm and provides good clinical results.

In the Department of Cardiovascular Surgery of RI Cardiology, new technical aspects for the use of the right mammary and radial arteries were developed and implemented to improve the results of autoarterial coronary bypass surgery. A total of 119 patients were studied. Based on data, acquired from 50 patients, a method for assessment of the suitability of the right internal thoracic artery length for the right coronary artery bypass grafting was developed [10]. Based on data from 15 patients, a method for mammary coronary bypass of the right coronary artery with a placement of the right internal thoracic artery through the right pleural cavity was developed [11]. The double mammary coronary bypass surgery with preservation of blood supply to the sternum was developed as a result of analysis of data from 28 patients [12]. Based on the analysis of 28 patients, a method of radial artery fasciotomy for prevention of the compression effects of fascial compartment was developed.

The article presents the results of cardiac magnetic resonance imaging (MRI) for predicting adverse postoperative period in patients with ischemic cardiomyopathy. Authors propose to use a viable myocardium mass index (VMMI) as a new criterion. It equals to the ratio of the viable myocardium mass according to MRI to the patient’s body surface area. The article demonstrates that when preoperative VMMI is 70 g/m² and lower, the prognosis of postoperative course of the disease is unfavorable.

Aim: To study structural brain changes according to magnetic resonance imaging (MRI) data in adolescents with essential arterial hypertension (AH). A total of 150 12-18-year-old adolescents with essential AH were examined. The average age was 14.9±2.0 years. According to 24-hour blood pressure monitoring, patients were assigned to the following study groups: group 1 comprised 44 patients with “white coat hypertension”; group 2 comprised 50 patients with labile arterial hypertension; group 3 comprised 6 patients with stable AH. MRI study of the brain was performed at MR-imaging unit “Magnetom-OPEN” according to practical standard. The left ventricle function was assessed according to echocardiography data. Activity of von Willebrand factor (vWF) was determined in vitro with reagent kit (“Technology Standard”, Barnaul). Increases in the linear sizes of liquor-contained brain structures were found in 74% of patients. Minimal and moderate signs of hypertensive encephalopathy (HE) were documented in 49.3% and 24.7% of adolescents with essential AH, respectively. An increase in the subarachnoid space of posterior fossa by 0.14 mm (р=0.032) was observed in the presence of average BP increase by 1 mmHg during day hours; systolic blood pressure (SBP) time index increase by one unit (%)corresponded to an increase of in the subarachnoid space of posterior fossa by 0.09 mm (p=0.028) during night hours. The difference in mean values of von Willebrand factor level in the group of adolescents with essential AH and HE reached 18.83% (р=0.025) and was significantly higher than in the group of patients without structural brain disturbances. An increase in the liquor contained brain spaces can be interpreted as early marker of brain damage in the presence of adolescent essential AH. Average BP during the day and a time index of SBP during the night contribute to the development of structural brain disturbances.

Aim: To assess the indices of hormonal thyroid state during prolonged amiodarone therapy in children with arrhythmias at the ages from 0 to 7 years. 42 patients with WPW syndrome (n=19), atrial tachycardias (n=16), and ventricular tachycardias (n=7) received amiodarone therapy. The duration of amiodarone intake varied from 0.7 to 24 months (Me 6.00; IQR 1.83-9.00). The course of thyroid state was assessed in the following sequence: initially, during the prolonged treatment by amiodarone, but not earlier than in a month after the therapy started, and in 6 months after amiodarone withdrawal. Increases in thyroid stimulating hormone (TSH), thyroxine (total and free), and thyroglobulin as well as moderate decrease in triiodothyronine were demonstrated in the presence of amiodarone. The increases in total and free thyroxine (p=0.043 and p=0.037 correspondingly) were statistically significant. Statistically insignificant was the increase of TSH and thyroglobulin on amiodarone therapy. However, the decreases in the given indices were significant (p=0.006 and p=0.036 correspondingly) 6 months after amiodarone withdrawal. The comparison of initial indices with the results of their analysis 6 months after amiodarone withdrawal did not show any statistically significant differences. It should be noted that the clinical sings accompanying hypertyrosinemia during amiodarone therapy were not observed in our patients. The most significant changes of the thyroid state were discovered in infants. It should be noted that, the median indices did not go beyond reference range at all stages of amiodarone treatment including also their statistically significant changes at the peak of the therapy. Amiodarone-induced changes of thyroid state were of reversible nature and normalized 6 months after the therapy withdrawal.

The aim of the study was to analyze the distribution of genotypes and alleles of genetic polymorphisms of blood clotting factor and platelet membrane glycoproteins in 102 children with congenital heart disease (CHD) with single ventricle malformations and in 98 healthy children. Wild type (GG) of factor II was detected in 99 children (97.1%) with CHD; heterozygous type (GA) of factor II was detected in 3 patients (2.9%); no children had homozygous type. Factor V wild type (GG) genotype was detected in 96 patients (94.1%); heterozygous type (GA) was found in 6 patients (5.9%); no children were homozygous for mutant allele (0%). In group of children with CHD, wild type (GG) of factor VII was found in 74 patients (72.5%); heterozygous type (GA) was present in 24 patients (23.5%); and homozygous type (AA) was present in 4 patients (4.0%). Fifty two patients (51.0%) had wild type (GG) genotype for factor XIII; 44 patients (43.1%) had heterozygous genotype (Gî); and 6 patients (5.9%) had homozygous genotype (ТТ). Genetic polymorphism of factor FGB was distributed in children with CHD as follows: 53 children (52.0%) had wild type (GG); 40 children (39.2%) had heterozygous genotype (GA); and 9 children (8.8%) had homozygous genotype (AA). The study of allelic variants of PAI-1 gene in CHD group showed the presence of wild type (5G5G) in 15 children (14.7%), heterozygous genotype (5G4G) in 50 children (49.0%), and homozygous (4G4G) genotype in 37 children (36.3%). The study of platelet membrane glycoprotein GP Ia-IIа gene demonstrated that 45 (44.1%) children with CHD were carriers of wild type (СС), 41 (40.2%) patients had heterozygous type (CT), and 16 children (15.7%) had homozygous (TT) genotype. There were no significant differences in genotype distributions between children with CHD and healthy children. Frequencies of the genotypes corresponded to those in European population.

Opioid peptides belong to the new actively studied class of the pharmacological agents showed to possess a stress-limiting and possibly cardioprotective effects modulating the activity of μ- and δ-opioid receptors. Thereby, studying the prospects for clinical application of opioid receptors is extremely important. Aim: to study the role of opioid receptors agonist dalargin and opioid receptor antagonist naloxone in heart rhythm disorders and in altered repolarization phase of the ventricles in the model of experimental cerebral fat embolism including hypothalamic damage in rabbits. A total of 48 chinchilla rabbits were used as experimental models for the rhythm disorders occurred as a complication of cerebral fat embolism; the antiarrhytmic and cardioprotective effects of opioid receptors (OR) agonists dalargin and opioid receptor antagonist naloxone were examined. Data showed that experimental cerebral fat embolism caused various types of arrhytmias with different morphology and severity, myocardial infarction-like ECG changes, and WPW-like ECG changes. Both classes of drugs increased survival of animals with cerebral fat embolism. Naloxone surpassed dalargin in reducing the frequency of ventricular fibrillation and WPW activity. Results of our research show that experimental cerebral fat embolism is associated with hypothalamus damage and high risk of development of fatal arrhythmias. Administration of opioid receptors agonist dalargin or opioid receptors antagonist naloxone provided the stress-limiting, antiarrhytmic, and probably cardioprotective effects, significantly improving survival of animals.

The article presents main results of 30-year-long activity of the WHO program “Registry of Acute Myocardial Infarction” (RAMI) in Tomsk. Characteristics of epidemiology, clinical course, outcomes, and long-term prognosis of acute myocardial infarction (AMI) were studied in the population including working-age patients. Mathematical model was developed to identify the group of patients with high risk for adverse cardiovascular events in the long-term period of myocardial infarction (MI). Apart from comprehensive studies of AMI, epidemiology of unstable angina (UA) was analyzed and unique data were generated regarding the prevalence rate, specific aspects of onset, and clinical course of this pathology both in general and for individual clinical forms. The use of RAMI data enabled to receive valuable information for practice and to develop practical recommendations for optimal ambulatory management of high- and very high-risk patients who suffered acute coronary event.

The aim of the study was to investigate the multifactorial associations between the traditional cardiovascular risk factors and prevalence of carotid atherosclerosis in general population of Tomsk. Cross-sectional epidemiologic study of general Tomsk population aged 25-64 years (n=1600) consisted in screening examination of extracranial carotid vascular bed to detect the presence of atherosclerotic plaques by ultrasonography. We examined age, gender, smoking exposure duration, total cholesterol, high density cholesterol, abdominal obesity, low educational status, systolic blood pressure, hsCRP, fasting plasma glucose, diabetes mellitus, antihypertensive treatment, and cholesterol-lowering treatment as potential determinants of carotid atherosclerosis. To study associations, we used logistic regression analysis. Error probability <5% was considered as statistically significant. Single-factor analysis showed that all factors were significantly associated with carotid plaque prevalence. After adjustment for age and gender, only three factors, namely: total cholesterol, smoking exposure duration, and low education were significantly associated with carotid plaques. Multiple regression analysis showed that eight factors correlated with carotid plaque prevalence in an independent manner. Among these factors, the most influential determinants of carotid plaques were age, total cholesterol, smoking exposure duration, high density cholesterol, and gender. Results of the study provide rationale for more efficacious control of target lipid profile parameters, first of all, of total cholesterol, as well as for prevention of smoking exposure to reduce prevalence of atherosclerosis in the adult urban population of Siberian region.

The authors studied the incidence of common and professional risk factors of arterial hypertension (AH) in police employees serving in the Khabarovsk region. The study involved 416 men aged 20 to 50 years, 340 of whom had various degrees of arterial hypertension. Control group comprised 76 men with normal blood pressure. Obesity, heredity, smoking, frequent 24-hour duty shifts (more often than twice a week), serving period in police exceeding 10 years, moderate to high situational and personal anxiety, belonging to the 3-4^th professional groups, lack of physical activity, regular alcohol intake as well as sitting at the computer for the greater part of the working day were found to be the most important AH risk factors. The present analysis can be useful in elaborating preventive measures in employees of AH high risk group.

Data of many researchers suggest that the level of cardiac biomarkers indicating necrosis of cardiomyocytes increases during endovascular procedures on the coronary arteries. The risk of subsequent major cardiac events including death and myocardial infarction is associated with the degree of elevation of cardiac enzymes after surgery. Therefore, therapeutic strategies attenuating the frequency of procedural myocardial injury can have a positive impact on clinical outcomes after endovascular interventions. The authors demonstrated that the use of high loading doses of potent statins (atorvastatin and rosuvastatin) with a planned endovascular coronary intervention in patients who already receive standard lipidlowering therapy long-term, has a similar effect on the dynamics of cardiac biomarkers after PCI. At the same time, administration of a loading dose of rosuvastatin has an advantage due to a significantly smaller increase in the levels of creatine kinase-MB and TnI (26.7% and 27.1%, respectively) during the first 12 hours after the procedure. The second part of the work demonstrates that the addition of trimetazidine to standard therapy in endovascular revascularization in patients with impaired glucose metabolism reduces acute myocardial damage, although the clinical significance of the effect of that protection on remote patient outcomes requires more studies.

The article presents and discusses capabilities of magnetic resonance imaging with paramagnetic contrast enhancement as a possible tool for long-term follow-up of atherosclerotic plaques. Authors present a case of following-up a patient with bilateral carotid atherosclerotic plaques treated with atorvastatine at a dose of 40 mg per day for as long as two years. Data suggest that long-term treatment with atorvastatine is associated with decrease in contrast enhancement of atherosclerotic plaques of carotid arteries and also with stabilization/improvement in MRI scans of the brain itself.

This article presents clinical case of the use of multi-slice spiral computed tomography and magnetic resonance tomography (MRT) with stress test for establishing diagnosis and determining treatment tactics in a female patient with cardialgia of unclear genesis. To verify diagnosis of ischemic heart disease, a diagnostic algorithm of the existing NICE CG95 47938 NHS protocol was implemented. This approach enabled to verify coronary atherosclerosis with stenosis and demonstrated the need for endovascular myocardial revascularization to achieve angiographic and clinical success.

The purpose of the study was to identify features of the circadian rhythm of blood pressure in patients with arterial hypertension in the presence of hyperuricemia and to assess the impact of monotherapy with losartan, enalapril, and lisinopril on circadian blood pressure profile, the level of uric acid and lipid profile. The study included 76 patients attending the clinic, in the presence of arterial hypertension degree I and II in conjunction with hyperuricemia. We conducted clinical examination, echocardiography, 24-hour monitoring of arterial blood pressure, kidney ultrasound, lipid profile, and determined the levels of uric acid in the blood and in the daily urine. Patients were divided into three groups: I (n=30), II (n=22), and III (n=24) who received monotherapy with losartan, enalapril, and lisinopril, respectively. The duration of drug intake by patients of all groups was 12 weeks. In patients with a combination of arterial hypertension and hyperuricemia, we identified dysregulation of blood pressure, evidenced by the increases in the time indexes for systolic and diastolic blood pressure, variability and increase in the morning systolic blood pressure rise, contributing to the development of the load on the target organs, in particular, leading to the left ventricle hypertrophy. The 24-hour arterial blood pressure monitoring showed that predominant types of inversion of the systolic and diastolic blood pressure circadian rhythms were insufficient reduction (non-dipper) in 58-67% and nocturnal hypertension (knight-picker) in 18-33% of cases, with the worst parameters of systolic and diastolic blood pressure registered at nighttime. The study revealed that impact of therapies on the level of blood pressure was comparable. The normalization of the circadian dipper blood pressure profile was observed almost in half of patients. However, moderate decrease in the level of uric acid in the blood and increase in the uric acid excretion occurred only in case of monotherapy with losartan.

In our country, the real prevalence of early stages of carbohydrate metabolism disorders across all age groups was studied not enough. We conducted an open observational study that comprised 58 adolescents (28 females and 30 males) with obesity of 1-4^th degrees. The evaluation of early carbohydrate metabolism disorders in adolescents was based on the results of oral (OGTT) and intravenous glucose tolerance (IVGTT) tests; dynamic changes in parameters were estimated in the presence of metformin therapy. Early markers of carbohydrate metabolism disorders were high level of glycemia at the third minute of IVGTT, slow decline in blood glucose, and high postprandial level of glycemia. Six-month metformin therapy in obese adolescents with impaired glucose tolerance resulted in an increase in the index of insulin resistance HOMA due to a decrease in the level of glycemia and an increase in the fasting insulin concentration suggesting recovery of the secretory function of ß-cells. Data of IVGTT compared with OGTT enabled to differentiate carbohydrate metabolism disorders at early stages, to identify a primary mechanism (reduction of insulin secretion or impaired peripheral glucose utilization rate), and to assign patients with obesity to groups of high risk for type II diabetes mellitus. Further studies are required for more careful identification of optimal dose and duration of metformin therapy.

The article presents the history of the Department of Faculty Therapy of Tomsk Medical Institute and its contribution to the victory in the Great Patriotic War (1941-1945).