Vol 91, No 9 (2019)

One of the most outstanding scientific achievements in the thrombolysis is the development and administration of fibrinolysin - the first Soviet drug that lyses blood clots. Intracoronary administration of fibrinolysin reduced the mortality of patients with myocardial infarction by almost 20%. For his work in this field Yevgeny Chazov was awarded the Lenin Prize in 1982. Over the next decades, under his leadership, the Cardiology Center established scientific and clinical laboratories that created new generations of drugs based on fibrinolytics for treating patients with myocardial infarction, restoration of blood flow in ischemic tissue, and also studying the mechanisms of remodeling of blood vessels involving the fibrinolysis system. It have been found new mechanisms of regulation of the navigation of blood vessels and nerves growth, tumor growth and its metastasis with the participation of the fibrinolysis system proteins. The review reports the role of the fibrinolysis system in the thrombolysis, blood vessels growth and remodeling, neurogenesis, carcinogenesis and fibrosis. The article is dedicated to the 90th anniversary of academician E.I. Chazov.

Aim: to estimate the effects of exercise training on erectile function after coronary artery bypass grafting. Materials and methods. 114 men with stable coronary artery disease undergoing on - pump coronary artery bypass grafting were examined. Patients with ED were randomized into two groups comparable in the main demographic, clinical and baseline parameters: a group of patients undergoing supervised exercise trainings at the outpatient rehabilitation center (n=53) and a group of patients without any exercise trainings at the outpatient hospital (n=61). Patients were assessed 1, 6 and 12 months after CABG. All patients underwent echocardiography (ECHO-CG), bicycle ergometer test without discontinuation of the drug therapy, measurement of nocturnal penile tumescence (NPT), ultrasound assessment of the cavernous arteries with the further estimation of their endothelial function. Results. In addition to the expected improvements in exercise tolerance, regular cycling exercises led to a significant recovery of erectile function (number and duration of NTP, increased penile blood flow volume, estimated during NTP measurement), improved endothelial function of the cavernous arteries, compared to patients without exercise trainings. However, the obtained effects in the group with exercise trainings were short - term. One year after CABG, the number of NTP and penile blood flow volume were superior in patients undergoing exercise trainings. Differences in other parameters became less reliable between the groups. Conclusion. Aerobic exercise trainings appeared to be effective for optimizing exercise tolerance, erectile and endothelial function, and allow improving the prognosis of these patients and, therefore, are needed to be included in the rehabilitation programs for patients undergoing CABG.

Aim: to compare the antianginal and pulse slowing effects, the impact on the ectopic myocardial activity as well as the safety of the treatment with beta - adrenoblocker bisoprolol, calcium antagonist verapamil and the combination of bisoprolol with amlodipine in patients with stable angina (SA) and bronchial asthma (BA). Materials and methods. The study included 90 patients with SA II-III functional class (FC) having concomitant persistent asthma of moderate severity, controlled, without exacerbation. The patients were divided into three groups with 30 individuals in each one depending on the main antianginal drug prescribed. Group 1 patients received a cardio - selective beta - adrenergic blocker bisoprolol (Concor) at the dose of 5 mg/day, patients of group 2 were treated by a calcium antagonist verapamil at the dose of 240 mg/day, patients of group 3 received combined therapy with bisoprolol at the dose of 5 mg/day and amlodipine at the dose of 5 mg/day given as a fixed combination (Concor AM 5/5). All the patients were investigated by the methods of daily ECG monitoring and respiratory function study (RFS) in addition to physical examination at baseline and after 4 weeks of treatment. Results. After 4 weeks of treatment, patients of group 1 and group 3 did not complain of angina attacks and did not use nitroglycerin unlike patients of group 2. The achieved heart rate (HR) in group 1 patients was 68.6±8.5 beats/min, in group 2 - 74.3±5.6 beats/min, in group 3 - 67.3±4.8 beats/min. A significant decrease in the number of supraventricular and ventricular extrasystoles occurred in patients of group 1 and group 3 only. Thus, the pulse slowing, antianginal, antiischemic and antiarrhythmic effect of the calcium antagonist verapamil, even at the dose of 240 mg/day, is not always sufficient for the patients with SA II-III FC and concomitant BA, unlike therapy with the inclusion of beta - blocker bisoprolol. During the study there was no registered deterioration in the indices of bronchial patency according to the RFS data in the patients of all three groups. Conclusion. In patients with coronary artery disease and concomitant asthma, all three types of pulse slowing therapy do not have any negative effects on bronchial patency. Therapy with the inclusion of beta - blockers (bisoprolol or its combination with amlodipine), in contrast to verapamil, reliably reduces heart rate and the number of supraventricular and ventricular extrasystoles in addition to a good antianginal effect.

Aim. To evaluate efficacy and safety of reduced dose of direct oral anticoagulants (DOACs) as part of triple antithrombotic therapy in AF patients, undergoing elective percutaneous coronary intervention (PCI), and to identify factors, associated with this strategy. Materials and methods. The study is a cohort analysis of AF patients with AF, who successfully underwent elective PCI and assigned DOACs as part of triple antithrombotic therapy (TAT).Influence of a reduced DOACs dose as a part of TAT on the frequency of thecomposite efficacy endpoint (acute coronary syndrome, ischemic stroke, venous thromboembolic events, cardiovascular death and angina pectoris aggravation/need for unplanned PCI) and safety endpoint (hemorrhagic complications BARC types 2-5) were assessed using the Log-Rank criterion. Results. The study included 124 pts (69.4% women, mean aged 69±8.2 years). Themedian total score CHA2DS2-VASc was 5, the median of the Charlson index composed 7. Half (52%) of AF patients with high risk of thrombotic events after elective PCI received reduced-DOACs dose. Median follow up period was 11.0 month. 17 adverse thrombotic events were recorded during this period, BARC 2-5 bleedings occurred in 27 patients. Reduced DOACs doses in AF patients undergoing PCI were associated with significant increase of thrombotic events during follow up period compared to patients received full DOACs doses (0.79 vs 0.93, Log-Rank p=0.0292). Patients, who received full and reduced DOAC doses, were comparable in the frequency of BARC 2-5 bleedings (0.78 vs 0.75, Log-Rank p=0.06742). Conclusions. The administration of a reduced DOACs dose as a part of TAT in patients with AF, who underwent PCI, was associated with significant increase in the incidence of all thrombotic events, compared to patients, who received full dose of anticoagulants. The number of hemorrhagic complications was comparable.

Aim: to study the flow phenomena of influenza and ARVI in patients with arterial hypertension, as well as the effectiveness of antiviral therapy. Materials and methods. Analyzed data was collected during the international multicenter prospective observational FLU-EE study "Treatment of ARVI and influenza in routine clinical practice". The study included 18946 patients with established diagnosis of influenza or ARVI of varying severity. 577 patients 51-70 years old who have a history of arterial hypertension (70% of women) were selected from this cohort. These patients regularly received angiotensin - converting enzyme inhibitors for treatment in monotherapy or in combination with other drugs, used to heal diseases of the cardiovascular system. Patients were divided into two groups depending on the therapy. The first group received symptomatic treatment of influenza and ARVI (comparison group, n=86); the second group received the antiviral drug Kagocel in the complex treatment (n=491). Results. Persons with arterial hypertension and other diseases of the cardiovascular system are at risk for severe flu. The administration of the antiviral drug Kagocel as part of the complex therapy of influenza and ARVI makes it possible to speed up the regression of the intoxication syndrome, reduce the incidence of bacterial complications by 36% and the need for antibiotic therapy by 38%. Moreover, a positive effect was registered both with the early treatment of patients for medical help (by 45%) and with delayed treatment, on the 3rd day and later (by 35%). Conclusion. The use of the antiviral drug Kagocel as part of complex therapy for influenza and other acute respiratory viral infections has shown its effectiveness for different groups of patients, including hypertension, despite the fact that cardiovascular pathology, often combined with comorbid diseases, significantly worsens the course and outcome of ARVI.

Aim: to study the correlation of epicardial adipose tissue (EAT) with metabolic parameters, 24-hours profile of blood pressure (BP) and left ventricular remodeling, with the volume of intraabdominal adipose tissue (IAAT), measured by multislice computed tomography (MSCT) in patients with abdominal obesity and metabolic syndrome. Materials and methods: the study included 80 participants with abdominal obesity (waist circumference > 80 cm in women and >94 cm in men) and without cardiovascular diseases and diabetes. Within this study the following examinations were performed: waist circumference and the body mass index measurement, blood sampling and measurements of lipid levels, uric acid, fasting glucose, insulin, HOMA index, 24-hour ambulatory blood pressure monitoring. Left ventricular (LV) mass index, relative wall thickness, LV mass/height index were estimated from echocardiographic data. EAT volume and IAAT was measured by MSCT. All patients was devided in two groups for analysis: 1 (n=28) - patients with isolated abdominal obesity, without metabolic syndrome, age was 37.5±6.43 years; 2 (n=52) - patients with metabolic syndrome, age - 38.8±5.88 years. The control group 0 included healthy individuals (n=13) without obesity, age was 30.5±5.97 years. Results. A positive correlation was found between the volume of EAT with the level of insulin in the blood (r=0.2937, p<0.05), HOMA-IR (r=0.3068, p<0.05), negative correlation - with high density lipoproteins cholesterol (HDL cholesterol; r=-0.2328, p<0.05). The EAT volume correlated with mean diastolic blood pressure at night (r=0.2270, p<0.05). Quantitative analysis by cardiac parameters showed that EAT volume had correlation with the size of the left atrium (r=0.3907, p<0.05), LV mass (r=0.4566, p<0.05), the left ventricular myocardium mass index (r=0.2700, p<0.05) and relative wall thickness(r=0.2991, p<0.05). The EAT volume correlated with the volume of IAAT (r=0.6330, p<0.05), negative correlation - with the ratio of the volume of subcutaneous fat to IAAT (r=-0.4236, p<0.05). Conclusion. In the presented study the EAT volume was associated with the insulin resistance index, metabolic parameters and remodeling parameters of the left heart in young people with abdominal obesity. EAT can be considered as a marker of visceral obesity because it strongly correlated with IAAT.

Hypertension is one of the most important risk factors for cardiovascular diseases (CVD) in the world, including Russia. Current Guidelines for the management of arterial hypertension do not include different theatment strategies for men and women. Gender and age analysis of antihypertensive treatmen in men and women could reveal unreasonable and non - optimal treatment in each group. The purpose of this study was to identify the gender features of antihypertensive therapy used by primary care physicians in patients with hypertension. Materials and methods. The study is based on the Arterial Hypertension Registry established in 2012. The methodology of it has been described previously [1]. Medical data from outpatient cards were entered by doctors of 53 city primary care medical centers and 5 cardiology clinics from 22 regions of the Russian Federation. The study included the data of 33 564 patients from 18 years and older with diagnosis of arterial hypertension. Gender, age, height, body weight, smoking status, office blood pressure (BP), laboratory and instrumental examination methods, diagnosed cardiovascular and cerebrovascular diseases and comorbidities in accordance with the International Classification of Diseases of the 10th revision [ICD-10], as well as the treatment (antihypertensive and lipid - lowering therapy) were listed. Results and conclusion. Gender differences in the prescription antihypertensive therapy (AHT) in men and women with hypertension were revealed. Apparently, one of the reasons for these differences is the earlier and more frequent development of cardiovascular and cerebrovascular complications of hypertension in men than in women. Beta - blockers (BB) and angiotensin - converting enzyme inhibitors (ACEi) are more often prescribed to men with hypertension and with coronary artery disease (CAD), myocardial infarction (MI) and chronic heart failure (CHF). Women with hypertension are more often prescribed angiotensin receptor blockers (ARB), thiazide and thiazide - like diuretics. The study also showed non - optimal treatment of patients with hypertension. Insufficient prescription of medication which could improve the prognosis of the disease (ACE inhibitors /ARB, BB, mineralocorticoid receptor antagonist) have been identified in patients with hypertension and CAD, MI, CHF. It is noteworthy that in the some outpatient cards of patients with AH there is no record of AHT prescription: at a young age - in 9.6%, at old age in 15.1% of cards. Despite the fact of high and very high cardiovascular risk of the majority of patients, lipid - lowering therapy (statins) was prescribed insufficiently. The most statin administration was observed in hypertensive patients with coronary artery disease (50.1%) and myocardial infarction (62.7%).

Aim. To conduct a comparative analysis of the level of asymmetric dimethylarginine (ADMA) in two groups of patients with a diagnosis of essential arterial hypertension (AH). Group I - patients with uncontrolled hypertension (UCAH) and group II - patients with controlled course of hypertension (CAH). Materials and methods. The study included 109 patients: group I - 73 patients with UCAH, group II - 36 patients with CAH. Groups were comparable. Clinical, laboratory and instrumental examination was performed, including determination of ADMA concentration in blood plasma. Results. The concentration of ADMA in patients with UCAH was significantly higher than in the group with CAH. In patients with UCAH, a pronounced positive correlation was found between the concentration of ADMA and creatinine level (r=0.615, p<0.05), and a significant negative correlation was identified between the levels of ADMA and the filtration function of the kidneys, estimated using GFR (r=-0.444, p<0.05). As the level of ADMA in the blood increased, a statistically significant decrease in GFR was detected (p<0.05). Also in the group of patients with UCAH, a significant positive correlation of the average strength was found between the concentration of ADMA and progression of stenosis of brachiocephalic arteries (BCA; r=0.5, p<0.05). Conclusion. A significant increase in ADMA level was revealed in patients of both groups compared to the physiological norm (p<0.05), and it was significantly higher in patients with UCAH compared to those in group II, which indicates that UCAH enhances the severity of endothelial dysfunction. Establishing a reliable correlation between the level of ADMA in patients with UCAH with indicators of renal function damage, progression of BCA stenosis indicates the potential use of this substance as a marker of target organ damage and prognosis of the course of the disease.

Tumors in the heart are rare and difficult to diagnose pathologies. There are primary and secondary tumors, the letter tumors include metastases of other tumors. In this work is presented clinical case of metastatic lesion of the right atrium with renal cell carcinoma. Modern methods of diagnostics of patients with intracardiac formations are discussed.

The literature review presents the characteristics of modern high - sensitivity tests for detection of Tn (hs - cTn) in the blood and the results of large studies on the diagnosis of non segment elevation myocardial infarction (nonSTEMI) using hs - cTn. The results of these studies served as the basis for the development of three - and one - hour diagnostic algorithms nonSTEMI, presented in the recommendations of the European Society of Cardiology 2012 and 2015 and also in fourth Universal Definition of Myocardial Infarction 2018.

Despite significant advances in therapy, pulmonary arterial hypertension (PAH) remains a progressive disease with a poor prognosis. Immediately after establishing the diagnosis of PAH, urgent treatment with PAH-specific therapy is required. Due to the progressive nature of the disease, all patients should be closely monitored and their treatment regimen should be promptly changed according to clinical need. Risk stratification is an important method for informing the clinician and the patient about the prognosis of disease and the choice of therapy methods. The REVEAL scale and the ESC/ERS 2015 risk assessment table are important multifactorial tools for making decisions about the prescription and correction of PAH therapy, as well as for assessment of patients' response to therapy. Current guidelines for PAH indicate that the most important task of treatment of PAH is to achieve the low - risk status.