The aim — to determine the role of clinico-anamnestic, demographic indicators and a number of parameters of structural-functional state of the left heart for the prediction of recurrence of persistent atrial fibrillation (AF) within 6 months after cardioversion.

Materials and methods. 225 patients with persistent form of non-valvular AF who were planning to have sinus rhythm of the heart restoration, underwent general clinical examination, ECG, transthoracic and transesophageal echocardiography (EchoCG) in order to define the standard parameters of the structure and function of the heart, as also ejection fraction (EF), left atrium (LA) and right atrium, structural and anatomical features and EF of the ear of LA (ELA), expressiveness of the phenomenon of spontaneous contrast (PSC), type of intra-atrial hemodynamics (IAH) by D. Fatkin et al classification, speed performance of flow in the pulmonary veins (S, D, S/D code). All patients received medication according to prescriptions. Re-examination, ECG and echocardiography were performed 6 months after cardioversion. For parametric and rank performance whose changes were associated with recurrent AF we calculated thresholds by Wald’s method in order to predict recurrence of AF within 6 months after cardioversion.

Results and discussion. Within 6 months after cardioversion, AF recurrence appeared in 47 (20.9 %) patients. Independent effect on the likelihood of recurrence of AF were: age > 60 years (OR 7.28; 95 % CI 2.61 — 8.94; p < 0.001), end-systolic volume of the left ventricle (LV) 80 ml (OR 13.83; 95 % CI 3.67 — 9.91; p < 0.001), LA volume index of 50 ml/m2 (OR 9.67; 95 % CI 2.93 — 20.35; p < 0.001), 2 months’ duration of illness (OR 99.34; 95 % CI 6.98 — 348.47; p < 0.001), diabetes, duration of the last episode of AF > 1 month (OR 6.30; 95 % CI 2.33 — 5.91; p < 0.001), functional class of heart failure by NYHA (OR 2.76; 95 % CI 1.19 — 5.11; p < 0.01), PSC and average velocity of blood ejection from ELA < 25 cm/s (OR 2.05; 95 % CI 1.01 — 2.98; p < 0.05). Overall accuracy of the model was 94.67 %, including sensitivity — 82.98 % and specificity — 97.75 %.

Conclusions. Recurrence of AF at 6 months after cardioversion was registered in 20.9 % of patients. The following parameters have independent value in predicting the course of persistent AF: age of patients, duration of illness and the last episode of AF, diabetes, heart failure functional class and left ventricular end-systolic volume of 80 ml, LA volume index of 50 ml/m2 and average speed of ejection of blood from the ELA < 25 cm/s, PSC.

Keywords: persistent atrial fibrillation, prognosis of recurrence, structure and function of the myocardium, echocardiography.

The aim — angiographic assessment of the distribution and severity of lesions in the arteries of the lower extremities in patients with critical limb ischemia and analysis of influence of arterial lesions anatomy on the selection of the method of revascularization.

Materials and methods. We analyzed preoperative angiography of the arteries of the lower limbs in 462 patients with critical limb ischemia who underwent revascularization of the lower extremities with endovascular (320 patients) or open surgical (142 patients) techniques. The analysis was performed of the distribution and severity of lesions on the arterial segments using a modified system of quantitative assessment.

Results and discussion. The vast majority of patients with critical limb ischemia had multilevel lesions with considerable dominance of infrainguinal artery lesions over iliac artery ones (p < 0.05). Patients with concomitant diabetes had significantly more arterial lesions of distal segments (p < 0.05), whereas patients without diabetes more often revealed lesions of the proximal segments (p < 0.05). The frequency and severity of the infrapopliteal lesions was significantly higher and the frequency of aorto-iliac lesions was significantly lower in the group of patients with 4th stage of ischemia than in the group of patients with 3rd stage (p < 0.05). The group of patients with surgical revascularization had significantly greater number of widespread and severe aorto-iliac and femoropopliteal lesions compared with the endovascular group that manifested more severe lesions of the crural arteries (p < 0.05).

Conclusions. The typical pattern of disease in patients with critical limb ischemia is multilevel infrainguinal lesions. The pathoanatomical pattern of disease dictates the choice of treatment modality. The great majority of patients with critical limb ischemia, especially with infrapopliteal lesions, can be treated by endovascular means. Open surgery remains the treatment of choice for patients with long occlusive lesions of the aorto-iliac and femoropopliteal segments.

Keywords: peripheral artery disease, critical limb ischemia, revascularization, endovascular intervention, open reconstructive surgery.

The aim — to identify the independent predictors of patients’ nonresponse (fatal outcome) to long-term therapy with low doses of phosphodiesterase-5 inhibitor sildenafil in patients with pulmonary artery hypertension (PAH).

Materials and methods. 61 patients were studied with PAH of II — III FC (WHO), including those with idiopathic PAH (31 patients aged 28.7 ± 3.3 years, 24 (77.4 %) of them women) and congenital heart defect in the phase of Eisenmenger syndrome (30 patients of mean age of 35.3 ± 3.9 years, 20 (66.7 %) of them women). The survey included a sample of 6-minute walk test, Doppler echocardiography assessment of systolic function of the right and left heart and systolic function of the left heart, determination of levels of endoteline-1 and von Willebrand factor activity in the plasma of venous blood by ELISA before and after 6 months of treatment with sildenafil 50 mg/day.

Results and discussion. At the end of a long observation, the connection was established with 45 PAH patients — 22 patients with idiopathic PAH and 23 — with Eisenmenger syndrome. 16 (26.3 %) out of 61 patients with PAH died on average in 14.1 months after the study began. Depending on the outcome of therapy with sildenafil, PAH patients were retrospectively divided into two groups: those with a good response to therapy (long-term survivors within 21 months of treatment with sildenafil) and poor response (dead). A stepwise discriminant analysis was performed which investigated 24 factors (age, sex, personal history, level of dyspnea on Borg scale, a 6-minute walk distance, cardiac morphology and function indicators, level of biochemical markers of endothelial function) and identified five among them that are associated with poor response of PAH patients to therapy with sildenafil — the beginner level of endothelin-1 in blood plasma > 2.0 fmol/ml (х₁), the absolute value of endothelin-1 reduction in plasma after 6 months of treatment with sildenafil < 0.5 fmol/ml (х₂), the duration of symptoms of the disease > 8 years (х₃), syncope history (х₄), the relative increase in distance of a 6-minute walk after 6 months of treatment < 10 % (х₅). Equations of linear discriminant functions based on these factors were developed:
Y₁ = –4,73917 + 5,54821 · x₁ + 3,15810 · x₂ + 6,7135 · x₃ + 4,63954 · x₄ + 5,11707 · x₅;
Y₂ = –0,22306 + 0,80601 · x₁ + 1,14207 · x₂ + 0,91234 · x₃ + 0,75671 · x₄ + 0,72280 · x₅;
It has been found that in case of Y₁ > Y₂ the probability of transition of PAH patients into the group of non-responders to therapy with sildenafil at a dose of 50 mg/day with a likely fatal outcome is 86.7 %. If Y₁ < Y₂, the probability of survival of patients with a good response (survivors after a long, within 21 months, treatment with sildenafil) and a poor response (dead) to sildenafil therapy is 84.9 %.

Conclusions. The independent predictors of poor response of PAH patients to long-term therapy with sildenafil include: beginner level of endothelin-1 in blood plasma > 2.0 fmol/ml, its reduction to < 0.5 fmol/ml after 6 months of therapy, the duration of symptoms> 8 years, a history of syncope, a relative increase in distance of a 6 — minute walk distance after 6 months of therapy < 10 %. Using these variables in the equations of linear discriminant functions allows predicting the probable death outcome with accuracy of almost 86.7 %. The most significant independent predictor of poor response of PAH patients to long-term therapy with sildenafil at a dose of 50 mg/day is initially elevated plasma levels of endothelin-1 > 2.0 fmol/ml, which indicates a high (86.7 %) risk of transition of PAH patients into group with poor response to sildenafil therapy with fatal outcome.

Keywords: pulmonary arterial hypertension, sildenafil, endothelin-1.

The aim — analysis of venous hemodynamics after removing the femoral vein for aortofemoral reconstructions in patients at high risk of infectious complications.

Materials and methods. Results of immediate and remote follow-up of 12 patients were studied after autovenous aorto-iliac bypass performed at Gomel regional vascular surgery department in 2010—2013. Two groups of patients were formed: 5 patients with critical limb ischemia and 7 patients with false aneurisms.

Results and discussion. Arterial flow was successfully restored in all cases. Patients with critical limb ischemia developed stable venous edema with lymphorhea. Patients with false aneurisms manifested moderate edema that lasted 5 days. There was no need in fasciotomy in all cases. In remote period, no signs of sub- and decompensated stages of chronic venous insufficiency were observed.

Conclusions. Femoral vein harvesting for aortoiliac reconstruction at critical limb ischemia and for correction of anastomotic false aneurisms does not cause significant disorders of venous outflow.

Keywords: femoral vein, prosthetic infection, false aneurism, critical limb ischemia, aortofemoral reconstruction.

The aim — to assess changes in the longitudinal, circumferential, radial strain of left ventricle (LV), its rate, rotation and twist in patients with different localization of acute Q-myocardial infarction (Q-AMI) and to determine their relation to the structural and functional state of the LV.

Materials and methods. We studied 60 patients with Q-AMI belonging to group 1, who were divided into subgroup 1A (32 patients with posterior localization) and subgroup 1B (28 patients with anterior localization of Q-AMI). The second group included 28 people without cardiovascular diseases. We performed echocardiography in M-, B-modes and calculated end-diastolic volume index, LV ejection fraction (EF), wall motion score index, LV myocardial mass index (LVMMi). Speckle tracking echocardiography (STE) determined global longitudinal strain (GLS) and strain rate (GLSR), global circumferential strain (GCS) and strain rate (GCSR), global radial strain (GRS) and strain rate (GRSR), apical and basal rotation, twist.

Results and discussion. Decrease of strain and strain rate in the longitudinal, circumferential and radial directions in group 1 was observed. All indicators of strain and strain rate of LV, as well as twist were significantly correlated with LV EF, wall motion score index and end-diastolic volume index. Inverse correlations were established between GLS and heart rate (r = –0.38, p < 0.01) as well as GLSR and LVMMi (r = –0.37, p < 0.01). Values of GLS, GLSR and apical rotation were significantly lower in subgroup 1B than in subgroup 1A; in subgroup 1A we observed a tendency to a decrease of basal rotation compared to subgroup 1B.

Conclusions. In patients with Q-AMI and preserved LVEF we found an alteration of LV contraction geometry in the longitudinal, circumferential and radial directions. Myocardial deformation correlated with LV contractile function and the increase of LV miocardial mass and heart rate associated with a decrease of the longitudinal myocardial deformation component. Changes of the apical and basal LV rotation at the anterior and posterior localization of Q-AMI are oppositely directed, which may be a compensatory mechanism that ensures the preservation of LV systolic function.

Keywords: acute myocardial infarction, speckle tracking echocardiography, strain and strain rate, left ventricular systolic function.

The aim — to asses the effectiveness of the developed techniques for the surgical anastomosis and conduits formation of different versions during coronary artery bypass surgery on the beating heart in patients with coronary artery disease.

Materials and methods. The study included 279 operated patients who underwent different innovating surgeries for improvement and increasing the completeness of myocardium revascularization: suturing grafts to the problem aorta (n = 17), imposing an elongated anastomosis (n = 61), the creation of composite grafts (n = 84), jumping grafts (n = 117).

Results and discussion. Analysis of obtained results evidenced that 279 patients had one or combination of complicated variants of aorta or coronary arteries impairments, pathology of lower extremities subcutaneous veins. These patients required original surgical solutions to achieve the completeness of myocardium revascularization.

Conclusions. Patients with problematic aorta at coronary arteries multiple lesions in combination with stenosis at different levels or with varicose veins of the lower extremities require developed methods and techniques for coronary arteries bypass. Such techniques can increase completeness of myocardium revascularization due to techniques and variants of proximal and distal anastomosis suturing and significantly improve duration of shunt functioning at the expense of blood flow distribution from one shunt to some coronary arteries.

Keywords: аrtery bypass grafting surgery, problematic ascending aorta, branching conduits, jumping grafts, elongated anastomosis.

The aim — to evaluate the prevalence of polymorphous variants of Т(–786)С promoter of endothelial NO-synthase gene in patients with chronic ischemic heart disease and hemodynamically significant atherosclerosis of coronary arteries verified by selective coronary angiography as also to trace the relationship of the polymorphism with the clinical manifestations of the disease, the presence and severity of various vascular bed atherosclerotic lesions.

Materials and methods. 120 patients were examined with ischemic heart disease and stable exertional angina of II—III functional classes (mean age 58.7 ± 0.8 years), who, according to selective coronary angiography, revealed hemodynamically significant (> 50 %) stenoses of coronary arteries. The control group included 35 people without change of coronary arteries and with negative result of exercise stress test. The examination, besides selective coronary angiography, included determination of ankle-brachial index, Doppler ultrasound of the lower extremities and carotid arteries as well as the estimation of their intima-media thickness. The study of allelic polymorphism of endothelial NO-synthase gene promoter was performed by polymerase chain reaction.

Results and discussion. According to the results of genotyping of Т(–786)С gene polymorphism of endothelial NO-synthase, the share of T/T and C/T genotypes in the control group (45.7 % and 48.6 %) and in patients with ischemic heart disease (37.5 and 40.8 %) was not different, whereas the prevalence of the C/C genotype in patients with ischemic heart disease was significantly higher than in healthy individuals (21.7 % vs 5.7 %, p < 0.05). The patients were divided into two groups: I group — 46 people with T/T genotype, II group — 74 people with C/C and C/T genotypes. Patients of group II that were age and sex matched with those of group I had significantly more frequent arterial hypertension (in 85.1 % vs. 69.6 %, p < 0.05), family history of early onset of cardiovascular diseases (in 68.9 % vs 45.6 %, respectively, p < 0.05), manifestation of ischemic heart disease occurring at a younger age 43.6 ± 1.3 against 47.9 ± 1.4 years, respectively, p < 0.05) and the same frequency of other cardiovascular risk factors, myocardial infarction, acute cerebrovascular accidents. According to the results of selective coronary angiography, the patients of group II as compared to patients of group I had significantly more frequent multivessel lesions of coronary arteries (in 37.2 % vs 15.2 %, respectively, p < 0.05), greater intima media thickness (0.97 ± 0.02 mm vs 0.90 ± 0.02 mm, p < 0.05) and lower ankle-brachial index (0.80 ± 0.02 vs 0.88 ± 0.03, respectively; p < 0.05). According to the stepwise regression analyzes, independent associations of C allele of polymorphism of Т(–786)С promoter of endothelial NO-synthase gene with intima media thickness of larger magnitude (β = 0.547; В = 0.153; p < 0.05), ankle-brachial index of lower magnitude (β = –0.338; В = –0.134; p < 0.05) and multivessel coronary artery lesions (β = –0.743; В = 1.859; p < 0.05) were revealed.

Conclusions. Among the Ukrainian population, the mutant genotype C/C of polymorphism of Т(–786)С promoter of endothelial NO-synthase gene in patients with ischemic heart disease and hemodynamically significant coronary artery atherosclerosis is found significantly more frequently than in healthy individuals. The presence of the mutant allele C of polymorphism of Т(–786)С promoter of endothelial NO-synthase gene in patients with ischemic heart disease is associated with a higher frequency of multivessel type of atherosclerotic lesion of coronary arteries, according to selective coronary angiography, greater intima media thickness and smaller ankle-brachial index.

Keywords: atherosclerosis, ischemic heart disease, polymorphism of endothelial NO-synthase gene, cardiovascular disease, risk factors.

The aim — to study the influence of isosorbide dinitrate and verapamil on cardialgia in combination with hypertensive syndrome in 925 patients with ishemic heart desease (IHD) and essential hypertension, stable exertional angina of III — IV functional class (FC), before, during, and after coronagraphy (CG).

Materials and methods. During coronagraphies performed in 925 patients with IHD accompanied by hypertension and stable exertional angina of III — IV FC, 598 patients showed cardialgia with hypertensive syndrome, and 327 patients had hypertensive

syndrome without cardialgia before coronagraphy. Treatment with isosorbide dinitrate and verapamil was administered in order to correct cardialgia and hypertensive syndrome in 925 patients with IHD, hypertension and stable exertional angina of III — IV FC before and during coronagraphy. Hemodynamics was evaluated during the correction of hypertensive syndrome before coronagraphy 0.05 mg/kg of verapamil (1 group). Stability of hemodynamics while using verapamil (0.05 mg/kg) with isosorbide dinitrate (0.02 mg/kg) was defined in patients with hypertensive syndrome in combination with cardialgia before and during coronagraphy (2 group). The evaluation of synergistic interaction was performed during the injection of 0.02 mg/kg of isosorbide dinitrate with 0.05 mg/kg of verapamil before coronagraphy and 0.02 mg/kg of isosorbide dinitrate when cardialgia recurred during coronagraphy (3 group). The role of preload and other factors on hemodynamics during and after coronagraphy was studied.

Results and discussion. Previous research discovered that in case of IHD, essential hypertension and stable exertional angina of III — IV FC, correction of hypertensive syndrome with the help of 0.05 mg/kg of verapamil before coronagraphy (1 group) and 0.02 mg/kg of isosorbide dinitrate for cardialgia during coronagraphy (2 group) — is sufficiently effective and does not lead to hemodynamic interruption (p < 0.05). When cardialgia occurs before coronagraphy, the synergistic use of 0.02 mg/kg of isosorbide dinitrate with 0.05 mg/kg of virapamil and a repeated injection of isosorbide dinitrate (0.02 mg/kg) in case of cardialgia during coronagraphy led to mild hypotension (3 group). In 6.1 % cases during coronagraphy (p < 0.05) and in 2.1 % — after coronagraphy (p < 0.05) in the third group of patients, mild hypotension transformed into hemodynamically important hypotension which was corrected by intensive infusion therapy. In the subgroup of 39 patients of the third group with a low preload level, hemodynamic synergystics could be observed during and after coronagraphy in case of repeated usage of isosorbide dinitrate with verapamil and isosorbide dinitrate, which led to hemodynamically important hypotension during coronagraphy in 43.5 % cases.

Conclusions. The use of 0.05 mg/kg of verapamil (1 group) before coronagraphy in 925 patients with IHD, essential hypertension, stable exertional angina of III — IV FC with hypertensive syndrome, and correction of hypertensive syndrome with cardialgia before coronagraphy by 0.05 mg/kg of verapamil with 0.02 mg /kg of isosorbide dinitrate (2 group) does not lead to any interruptions of hemodynamics (p < 0.05). When cardialgia occurs before coronagraphy in the third group of patients, the use of 0.02 mg/kg of isosorbide dinitrate with 0.05 mg/kg of verapamil, as also repeated synergistic injection of 0.02 mg/kg of isosorbide dinitrate for cardialgia during coronagraphy lead to hypotension: in 6.1 % of cases — to hemodynamically important hypotension during coronagraphy, and in 2.1 % — after coronagraphy (p < 0.05). In the subgroup with a low preload of a third group, strengthening of the antihypertensive medications and the medications from nitroglycerin group before coronagraphy, and synergistic effect of verapamil and isosorbide dinitrate during coronagraphy lead to hemodynamically important hypotension requiring intensive infusion therapy in 43.5 % of the patients.

Keywords: coronagraphy, ishemic heart desease, cardialgia, hypertension syndrome, verapamil, isosorbide dinitrate, intensive infusion therapy.

The aim — to examine the specific features of changes in intima — media of common and internal carotid arteries depending on the degree of lead exposure.

Materials and methods. The study involved 189 men whose work was connected with the negative impact of lead on the body. Depending on the level of lead in blood, the patients were divided into three groups. The 1st group included persons with the highest levels of lead — 2.070 ± 0.018 μg/l, the 2nd — those with the medium level — 1.740 ± 0.065 μg/l, the third — those with a minimum one — 1.040 ± 0.073 μg/l. The control group consisted of 57 practically healthy persons, mean age 44.7 ± 1.5 years. Ultrasound examinations were performed by the scanner ALOKA SSD 1700 using a 7.5 MHz linear transducer. To study the structural changes of arterial vascular region we determined the intima — media thickness of the common carotid artery (IM CCA) and internal carotid artery (IM ICA) by standard methods.

Results and discussion. It was found that the thickness of IM CCA increases with the rise of lead content in blood. Maximum thickness of IM CCA and IM ICA was observed in patients of group 1 whose blood levels of lead were high — correspondingly, 2.05 and 2.1 times higher than in the control group. These indicators exceeded the concentrations recommended by the experts of the European Society of Hypertension and the European Society of Cardiology. The thickness of IM CCA and IM ICA in patients of group 2 significantly exceeded that in the control group — by 1.47 and 1.5 times respectively, but did not go beyond the standard. In patients of group 3, the thickness of IM CCA was 1.08 times higher than in the control group; at the same time the thickness of IM ICA was normal.

Conclusions. The thickness of IM CCA and IM ICA increased proportionally to the rise of the lead level in the blood, the maximum levels being observed in patients of group 1.

Keywords: intima — media complex, common carotid artery, internal carotid artery, microsaturnism, lead.

Applying into practice highly active antiretroviral therapy (HAART) has lead to significant reduction in mortality rate due to HIV infection and increase of life expectancy of patients suffering from this pathology. At the same time the problem of cardiovascular disease, indirectly or directly associated with the infection, is becoming increasingly urgent. Cardiovascular diseases in these individuals are known to be associated with HIV infection itself, opportunistic infections, HAART or agents for the treatment of the opportunistic complications of HIV infection, the way of contamination or the classic (HIV-unrelated) cardiovascular risk factors (such as smoking, age or heredity). Affection of cardiovascular system in HIV-infected individuals always deteriorates prognosis. Due to serious epidemiological situation, the presence of severe cardiovascular pathology, especially in young people, should be always considered from the point of view of its possible association with HIV infection. Data on the prevalence of cardiovascular disease at HIV infection: vascular (atherosclerosis, vasculitis, pulmonary hypertension) and heart lesions (endocarditis, myocarditis, pericarditis, HIV-associated dilated cardiomyopathy), tumors (Kaposi’s sarcoma, lymphoma) are presented in this review. The risk factors for atherosclerosis in HIV-infected patients, which can be divided into 3 groups associated with the host, virus or anti-retroviral therapy, are considered in details. Also the basic mechanisms of the pathogenesis of these diseases and their clinical features are described.

Keywords: HIV, cardiovascular diseases, risk factors, antiretroviral therapy.

Objective — to study the efficiency and safety of the endovascular treatment method for coronary heart disease (CHD) elderly and geriatric patients. During the period from 2007 to 2011 years 57 coronarographies (CG) were performed for patients of geriatric age from 80 to 87 years (the mean age was 83.5 ± 3.5 years) in the National Institute of Cardiovascular Surgery, there were 43 men and 14 women. According to the results of the CG the percutaneous coronary intervention (PCI) was performed in 27(47 %) patients, coronary artery bypass grafting (CABG) — in 24 (42 %), and 6 (11 %) were administered drug therapy due to impossibility of surgical or endovascular treatment. We eliminated completely hospital mortality in the group of PCI treated patients. Conclusions: the geriatric age of patients is not a contraindication for the CG and angioplasty followed by coronary artery stenting. Such revascularisation can be performed in most patients. The application of PCI in geriatric patients leads to disappearance of clinical symptoms of CHD, stabilization of patient’s health and reduction of heart failure. The quality of life and tolerance to physical stress improve.

Keywords: geriatric group, coronarography, percutaneous coronary intervention.

The article presents the literature data on the occurrence, prevalence, mechanisms and clinical manifestations of hypersensitivity reactions and allergies associated with clopidogrel. The article describes the general principles of treatment of patients with hypersensitivity reactions to medications and methods of their occurrence prevention. The article presents a case of side effects of clopidogrel in the form of cutaneous manifestations in patients with coronary artery disease, which demonstrates the problem of choosing the right tactics of therapy.

Keywords: clopidogrel, skin rash, antiplatelet therapy, hypersensitivity reactions.