The aim — to identify variants of changes in the morphology of coronary arteries (CA) in patients with early post-infarction angina (EPIA) by evaluating the instability of plaques (jagged edges, ulceration, signs of thrombotic layers), and the prevalence of CA lesions at radiopaque coronary angiography, followed by an explanation of their clinical importance and connection with changes in markers of inflammation and endothelium-dependent vasodilation (EDVD) in a conservative strategy of supervision.

Materials and methods. A prospective study was conducted of 150 patients with myocardial infarction (MI) under the age of 75 years (average of (57.3 ± 7.9) years, 84 % men) with acute left ventricular failure not exceeding class II Killip, left ventricular ejection fraction of more than 45 % and a history of chronic cardiac insufficiency of stage IIA without significant concomitant diseases, particularly inflammatory ones. All patients were treated without use of primary and early percussion coronary interventions. EPIA was diagnosed in 72 patients according to conventional clinical criteria. The control group included 78 patients without EPIA matched by risk factors and clinical characteristics. The research methods included a radiopaque coronary angiography and a cuff test with determination of EDVD. We also evaluated white blood cell count and fibrinogen levels in the peripheral blood in dynamics as markers of nonspecific inflammation. The patients were followed for 12 months, with assessment of clinical events.

Results and discussion. Patients with EPIA differed from comparable by clinical characteristics patients without EPIA in the presence of vulnerable plaque (VP) (86.6 % vs. 4.5 % of patients, respectively; p < 0.001), higher prevalence of three-vessel lesions (59.6 % vs. 18.2 % patients, respectively; p < 0.001) and a lower EDVD (4.4 vs. 6.2 %, respectively; p < 0.001). Patients with EPIA and signs of VP in a non-infarct-dependant artery (non-IDA) (42.4 % of patients with EPIA) differed from those with probable localization of VP in an infarct-dependent artery (IDA) (44.2 % of patients) in a greater frequency of three-vessel lesions (81.8 % vs. 34.8 %; p < 0.05) and ischemic ECG changes (77.2 % vs. 47.8 %; p < 0.05), a higher number of white blood cells at admission ((11.2 ± 2.1) vs. (9.3 ± 1.5) 10⁹/L; p < 0.05), a larger increase in fibrinogen level after EPIA or in the control group in comparable terms ((5.5 ± 0.5) vs. (4.6 ± 0.5) g/L; p < 0.05) and a decreased EDVD (3.9 % vs. 4.8 %; p < 0.05). A variant of EPIA without VP (13.4 % of patients with EPIA) was associated with a significantly lower incidence of nocturnal pain in comparison to the variant of VP in a non-IDA (28.5 % vs. 63.6 % of patients, respectively; p < 0.05), ischemic changes on ECG (14.2 % and 77.2 % of patients, respectively; p < 0.001), later development of EPIA ((14.5 ± 2.1) vs. (9.6 ± 1.2) day, respectively; p < 0.05) as well as a smaller number of leukocytes ((10.0 ± 1.7) vs. (12.8 ± 2.2) 10⁹/L, respectively; p < 0.05) and a lower level of fibrinogen ((4 6 ± 0.4) and (5.5 ± 0.5) g/L, respectively; p < 0.05) after development of EPIA. Patients with EPIA and VP in a non-IDA differed from those without VP in a greater frequency of MI recurrence (22.7 vs. 0 %, respectively), recurrent MI during the year (18.1 and 0 %, respectively) and from patients with VP in IDA in a higher mortality (22.7 % of patients vs. 4.3 %); all p < 0.05.

Conclusions. The most unfavorable prognosis variant is EPIA with VP in a non-IDA (42.4 % of EPIA cases), which, compared to the variant of VP in IDA (44.2 %) and the variant without VP (13.4 %), is associated with most pronounced signs of myocardial ischemia and markers of nonspecific inflammation, reduction of EDVD and a worse prognosis.

Keywords: early post-infarction angina, vulnerable plaque, infarct-dependant artery.

The aim — to carry out a wavelet analysis of the spectral components of laser Doppler fluorometry (LDF) signals in patients with chronic critical ischemia of lower limbs (CCILL) before and after revascularization surgery in order to identify quantitative indicators of changes of microvascular perfusion and their correlation with changes in the ankle-brachial index (ABI) of the affected limb.

Materials and methods. The study involved 20 CCILL patients with pain at rest, but without skin lesions, ulcers or gangrene (Stage III Fontaine — Pokrovsky) who underwent revascularization of the limb. 16 patients had direct arterial revascularization, 4 patients had profundoplasty. All patients were examined by ultrasound duplex scanning of arteries of the lower extremities with the calculation of the ABI pressure and selective angiography of the extremities to detect the level and degree of stenosis of the arteries. LDF signals were analyzed by wavelet transformation, their characteristics (in units of perfusion — UP) were measured before and after revascularization. The diagnostic sensitivity, specificity, efficiency of LDF method were determined; Doppler ultrasound data of the lower extremities main arteries was used as the «golden standard».

Results and discussion. After revascularization all patients showed a significant increase in ABI— from 0.36 ± 0.11 to 0.57 ± 0.13 (by 58 %) (p < 0.05) and in baseline LDF — from (12.30 ± 3.7) to (21.60 ± 6.2) UP (by 47 %) (p < 0.05). After limb revascularization, the greatest changes occurred in the cardiac frequency range, after endarterectomy of the common femoral artery with profundoplasty, the effects of revascularization were less obvious and concerned myogenic spectrum. The most sensitive and specific changes appeared in the cardiac and myogenic frequency: sensitivity, specificity and efficiency accounted for 56, 88, 72 % and 65, 93 and 72 %, respectively.

Conclusions. LDF allows to evaluate objectively and effectively the result of the operation. LDF method is sensitive to changes in microcirculation of limbs at CCILL and can be used in cases where a direct revascularization is impossible and the treatment of pathology involves impact on collateral blood flow to facilitate the evaluation of treatment.

Keywords: laser duplex flowmetry, critical limb ischemia, the wavelet-analysis.

The aim —to carry out testing of criteria for evaluating the severity of iron deficiency (ID) in patients with chronic heart failure (CHF) and ejection fraction (EF) of the left ventricle (LV) > 40 % with «idiopathic» iron deficiency anemia (IDA) and without anemia, as well as to evaluate the association of ID with changes in indicators of exercise tolerance (ET) and the pumping function of the heart.

Materials and methods. The prospective study included 98 clinically stable patients aged 50 — 75 years (mean age (69.9 ± 0.1) years, men — 65.3 %) with CHF of IIA—ІІB stages according to N. D. Strazhesko and V. H. Vasilenko classification (including IIA stage in 84.6 % of cases) due to ischemic heart disease and/or hypertension with left ventricular ejection fraction > 40 %. IDA was diagnosed in 50 of them in the absence of reasons for loss of blood and iron on the basis of reduction of hemoglobin (Hb) level less than 130 g/L in men and less than 120 g/L in women and symptoms of iron deficiency according to the reduction in the color index, erythrocyte indices, levels of serum iron, transferrin saturation with iron (TSI). Anemia was absent in 48 patients matched by the main clinical and demographic characteristics. During the laboratory examination, parameters of iron metabolism (ferritin, transferrin, TIBC, TSI) and the ID severity (absolute — if ferritin < 30 g/L at TSI < 20 %; relative — if ferritin ≥ 30 mg/L and TIBC > 65 mmol/L at TSI < 20 %) were evaluated. If anemia was present, it was evaluated as «isolated» IDA and IDA in combination with anemia of chronic inflammation (ACI). All patients also had the six-minute walking test and Doppler echocardiography with estimation of end-diastolic (EDV) and end-systolic volumes (ESV) of LV by Simpson, left ventricular ejection fraction, left atrial (LA) and right ventricular (RV) diameters. The drug therapy for chronic heart failure and the drug doses were not significantly changed at least 2 weeks prior to and during the study.

Results and discussion. The average Hb level in patients with iron deficiency anemia was (96.9 ± 1.7) g/L, in the absence of anemia — (144.1 ± 1.3) g/L (p < 0.001), TSI was (8.6 ± 0.3) and (23.5 ± 1.0) %, respectively, (p < 0.001) and ferritin — (74.7 ± 10.8) and (101.1 ± 5.7) mg/L (p < 0.001). Among patients with probable IDA, isolated IDA with absolute ID by D. O. Okonko criteria was present in 22 (44 %) patients, with a functional ID, that is, in combination with ACI — in 28 (56 %). Patients with CHF and iron deficiency anemia with absolute ID did not differ from those with functional ID in NYHA FC (on average 2.9 ± 0.1 and 2.8 ± 0.1), six-minute walk distance ((264.9 ± 11.7) and (259.6 ± 13.0) m), EDV ((157.9 ± 13.4) and (142.4 ± 7.8) mL), ESV ((70.1 ± 8.6) and (63.6 ± 5.3) mL), left ventricular ejection fraction ((56.2 ± 2.0) and (259.6 ± 13.0) %), LA ((3.92 ± 0.1) and (3.88 ± 0.1) cm), RV ((2.8 ± 0.1) and (2.9 ± 0.1) cm; all p > 0.05), despite the significant difference in Hb level ((86.4 ± 3.3) and (102.6 ± 2.1) g/L) and ferritin level ((16.5 ± 1.7) and (82.8 ± 12.1) mcg/L; p < 0.001). TSI < 20 % was diagnosed in 10 (20.8 %) patients with chronic heart failure without anemia. These patients did not differ from patients with normal TSI in age, myocardial infarction in anamnesis, diabetes, and chronic heart failure stage (IIA, 90.0 and 86.8 %, respectively, all p > 0.05). However, they had a higher frequency of III — IV FC by NYHA (80.0 % vs. 50.0 %) and a decrease in the six-minute walk distance of < 325 m (50 % vs. 15.8 %, both p < 0.05), despite the same level of ferritin ((87.4 ± 13.9) and (108.8 ± 4.3) mcg/L, respectively; p > 0.05).

Conclusions. Patients with chronic heart failure and ejection fraction > 40 % with isolated IDA (absolute ID according to ferritin levels < 30 mcg/L) do not differ from patients with IDA in combination with ACI (with functional ID) in reduction of ET by NYHA functional class and six-minute walk distance, and the main indicators of morpho-functional condition of the heart, despite their having a more pronounced severity of anemia. In patients with chronic heart failure and ejection fraction of > 40 % without anemia (20.8 %), the presence of ID according to TSI of < 20 % is associated with a higher NYHA functional class and the deterioration of ET according to the six-minute walking test.

Keywords: chronic heart failure, anemia, iron deficiency.

The aim — to identify normal values of regional and global longitudinal, circumferential and transmural strain and strain rate (SR) in healthy volunteers aged 45 to 70 years without diseases of cardiovascular system according to transthoracic echocardiography.

Materials and methods. The study included 50 healthy volunteers (27 women and 23 men) aged 45 to 70 years (average of (53.8 ± 7.4) years). The study was performed with an ultrasonic scanner Toshiba Aplio 500. Mapping the strain was carried out by determining the SR. Regional strain parameters (SP) of each segment were determined: end-diastolic longitudinal (ε_l), circular (ε_c) and transmural (ε_t) strain and pick systolic speed of longitudinal (ε'_l), circular (ε'_c) and transmural (ε'_t) strain. Global indicators of ε_L, ε_C, ε_T, ε'_L, ε'_C, ε'_T, as well as their correlations ε_L /ε_C, ε_L /ε_T, ε_C /ε_T and ε'_L /ε'_C, ε'_L /ε'_T, ε'_C /ε'_T were calculated.

Results and discussion. Global εL equaled (–15.6 ± 2.3) %, ε'_L — (–0.8 ± 0.1) %/s, ε_C — (–20.3 ± 3.9) %, ε'_C — (–1.1 ± 0.2) %/s, ε_T — (44.7 ± 8.0) %, ε'_T — (2.4 ± 0.4) %/s. No significant difference in SP between men and women were identified. Negative impact of overweight (body mass index (BMI) 25.1 — 32.9 kg/m², compared with a BMI of 20.5 — 25.0 kg/m²) on SP was defined, but the correlation was quite weak. The gradient of values from the base to the top was not revealed in analyzing the regional SP. Correlations of ε_L /ε_C, ε_L /ε_T and ε_C /ε_T equalled 0.85 ± 0.13, –0.34 ± 0.06 and –0.41 ± 0.08, respectively. Correlations of ε'_L /ε'_C, ε'_L /ε'_T and ε'_C /ε'_T equaled 0.82 ± 0.12, –0.33 ± 0.06 and –0.41 ± 0.07. Correlation of ejection fraction and excursions of mitral annulus with global strain and SR of the left ventricle were determined.

Conclusions. The indicators of global and regional strain of the left ventricle myocardium in patients without cardiovascular diseases at the age of 45 to 70 years do not depend on sex and localization of myocardial segments, which eliminates the need in their valuation for each segment. The presence of excess body weight was accompanied by a weak negative influence on global longitudinal and transmural SR.

Keywords: echocardiography, strain, strain rate, strain mapping.

The aim — to study the level of galectin-3 in patients with mitral valve lesions (MVL) depending on etiology of the valve failure, gender, age, heart failure functional class, atrial tachycardia history.

Materials and methods. In total, 95 patients with mitral valve lesion were evaluated (mean age 57.4 ± 9.6). Isolated mitral valve stenosis was detected in 40 (42.1 %) patients, 48 (50.5 %) patients presented with mitral insufficiency, 7 patients had combined valve lesions. During the study, all patients underwent standard diagnostic examination, including medical history, physical examination, 12-channel ECG, transthoracic echocardiography to evaluate the systolic function and structural heart disease, laboratory tests (C-reactive protein, seromucoid, creatinine, galectin-3 level) and a 6-minute walk test. Galectin-3 in the blood plasma was detected by ELISA (enzyme immunodetection) using a recruitment firm eBioscience, USA.

Results and discussion. Comparative evaluation of galectin-3 level, depending on the type of defect has shown that patients with mitral stenosis demonstrated significantly lower galectin-3 level than with the mitral insufficiency: accordingly 19.4 ± 3.7 ng/ml and 25.7 ± 4.8 ng/ml (p < 0.05). In infectious endocarditis galectin-3 level was significantly higher comparing with chronic heart rheumatism and degenerative MV lesions ((29.7 ± 5.6); (22.7 ± 3.4) and (16.8 ± 6.3) ng/ml accordingly; р < 0.05). Patients with MV lesions and heart failure of III — IV functional class showed higher galectin-3 level than in patients with heart failure of I — II functional class ((24.4 ± 3.6) and (16.4 ± 6.3) ng/ml accordingly; р < 0.05). There was a significant correlation between galectin-3 level and C-reactive protein, seromucoid and NT-proBNP (0.79; 0.80 and 0.74 accordingly (all р < 0.001).

Conclusions. The level of the galectin-3 depends on the etiological factor of mitral valve lesion and is the highest in infectious endocarditis comparing with patients with chronic heart rheumatism and degenerative etiology. Association of galectin-3 levels with markers of systemic inflammation was proved. A positive correlation of the galectin-3 with the CRP, NT-proB and seromucoid was established. Patients with MV lesions and heart failure of III — IV functional class showed higher galectin-3 level than in patients with heart failure of I — II functional class.

Keywords: galectin-3, mitral failure, mitral stenosis, heart failure.

The aim — to explore the relationship between a pattern of circulating endothelial microparticles (EMP) and subclinical hypothyroidism (SH) in patients with chronic heart failure (CHF).

Materials and methods. Main cohort of patients (n = 388) was formed retrospectively from patients with CHF of I — IV functional class (FC) by NYHA classification and diagnosed coronary heart disease. All patients were divided into two groups (1st group — 53 and 2nd group — 335 patients) depending on the availability of diagnosed SH according to generally accepted criteria. Phenotyping of EMP populations was performed by flow cytometry using monoclonal antibodies labeled with phycoerythrin fluorochrome against antigens CD31, CD144, CD62E and fluorochrome FITC (fluorescein isothiocyanate) against antigen annexin V.

Results and discussion. The number of EMP with phenotype CD31⁺/annexin V⁺ patients with SH was significantly greater than in patients without SH (p < 0.001), which resulted in the increase of the ratio of CD31⁺/annexin V⁺ and CD62E⁺ EMP in the cohort of patients with SH (p < 0.001). Results of univariate and multivariate regression analysis corrected by age and sex showed that independent predictors of increasing the ratio of CD31⁺/annexin V⁺ and CD62E⁺ EMP were thyroid-stimulating hormone (odds ratio (OR) 1.23 by 6.5 mcU/L, p = 0.001) SH (OR 1.22; p = 0.001), N-terminal brain natriuretic peptide (OR 1.19, p = 0.001), CHF FC by NYHA (OR 1.09; p = 0.001), high-sensitivity C-reactive protein (OR 1.05 by 4.50 mg/L, p = 0.001), dyslipidemia (OR 1.06; p = 0.001), concentration of uric acid (OR 1.04 by 9.5 mmol/L, p = 0.022).

Conclusions. SH in patients with chronic heart failure may be associated with impaired ratio of EMP subpopulations with increased apoptotic microparticles pool against the background of the trend towards deficit of microvesicles, secreted by activated endotheliocytes. Ratio of both subpopulations of endothelial microvesicles evidently may be viewed as an early biological marker of endothelial dysfunction with possible prognostic potential.

Keywords: chronic heart failure, endothelial-derived microparticles, subclinical hypothyroidism.

In recent years, resistance to the antiplatelet effect of acetylsalicylic acid (ASA) is the subject of wide speculation. However, several debating points are still presented regarding the causes, definitions and particularly acceptability of this term. The interest in «ASA resistance» waned rapidly since 2013 when recent study results in this field were published. The first part of the review presents information about mechanism of the antiplatelet action of ASA, its ability to affect favorably not only cardiovascular risk but also colorectal cancer risk due to systemic anti-inflammatory effect. The author emphasizes the importance of use of ASA as antiplatelet agent from the standpoint of current clinical classification of myocardial infarction. Definitions of such terms as «ASA resistance», «ASA pseudoresistance», as well as current approaches to «ASA resistance» classification, particularly its pharmacodynamic and pharmacokinetic types were given. Explanations are proposed for such causes of development of «ASA resistance» as nonatherothrombotic factors, reduced ASA bioavailability, activation of cyclooxygenase 1 independent pathways, accelerated platelet turnover, etc. Ongoing inconsistencies as for approaches to definition and classification of «ASA resistance» have been shown on the basis of data presented.

Keywords: resistance, antiplatelet therapy, acetylsalicylic acid, pseudoresistance, cardiovascular risk, poor response to aspirin, treatment failure.

The review presents an analysis of the literature on the vascularization of the spinal cord and the pathophysiology of the cervical spinal cord infarctions. Particular attention is paid to the cervical spinal cord, because ischemic attacks in this area cause a severe neurological deficit, including muscle weakness, paraplegia, or tetraplegia, or even a quick death as in cases of ischemic foci extendening to the brainstem. We discuss the problem of terminological confusion regarding the names of the arteries that supply the cervical spinal cord. Also we describe the pathophysiological aspects of regulation and compensation of the spinal blood circulation, which take on special clinical significance, due to occurrence of the steal phenomenon and distant ischemic foci both in the spinal cord and the cerebrum caused by arteriovenous anastomoses, myelobulbar arterial anastomoses, adjacent areas of blood supply in this area. The review substantiates the necessity of spinal cord infarctions prophylactic measures development.

Keywords: cervical spinal cord infarction, vascularization of spinal cord, radiculomedullary arteries, steal phenomenon, distant foci of ischemia.

The article highlights the modern data of scientific literature on angiogenesis, its role in the growth and development of the organism, regenerative processes. Particular attention is paid to angiogenesis in chronic and acute ischemia and other pathological processes. The role of HIF1 and HIF2 as inducers of angiogenesis at hypoxic processes in tissues is highlighted. A theoretical opportunity of controlled influence of angiogenesis regulation on the course of some pathological conditions is presented.

Keywords: angiogenesis, vasculogenesis, HIF1, HIF2, VEGFs.

The article presents the modern data about etiology of coronaritis in childhood and relevant postmortem changes of the coronary arteries. Coronaritis in children may cause myocardial infarction and associates with a high risk of sudden cardiac death in childhood. Patients with coronaritis belong to the group of high risk of early atherosclerosis. Further study of the pathology of coronary arteries has practical importance for doctors of various specialties, including pathologists in postmortem examination.

Keywords: coronaritis, childhood, etiology, postmortem changes.

Acute decompensation of heart failure (ADHF) significantly impairs short and long-term prognosis of patients with chronic heart failure. It is associated with significant worsening of quality of life and costs of inpatient and outpatient treatment. One of the most important pathophysiological mechanisms of ADHF development and progression is generalized vasoconstriction and interaction between the progressive decrease in cardiac activity and severe increase in systemic vascular resistance, the so-called afterload mismatch. This results in reduced cardiac output and increased left ventricular filling pressure. The increase in left ventricular filling pressure, in its turn, leads to a sharp increase in venous pulmonary hypertension and, consequently, increased pressure in the pulmonary capillaries, causing exudation of fluid from blood vessels into the lung interstitium and alveoli, leading to congestion in the lungs and shortness of breath. The main direction of pathogenetically reasonable treatment of acute decompensated heart failure is the use of vasodilators and loop diuretics. However, loop diuretics are often underutilized. Despite the long history of the use of vasodilators, fundamental understanding of the evidence base on their safety profile in ADHF remains limited. Data on the use of vasodilators in existing standards-based treatment is primarily based on expert opinion and not on the results of large-scale clinical trials. The article briefly considers the most important data on the experience of vasodilators use in ADHF on the basis of the largest multicenter studies conducted in this area.

Keywords: heart failure, аcute decompensation of heart failure, left ventricular heart failure, vasodilators, diuretics.

The article presents the social characteristics of elderly patients with essential hypertension (EH). Problems of marital status, namely the role of widowhood in the formation and progression of EH have been considered. The presence of a negative relationship between cardiovascular disease, including EH, and socio-economic status of patients was indicated. Lack of financial abilities reduces the amount of diagnostic tests and the possibility of laboratory and instrumental monitoring of the elderly patients with EH compared with young and middle-aged patients, which results in the increase of frequency and complications of EH and worsening of prognosis. It has also been indicated that social isolation is a proven factor of the deterioration of the course of EH and increase of cardiovascular morbidity and mortality. Exclusion of elderly patients from active life has a negative affect both on the level of blood pressure and the ability to control it. Data on the negative role of improper diet in the development and progression of EH in these patients are presented. Biological and social mechanisms that prevent the elimination of the risk factors have been considered. It has been proved that elderly patients with hypertension are a group of medical and social risk. The value of communicative role of the doctor for the patients’ education regarding healthy lifestyles and reduction of the impact of negative social factors has been shown.

Keywords: essential hypertension, arterial hypertension, etiology, risk factors, elderly patients, group of medical and social risk.

A clinical case is described of rupture of chord of back mitral valve in an elderly patient with arterial hypertension, ischemic heart disease and chronic obstructive pulmonary disease, which reflects all the stages of diagnostic search and the difficulties that arose during the diagnosing. Basic concepts of medical and surgical treatment, features of the choice of treatment strategy depending on the degree of mitral valve insufficiency are analyzed. Also the etiologic role of various factors in causing rupture of chord of mitral valve, such as chronic rheumatic heart disease, bacterial endocarditis, stenosis of the aortic valve, arterial hypertension, ischemic heart disease, including acute myocardial infarction, degenerative disease of valves, connective tissue disease, chest injury, congenital heart defects. Modern classification of the described nosology, features of manifestation and clinical course are presented.

Keywords: chord rupture, heart failure, mitral valve insufficiency.

The case is analyzed of fibromuscular dysplasia (FMD) of aorta in a 61 years-old woman. The pathology was detected by sonographic study and successfully eliminated surgically — aortic aneurysm resection with prosthetics. This case has several features: 1) a rare localization and type of FMD of aorta — aneurysm of the abdominal aorta; 2) a combination of FMD and Sshaped pathological deformation of the aorta; 3) pathological pattern of FMD — defeat of all layers of the aorta in a total restructuring of the vascular wall with complete loss of elastic and fibromuscular proliferation; 4) the etiology and pathogenesis of FMD are related to hormonal and ischemic factors, the impact of xenobiotics is not excluded.

Keywords: S-shaped deformation of the aorta, abdominal aortic aneurysm, fibromuscular dysplasia of aorta, nonatherosclerothic aortic lesions.