Structure Of Cardiovascular Diseases Research Articles

Features of the Dynamics of Cardiovascular Diseases and Risk Factors for Their Development in Individuals with a History of Long-Term Work Under the Influence of Noise

Introduction. In this study, we aimed to identify the features of the dynamics of cardiovascular diseases (CVD) and risk factors for its development in individuals who have worked under the influence of noise for a long time. Patients and Methods. 56 archival case histories of patients with occupational sensorineural hearing loss and 47 outpatient records of patients who worked in relative silence were studied. CVD and cardiovascular risk factors were analyzed in dynamics. Results. The groups were comparable in age, body mass index, prevalence of smoking, obesity and burdened heredity. In patients with occupational sensorineural hearing loss, total cholesterol exceeded the upper limit of normal and the level in the comparison group, and was, respectively, 5.6 ± 1.2 mmol/l and 5.0 ± 0.9 mmol/l (p = 0.046) at the first visit and 5.6 ± 1.1 mmol/l and 5.2 ± 1.1 mmol/l at the last visit (p = 0.037). Hypertension was the leader in the structure of CVD in both groups. In individuals with occupational sensorineural hearing loss, the total number of cases of atherosclerotic cardiovascular diseases was significantly higher, both at the first (5 and 0 cases, respectively, p = 0.04) and at the last visit (14 and 3 cases, respectively, p = 0.01). Conclusion. Individuals who have worked in noise for a long time have an increased cardiovascular risk by the time occupational hearing loss is established. Abnormalities of lipid metabolism presumably represent a main contribution to the formation of this risk. At the same time, atherosclerotic cardiovascular diseases are more often detected among individuals who worked in noise than among those who worked in relative silence.

Potential role of mitochondrial dysfunction in arrhythmogenesis in coronary artery disease

Introduction. Coronary artery disease (CAD) continues to be the most common pathology in the structure of cardiovascular diseases over the past decades, both in Russia and around the world. In the normal condition, the mitochondria of all body cells have the same function capabilities due to the carriage of the same genome. Therefore, it is possible to assess the respiration activity of cardiomyocyte mitochondria by the respiration of mitochondria from peripheral blood leukocytes.Aim: To compare respiratory activity of mitochondria of peripheral blood leukocytes in patients diagnosed with coronary artery disease and coronary artery disease with developed cardiac rhythm disorders (CRD).Material and methods. The studied groups included 45 patients with CAD without CRD and 39 patients with CAD complicated by CRD. Mitochondria were isolated from peripheral blood leukocytes by differential centrifugation. The rate of oxygen loss in pyruvate-malate and succinate incubation buffers was measured when isolated mitochondria were introduced, as well as when palmitic acid was added to the medium. Oxygen consumption rate for the V3 (active phosphorylating) and V4 (nonphosphorylating) metabolic sates was determined, and on their basis respiratory control coefficient was calculating using the formula V3/V4. Statistical data processing was carried out using STATISTICA 13.0 software.Results. Oxygen consumption rate in mitochondria of patients with uncomplicated CAD and CAD with CRD had no significant differences in either pyruvate-malate or succinate buffers. When palmitic acid was added to the incubation medium, the mitochondria of CAD patients without CRD significantly increased oxygen consumption rate in both incubation media. Mitochondria of CAD patients with CRD did not change oxygen consumption rate in both metabolic states after the addition of palmitic acid in incubation media.Conclusion. On the basis of the data obtained, it can be concluded that the function capabilities of mitochondria in the complicated course of CAD has been exhausted, which manifests itself in the inability to increase ATP synthesis in response to the introduction of additional substrates.

Cardiovascular and metabolic status in patients with primary hyperparathyroidism: a single-center experience.

Cardiovascular diseases (CVD) and metabolic disorders (MD) have retained leading positions in the structure of morbidity and mortality for many years. Primary hyperparathyroidism (PHPT) is also associated with a greater incidence of CVD and MD. The aim of the present study was to describe the prevalence and structure of CVD and MD in hospitalized patients with PHPT and to search for possible associations between these pathologies. 838 patients with a verified PHPT were included in the study. The studied cohort was divided into 2 groups according to their age at the time of admission: patients aged 18 to 49 years (group A, n = 150); patients aged 50 years and older (group B, n = 688). There were no significant differences between two groups in parameters of calcium-phosphorus metabolism. Obesity was diagnosed in 24.2% of patients in group A and in 35.9% in group B. Type 2 diabetes mellitus was more common in older patients (14.4% in group B vs. 2.6% in group A). Arterial hypertension, ischemic heart disease, chronic heart failure and brachiocephalic arteries atherosclerosis were more frequent in older patients, occurring in 79.1%, 10.8%, 8.4%, and 84% of cases respectively. The cutoff points that increased the risk of CVD detection turned out to be age above 56 years, eGFR below 92 ml/min/1.73m2, BMI above 28.3 kg/m2. The present study demonstrated a high incidence of some CVD, as well as disorders of lipid, carbohydrate and purine metabolism in patients with PHPT.

ФУНКЦИОНАЛЬНАЯ СОСТОЯТЕЛЬНОСТЬ И ПОЛИМОРФИЗМ ГЕНОМА МИТОХОНДРИЙ ЛЕЙКОЦИТОВ ПРИ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА, ОСЛОЖНЕННОЙ НАРУШЕНИЯМИ РИТМА

Introduction. Ischemic heart disease (CHD) is the most common pathology in the structure of cardiovascular diseases. Ischemia is a trigger for the occurrence of cardiac arrhythmias (HRDs), requiring the implantation of cardioverter-defibrillators. The functioning of cardiomyocytes is closely associated with respiratory processes in mitochondria (Mtx). Normally, all Mtx in the human body carry the same genome - mitochondrial DNA (mtDNA), respectively, the functional capabilities of all Mtx within the body are similar. Carriage of polymorphic variants of genes encoding subunits of respiratory chain complexes and rRNA may affect the functionality of Mthx. Target. To study the respiratory function of Mtx and the features of mtDNA of leukocytes in patients with coronary artery disease, accompanied by life-threatening NRS. Material and methods. Peripheral venous blood was taken from patients with coronary artery disease (n=45) and ischemic heart disease with HRS (n=120). Mtx was obtained by differential centrifugation in a sucrose gradient. Oxygen consumption rates (OCR) (nM O2/min/mg protein) Mthx were measured in two energy states: V3, the presence of oxidation substrate(s) and phosphorylation substrate (ADP) in the incubation buffer; V4 - after the consumption of ADP in the buffer. Succinate and a mixture of pyruvate and malate were used as oxidation substrates. To assess the functional reserve of Mtx, OPC was determined in the presence and in the absence of saturated palmitic acid (PA) in buffer. The coefficient of conjugation of oxidative processes and phosphorylation was calculated - respiratory control (RC) (V3/V4). The mtDNA haplogroup was established, as well as the carriage of polymorphic variants of genes encoding subunits of the respiratory chain complexes and ribosomal RNA (rRNA) (12S and 16S subunits). Statistical evaluation was carried out in the STATISTICA 13 program using the Mann-Whitney test for independent samples and the Wilcoxon test for dependent data groups. Data are presented as medians and quartiles (Me (Q1; Q3). Differences were considered statistically significant at p<0.05. Results. SPK in V3, V4 and DC of mitochondria in CAD and CAD with HRS did not have significant differences in both buffers without PC. When PA was added to the buffer, a significant increase in SEC was observed in Mth patients with isolated CAD. Thus, in the V3 state, SPK in pyruvate-malate buffer increased from 127.7 (85.3; 196.4) to 198.3 (162.7; 234.9) nM O2/min/mg of protein (p=0, 04), and in the V4 state from (46.6 (38.5; 56.3) to 64.4 (60.3; 87.7) nM O2/min/mg protein (p=0.02). the use of succinate buffer and PC, the mitochondrial SPK in patients with uncomplicated coronary artery disease increased slightly (p = 0.07) from 125.5 (64.4; 172.3) to 184.3 (47.3; 406.3) and from 44, 2 (27.5; 71.9) to 86.1 (36.9; 159.4) nM O2 / min / mg protein in V3 and V4, respectively. In the group of CAD with HRS, the addition of PA to the buffer did not affect the SEC in V3 and V4, as well as DC when using both buffers.mtDNA genotyping found that the main haplogroup in patients with IHD and HRS is haplogroup H - 41%.In 90% of cases, patients in this group were carriers of missense polymorphisms of 16S rRNA genes, which correlates with earlier studies of mtDNA in patients with uncomplicated CAD.In almost half of the cases, tRNA polymorphisms were detected in patients with CAD with HRS.Rarely (less than 40%), missense polymorphisms of the respiratory chain complex I genes were found. Polymorphisms of the genes for cytochrome B, cytochrome c oxidase, ATP synthase, and 12S rRNA turned out to be minor in frequency of occurrence. The frequencies of occurrence of all these polymorphic variants of the genes were similar to those in patients with uncomplicated coronary artery disease. The mtDNA of patients with HRS was 1.5 times more likely to have multiple missense polymorphisms in the protein genes of two different respiratory chain complexes. For genes with missense substitutions in three complexes and substitutions simultaneously in 12S and 16S rRNA, the differences between the groups were 1.6 and 1.7 times. Conclusion. Patients with CAD complicated by HRS are characterized by a reduced functional reserve of mitochondria, in contrast to patients with uncomplicated CAD. This may be due to the carriage of polymorphic variants of the mtDNA genes responsible for coding subunits of proteins of the Mth electron transport chain and mitochondrial rRNA. Also, in patients with CAD and HRS, compared with patients with uncomplicated CAD, the combined carriage of several polymorphic variants of the genes encoding these proteins and rRNA was more often detected.

Giant postinfarction posterolateral left ventricular aneurysm, complicated by mitral insufficiency

Ischemic heart disease holds the leading position in the structure of cardiovascular diseases. Early reperfusion therapy for acute myocardial infarction led to a decrease in mortality and severe complications of coronary artery disease. Despite advances in the treatment of coronary artery disease, dilatation and remodeling of the left ventricle develop in 20% of patients who have had a heart attack, leading to mitral insufficiency and systolic dysfunction of the left ventricle. Aneurysm of the left ventricle is a delayed severe complication of myocardial infarction, which significantly worsens the prognosis. Large aneurysms of the left ventricle cause progressive dilatation of the left ventricle, its volumetric overload with an increase in wall tension in the non-infarction zone, decreased functional characteristics of the left ventricle, thrombosis in the aneurysm cavity, life-threatening arrhythmias, and sudden death. Postinfarction left ventricular remodeling can lead to secondary mitral regurgitation, which is an independent predictor of mortality in the longterm period. Surgical treatment of coronary heart disease and its complications is one of the main problems of modern cardiovascular surgery.

Psychological support algorithms for underground miners to assess hypertension development risk

Objective. To study the psychovegetative status of underground miners and form psychological support algorithms to identify the risk for developing hypertension. Hypertension occupies a leading place in the structure of cardiovascular diseases, and determining the risk of its development is of great preventive importance for professional longevity. The study of the psychovegetative status to identify the risk of this pathology corresponds to modern diagnostic approaches within the framework of industrial corporate programs.
 Materials and methods. There were examined 109 male underground miners of the enterprise for the extraction of chromium ore. The patients were divided into two groups: the main group 60 men working in underground conditions, whose work is classified as "harmful" (class 3.33.4); the comparison group 49 men engaged in ground works, the conditions of which are classified as class 3.2. The main group was divided into two subgroups: I workers under 45 years old (n = 20, age 38.45 2.95 years), II over 45 years old (n = 40, age 50.90 1.46 years.); the comparison group was divided accordingly (23 employees, aged 38.0 2.8 years, experience 9.3 1.5 years; comparison group 45 years and 26 employees, aged 49.2 2.1 years, experience 24.0 1.8 years; comparison group 45 years). A complex of research methods was used: analytical (analysis of special assessment cards of working conditions, sociodemographic questionnaires), psychophysiological, functional and clinical and laboratory diagnostics, mathematical statistics (ROC analysis, multivariate logistic regression).
 Results. In two subgroups, two phenotypes were identified; in group I, there was a correlation of psychovegetative indicators with age and experience, and in group II a negative correlation. It has been proved that, depending on age, the psychologically realized adaptive phenotype is transformed into a psychosomatic one.
 Conclusions. Diagnostics of phenotype transformation formed the basis of the developed algorithms for psychological support, which makes it possible to assess the risk for developing arterial hypertension.

Analysis of the prevalence of arterial hypertension in the child population of the city of Grodno in the pre-covid and during the SARS-CоV-2 pandemic period

BACKGROUND: One of the leading problems in pediatric cardiology in recent years has become arterial hypertension, which worldwide tends to increase the share of this pathology in the structure of cardiovascular diseases.
 AIM: The aim of the study is to analyze the prevalence of arterial hypertension in the childrens population of Grodno in the pre-COVID period and during the SARS-CoV-2 pandemic.
 MATERIALS AND METHODS: The level of the incidence of arterial hypertension, gender and age characteristics of the pathology were studied using reports on medical care for children (Form 1 children of the Ministry of Health) for 20102019, analytical and market reports, reviews and certificates of the chief freelance pediatric cardiologist of the Health Department of the Grodno Region, chief physicians and city pediatricians. During the period of work in the time of the SARS-CoV-2 pandemic from January 2021 to September 2021, the course of 99 cases of arterial hypertension in children was analyzed.
 RESULTS: An increase in the overall incidence of arterial hypertension in children from 55.67 to 99.92 was established in Grodno, and a relative pattern of reliability of incidence occurred, the incidence was 27.33 (2010) and 28.11 (2019) cases per 100,000 children early age, and a 1.5-fold increase in the share of this pathology in the structure of cardiovascular diseases over the analyzed period. Almost the same proportion of cases of arterial hypertension was revealed in the entire childrens population of Grodno both before the pandemic and during the pandemic.
 CONCLUSIONS: For the period 20102019, an increase in the overall incidence of arterial hypertension in the childrens population of Grodno was revealed. Compared with the pre-COVID period during the SARS-CoV-2 pandemic, the prevalence of newly diagnosed hypertension in the same population has not changed.

ENDOVASCULAR ANGIOPLASTY FOR MULTI-LEVEL STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL-DISTAL ARTERIAL BED IN CASES OF STENOTIC-OCCLUSIVE PROCESS OF THE TIBIAL ARTERIES

Background. Occlusive-stenotic lesions of the lower extremity arteries are the second in the structure of cardiovascular diseases, after only coronary heart disease. Surgical treatment of patients with infrainguinal atherosclerotic lesions of the arterial segment is challenging in a number of cases. At the same time, revascularizing surgical interventions on the femoral-distal artery and especially on the tibial arteries in chronic critical ischemia is the only chance to avoid amputation of the lower limb. In this regard, the search and study of optimal methods of revascularizing surgery on the infrainguinal artery for stenotic-occlusive lesions of the arteries of the tibial segment is urgent.
 Objective. This study is aimed at promotion of endovascular and hybrid technology in cases of stenotic-occlusive process of the tibial arteries and choosing the optimal surgical treatment tactics in this case.
 Methods. Endovascular interventions of the femoral-distal arterial bed in cases of stenotic-occlusive process of the tibial arteries performed for 135 patients at the Department of Vascular and Cardiac Surgery of Ternopil Regional Clinical Hospital have been analysed.
 Results. In most cases, endovascular angioplasty of two tibial arteries in hybrid and endovascular methods of revascularization of multilevel atherosclerotic process of the femoral-distal arterial segment of the lower extremity prevents development of thrombosis in tibial segment and allows maintaining the patency of the reconstruction segment and preservation of the lower extremity in 97.57% and 93.44% of cases, respectively.
 Conclusions. Endovascular angioplasty of two tibial arteries provides a better result than angioplasty of one isolated tibial artery and allows maintaining the patency of the reconstructed segment for more than 90 percent compare to one isolated angioplasty.

К вопросу о клиническом значении ХС ЛПВП на современном этапе

The leading death cause in the world is diseases of the cardiovascular system, with CHD as the leader in the structure of cardiovascular diseases. The cause of this disease is atherosclerosis. One of the possible causes of atherosclerosis is an increase in LDL-C and a decrease in HDL-C in the blood. Many epidemiological studies have reliably shown that HDL cholesterol reduces the risk of developing cardiovascular diseases. Data from recent studies cast doubt on this data. The review briefly describes the current understanding of the effect of HDL-C high levels on morbidity and mortality, lists the new approaches to assessing the role and function of these particles, presents the results of clinical studies of drugs that affect their concentration in blood plasma and the probable causes leading to an increase of the HDL-Cin content in the blood.

Сравнительное изучение структуры сердечно-сосудистых патологий сельского и городского населения Республики Узбекистан, страдающих ХБП 5-й стадии на программном гемодиализе

Сравнительное изучение структуры сердечно-сосудистых патологий сельского и городского населения Республики Узбекистан, страдающих ХБП 5-й стадии на программном гемодиализе

Gastroesophageal reflux disease and atrial fibrillation: comorbidity or overlap syndrome? View of gastroenterologist

Аtrial fibrillation (AF) still occupies a special place in the structure of cardiovascular diseases, both due to its high prevalence, close association with socially significant diseases, and due to the high risks of death, stroke, and other thromboembolic complications. In turn, a patient with AF is always a comorbid patient, and among extracardiac pathology, the prevalence of diseases of the upper gastrointestinal tract, especially gastroesophageal reflux disease (GERD), pay attention. Recently more and more data have appeared that indicate the non-randomness of this combination. Many authors consider GERD as another independent risk factor for AF, while others propose to consider AF as an extra-esophageal manifestation of GERD, of course, in the absence of other cardiac risk factors. This review discusses the main pathophysiological mechanisms that determine the pathogenetic relationship of AF and GERD, known to date.

Metabolic Cardiomyopathy in Paediatric Practice

Aim. To review Russian and foreign literature of the recent years pertaining to the modern methods of diagnosis and management of children and adolescents suffering from cardiomyopathies.Materials and methods. Russian and foreign literature was analysed using the following databases: RSCI, Scopus, Web of Science, Pubmed.Results. There has been an increase in the proportion of non-specifi c myocardial lesions of non-infl ammatory origin in the structure of cardiovascular diseases in children and adolescents. Cardiomyopathies (CMP) constitute a group of myocardial diseases, which have been defi ned relatively recently and are increasingly attracting much research attention of cardiologists, morphologists, geneticists and cardiac surgeons. CMPs in children constitute a severe pathology and are characterised by a progressive course, resistance to therapy, as well as by an unfavourable prognosis. In this connection, a fundamentally new concept of CMP diagnosis, as well as its role in the structure of cardiovascular diseases, has been introduced, which is associated with the achievements in the spheres of medical genetics, immunology and molecular endocrinology. The article presents data from the Russian and foreign publications on paediatric aspects of metabolic CMP. In ths paper, we consider clinical, paraclinic and instrumental criteria for the diagnostics of non-coronary myocardial pathologies and associated pharmacotherapy, as well as some terminological issues.Conclusion. The problem of effi cient CMP diagnostics remains to be solved; its complexity is explained by the absence of specifi c clinical disease markers and a long asymptomatic course. CMPs occupy a special place among myocardial diseases of various origins, thus requiring a common diagnostic algorithm, as well as a complex of preventive, therapeutic and rehabilitation measures to be used in the paediatric practice.

Clinical and morphological changes of the cardiovascular system in patients with cardioneurosis (neurocirculatory dystonia)

The term “cardioneurosis” (neurocirculatory dystonia (NCD)) refers to somatoform dysfunction of the autonomic nervous system, which is caused by the imbalance of the sympathetic, parasympathetic and metasympathetic parts of the nervous system. It is a polyetiological disease characterized by multiple clinical symptoms, mainly from the cardiovascular system, which occur and aggravate against the background of acute and chronic stress effects, but has a benign course and a good prognosis. Despite the functional nature of the disease, pathology of the cardiovascular system in some patients may transform into organic one after a certain period of time. Due to the significant prevalence of NCD in the overall structure of cardiovascular diseases (up to 50%), especially among young and able-bodied people, the study of clinical features and the search for a morphological substrate of cardioneurosis is relevant. The purpose of the study is to evaluate the effect of NCD on the heart connective tissue matrix (CTM) and the appearance of cardiac syndromes in NCD, their clinical manifestations on the part of the cardiovascular system. The analysis is based on a review of national and foreign original articles and research, using databases PubMed, eLIBRARY.RU, Web of Science. The article deals with the clinical features of cardioneurosis, in particular the appearance of cardiac syndromes in NCD and their clinical manifestations, as well as the role of structural disorders in CTM, as in a locus of primary neurovascular and neuroendocrine interactions. CTM changes that occur with NCD are associated with pathology which is caused by damage to the connective tissue, and in particular with non-differentiated dysplasia of connective tissue. Therefore, systemic dysplastic changes in CTM may be a marker of constitutional psycho-vegetative insufficiency and a morphological substrate of NCD.

Long-Term Results of Surgical Treatment of Pulmonary Embolism (PE) by Balloon Angioplasty (BAP) in Combination with Thrombolytic Therapy

Introduction. Pulmonary Arterial Thromboembolism (PATE), which is characterised by low prognosis probability and potentially high danger, ranks third in the mortality structure of cardiovascular diseases. The primary method for treating PATE is recanalisation of the pulmonary arteries affected by embolism. Although the destruction of thromboemboli with thrombolytic drugs has proven effective, the right ventricular failure progresses faster in a majority of patients with massive pulmonary embolism. The aim of the present study is to evaluate the long-term results of surgical treatment of PATE by balloon angioplasty in combination with thrombolytic therapy in comparison with isolated systemic thrombolysis.Materials and methods. The treatment of 80 patients with pulmonary embolism was analysed. Depending on the selected treatment approaches, the patients were divided into 2 groups as follows: group 1 — 39 patients, conducted by the BAP LA, in combination with thrombolysis; group 2 — 41 patients who underwent conservative treatment (thrombolysis and subsequent anticoagulation therapy).Results. Despite the small sample and short period of observation, we may note the significantly better results of treatment in group 1 of the study. Positive dynamics of ECG indicators — in particular, pulmonary hypertension, RV KDR, functional class of heart failure NYHA as well as the reduction of right ventricular overload according to the ECG — indicates that the BAP LA method for the surgical treatment of pulmonary embolism, in combination with thrombolytic therapy, is effective and safe.Conclusions. Balloon angioplasty of pulmonary arteries in combination with thrombolytic therapy can significantly reduce the degree of pulmonary hypertension (рχ2 = 0.034), as well as helping to normalise the size of the right ventricle (рχ2 < 0.001) and improvement in functional class of heart failure NYHA (рχ2 = 0.026) in patients with pulmonary embolism compared with patients with isolated thrombolytic therapy.

Cardiovascular Diseases and Drug Treatment in Patients with the History of Cerebral Stroke: Data of the Outpatient Registry REGION

Aim. To evaluate the structure of combined cardiovascular diseases, drug treatment and observation of patients with a history of stroke in the framework of prospective outpatient registries. Material and methods. The study was conducted based on 3 outpatient clinics of Ryazan city. Patients with a history of acute cerebrovascular accident (ACVA) of any remoteness (AR) were included into ACVA-AR outpatient registry (n=511). Patients who had visited the outpatient clinics for the first time (FT) after cerebral stroke (n=475) were included into the ACVA-FT outpatient registry. The structure of the cardiovascular diseases (CVD), compliance with the clinical recommendations of the prescribed and received drug therapy were evaluated. The proportion of patients with dispensary observation for CVD, using preferential drug provision was determined. Results. A combination of 2 or more CVDs was found in 84.4% and 82.5% of cases, and severe cardiovascular multimorbidity (3-4 CVDs) – in 69% and 64% of cases, respectively, in ACVA-AR and ACVA-FT registers. Compliance with the clinical guidelines prescribed and received drug therapy was insufficient at the outpatient stage. Necessary prescription of drugs with a proven beneficial effect on the prognosis were observed significantly more frequent in the ACVA-FT registry, compared to the ACVA-AR registry at the enrolling stage of the study (p<0.05): statins for stroke – 50.1% vs 25.2%; statins for coronary heart disease (CHD) – 47.2% vs 27.9%; antiplatelet agents for CHD without atrial fibrillation – 65.6% vs 54.3%; anticoagulants for atrial fibrillation – 17.7% vs 9.3%; beta-blockers for heart failure 43.5% vs 33.1%, respectively. After 2-3 years of the follow-up frequency of prognostically significant prescriptions in patients of the compared registries were not significantly different, except prescriptions for statin therapy (47.6% vs 21.3%, respectively). The prognostically significant prescriptions during the enrolling stage in ACVA-AR and ACVA-FT registries occurred in 44.4% and 54% of the total number of proper prescriptions, and in the long-term follow-up period – in 55% and 57%, respectively; and the dispensary observation coverage was only 35.0% and 31.8%, respectively. According to patient contact only 21-24% of patients used the system of preferential drug provision at the stage of inclusion into the registers, and after 2-3 years of follow-up – 1.5-2 times less (12-14%). Conclusion The results of the study REGION found the presence of cardiovascular multimorbidity in 83% of patients with a history of stroke, insufficient quality of prescribed drug therapy in the out-patient clinic, especially in the ACVA-AR registry. The quality of medical treatment of patients improved within 2-3-year follow-up after the reference visit to out-patient clinic, but not sufficiently. Increase in dispensary observation coverage and optimization of the system of preferential drug provision are also important reserves for improving the quality of treatment of patients with a history of stroke, as well as prevention of cardiovascular complications.

Metabolic cardiomyopathy in pediatrics.

Currently, the percentage of non-specific myocardial lesions of non-inflammatory genesis has significantly increased in the structure of cardiovascular diseases in children and adolescents. Cardiomyopathies are a cluster of myocardial diseases that have become more of interest by cardiologists, morphologists, geneticists, and cardiac surgeons. Cardiomyopathies in children are regarded as a severe pathology characterized by a progressive course, resistance to therapy, and result in an unfavourable prognosis. The current article presents data from international publications dedicated to cardiomyopathy diagnostics in children. This article deals with terminology issues in compliance with international disease classification, primary diagnostic criteria of non-coronary myocardium pathology, and modern methods of diagnostics and pharmacotherapy.

Cardiovascular disease and associated comorbid conditions as determinants of adverse perinatal outcomes in pregnancy - an analysis of the results of the register of pregnant BEREG.

the Aim of the BEREG Registry was to analyze the prevalence and structure of cardiovascular diseases, associated comorbid conditions and assess their effects on pregnancy and perinatal outcomes in real clinical practice. In Tula city regional perinatal center the observation study named "Assessment of the clinical condition of the pregnant women with cardiovascular disease during gestation, at child delivery, at the early postpartum period and at twelve months after childbirth and assesment of perinatal outcomes, condition of the fetus and the newborn and the quality of treatment of these patients groups.  All eligibly pregnant women hospitalized in 2014 to "Tula regional perinatal center" have been recruited in the Registry. Clinical and demographic data at admission, obstetric history, laboratory and instrumental examination data, previous medical history have been investigated. The following endpoints were evaluated: maternal mortality, death of the fetus and newborn baby; preeclampsia or/and eclampsia, heart failure, arrhythmia, thromboembolism events.  Statistical processing of obtained data was carried out using the software package STATISTICA 10.0 (StatSoft, USA). The study included 3214 women delivered babies in the perinatal center in 2014, of which 691 (21,4%) were diagnosed with cardiovascular disease (CVD) in most cases (451 women, 65,9%) - these were different clinical variants of arterial hypertension (AH). Five women (0.7%) had acquired and 23 women ( 3.3%,) congenital heart defect, non-significant heart development abnormities were found in 80 subjects, (11.6%). and Cardiac arrhythmias and conductivity disturbance have been revealed in 116 and 16 cases (16.8% and 2.3%) correspondingly. Patients with CVD were significantly older than women without CVD and more often had a variety of disorders of carbohydrate metabolism, overweight, obesity and chronic varicose disease of the lower extremities. Pregnancy in women with CVD significantly more often was complicated by the threat of interruption, placental insufficiency, preterm and operative babies delivery. Arterial hypertension as well as obesity, placental insufficiency and threatened miscarriage became prognostically unfavorable conditions that contributed of premature birth and fetal death. Fetal death or newborn babies death took place in 1,3% of all the subjects enrolled. In this cohort antenatal death have been registered in 43,2%, intrapartum one in 2.3% and neonatal death in 54.5%. Negative prognostic factors for low birth-weight babies were: placental insufficiency, various clinical variants of AH, obesity and infectious diseases; less input had endocrine diseases and risk of abortion. Adverse factors for the fetus death or newborn death were different clinical variants of arterial hypertension and the risk of abortion in any trimestre of pregnancy.

The problem of preoperative left ventricular modeling

Coronary heart disease has one of the leading places in the structure of cardiovascular diseases. Post-infarction left ventricular aneurysm significantly aggravates the prognosis of coronary heart disease. The main goals of surgical treatment of postinfarction left ventricular aneurysm are the maximal removal of asynergia areas and restore of correct geometry of left ventricle. Choice of left ventricular plasty technique should be individual for each patient based on instrumental examination data. Considering disadvantages of echocardiographic preoperative left ventricular modeling, attempts to model the left ventricular cavity via magnetic resonance imaging are developing at present time. Development of algorithms of left ventricular modeling by magnetic resonance imaging will optimize left ventricular reconstructive techniques and will help to avoid unfounded correction in some cases.

About the need of organization of clinical examination of young people with small developmental heart abnormalities.

Due to the signifi­cant increase of complications developing in young people suffering from low cardiac abnormalities, detection of this disease is important. The aim of the study was to analyze the prevalence and structure of cardiovascular diseases in persone aged 18-21 years who have referred to the medical center of Dnepropetrovsk Medical Academy in the period from 2012 to 2013 in order to determine the mode of physicol exercises. We examined 268 students of 1-2 courses of medical academy, who, along with the clinical examination underwent standard echocardiography 2 times a year. It is established that in the structure of cardiovascular diseases in the studied group small anomalies of the heart occupy the first place; valve pathology the second place. In the structure of small abnormality of the heart, mitral valve prolapse is detected the most frequently. Since this anomaly affects the level of tolerance to physical stress and can lead to heart disorder, routine screening of patients with this disease is mandatory and must be carried out to address the choice of the level of physical activity.

Surgical treatment of ischemic heart disease on beating heart

Till the present time ischemic heart disease is a dominate pathology in structure of cardio-vascular diseases. Heart failure considered to stenotic and occluding lesions of coronary vessels and their complications remain the main reason of mortality and disability of population in all industrially advanced countries. Using of modern methods of surgical treatment of ischemic heart disease lets to provide myocardial revascularization on beating heart of any complexity with low mortality and complication rates in patients with different risk of lethal outcome with good immediate and follow-up results.