Takayasu arteritis is a well-known rare form of large vessel vasculitis. This review details the clinical features, opportunities of disease activity assessment including new serum biomarkers and imaging diagnostics. Current evidence based treatments are presented and discussed. Particular attention is paid to the effectiveness and complications of interventional and surgical treatment in arteritis Takayasu.

The molecular mechanisms of atrial fibrosis, including the role of serotonin, in atrial fibrillation as well as possible therapeutic approaches are discussed. 

Hypertrophic cardiomyopathy (HCM) is a leader in genetic structure of cardiovascular system. According  to modern concepts, hypertrophic cardiomyopathy associated with mutations of sarcomere proteins is just one  of the reasons leading to the left ventricular hypertrophy (LVH). Hypertrophic phenotype is also observed in a number of genetically and non-genetically related diseases. According to population-based studies conducted in the USA, Europe and Japan, the prevalence of HCM is 1:500. Apparently, the data obtained in these studies and  based primarily on the phenotypic screening cannot be extrapolated to the full cohort of patients with HCM and  reflect the general incidence of hypertrophic phenotype in different populations. There are some publications on the prevalence of HCM in the structure of LVH of unknown cause in children and adolescents. The features of the clinical course of HCM, risk stratification of sudden cardiac death (SCD), medical management in young and middle age are studied. At the same time elderly patients with unexplained LVH are the least studied cohort.  Study of the natural history of the disease, risk factors for adverse events, including the SCD, the impact of comorbidity on the clinical manifestations of HCM in the elderly will contribute better understanding of this pathology, as well as a number of other diseases occurring under the guise of HCM. This can help to develop the algorithms for diagnosis, prediction criteria and management of LVH of unknown cause. 

Adrenal incidentaloma is an unsuspected and asymptomatic mass, usually detected by an imaging study performed for other purposes. The widespread use of diagnostic ultrasound, computed tomography, magnetic resonance imaging has resulted in the frequent incidental discovery of asymptomatic adrenal mass. Adrenal incidentalomas represent a public health challenge because they are increasingly recognized in current medical practice. The majority of adrenal incidentalomas are benign, but careful evaluation of all patients is warranted to be certain that malignant tumours and functional adenomas are not missed. The article reviews the presentation, evaluation and management of adrenal incidentalomas.

Objective. To assess osteoprotegerin (OPG) and soluble ligand receptor activator of transcription factor kappa-B (RANKL) levels in patients with  aortic stenosis and systemic hypertension.

Design and methods. Sixty-one patients with aortic valve stenosis (AVS) [31 patients with bicuspid aortic valve (BAV) and 30 patients with tricuspid aortic valve (TAV)] were examined. Thirty-two patients without heart diseases formed the control group. Serum levels of C-reactive protein, ОPG, sRANKL and lipid profile were assessed in all patients.

Results. Elevated blood pressure (BP) was found in 93 % patients with TAV and in 71 % patients with BAV. Serum concentration of OPG was increased in patients with TAV and BAV vs control group. OPG concentration was negatively correlated with BP level only in patients with TAV. sRANKL level was increased only in patients with BAV. At the same time sRANKL level positively correlated with BP in patients with TAV.

 Conclusion. Systemic hypertension is the key risk factor for OPG/RANKL/RANK system activation in patients without congenital heart disease.

Objective. Hypertension (HTN) is a well-known risk factor of coronary artery disease (CAD). Despite this, history of HTN was positively associated with collateral flow index. We analyzed left ventricle (LV) structure and function parameters among CAD patients with and without HTN.

 Design and methods. We included 93 patients with isolated left anterior descending artery disease (40 of them had chronic total occlusion, CTO). All patients had positive exercise stress echocardiography test with the ischemia in the left anterior descending artery (LAD) zone. Eighteen patients underwent left internal mammary artery to LAD grafting, 56 patients had percutaneous coronary intervention and 19 patients did not undergo revascularization. Mean follow-up period was 6 years. End-diastolic diameter, end-diastolic volume, end-systolic volume and LV ejection fraction (EF) were assessed. Exercise stress-echocardiography was performed and wall motion score index was estimated before and after the stress.

Results. End-systolic volume increased significantly in patients without HTN and did not change in hypertensive patients (p < 0,05). EF increased in hypertensive patients with CTO, in normotensives slight reduction was observed (p < 0,05). No significant differences of stress-echo parameters were found between the groups. Δ wall motion score index parameter significantly decreased in both groups (p < 0,05).

Objective. To estimate clinical status, quality of life (QOL), physical activity, structural and functional pe-  structural and functional penal peculiarities of the heart in patients with chronic heart failure with preserved ejection fraction (CHF-PEF).

Design and methods. Seventy-two patients with CHF-PEF (age 47–77 years) were examined. Clinical status, QOL by Minnesota questionnaire, 6-minute walk test, heart ultrasound, serum N-terminal brain natriuretic propeptide level were assessed in all patients.

Results. Main complaint was dyspnea at physical activity in patients with CHF-PEF (95,8 %). Structural and functional myocardium changes were more expressed in patients with higher functional class. General total score by Minnesota questionnaire was 21,5 [14,5; 40,0] in men and 48,5 [36,0; 59,0] in women. Tolerance to physical activity influenced QOL.

Conclusions. All patients had echocardiographic signs of left ventricular diastolic dysfunction. The higher functional class of heart failure was associated with the more pronounced myocardial hypertrophy, decreased QOL and physical activity. QOL was higher in men, than in women. Diabetes mellitus, ischemic heart disease were associated with the clinical progression of CHF.

Objective. The comparative study of the actual performance of diagnostic procedures for in-patients with essential hypertension. Design and methods. Evaluation of the execution of diagnostic standards was done by the assessment of the percentage of factual performance of recommended diagnostic methods according to primary medical reports. The methods used in the research are content analysis, analytical and statistical analysis.

Results. Out of 44 (100 %) recommended parameters of standard diagnostic procedures only 16 (36,4 %) were performed in Central District Hospital, 18 (40,9 %) — in the city hospitals, 13 (29,5 %) — in the regional and federal hospitals. Out of 27 parameters only 12 were carried out with the required frequency 1,0, while the rest 15 parameters were carried out with the frequency 0,2–0,9. Few parameters were performed more frequently than it is recommended by the standards.

Conclusion. The defined defects emphasize the necessity of the further analysis of the reasonability of the evaluation and performance of some diagnostic procedures at different levels of medical health care delivery.

Objective. To assess office and outpatient blood pressure (BP) in patients with the persistent and masked hypertension (HTN) and obstructive sleep apnea syndrome (OSAS).

Design and methods. We enrolled 121 subjects with BP increase and verified OSAS by multifunctional monitoring including registration of electrocardiogram, BP and respiration (Кardiotekhnika 04-BP3 (M), St Petersburg, Russia) that were divided into 2 groups: patients with stable and masked HTN.

Results. The groups differed by age, office and ambulatory BP in subjects younger 40 years. Males were prevalent among patients with OSAS and masked HTN. Smoking rate was also higher in this group. Both daytime and nocturnal BP were higher in subjects with OSAS and masked HTN. According to multiple regression analysis there were several predictors of masked HTN in OSAS patients: male gender, high normal BP, smoking and BP elevation at night.

Conclusions. Multifunctional monitoring with the registration of BP and respiration is obligatory in patients with HTN and suspected sleep breathing disorders in order to diagnose latent HTN.

Objective. To determine the prevalence of primary aldosteronism (PA) through routine practice — among patients visiting a specialized antihypertensive center due to uncontrolled hypertension or with adrenal incidentalomas.

Design and methods. We included 314 patents with uncontrolled hypertension and 195 patients with incidentalomas. Aldosterone-renin ratio (ARR), hormonal tests and examination for exclusion of symptomatic hypertension were performed in all subjects.

 Results. PA diagnosis was confirmed in 27 patients with uncontrolled hypertension (8,6 % hypertensive patients) and in 17 % patients with adrenal incidentalomas. ARR increase as well as elevated aldosterone level were found in all subjects, and all of them had high PA risk.

Conclusions. The prevalence of PA is 8,6 % patients with uncontrolled hypertension and 17 % patients with adrenal incidentalomas. ARR increase along with aldosterone level elevation should be considered at patient evaluation.

Objective. To analyze the work of the Hypertension office to explore the risk factors of cardiovascular disease and prevention opportunities.

Design and methods. The study included 2049 subjects (1549 women and 500 men) surveyed in 10 Hypertension offices. The special software «Cardiometer-MТ» JSC «MICARD-LANA» (Russia) was used for the automated integral estimation of the functional state of the cardiovascular system.

Results. The fatal cardiovascular risk by the SCORE scale was estimated: very high risk was observed in 33,7 % cases, high risk — in 31,1 %, moderate risk — in 12,4 %, low risk — in 19,7 % cases.

 Conclusions. The methods applied in this work contribute to the development of the database and to the primary prevention in people with cardiovascular risk factors.

stenoses of precerebral arteries, to determine predictors of the complications of verticalization in order to perform a more differentiated approach to the implementation of the protocol to ensure the safety of the process.

 Design and methods. The study included 50 patients with hemispheric ischemic stroke. Group 1 (n = 30) included patients without hemodynamically signiicant stenoses of the brachiocephalic arteries (BCA), group 2 (n = 20) included patients with hemodynamically signiicant stenoses of the BCA. Verticalization was carried out on a tilt-table «Vario-Line» («Beka») on the 1, 2, 3, 4, 5 and 14 day from the onset of the disease.

 Results. In group 2 an earlier decline in the rate of cerebral blood low (CBF), as well as the re-reduction rate of the CBF during the session of verticalization were detected. During the interruption between the sessions, indicators of autoregulation recovered more slowly in patients from group 2. Moreover, the cerebral autoregulation indicators were decreased during the course of verticalization, by 14 day only a quarter of these patients had a ratio of 10 % overshoot.

Conclusions. Patients with hemodynamically signiicant stenoses of symptomatic BCA need to use a special regimen of verticalization that would appear «gentle» in order to prevent the complications of verticalization. Assessment of cerebral blood low autoregulation by the overshoot factor can help to identify patients with the increased risk of complications.