Combination antihypertensive therapy is supposed to be reasonable at first stages of the disease. The review summarizes the data on metoprolol succinate and felodipine effects as a combination medicine Logimax that due to its pharmacodynamics can be the used both in isolated hypertension and in concomitant coronary heart disease.

The heritable connective tissue disorders with common general phenotypical and clinical features should be called dysplasia of the connective tissue. Classification of the basic dysplastical syndromes and phenotypes is offered. Article considers the algorithm of diagnostics of the basic syndromes and phenotypes and the practical questions arising at attempt of their classification.

The article summarizes the available data on ramipril in hypertensive patients of high cardiovascular risk. The results
of studies demonstrate strong and long-lasting antihypertensive effect of ramipril. Moreover, ramipril treatment decreases
cardiovascular events rate, damage of target organs, atherosclerosis progression and new cases of diabetes mellitus. The
treatment by ramipril represents vasculoprotective and renoprotective effects in diabetes patients. Possible antiarrhythmic
activity of ramipril is of particular interest in atrial fi brillation. Ramipril shows both high effi cacy and low adverse event
rate. All this properties make ramipril extremely attractive for the everyday practice.

3700 men working as railway train drivers were examined. 53 persons of them with diagnosed chronic stress-induced cardiomyopathy were chosen. (All patients were of similar age group 32.5 ± 1.5 y.). EchoCG indicated presence of altered LV function as to IVRT and Tdec values. The SPECT-imaging results showed sectors with moderate to significant alteration of radiopharmaceutical uptake in myocardium of left ventricle. SPECT-imaging with Tc¹³¹ tetraphosmine makes possible to visualize and assess spread and severity of metabolic disorders in myocardium in patients with stress-induced cardiomyopathy caused with psychoemotional strain. On our opinion, identification of the signs mentioned below provides basis to diagnose stress-induced cardiomyopathy caused with chronic psychoemotional strain: EchoCG signs of diastolic dysfunction of the left ventricle, moderate to severe impairment of radiopharmaceutical agent uptake at SPECT-imaging.

Objective. To compare the effect of torasemide (Td) and furosemide (Fd) on the daily blood pressure profile (DBPP), blood pressure (BP) during aclive orthostatic test (OT) and dynamics in brain natriuretic peptide (BNP) levels in patients with heart failure (HF) III-IV (NYHA). Design and methods. 40 patients with stable HF III-IV (NYHA); left ventricular ejection fraction (LVEF) ≤ 40 %; 90 ≤ systolic BP ≤ 140 mmHg; 60 ≤ diastolic BP ≤ 90 mmHg were included. Clinical status, 6-minute walking test (SWT), BNP and aldosterone levels, quality of live (QL), DBPP, OT were assessed. The patients were randomized into two groups: torasemide group TG (n = 20) receiving Td, and furosemide group (FG) (n = 20) receiving Fd. Results. The patients with lower BP during OT and DBPP had higher level of BNP. The low BP levels complicated with drug titration till the recommended doses for HF reatment. We observed the decrease of HF functional class, BNP level, the increased distance in SWT in both groups. TG showed higher BP levels and less BP decrease during OT that allowed us to achieve the highest β-blockers doses and significantly improve QL. Conclusions. 1. Patients with HF with lower BP during DBPP and more expressed decrease of BP in OT had a higher BNP level. 2. The Fd replacement by Td results in the decrease of orthostatic reaction, optimization of SBPP and more significant positive changes in QL. 3. The replacement Fd by Td allows significantly increasing the doses of β-blockers.

The purpose of the study was to assess the predictive value of standard prognostic markers in ambulatory patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) discharged after heart failure hospitalization. We used prospectively collected information, including medical history, physical examination, 6-minute walking test, chest X-ray, electrocardiogram, echocardiography, blood test (including brain natriuretic peptide (BNP)) (totally 450 variables) in 98 hospitalized patients 45-65 years old (mean age 61 ± 0,8 years, 75 men), with NYHA class HF II-IV, COPD 2-4 stage. After hospital discharge all patients were followed up by cardiologists specialized in HF for a mean period of 5 years. Correlation analysis was used to assess the predictive value of standard prognostic markers. 5-year survival was 81 %. Prognostic markers including older age, ischemic aetiology of HF, diabetes mellitus, angiotensine converting enzyme-inhibitors and β-blockers therapy, tachycardia, low blood pressure, low body mass index, marked elevation of BNP, creatinine, bilirubin, anemia, hyponatriemia, low left ventricular ejection fraction, restrictive mitral filling pattern had no influence on 5-year survival in HF patients with COPD.

Objective. The aim of this research was to optimize cardioprotection by means of isothermal intermittent blood cardioplegia in patients with left ventricle myocardial hypertrophy (LVMH). Materials and methods. We analyzed 700 pair samples of transmyocardial blood, taken from 100 patients divided into two groups: research group with LVMH (n = 50, left ventricle posterior wall ≥ 11 mm), and control group without LVMH (n = 50, LVPW < 11 mm). The comparison of average levels of transmyocardial lactate, venous saturation, pH, oxygen consumption, venous carbon dioxide tension (pvCO2) initially and at the end of each cardioplegia depending on its time and volume parameters was carried out in each group with the use of Student and Wilkokson criteria. Results. Average cross clump time and the number of cardioplegia sessions in research and control groups had no significant differences (37,7 ± 12,8 and 38,9 ± 24,8 minutes; 3,1 ± 2,2 and 3,5 ± 3,1 sessions accordingly; p > 0,05). If the intervals between cardioplegia sessions were 12-15 minutes the average transmyocardial lactate level was significantly higher in research group (2,2 ± 1,7 and 1,6 ± 1,1 mmol/l; p < 0,05), if the intervals were more than 15 minutes the changes were even more expressed (2,5 ± 1,9 and 1,7 ± 0,9 mmol/l; p < 0,05). When the maintenance coronary sinus lactate level was less than 2,2 mmol/l in both groups, average time between cardioplegia sessions was 11,3 ± 5,9 minutes and was significantly lower, than in group with compromised myocardium metabolism. Conclusion. Our data show that the quality of cardioprotection depends on LVMH presence and cardioplegia volume-time characteristics.

The effect of coronary artery bypass grafting (CABG) lasts as long as the grafts are patent. Between January 2002 and September 2008 a total of 231 patients underwent CABG in Almazov Federal heart, blood and endocrinology centre. They were divided in two groups. The first group (n = 117) underwent off-pump coronary artery bypass grafting (OPCAB), patients of the second group (n = 120) underwent on-pump CABG with crystalloid cardioplegia. Complete revascularization using arterial grafts (internal thoracic arteries, radial arteries) and saphenous vein grafts was performed in all patients. The purpose of this research is to show the opportunity of successful OPCAB with arterial grafts. We conclude that the absence of anoxic period during OPCAB decrease the risk of myocardium damage. It allows avoiding complications, decreasing the time of artificial ventilation and stay in the intensive care unit. The use of arterial grafts during OPCAB is a perspective way.

We studied the changes in adenosine diphosphate (ADP)-induced platelet aggregation in patients with coronary artery disease (CAD) and concomitant anxiety and depression. We found a significant reduction of platelet aggregation response (time of aggregation at ADP concentration 1,25 and 2,5 µM, maximum percentages of aggregation at ADP concentrarion 1,25 µM) in plasma of patients with CAD and concomitant anxiety and depression as compared with patients with CAD without anxiety and depression. Our results do not support hypothesis of an increased thrombosis in patients with CAD and anxiety and depression.

The short- and long-term outcome of coronary artery bypass grafting surgery (CABG) in 130 patients with non-ST elevation
acute coronary syndrome (NEST ACS) is presented. 73,1 % of patients had the benefi cial CABG effect towards the
end of 48-month follow-up. We observed increasing recurrent angina rate with time after CABG. The recurrent myocardial
ischemia after urgent CABG is associated with younger age, severe angina in past, off-pump CABG performing and keep
on smoking after myocardial revascularization.

The semi-quantitative histologic and immunohistochemical analyses were carried out on the biopsy and autopsy samples of right atrium, interatrial septum and left ventricle of 110 patients. The antibodies against calcineurin, natriuretic peptide, prealbumin (transthyretin), λ- and κ-light chains, АА amyloid, Ki-67-antigen, VP1-antigen of enterovirus, herpes simplex virus, cytomegalovirus, LMP- antigen of Epstein-Barr virus, adenovirus, parvovirus B19 were used. All cases with persistent atrial fibrillation are characterized by myocarditis, amyloidosis signs and by the presence of enterovirus and parvovirus B19 antigens, and more rarely by adenovirus.

The aim of our study was to evaluate the prevalence of type 2 diabetes mellitus (DM), arterial hypertension and coronary artery disease (CAD) in perimenopausal women with a history of polycystic ovary syndrome (PCOS) treatment. A group of 38 women aged 45-59 years, who had been treated for typical symptoms of PCOS in different hospitals of St Petersburg in 1972-1989 years, were included in the study. An age-matched sample of women without PCOS (N = 308) was selected. There was no difference in waist circumference, body mass index and in the proportions of women with obesity between these two groups. The mean fasting glucose was significantly higher and the impaired fasting glucose was found more often in PCOS women, than in controls. The mean concentrations of lipids showed no difference in the groups. Patients with PCOS had significantly higher prevalence of type 2 DM and arterial hypertension. There was no difference in the prevalence of CAD.

Objective. The study addresses differentiation of ischemic and non-ischemic cardiomegaly by positron emission tomography (PET). Design and methods. Based on echocardiography data 50 patients with cardiomegaly and reduced systolic function were included in the study: 32 patients with coronary heart disease (CHD) and 18 patients with normal coronary arteries according to angiography results (6 of them had alcohol abuse). All patients underwent PET with [13N]-ammonia and [18F]-FDG for myocardial perfusion and metabolism evaluation. A semiquantitative analysis of the images was performed. Results. All patients with CHD showed large hypoperfusion areas (more than 3 segments) matching the coronary artery flow. Perfusion/metabolism match was revealed in all (100 %) patients with CHD and perfusion/metabolism mismatch was observed in 25 (79 %) patients of the same group. The patients with noncoronarogenic cardiomegaly (NCM) had diffuse heterogeneity of myocardial perfusion, 5 of them showed small and mild perfusion defects with non-segmental distribution. The areas of abnormal perfusion were significantly larger in cases of CHD. Perfusion/metabolism match was noted in 2 (11 %) patients with NCM and none of the patients with NCM showed perfusion/metabolism mismatch. Conclusion. Diffuse heterogeneity of myocardial perfusion, non-segmental distribution of perfusion defects and lack of perfusion/metabolism mismatch are the most important features of noncoronarogenic cardiomegaly as compared to ischemic cardiomegaly.

The possibilities of¹⁸F-FDG PET in differential diagnosis of vascular dementia
Stanzhevskiy A.A. ^1,2, Tyutin L.A. ¹, Kostenikov N.A. ¹, Pozdnyakov A.V. ¹¹Russian Research Center of Radiology and New Surgical Technologies,²Federal Almazov Centre Heart, Blood and Endocrinology, St-Petersburg, Russia
Purpose: To evaluate of possibilities of¹⁸F-FDG PET in differential diagnosis of vascular dementia and other nosological forms of this disease. PET data were compared with results of imaging and clinical methods of examinations.
Materials and methods: 38 patients with different forms of dementia were examined by¹⁸F-FDG PET. Results: Metabolic patterns of the main types of dementia were revealed.
Resume:¹⁸F-FDG PET is very effective imaging tool to make early diagnosis of main clinical types of dementia.

The purpose of the work was the development of a technique of defi nition screening markers of genetic predisposition to
the development of diabetic cardiomyopathy. Research problems: revealing morphological signs of diabetic cardiomyopathy
at patients with type 2 diabetes on the basis of the echocardiography data; an establishment of screening dermatoglifi c criteria
of diabetic cardiomyopathy. The research group included 68 patients with type 2 diabetes, the control group included almost
healthy 68 people. The signs of diabetic cardiomyopathy were observed in all patients with type 2 diabetes and included
the changes of structural and functional indicators of heart, hypertrophy of heart chambers, and the presence of diastolic
dysfunction. The prominent features of dermatoglifi c picture were revealed in patients with type 2 diabetes, that testifi es the
participation of the genetic factor in formation of predisposition to this kind of pathology. The offered biometric technique
can be used for revealing people with the increased risk of diabetic cardiomyopathy development.

Background. Aortic valve-sparing operations are one of the relatively new approaches for treatment of patients with aortic root aneurysm and aortic valve insufficiency, but nowadays the common treatment strategy is absent. Methods. We studied the short-term results of David I valve-sparing operations in 19 patients with aortic root aneurysms and aortic insufficiency. Results. There were no lethal cases observed. 3 patients had mild aortic regurgitation, the majority of patients had no or trace aortic insufficiency. The significant decrease of left ventricle sizes was shown.
Conclusions. The David I technique of aortic valve reimplantation seems to be optimal in patients with aortic root aneurysm, aortic insufficiency and normal aortic cusps.

The aim of our investigation was to compare the effectiveness of radiofrequency ablation of ventricular tachycardia in patients after myocardial infarction conventional fluoroscopic catheter mapping vs. electroanatomic mapping. 52 patients with ventricular tachycardia after myocardial infarction were included, 17 of them passed radiofrequency ablation using electroanatomic mapping. The preference of electroanatomic mapping was indubitable. The visualization of the anatomical structures, evaluation of intracardiac electrical activation extension in relation to anatomic location using both conventional and stimulation mapping are the most optimal and useful method of radiofrequency ablation of ventricular tachycardia.

Recent research on the molecular physiology of fibrillin and the pathophysiology of Marfan syndrome and related connective tissue disorders has changed our understanding of this pathology by demonstrating changes in growth factor signalling and in matrix-cell interactions. Marfan syndrome is an autosomal dominant disorder of connective tissue caused by mutations in fibrillin-1. Fibrillin-1 contributes to the regulated activation of the cytokine TGF-ß, and enhanced signaling is a consequence of fibrillin-1 deficiency. Thereby, increased TGF-ß signaling may contribute to the multisystem pathogenesis of Marfan syndrome, including the development of myxomatous changes of the atrioventricular valve, aortic aneurysm and dissection, joint hypermobility syndrome. These data suggest that anti-TGF-β therapeutic strategy for patients with Marfan syndrome can be useful in prevention of the major life-threatening manifestation of this disorder.

Two cases of the successful cool radiofrequency ablation of the atrial fibrillation and typical atrial flutter in the conditions of artificial blood circulation after performance of the basic stage of surgery (the first case - bioprosthetics of the mitral valve, anuloplastic of the tricuspidal valve on the basic ring «Carpentier-Edwards», the second case - a plastic of the mitral and tricuspidal valves on basic rings «Carpentier-Edwards», defect elimination of the interatrium partitions by autopericard) are represented.

A simple method of evaluating the quality of medical care is presented. Using offered form and expert findings it is possible to make a quantitative conclusion assessing different stages of the diagnostic and treatment procedures, comparing different departments and workers, and analyzing co-elaboration between multitype Federal centre and regional health care system of Russian federation in performing high-technology treatment and diagnostics. There are several examples showing comparative sample check examination between different cardiology departments, and an example of an expert evaluation of an acute coronary syndrome case is given.

The main distinctions of original and generic drugs are described, and the registration criteria of generics are given. The article considers the main causes of bioequivalence and therapeutic equivalence mismatch of original and generic medicines presenting several examples based on the results of clinical comparative studies, including Enalapril Maleate (comparison of original Renitec and generic Enam). The main approaches of planning the therapeutic equivalence comparative studies are offered.

The problem of a new technology and quality of prevention as the medical examination of the population is the most actual in the new socio-economic conditions. The results of additional medical examination of the working citizens of St Petersburg during 2006-2008 years are presented. To evaluate the demand and the type of the medical care required, including high technology, the groups of people according to the healthy state were specified.