[Role of preoperative cardiology consultation in patients undergoing cancer surgery].

AIM: To evaluate the effects of preoperative cardiology consultation on the risk of perioperative cardiac complications in patients undergoing cancer surgery. MATERIALS AND METHODS: 74 patients with bronchial, lung, mediastinal and gastrointestinal cancer were referred to the cardiologist as a part of the preoperative management. Patients were assigned either to Group 1 (n=21), who required non - invasive testing or invasive coronary angiography (CAG), or to Group 2 (n=53), who did not have any indications to additional testing. RESULTS: The median age was 65.8 years in Group 1 and 64.5 years in Group 2, p=0.408. Group 1 patients had higher RCRI than Group 2 patients (7.4±4.5 vs. 2.9±4.5, respectively, p=0.002). Four (19.05%) patients in Group 1 underwent minimally invasive examination without any further indications to CAG. 16 (76.2%) patients underwent CAG. Of them, 5 (23.8%) patients had severe coronary artery stenosis, and 4 (19.0%) patients had severe brachycephalic artery stenosis (≥50%). After CAG findings, one carotid artery and three coronary arteries (14.3%) were stented. Drug therapy was prescribed to one patient. One patient required stenting after the treatment of the underlying disease. Group 2 patients were more likely to achieve the endpoints - heart rhythm disturbances, decompensation of chronic heart failure, cardiac death (5.45% in Group 2 vs. 4.76% in Group 1, p>0.05). Multivariate analysis reported that angina pectoris was an independent factor to refer patients to the additional testing (p.

Difficulties of Diagnostics of Obstructive Coronary Artery Lesions in Patients with Stable Ischemic Heart Disease and Possibilities of Single-Photon Emission Computed Tomography.

PURPOSE: to assess diagnostic capabilities of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery (CA) lesions, depending on the meeting appropriate use criteria. MATERIALS AND METHODS: We used in this retrospective analysis data from 107 patients with previously diagnosed ischemic heart disease (IHD) or in need to exclude it, who were hospitalized in inpatient departments of the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2012 to 2015. All patients underwent coronary angiography (CAG) and SPECT (the time interval between the studies did not exceed 3 months) for detection of hemodynamically significant CA stenoses. Patients were distributed into two groups according SPECT imaging appropriateness score: group 1-88 patients with score 7-9 (in whom SPECT imaging was appropriate), group 2-19 patients with score 1-6 (in whom SPECT imaging was uncertain, possibly appropriate, or inappropriate. RESULTS: Clinical signs and symptoms of angina pectoris were predominantly found in group 1 patients (p=0.499). Asymptomatic patients were more likely to be found in group 2 (p<0.001). Group 1 patients commonly had high pretest probability (PTP) (over 90 %, p<0.001), whereas group 2 patients commonly had low PTP (5-10 %, p<0.001). Mean PTP was 77 and 58 % in groups 1 and 2, respectively (p=0.003). According to positive SPECT imaging, significant CA lesions were more often found in group 1 compared to group 2 (31.8 and 10.5 %, respectively, p=0.060). Two- and three-vessel disease prevailed in group 1 (25 % and 14.7 %) according the analysis of prevalence and location of hemodynamically significant CA lesions, although the data did not reach statistical significance (p=0.057 and p=0.073). Stenoses >70 % were more commonly detected in group 1, compared to group 2: in anterior descending artery 52.3 vs. 5.3 % (p<0.001), circumflex artery 35.2 vs. 10.5 %; (p=0.034), right coronary artery 34.1 vs. 10.5 % (p=0.041). The sensitivity in both groups was rather low (40 % vs. 25 %), whereas specificity was 83 % in group 1 and 93 % in group 2. CONCLUSION: According to clinical examination, patients with IHD and indications for SPECT imaging more often had obstructive CA lesions (63.6 %), than patients with questionable or no indications (21.1 %). However, rate of positive findings during stress tests with SPECT imaging was low in both groups and did not differ significantly (p=0.06). Despite high specificity of SPECT imaging, its sensitivity was low in both groups.

Gender features of comorbidity in patients with coronary artery disease.

AIM: To study the factors associated with high levels of comorbidity in men and women with coronary artery disease (CAD). MATERIALS AND METHODS: The data analyzed 742 patients who were screened in the clinic of the research Institute CPSS in 2011, before planned operation coronary artery bypass grafting. All patients were divided into 2 groups: group I - men (n=595; 58 [54; 64] years), group II - women (n=147; 63 [57; 69] years). RESULTS: The analysis showed that the presence of arterial hypertension and atrial fibrillation prevailed in the group of women (p<0.05), and postinfarction cardiosclerosis (PIC) in the group of men (p=0.004). Men mainly observed lighter I and II functional classes (FC) of angina (p=0.057 and p=0.007) and I stage of chronic heart failure (CHS; p<0.001), women, on the contrary, III and IV FC angina (p=0.005 and p=0.050) and stage III CHS (p<0.001). Atherosclerotic lesions of the arteries of the lower extremities (ALE) were significantly more common in men (p=0.022). Diabetes mellitus (DM), thyroid disease, varicose disease and bronchial asthma (BA) prevailed in the group of women (p<0.05), and chronic hepatitis (p=0.079) and urolithiasis in the group of men (p=0.028). Calculation of the level of comorbidity did not show significant intergroup differences (p>0.05). Although the average level of comorbid pathology prevailed in the whole population - 66% among women and 70.4% among men. Independent predictors that increase the level of comorbidity in male group were: the presence of underground experience, PIC in anamnesis, diabetes, chronic lung disease, stenosis of the ALE for more than 50% increase in the level of glucose in the group of women - the presence of the clinic of angina pectoris IV FC, PIC and movements in the history of the ALE stenosis more than 50%, diabetes, peptic ulcer disease, chronic lung disease, ASTHMA, improving glucose levels (p<0.05). CONCLUSION: According to the analysis, a high level of comorbidity was found in 13.6% of women and 11.6% of men. Factors associated with high levels of comorbidity, both in men and women were: the presence of diabetes, chronic lung disease, PIC, atherosclerosis of the ALE. At the same time only in women the high level of comorbidity was associated with angina IV FC, peptic ulcer disease, BA, and only in men - with the presence of underground experience. Detection of comorbid pathology in patients with IHD taking into account gender features is advisable for the implementation of patient-oriented approaches in daily clinical work.

[The Problem of Minimally Changed Coronary Arteries at Elective Coronary Angiography].

AIM: to study rates and possible causes of detecting "clean" coronary arteries at elective coronary angiography. MATERIAL AND METHODS: Medical records of 711 patients who had undergone elective coronary angiography (ECAG) between 01/04 and 31/05 2014 were retrospectively reviewed. Four groups were distinguished: group 1 - patients with normal coronary arteries (n=234), group 2 - patients with coronary artery stenoses (CAS) <60% (n=94), group 3 - patients with 60-69% CAS (n=22), group 4 - patients with CAS more or equal 70% (n=361). RESULTS: Most patients were men (p<0.001), except group 1, where women prevailed (p<0.05). Patients in groups 3 and 4 were older than in groups 1 and 2 (p=0.019). Symptoms of angina were less likely to be found in group 1 (p<0.001). History of myocardial infarction (MI) prevailed in group 4 (p<0.001). Arrhythmias were detected more frequently in group 1 (p<0.001); there were less diabetics in this group (p=0.010). Group 1 contained more patients examined before cardiac valve surgery (p<0.001). Typical angina was more often found in group 4, whereas atypical angina - in group 1 (p<0.001). Cardialgia prevailed in groups 1 and 2 (p<0.001). Holter ECG monitoring was used more frequently in group 1 (p<0.001). Symptoms of latent coronary insufficiency were mainly reported in group 1 (p=0.006). The pretest probability of ischemic heart disease (IHD) was higher in groups 2 and 4 compared to group 1 (p<0.001). CONCLUSION: Among patients who had undergone ECAG 32.9% had no CAS. Younger females without history of MI and diabetes as well as patients with atypical angina or cardialgia prevailed in this group. This group of patients had the lowest pretest probability of IHD (58%). Patients without CAS were more often scheduled for EGAG before valvular heart surgery and because of cardiac arrhythmias.

[Right ventricular diastolic function in patients with lung diseases in the absence or presence of pulmonary hypertension]. / Diastolicheskaya funktsiya pravogo zheludochka u bol'nykh s zabolevaniyami legkikh v otsutstvie i pri nalichii legochnoi gipertenzii.

AIM: To investigate the indicators of filling of the right ventricle (RV) in patients with chronic lung diseases with and without pulmonary hypertension (PH) compared to healthy individuals. SUBJECTS AND METHODS: 365 people (198 men); mean age 64.6±8.0 years) were examined and divided into a group of patients with respiratory pathology without and with PH (n=124 and n=138, respectively) and a comparison group that included individuals without cardiovascular and respiratory diseases (n=103). All underwent echocardiography with examination of RV filling flows (Et, At, Et/At), data of the spectral tissue Doppler imaging of the fibrous ring of the tricuspid valve (e't, a't, e't/a't), and early tricuspid flow propagation velocity (ETFPV). RESULTS: All the groups were found to have an e't/a't decrease to 0.75 (0.63-0.90) - 0.8 (0.63-1.0; p=0.26). The groups showed no noticeable differences in indicators, such as Еt/Аt, e't/a't, and Еt/e't ratios, although the increased size of the right heart was noted in patients without PH along with the ETFPV decrease from 33.5 (28-39) to 31.5 (24.5-36) cm/sec, which continued to substantially decline to 27.1 (24-35) cm/sec in patients with PH (p<0.0001). CONCLUSION: Patients with chronic lung disease even without the development of PH exhibited a decreased ETFPV along with the increased size of the right heart. Another indicator of RV diastolic function is a tricuspid valve annular velocity ratio in early and late diastole; the e't/a't ratio was not considerably different in the groups, although its decline was observed in all the groups probably due to age-related changes. Thus, RV diastolic function should be comprehensively evaluated in patients with lung disease regardless of the presence of PH.

[Echocardiographic indices of the right heart in patients with coronary artery disease in different age groups].

The aim of study was to examine echocardiographic indices of right heart chambers in patients with coronary artery disease in different age groups. On 678 patients aged 38-85 years, who underwent echocardiography, are including with the use of spectral tissue Doppler. Obtained 2 age groups: 1st - patients up to 60 years (n=282) and group 2nd - patients 60 years and older (n=396). In the analysis the obtained results in patients with coronary heart disease in older age groups showed an increase in right ventricular wall thickness, systolic and average pressure in the pulmonary artery. These changes were accompanied by deterioration in left ventricular diastolic function, while the systolic function of the left and right ventricle were independent of age. Thus, the results can be recommended for assessment of right ventricular dysfunction in patients of older age groups.

[Influence of Type D Personality on Adherence to Treatment in Cardiac Patients].

AIM: of the study was to examine relationship between behavioral type D and adherence to therapy in cardiological patients. MATERIAL AND METHODS: Patients (n=308, 63 [20.5%] women and 245 [79.5%] men, mean age 59+/-4 years) with stable ischemic heart disease and arterial hypertension were divided into 2 groups: with (n=84) and without (n=224) type D. Psychological status was assessed using type D scale-14 (DS-14) questionnaire, adherence to treatment - with the help of S.V. Davydov method and the Morisky-Green test. RESULTS: Patients with compared with those without type D personality more often had indicators of lower adherence to treatment (48 vs 39%, <0.05). Indicators of higher adherence were found more often in the group without type D personality (11 vs 19%, p<0.003). Indicators of lower compliance were independently associated with type D personality (odds ratio 3.21, p=0.02). CONCLUSION: Patients with type D personality have lower adherence to therapy. This can be a link between type D behavior and unfavorable prognosis in patients with cardiovascular diseases.

[Immediate Outcomes of Coronary Artery Bypass Grafting in Patients With Multifocal Atherosclerosis: Gender Differences].

AIM: To assess the impact of presence of multifocal atherosclerosis (MFA) and gender differences on immediate outcomes after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Medical records of patients with MFA, who underwent elective CABG (n=764, 655 men, 109 women) were reviewed retrospectively. RESULTS: Women were older (<0.001), and more often were overweight (<0.001), had diabetes (<0.001), high angina functional class (=0.012) and congestive heart failure (=0.002). Cigarette smoking was more common among men. Men more often had reduced left ventricular ejection fraction (<0.001). Three-vessel coronary artery disease prevailed among women (=0.080). Rate of hemodynamically significant carotid stenosis was higher among women (=0.010), whereas that of peripheral artery disease - among men (=0.001). Total number of perioperative complications was 48.8% among women and 53.0% among men (=0.399). According to multivariate analysis, history of CABG was associated with increased risk of perioperative complications (=0.034), and combined involvement of left main coronary artery (LMCA) and three coronary arteries - with in-hospital mortality (=0.003). CONCLUSION: There were no gender differences in the incidence of perioperative complications. Women more often had carotid lesions, men - lesions in arteries of lower limbs. Women had more risk factors (other than smoking) what could explain high prevalence of three-vessel disease as well as more severe coronary insufficiency and heart failure. Regardless of patients gender and presence of MFA history of previous CABG and presence of combined LMCA and three coronary arteries involvement increased risk of perioperative complications and in-hospital mortality, respectively.

[Factors Associated With Immediate Results of Coronary Artery Bypass Grafting in Patients With Ischemic Heart Disease in the Presence of Type 2 Diabetes].

OBJECTIVE: to elucidate factors associated with cardiovascular events (CVE) after coronary artery bypass grafting (CABG) depending on the presence of type 2 diabetes mellitus (DM2). MATERIAL AND METHODS: Medical records of 667 patients who underwent CABG during the period from 2006 to 2009 (317 patients with and 350 patients without DM2 and other disorders of glucose metabolism with comparable by sex, age and CABG characteristics) were analyzed retrospectively. The relationship of registered possible predictors with incidence of CVE was evaluated in a logistic regression model. Predictors of CVE after CABG were different depending on the presence of DM2. The presence of left ventricular aneurysm, mitral regurgitation, reduced left ventricular ejection fraction (LVEF) and elevated level of glycated hemoglobin were independent predictors of CVE in diabetic patients. The increase in the age of patients, on-pump CABG, combined operations, presence of mitral regurgitation, decrease in LVEF were predictors of CVE in non-diabetic patients. CONCLUSION: Predictors of CVE after CABG were different depending on the presence of DM2. Data obtained emphasize the importance of control of glycaemia in patients with DM2 for improvement of immediate results of CABG.

[The values of cardio-ankle vascular and ankle-brachial indices in patients with carbohydrate metabolic disorders: The ESSE-RF study in the Kemerovo Region]. / Znacheniya serdechno-lodyzhechnogo sosudistogo i lodyzhechno-plechevogo indeksov u patsientov s narusheniyami uglevodnogo obmena (issledovanie ESSE-RF v Kemerovskoi oblasti).

AIM: To investigate factors associated with pathological cardio-ankle vascular and ankle-brachial indices (CAVI and ABI) in patients with carbohydrate metabolic disorders (CMD). SUBJECTS AND METHODS: A cross-sectional study was conducted in the framework of the multicenter epidemiological study "Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Russian Federation" (ESSE-RF) in March to October 2013. The standard ESSE-RF protocol was extended by an additional study of peripheral arterial stiffness, by estimating CAVI and ABI automatically. A sample of 1619 people was formed in several stages, in which 311 patients with type 2 diabetes mellitus and prediabetes were identified and divided into 3 groups: 1) 41 patients with pathological CAVI values (≥9.0); 2) 241 with normal CAVI (<9.0); 3) 29 with pathological ABI (<0.9). RESULTS: In the population-based sample of patients with CMD, the pathological CAVI values (≥9.0) were detected in 14.5%, and the pathological ABI was in 9.3% of the examinees. Regression analysis showed that the pathological vascular indices (both CAVI and ABI) were significantly associated with increases in blood pressure (BP) and heart rate (HR), and a decrease in glomerular filtration rate. At the same time, only the pathological CAVI was associated with advancing age (odds ratio (OR), 1.111; 95% confidence interval (CI), 1.050-1.176; p < 0.001), visceral obesity (OR, 3.088; 95% CI, 1.001-10.495; p=0.038), smoking duration (OR, 1.093; 95% CI, 1.008-1.185; p=0.009), prior stroke (OR, 4.695; 95% CI, 1.408-15.658; p=0.018), and a need for insulin therapy (OR, 18.947; 95% CI, 1.902- 87.783; p=0.006). The pathological ABI was associated with male sex (OR, 2.227; 95% CI, 1.040-4.765; p=0.039), prior myocardial infarction (OR, 8.646; 95% CI, 2.174-34.378; p=0.005), obesity (OR, 2.439; 95% CI, 1.010-5.889; p=0.034); hyperglycemia (OR, 2.439; 95% CI, 1.010-5.889; p=0.034), hyperuricemia (OR, 4.009; 95% CI, 1.850-8.684; p=0.033), and increases in triglyceride levels (OR, 2.984; 95% CI, 1.376-6.470; p=0.004) and CAVI (OR, 1.193; 95% CI, 1.034-1.377; p=0.005). CONCLUSION: The pathological vascular indices CAVI and ABI are associated with different risk factors for cardiovascular events in a cohort of patients with CMD. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate.

[Diagnosis of coronary artery disease prior to operations on noncoronary arterial basins].

Patients presenting with noncoronary atherosclerosis are found to have accompanying lesions of coronary arteries revealed in 25-90% of cases and being a considerable factor deteriorating the prognosis. A particular case of the given problem concerned is the development of cardiac complications in operations on noncoronary arterial basins. Therefore, determining optimal policy for diagnosis of coronary artery disease (CAD) in patients of the cohort concerned still remains currently important problem in cardiology and cardiovascular surgery. Present-day approaches to solving this problem are being considered regarded in the European and international guidelines. The basis of preoperative diagnosis is a step-by-step algorithm which is convenient for practical application, allowing to making it possible to avoid unnecessary wanton diagnostic procedures with low risk of cardiac complications, but in patients with initially higher risk of cardiac complications in vascular operations the use of this algorithm does not allow to reveal patients with symptom-free lesions of coronary arteries. In the presented review the authors give a detailed consideration thoroughly discuss to the problems of diagnosis of CAD in patients before operations on noncoronary arterial basins, relying upon both own studies and the critical analysis of data of world literature.

[The results of rehabilitation of the patients presenting with arterial hypertension: the types of adaptation, the vegetative status, and intracardial hemodynamics]. / Rezul'taty reabilitatsii bol'nykh arterial'noi gipertenziei: tipy adaptatsii, vegetativnyi status i vnutriserdechnaya gemodinamika.

AIM: The objective the present work was to study the changes of the types of adaptation in the patients presenting with arterial hypertension under the influence of the spa and health resort-based rehabilitative treatment. MATERIAL AND METHODS: The study included 50 patients with essential hypertension at the age from 54.0 to 62.0 (mean 58.0) years given a course of the spa and health resort-based rehabilitative treatment. All the patients underwent electrocardiographic and echocardiographic examination for the assessment of the systolic and diastolic left ventricular functions. Cardiointervalography with the use of the ORTO Expert diagnostic system was performed in the patients at rest and during the active orthostatic test (AOT); the types of the adaptation were evaluated. The patients were divided into 2 groups depending on the results of repeated AOT obtained after rehabilitation. Group 1 was comprised of the patients showing the improvement of adaptation (n=24), group 2 consisted of the patients in whom the level of adaptation remained unaltered (n=26). RESULTS: The structural characteristics of echocardiography estimated in both groups were not significantly different. The number of patients in group 1 showing the satisfactory level of adaptation intensity in the absence of its failures increased significantly. In group 2, a significant decrease of the following AOT parameters was documented: the tension index of the regulatory system (p=0.02), the standard deviation of NN-intervals (SDNN) (p=0.03), and root mean square of successive differences (RMSSD) (p=0.02). The multiple logistic regression analysis showed that the factors associated with the positive effect of rehabilitation were the normal and low degree of regulatory system tension (p=0.01) and the initially adequate or reduced response in the orthostatic test (p=0.04). CONCLUSION: The improvement of rehabilitation of the adaptive capacity was documented in as many as 48% of the patients who had undergone the spa and health resort-based rehabilitative treatment. The absence of positive dynamics or deterioration of adaptation were associated with the increase of the sympathetic activity at rest and in response to the AOT. The beneficial effect of rehabilitation was observed in the patients with the initially normal or low tension of regulatory systems and with the adequate or reduced baseline response in AOT.

[Cardio-Ankle Vascular Index and Subclinical Peripheral Atherosclerosis in Patients With Stable Coronary Artery Disease].

AIM: To study relationship between cardio-ankle vascular index (CAVI) and subclinical manifestations of noncoronary atherosclerosis in patients with stable ischemic heart disease (IHD). MATERIAL AND METHOD: We included into this study 511 patients with IHD examined within framework of a register of patients before aorto-coronary bypass surgery. CAVI was determined using VaSera-1000 device. RESULTS: We distinguished 2 groups of patients: (1) with abnormal (≥ 9.0, n = 128) and (2) normal (< 9.0, n = 383) CAVI. Group 1 compared with group 2 had high mean age (p = 0.02), comprised more women (p = 0.0016), hypertensive patients (p = 0.0061), patients with three vessel coronary disease, and patients with stenoses in carotid arteries. Multiple logistic regression analysis revealed independent association between elevated arterial stiffness and age. Elevated arterial stiffness was found in 25% of group 1 patients. Abnormal CAVI was associated with increased intima-media thickness and stenoses of carotid arteries but not with presence of stenoses in arteries of lower extremities.

[Predisposition to Psychological Distress in Patients After Coronary Bypass Surgery: Relation to One Year Prognosis].

AIM: to assess effect of type D personality (TDP) on one year prognosis after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: Personality type was evaluated using the DS-14 scale in 683 patients before and in 1 year after CABG; 152 patients had TDP, 531 had not. After 1 year of follow-up we assessed functional class of angina and chronic heart failure, and registered cardiovascular complications (CVC): deaths, myocardial infarctions, strokes, amputations, thromboses of arteries of lower extremities, hospitalizations, requirements in repetitive angiographies of coronary grafts. Rate of development of combined end point comprising all these events was also evaluated. RESULTS: During follow-up CVC developed more often in patients with TDP compared with those without TDP (31.8 and 14.6%, respectively, =0.049). According to multifactorial regression analysis TDP was independently associated with 3.21 fold increase in risk of CVC. CONCLUSION: Detection of TDP after CABG is advisable for conducting subsequent interventions directed at improvement of long term results of treatment.

[GENDER-RELATED FEATURES AND QUALITY OF LIFE OF THE PATIENT ONE YEAR AFTER CORONARY ARTERY BYPASS GRAFTING].

AIM: To study the influence of gender features on the quality of life (QL) of the patient one year after coronary artery bypass grafting and to determine factors associated with low QL after surgery. MATERIALS AND METHODS: The study included 408 patients (70 women and 338 men) whose QL was estimated 1 year after surgery based on the SF-36 questionnaire. The groups were compared in terms of QL parameters before and after surgery, clinical data, and peculiarities of surgical treatment. In addition, factors associated with clinical data of QL were assessed in each group by logistic regression analysis. RESULTS: One year after surgery, QL improved in women and men of both groups: depression--48 [45, 54] and 50 [46,55] (p = 0.37], physical component--72 [61,78] and 72 [61, 81] P = 0.61) and psychological component--69 [60, 75] and 67 [56.76] (p = 0.43]. Multifactor analysis revealed association of multifocal atherosclerosis with the low level of physical and psychological components in women and depression in men. Diabetes mellitus had independent influence on the reduction of QL physical component in women. The absence of gender differences 1 year after surgery was due in the first place to the absence of differences between men and women in the number of affected coronary arteries, the number of shunts, the use of artficial circulation, and duration of surgery. CONCLUSION: Decreased frequency of depression, significant increase in the parameters of QL psychological and physical components one year after surgery are independent of the patients' sex due to the absence of differences in QL components between groups, severity of affection of the coronary bed and peculiarities of surgery.

[Assessment and reduction of risk of cardiac complications of noncardiac surgery].

One of actual problems of modern cardiology is assessment and correction of risk of cardiac complications of noncardiac surgery. Recommendations on this issue propose reduction of preoperative examination and wide use of drug therapy, primarily statins and ß-blockers. However, new data accumulated in recent years, as well as the recognition of scientific inconsistency of the DECREASE research series, force a new outlook at the problem. In this review in light of new facts the following important issues of perioperative medicine are discussed: administration of ß-blockers and statins, volume of preoperative cardiac examination, value of preventive myocardial revascularization.

[Optimization of organizational approaches to management of patients with atherosclerosis].

Despite undoubted achievements of modern cardiology in prevention and treatment of atherosclerosis, cardiologists, neurologists, and vascular surgeons are still facing severe stenotic atherosclerotic lesions in different vascular regions, both symptomatic and asymptomatic. As a rule hemodynamically significant stenoses of different locations are found after development of acute vascular events. In this regard, active detection of arterial stenoses localized in different areas just at primary contact of patients presenting with symptoms of ischemia of various locations with care providers appears to be crucial. Further monitoring of these stenoses is also important. The article is dedicated to innovative organizational approaches to provision of healthcare to patients suffering from circulatory system diseases that have contributed to improvement of demographic situation in Kuzbass.

[Role of multidetector computed tomography and stress- echocardiography in assessment of risk of cardiological complications of non-cardiac surgery].

AIM: to compare results of coronary angiography with data of multi-slice computed tomography (MSCT) - angiography, and analyze rate of detection of hemodynamically significant coronary artery lesions during preoperative examination of patients. MATERIAL AND METHODS: We analyzed case histories of 92 patients (median age 59 years) examined prior to surgery on non-coronary vessels or for exclusion of ischemic heart disease. All patients were subjected to selective coronary angiography (CA) and MSCT - angiography. According to results of CA we formed 2 groups - with coronary artery stenoses >70% (n=55, group 1) and <70% (n=37, group 2). In 46 patients (50%) dobutamine stress echocardiography was performed for detection of concealed coronary insufficiency. RESULTS: CA revealed hemodynamically significant stenoses >70% (>50% in left main coronary artery) in 91 of 324 arteries. MSCT angiography detected stenosis >50% in 184 of 324 arteries; in 148 patients results of MSCT were confirmed by presence of hemodynamically significant stenoses at coronary angiography (sensitivity 86%). Absence of lesions or presence of stenoses <50% were noted at MSCT in 368 arteries; in 345 cases this was confirmed by coronary angiography (predictive value of negative result 94%, specificity 91%). Result of dobutamine stress echocardiography was positive in 41% of patients in group 1 and in 20% - of group 2 (<0.001). Sensitivity of stress echocardiography for detection of significant stenoses was 41%, specificity - 80%, negative predictive value - 14%. CONCLUSION: Diagnostic value of MSCT for detection of coronary artery stenoses >70% have better sensitivity, specificity, negative and positive predictive value of compared with stress echocardiography. Results of this study confirm value of MSCT angiography for diagnosis of coronary atherosclerosis and allow to recommend it as a screening method for detection hemodynamically significant coronary artery involvement before extracardiac surgery.

[Gender-specific features of the prevalence and clinical manifestations of multifocal atherosclerosis].

UNLABELLED: Multifocal atherosclerosis (MFA) has negative effect on prognosis in various groups of patients with cardiovascular diseases. However, gender-specific features of MFA are practically unexplored which provided a rationale for the present work. AIM: To study gender-specific features of MFA in patients with atherosclerosis of different localization. MATERIALS AND METHODS: 1018 patients examined and treated prior to planned surgical intervention on coronary arteries, carotid basin, aorta, and arteries of lower extremities. Group 1 included 193 women aged 59 = 69 (mean 63) years, group 2 was comprised of 825 men aged 53-63 (mean 57 years). All the patients underwent coronarography (CG). Analysis of MFA prevalence was made. RESULTS: The women were older than the men, they were more frequently overweight, suffered arterial hypertension and diabetes mellitus (p < 0.001), showed the higher left ventricular ejection fraction (p = 0.011). Smokers more frequently occurred among men (p < 0.001). CG revealed more lesions in a single vessel (p = 0.023) and less t lesions affecting three vessels (p = 0.015) in men. Signs of MFA were recorded in 28.0% of the men and 24.4% of the women (p = 0.306). Combined lesions of the coronary and carotid basins were more frequent in women (p = 0.048). Clinically significant stenosis of the coronary bed, aortoiliac segment or lower limb arteries occurred more frequently in men (p = 0.012). All three basins were more frequently affected in men (p = 0.061). CONCLUSION: MFA before planned cardiovascular surgery was diagnosed in 27.3% of the cases. Combined lesions in coronary and carotid arteries more frequently occurred in women and those in coronary and lower limb arteries in men (p < 0.05). Most risk factors (except smoking) are more frequently inherent in women in association with the enhanced frequency of three-vessel lesions affecting coronary arteries.

[Factors influencing life quality improvement in patients of different age one year after coronary artery bypass surgery].

The study was aimed at examining the factors having an impact on changes in the quality of life (QL) parameters a year after coronary artery bypass surgery (CABG) in different age groups. 408 patients aged 31-79 years had their QL assessed by means of the SF-36 questionnaire before and one year after elective CABG. Additionally, the patients were tested for the presence of type D personality before and one year after CABG by means of the DS-14 questionnaire. The groups were comparable in terms of previous carotid endarterectomy, peripheral arterial and aortic reconstruction number (p > 0.05). One year after CABG the improved QL (p < 0.01) was reported whereas type D patients had significantly poorer psychological test results (p < 0.01). One year after CABG type D personality and high Euroscore had an independent impact on the QL improvement while previous carotid endartectomies resulted in a significantly improved psychological health component. Thus, along with the detection and treatment of non-coronary lesions the personality type assessment and focused behavioral interventions can contribute to the QL improvement in long-term CABG period.