Acquired heart diseases are very serious pathologies, the main and most effective method of its correction remains valve apparatus prosthetic. The aim of surgical interventions is not only increasing the life expectancy of patients, but also improving its quality, it is achieved by the adequate correction of hemodynamic disorders and largely depends on the possibility of developing a reverse myocardial remodeling in the postoperative period. Currently, the remodeling process involves molecular, cellular, interstitial and gene restructuring that clinically manifest by changing the size, shape and function of the heart after damage. The rates of reverse remodeling, regression of hypertrophy and restoration of the functions of the heart chambers depend on the degree of myocardial fibrosis, regulated by the system of matrix metalloproteinases and their tissue inhibitors. This review discusses the complex approach to the evaluation of myocardial remodeling in heart valve disorders, taking into account clinical, instrumental and humoral features.

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The aim of the research. To assess the possibility of improving the prognostic ability of the GRACE 2.0 risk scale by additional registration of the genotypes of polymorphisms rs4291 and rs4343 of the ACE gene.
Material and methods. A register prospective study included 353 patients with acute coronary syndrome (ACS). The genotypes and alleles of the polymorphisms rs4291 and rs4343 of the ACE gene were determined on the Cycler iQ (BIO-RAD, USA) by the TaqMan- sample method. In 36 months after the index event, telephone contact was made with patients or relatives to identify endpoints. The patient's status "alive or dead" was found out in 96.6 ± 1.0% of cases.
Mortality from any cause was 11.4 ± 1.7% (n = 39), cardiovascular mortality was 7.9 ± 1.5% (n = 26). 
Results. On the first stage of the study it was revealed that both the rs4343 polymorphism and the rs4291 polymorphism of the ACE gene are associated with a high risk of death within three years after ACS. Moreover, the association of these variants is stronger with cardiovascular mortality than with the general one, and the identification of patients with a combination of the risk genotypes TT polymorphism rs4291 and GG polymorphism rs4343 allows even more reliable identify the group of extremely high risk of death within three years after ACS (odds ratio 9, 10 (3.81-21.71), p <0.001, x2 = 33.20). The construction of ROC curves revealed that the combination of polymorphisms rs4291 and rs4343 of the ACE gene significantly improved the prediction by GRACE scale the above-described endpoints during three years of observation after ACS. The values of the area under the ROC curves for the prediction of the overall lethality were, respectively, for the GRACE and GRACE + ACE scales 0.71 (0.62-0.80) and 0.78 (0.70-0.86) (p <0,00001), in predicting of cardiovascular mortality - 0.72 (0.62-0.81) and 0.81 (0.73-0.88) (p <0.00001).
Conclusion. Modification of the GRACE 2.0 scale by adding data about genotypes of the polymorphisms rs4291 and rs4343 of the ACE gene significantly improves the prediction of lethality within three years after ACS.
Key words: acute coronary syndrome, polymorphisms rs4291 and rs4343 of the ACE gene, GRACE Scale.
Citation: Zykov MV, Kashtalap VV, Karetnikova VN, Makeeva OA, Goncharova IA, Barbarash OL. The role of polymorphisms RS4291 and RS4343 ACE gene in modification of Grace scale in patients with acute coronary syndrome. Siberian Medical Review. 2017; (2):22-29. DOI: 10.20333/2500136-2017-2-22-29

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The aim of the research. To search and study the association with sudden cardiac death (SCD) in the Novosibirsk population of single nucleotide polymorphisms rs13246896 of the gene HDAC9, rs35089892 of the gene CAMK2B, which are identified as associated with SCD in its own full genome associative study performed on pooled DNA.
Material and methods. The SCD group was formed using the criteria of sudden cardiac death of the World Health Organization and the European Society of Cardiology (n = 391, average age 52.9 ± 9.2 years, men - 77.2%, women - 22.8%). The control group was selected by sex and age from the DNA bank of international HAPIEE projects (Health, Alcohol and Psychosocial factors in Eastern Europe), MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) (n = 376, average age 52.4 ± 8, 8 years, men - 62.3%, women - 37.7%).
DNA was picked out by phenol-chloroform extraction from myocardial tissue in the SCD group, and venous blood in the control group. Group genotyping was carried out by polymerase chain reaction method with subsequent analysis of restriction fragments length polymorphism according to the own methods.
Results. There were no statistically significant differences between the groups in allele frequencies and genotypes of polymorphism rs13246896 of the HDAC9 gene. The genotype TT polymorphism rs35089892 of the CAMK2B gene is associated with protective effect according to SCD (p = 0.018, OSh = 0.52, 95% DI 0.31-0.89).
Conclusion. The polymorphism rs35089892 of the CAMK2B gene is associated with SCD in the sample of the suddenly died residents of Novosibirsk.

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The aim of the research. To study the possible influence of polymorphism of the genes CYP3A5 (6986A> G), CYP2C9 (430C> T), CYP2C9 (1075A> C), SLCO1B1 (521T> C) and BCRP (ABCG2,421C> A) on the occurrence of muscle symptoms in the treatment of simvastatin in patients with coronary heart disease, ethnic Uzbeks.
Material and methods. In the "case-control" study, 63 patients with chronic coronary heart disease (CHD) were included. The "case" group was consisted of 13 patients who had clinical signs of myopathy, and 4 of them simultaneously showed an increase in the level of transaminases > 3 times. The "control" group included 50 patients with chronic coronary heart disease, without side effects when treated with simvastatin. Genotyping was performed by the PCR-RFLP method.
Results. When comparing the prevalence of the most common homozygous genotypes with variant, it turned out that the genotype *3 / *3 of the CYP3A5 gene was prevailed in the "case" group (OSh 8.56, 95% DI 2.14-34.1, P = 0.003). When comparing the distribution frequency of alleles the SLCO1B1 gene in the group "case" the carriage of allele C was prevailed (OSh 3.54, 95%, DI 1.35-9.27, f = 5.7, P = 0.017).
Conclusion. In patients with CHD, ethnic Uzbeks, the carriage of the genotype *3/*3 of the CYP3A5 gene and the C allele of SLCO1B1 gene is associated with muscular symptoms caused by simvastatin.

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The aim of the research. To study the indices of local and regional vascular stiffness of muscular and elastic types of arteries in patients with pathological values of the ankle-brachial index (ABI).
Material and methods. The study included 133 patients, 75 men and 58 women, the average age was 57.8 ± 10.7 years. Depending on the values of the ABI, patients were divided into four groups. There were conducted a clinical examination, the collection of anamnestic data, the definition of laboratory indicators. Measurement of ABI was carried out in accordance with the recommendations of the American Heart Association scientific report. Regionar aortic stiffness and arterial stiffness of muscular type were determined by recording the pulse wave velocity. Indices of local vascular stiffness were determined at the site of the common carotid artery (CCA).
Results. In patients with ABI > 1.4, the extensibility of the CCA was significantly less than in patients with normal ABI. Patients with ABI > 1.4 also differed from patients with normal ABI with higher values of the Peterson module - 931 mm Hg. (695; 1025) against 726 mm Hg. (540, 916), as well as a decrease in CCA strain of 5.49% (5.07, 6.07) vs. 7.40% (6.07, 9.33) in patients with normal ABI and 9.52% (7.02,
11.3)	in patients with reduced ABI, which indicates an increase in local rigidity of CCA in these patients. The values of aortic stiffness were significantly higher among patients with ABI > 1.4 -14.1 m / s (11.8,17.2) compared with patients with normal ABI -11.6 m / s (9.64; 13.4) and reduced ABI -11.8 m / s (10.8,13.1).
Conclusion. Patients with pathologically heightened ABI > 1.4 differed significantly in larger values of local and regionar vascular stiffness, in comparison at patients with both normal and decreased ABI.

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The aim of the research. To estimate the prevalence of the main factors of cardiovascular risk among students of the South Ural State Medical
University (SUSMU), and also to determine the effectiveness of the influence of training in the "Health School" on the parameters of these factors.
Material and methods. Examination of 1556 graduate students of SUSMU was conducted, the average age was 23.2 ± 1.7 years. The parameters
of behavioral and biological risk factors of cardiovascular diseases, as well as anxiety-depressive symptoms were evaluated. The clinical observation
group (n = 84) was divided by simple randomization into 2 subgroups, comparable in gender and age. In the first group training was in the "Health
School", in the second group there was no training; reassessment of the parameters of cardiovascular risk factors in both groups was performed
after 6 months.
Results. Among the graduate students of the medical university, a high prevalence of active and passive smoking, alcohol consumption, irrational
nutrition, low physical activity, abdominal obesity is revealed. In the female population compared with the male population, the prevalence of body
mass deficit, low physical activity, anxiety is significantly higher, and lower - active smoking, excessive alcohol consumption, irrational nutrition,
obesity, abdominal obesity, hypertension. The risk of hyperleptinemia increases with the presence of burdened heredity for cardiovascular diseases,
abdominal obesity, overweight, deficiency of final metabolites of nitric oxide, hyperuricemia, and decreases with a normal body mass index and an
average academic rating of ≥ 4.5. The training of 6th year students of the SUSMU with cardiovascular risk factors in the "Health School" leads to a
decrease in the body mass index, waist circle, the number of cigarettes smoked per day, the amount of alcohol consumed per day, and the level of
anxiety and depression.
Conclusion. In the population of the graduates of the Medical University is established the unfavorable situation in the prevalence of the main
factors of cardiovascular risk. Adequate control over these factors is achieved by training students in the "Health School".

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The aim of the research. To identify the clinical parameters that influence to the evaluation of the prognosis of chronic heart failure (CHF) in
highly-compliance patients, depending on its etiology.
Material and methods. The study included 260 highly-compliance patients suffering from heart failure III-IV functional class according to
NYHA. All patients included in the study gave a written agreement for the study. The adherence of patients to the therapy was assessed using
the Moriski-Green test. The diagnosis of heart failure is based on an assessment of the level of the brain natriuretic peptide and evaluation of
the morphological changes in the myocardium by echocardiography, including an evaluation of the transmittal flow parameters. The diagnosis
of heart failure is based on an assessment of the level of the brain natriuretic peptide and evaluation of the morphological changes in the
myocardium by echocardiography, including an evaluation of the transmittal flow parameters. The etiology of heart failure was analyzed in
details: in 160 patients heart failure developed against coronary heart disease, confirmed by coronary angiography. 100 patients suffered
CHF on the background of other causes: hypertensive disease (HD), acquired heart disease, pulmonary heart, idiopathic cardiomyopathy,
chemotherapy. A comparative analysis of clinical data as well as a regression analysis of the studied parameters influence to the prognosis of
heart failure during a two-year control.
Results. The study revealed significant differences of the frequency of stable heart failure in the study groups and deaths. Notable differences
in the reasons for repeated hospitalizations in the study groups were marked. Significant target levels of lipidogram indices, renal function and
troponin T concentration were obtained, the achievement of which positively affects to the outcome of heart failure.
Conclusion. The appointment of prolonged intensive lipid-lowering therapy may possibly have a positive effect on the outcome of heart failure
in the absence of coronary heart disease. It was found that the presence of a preserved renal function also positively affects to the outcome of
heart failure, regardless of its etiology. However, these hypotheses should be checked by a longer observation period

1. Belenkov YuN, Fomin IV, Mareev VYu. The prevalence of chronic heart
failure in the European part of the Russian Federation-data AGE–CHF (part 2).
Journal of Heart Failure. 2006;7(3):3-7. (In Russian)
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of cardiovascular disease in the United States: a policy statement from the
American Heart Association. Circulation. 2011;123(8):933–44. DOI:10.1161/
cir.0b013e31820a55f5.
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of Echocardiography-European Association of Echocardiography guidelines for
diastolic function in patients with depressed ejection fraction: an echocardiographic
and invasive haemodynamic study. European Journal of Echocardiography.
2011;12(11):857–64. DOI:10.1093/ejechocard/jer157.
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Investigative Medicine. 2004;52(4):248–53. DOI: 10.2310/6650.2004.04015.
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cardiology and internal medicine on the diagnosis and treatment of chronic heart
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improving. Journal of the American College of Cardiology. 2000;36(7):2284–6. DOI:10.1016/s0735-1097(00)00995-5.
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Definition and epidemiology (the message 1). Sibirskij Medicinskij Zurnal (Irkutsk). 2006;61(3):93–7. (In Russian)
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factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52. DOI:10.1016/s0140-6736(04)17018-9.
10. Heidenreich PA, Trogdon JG, Khavjou OA. Forecasting the future
of cardiovascular disease in the United States: a policy statement from the
American Heart Association. Circulation. 2011;123(8):933–44. DOI:10.1161/
cir.0b013e31820a55f5.
11. Oudejans I, Mosterd A, Bloemen JA. Clinical evaluation of geriatric
outpatients with suspected heart failure: value of symptoms, signs, and additional
tests. European Journal of Heart Failure. 2011;13(5):518–27. DOI:10.1093/eurjhf/
hfr021.
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diagnosis, management and models of care. Nature Reviews. Nephrology.
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Part I; diagnosis, prognosis, and measurements of diastolic function. Circulation.
2002;105(11):1387–93. DOI:10.1161/hc1102.105289.
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chronic heart failure (the GISSI–HF trial): a randomised, double-blind, placebocontrolled
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multimarker approach. Progress in Cardiovascular Diseases. 2011;54(2):86–96.DOI:10.1016/j.pcad.2011.03.003.
18. Khand A, Gemmel I, Clark AL. Is the prognosis of heart failure
improving? Journal of the American College of Cardiology. 2000;36(7):2284–6. DOI:10.1016/s0735-1097(00)00995-5.
19. Rebrova OYu. Statistical analysis of medical data. Application software
package STATISTICA. M.: Media Sphere; 2008. 200 p. (In Russian)
20. Oudejans I, Mosterd A, Bloemen JA. Clinical evaluation of geriatric
outpatients with suspected heart failure: value of symptoms, signs, and additional
tests. European Journal of Heart Failure. 2011;13(5):518–27. DOI:10.1093/eurjhf/
hfr021.
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physical examination and additional testing in primary care patients with
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Heart. 2006;92(10):1425–9. DOI:10.1136/hrt.2005.081521.
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natriuretic peptide in the diagnosis of clinical heart failure and population screening
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The aim of the research. Assessment of the relationship between behavioral and biological risk factors among themselves, as well as with
anxiety-depressive disorders in a random sample of residents of St.-Petersburg.
Material and methods. Within the framework of the transverse epidemiological observational study of ESSE-RF, a random sample of 1600 inhabitants
of St.-Petersburg, stratified by sex and age, was formed. Participants wrote in a standard questionnaire on lifestyle, concomitant diseases and
therapy. Anthropometry, measurement of blood pressure, determination of the lipid spectrum and the level of glycemia were performed according
to standard procedures. Emotional status was assessed using the Hospital scale of depression and anxiety.
Results. The increased level of depression was registered in 334 (20.9%) participants, anxiety - in 778 (48.7%), clinically significant level of
depression and anxiety was noted in 103 (30.8%) and 277 (35.6% ) of participants, respectively. Arterial hypertension and obesity were associated
with depression and anxiety. Most of the behavioral risk factors were associated with a particular psychological disorder. Depression and anxiety
were associated with low incomes (OR = 2.1 (95% CI 1.4-3.1) and OR = 2.3 (95% CI 1.7-2.8), respectively p <0.001 ), hypodynamia (OR = 1.3 (95%
CI 1.2-1.4) and OR = 1.2 (95% CI 1.1-1.3), respectively, p <0.05), insufficient consumption of vegetables and fruit (OR = 1.4 (95% CI 1.2-1.7) and
OR = 1.4 (95% CI 1.2-1.6), respectively, p <0.05).
Conclusion. In a random sample of inhabitants of St.-Petersburg some associations between socio-economic, behavioral and biological risk factors
were identified, but multiple regression analysis did not show any. Psychological disorders can partially explain the mutual influences in these
groups of risk factors, because they are associated with both social factors, unhealthy lifestyle and nutrition, and with hypertension and obesity

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The aim of the research. To study the expression of left ventricular hypertrophy in patients of older age groups with arterial hypertension.
Material and methods. It was conducted the comparison of echocardiographic parameters in 535 patients with arterial hypertension
aged 45 to 90 years old living in Krasnoyarsk. All patients were divided by sex and age. The average age was 65.24 ± 0.43 years. There
were 246 men (46%, mean age 63.56 ± 0.62 years) and 289 women (54%, mean age 66.67 ± 0.58 years). The following parameters were
compared: the thickness of the back wall of the left ventricle in the diastole, the thickness of the interventricular septum in the diastole,
the mass of the myocardium of the left ventricle, the ejection fraction.
Results. In elderly and senile age there was a decrease in the ejection fraction compared to the control group. By the size of the left atrium
there were large values in the older age groups. By the thickness of the back wall of the left ventricle and the thickness of the interventricular
septum in elderly and senile patients tere were determined higher values than in the control group. There were no significant differences
in the mass of the myocardium of the left ventricle.
Conclusion. In elderly and senile age there were noted more expressed hypertrophy of the left ventricle than in the control group. Also in
these age groups, lower values of the ejection fraction were noted, that may indicate to the higher frequency of heart failure in older age
groups.

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The aim of the research. To study retrospectively the features of the choice of anticoagulant therapy in comorbid patients with different forms of
atrial fibrillation in real hospital practice.
Material and methods. A total of 1716 patients in the cardiac department of the SOKKD from January 2013 to July 2014 were examined. There
were 502 patients (29.3%) among them with AF (303 men and 199 women, the average age was 68.7 ± 10.7 years). Patients were divided into 3 groups
depending on the form of AF: group I - patients with paroxysmal form, II - with persistent, III - with constant.
Results. Most of the patients with CVD, represented by men, had a permanent form of AF. Arterial hypertension, diabetes mellitus, diseases of the
gastrointestinal tract were observed with the same frequency in all three categories. The comorbid pathology (previous myocardial infarction (PMI),
cerebral circulation disorder (CCD), respiratory and urinary diseases) was noted mainly in patients with a permanent form of AF. NYHA III and NYHA
IV were significantly more common in group III.
As per analysis of the use of anticoagulant therapy, in the I group were prescribed warfarin to 65 patients, rivaroxaban - 20, dabigatran etexilate - 12;
in the II group warfarin - 93 patients, rivaroxaban - 17, dabigatran - 4; in the III group warfarin 111 patients, rivaroxaban - 24, dabigatran - 8. In most
cases, the causative factor of anticoagulant absence in therapy of AF is not indicated. Low compliance was found in 3.9% of patients.
Conclusion. In our study among patients with CVD, patients with a constant form of AF were prevailed, most of them were of male sex, with different
comorbid pathology. Anticoagulant therapy, mainly warfarin, was prescribed in 53.6% of patients

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The aim of the research. To identify the main types of respiratory disorders in patients with coronary heart disease (CHD) that came for routine
coronary artery bypass grafting (CABG).
Material and methods. Patients with CHD that had come to the planned CABG were examined.
The formation of groups was based both on the presence in the anamnesis, and the revealed respiratory pathology at the preoperative stage. In
order to identify respiratory disorders, a set of studies including spirometry, bodipletizmography and determination of the diffusivity of the lungs
on the EliteDl-220v bodipletizmograph (MedicalGraphicsCorporation, USA) was performed.
Results. In patients of all the examined groups, respiratory parameters were within the proper values, with the exception of the Tiffno index - in
patients with a newly diagnosed pathology of the respiratory system that was lower and the level of diffusivity of the lungs - in patients with a
respiratory system pathology (as previously known and revealed at the stage of admission to the CABG) in comparison with isolated CHD. Among
all types of ventilation disorders, the predominant one was respiratory tract obstruction. Signs of the formation of the "air trap" were more common
than the hyperinflation of lung tissue.
Conclusion. Signs of dysfunction of the respiratory system have been verified in the majority of patients with CHD admitted for cardiac surgery.
Among all types of ventilation disorders, the obstructive pattern was prevalent

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Serdechno-Sosudistyh Zabolevanij. 2016;(1):37-50. DOI: http://dx.doi.
org/10.17802/2306-1278-2016-1-37-50 (In Russian)
38. Panova EI, Martyshina OV, Danilov VA. Associated pathology with
obesity: frequency, character and some formation mechanisms. Sovremennye
Tehnologii v Medicine. 2013;5(2):108-15. (In Russian)

The aim of the research. The choice of the best predictor of mortality during the heat and cold waves in a sharply continental climate. Stratification
of mortality risks during such waves in Krasnoyarsk for the main reasons and age groups for revealing the main temperature factors of increased
mortality. Comparison of risks with similar results obtained in the southern cities of Russia.
Material and methods. Meteodata for 6 selected cities in Siberia with sharply continental climate were obtained from the site of Roshydromet. To
analyze the impact of long periods of extreme air temperatures on mortality, Krasnoyarsk was chosen as the largest of the studied cities; data on the
daily mortality in Krasnoyarsk were provided by Rosstat. To calculate the relative risks of mortality during heat and cold waves, the Poisson regression
model of daily mortality was used, corrected for the long-term and seasonal mortality trends, day of the week and daily temperature difference.
Results. For the period 1999-2014 in Bratsk, Barnaul, Irkutsk, Kemerovo, Krasnoyarsk and Chita, a total of 73 waves of heat and 83 cold waves were
identified. For heat, the effective air temperature is a better predictor of mortality than the temperature of a dry thermometer, and for the cold, the best
predictor is the wind-cold index. For the majority of the studied indicators, statistically reliable estimates of the death rate increases were obtained
both during the heat waves and during the cold waves and it was shown that during the heat they were more significant.
Conclusion. The main contribution to increased mortality during extreme temperatures is provided by cerebrovascular diseases. The risks from heat
waves in Krasnoyarsk are less pronounced than in the southern cities of the European part of Russia; on the waves of cold there were no significant
differences

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The aim of the research. To assess the dynamics of the indicators of the main risk factors for cardiovascular diseases (hypercholesterolemia,
hyperglycemia, hypertension, obesity, smoking and alcohol overindulgence) during the last decade among the indigenous inhabitants of
Gornaya Shoriya, in connection with the changed living conditions.
Material and methods. The study was carried out under expeditionary conditions by a continuous method in two stages. The first stage - in
the period of 1998-2002, the second - 2012-2015. 631 and 434 aboriginals were examined, respectively. The examinations were carried out
according to a single program and standard methods at the feldsher-midwife stations and in outpatient clinics of district hospitals.
Results. During the analyzed 15-year period, the females Shorians were more susceptible to the change in biochemical and clinicalanthropometric
indicators than the males Shorians. From all the indicators studied, only the level of blood pressure showed a positive dynamics
in the form of a decrease in the mean values of SBP and DBP levels in both sexes, in contrast to the mean values of OXC and glycemia. The
average level of fasting glycemia significantly increased in all age groups in both sexes. The most susceptible to the dynamics of behavioral risk
factors were the male Shorians: a decrease in smoking in young and middle-aged people was detected, and there was a decrease in the number
of people, consumed moderate amounts of alcohol in the younger age group and did not drink alcohol in the older age group. In the above
mentioned cohorts there was an increase in the number of people who abused and consumed alcohol in moderate amounts, respectively. At the
same time, it was noted the increase in the number of smokers in female Shorians only at the age of 50-59 years.
Conclusion. Among the indigenous population of Mountain Shoria over the past 15 years there were some changes in the prevalence of the
main RF of the CVD.

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The aim of the research. To reveal the clinical characteristics influencing to the achievement of target BP in patients with AH, observed in the
polyclinic of the working village of the Saratov region.
Material and methods. The data of outpatient cards of 182 patients with essential hypertension (mean age 64.6 ± 11.3 years, 48.5% - men)
were studied, they asked for medical care in the polyclinic of the working village of the Saratov region in the period from 01.07.2015 to 31.07
.2015 - the first stage (n = 88) and from 01.07.2016 to 31.07.2016 - the second stage (n = 94). There were included all consecutive patients, visited
a district doctor, general practitioner or cardiologist during one randomly chosen reception at the first and second stages. To identify the factors
associated with achieving the target blood pressure, we used discriminant analysis.
Results. In the study group (n = 182), BP corresponded to the target level in 93 patients with AH (51%). Patients with targeted BP were rarely
females (53.8% vs. 69.7, p = 0.028), more likely to have a history of myocardial infarction (22.6% vs. 10.1%, p = 0.024), less likely to have other
forms of stable ischemic heart disease (55.9% vs. 73%, p = 0.016), received fewer antihypertensive drugs: 1.63 ± 0.12 versus 1.98 ± 0.11 (p =
0.018).
The constructed discriminant model had a high predictive value (OR 5.4 (95% CI 2.7-10.7), p <0.001) and took into account two most significant
factors: previous myocardial infarction in the anamnesis (OR 2.6 (95% CI) 1,1 - 6,6), p = 0,032) and the number of prescribed antihypertensive
drugs ≥ 2 (OW 0.4 (95% CI 0.2-0.7), p = 0.003).
Conclusion. In patients, underwent myocardial infarction and received less than two antihypertensive drugs, the probability of achieving the
target blood pressure is 5.4 times higher than in the absence of these factors.

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The aim of the research. To assess the possibility of slowing the progression of ischemic dilated cardiac pathology by adding a selective antagonist of
mineralocorticoid receptors-eplerenone to standard therapy.
Material and methods. The work was based on the results of clinical and instrumental studies in patients with ischemic dilated cardiopathy without
clinical signs of decompensation. The ischemic origin of cardiopathy is confirmed by the results of coronary angiography and / or myocardial infarction in
the anamnesis. Patients of the main and control groups were assigned ramipril, nebivolol, enteric-soluble form of acetylsalicylic acid and rosuvastatin in the
maximum tolerated doses. In the main group, eplerenone has been added to the therapy under the control of the electrolyte level. The patients of the control
group did not receive eplerenone.
Results. Therapy for 3 and 6 months, by selective antagonist of mineralocorticoid receptors eplerenone in addition to standard treatment leads to a
significant decrease in the final diastolic size of the left ventricle, the final diastolic size of the right ventricle. Reduces the degree of regurgitation on the mitral
and tricuspid valves. There is a significant increase in the test of a six-minute walk. Despite the long reception of this drug, the level of potassium and sodium
remains within normal limits. In the control group, an increase in the diastolic size of the right ventricle is observed, and the final diastolic dimension of the
left ventricle does not change reliably. The expression of regurgitation on the mitral and tricuspid valves also increases. The result of treatment depends on
the degree of dilatation of the left ventricle before the start of the drug. The effect of therapy is more pronounced in patients with higher end-diastolic values
of the left ventricle.
Conclusion. When eplerenone is added to standard therapy with angiotensin-converting enzyme inhibitors, beta-blockers, statins and antiplatelet agents,
an effective improvement of cardiohemodynamic parameters and functional state of the myocardium is observed. The functional class of chronic heart failure
decreases. Despite the long reception of eplerenone, the level of potassium and sodium remains within normal limits

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The article presents a clinical case of myocardial infarction in a patient with complicated anatomy of coronary vessels and
anemic syndrome. The authors demonstrated how a reasonable assessment of the risks and benefits of invasive and medically-oriented
coronary vasculitis reperfusion resulted to a favorable outcome in a patient with increased risk of fatal cardiovascular complications.

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Pain in the chest is one of the most frequent complaints when seeking medical care. Moreover, diseases of the musculoskeletal
system are the leading causes of pain in the anterior chest wall. Costochondritis and Tietze syndrome - inflammation of the rib-chest joints are
not so rare, as undeservedly forgotten diseases. The article contains the own clinical case of the Tietze syndrome and an overview of current
publications on this topic. Particular attention is paid to a multidisciplinary approach in differential diagnostics and verification of the diagnosis
at an early stage

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