The article presents the analysis of modern approaches to risk stratification of development of stroke and systemic thromboembolism in patients with non-valvular atrial fibrillation and also risk stratification of major bleeding on a background of antithrombotic therapy. The comparative characteristic of new oral anticoagulants is given.

The purpose of this survey is to present information on the clinical use of cardiopulmonary exercise test in patients with cardiovascular disease, with particular emphasis on evidence base for the functional evaluation, prognosis and assessment of interventions.

The historical background and actual condition of a problem of acute and chronic psychoemotional stress contribution in genesis of ventricular arrhythmias of various etiology is considered; pathophysiologic mechanisms, diagnostic, treatment are discussed.

High risk strategy at present is one of the most effective strategies of prevention. Primary prevention of CVD (coronary vascular disease) consists of evaluation of risk and following choice of preventive measures and treatment of individuals. Current risk scores by using traditional risk factors, such as SCORE etc., lead to forming of numerous groups of intermediate risk patients which contains underestimated high risk patients, who need more aggressive therapeutic measures. Subclinical organ damage detection which is also called visualized risk biomarkers is one of the most important additional methods of examination for risk stratification. Every discussed method of organ damage detection has his own advantages and disadvantages, different base of evidence and economic effectiveness, which leads to absence of universal guidelines. Existence of great number of markers is determined by some reasons: first and foremost, by necessity of development of effective primary prevention criteria; secondly, by necessity of economic expenses accounting on population screening level. Searching of new visualized biomarkers is continued, which would be used on a population level according to an optimal balance of its cost, sensitivity and specificity.

Lipid abnormalities, particularly hypertriglyceridemia, are risk factors for coronary heart disease (CHD) and myocardial infarction (MI). Carriage of certain genotypes of the apolipoprotein AV gene is associated with different levels of triglycerides (TG). The data of studies on the relationship S19W polymorphism of the apolipoprotein AV gene with an increased risk of myocardial infarction (MI) are contradictory. In this regard, in this study occurrence of S and W alleles and distribution S19S, S19W and W19W apolipoprotein AV gene genotypes in patients with CHD, after MI at different age, and in healthy men, residents of St. Petersburg, was analyzed. The study included 406 men, residents of St. Petersburg. The first group consisted of 194 patients after MI under the age of 45 years, mean age 44,3 ± 0,4 years old. The second group included 95 men aged 60 to 84 years (mean age 71,5 ± 0,6 years old), in which MI developed over the age of 60. The third group consisted of 117 apparently healthy men of comparable age from the first group (42,7 ± 0,4 and 44,3 ± 0,4 y.o., respectively; p > 0,05). All the men were determined with lipid profile of blood serum and identified with S19W polymorphism apo AV gene. In patients after MI under age of 45 years, the levels of TC, TG and VLDL were significantly higher, and the value of HDL-C was significantly lower compared with those in healthy men and in patients after MI over the age of 60 years. Among MI patients under age of 45 years were significantly more carriers of S19W genotype than among healthy men (p < 0,05, OR = 5,4 (1,58 ÷ 18,23). Carriage of S19W apolipoprotein AV genotype is associated with increased risk of myocardial infarction in young men. Lipid profile of blood serum do not differ in men with myocardial infarction - S19S carriers and S19W genotype apolipoprotein AV gene.

The article presents data of the impact of chronic kidney disease (CKD) on the clinical course of myocardial infarction (MI). 455 patients with myocardial infarction observed at the St. Petersburg Research Institute for Emergency Medical Care were included in the study. The patients were divided into 3 groups. The first group involved patients with CKD stages 1 st., CKD stages 2 st. and without it, the second one with CKD 3a, and patients with CKD 3b were enrolled in the third group. We revealed significant elevation in the rate of reinfarction, heart failure, early postinfarction angina, recurrent MI, cardiac arrhythmia and mortality depending upon severity of renal dysfunction. Patients with MI and renal disorders require more attention, more frequent control and special consideration of medication's nephrotoxicity.

The objective of the study was to assess the cost of treatment and input pattern of coronary heart disease patient 2-years treatment after coronary artery bypass surgery depending on cardiac rehabilitation participation. Average cost of treatment before surgery was 89 454,6 roubles per 1 person per year, whereof 53,4 % was hospital inpatient care cost. After coronary artery bypass surgery hospital inpatient care cost decreased by 18,5 times to 6,3 % of total cost by the end of the 2^nd year in cardiac rehabilitation group patient (p < 0,001) and was 16,4 times less as in II group (p < 0,001). Emergency care cost decreased by 35,7 times and was 52,4-times less as in group II (p < 0,001). Out-patient treatment was a major part of cost - 45,2 % of total cost pattern. Saving on cost of I group patient treatment was 70 606,8 rubles per each person for 2 years. In summary, 2-years cardiac rehabilitation participation after coronary artery bypass surgery result in a decrease in hospital inpatient care cost by 10,4 times, emergency care cost - by 7,9 times, drug therapy cost - by 1,7 times.

Endothelial Progenitor Cells (EPC) were first described in 1997 and since that they have been the subject of numerous investigative studies exploring the potential of these cells in the process of cardiovascular damage and repair. Whilst their exact definition and mechanism of action remains unclear, they are directly influenced by different cardiovascular risk factors and have a definite role to play in defining cardiovascular risk. We have studied the proliferative activity of early circulating EPC as well as the number of EPC endothelial colony-forming units (CFU-EC) in a carefully selected groups of patients: 18 with arterial hypertension, 19 - healthy control and 58 with chronic heart failure (36 with ischemic heart disease vs 36 with dilated cardiomyopathy). The study shows reduced CFU-EC as in patients with arterial hypertension and in patients with chronic heart failure. Changing the proliferative abilities of cells is closely related to pathological remodeling of the left ventricle and elevated SCORE index. Study colony-forming ability of early EPC maintains its position as an important prognostic biomarker reflecting the angiogenic potential.

Our purpose was to determine the effect of inhaled iloprost on pulmonary and systemic hemodynamics in patients with pulmonary hypertension associated with left ventricular systolic dysfunction. 29 vasoreactivity tests (VRT) with 20 micrograms inhaled iloprost (Ventavis, Bayer) were performed in candidates on heart transplantation. All patients had heart failure of IIINIV NYHA class and PH with pulmonary vascular resistance (PVR) more than 2.5 Wood units. Hemodynamic parameters were evaluated at baseline and 15 minutes after inhalation of iloprost. A prospective study was consistent. Iloprost significantly decreased PAPmean x from 34.6 ± 9.1 mm Hg. to 29.2 ± 9.1 mm. Hg (p < 0,0001), while reducing PAPmean more than 20 % was achieved in 16 cases (55.2 %).There was a significant decrease in PVR from 4.5 ± 1.6 Wood units to 2.9 ± 1 Wood units (p <0,0001). PVR dropped more than 20 % in 24 cases (82.8 %). Iloprost inhalation increased stroke volume index (SVI) from 24.9 ± 7.9 ml/m² to 30.1 ± 10.2 ml/m² (p-0,0003). Reduction of systemic vascular resistance (SVR) was the main cause of LV output augmentation. SVR decreased from 1905 ± 477 dynes∙sec∙cm^{- 5} to 1505 ± 460 dynes∙sec∙cm^{- 5} (p-0,0001). Conclusions. In patients with LV systolic dysfunction inhaled iloprost caused reduction of PAPmean and PVR. Moreover, inhaled iloprost improve LV output due to afterload decline.

Between 2004 and April 2014, in the aortic, coronary and peripheral arteries surgery centre surgery pulmonary thromboendarterectomy (TAE) was performed in 169 patients with chronic postembolic pulmonary hypertension. Operation was performed by the developed technique using hypothermia and circulatory arrest. For the assessment of dynamic of clinical and functional status underwent the following: test with 6-minute walk, right ventricular echocardiographic parameters (ejection fraction, end-diastolic volume, end-diastolic dimension), mean pulmonary artery pressure and vascular resistance, pulmonary circulation (according to right heart catheterization) and the diameter of the pulmonary artery trunk (PA) (according to the MSCT-angiography of the pulmonary artery). The distance of 6-minute walk indicated the functional class of chronic heart failure classification NYHA. The results of studies presents that pulmonary TAE operation is direct at the main causes of pulmonary hypertension - thrombotic obstruction of the pulmonary arteries which leads to the normalization of the pulmonary circulation, reduce the load on the right ventricle and a significant improvement in functional status of patients. The TAE operation in the branches of PA leads to improved clinical and functional status of patients with chronic postembolic pulmonary hypertension during hospital stay and more lately after surgery. This evidenced by an increase of distance in 6-minute walk test more than 2.5 times, reduction of CHF FC (by NYHA). Reducing the size of the right heart, the increase in right ventricular ejection fraction, decreased vascular resistance, pulmonary circulation from 539.66 ± 120.59 dyn∙sec∙cm^-5 (before surgery) to 101.39 ± 89.20 dyn∙sec∙cm^-5 in the remote period indicates right ventricular remodeling and distal arterioles of the pulmonary circulation. Reducing of the diameter of PA 35.10 ± 5.25 mm before surgery and up to 30.30 ± 8.65 mm in the remote period according to MSCT-angiography of PA indicate the restructuring of pulmonary bloodstream with a tendency towards normalization and the effectiveness of the surgical treatment.

Since January, 2012, till March, 2013, 29 combined ascending aortic and arch procedures were performed in the Centre. In all cases we used continuous intraoperative cerebral oximetry. In most part of cases aortic arch procedures were performed with circulatory arrest, moderate hypothermia and antegrade cerebral perfusion. Hospital mortality was 3 % (1 patient). In 2 cases post-operative course complicated with stroke. We revealed correlation between cerebral saturation measured during circulatory arrest and neurological adverse events in post-operative period. This method of monitoring of cerebral protection efficacy is effective and safe. Further investigations to assess cognitive function in the late post-operative period are needed.

A historical and biographical article about scientists and physicians who have made a decisive contribution to the development of the basic ideas in Thyroidology. It covers the circumstances and significance of basic discoveries and descriptions in the field of Physiology and Pathology of the thyroid gland and biomedical role of iodine since 1600 till the middle of XIX century.