Congenital heart defects (CHD) are the most common form of congenital malformations in children. Due to early diagnosis, rapid development of cardiac surgery technologies as well as successes in the care of severe patients after surgical correction of CHD, the survival and life expectancy of patients with CHD have significantly increased over the past decades. All this has led to the emergence of new population of patients with severe CHD and unique cardiac hemodynamics due to palliative intervention or multi-stage correction with large amount of exposure. Such patients have specific functional capabilities, special cardiopulmonary performance as well as the risk of serious adverse events (heart failure, life-threatening cardiac arrhythmias, sudden cardiac death and others). The review presents generalized current understanding about the possibilities of a cardiorespiratory test in children with various CHD.

Aim. To compare clinical and hemodynamic parameters with survival of incident patients with idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) with a prognostically unfavorable pattern of cardiopulmonary exercise testing (CPET) parameters.Material and methods. The study included 48 incident cases with a verified diagnosis of IPAH (n=18) and CTEPH (n=30). All patients were examined in accordance with the European Society of Cardiology and the European Respiratory Society guidelines (2015). The inclusion criterion was the ventilatory equivalent for carbon dioxide (CO2) according to the CPET (VE/VCO2) >44, indicating an unfavorable prognosis for patients.Results. VE/VCO2 in the examined patients with IPAH and CTEPH averaged 70,6±0,8 and did not differ in the study groups. Hemodynamic parameters of patients with IPAH and CTEPH also indicated a high risk of adverse events as follows: cardiac index — 1,9±0,1 and 1,8±0,1 l/min/m2, respectively (p=0,3). Peak oxygen consumption, anaerobic threshold level, oxygen delivery to work performed were reduced in both groups. However, patients with IPAH did not have a decrease in dead space ventilation and desaturation severity during exercise was greater than in patients with CTEPH. Patients with CTEPH had better survival compared to patients with IPAH: 1 year — 89 vs 83%, 3 years — 84 vs 65%, 5 years — 73 vs 35%, 7 years — 55 vs 36%.Conclusion. Among patients with IPAH and CTEPH who have an unfavorable prognosis, patients with IPAH demonstrate a more pronounced decrease in cardiovascular and respiratory reserves, which negatively affects patient survival. CPET may be a valuable non-invasive method for death risk stratification in patients with IPAH and CTEPH.

Aim. To assess the changes of quality of life (QoL) in patients after heart transplantation (HTx) and identifying factors associated with its changes.Material and methods. We retrospectively assessed the register created on the basis of the original database "Mental status of patients after heart transplantation: experience of the Almazov National Medical Research Center" № 2023622138. There were following inclusion criteria: recipients aged over 18 years with preserved cardiac transplant function (Simpson's left ventricular ejection fraction >55%) with a follow-up period >3 months after transplantation. After inclusion on the heart transplant waiting list, patients filled out the SF-36 questionnaire and a coping test, while then 3-6 months, 1 and 3 years after HTx — SF-36, a coping test and the International Physical Activity Questionnaire (IPAQ).Results. The mean age of recipients included in the study (n=112; 84 men) was 48±11-year-old. According to the SF-36 results after HTx, patients improved most of the indicators of physical QoL, except for Bodily Pain (BP), while the level of mental QoL increased by 3-6 months after surgery and did not undergo significant changes thereafter. According to the Lazarus coping test, during the 1st year after HTx the level of coping mechanisms did not change, but by 3 years after the surgery there was a positive trend in the form of a gradual decrease. In the first 3-6 months after HTx, one third of the patients were physically active, the rest led a sedentary lifestyle. After HTx, the number of physically active recipients increased, and after 3 years they accounted for only half of the observed patients. According to the SF-36 and the coping test, the following components of QoL (BP, role-functioning physical, role-functioning emotional, vitality) and self-control were higher in physically active recipients. Other indicators did not change depending on physical activity (PA; p>0,05). There were no differences in SF-36, Lazarus test and IPAQ scores depending on whether patients worked after HTx or not. After HTx, there were no significant correlations between QoL indicators and recipients' sex, length of stay in the HTx waiting list and in the ICU after HTx, or the use of mechanical circulatory support prior to HTx.Conclusion. After HTx, physical QoL improved, remaining at a stable level during 3 years follow-up, and its positive changes were directly related to the PA of patients. Older age and lack of PA negatively affected post-transplant QoL. Compared with the results during stay in the HTx waiting list, 3-6 months after HTx, mental QoL improved and remained stable at 3 years after surgery, which was associated with the clinical condition of the patients and the normal functioning of the heart transplant. At the same time, the main factors that positively affected its dynamics were male sex, a sedentary lifestyle, as well as a lower level of the coping mechanism of escape-avoidance of the problem and a higher level of self-control.

Background: despite the great contribution of physical activity (PA) to the health of children after correction of congenital heart defects (CHD), in the literature there are only isolated data on PA and the performance of children after correction of congenital heart defects. Objective: to assess physical activity and physical performance in children after radical intervention for congenital heart disease. Material and methods. The study included 32 children after radical correction of congenital heart disease. In addition to standard research methods, all patients underwent a cardiopulmonary stress test (CPST), as well as a structured interview on physical activity. Results. According to the survey, 81 % of children did not achieve the recommended 60 minutes of daily PA. Only 44 % of children attended sports clubs or sections. The amount of sedentary time in children was 8.4 hours a day, while the duration of entertainment “screen time” was 3 hours. A separate analysis of physical performance was carried out in subgroups formed depending on physical training (PT) activities. In children who regularly engaged in PT, the threshold load power and heart rate at the height of physical activity were higher compared to children who did not engage in PT. In addition, they had higher VO2peak and lower ventilator CO2 equivalent (VE/VCO2). Conclusion. Children with corrected congenital heart disease, without contraindications to physical education and sports, mostly lead a sedentary lifestyle and have insufficient physical activity and performance. However, regular physical training after radical correction of congenital heart disease significantly increases the performance of children due to an adequate increase in cardiac output and minute ventilation during physical activity.

OBJECTIVE: Revealing the correlation between sonography indicators of diaphragm performance and spirometry data of healthy persons. MATERIALS AND METHODS: The study was conducted at the Almazov National Medical Research Centre. The structural (thickness) and functional (thickening fraction and excursion of diaphragm) state of diaphragm of 50 healthy individuals (female — 30) was assessed with an ultrasound machine, and the spirometry characteristics of the external breathing apparatus were assessed with a ventilator. Afterwards the statistical and correlation analysis was conducted. RESULTS: It was possible to assess the thickness of diaphragm on both sides and the diaphragm excursion on the right in all subjects, the diaphragm excursion on the left — only in 20 % of subjects. Spirometry has been performed in all subjects. The obtained data are consistent with the literature. In particular, sonography and spirometry indicators of the healthy individuals are within reference values. Inspiratory muscles strength has also proved to be consistent with the literature data. Correlation analysis has revealed no statistically significant relationship between the examined sonography and spirometry parameters. In addition, no relation between age and sonography indicators of diaphragm has been found. There are weak statistically significant relations revealed between the structural and functional state of diaphragm and such anthropometric characteristics of the subjects as body mass and body mass index. CONCLUSIONS: Sonography indicators of diaphragm performance do not correlate or correlate poorly with spirometry data. There is no reason to use sonography of diaphragm in healthy individuals since it does not practically provide any additional information about the state of external respiratory apparatus.

The purpose of the study. To identify structural changes and functional modifications in respiratory muscle performance in patients with congestive heart failure. Materials and methods. We conducted prospective observational study at the V. A. Almazov National Medical Research Center involving 118 subjects: 49 patients with congestive heart failure (CHF-group) and 69 healthy people (control group). NYHA functional classes of II to IV were taken as inclusion criteria in the CHF group, and respiratory diseases, abdominal pathology, morbid obesity, and anemia — as exclusion criteria. Ultrasound imaging was used to assess the structural (thickness) and functional (thickening and excursion indices) diaphragmatic impairments during quiet (resting) and deep breathing. Facemask spirometry was used to assess pulmonary function. Results. Patients with CHF were on average older than 59.0 years (53.0; 70.0) vs. 25.0 years (24.0; 26.0) in the control group, P =0.000001, had excessive body weight — 82.0 (73.0; 95.0) vs. 68.5 (55.0; 84.0) kg, P =0.000005 and higher body mass index — 28.4 (24.3; 31.3) vs 21.8 (19.9; 24.0) kg/m 2 , P =0.000001, but did not differ in height 173.0 (166.0; 179.0) vs. 170.0 (165.0; 183.0) cm, 0.97. Lower maximum inspiratory volume (MIV): 3000.0 (2300.0; 4000.0) vs. 3684.1 (3392.5; 4310.8) ml, P =0.0006, and negative inspiratory force (NIF) measured as max negative pressure generated by the respiratory muscles: 43.1 (–56.7; –33.0) vs. 53.5 (–58.8; –50.9) mBar, P =0.000082, respectively were found in patients with CHF. The diaphragm was significantly thicker (mm) in patients with CHF during quiet (eupnea) and deep breathing compared to healthy subjects. The thickness at the end of quiet inspiration was 3.0 (2.2; 3.6)/1.9 (1.5; 2.2) in the right hemi-diaphragm, P <0.001; and 3.0 (2.4; 3.5)/1.7 (1.4; 2.0) — in the left, P =0.000001; thickness at the end of quite expiration — 2.2 (1.8; 2.9)/1.5 (1.2; 1.7) in the right dome, P =0.000001; and 2.0 (1.7; 2.5)/1.4 (1.2; 1.5) — in the left, P =0.000001. Thickness at the end of deep inspiration was 5.1 (4.4; 6.1)/4.4 (3.6; 5.1) in the right dome, P =0.0005, and 4.9 (4.2; 6.2)/ 3.7 (3.1; 4.8) — in the left, P =0.000007.The diaphragm thickening index during deep breathing was lower in the CHF group than in the control group: 131.1 (82.5; 181.8) vs. 190.9 (150.0; 240.0) in the right dome, P =0.000004; and 148.8 (112.5; 190.3) vs. 175.2 (130.7; 227.7) — in the left, P =0.03, respectively. Diaphragmatic excursions during quiet breathing were larger in patients with CHF than in healthy controls: 2.3 (1.6; 2.8)/1.7 (1.5; 1.9), P =0.0001 and 1.8 (1.5; 2.2)/1.5 (1.3; 1.9), P =0.03 of the right and left domes, respectively. Conclusion. Congestive heart failure contributes to the development of structural and functional impairments of the diaphragm.

Pulmonary veno-occlusive disease (PVOD) is verified by identifying typical pathological changes in lungs or mutation in the EIF2AK4 gene. Clinical suspicion is based on combination of specific pulmonary pattern on computed tomography scan, hypoxemia with low diffusing lung capacity (DLCO) and inadequate response to specific therapy of pulmonary arterial hypertension (PAH). The rapid course of PVOD with high mortality determines the importance of early diagnosis and lung transplantation refferal. We present an unusual clinical case of 40-year-old woman with expected idiopathic PAH and extremely low DLCO with verified EIF2AK4 gene mutation, who demonstrated a positive vasoreactive test (VRT) and clinical response to calcium channel blockers therapy at the onset of the disease. The loss of positive VRT and subsequent PAH specific therapy escalation resulted in PVOD manifestation with severe desaturation, recurrent syncope and pulmonary edema. The combination of low DLCO and inadequate response to PAH therapy in idiopathic PAH patient should be of a paramount awareness of PVOD. Careful PAH therapy escalation with meticulous follow-up, pulmonary multispiral CT and genetic testing could improve early PVOD diagnostics and lung transplantation referral.

Aim. To assess hemodynamic response to active standing test (AST) with beat-to-beat blood pressure (BP) monitoring, their association with office BP and symptoms of orthostatic intolerance in patients with heart failure (HF).Material and methods. Outpatient HF patients with documented left ventricular ejection fraction <40%, followed up in a HF center and receiving optimal medical therapy, underwent AST with beat-to-beat non-invasive BP monitoring.Hemodynamic response was assessed according to the European Federation of Autonomic Societies criteria.Results. The study included 87 patients (mean age, 57±10 years; men, 76%). Normal hemodynamic response to orthostatic stress was observed in 36 (41,4%) patients. Pathological response prevailed during the first minute of orthostatic stress — initial orthostatic hypotension (OH) (n=29, 33,3%) and delayed BP recovery (n=18, 20,7%). Classical OH was detected in 4 (4,6%) patients. There was no orthostatic hypertension, defined as an increase in systolic BP (SBP) ≥20 mm Hg. According to office BP, hypotension was observed in 19 (21,8%) patients (SBP <90 mm Hg in 4 patients and 90-100 mm Hg in 15), hypertension (SBP >140 mm Hg) in 11 (12,6%) patients. Pathological response to orthostatic stress were more often observed in office SBP >140 mm Hg compared to SBP ≤140 mmHg (90,9% and 53,9%, p=0,020).Orthostatic intolerance was noted in 43 (49,4%) patients and were not associated with the level of office SBP (p=0,398) or pathological responses to orthostatic stress (p=0,758 for initial OH and p=0,248 for delayed BP recovery).Conclusion. The pathological hemodynamic response in AST with beat-to-beat BP monitoring in ambulatory patients with HF is most often represented by initial OH and delayed BP recovery associated with office SBP >140 mmHg. The frequency of symptoms of orthostatic intolerance did not differ between groups depending on the presence of an inadequate response to orthostatic stress.

Aim To determine possibilities of the cardiopulmonary stress test (CPST) as an unbiassed, noninvasive method for evaluation of the effect of managing patients with chronic thromboembolic pulmonary hypertension (CTEPH). Material and methods This study included 37 patients with CTEPH, 24 men (mean age, 53 +/- 15 years) and 13 women (mean age, 58 +/- 8.5 years). The diagnosis was verified and the Coperability was assessed according to 2015 European Society of Cardiology Clinical Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension (PH). The surgical treatment was used in 65% (n=24) of CTEPH patients: the group with pulmonary thromboendarterectomy constituted 35% (n=13); the group with balloon pulmonary angioplasty 30% (n=11); and the conservative tactics was used in 27% (n=10) of patients. Results Baseline CPST parameters significantly correlated with parameters of right heart catheterization (RHC): mixed venous oxygen saturation (SvO(2)) significantly positively correlated with V'O-2peak (r=0.640, p<0.05), V' O-2/(heart rate) (HR) (r=0.557; p<0.001), PETCO2 (peak) (r=0.598, p<0.05), and V'E/V'CO2 (r=0.587; p<0.001); cardiac output (CO) correlated with V'O-2(/HR) (r=0.555, p<0.001), PETCO2peak (r= -0.476; p<0.05 and r=0.555, p<0.001 for 'E/V'CO2). In repeated testing, the physical working capacity (V'O-2peak) increased only in patients after the surgical treatment of CTEPH. Importantly in this process, significant correlations remained between a number of CPST and RHC parameters: SvO(2) correlated with V'O-2peak( )(r=0.743; p<0.05), V'O-2/HR (r=0.627; p<0.001), PETCO2peak (r=0.538; p<0.05), and V'E/V'CO2 (r=0.597; p<0.001); V'O-2/HR, PETCO2peak, and V'E/V'CO2 significantly correlated with CO (r=0.645, p<0.001; r= -0.516, p<0.001, and r=0.555, p<0.001, respectively. Conclusion CPST can be used as a noninvasive instrument for evaluation of the effect of CTEPH treatment, particularly in the absence of echocardiographic data for residual PH.

Aim: to estimate physical capacity and quality of life (QoL) and defi ne factors which impact on their dynamic in recipients after heart transplantation (HTx). Materials and methods. From January 2010 to September 2016 we performed 76 HTx (mean age – 45,4 ± 1,6 yrs). Physical activity (PA) was evaluated by IPAQ questionnaire, QoL – by SF-36 (6 months and 1 yr after HTx). Patients underwent cardiopulmonary exercise test (Oxycon Pro, Germany) before, 6 months (n = 32) and 1 yr (n = 31) after HTx. Results. In 6 months after HTx PC improved (VO2peak – 12,6 ± 0,5 and 17,3 ± 0,6 ml/min/kg, p < 0,001). One yr after HTx physically active recipients (n = 21) showed better results (VO2peak – 18,7 ± 0,9 vs. 16,7 ± 0,4 ml/min/kg, p < 0,05). Moreover, 6 months 59,4% (n = 19) and 1 yr after HTx 77,4% (n = 24) of all patients reached normal values, 20 of them were physically active. We did not fi nd any difference in results depending on heart failure severity, duration of illness and of time spent in HT waiting list. In 6 months after HTx physical health (PH) increased (32,2 ± 1,1 vs. 48,2 ± 1,6, p < 0,001), on the other hand, results of mental health (MH) were the same and remained stable in 1 yr after HTx. In addition, QoL was higher in physically active patients than in sedentary lifestyle ones. There was correlations between PH and PA duration (r = 0,4; p < 0,05), VO2peak (r = 0,3; p < 0,05), VO2 at AT (r = 0,4; p < 0,05) and VE/VCO2 (r = –0,5; p < 0,05). Conclusion. After heart transplantation physical capacity and physical health improved but physically active recipients showed better results. Factors affecting the increase in physical capacity were improvement in the functional state of the cardiovascular system and physical activity.

Heart failure (HF) is associated with unfavorable outcomes and high health care costs. Determination of the hemodynamic response to orthostasis can be an additional tool in assessing the stability and compensation of HF patients. Active orthostatic test (AOT) with blood pressure monitoring serves as a simple and available screening method. However, a complete characteristic of the hemodynamic response, especially during the first minute of orthostasis, can be obtained only with continuous blood pressure monitoring. The presented case series demonstrate the types of hemodynamic response in patients with heart failure with reduced ejection fraction in AOT with continuous blood pressure monitoring, available data on the mechanisms of its development, clinical and prognostic role, and also presents the advantages and limitations of AOT.

Aim. To determine the clinical features of arrhythmogenic right ventricular dysplasia (ARVD) in recipients on heart transplant waiting list (WL) and after a heart transplantation (HTx).Material and methods. From January 2010 to December 2018, we included 192 recipients in heart transplant waiting list (HTx WL) on behalf of Almazov National Medical Research Center. ARVD was diagnosed in 4 subjects (F Marcus et al. criteria, 2010). All 4 patients (female, mean age 46,5 years-old (16-54-year-old)) underwent HTx. Prior to HTx, arrhythmias (atrial fibrillation, atrial flutter) were diagnosed in 3 recipients. In patient №2, pacemaker in VVI mode was implanted due to sick sinus syndrome (SSS) and tachycardia-bradycardia syndrome and others underwent ICD implantation.Results. Survival after HTx was 30,9 (3,9-46,2) months. All recipients were treated with triple-drug immunosuppressive therapy (calcineurin inhibitors, mycophenolic acid, steroids) and induction with Basiliximab. All patients experienced high sensitivity to immunosuppressive therapy (agranulocytosis), and therefore a colony-stimulating factor was administered to all of them. After immunosuppression reduction (Tacrolimus plus Methylprednisolone) agranulocytosis did not recur.Conclusion. ARVD is a rare disease in the structure of end-stage heart failure in recipients in HTx WL. An examination of this pathology is necessary to manage patients on-time with surgical treatment (ICD, HTx). According to our results, causal variants in desmosome genes were determined in 1 from 4 patients and simultaneous presence of two unique genetic variants in the RKR2 gene were found in one. A special feature of post-HTx management was the development of agranulocytosis, which once again underlines the need for a personalized approach to the selection of the immunosuppressive therapy.

Abstract Introduction Currently there is no evidence-based strategy for PAH drug application adjusted for patients with HIV-associated PAH. Data regarding the use of sildenafil and endothelin receptors antagonists (ERA) are limited case series. Purpose To present the long-term data on treatment with sildenafil, macitentan and ambrisentan in pts with HIV-PAH. Material and methods In prospective study were consecutively enrolled 18 treatment-naïve pts with HIV-PAH (7 males, 34.5 yrs; 29; 53 yrs), mean follow-up was 1.64yrs; 0,16–59–9.28 yrs. 4 pts were in IV FC, 5-III FC and 9 in II FC PAH (WHO). RHC, ECHO, 6MWT, ergospirometry and NTproBNP level were evaluated at a baseline. Intravenous drug abuse reported in 72% pts, all of them were co-infected with hepatitis. Nine pts (50%) treated with HAART therapy at a baseline. Five pts did not have PAH-specific therapy, 11 pts received sildenafil, 1 IV FC PAH pt with HAART – sildenafil+macitentan and 1 III FC PAH pt with HAART-sildenafil+ambrisentan. Follow-up data (FC, 6MWT, ECHO, ergospirometry, NT-proBNP) were available for 8 PAH-treated pts. Results Pts on PAH therapy had achieved improvement in 6 MWT with mean distance increase 69.3±52 m (p=0.01); NTproBNP level decrease (p=0.018) and FC PAH improvement in 7 pts. In pts with PAH therapy the size of right atrium decreased (56.4±7.8 vs 47.8±6.7 mm, p=0.027). The combinations of sildenafil and macitentan and sildenafil with ambrisentan were well tolerated and resulted 6MWT increase, low NTproBNP and FC improvement. Nevertheless there was no significant changes in peak VO2 consumption. Two pts with sildenafil therapy lost for follow up. Three pts with sildenafil but without HAART therapy dead: in one case due to pneumonia, other 2 cases due to pulmonary embolism. Four pts without HAART and PAH therapy dead. In our population strong association between survival and HAART therapy presence was revealed (p=0.01). Conclusion No adverse reactions of PAH-specific therapy were reported in pts on HAART. PAH therapy had a positive influence on FC, exercise capacity, heart remodeling and NT-proBNP level. There were no deaths in pts who receive HAART and PAH therapy. Nevertheless in our population strong association between survival and HAART therapy presence was revealed. Funding Acknowledgement Type of funding source: None

Background Recently, transcatheter pulmonary artery (PA) ablation aiming at sympathetic denervation has been proposed in pulmonary arterial hypertension (PAH). This pilot feasibility study aimed to assess the feasibility of selective radiofrequency PA ablation based on response to high-frequency stimulation mapping. Methods The study comprised 3 female patients with idiopathic PAH (IPAH). The following reactions to PA stimulation were noted and marked by color points on the three-dimensional map: sinus bradycardia (heart rate decrease ≥15%), tachycardia (heart rate increase ≥15%), phrenic nerve capture, and cough. Since the most appropriate ablation strategy was unknown, two approaches were suggested, according to stimulation results: ablation at points with any heart rate response (either bradycardia or tachycardia)—this approach was applied in patient #1 (IPAH long-term responder to calcium channel blockers); segmental ablation at points with no response and with tachycardia response (one IPAH long-term responder to calcium channel blockers patient and one–IPAH with negative vasoreactive testing). Hemodynamic measurements were performed before and after denervation. Follow-up visits were scheduled at 6 and 12 months. Results Six-months follow-up was uneventful for patients #1 and 3; patient #2 had one syncope and reduced 6-minute walk test distance and peak VO2 consumption. At 12 months, there was a normalization of mean PA pressure and pulmonary vascular resistance (PVR) in patient #1. Patient #2 had no change in PA pressure and PVR at 12 months. Patient #3 remained in II functional class; however, there was an increase in mean PA pressure and loss of vasoreactivity. Conclusions Electrical high-frequency stimulation of the PA identifies several types of evoked reactions: heart rate slowing, acceleration, phrenic nerve capture, and cough. The improvement in clinical and hemodynamic parameters following targeted PA ablation in the IPAH patient with positive vasoreactive testing should be confirmed in larger studies.

Objective: to assess the personal psychological profile of heart transplant recipients as the first stage in the development of post-transplant personalized rehabilitation programs. Materials and methods. From January 2010 to July 2019, 129 HTs were performed (mean age 46.6 ± 14.1 years; 74% (n = 95) were men, 26% (n = 34) were women). All patients in the heart transplant waiting list were examined by a clinical psychologist and a psychotherapist to exclude contraindications to transplant surgery. To assess personal traits, we used the standard multifactorial questionnaire by Cattell R., 16 PF (version A), which included 187 questions. Heart transplantation and absence of post-transplant severe cognitive impairments were the selection criteria for this study. Patients were surveyed before they were discharged from the hospital – 30–60 days following HT: during the period of complete recovery after surgery. In the present study, a retrospective assessment of the results was performed in 107 patients (n = 76 – men; n = 31 – women). Results. Analysis of the personality portrait revealed that over half of recipients were reserved, distant (factor A – schizothymia) and restrained (factor F – restraint; F2 – introvert; F4 – conforming) with lower mental capacity (factor B), and were shy, timid (factor H), with low super ego (factor G: irresponsible, tolerates disorder, flexible, open to change). Our results showed that 47% of patients (n = 18 out of 38 patients, n = 22 are pensioners) with a weak degree of factor C (reactive, affected by feelings) are workers to 42% (n = 29 out of 69, n = 28 – retirees) with a strong degree of the same factor. One year after HT, the number of physically active patients was higher among those with low anxiety compared with high anxiety (41% (18 of 44) and 32% (20 of 63), respectively, p = 0.41). Conclusion. Personality factors are non-modifiable characteristics of patients. They affect human behavior, return to work and to social life, as well as physical and psychological recovery from HT. Knowing the personal traits of recipients would allow to develop a personalized approach to their rehabilitation and a technique for timely examination after HT.

Objective: to assess the personal psychological profile of heart transplant recipients as the first stage in the development of post-transplant personalized rehabilitation programs. Materials and methods. From January 2010 to July 2019, 129 HTs were performed (mean age 46.6 ± 14.1 years; 74% (n = 95) were men, 26% (n = 34) were women). All patients in the heart transplant waiting list were examined by a clinical psychologist and a psychotherapist to exclude contraindications to transplant surgery. To assess personal traits, we used the standard multifactorial questionnaire by Cattell R., 16 PF (version A), which included 187 questions. Heart transplantation and absence of post-transplant severe cognitive impairments were the selection criteria for this study. Patients were surveyed before they were discharged from the hospital – 30–60 days following HT: during the period of complete recovery after surgery. In the present study, a retrospective assessment of the results was performed in 107 patients (n = 76 – men; n = 31 – women). Results. Analysis of the personality portrait revealed that over half of recipients were reserved, distant (factor A – schizothymia) and restrained (factor F – restraint; F2 – introvert; F4 – conforming) with lower mental capacity (factor B), and were shy, timid (factor H), with low super ego (factor G: irresponsible, tolerates disorder, flexible, open to change). Our results showed that 47% of patients (n = 18 out of 38 patients, n = 22 are pensioners) with a weak degree of factor C (reactive, affected by feelings) are workers to 42% (n = 29 out of 69, n = 28 – retirees) with a strong degree of the same factor. One year after HT, the number of physically active patients was higher among those with low anxiety compared with high anxiety (41% (18 of 44) and 32% (20 of 63), respectively, p = 0.41). Conclusion. Personality factors are non-modifiable characteristics of patients. They affect human behavior, return to work and to social life, as well as physical and psychological recovery from HT. Knowing the personal traits of recipients would allow to develop a personalized approach to their rehabilitation and a technique for timely examination after HT.

Background . Abdominal obesity (AO) is a key factor of metabolic syndrome (MS) and risk factor of cardiovascular diseases (CVD). The level of physical capacity (PC) is an important diagnostic and prognostic criteria and a risk stratification factor in healthy individuals and patients with CVD. Objective . To evaluate the effect of changes in the level of PC on the course of MS in patients with AO on the background of non-drug correction of body weight. Design and methods . A 3-year prospective study was conducted on weight loss by non-drug methods in 153 patients with AO and MS and /or CVD risk factors. The dynamics of MS, indicators of carbohydrate and lipid metabolism, and blood pressure levels were evaluated depending on changes in the level of PC. Results . The favorable course of the MS was more common in patients with an increase in the level of PC than in patients with a decrease in this indicator (82.3 and 37.5 %, respectively; p = 0.0001). When increasing VO 2peak > the 5 % to 15 % chance of a favorable course of MS increases by 5.8 (1.5–22.3) and 15.1 (5.7–39.9) times, respectively. Conclusion . An increase in the level of PC is associated with a favorable MS dynamic.