Aim. To determine differences in laboratory coagulation parameters using routine and integral monitoring methods in patients depending on anticoagulant therapy >12 months after pulmonary embolism (PE) with a high recurrence risk. Material and methods. The study included 72 patients who, according to indications, received long-term anticoagulant therapy >12 months due to a high risk of recurrent thromboembolism. During the follow-up period (15-20 months from the first pulmonary embolism episode), the plasma coagulation parameters were studied using a conventional panel and D-dimer assessment, as well as a thrombin generation test and thrombodynamics. Patients adherent to prolonged anticoagulation were included in group 1. During the collection period, 8 patients independently stopped taking anticoagulants, despite the high risk of recurrent pulmonary embolism (group 2). Results. There were no significant differences in coagulation parameters and D-dimer levels between the studied groups of patients. In the group of patients continuing to take anticoagulants, there was an increase in clot growth delay parameters in comparison with patients of group 2 according to the thrombodynamics results (p=0,046) and the thrombin generation test in platelet-poor plasma in comparison with reference values (p=0,001). Conclusion. Long-term anticoagulant therapy effectively prevents recurrent venous thromboembolism. In patients after primary pulmonary embolism who refuse anticoagulation, the clot growth delay values are shortened, which indicates an increased risk of recurrent venous thromboembolism. The most stable plasma coagulation parameters are observed in patients taking direct oral anticoagulants.

BackgroundThrombolytic therapy is effective method in the high-risk acute pulmonary embolism (PE) treatment. Reduced-dose thrombolysis (RDT) plus oral anticoagulation therapy is effective and safe method in the moderate and severe PE treatment. It is leading to good early and intermediate-term outcomes. In the RE-COVER and RE-COVER II studies, dabigatran showed similar effectiveness as warfarin in the treatment of acute PE. Dabigatran leads to fewer hemorrhagic complications and is not inferior in efficacy to warfarin in the prevention of PE after mechanical fragmentation and RDT (catheter-directed treatment [CDT]+RDT) in patients with high and intermediate to high PE risk. We sought to evaluate the efficacy and safety (incidence of clinically significant recurrence of venous thromboembolic complications and deaths) during a 6-month course of treatment with dabigatran or warfarin in patients with high and intermediate to high acute PE risk after endovascular mechanical thrombus fragmentation procedure with RDT (CDT+RDT).MethodsThe RE-SPIRE is a prospective, multicenter randomized double-arm study. Over a 5-year period, 66 consecutive patients with symptomatic high and intermediate to high PE risk after endovascular mechanical thrombus fragmentation procedure with RDT (CDT+RDT) were randomized into two groups within the next 48 hours. The first group continued treatment with dabigatran 150 mg twice a day for 6 months; the second group continued treatment with warfarin under the control of international normalized ratio (2.0-3.0) for 6 months. Both groups received low molecular weight heparins for 2 days after surgery. Then, group 1 continued to receive low molecular-weight-heparin for 5 to 7 days, followed by a switch to dabigatran at a dosage of 150 mg two times a day. Group 2 received both low-molecular-weight heparin and warfarin up to an international normalized ratio of >2.0, followed by heparin withdrawal. The follow-up period was 6 months.ResultsThere were 63 patients who completed the study (32 in the dabigatran group and 31 in the warfarin group). In both groups, there was a statistically significant decrease in the mean pulmonary artery pressure. The mean pulmonary artery pressure at the 6-month follow-up after surgery was 24 mm Hg (interquartile range, 20.3-29.25 mm Hg) in the dabigatran group and 23 mm Hg (interquartile range, 20.0-26.3 mm Hg) in the warfarin group. The groups did not differ statistically in the deep vein thrombosis dynamics. Partial recanalization occurred in 52.0% vs 73.1% in the dabigatran and warfarin groups, respectively (P = .15). Complete recanalization occurred in 28.0% vs 19.2% in the dabigatran and warfarin groups, respectively (P = .56). The groups did not differ in the frequency of major bleeding events according to the International Society for Thrombosis and Hemostasis (0% vs 3.2% in the dabigatran and warfarin groups, respectively; P = 1.00). However, there were more nonmajor bleeding events in the warfarin group than in the dabigatran group (16.1% vs 0%, respectively; P = .02).ConclusionsThe results of the study show that dabigatran is comparable in effectiveness to warfarin. Dabigatran has greater safety in comparison with warfarin in the occurrence of all cases of bleeding in the postoperative and long-term periods. Thus, dabigatran may be recommended for the treatment and prevention of PE after CDT with RDT in patients with high and intermediate to high PE risk.

Aim: To study approaches to the management of patients with pulmonary embolism at the hospital stage with varying degrees of risk of death in the clinical practice of Russian hospitals. Design: Registry, multicentre, prospective observational study. Materials and methods. The study included 571 patients (SIRENA registry database), in all patients the risk of death was calculated according to the Pulmonary Embolism Severity Index (PESI). A comparative analysis was carried out in three groups of patients: with low (PESI I + II class), intermediate (PESI III class) and high risk (PESI IV + V class). Results. Among patients with low and high risk for PESI who received thrombolytic therapy (TLT), fewer people died than among those who did not: 2 vs. 5.9%, respectively, and 13 vs. 30% (p = 0.01), respectively. In the group of intermediate-risk patients with TLT, all remained alive, and among patients without TLT, 25.8% died (p = 0.033). In patients at low risk for PESI, the most common cause of thrombolysis was massive thrombosis of the main branches and trunk of the pulmonary artery (PA) (3.9%), the first diagnosis of acute coronary syndrome with ST elevation (0.8%), and persistent signs of respiratory failure against the background of anticoagulant therapy (5.5%). At intermediate risk according to PESI, the most common reasons for thrombolysis were the presence of respiratory failure with low blood pressure (6.2%) and massive thrombosis of the pulmonary arteries (2.7%). Conclusion. In patients with intermediate and high risk according to the PESI index, a significant efficacy of systemic TLT in reducing the risk of in-hospital mortality has been proven. Patients with low and intermediate risk according to PESI need to conduct a more thorough analysis of the presence of comorbidities and risk factors, additional instrumental and laboratory parameters, aggravating factors (central massive pulmonary thrombosis in combination with a respiratory failure clinic), followed by consideration of the possibility and feasibility of TLT. Keywords: Pulmonary Embolism Severity Index, pulmonary embolism, SIRENA registry, thrombolysis.

Background. The study of the tactics of managing patients with pulmonary embolism in the hospital period allows to find new approaches to treatment to reduce mortality. At the same time, it is known that the risk factors for death in patients of different age categories differ. Aim. To study the features of the course of the disease and risk factors for a fatal hospital outcome in patients with pulmonary embolism in different age groups of participants in the All-Russian registry, which was named SIRENA (RusSIan REgister of pulmoNAry embolism). Material and methods. The study included 570 patients with pulmonary embolism (database of the SIRENA multicenter registry in 20182019), who underwent a standard examination. They were divided into two groups according to age: the first group was 1869 years old inclusive (n=369), the second group was 70 years and older (n=201). Differences in clinical history, laboratory and instrumental parameters in the studied groups of patients were assessed. Statistical comparison of data was performed using the MannWhitney test, Pearson test, and Fisher's exact test. For a quantitative description of the closeness of the association of a sign with the outcome of the disease, the odds ratio with a 95% confidence interval was determined. Results. In the group of patients aged 1869 years, deaths occurred 3 times less frequently than in the group of patients aged 70 years and older (8.9 vs 26.3%; p 0.0001). The risk of death increases in the presence of atrial fibrillation by 2.6 times (p=0.032), anemia with hemoglobin 113 g/l by 4.3 times (p=0.0002), chronic kidney disease by 5.5 times (p=0.001), increase in blood creatinine 125 mmol/l 5.8 times (p 0.001). Additional risk factors in patients aged 70 years and older are ischemic heart disease (p=0.02), a history of stroke (p=0.003), and immobilization for 12 months prior to hospitalization (p 0.0001). Conclusion. In patients aged 1869 years, atrial fibrillation, anemia, and impaired renal function are fatal risk factors; at the age of 70 years and older, along with these, previous immobilization and comorbid cardiovascular pathology have an adverse effect.

Aim. To evaluate the incidence and severity of acute kidney injury (AKI), as well as its ability to reclassify the risk of premature mortality and association with inhospital mortality in patients with pulmonary embolism (PE) in the Russian population.Material and methods. From April 2018 to April 2019, the SIRENA Russian Multicenter Registry included patients with PE, as well as the deceased, in whom the PE was detected by autopsy. AKI was diagnosed according to current KDIGO guidelines (2012). Creatinine calculated according to the MDRD equation and corresponding to a glomerular filtration rate of 75 ml/min/1,73 m2 (baseline) was taken as the initial one, with subsequent assessment relative to the parameter value upon admission. The risk stratification of early death was carried out in accordance with the current ESC clinical guidelines (2019).Results. A total of 604 patients with PE were examined (men — 293 (49%), women — 311 (51%), mean age — 64±15 years). AKI was diagnosed in 223 (37%) of them. Stage 1 AKI was detected in 146 (65%), 2 — in 55 (25%), 3 — in 22 (10%) patients. Prior chronic kidney disease was recorded in 61 (10%) patients. Seventy-one (12%) patients had a high risk of death, 364 (61%) — intermediate risk, and 164 (27%) — low risk. The AKI incidence increased as the severity of PE increased: at low risk of death — 26%, intermediate — 38%, high — 59% (p<0,0001). In total, 107 (18%) patients died in the hospital. AKI led to an increase in mortality within following risk groups: at low risk, this effect was a trend (6 (5%) vs 6 (14%); p=0,052); at intermediate and high risk, significant differences was obtained (30 (13%) vs 41 (30%), p<0,001; 4 (14%) vs 19 (45%), p=0,006, respectively). Multivariate Cox regression demonstrated that AKI is a predictor of inhospital death (odds ratio (OR), 3,66 (95% confidence interval (CI): 2,37-5,66; p<0,0001), regardless of increased troponin levels (OR, 1,31 (95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (OR, 1,23 (95% CI: 0,74-2,04; p=0,42).Conclusion. Thirty-seven percent of Russian patients with PE have AKI diagnosed by baseline creatinine. In 2/3 of the examined patients, stage 1 AKI is observed. The AKI incidence increases as the severity of PE increases. The presence of AKI reclassifies patients into a higher risk category for death and is associated with a significant increase in inhospital mortality.

В настоящее время отсутствуют единые научно обоснованные рекомендации по диагностике и лечению коронарной эмболии. В настоящей статье приведены данные мировой литературы относительно современных причин развития, клинического течения, диагностики и лечения острого эмболического инфаркта миокарда (ИМ). В 73% случаев эмболического ИМ наиболее частой этиологией коронарной эмболии, помимо наличия протезов клапанов сердца, кардиомиопатий, стеноза аортального и митрального клапанов, онкопатологии, является фибрилляция предсердий. Сложности клинической диагностики коронарной эмболии связаны с наличием тромбоэмболов, как правило, располагающихся дистально в обычно интактных коронарных артериях (КА), приводящие к трансмуральному ИМ, с возможностью реканализации эмбола (при этом развитие ИМ происходит в зонах, снабжаемых ангиографически нормальными КА) и субклиническим проявлением заболевания. Размеры эмбола, особенности анатомии коронарного русла и локализация окклюзии КА определяют клинические проявления коронарной эмболии. Частота полного восстановления кровотока при эмболии АК составляет около 65%.

Aim. To study the blood coagulation status by various laboratory methods in patients after pulmonary embolism (PE) receiving long-term anticoagulant therapy.Material and methods. The blood of 23 patients with pulmonary embolism, who received long-term anticoagulant therapy, was studied. The study of coagulation profile, D-dimer, thrombodynamics, thromboelastography and thrombin generation test were carried out.Results. The thrombin generation test shows a significant increase in the time of its formation, while the maximum amount of thrombin formed is half that of the reference values. There is a slightly increased median fibrin clot growth rate in the thrombodynamics test — 30,4 gm/min with a normal coagulation rate of 20-29 gm/min. The result of thromboelastography also reflects the blood hypocoagulation, in terms of R, Angle a and CI.Conclusion. Integral methods for assessing the thrombotic readiness in combination with a routine coagulation panel demonstrate a complete picture of blood coagulation potential in patients after pulmonary embolism requiring long-term anticoagulant therapy.

Objective. To identify the association of a number of clinical features and structural and functional characteristics of the heart with the progression of chronic heart failure (CHF) in patients one year after ST-segment elevation myocardial infarction (MI) (STEMI) with preserved and reduced left ventricular ejection fraction (EF) (LVEF). Design and methods. 120 patients with STEMI were included in a prospective study. During the study, all patients underwent an echocardiographic study using a Sonos 2500 device (Hewlett Packard, USA) on the 1st day (point I), on the 12th day (point II) of hospitalization, and also after 1 year (point III). Depending on the parameters of EF on the 1st day of the disease, the total sample of patients was divided into two: the 1st group — with preserved LVEF was represented by 86 (71,7 %), the 2nd group — with a reduced LVEF was represented by 34 (28,3 %) patients. Results. A total of 19 (15,8 %) adverse events were registered. In two cases, a fatal outcome (1,7 %) was recorded, the cause of which was repeated MI, in five (4,2 %) patients decompensation of СHF was noted, in eight (6,7 %) patients a clinic of progressive angina was traced, in four (3, 3 %) of patients were diagnosed recurrent MI. Deterioration of systolic and diastolic function was established one year after STEMI with preserved (≥ 50 %) LVEF: 17,6 % of patients began to correspond to the intermediate range of EF (40-49 %), the number of patients with diastolic dysfunction increased by 10 % compared to with acute study. Conclusions. Within a year after a STEMI with initially preserved LVEF, there is a deterioration in myocardial function in the form of a decrease in myocardial contractility and an increase in the number of patients with diastolic dysfunction.

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR) <60 ml/ min/1,73 m2. Risk of early (hospital or 30-day) death was stratified in accordance with the current 2019 ESC Clinical Guidelines. During the study, we analyzed inpatient mortality and complication rate.Results. A total of 604 patients (men, 293 (49%); women, 311 (51%)) were in the study. RD was detected in 320 (53%) patients, while severe dysfunction — in 63 (10%) ones. In addition, 71 (12%) patients had high death risk, 364 (61%) — intermediate, 164 (27%) — low. During hospitalization, 107 (18%) patients died, including 32% from the high-risk group, 20% — moderate, and 7% — low. RD in the deceased patients was diagnosed more often, while GFR <50 ml/min/1,73 m2 reliably predicted hospital mortality (sensitivity, 67%; specificity, 72%; AUC=0,72; p<0,001). In patients with simplified Pulmonary Embolism Severity Index (sPESI) of 0 and ≥ 1, the presence of RD led to at least a 2-fold increase in mortality. Multivariate Cox regression revealed that RD is a predictor of in-hospital mortality (hazard ratio (HR), 3,41; 95% confidence interval (CI): 2,15-5,41; p<0,001), regardless of the presence of death risk reclassifies, such as high troponin (HR, 1,31; 95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (HR, 1,23; 95% CI: 0,74-2,04; p=0,42).Conclusion. In patients with PE of the Russian population, there is a high incidence of RD, which is diagnosed in every second patient and is severe in 10% of cases. The presence of RD is associated with a significant increase in in-hospital mortality, while the risk of death increases with a decrease in GFR. The addition of RD, considered as a decrease in the estimated GFR <60 ml/min/1,73 m2, to the sPESI improves risk stratification and allows identification of patients at high risk of in-hospital death.

Aim. To create a new prognostic scale for in-hospital mortality risk assessment in patients with pulmonary embolism (PE).Material and methods. The study was carried out on the basis of Russian register of acute pulmonary embolism SIRENA.Results. Based on the Russian register of acute pulmonary embolism SIRENA (n=609; women — 50,7%; mean age — 63,0±1,5 years), independent predictors of in-hospital death were determined: left ventricular ejection fraction <40%, immobilization in the last 12 months, creatinine clearance <50 ml/min, syncope as a PE symptom, cyanosis at admission. Each of these factors with a value of 1 became a component of the novel SIRENA score. At the score of 0, 1, 2, 3 and more, in-hospital mortality was 3,1%, 7,0%, 16,7% and 40,0%, respectively. Mortality with a SIRENA score <2 (low risk) was 5,0%, and with a score ≥2 (high risk) — 24,3% (relative risk (RR), 4,87; 95% confidence interval (CI), 2,97-7,98; p<0,001). Predictive sensitivity and specificity for in-hospital mortality were 62,7% and 78,5%, respectively. The area under the ROC curve was 0,76 (95% CI, 0,690,83), which did not differ significantly from sPESI score — 0,73 (95% CI, 0,66-0,80). With a high risk for sPESI and SIRENA, the mortality was 27,1%, which was significantly higher compared to patients with a high risk only for sPESI — 13,9% (RR, 1,94; 95% CI, 1,36-2,82; p<0,001), but did not differ significantly compared with patients at high risk according to SIRENA score — 24,3% (RR, 1,11; 95% CI, 0,75-1,65; p=0,78).Conclusion. Based on the Russian register of acute pulmonary embolism, the SIRENA score was developed, which has a high accuracy (sensitivity, 62,7%; specificity, 78,5%) in predicting in-hospital mortality.

Background . Monitoring of hemostasis in patients with pulmonary embolism (PE) to assess the efficacy and safety of anticoagulant therapy is one of the most emerging needs in clinical practice. Aim. To determine the factors associated with an insufficient decrease in the rate of fibrin clot formation in patients after pulmonary embolism receiving anticoagulation therapy. Methods. 33 patients were recruited in the study. To control plasma hemostasis, we measured coagulogram indices and performed dynamic thrombophotometry (T-2 Thrombodynamics Registrar, GemaCore, Russia). Results. The median rate of fibrin clot formation in the general sample of patients was within the normal range. However, 13 patients (39.4%) had these values higher than 29 pm/min. Patients with an insufficient decrease in the rate of fibrin clot formation were significantly younger (p = 0.045), more often had massive PE of the main branches of the pulmonary artery (p = 0.015), and high systolic pulmonary artery pressure (p = 0.043). Conclusion. Thrombodynamics allows identifying patients with PE and an increased thrombogenic potential under anticoagulation therapy by the end of the hospital stage. A high rate of fibrin clot formation by the end of the hospital period is observed in younger patients with thrombosis of the main branches of the pulmonary artery and high pulmonary hypertension.

Цель исследования: изучение частоты и причины неблагоприятных исходов, а также факторов, с ними связанных, в течение года наблюдения у пациентов с тромбоэмболией легочной артерии (ТЭЛА). Материалы и методы: В одноцентровый регистр проспективного наблюдения методом сплошного включения включены 185 пациентов с ТЭЛА. Проводилось стандартное обследование пациентов, диагноз подтверждался по результатам мультиспиральной компьютерной томографии. Период наблюдения составил 12 мес, в течение которого отслеживали исходы пациентов, выписанных под амбулаторное наблюдение. Конечными точками являлись все случаи смерти и рецидивов ТЭЛА. Статистическую обработку результатов осуществляли с помощью пакета программ MedCalc Version 16.2.1 (Softwa, Бельгия). Результаты: Годовые исходы были определены у 161 пациента. Фатальный исход в течение года после выписки из стационара наступил у 22 (13,6%) больных ТЭЛА: у 45,5% по причине рецидива ТЭЛА, у 22,7% — онкологической патологии, у 13,6% — из-за острого нарушения мозгового кровообращения (ОНМК). Развитие летальных исходов было ассоциировано с такими факторами, как пожилой возраст, наличие ишемической болезни сердца, злокачественных новообразований, застойной сердечной недостаточности, ОНМК, а также со снижением глобальной сократимости миокарда левого желудочка, высоким риском по шкале PESI (англ. Pulmonary Embolism Severity Index) и отказом от антикоагулянтной терапии в течение первых 6 мес. Рецидив ТЭЛА в течение года наблюдения выявлен в 11,2% случаев и был связан с наличием тромбоза глубоких вен нижних конечностей, нижней полой вены и подвздошных вен, застойной сердечной недостаточностью и дилатацией правых отделов сердца. Установлено, что отказ от антикоагулянтной терапии в течение 11 мес после первичного эпизода повышает риск развития рецидива ТЭЛА. Заключение: У пациентов с ТЭЛА в течение первого года наблюдения летальный исход развился в 13,6% случаев, а рецидив ТЭЛА — в 11,2%. Наиболее значимым неблагоприятным фактором, связанным с данными конечными точками, являлся отказ от антикоагулянтной терапии ранее 6 мес после эпизода ТЭЛА. Objectives: to study the incidence, causes and factors associated with adverse outcomes in patients with pulmonary embolism (PE) during the year of observation. Patients/Methods: The single-center prospective follow-up register included 185 patients with PE. Standard examination was carried out; the diagnosis was confirmed by multispiral computed tomography. During follow-up period of 12 months we tracked outpatient outcomes. The endpoints were all-cause mortality and PE relapses. Statistical analysis was performed by MedCalc Version 16.2.1 software package (Softwa, Belgium). Results: Twelve-month outcomes were determined in 161 patients. Post-discharge fatal outcome within a year occurred in 22 (13.6%) patients with PE: in 45.5% due to PE relapse, in 22.7% due to oncological pathology, in 13.6% because of acute stroke. Lethal outcomes were associated with elderly age, ischemic heart disease, malignant neoplasms, congestive heart failure, stroke, reduction of left ventricular global myocardial contractility, a high risk according to PESI (Pulmonary Embolism Severity Index) scale and the refusal of anticoagulant therapy during the first 6 months. Within a year of observation PE relapse was detected in 11.2% of patients and was associated with deep vein thrombosis of the lower limbs, inferior vena cava and iliac veins, congestive heart failure and dilatation of right heart compartments. Refusal of anticoagulant therapy within 11 months after the initial episode increased the risk of PE relapse. Conclusions: In patients with PE during the first year of observation a fatal outcome occurred in 13.6% patients with PE and PE relapse — in 11.2%. Refusal of anticoagulant therapy earlier than 6 months after the episode of PE was the most significant adverse factor associated with these endpoints.

Aim To study a relationship of several factors (clinical and genetical markers) with unfavorable outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in long-term follow-up.Material and methodsThis full-design, prospective study included 415 patients with NSTE-ACS. 266 patients were evaluated for the presence of multifocal atherosclerosis (MFA). Typing of polymorphic variants rs1041981 LTA, rs1800629 TNF, rs4986790, and rs498679 TLR4, and also rs3024491 and rs1800872 IL10 was performed. Follow-up period lasted for 67±4 months. By the end of this period, information about clinical outcomes for 396 patients became available.ResultsDuring the entire follow-up period, unfavorable outcomes were observed in 239 (57.5 %) patients with NSTE-ACS. The following clinical signs were associated with unfavorable outcomes: history of myocardial infarction, age >56 years, left ventricular ejection fraction (LV EF) ≤50 % and GRACE score ≥100, significant stenosis of brachiocephalic arteries, MFA, carriage of genotype А / А rs1041981 LTA (OR, 6.1; р=0.02) and allele А (OR, 1.9; р=0.01). According to results of a multifactorial analysis, the most significant predictors included LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.ConclusionStratification of patients with NSTE-ACS into groups of high or low risk for having an unfavorable outcome within the next 6 years is possible using the prognostic model developed and presented in this study. The model includes the following signs: LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.

Aim. To study the clinical course and management of patients with pulmonary embolism (PE) of various age groups hospitalized in a cardiology hospital.Material and methods. This prospective single-center study in the period from 2016 to 2018 included 154 patients with PE verified by computed tomography. Statistical processing was conducted using the MedCalcVersion 16.2.1 software package (Softwa, Belgium).Results. In all groups, female patients dominated, but the highest number of women (70,7%) belonged to the group of senile patients, while in the group <60 years, only half of patients with PE were women. Comorbid cardiovascular disease and deep vein thrombosis was diagnosed in eldest patients significantly more often than in those <60 years of age. The highest prevalence of cancer and recurrent PE were identified in the group of elderly patients. Thrombolytic therapy was performed most often in patients 60-75 years old, since these patients had a high risk of 30-day mortality according to Pulmonary Embolism Severity Index, but did not have severe comorbidities, as patients older than 75 years. An increase of right atrium size was found in the group of elderly and senile patients in comparison with patients <60 years. The highest pulmonary artery systolic and diastolic pressure was observed in the patients older than 75 years.Conclusion. In the Kemerovo Oblast, PE most often develops in patients aged 60-75 years and is characterized by a more severe clinical course compared with patients younger than 60 years. Patients over the 60 years of age have severe cardiovascular comorbidity status, atrial fibrillation/flutter and recurrent PE. Surgical treatment for senile patients is limited due to the high risk of postoperative complications, which specifies high mortality. Patients <60 years of age are a third of all patients hospitalized with PE. They have a low risk of mortality, but have an unfavorable course of the hospital period.

Aim. To assess the features of diagnosis, treatment and outcomes of pulmonary embolism (PE) in patients of Russian hospitals.Material and methods. The register included all hospitalized patients with PE identified by any diagnostic method. Duration of inclusion was 12 months. In-hospital period management was assessed. Information about the included patients was provided by 20 hospitals from 15 Russian cities.Results. For the period from April 15, 2018 to April 15, 2019, 609 patients were included in the register (women — 50,7%, mean age — 63,0±14,5 years, minimum-maximum — 19-94 years). Among the known risk factors for PE, the most common were lower limb varicose veins (31,4%), heart failure (23,3%), previous deep vein thrombosis (19,4%), cancer (17,1%). The median time from symptom onset to suspicion/confirmation of PE was 4 days (1-3 quartiles — 1-8 days). Shortness of breath, syncope/presyncope, chest pain/discomfort, cough, leg pain or lower extremity asymmetry and hemoptysis were noted in 88,7%, 30,0%, 29,8%, 17,3%, 9,4% and 8,5% of patients, respectively. Echocardiography was performed in 89,5%, and Doppler ultrasound of lower limb veins — in 85,9% of patients. Signs of venous thrombosis were found in 57,8% of patients. Computed tomographic (CT) pulmonary angiography was performed in 89,2% of patients, pulmonary scintigraphy and pulmonary angiography — 0,8% each.Conclusion. Symptoms and main risk factors for PE in Russian patients did not fundamentally differ from those previously known. There was good adherence to modern guidelines for the diagnosis of PE, but adherence to guidelines on drug therapy met requirements only in half of the cases. There was an excessive use of TLT, as well as the use of ineffective methods of administering and monitoring anticoagulant therapy.In total, imaging technologies were used in 90,6% of patients, and signs confirming PE were found in 92,7%. Thrombolytic therapy (TLT) was performed in 25,0%; 92,0% of patients received anticoagulants. At the same time, unfractionated heparin (UFH) was injected subcutaneously in 26,3% of cases, and in one third of patients the drug was injected in doses unadjusted by body weight. In 42,7% of patients received UFH, the target activated partial thromboplastin time was not achieved. With warfarin treatment, the target international normalized ratio was achieved in only 48,4% of patients. Inferior vena cava filter placement and thrombectomy were performed in 1,3% each. During hospitalization (median — 11 days), 9,9% of patients died.

С.А. Бернс1, 2, Е.А. Шмидт1, А.В. Клименкова3, С.А. Туманова3, О.Л. Барбараш1 1 ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», г. Кемерово 2 ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава России 3 ГБУЗ КО «Кемеровский областной клинический кардиологический диспансер имени академика Л.С. Барбараша»

Aim: Identification of predictors of unfavorable annual prognosis in patients with acute coronary syndrome with ST-segment elevation (STEMI). Material and methods: The study included 69 patients with STEMI who were hospitalized in the period from March 2014 to January 2017 in the hospital named after Zhadkevich. The follow-up period was 12±3 months after the index STEMI Longterm prognosis was established in 62 (89.8%) patients. Results: the fatal outcome was observed in 7 (11.3%) patients. Nonfatal myocardial infarction developed in 10 (16.2%), hospitalization with heart failure decompensation - in 5 (8%), nonfatal acute cerebrovascular accident - in 3 (4.8%) patients. Predictors of adverse prognosis were: age >60 years, level of brain natriuretic peptide (BNP) >29.2 pmol/l, C-reactive protein (CRP) >4.7 mg/l, left ventricular ejection fraction (LVF) 60 years and BNP level >29.2 pmol/l. Conclusion: Adverse factors affecting the long-term outcome of the disease (12±3 months after the STEMI) are: BNP level >29.2 pmol/l, CRP level >4.7 mg/l, LV FV value 60 years.

Lymphotoxin-α (LTA) is a major pro-inflammatory cytokine produced at the early stages of vascular inflammation, taking part in the formation of arterial atherosclerosis and development of coronary heart disease. Functional changes in the gene encoding LTA production may influence the development of coronary heart disease with unfavorable progression. However, studies for associations between rs1041981 (C-804A) LTA gene variant and development of acute cerebrovascular accidents, myocardial infarction, and severity of coronary atherosclerosis have yielded contradictory results. The purpose of our study was to investigate an association of rs1041981 gene LTA with risk of adverse events within five years of follow-up in the patients with acute coronary syndrome without ST elevation ST (nonST-ACS). 178 patients with nonST-ACS from the Kemerovo Cardiology Center Registry were included into the study. Genotyping of rs1041981 site variable LTA gene was performed by TaqMan technique using an “iCycler iQ” device (BIO-RAD, USA). Results: we have found that the A allele and A/A genotype polymorphism in LTA gene (rs1041981) have been associated with development of adverse cardiovascular events over five years of observation (respective p levels were 0.02 and 0.036). In patients with A/A genotype, the rs1041981 polymorphism in LTA gene was associated with 3.8-fold increase in adverse cardiovascular events, compared to patients having A/C or C/C genotype. Carriage of A allele in LTA gene (rs1041981) doubles the risk of adverse cardiovascular events in patients with nonST-ACS at long observation terms. By means of Kaplan-Meier method, we have determined that survival to the first endpoint occurred more often in carriers of the genotype A/A of LTA gene (rs1041981). The A/A genotype of LTA gene (rs1041981) proved to be more significant (p = 0.016) for development of adverse outcomes, when combining the patients with A/C and C/C genotypes. One may draw a conclusion that A allele and A/A genotype of rs1041981 LTA polymorphism is associated with development of adverse cardiovascular events during the five-year period following the index event in patients with nonST-ACS.