This article presents a view of heart transplantation from asystolic donors. Based on the recent evidence of modern research, the difficulties in heart transplantation from donors of this category are described. This article presents a classification of asystolic donors, specifies the features of each category in relation to heart donation. Based on the recent evidence of modern knowledge about asystolic donors, possible methods of assessment and management protocols for donors are presented. The article may be of interest to pathophysiologists, transplantologists, cardiologists, and medical students.

Introduction. This is part of research with aim of increasing the effectiveness of echocardiography in patients with coronary atherosclerosis by assessing local elastic properties of the thoracic aorta using modern ultrasound technologies. Aim. To analyze correlations between deterioration of local elastic properties of the thoracic aorta, impairment of renal filtration function, severity of left ventricular hypertrophy and ischemic heart disease (IHD) risk factors in patients with coronary atherosclerosis. Materials and methods. From 2016 to 2019, 109 patients aged 39 to 82 years, who were divided into 2 groups according to the results of invasive coronarography, were examined: 64 patients with coronary atherosclerosis and 45 patients without coronary atherosclerosis. Using transthoracic echocardiography, the following were obtained: coefficient of distensibility, compliance coefficient, Peterson’s elasticity modulus, stiffness index of the ascending thoracic aorta. Analysis of correlations between these indices, indicators of IHD risk factors, left ventricular mass index (LVMI), glomerular filtration rate (GFR) was done. Results. Group without coronary atherosclerosis showed negative correlations of compliance coefficient with LVMI (r=–0.421), positive correlations of Peterson’s elasticity modulus and stiffness index with LVMI (r=0.304, r=0.397). Group with coronary atherosclerosis showed negative correlations of the coefficient of distensibility with LVMI (r=–0.331), Peterson’s elasticity modulus and stiffness index with GFR (r=–0.473, r=–0.469). Positive correlations were found between coefficients of compliance and distensibility with GFR (r=0.418, r=0.473), Peterson’s elasticity modulus and the stiffness index with LVMI (r=0.33, r=0.304). Conclusion. Research reveals relationship between the local elastic properties of the thoracic aorta, GFR and severity of LV hypertrophy in patients with coronary atherosclerosis and the effectiveness of echocardiographic technologies in their assessment.

Introduction. Coronary artery bypass grafting is worldwide accepted method of treatment of ischemic heart disease. Nevertheless, intraoperative ischemic-reperfusion injury, especially when associated with graft dysfunction, could influence on surgical outcomes. There is no data about precise cut-off level of troponin I associated with graft failure after coronary artery bypass grafting. Aim – to evaluate relationship between troponin I elevation and probability of graft thrombosis. Materials and methods. During single-center non-randomized clinical trial involving 336 patients, admitted for elective coronary artery bypass grafting, role of troponin I level for surgical approach after coronary artery bypass grafting was evaluated in three groups: off-pump, n=181, on-pump, n=128 and pump-assisted (with cardiopulmonary bypass without aortic cross-clamping), n=27. Results. In patients with cardiac index >2.2, troponin I level exceeded the upper reference limit by almost 100 times: 0.5 ng/ml in off-pump group, 4.5 ng/ml in on-pump group. In patients with cardiac index <2.2, troponin I level was more than 2 times higher than in patients with cardiac index >2.2 and amounted to 1.6 ng/ml in off-pump group and 13 ng/ml in on-pump group. In patients with graft thrombosis, troponin I level was 1.6 ng/ml in off-pump group and 25.8 ng/ml in on-pump group. Conclusion. Troponin I level has an important role in choice of surgical approach after coronary artery bypass grafting. Intraoperative ultrasound examination of grafts with assessment of blood flow according to Doppler sonography and visualization of the stenotic area, if any, could be recommended for early diagnosis of graft failure and choice of surgical approach after coronary artery bypass grafting.

Introduction. Diabetes mellitus is one of the most common diseases in the world. In 4–25 % of patients with this pathology, diabetic foot syndrome develops, leading to a large number of amputations accompanied by postoperative mortality. Aim. To assess the relationship of polymorphisms of the VEGFA 634 C˃G and MMP9 8202 A˃G genes with markers of endothelial dysfunction and state of the microvasculature in diabetes mellitus. Materials and methods. In 198 people with uncomplicated diabetes mellitus and 199 people with diabetic feet, polymorphisms 634 C˃G of the VEGFA gene and 8202 A˃G of the MMP9 gene were studied by polymerase chain reaction. The content of endothelin 1, NO₂ and NO₂^– /NO₃^–, MMP 9 and state of microcirculation at three points were studied by laser Doppler flowmetry in 30 people from each group, comparable in frequency of the indicated gene polymorphisms. Results. The frequency of polymorphisms of genes VEGFA 634 C˃G, MMP9 8202 A>G did not differ in the groups of patients. In diabetic feet, a decrease in the total perfusion index by 1.4, 1.8 and 1.5 times was recorded at three points. At a point on the forearm with a diabetic foot, a 1.6-fold decrease in the temporal variability of perfusion was revealed; at the dorsum and first toe of the foot, a decrease in the coefficient of variation by 1.7 and 1.5 times was revealed. In patients with different variants of the course of diabetes mellitus, there were no differences in the levels of endothelin-1, NO₂ and NO₂^– / NO₃^–, MMP 9. Conclusion. Polymorphisms of the VEGFA 634 C˃G, MMP9 8202 A˃G genes in different variants of the course of3 – diabetes mellitus correlate with indicators of general state of the microvasculature. The parallelism of changes in the content of endothelin 1, MMP 9 and polymorphic variants of the MMP9 8202 A˃G gene indicates a deep remodeling of the vasculature, which may be an important link in the pathogenesis of the development of complications of diabetes mellitus.

Aim. Determination of the functional state of cardiopulmonary hemodynamics in patients with chronic obstructive pulmonary disease (COPD) with varying severity of bronchial obstruction and respiratory failure using echodopplercardiography. Materials and methods. In 82 patients with COPD, the functional state of cardiopulmonary hemodynamics was evaluated using ultrasound methods. All subjects were divided into 2 groups depending on the severity of COPD (moderate and severe course). Results. It was found that in patients with COPD, impaired diastolic function of the right ventricle (RV) may be preclinical. Thus, in patients with COPD stage 2, compared with control in the P-mode and tissue Doppler sonography (TDI), mild changes in the diastolic function (impaired relaxation) of the RV myocardium were revealed (E/A 0.70±0.13 and 1.56±0.18, E/Em 8.45±0.15 and 6.89±0.19, respectively). In patients with COPD stage 3, the mean values of these RV parameters significantly differed (E/A 0.69±0.04 and E/Em 9.34±0.18) and corresponded to moderately expressed diastolic dysfunction. Conclusions. In severe COPD in stage 3, significant violations of the structure and function of the RV were determined. The compensatory capabilities of both cardiac ventricles were depleted, the interventricular interaction changed, which created the conditions for the progression of heart failure and the development of chronic cor pulmonale.

Introduction. Common combination of arterial hypertension (AH) with type 2 diabetes mellitus (DM2) which has a negative impact on the incidence and prognosis of coronary artery disease (CAD) imposes a requirement to study their interdependent effects, primarily at the microcirculation (MC) level. Aim. To study peculiarities of functional state of skin MC in patients with a combination of AH and DM2 compared to patients with AH. Materials and methods. Two groups of patients were examined: group 1 (n=66) – patients with a combination of AH and DM2, and group 2 (n=93) – patients with AH. Skin MC was assessed by laser Doppler flowmetry. Basal blood flow, amplitude-frequency spectrum of its oscillations, occlusion indicators, and incidence of various hemodynamic MC types were assessed. Results. In patients with a combination of AH and DM2, progressive deterioration of MC indicators was detected, compared to patients with AH without DM2. Statistically significant differences were revealed in more pronounced tone of the precapillary segment of the microvascular bed (myogenic tone 60.5 [37.4; 83.6] vs 49.1 [31.3; 61.0] units; р=0.014). Impaired function of active blood flow control mechanisms with increase in the role of passive regulation factors was found, as evidenced by lower modulation index (1.3 units in group 1 vs 2.8 units in group 2). In patients with a combination of AH and DM2, there were detected the strengthening of arterio-venous shunts bypassing the capillary bed and blood flow productivity reduction (increase in indicator of bypass grafting up to 1.6 [1.0; 2.1] units) compared to patients with AH and without DM2 up to 1.2 [0.8; 1.5] units; р=0.037), limitation of vasodilation blood flow reserve which amounted to 173.4 % [135.3; 195.4] vs 184.9 % [166.1; 231.3] (р=0.025). Conclusion. More significant changes in microhemocirculation were registered in patients with a combination of AH and DM2 compared to patients with AH. It was characterized by constriction of the microvascular bed precapillary segment with restriction of capillary blood flow, strengthening of arterio-venous shunts bypassing with formation of venous congestion, and reduction of MC reserve potential.

Introduction. The method for assessing the flow-dependent vasodilation (FDV) and vasodilation induced by local iontophoresis of acetylcholine (Ach) is widely used, but has not yet been introduced into everyday clinical practice. Aim. Comparison of 2 ultrasound methods for assessing endothelial function in patients with diabetes mellitus (DM). Materials and methods. Effectiveness of reactive hyperemia tests of the brachial artery was compared using Vivid7pro ultrasound device, GE, with transducer 7.5 MHz. and the endothelium-dependent vasodilation and Ach iontophoresis in the microvasculature of the forearm were evaluated using a Minimax-Doppler-K ultrasound device with a 25 MHz transducer. After iontophoresis Ach, the linear blood flow velocity (%) was measured in comparison with the initial velocity. FDV is expressed as a % increase in arterial diameter in response to the test performed. Results. % of increase in blood flow velocity in the DM group was less than that in the control group for 2–6 minutes after the test and varied from 105.35 to 119.11 % in the DM group and from 130.0 to 270.0 % in healthy control subjects (p<0.05 for 2–6 min). After occlusion of the artery in reactive hyperemia test, as well as after 20, 40, and 180 sec, patients with DM had a lower % of increase in the diameter of the vessel, compared with healthy control subjects. When performing Celermaer test in 7 patients (43.75 %), in a number of measurements, an increase in the diameter of the vessel of more than 10 % was observed (which is characteristic of healthy control subjects). Conclusion. We associated the poor reproducibility of reactive hyperemia of the brachial artery with the difficulty in interpreting the results, which is probably due to the real-time resolution of the ultrasound method, and the Doppler method for assessing the linear blood flow velocity in the microvasculature turned to be less operator-dependent and more reproducible.

Introduction. Liraglutide therapy has been shown successful in improving glycemic control in patients with type 2 diabetes, but the prospects of this drug use in treating patients with type 1 diabetes mellitus remain unclear. Therefore, the studies of liraglutide angiotropic effects have considerable scientific and practical interest. The aim of present study was to investigate the effect of glucagon-like peptide-1 receptors agonist – liraglutide – on microcirculation in conditions of alloxan-induced insulin deficiency in white rats. Materials and methods. The study was carried out in 40 white nonlinear rats that were divided into control (n=20), comparative (10 rats with alloxan-induced diabetes at a dose of 100 mg/kg) and experimental (10 animals with alloxan-induced diabetes that were treated with liraglutide) groups. Liraglutide at a dose of 0.4 mg/kg/day was injected subcutaneously in animals of the experimental group from Day 21 till Day 42 of the experiment. On Day 42 of the experiment, the concentrations of glucose and glycated hemoglobin in the blood in animals of the comparison and the experimental group were evaluated, as well as the microcirculation of dorsal skin of posterior paw was monitored with Laser Doppler Flowmetry (LDF). Results. Disorders of carbohydrate metabolism induced by alloxan in rats entailed pronounced changes in the microcirculation of posterior paw dorsal skin, associated with a decrease in endothelium-dependent vasodilation and increased neurogenic tone. Treatment with liraglutide caused normalization of glycemic metabolism and significantly (р<0,00001) increase perfusion of posterior paw dorsal skin in rats with alloxan-induced diabetes to 12,9 (12,4;13,4) perfusion units regarding to 9,6 (9,1; 10,1) in animals of the comparison group. Restoration of posterior paw skin microvascular perfusion under the influence of liraglutide was realized by stimulation of endothelium-dependent vasodilation. Conclusions. The administration of liraglutide in a dose of 0.4 mg/kg/day for 21 days in rats with alloxan diabetes leads to normalization of carbohydrate metabolism and restoration of normal perfusion of posterior paw dorsal skin.

The lack of donor hearts for transplantation in patients with end-stage chronic heart failure makes us look for new ways to increase the pool of donors. One of the possible ways to increase the donor base may be the use of asystolic donors, i. e. patients with in-hospital cardiac arrest or patients with cardiac arrest after brain death. The aim of the study was to examine the morphofunctional state of the heart after various periods of normothermic asystole in an experiment on rats. Materials and methods. Experiments were performed on female Wistar rats. After cervical dislocation and registration of respiratory arrest, the body temperature of the rat was maintained above at 36.5±0.5 °C for 10, 15 and 20 minutes, depending on the group. After asystole period, the heart was connected to the Langendorff apparatus to provide perfusion for 90 minutes. During perfusion of the heart, the pulse pressure inside the left ventricle (LVPP) and the volumetric flow rate of coronary perfusion (CP) were recorded every 15 minutes. After the end of the experiment, the volume of necrosis was calculated. Results. In the group with 20-minute ischemia, there was no recovery of ventricular contractions, the volume of necrosis was 34,9±11,7 %. In the group with 15-minute ischemia, the volume of necrosis was 19,5±7,6 %. In the group with 10-minute normothermic ischemia, the volume of necrosis was 13,1±5,1 %. Conclusions. 15 minutes of normothermic cardiac arrest in situ causes irreversible damage to the heart of the animal, which does not allow us to consider it as a potential donor heart. However, this volume of damage to the myocardium and microvasculature, together with the restoration of the contractile activity of the heart, makes this group the main one for the continuation of such experiments using various methods of heart reconditioning.

The purpose of work is to conduct a mathematical analysis of the relationship of central hemodynamic parameters (CHP) with blood flow indicators in the microvascular bed (MVB) in the skin of people and linear and volume indicators of blood flow in the MVB. Materials and methods. The analysis of CHP parameters (HR, BPs, BPd, BPp) with linear and volumetric parameters of blood flow in the MVB in 25 healthy men (19–60 years old), at rest, during the stress test in the bicycle ergometry, in the recovery period (RP) was performed. The parameters of blood flow in the MVB were measured by high-frequency ultrasound dopplerography on the skin of the finger nail fold with 20 MHz sensor. For analysis one-factor dispersion analysis (ANOVA) with Fisher criterion (p≤0.05), the method of main components, the Shapiro–Wilk criterion, LSD-criterion and the Tukey criterion were used. Results. There is a relationship between indicators of the CHP (HR, BPs, BPd, BPp) and parameters of blood flow in the MVB: maximum systolic velocity (Vs), maximum average velocity (Vm), maximum diastolic velocity (Vd) in the MVB during the stress test in the bicycle ergometry and in the RP. The indicators were divided in 3 groups after converting in the new coordinate system. Group 1 (n=10) was characterized by good blood flow of the capillary part of MVB (Vam=0.41±0.14 сm/s). Group 2 (n=8) had a reduced blood flow (Vam =0.16±0.06 сm/s). In group 3 (n=7), the capillary blood flow indices were low (Vam=0.115±0.07сm/s), but there was a high blood flow velocity in the arteriolar part (Vs=1.89±0.3 сm/s). Conclusions. The mathematical analysis showed the relationship of blood flow parameters in the arteriolar part of the MVB with indicators of the CHP. Indicators of blood flow in the arteriolar and capillary parts of the MVB in the skin of healthy people at rest differ in velocity and blood filling.

A brief review is dedicated to the latest advances in the field of non-invasive studies of capillary blood flow in humans based on the developments of Russian scientists. Modern computer technologies have significantly expanded the capabilities of researchers and make it possible to obtain information about fundamental processes at the level of the metabolic link of the vascular bed not only in a hospital setting, but also in a remote access mode, which is extremely important in the context of a pandemic caused by the SARS-CoV-2 virus.