Relevance. The results of the structural and functional condition of the heart in patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction and chronic kidney disease stage 3 were analyzed. Purpose. To study clinical and laboratory parameters, as well as the structural and functional condition of the myocardium in patients with chronic kidney disease stage 3 and chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction. Materials and methods. A total of 41 patients with chronic stage 3 kidney disease and chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction were examined. Structural and functional changes in the myocardium were estimated by means of echocardiography and tissue Doppler imaging. Results and conclusion. In patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction, the presence of chronic kidney disease stage 3b in comparison with stage 3a is characterized by a more significant interatrial conduction abnormality, AV-node and bundle of the His, and also more significant violation of systolic function, not only the left, but also right ventricles. In the patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction and the presence of chronic kidney disease stage 3a, diastolic dysfunction of the left ventricle of the I type prevails significantly more often. In the patients with chronic kidney disease of 3b stage diastolic dysfunction of the left ventricle type II is more common.

A total of 51 men at a mean age of 55±5.2 years with coronary heart disease were available for examination. Twenty of them presented with confirmed age-related androgen deficiency while the remaining 31 had the testosterone level within the normal reference values. The study included characteristic of lipid and carbohydrate metabolism, diagnosis of obesity and its type, estimation of the depression level, echocardiographic imaging, 24-hour ECG monitoring, and myocardial perfusion scintigraphy. The patients with androgen deficiency were shown to more frequently suffer abdominal obesity and high-level depression than those with the normal testosterone level. Moreover, patients of the former group usually had atypical anginal syndrome. The deficit of androgens was not infrequently associated with a rise in the number of ventricular extrasystoles. The correlation analysis demonstrated a significant negative relationship between the total testosterone level, blood glucose and triglyceride levels, the duration of ST segment ischemic depression.

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A total of 161 men with at a mean age of 58 (52; 64) years were available for examination. Sixty of them presented with coronary artery disease and confirmed late-onset hypogonadism, 80 had coronary artery disease and normal testosterone, 21 had no coronary artery disease and no hypogonadism. The study included echocardiography, Holter monitoring, heart computed tomography, coronarography and estimation of depression level. We found that low testosterone in patients with coronary artery disease is associated with decreased left ventricular ejection fraction, atypical anginal syndrome and subclinical depression. Men with androgen deficiency and ischemic heart disease have lower heart rate variability, longer time of ST interval depression and greater amount of extrasystoles, than patients with ischemic heart disease and no androgen deficiency. There is a negative correlation between total testosterone and amount of myocardial revascularisation operations in men with normal testosterone. Patients with free testosterone <9pg/ml have more severe coronary artery disease than men with free testosterone >9pg/ml according to coronary angiography.

We reported a case of a twenty-one-year-old man with an atrial flutter as the first manifestation of progressive cardiac conduction disease. The patient was admitted to the cardiology department due to complaints of shortness of breath and a decrease in exercise tolerance, which had happened after physical exercises (running). During ambulatory ECG monitoring persistent AFL was observed with atrial rate 262-297 bpm and ventricular rate 26-136 bpm (average 56 bpm). AV conduction was very variable – 4:1-14:1. The results of ambulatory ECG monitoring during the whole period of recording indicated signs of atrioventricular conduction disturbances. After cardioversion sinus rhythm was restored additional rhythm and conduction disorders were revealed. Ambulatory ECG monitoring was performed two weeks after the initial one, and throughout this recording were registered sinus rhythm on the background of first-degree AV block; transient Mobitz I AV block; and type 2 second-degree sinoatrial block. Trans-esophageal electrophysiology study was performed. During pharmacological denervation of the heart, signs of slowing of the atrioventricular conduction and sinus node recovery time persisted. These changes along with right bundle branch block were regarded as a progressive cardiac conduction disease with an apparently hereditary cause.