Coronary artery disease (CAD) remains a top cause of morbidity and mortality nowadays. Current guidelines are used to deϐine timely diagnostic and management strategies for a patient with new angina symptom. According to the guidelines, the main purpose is assessment of the pretest probability of obstructive CAD. Exercise electrocardiography is the most accessible methodwith 85-90% speciϐicity and 45-50% sensitivity. Cardiopulmonary exercise testing (CPET) with concomitant monitoring of electrocardiogram, heart rate and blood pressure, expired gas analysis has become widespread among different exercise tests. CPET is an important clinical tool to estimate exercise capacity. In most cases it allowsto determine the causes of limited physical activity, evaluate both the blood supply (pulmonary, cardiovascular, haematopoietic systems) and tissue oxygen metabolism (skeletal muscle system) in response to physical exercise.The indications for invasive coronary angiography include: high clinical risk of CAD, symptoms which are refractory to medical therapy, low tolerance to exercise or if revascularization is considered for improvement of prognosis. The aim. To highlight the need for a combination of non-invasive stresstesting (CPET, stress echocardiography) and invasive testing (such as coronary angiography) to develop proper tactics of treating patients with established CAD. Conclusion. Described clinical case demonstrates preferences of combined different functional non-invasive tests (CPET, stress echocardiography) in a patient with confirmed CAD, who received prognosis modifying therapy and had high exercise tolerance due to regular cardio training. This gave the reason for postponing the repeated ICA to determine the dynamics of the progression of coronary atherosclerosis. However, when an anginal attack occurred and repeated urgent ICA was performed, it became necessary to perform coronary artery bypass grafting and, later, due to the continuation of anginal attacks and the presence of areas of ischemia, stenting of the trunk of the left coronary artery.

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The aim — to determine the frequency of different combinations of criteria of heart failure (HF) with preserved ventricular ejection fraction (EF), established by the European Society of Cardiology (ESC) in 2016, in symptomatic patients with arterial hypertension (AH) in clinical practice and to assess their relationship to the clinical profile and the structural and functional state of the heart and arteries.Materials and methods. The study included 103 patients aged 43 to 85 years, with symptoms and signs of HF, AH and LVEF ³ 50 %, which had signs of diastolic dysfunction (DD) according to Doppler EchoCG data. The level of N­terminal fragment of the brain natriuretic peptide (NT­proBNP) was assessed by an enzyme immunoassay. The pulse wave velocity (carotid­femoral) (PWVcf) was assessed using applanation tonometry. Using ECG, the back wall thickness (BWT) of the left ventricle (LV) and interventricular septal thickness (IST), end­diastolic index (EDI) and end­systolic index (ESI) of the LV, left ventricular myocardial index (LVMI), left atrium volume index (LAVI) and left ventricular ejection fraction (LVEF). Early (E) and late diastolic left ventricular filling velocity (A), E/A ratio, diastolic speed of septal and lateral motion of fibrous mitral valve ring, the mean value e¢, the relation Е/e¢, tricuspidal regurgitation velocity (TRV), the deceleration time of early diastolic filling (DT) and left ventricular isovolumic relaxation time (IVRT), and systolic pulmonary artery pressure (SPAP) — with the use of Doppler EchoCG were evaluated. Patients with ratio E/e¢ 9 — 13 at rest underwent diastolic stress test.Results and discussion. According to the ESC algorithm, HF was absent in 11 (10.6 %) patients (group 1); 28 (30.4 %) patients had structural criteria and no functional criteria (group 2); 64 (69.5 %) patients had three structural and functional criteria of HF according to ESC algorithm (group 3). High left ventricular filling pressure (LVFP) was found in all 35 (54.6 %) patients of group 3 without atrial fibrillation (AF) and in 7 (26.9 %) patients of group 3. Normal left ventricular filling pressure was found in all patients of group 1 and 7 (26.9 %) patients of group 2. Left ventricular filling pressure could not be identified in 4 (36.3 %) patients of group 1 and 12 (46.1 %) patients of group 2 (all p < 0.01). AF was present in 29 (45.3 %) patients of group 3 and in 2 patients (7.1 %) of group 2 (p < 0.01). Increase in SPAP was noted in 52 (81.2 %) patients of group 3 and 4 (14.2 %) patients of group 2 (p < 0.01). The dilatation of the right ventricle (RV) was more pronounced in group 3 than in groups 2 and 1 (p < 0.01 and p < 0.05). Patients of groups 1 and 2 were comparable according to PWVcf, patients of group 3 had higher values of this indicator than those of groups 2 and 1 (all p < 0.01). E/e¢ while exercise stress was more than 13 in 78.5 % patients of group 2 and in 18.2 % of group 1 (p < 0.01). Groups 2 and 3 had high levels of NT­proBNP — 438.4 ± 97.2 and 1057.3 ± 157.0 pg/ml, accordingly, in group 1 its level was 199.7 ± 17.2 pg/ml (all p < 0.01).Conclusions. In 70 % of patients with hypertension and clinical signs of HF, both structural and functional criteria of diagnosis of HF with preserved LV EF were defined according to the recommendations of the ESC (2016), which was associated with an increase in LV feeling pressure, AF — in 45 %, pulmonary hypertension — in 52 (81.2 %), with right ventricle dilatation — in 81 % and 27 % increase in PWVcf in compared with age and sex matched patients with AH without HF. AH patients with only two structural criteria of heart failure with a preserved LVEF in the absence of functional criteria (30 % of cases) differ from patients with AH without HF in terms of the level of NT­proBNP, an increase in E/e’ while exercise (85 % of cases) and comparable severity of clinical signs of heart failure.