Dilated cardiomyopathy (DCM) remains a disease with a poor prognosis. The improvement of the risk stratification for the fatal events, especially sudden cardiac death (SCD) to introduce preventive measures timely is an unmet need. Previously proposed non-invasive electrophysiological predictors - heart rate turbulence (HRT) and variability (HRV), deceleration (DC), acceleration (AC) capacity and high-sensitivity troponin (hs-Tn) - have not been evaluated in DCM. Material and methods. We enrolled 54 patients with DCM and sinus rhythm aged 42 [30; 58] years (36 males) and 54 people without cardiovascular diseases (32 males, median age 47 [27; 64] years) in the control group. The follow-up period was 4 years. At baseline, we performed ambulatory (Holter) ECG monitoring (AECG) with the assessment of HRV, HRT, DC, AC, echocardiography. In 30 patients with DCM and 14 persons without cardiovascular pathology was carried out biochemical blood analysis with determination of the concentration of hs-Tn. Patients received standard treatment for CHF, 18.5 % of patients underwent implantations of cardioverter defibrillators (ICDs). Results. The median LVEF in the study group was 32 % [22; 38]. CHF signs were reported in 93 % of patients. Patients with DCM differed from the control group, significantly lower values of SDNN, pNN 50, DC, TO, TS, and higher values of AC in early morning hours and a higher concentration of high-sensitivity troponin. During the 4 years, one SCD was reported, 7 patients died due to CHF progression, and one adequate shock in a patient with ICD was detected (a total of 9 fatal events). Patients with fatal events compared to survivors had lower EF, VRS, DC, large end-diastolic volume, the class CHF, ACE in early morning hours, the number of episodes of unstable ventricular tachycardia (NHT), however, was not characterized by higher levels of hs-Tn. In univariate analysis, the following predictors significantly increased the risk of fatal events (in order of importance): LVEF (Odds Ratio (OR) 32), SDNN (OR21), DC (OR 9), AC (OR 7'), pNN50 (OR6), nVT (OR5.2; p = 0.05). In multivariate analysis, LVEF < 26 % was the only independent predictor of fatal events (sensitivity 80 %, specificity 90 %). Conclusions. Non-invasive electrophysiological predictors of AC, DC, HRV may be used as additional methods of risk stratification of fatal events in patients with dilated cardiomyopathy. The determination of the concentration of hs-Tn is inappropriate. However, the only independent predictor of adverse outcome during 4 years is the PV of the left ventricle. The decrease in EF less than 26 % increases the risk of fatal events in 32 times.

New modifications of ultrasonic devices differ the high-quality visualisation, differentiated use of a frequency range, harmonious techniques, and integration of new digital technologies has approached transthoracic and transesophageal echocardiography. We have studied indicators of diagnostic accuracy transesophageal and transthoracic bicycle stress-echocardiography in diagnostics of the coronary insufficiency. It has been as a result proved, that new possibilities have raised the general specificity and sensitivity in diagnostics of CAD of the anterior-descending artery, however in identification of the coronary insufficiency of back wall the classical technique has appeared less reliable. It once again confirms an urgency transesophageal stress-echocardiography for inspection of persons with great volume of a thorax or not diagnostic «acoustic windows».

The article presents a literature review devoted to modern concepts of central aortic blood pressure (CAP) as an important indicator of arterial stiffness. Particular attention was paid to the clinical and prognostic significance of CAP, as well as the need to evaluate its parameters for choosing the optimal tactics for the treatment of hypertension.

The article presents the results of an open randomized study that examined the effectiveness of transcranial magnetic stimulation (TMS). Patients were randomized into 2 therapeutic groups. Patients of the first group underwent a course of repeated TMS of the left dorsolateral prefrontal cortex. Patients of the second group underwent adequate psychopharmacotherapy with the use of antidepressants. Analysis of the effectiveness of therapy, depending on the severity of depression, showed that TMS is more effective in treating severe depressions compared with adequate psychopharmacotherapy. It is most expedient to use this method in stable patients with prevalence of negative symptoms on the background of supporting antipsychotic therapy.

The current review is focused on the potentials of stress echocardiography (stress-echo) in cardiomyopathies (CM). The target parameters recommended for contractile reserve assesment and concomitant hemodynamic disorders (mitral regurgitation, pulmonary hypertension), as well as principles for interpreting the results of stress test in patients with dilated CM are mentioned. The algorithm for diagnosis and management of patients with hypertrophic CM with both symptomatic and subclinical obstruction of the left ventricular (LV) outflow tract is proposed.

Current review contains actual data concerning the role of stress echocardiography in aortic valve diseases. The indications for stress testing, main objectives, test procedure, most important parameters for assessment and principles of interpretation are discussed. Particular attention is paid to assessment the severity of low gradient aortic stenosis. The strategy of treatment of patients with aortic valve diseases, indications for valve surgery, including transcathether interventions, are summarized.

N our review we present update on modern state of knowledge and implementation of diagnostic transcranial magnetic stimulation in pediatrics. We review both literature and our own data. TMS may be implemented in normal as well as pathological conditions; it s safe and permitted for use in pediatrics. There are certain limitations due to incomplete myelination of motor pathways in children. Due to that some motor evoked potentials in healthy children may possess properties which would be considered pathological if registered in adults. Taking into the consideration these limitations, diagnostic TMS may be and should be implemented more aggressively in pediatrics.