Aim. To develop a prognostic model for the probability of adverse cardiovascular events over three years in patients over 70 years of age with prior myocardial infarction (MI), frailty syndrome, and myocardial revascularization.

Material and methods. This prospective study included 92 patients over 70 years of age with MI. Clinical and history data, the Charlson comorbidity index, general laboratory data, myocardial stress and fibrosis biomarkers (NT-proBNP and ST-2), and structural and functional cardiac parameters were assessed. The Age Is Not a Barrier questionnaire was used to identify frailty. The median follow-up period (Q1; Q3) was 1045 (367; 1099) days. An adverse cardiovascular event was chosen as the endpoint. Nonparametric statistical methods, Cox regression, and logistic regression were used.

Results. The mean age of patients was 77,3±2,4 years. Using Cox regression, following 3-year predictors of adverse cardiovascular events were identified: age ≥80 years (p=0,001), prior MI (p=0,011), CKD-EPI glomerular filtration rate on admission ≤55 ml/min/1,73 m2 (p=0,008), and pulmonary artery systolic pressure ≥38 mm Hg (p=0,022), Simpson’s ejection fraction ≤45% (p<0,001), left ventricular local contractility index ≥1,55 (p=0,001), serum NT-proBNP ≥650 pg/ml (p<0,001), serum ST2 ≥8,2 ng/ml (p<0,001), the Age Is Not a Barrier questionnaire score ≥3 (p<0,001), Charlson comorbidity index ≥6 points (p=0,001). Percutaneous coronary intervention (PCI) during the current hospitalization was associated with an improved prognosis for patients within three years (odds ratio 0,28 [0,14-0,58], p=0,001). The regression prognostic model for patients over 70 years of age with MI included three following parameters: the Age Is Not a Barrier questionnaire score ≥3, PCI performed during hospitalization for MI (Yes/No), and Simpson’s left ventricular ejection fraction (%).

Conclusion. PCI in patients over 70 years of age with MI and frailty reduces the risk of adverse cardiovascular events over three years. Prediction of adverse cardiovascular events is possible based on the proposed prognostic model.

Aim. To determine the prevalence of aberrant musculoskeletal status (MSS) variants among patients with stable coronary artery disease (CAD) and to evaluate their paraclinical characteristics.

Material and methods. Clinical and paraclinical from 160 patients with stable CAD treated at the Kemerovo Research Institute for Complex Issues of Cardiovascular Diseases were analyzed. The mean age of patients was 67 years (62,5; 73). The most common comorbidities included hypertension (n=152 (95%)), diabetes mellitus (n=46 (28,7%)), heart failure (n=160, (100%)), and chronic kidney disease (n=111 (69,4%)). Sarcopenia was verified according to the consensus of the European Working Group on Sarcopenia in Older People 2 (2019). The basis for establishing such pathology as osteoporosis and osteopenia were the t-test values in accordance with the current federal clinical guidelines. In the case of a combination of osteoporosis/osteopenia and sarcopenia, the condition was assessed as osteosarcopenia. Results. Patients with intact MSS were predominantly men; the group with aberrant MSS was predominantly women, which, naturally, was accompanied by shorter height, weight, and body mass index. No differences in the prevalence of comorbidities were observed. Paraclinical investigations revealed that patients with musculoskeletal system abnormalities had lower hemoglobin levels, activated partial thromboplastin time, and international normalized ratio, higher platelet counts, and lower dynamometry, musculoskeletal index, and femoral neck t-score values.

Conclusion. Aberrant MSS is a fairly common pathology in patients with CAD, occurring in more than half of cases. Osteopenia is the most common pathology (68,8%), equally distributed among men and women. Osteoporosis and osteosarcopenia are observed in 13,3% and 16,8% of cases, respectively. Accordingly, isolated sarcopenia occurs in only 1,1%. MSS pathology is associated with older age, female sex (except for osteopenia), and lower height and weight.

Aim. To study the strategy for primary coronary computed tomography angiography (CCTA) in patients 80 years and older with intermediate-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Material and methods. The study included 113 patients 80 years and older with intermediate-risk NSTE-ACS (men 26,5%, mean age 82,8±2,3 years). Patients in group 1 (n=43, men 25,6%, mean age 82,9±2,8 years) underwent coronary computed tomography angiography (CCTA), while patients in group 2 (n=70, men 27,1%, mean age 82,7±2,05 years) underwent invasive coronary angiography (ICA).

Results. Among 43 patients in the coronary CCTA group, the relationship between age and coronary calcium score values were insignificant (Rs=0,67), while more than 70% of patients had moderate coronary calcium index values, allowing for high-quality CCTA. In the coronary CCTA group, 6 patients required ICA, which resulted in percutaneous coronary intervention in two patients, multivessel disease in one patient, and a related artery diameter <2 mm in one patient, which was not amenable to stenting. In two patients, coronary artery lesions were hemodynamically insignificant. In the second group, 10 percutaneous coronary interventions (14,3%) were performed. Multivessel disease was detected in 7 patients (10%). In 38 patients (54,3%), stenoses were hemodynamically insignificant, and in 14 patients (20%), coronary arteries were not changed. Chronic coronary occlusion was detected in one patient (1,4%).

During an 18-month follow-up period, 5 patients (11,6%) died from all causes in the coronary MSCT group and 9 patients (12.9%) in the iCAG group.

Conclusion. In intermediate-risk NSTE-ACS patients aged 80 years and older, the strategies of CCTA and ICA did not significantly differ in the number of stenting procedures performed, the detection rate of multivessel coronary disease, or all-cause mortality.

Aim. To optimize the risk assessment of hemodynamically significant coronary artery (CA) stenosis in COVID-19 survivors with chronic coronary syndrome (CCS) based on a comprehensive analysis of anamnestic, clinical and paraclinical parameters.

Material and methods. The study included 431 patients with CCS and positive SARS-CoV-2 serological tests for >12 weeks prior to enrollment (203 with mild and 228 with moderate COVID-19). The examination included clinical and laboratory parameters (including apolipoprotein A1 and B, lipoprotein(a)), systemic inflammation biomarkers, echocardiography, coronary angiography, and residual risk assessment. Multivariate logistic regression analysis was performed to identify independent predictors of hemodynamically significant coronary artery stenosis. Statistical processing was performed using RStudio 2025.05.0 (R 4.4.2), with p<0,05 considered statistically significant.

Results. Patients with moderate COVID-19 were more likely to have class II obesity (p=0,004), type 2 diabetes (p=0,007), C3-C4 chronic kidney disease (p<0,001), functional class III angina (p<0,001), heart failure with mildly reduced ejection fraction (p=0,003), as well as more pronounced metabolic disorders and inflammatory shifts. In this group, GZSCA (86,4% vs, 68,0%; p<0,001), multivessel disease (p=0,046), and coronary artery restenosis (p=0,042) were diagnosed significantly more often. Multivariate logistic regression analysis identified the following predictors for hemodynamically significant CA stenosis: moderate COVID-19 (odds ratio (OR) 1,84 [1,02; 3,39], p=0,047), aortic diameter >3,28 cm (OR 2,52 [1,42; 4,55], p=0,002), segmental myocardial contractility disorders (OR 3,72 [1,71; 9,06], p=0,002), extracranial artery atherosclerosis (OR 2,56 [1,37; 4,78], p=0,003), hyperuricemia >308,5 μmol/L (OR 2,22 [1,25; 3,95], p=0,006), high-density lipoprotein <1,27 mmol/L (OR 1,99 [1,11; 3,62], p=0,021), high residual risk for low density lipoprotein (OR 2,48 [1,31; 4,7], p=0,005), triglyceride-glucose index >9,46 (OR 1,89 [0,91; 4,22], p=0,102), fibrinogen >3,25 g/L (OR 1,62 [0,83; 3,12], p=0,149), history of hypertension >16 years (OR 1,85 [0,98; 3,6], p=0,064) and age >56 years (OR 1,65 [0,88; 3,09], p=0,116). Based on the resulting multifactorial model, an online risk prediction calculator for hemodynamically significant CA stenosis in COVID-19 survivors with CCS.

Conclusion. Previous COVID-19, especially with moderate course, is associated with a more unfavorable clinical and angiographic phenotype of CCS. The developed risk prediction algorithm for hemodynamically significant CA stenosis can serve as a practical tool for early risk stratification and optimization of patient management in the post-COVID period.

Aim. To study the relationship between impaired left ventricular (LV) myocardial perfusion identified by dynamic single-photon emission computed tomography (SPECT) and left ventricular contractile dysfunction assessed using magnetic resonance feature tracking (MR-FT).

Material and methods. The study included 31 patients (men, 80,6%; median age, 63 years) with multivessel coronary artery disease (CAD). All patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) and dynamic SPECT with myocardial flow reserve (MFR) quantification. Depending on the global MFR, patients were divided into 2 following groups: group 1 (n=23) included patients with reduced MFR (≤2), and group 2 (n=8) included patients with preserved MFR (>2).

Results. According to contrast-enhanced cardiac MRI, patients with multivessel CAD and preserved MFR were characterized by a lower median LV mass, compared with the group with reduced MFR (105,68 (89,04; 108,70) g; 120,71 (84,13; 132,0) g, respectively). Moreover, the group of patients with preserved MFR had a higher proportion of LV myocardial fibrosis. Subanalysis of data by vascular regions based on two subgroups (with (MFR ≤2,0) and without microcirculatory disorders) showed that regional microcirculatory disorders are associated with a higher perfusion defect value, maximum stenosis, and an increase in regional longitudinal strain in a related vascular system. Correlation analysis revealed a relationship between regional MFR according to SPECT data and regional longitudinal strain according to cardiac MRI data (p=0,002; r=-0,404).

Conclusion. The combined use of quantitative SPECT perfusion and regional myocardial strein assessment using MR-FT provides unique, complementary information in patients with multivessel CAD. This directly links hemodynamic significance of stenosis with related myocardial function consequences. Regional longitudinal strain analysis serves as a highly sensitive and specific marker of ischemic dysfunction, maintaining diagnostic value even in patients with multivessel CAD, making it an additional marker of the functional significance of stenosis.

Aim. To study and compare the informative value of machine learning models based on radiomics parameters of non-contrast cine-cardiac magnetic resonance imaging (CMI) for differentiating between areas of post-infarction cardiosclerosis and intact myocardium in patients with ischemic cardiomyopathy (ICM).

Material and methods. This retrospective study included 88 patients with indications for surgical treatment of ICM. Preoperatively, all patients underwent contrastenhanced cardiac MRI. Radiomics analysis was applied to unenhanced cine MRI images. All images were segmented using 3D slicer software (version 5.2.2), and radiomic features were extracted using the SlicerRadiomics module. Texture analysis was performed on 176 cine cardiac MRI image regions, with 107 texture features identified for each one. The following machine learning algorithms were used: random forest, logistic regression, and gradient boosting with and without feature selection. Statistical data processing and machine learning model generation were performed using the Python programming language.

Results. Collinearity diagrams were constructed. Non-valuable features were identified. The cumulative value of features was estimated based on their total number, and the parameters with the least value were identified. Thirty-four features were found to contribute nothing to the total value. Lasso regularization resulted in the selection of the 10 most informative parameters (three shape features, two firstorder features, and five texture characteristics). Along with the logistic regression model (AUC=0,83), the CatBoost gradient boosting algorithm demonstrated high performance (AUC=0,8), and feature selection improved all models used in the study, with the highest CatBoost scores (AUC=0,83). The random forest algorithm demonstrated less reliable results compared to other models and can be considered as an additional method when feature interpretation is required.

Conclusion. Radiomics analysis has demonstrated high potential for differentiating scarred and viable left ventricular myocardium in patients with ICM. This opens up the prospect of using it as an alternative to traditional delayed contrast-enhanced methods in these patients.

Aim. To study the results of the heart failure center (HFC) implementation at a level 3 cardiology facility and to assess the rehospitalization risks and the economic impact of HFCs in real-world clinical practice.

Material and methods. The study included 414 patients undergoing inpatient treatment at a level 3 facility. The primary inclusion criterion was the echocardiographic detection of reduced and mildly reduced ejection fraction. Patients were divided into two following groups: group 1 (n=154) — patients who continued outpatient follow-up in the HF office after discharge; group 2 (n=222) — those who were not followed in the HF office. An analysis of patient readmissions was conducted using data from a unified digital platform. Statistical data processing was performed using Excel and Biostat, with Student’s t-test and chi-square tests. The cost-effectiveness of the HF office was calculated.

Results. A HF office was established at a level 3 facility, comprising inpatient and outpatient follow-up phases using a seamless model. In both groups, there were more men than women. Patients were comparable in age, clinical status, and comorbidities. The main causes of HF in the study groups were coronary artery disease, including prior myocardial infarction, and atrial fibrillation. Upon discharge from the hospital, all patients were recommended quadruple therapy for HF. Patients in the first group visited the HF office 362 times over the course of a year. An analysis of readmissions was conducted over a one-year follow-up period after discharge. The proportion of patients readmitted to the hospital within a year of discharge was significantly higher in group 2 (37,5%) than in group 1 (13,6%) (odds ratio 3,782; 95% confidence interval 2,216-6,454; p<0,0001). The cost-effectiveness was RUB 1111564.

Conclusion. Monitoring in the HF office significantly reduces readmissions and alleviates the burden on the healthcare system.

Aim. To evaluate the impact of a clinical decision support system (CDSS) in the management of patients with hypertension (HTN) and atrial fibrillation (AF) on compliance with clinical guidelines in real-world clinical practice.

Material and methods. A cluster-randomized comparative study was conducted in 8 internal medicine departments in Samara. The departments were randomized into two following groups: one with the CDSS for prescribing anticoagulant, antiarrhythmic, and antihypertensive therapy (n=3; 2 inpatient and 1 outpatient department) and one without the CDSS — routine clinical practice (n=5; 3 inpatient and 2 outpatient departments). The study included patients with both hypertension and AF. The mean follow-up period was 11,5±5,7 months.

Results. The study included 272 patients. Prescription rate of reduced doses of direct oral anticoagulants was significantly lower in the CDSS group as follows: apixaban 2,5 mg (0,8% vs 4,4%, p<0,001) and rivaroxaban 15 mg (4,2% vs 15%, p<0,001). In the CDSS group, amiodarone was prescribed significantly less frequently for rhythm control (3,6% vs 30%, p<0,001), and catheter ablation were performed more frequently (16% vs 5%, p=0,014). With the use of CDSS, the proportion of patients with cardiovascular events (CVEs) during the 12-month follow-up period decreased (4,2% vs 13,9%; when converted to 10 patient-years, 0,39 and 1,71, p<0,001).

Conclusion. CDSS implementation demonstrated a significant improvement in physician compliance with clinical guidelines in terms of prescribing optimal anticoagulant and antiarrhythmic therapy. Patients were more frequently referred for catheter ablation of AF. CDSS is associated with a reduced incidence of CVEs in patients with hypertension and AF.

Aim. To evaluate the potential of a fixed-dose combination of amlodipine and indapamide in hypertensive (HTN) patients with high pulse pressure (PP).

Material and methods. The study included 39 male and female patients aged 20 to 75 years (56,2±7,8 years) with HTN. Patients were examined using a standard protocol, including collecting a history and complaints, a physical examination, and laboratory and functional diagnostic tests, including electrocardiography, 24-hour blood pressure (BP) monitoring, echocardiography, and volume sphygmography with arterial stiffness measurements. Investigations were performed at baseline and after 3-month antihypertensive therapy with amlodipine and indapamide at doses of 5/1,5 mg or 10/1,5 mg. Statistical analysis of the obtained data was performed using Microsoft Office XP and Statistica 10 (StatSoft Inc., USA).

Results. After 3-month therapy, significant improvements were recorded in office systolic and diastolic BP, which decreased from 163,2±6,72 to 134,6±5,81 mm Hg (p<0,001) and from 89,9±7,51 to 78,4±5,54 mm Hg (p<0,001), respectively. In addition, 24-hour BP profile were improved — the overwhelming majority of patients moved into "dipper" HTN phenotype (62%). Left ventricular mass index decreased from 115,6±7,1 to 95,3±5,21 g/m2 (p<0,01), and the transmitral E/A ratio increased from 0,88±0,04 to 0,94±0,06 (p<0,05). PP significantly decreased from 68,1±4,9 to 52,4±4,7 mm Hg (p<0,001). Initially elevated right and left CAVI decreased by 13,8% and 14,2%, respectively, reaching reference values (p<0,01), while the biological vascular age also decreased, reaching the rated value. Target BP values were achieved in 88% of patients.

Conclusion. Achieving target levels and improving the 24-hour BP profile, echocardiographic parameters, and vascular stiffness parameters, along with PP normalization in the vast majority of study patients after 3-month therapy support the high efficiency of the fixed-dose combination of amlodipine and indapamide in real-world practice for hypertensive patients with high PP.

Aim. To conduct a comparative cost-effectiveness analysis of therapy with sodiumglucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists in patients with type 2 diabetes (T2D) and high cardiovascular risk in the Russian Federation.

Material and methods. Given the comparable clinical efficacy of these drug classes for the major adverse cardiovascular events (MACE), as confirmed by systematic reviews, a cost-minimization approach was chosen for the analysis. Annual costs were calculated for agents from the list of vital and essential drugs for a target population of 2,74 million patients.

Results. The average annual cost of therapy with SGLT2 inhibitors was RUB 29973,53 and was more than 2 times lower than the cost of therapy with GLP-1 agonists (RUB 66594,10). Using SGLT2 inhibitors across the entire target population will save RUB 100,33 billion per year (the costs of GLP-1 therapy are higher then 122%) with comparable clinical efficacy.

Conclusion. Based on comparable clinical efficacy and significant cost advantage, SGLT2 inhibitors can be recommended as priority therapy in Russian clinical practice to reduce cardiovascular risk in patients with T2D.

The safety and efficacy of prehospital intraosseous administration of nonimmunogenic staphylokinase in a patient with ST-elevation acute coronary syndrome (STE-ACS) was clinically confirmed. A case of prehospital intraosseous thrombolytic therapy with non-immunogenic staphylokinase at a single bolus dose of 15 mg in a patient with STE-ACS is described. Intraosseous administration is a rapid and reliable emergency, which can be used, among other things, for thrombolytic therapy.

This article presents a case of systemic thrombolytic therapy in a patient with intermediate-high risk pulmonary embolism (PE). Several randomized clinical trials of thrombolytic therapy in this patient population are currently underway worldwide, but the related evidence base remains insufficient. The efficacy and safety of thrombolytic therapy are demonstrated. The complexity and lack of definitive criteria for deciding on thrombolysis in real-world clinical practice are emphasized. We noted the importance of an individualized assessment of the clinical situation.

Aim. To substantiate the design characteristics of an innovative Russian-made selfexpanding nitinol stent prototype, as well as to evaluate the outcomes of its implantation in laboratory animals in an experimental study.

Material and methods. We selected five domestic pigs for a study of the efficacy and safety of Russian-made self-expanding nitinol stents within the iliac artery. Animal measurements were regularly monitored throughout the experimental period. Three months after stenting, iliac and femoral vessels was assessed using angiography and ultrasound, after the animals were euthanized. Next, a histological analysis of the stented vascular segments followed. We also analyzed stent geometric characteristics and their impact on the external environment, including external pressure, using computer modeling methods.

Results. During the three-month follow-up period, the health of all study animals remained stable and without abnormalities. Repeated examinations, including angiography and ultrasound, conducted after this period confirmed complete vascular patency and no hyperplasia in the implantation area. Histological revealed the integrity of the stent wall and no signs of damage. By modeling the implanted stent behavior under external pressure, we developed an optimal design for future medical devices.

Conclusion. The developed models of all-metal nitinol stents have successfully completed preclinical testing in animal models, confirming their safety and efficacy. Furthermore, innovative bare-metal stent designs for the treatment of peripheral arterial diseases have been created, featuring a unique structure with adjustable spacing between the corrugations.