Aim. To evaluate real-world clinical practice in diagnosing obstructive coronary artery disease (CAD).

Material and methods. This prospective multicenter study was conducted as part of the international EURECA registry (May 2019 — March 2020) with the participation of the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo). In our center, 201 patients were included in the study. There were following inclusion criteria: stable chest pain, shortness of breath on exertion, suspected or confirmed CAD. The primary endpoint of the EURECA study was adherence to the 2019 European Society of Cardiology (ESC) guidelines in the selection of the initial imaging test and throughout the diagnostic process.

Results. In the study group, the mean age was 64,0±10 years, and 53,3% were men. Typical angina was detected in 51,2% of patients, and atypical angina was detected in 30,8%. High pre-test probability (>15%) was observed in 41,3% of patients. Noninvasive diagnostic methods were used in only 21,4% of cases. Invasive coronary angiography was performed in 84,6% of patients, with 77,1% performing the initial diagnostic test. Obstructive CAD were detected in 41,2% of patients. Compliance with the 2019 ESC guidelines was noted in 31,8% of cases.

Conclusion. Significant deviations were identified in the EURECA registry at our center: noninvasive tests were performed in only 21,4% of patients, while invasive coronary angiography was performed in 77,1%. The 2019 ESC guidelines were followed in 31,8% of cases. The detection rate of obstructive CAD was 41,2%, but adherence to the guidelines did not increase this rate. In future studies, it is important to consider the clinical probability of obstructive CAD and more widely use noninvasive methods.

Purpose. To evaluate the prognostic value of contrast-enhanced magnetic resonance imaging (MRI) performed early after acute myocardial infarction (AMI) in the development of adverse outcomes during the follow-up period of 12 months.

Materials and methods. This observational study consecutively enrolled 88 patients admitted to the cardiology emergency department with a primary diagnosis of AMI, with or without ST-segment elevation. A combined endpoint was formed at the end of the 12-month follow-up period, including 'hard' clinical outcomes. All patients underwent cardiac magnetic resonance imaging (CMR) with contrast on days 4–7 after admission. CMR was used to measure the main volumetric indices of the heart chambers and their function, as well as the tissue characteristics of the myocardium, such as edema percentage, infarct size, and the grey zone of myocardial infarction, expressed as a percentage and in grams of left ventricular myocardial mass (LVMM).

Results. The follow-up period was 357 ± 23 days. Endpoint (EP) data were obtained from all 88 patients in the sample (100%). A total of 16 patients (18%) were found to have achieved the combined EP. Myocardial infarct size, as expressed by LV myocardial mass and LV end-diastolic index, is an independent predictor of the development of adverse cardiovascular events in the mid-term follow-up period in patients undergoing acute myocardial infarction. The prognostic model based on clinical data and MRI scans had a higher prognostic value, but this did not reach statistical significance in the sample of patients considered. Meanwhile, the prognostic models based on clinical risk factors for adverse cardiovascular events (ACE) (sex, age and GRACE risk) and those based on CMR data did not differ significantly in terms of informativeness.

Conclusion. Cardiac structural and functional indices obtained by CMR are associated with the severity of the disease at the hospital stage in patients after an acute myocardial infarction and can be used as prognostic predictors of adverse cardiovascular events in the medium term. These indices can also be used as prognostic predictors of adverse cardiovascular events in the medium term.

Aim. To determine the threshold value of interleukin (IL)-18 for assessing the risk of nonST-segment elevation acute coronary syndrome (NSTE-ACS) and ST-segment elevation acute coronary syndrome (STE-ACS) and to construct a 12-month prognostic model.

Material and methods. A total of 109 patients with stable coronary artery disease (CAD) living in a large industrial city in central Russia were examined. Serum IL-18 concentrations, reflecting the risk of ACS, were determined using enzyme-linked immunosorbent assay. A prognostic model for determining the risk of ACS was constructed.

Results. IL-18 has a direct relationship with the risk of ACS in patients with stable CAD. An increase in IL-18 by 1 unit increases the ACS probability by 1,007 times (95% confidence interval (CI): 1,004-1,011), i.e. by 0,7%. The optimal cutoff value of IL-18 associated with the ACS risk in patients with stable CAD was established to be 361 pg/ml. With an IL-18 value ≥361 pg/ml, a risk of ACS in patients with stable CAD was noted. The obtained ROC curve was characterized by an AUC value of 0,881±0,032 (95% CI: 0,818-0,944) (p<0,001). During 12-month follow-up, ACS developed in 21 (19%) patients. Significant correlations were established between IL-18 and other biomarkers (IL-1, IL-4, and TNF-alpha).

Conclusion. The obtained data confirm the significance of IL-18 as a predictor of ACS risk.

Aim. To analyze bulbar conjunctival microcirculatory parameters in patients with stage I-III hypertension (HTN) and stage I heart failure (HF) with preserved left ventricular (LV) ejection fraction (EF), depending on diagnostic criteria.

Material and methods. Of 139 patients with stage I-III HTN and preserved (≥50%) EF, stage I HF was identified in 89 patients according to the 2024 clinical guidelines on heart failure. According to the diagnostic criteria, all patients with stage I HF met the criteria. The subjects were divided into 3 following groups: group 1 (n=56) with echocardiographic criteria and normal N-terminal pro-brain natriuretic peptide (NT-proBNP) levels; group 2 (n=10) with isolated elevated NT-proBNP levels and no echocardiographic findings; group 3 (n=23) with a combination of echocardiographic findings and elevated NT-proBNP levels. All subjects underwent bulbar conjunctival microcirculation (MC) examination using biomicroscopy.

Results. Microcirculation in different phenotypes of HF with preserved EF (HFpEF) has own characteristics, depending on the set of diagnostic criteria for HF. In the group of patients with isolated elevated NT-proBNP levels, minimal mean venule diameters, decreased mean arteriolar and capillary diameters, and their number per 1 mm2 of conjunctival surface were observed compared to patients receiving only echocardiography as diagnostic criteria for HF. The most pronounced changes in microcirculation were observed in the group of patients meeting both diagnostic criteria for HF with LVEF (echocardiography and NT-proBNP). These changes were manifested by minimal mean arteriolar and capillary diameters, arteriole-to-venule ratio, and significant capillary rarefaction (2,7 U/mm2). Exclusion of patients with type 2 diabetes in the subanalysis did not affect the microcirculation results.

Conclusion. The results demonstrated heterogeneity in the phenotype of stage 1 HFpEF in terms of changes in the bulbar conjunctiva microcirculation depending on the set of HF diagnostic criteria. This requires further research to better understand the functional characteristics of this HF phenotype and treatment approaches.

Aim. To evaluate the impact of the blood pressure (BP) measurement timing and the patient’s positioning on BP values and myocardial performance data according to echocardiography.

Material and methods. This prospective study included 100 patients aged 21 to 84 years. BP was measured on the right arm using a mechanical BP monitor four times depending on the time and patient positioning as follows: before echocardiography in the supine position (BP1); before echocardiography in the left lateral position (BP2); during echocardiography when apical view were established (BP3); after echocardiography, when the patient was again lying supine (BP4). To calculate myocardial work, the pressure-strain curve method was used for each of the obtained BP measurements.

Results. The highest systolic blood pressure (SBP) was observed during the baseline measurement (BP1) and amounted to 120±12 mm Hg. Between BP1 and BP2 measurements, SBP significantly decreased (p<0,001). The decrease in SBP between BP2 and BP3 was 3% (p=0,598). During BP3 measurement, SBP decreased by 10,3% from the baseline (lowest, 109±12 mm Hg). Between BP3 and BP4 measurements, SBP values increased significantly (p<0,005). The SBP values at BP4 were significantly lower compared to BP1 (p<0,001). Accordingly, the myocardial work index was 1716±301 mm Hg% at BP1, decreased to 1597±277 mm Hg% and 1551±260 mm Hg% at BP2 and BP3, respectively, and increased to 1623±254 mm Hg% at BP4 (pBP1-BP2<0,005; pBP2-BP3=0,226; pBP3-BP4<0,05; pBP1-BP4<0,05).

Conclusion. To obtain reliable and comparable values when calculating myocardial work, a standardized approach to blood pressure measurement is necessary. Standardized blood pressure measurement implies its performance at a specific point in time and in a specific body position of the patient. The optimal time and position for measuring blood pressure to calculate myocardial work are at the end of the echocardiography, after turning the patient supine.

Aim. To compare the diagnostic parameters of machine-learning-based score for assessing the long-term mortality risk after myocardial infarction (MI) and unstable angina (UA), based on a machine-learning model, and the Global Registry of Acute Coronary Events (GRACE) 2.0 scale.

Material and methods. This retrospective review of 1515 medical records of patients with MI and UA were performed. During 62-month follow-up, 238 cases of cardiac death and 1277 favorable outcomes were recorded. Eighty percent of the data were used for training using a categorical boosting classifier. The final model utilized eight automatically extracted, most significant variables. The model’s performance was assessed using following key metrics: sensitivity, specificity, positive and negative predictive value, positive to negative likelihood ratio, F1 score (the harmonic mean between sensitivity and positive predictive value), receiver operating characteristic (ROC), Youden index, and summary predictive index.

Results. The diagnostic accuracy of the GRACE 2.0 score (area under the curve (AUC)=0,74) and the machine learning (ML)-based long-term mortality risk assessment score after MI and UA (AUC=0,73) were consistent. The ML risk score demonstrated consistent performance across all stages of cross-validation. In the ML risk score, the feature with comparable significance to age was left ventricular ejection fraction (LVEF). After 30 months, survival of patients with a baseline LVEF ≤40% decreases significantly from the time of MI or UA. Verification of a high mortality risk based on the ML risk score will classify the patient as high-risk, even with dynamic improvement in LV function.

Conclusion. Long-term mortality risk after MI or UA is assessed using the ML model using the following 8 parameters: age, LVEF, body surface area, creatinine level, systolic blood pressure, heart failure stage, and comorbidity. The accuracy of predicting mortality in patients after MI or UA using the ML risk score is comparable to that of the GRACE 2.0 score. Diagnosing a high risk of cardiac mortality in patients with MI or UA with n LVEF ≤40% may optimize secondary prevention measures in this group of patients.

Aim. To compare the prognosis of patients with acute heart failure (AHF) with positive and negative cardiac fatty acid binding protein (cFABP) tests.

Material and methods. In 63 patients hospitalized for severe Killip class III-IV AHF, cFABP was measured within the first 3 hours of symptom onset using a qualitative method with individual test kits. Patients were followed for 12 [9; 13] months. Results. Patients with a positive cFABP test had higher in-hospital and overall mortality. Troponin I levels above the 99th percentile are associated with higher long-term mortality, while N-terminal pro-brain natriuretic peptide is not associated with the death risk in patients with severe AHF.

Conclusion. cFABP can be considered a prognostic marker of adverse outcome in patients with severe AHF.

Aim. To compare the effectiveness of glomerular filtration rate (GFR) estimation equations (CKD-EPI, MDRD, MCQ, Cockcroft-Gault) in predicting in-hospital death and/or acute renal failure in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG).

Material and methods. An analysis of anonymized medical data from 2600 patients with stable CAD who underwent elective isolated CABG. All patients underwent renal function assessment using four equations (CKD-EPI, MDRD, MCQ, and CockcroftGault) and were then divided into groups based on their baseline GFR level: group

1        — patients with high or optimal renal function (GFR ≥90 ml/min/1,73 m2), group

2        — patients with slightly reduced GFR (60-89,9 ml/min/1,73 m²), group 3 — patients with moderately reduced GFR (45-59,9 ml/min/1,73 m²), group 4 — patients with significantly reduced GFR (30-44,9 ml/min/1,73 m²), group 5 — patients with extremely reduced GFR (<30 ml/min/1,73 m²). The endpoint was a composite outcome of death and/or acute kidney injury (AKI) within 30 days after CABG. To assess the prognostic value of different methods for estimating GFR in each group, we used ROC analysis, plotting curves and calculated the area under the curve (AUC), followed by pairwise comparison of AUC using the DeLong method.

Results. In the general patient group, all GFR equations demonstrated significant ability to predict outcome (p=0,004 for all). However, pairwise comparison using AUC with the DeLong method revealed that the MCQ and CKD-EPI formulas had a significant advantage over the MDRD. In group 1, the CKD-EPI (AUC 0,620, p=0,048) and MCQ (AUC 0,605, p=0,020) equations demonstrated the best prognostic capabilities. In a pairwise comparison of AUC, both equations had a significant advantage over MDRD (PCKD-EPI=0,042, PMCQ=0,011). In group 2, initially only CKD-EPI (AUC 0,614, p=0,005) showed an advantage; however, when comparing the curves according to DeLong, both CKD-EPI (p=0,034) and MCQ (p=0,045) were more effective than MDRD. In group 3, CKD-EPI proved to be more accurate in predicting outcomes (AUC 0,656, p=0,049); when comparing AUC according to DeLong, CKD-EPI had a probable advantage over MDRD (p=0,071). In Group 4, the Cockcroft-Gault equation had the highest AUC of 0,759 (p=0,032). However, its accuracy was not confirmed in a pairwise comparison with other equations. Calculation of parameters was not possible for group 5 due to small sample size.

Conclusion. The CKD-EPI and MCQ formulas were significantly superior to the MDRD in assessing the risk of death and/or acute renal failure after CABG in patients with CAD and high or slightly reduced renal function (GFR >60 ml/min/1,73 m²). The MDRD equation was less reliable in predicting adverse postoperative outcomes. The data obtained regarding the effectiveness of the above formulas, including the Cockcroft-Gault one, in patients with lower GFR require verification in studies with larger sample sizes. This will allow the development of more precise practice recommendations.

Aim. The aim of this study was to investigate the association between serum adropin levels and the presence of chronic total or subtotal coronary artery occlusion, and to explore its relationship with the Japan CTO score.

Material and methods. As a single-center prospective study, individuals with atherosclerotic plaque or chronic non-total lesion in the coronary artery were classified as the control group (n=40), and individuals with chronic total or subtotal occlusion in any of the coronary arteries were included in the study group (n=50). Demographic and clinical characteristics of all individuals were recorded. Adropin and other blood parameters were measured.

Results. The average serum level of adropin in the study group was measured as 52.76±41.7 pg/mL, and in the control group was measured as 35.76±4.88 pg/mL, respectively (P<0.001), which was statistically significant. The average of high-sensitivity C-reactive protein in the study group was determined as 8.7±18.7 mg/dL, and in the control group, it was 5.3±8 mg/dL, with p=0.05, which was borderline significant between groups.

Conclusion. Serum adropin levels were significantly higher in patients with chronic total occlusion compared with non-CTO controls. These findings suggest an association between adropin and chronic total occlusion presence rather than a direct measure of collateral effectiveness.

Aim. To study the clinical and demographic data of a non-selective population of patients with post-infarction ventricular septal rupture (VSR) at a single center in Russia.

Material and methods. This single-center, retrospective, observational cohort study included all patients with post-infarction VSR admitted to the Chazov National Medical Research Center of Cardiology in Moscow between 2019 and 2025. Demographics, comorbidities, clinical course, echocardiographic data, frequency and timing of open surgical repair and percutaneous closure, mechanical circulatory support, and patient routing were assessed using descriptive statistics. A search for independent factors influencing the choice of primary intervention was conducted using multiple logistic regression.

Results. A total of 94 patients with post-infarction VSR were included in the study between 2019 and 2025. The mean age was 68,5±12 years (women, 56,4%). The most common medical history included hypertension (82/94, 87,2%), diabetes (35/94, 37,2%) and obesity (27/94, 28,7%). An attempt of coronary reperfusion was made in 69,2% of patients (65/94), while only in 28,7% (27/94) it was timely and successful. Cardiogenic shock (CS) occurred in 66% (62/94) of cases, most often stages D 24/62 (38,7%) and E 20/62 (32,3%). Mechanical circulatory support was used in 53,2% of cases. Any curative treatment was performed in 87,2% of cases. Independent predictors of percutaneous closure were pre-intervention CS (8,31 [2,77-24,93], p<0,001) and age over 65,5 years (3,98 [1,36-11,59], p=0,011).

Conclusion. Patients with post-infarction VSR have significant comorbidity. Timely successful coronary reperfusion was achieved in less than a third of patients. A high incidence of end-stage CS is noted, which, along with age over 65,5 years, is an independent predictor of performing percutaneous closure.

Aim. To present the clinical and demographic characteristics of patients with hypertension (HTN) receiving dual antihypertensive therapy (AHT), with a focus on the combination of amlodipine (AMLO)+indapamide (INDA) and AMLO+perindopril (PERINDO) in 2018-2022, based on data from Russian population-based studies.

Material and methods. The study included data from a representative sample of 13879 individuals with HTN aged 35-64 years from 34 Russian regions. This observational cross-sectional study included a survey (AHT over the past 2 weeks was recorded, with the medication brand name indicated and coded) and paraclinical tests (including blood pressure measurement). Statistical analysis was performed using the R statistical programming language (version 4.4). Quantitative variables are described by the median and interquartile range (Me) [Q25; Q75] or the mean and standard deviation (M±SD). Qualitative indicators are described as relative frequencies in percentages. Associations between antihypertensive therapy (AHT) use and clinical and epidemiological factors were assessed using logistic regression.

Results. Among individuals with HTN, 59,6% (8274/13879) received treatment, of which 58,1% — monotherapy, 31,4% — dual therapy, 9% — triple therapy, and 1,5% — quadruple therapy. The most common combinations in dual AHT are ACE inhibitors+beta-blockers (18,8%) and ACE inhibitors+diuretics (17,5%). The proportion of patients receiving AMLO+PERINDO and AMLO+INDA combinations is low (3,2% (262/8274) and 3,0% (246/8274), respectively). The proportion of fixed-dose combinations among those receiving AMLO+INDA was 28,0% (69/246), and among those receiving AMLO+PERINDO — 64,9% (170/262). In multivariate analysis, male sex was independently positively associated with AMLO+PERINDO use (odds ratio (OR)=1,89), while no higher education AMLO+PERINDO (OR=0,67) and the presence of COPD (OR=0,65) were associated negatively. Older age (OR=1,54), hyperuricemia (OR=1,98), and type 2 diabetes (OR=1,55) were positively associated with AMLO+INDA use, while chronic kidney disease was associated negatively (OR=0,56).

Conclusion. Among patients with HTN in the Russian population, the proportion of patients receiving rational dual combinations of AMLO+PERINDO and AMLO+INDA is low, and their use as fixed-dose combinations is extremely limited.

Aim. To evaluate the effect of dapagliflozin on the left ventricular (LV) structural and functional characteristics based on magnetic resonance imaging (MRI) data and markers of heart failure in patients with myocardial infarction (MI) after revascularization.

Material and methods. A total of 82 patients aged 58 [53; 61] years were included. All patients received pharmacotherapy in accordance with current clinical guidelines. The subjects were divided into following groups: group D (n=41): dapagliflozin 10 mg was added to therapy for MI at hospital discharge; group C (control) (n=41): patients received standard therapy. Cardiac MRI and blood tests were performed at baseline and after 24 weeks. A 6-minute walk test was performed after 5-6 and 24 weeks.

Results. According to cardiac MRI, scar mass (in grams) decreased by 26,6% (p<0,001) in group D, with a significantly lower change in group C (p=0,024). Regression of peri-infarct zone (PIZ) heterogeneity (in grams) in patients of group D was 30,2% (p=0,002), and in group C — 20,8% (p=0,017). The global contrast index (GCI) decreased by 15% in group D (p=0,006). In the comparison group, the changes were minimal (p=0,001). The frequency of microvascular obstruction in group D decreased from 57,5% to 32,5% (p=0,025). In group C, microvascular obstruction was initially diagnosed in 43,6%, and recurrently in 25,6% (p=0,095). Only in group D, there was a significant decrease in the extracellular fluid volume (ECV) in the infarct core revealed, from 63 (51; 70) to 56 (42; 67)% (p=0,003). Dapagliflozin therapy resulted in a 61,3% (p=0,001) regression of N-terminal probrain natriuretic peptide after 24 weeks, and an increase in a 6-minute walk test distance from 450 (400; 480) m 5-6 weeks after MI to 550 (450; 580) m by the end of the follow-up (p<0,001). These parameters remained unchanged in Group C.

Conclusion. In patients in the post-MI period, dapagliflozin demonstrated a cardioprotective effect in various infarction zones according to MRI data, which was accompanied by an improvement in heart failure markers.

Aim. To assess the clinical significance of arrhythmias during the recovery period of a bicycle stress test (BST) in asymptomatic patients, determining their possible association with cardiac remodeling and renal dysfunction.

Material and methods. This cross-sectional, continuous study included 44 asymptomatic patients (mean age, 54,0±11,8 years), who underwent exercise testing and had a negative BST. Based on the BST results, patients were divided into 2 following groups: group 1 (n=18) — those with supraventricular and/or ventricular premature beats during the recovery period; group 2 (n=26) — those without arrhythmias during the BST.

Results. Patients in both groups had a comparable mean age, prevalence of risk factors, hypertension, and diabetes. There was a tendency toward an increased prevalence of smoking, overweight, and obesity in patients in group 1 compared to group 2. Patients in group 1 had a 2,1-fold lower maximum oxygen consumption than those in group 2. A 28,3% (χ²=4,380, p=0,037) higher incidence of decreased glomerular filtration and a 2,4-fold higher incidence of albuminuria (χ²=4,072, p=0,044) were observed. The level of albuminuria in patients in group 1 was 3,1 times higher (p<0,01).

Conclusion. We found no significant differences in the frequency of clinical factors and echocardiographic parameters in the examined individuals. Asymptomatic patients with premature beats during the recovery period of the BST have a higher prevalence of decreased glomerular filtration and albuminuria compared to individuals without arrhythmias. The clinical significance lies in the need for an interdisciplinary approach to this category of individuals, including mandatory screening for markers of chronic kidney disease.

Russian Society of Cardiology (RSC), Society of Heart Failure Specialists, Russian Scientific Medical Society of Internists, Association of Cardiovascular Surgeons of Russia

Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation