Aim.  To assess the  detection  rate  of infective endocarditis  (IE) in postoperative period in patients with aortic stenosis  (AS) and analyze the impact of late diagnosis on disease outcomes.

Material and methods. A retrospective analysis of the register of 1764 patients with AS, formed on the basis  of transthoracic echocardiographic (echo)  tests  in2009-2011, was performed. During the 8-year follow-up period, 679 patients were operated  on;  IE  was  diagnosed  in  131  people.  Patients  were  divided  into subgroups depending  on the  valve morphology  and  the  time of IE verification before   or  after  surgery.   IE, first  detected  in  the  postoperative  period,  was considered as latent IE.

Results. Among patients  with AS, the proportion of people  with IE was only 3,7%, however, pathomorphological examination revealed  IE signs in 19,3%. In 58,8% ofcases, IE was detected for the first time in the postoperative period. In 66,2% of cases,latent IE was diagnosed in patients with congenital heart disease (CHD) — bicuspidaortic valve (BAV). In the group of patients with known IE before surgery, there were lower levels of hemoglobin, erythrocytes and a higher level of creatinine. According to the results of a histological examination, inactive IE was diagnosed in 28% of cases. In 26,5% of patients  stage  3 activity IE was defined,  among  which latent course  was recorded in 16%. Single-agent antibiotic therapy (ABT) was carried out in 40,5% of patients, dual-agent ABT — in 50,0%, triple-agent — in 9,5%. The median duration of ABT was 14 days (7 to 42). The eight-year survival rate for patients with IE was 91,2%. Of the 9 deaths, only 5 (56%) had a diagnosis of IE before surgery.

Conclusion. More than half of the patients operated on for AV defects  had a latent course  of IE and,  as  a  result,  late  diagnosis,  which could  affect  medium-term survival. Most of the people  with latent IE included in the analysis had CHD-BAV, which requires the development of IE preventive measures in this patient population. Various  approaches to  the  ABT of latent  IE in clinical practice   determine  the relevance  of additional  studies  aimed  at unification the  ABT approaches in this clinical setting.

Aim. To study volumetric and linear parameters of the left atrium (LA) in operated and non-operated patients with severe  aortic stenosis  (AS) in comparison  with the control group of a similar age and gender.

Material and methods. Eighty-one patients with AS were examined, 49 patients — in the long term after aortic valve replacement (AVR), and 30 patients of similar age and gender  — without a heart defect.  Echocardiography  was performed  using an Acuson Sequia 512 ultrasound scanner.

Results. The volumetric parameters of LA (LA volume index (LAVI)) and the ratio of the  minimum LA  with LV  volume at  this time point (LAVmin/LV)  were  the  most sensitive  parameter when  evaluating  the  LV  diastolic  function  in patients  with isolated AS when comparing  non-operated and operated patients  and the control group. The study of association of non-operated AS patients with LAVI (greater than or less than 32 ml/m²) showed only a slight divergence  between the Kaplan-Meyer curves with a log-rank test of 0,15. Only the values of the LV ejection fraction (LVEF) differed from parameters of died (n=21) and alive patients at the time of the study (n=60): 61,0 (56,4-69,3)% in alive versus 46,4 (39,1-55,4)% in dead ones (p<0,0001). The time elapsed from the diagnosis to the date of the examination also differed: 0,5 (0,4-11,0)  years  in alive versus  7,0 (3,0-19,0)  years  in dead  ones  (p=0,004).  With multiple regression, the  highest  and  statistically significant beta  coefficient  was found only in LVEF (beta — -0,52, p=0,002).

Conclusion. Linear and volumetric parameters of LA slightly associate with the age and  gender   of  operated  and  non-operated  AS patients.   These   parameters statistically  significantly differ in the  groups  of non-operated AS patients  and patients after AVR compared with the control group, including patients without heart disease. The values of linear and volumetric LA parameters in patients with AS after AVR are close to those in the control group.

Aim. To assess the predictive value of polymorphic variants analyzing of interleukin-6  (IL-6)  gene  in patients  with postpericardiotomy  syndrome  (PPS) during open-heart surgery.

Material and methods. The study included 200 patients. All patients were analyzed for acute  phase   parameters in serum,  effusion  fluid and  region  of IL-6  gene promoter sequence.

Results. When analyzing the effusion fluid, in 15% of patients  with early PPS,  in accordance with the Light RW criteria, transudate was detected. Application of the Roth  BJ  criteria  increased this  proportion  to  32%.  An increase   in the  level of C-reactive  protein  (CRP), procalcitonin,  and  adenosine deaminase (ADA) activity indicated a systemic inflammatory response. The viral genome of cardiotropic viruses was detected in the effusion fluid in 10-12% of patients with PPS. Scanning mutations in the IL-6 500 bp region revealed one polymorphism of -174G>C. The frequency ofPPS  in patients  with different  genotypes (-174GC,  -174GG and  -174CC)  did not significantly differ. An association of the -174GG genotype of the IL-6 gene with a high risk of developing systemic inflammation in open-heart surgery and more frequent postoperative infectious complications has been established. In addition, the -174GG genotype was more often detected in patients with late PPS (p=0,017). There was nocorrelation between  the occurrence of genotypes, as well as the distribution of IL-6 gene  and coronary  obstruction  index. However, carriage  of the G allele was more often detected in patients with injury of left main coronary artery.

Conclusion. The presence of the -174GG genotype of the IL-6 gene and cardiotropic viruses contribute to the systemic inflammation during cardiosurgical interventions in extracorporeal circulation, but do not have predictive value for the PPS development.

Aim. To assess the diagnostic significance of chronic heart failure (CHF) criteria and to study the features  of structural  and  functional remodeling  of the left heart  in patients with coronary artery disease (CAD) and thyrotoxicosis.

Material and methods. We examined  131 patients  aged  45-65  years  with CAD, CHF and/or  thyrotoxicosis. The clinical state  of patients,  exercise  tolerance,  NT-proBNP level were evaluated. Holter ECG monitoring and Doppler echocardiography (echo) were performed.

Results. Heart  rhythm disturbances (atrial fibrillation, sinus  tachycardia, supraventricular  extrasystole),  more severe vegetative imbalance with sympathetic predominance in patients with CAD, CHF and thyrotoxicosis were determined moreoften than in patients  with CAD and CHF without thyrotoxicosis. Elevated levels of NT-proBNP (more  than  125  pg/ml)  were  found  in both  patients  with CHF and patients with thyrotoxicosis, regardless of the presence of cardiovascular  disease. NT-proBNP levels  in  patients   with CAD and  thyrotoxicosis  without  CHF has exceeded the  threshold  value of 2,8  times  (p=0,001).  The highest  level of NT-proBNP was found in patients with CAD, CHF and thyrotoxicosis. A higher threshold value of NT-proBNP (556,4 pg/ml according  to the results of this study) in HFpEF and HFmrEF patients with CAD and thyrotoxicosis was determined. Analysis of echo parameters in patients with CAD, CHF and thyrotoxicosis revealed significantly lower values  of linear  and  volumetric LV  parameters, type  I  LV  diastolic  dysfunction(100%), HFmrEF (48%), more frequent  occurrence of LV concentric  hypertrophy (84%).

Conclusion.  For  HF diagnosis   in patients   with CAD and  thyrotoxicosis,  it is necessary  to  take  into  account   the  clinical features, heart  rate  variability, LV remodeling, as well as to use a higher threshold level of NT-proBNP.

Aim. To determine  the relation between  idiopathic hypertrophic  cardiomyopathy (HCM) and HCM phenocopies, as well as to study the etiological pattern  of HCM phenocopies in patients  of the  North-Western  region  of Russia  in different age groups.

Material  and  methods. The  study  included  321  patients  with left  ventricular hypertrophy ≥15 mm according  to an echocardiography. All the necessary clinical, laboratory and instrumental  diagnostic  methods  for verification of HCM and HCM phenocopies was carried out. In the diagnosis, the MOGE(S) classification was used.

Results.  At  a  young  age,   idiopathic  HCM accounts  for  92%  (n=62),  HCM phenocopies — 8% (Danon disease (n=1 (2%)), isolated cardiac  sarcoidosis (n=1 (2%)) and systemic AL amyloidosis (n=3(4%)). Idiopathic HCM is also found in the vast majority of middle-aged patients — in 85% of cases (n=86). HCM phenocopies (15%) were in isolated  cardiac  sarcoidosis (n=3 (3%)), systemic amyloidosis variants (n=12 (12%)) — AL amyloidosis with predominant cardiac injury (n=11,11%), hereditary transthyretin amyloidosis (n=1,1%). Of the 153 examined  patients  with HCM aged  ≥60 years  old, 85% (n=131) were diagnosed with idiopathic HCM. HCM phenocopies were detected in 15% of cases (n=22). In the etiological pattern  of HCM phenocopies, transthyretin  amyloidosis was  10%:  non-hereditary   transthyretin  amyloidosis  — 6%  (n  =  9),  hereditary transthyretin  amyloidosis — 4% (n=6); AL amyloidosis — 4% (n=6). In 1 patient, acromegalic  cardiomyopathy (1%) was verified. In this article, we present 3 clinical cases that demonstrate the difficulty of differential diagnosis  between  idiopathic HCM and various HCM phenocopies.

Conclusion. In all age groups,  idiopathic HCM predominates. Lysosomal storage diseases classify as  rare  diseases. Isolated  cardiac  injury with amyloidosis  and sarcoidosis is widely met but less often diagnosed. We determined a high frequency of isolated cardiac injury with amyloidosis under the age of 45 years. The etiological pattern  of HCM phenocopies in the elderly is represented mainly by transthyretin cardiomyopathic  amyloidosis of hereditary and non-hereditary  variants.

Aim. To assess cardiovascular remodeling in patients with diabetic cardiomyopathy (DCM) and compare  it with healthy individuals.

Material and methods. Among outpatients with newly diagnosed type 2 diabetes (T2D), according  to inclusion and exclusion criteria, a group of participants  with diabetic cardiomyopathy (DCM) with left ventricular diastolic dysfunction (LV DD) was made before treatment. The second group consisted of healthy individuals of the  corresponding  age.  The  structural  and  functional  state  of the  heart  was studied using echocardiography and determination of the N-terminal prohormone of the brain natriuretic peptide  (Nt-proBNP) in the blood; of the arteries  — using volume sphygmoplethysmography. Markers  of fibrosis were  determined in the blood:  tissue  inhibitor of matrix metalloproteinase-1 (TIMP-1) and  C-terminal telopeptide  1 (CTP-1).

Results. The DMC prevalence in patients with newly diagnosed T2D was 18,7%. LV DD was associated not only with T2D, but also with obesity (r=0,48; p=0,029), blood pressure even in the normal range  ((r=0,42; p=0,031  for systolic blood pressure; (r=0,39; p=0,042) for diastolic blood pressure). The Nt-proBNP levels in the normal range  and  TIMP-1 were  higher  in the  DCM group  compared with the  group  of healthy individuals (p<0,001 and p<0,001, respectively). CTP-1 was lower in the first group compared with the second (p<0,001).  In the DCM group,  a higher cardioankle  vascular  index (CAVI1)  was  recorded compared to  the  group  of healthy individuals (p<0,001).

Conclusion. LV DD cannot  be presented as a pathognomonic criterion for DCM. Nt-proBNP levels in the normal range of 76,23+14,47 pg/ml, which do not reach the diagnostic criteria for heart failure, an increase  in TIMP-1 and a decrease in CTP-1can be considered as additional markers  of DCM. Given the fact that two parallel processes occur  during the DCM formation, manifested  by cardiac  and arteries’ remodeling, the CAVI1 can also be considered as an additional DCM marker.

Aim. Based  on the results  of a long-term  follow-up, to determine  the clinical variants  of  hypertrophic  non-obstructive cardiomyopathy  (HNOCM) and  develop criteria for the progression of the disease.

Material and methods. The results of long-term follow-up were evaluated  for 97 patients  with HNOCM, men — 57 (58,8%), women — 40 (41,2%), average  age — 42,5±1,52  years  (M±σ). The  average  follow-up was  11,0±5,73  years.  Research methods   were  physical  examination,  electrocardiography (ECG), 24-hour  ECG monitoring with assessment of heart  rate  variability, Doppler  echocardiography (echo).   Physical  and  instrumental   re-examination   of  patients   was  used   for determining of changes.

Results.  Clinical progression was  detected in 46  (47,4%)  patients.   The  most common progression variants were deterioration  of chronic heart failure (54,3%), cardiac arrhythmias (45,7%) and a combined  one (37%). The aggravation of echo data was found in 43 (44,3%) patients. The most frequent progression variants werecombination of different dynamics scenarios (79,1%), including a decrease in the mobility of left ventricle walls (67,4%), an increase  of left atrium dimension (58,1%), and diastolic dysfunction deterioration  (67,4%). Aggravation of myocardial hypertrophy  was noted  in only 3 cases. In 5 (5,15%) cases, the dilation stage  of HNOCM was recorded. A  scoring  model for assessing of progression risk were proposed. It includes  the duration of HNOCM >20 years,  baseline  ≥II FC chronic heart  failure, ≥2 clinical manifestations  of the disease, left ventricular myocardialmass index >200 g/m² , left atrial volume index >34,0 ml/m² , cardiac output <5 l/min, decrease in heart rate variability.

Conclusion.  HNOCM is a disease with a complicated  prognosis, progressing in 64% of patients, more often with a long course.  The clinical progression of HNOCM was manifested  by the diverse dynamics of complaints.  Structural  and functional progression was manifested mainly by a combination of different dynamics variants (in 79,1% of cases), including a decrease in the mobility of left ventricular walls, an increase  of left atrium  dimension,  aggravation  of diastolic  dysfunction,  but  not deterioration  of myocardial hypertrophy. The main criteria for progression: disease duration >20 years, baseline ≥II FC chronic heart failure, ≥2 clinical manifestations of the  disease, increase  of left ventricular myocardial mass  index and  left atrial volume index, decrease of cardiac output and heart rate variability.

The first presentation of the combination of non-compaction cardiomyopathy  with a restrictive-dilated phenotype  and massive chronic tuberculous pericarditis, which for a long time was under  the guise  of hydropericardium  in congestive  heart  failure in a patient of 30 years, is performed. The absence of congestion signs in a large circle of blood circulation became the reason  for diagnosis of agnogenic  pericarditis and pericardial puncture.  A large volume (>1 l) and lymphocytic nature of effusion, its bilateral character, post-tuberculous changes and calcifications in the lungs, and intrathoracic lymphadenopathy  testified  in favor of the tuberculous  etiology of the process. The negative result of all laboratory tests  for tuberculosis  (Diaskintest, exudate  PCR test, fluorescence microscopy, inoculation on liquid media, Ziehl-Neelsen stain) and the high risk of thoracoscopic biopsy did not allow to immediately verify the diagnosis.  It was made only after repeated elimination of 3,5 l of hemorrhagic exudate and the detection of mycobacterial DNA by PCR. As a result of quadruple tuberculostatic therapy, a remission of the process was achieved (there is no fluid in the pericardial cavity).

Cardiac involvement in sarcoidosis is considered quite rare, but it can cause the first significant disease manifestations and patient’s death. Timely disease detection improves the effectiveness of treatment and prognosis. The article presents modern approaches to the diagnosis and management of patients with cardiac sarcoidosisusing clinical case of a patient hospitalized by ambulance with a first revealed symptomatic third-degree atrioventricular block. We described methods of examining this patient, as well as difficulties in differential diagnosis.

Cardiovascular morbidity and mortality are associated with high demographic and economic  losses.  Their decrease is one  of the  main lines of development  and improvement of the world health systems. An analysis of the current situation in the Russian  Federation  (RF) demonstrates that  the  areas  of concern  in system  for cardiovascular  diseases (CVD) patients’  care  are  the  insufficient and  untimely identification of cardiovascular risk factors, as well as their ineffective management due to the incomplete  implementation  of existing risk stratification guidelines and decision  making.  To achieve  the  aim of reducing  mortality from cardiovascular diseases by 2024 and further preserving of this tendency, along with the introduction of a  long-term  population-based strategy   for creating  a  healthy  lifestyle, it is necessary  to  shift  the  focus  from  emergency care  and  performing  high-tech interventions to long-term management of cardiovascular risks. The introduction of a new model of specialized care for cardiovascular diseases, the cardiovascular risk management system,  is aimed  at the  efficient use  of healthcare resources and providing the reduction in cardiovascular mortality.

In the  spring  of 2018,  Harvard Medical School  and  the  Brigham and  Women’s Hospital reported  the retraction  of 31 articles of Dr. Piero Anversa lab, who have been  studying heart stem cells for more than 15 years,  due to the fact that these articles  “included  falsified  and/or   fabricated   data”.  This extremely  unpleasant incident cast  suspicion on other research groups  studying regenerative  effects  ofcells harvested  from the myocardium. It contributed  to skeptical opinion about thepossibilities of regenerative  technologies in cardiology in general and the complete denial of any regenerative  potential of heart. This review presents an analysis of Dr. Piero Anversa lab studies  and  other  works devoted  to the study of regenerative processes in the heart, a modern view on the mechanisms of the heart regenerative potential and the regenerative  effects of progenitor cells harvested  from the myocardium,  and  the  prospects for the  development  of cellular technologies in cardiology.

The conclusion of the Expert Council reports an agreement on the place of the P2Y₁₂ receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y₁₂ receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting.

Prevention and choice  of therapeutic strategies in patient,s  with type 2 diabetes (T2D) and heart failure (HF) is an urgent problem. This review presents a modern concept for HF development  from early  stages of T2D. Glucose-lowering  and cardiac  medications  for the  prevention  and  treatment of HF depending   on  its phenotypes were considered.

The article discusses modern ideas about the role of mechanical revascularization and anti-ischemic  therapy  in the treatment of patients  with stable  coronary heart disease (CAD). Modern  data  on the  comparative  effectiveness  of anti-ischemic drugs  are  presented, which became the basis  for the development  of  “diamond approach”  in the treatment of stable CAD. It is proposed instead of standard tactics using a hierarchical approach to the choice of anti-ischemic drugs. The features  of the anti-ischemic  drugs use in certain clinical situations, in patients  with the most common comorbidities or complications  of CAD, as well as in CAD variants, in the development  of which specific pathophysiological elements  play a role, are considered.

The survey based  on the last decade literature,  guidelines  of international and national professional  communities  summarizes  data  on myocardial  injury after non-cardiac surgery (MINS). It reflects the growing interest in this interdisciplinary problem aroused by MINS widespread  occurrence and its close association  with after surgery mortality. Observational studies devoted to a search  for risk factors and mechanisms of after surgery myocardial injury were scrutinized. The role of asymptomatic   increase   in cardiac  troponins  which is stiffly competitive  in its clinical and prognostic  significance with after surgery  myocardial infarction was highlighted.  Modern approaches to MINS diagnostics  and  prevention  were set out.  The possibilities  and  prospects for MINS treatment were  discussed with regard  for the  results  of the  recently  completed  randomized  controlled  study MANAGE (2018). Unresolved issues  and avenues  of further investigations in the field were specified.

The review discusses the problem of patient-oriented choice of anticoagulants for nonvalvular atrial fibrillation (AF). The efficacy and  safety  profile of dabigatran etexilate and a group of patients with advantage of dabigatran  application: patients with a  high  risk or  history  of ischemic  stroke,  patients  who are  indicated  for combination  antithrombotic  therapy,  and  patients  with a high risk of emergency surgical interventions and procedures, as well as with a high risk of bleeding,  etc. The place of idarucizumab, a direct dabigatran  etexilate antagonist, is shown.

The article is an analytical review of clinical studies  of structural  and  functional cardiac changes in patients with diabetes. Modern data on the mechanisms of the diabetic cardiomyopathy development,  the options of its prevention and treatment are summarized.  Particular attention  is paid to the features  of myocardial energy metabolism  and  replicative  aging  in this  pathology,  as  promising  targets   for therapeutic interventions.

The  review presents the  rationale  for  studying  cardiovascular  disease in HIV-infected patients, as well as the importance of specific therapy. The embrace of this problem is due the widespread use of antiretroviral therapy in the world over the past 20  years  has  led  to  an  increase   in the  life expectancy   of HIV  patients,  while cardiovascular  diseases have become a mortality and disability leader.  The review presents the most frequently reported  cardiovascular pathology and cardiac complications  in HIV  patients  that  occur  both  against  the  background of virus-mediated  action and as a result of antiretroviral therapy. Some pathogenetic mechanisms of HIV influence on cardiomyocytes and the extracellular matrix have been  demonstrated, resulting in early heart  failure and  pulmonary hypertension. Information is given on the role of statins in the management of HIV patients with the clinically significant atherosclerosis.

Idiopathic recurrent  pericarditis (IRP) is a relatively rare inflammatory disease of the pericardium,  often  requiring  emergency medical  care,   associated with a  high percentage of temporary  disability and  significant  economic  costs.  The review presents various  points  of view on  the  pathogenesis of recurrent   pericarditis, discusses the role of autoinflammation.  It touches on treatment issues  based  on modern  data  on the IRP immunopathogenesis, and considers promising areas  of laboratory diagnostics.

Dilatation of the left ventricle cavity and its contractility decrease with the subsequent heart failure development  against the background of prolonged  excessive  alcohol consumption  is commonly called alcoholic cardiomyopathy (ACM). The direct toxic effect of ethanol and its metabolites on the myocardium, neuroendocrine disorders,other manifestations  of alcoholism and a genetic  predisposition  play a significantrole in the development  of this pathology.  The purpose  of this review is to study modern  ideas  about  the  mechanisms of development   and  course   of ACM.  In particular, special attention is paid to discussing the doses  of alcohol necessary for the onset of symptoms and its regression. Actual data are presented in relation to a survey aimed at confirming alcohol abuse and the exclusion of alternative causes of myocardial injury, as well as treating patients and determining the prognosis.

The key step in achieving a significant reduction  in mortality in patients  with myocardial infarction (MI) was the organization of a wide network of specialized PCI-centers that provide care for patients with acute coronary syndrome (ACS) on the 24/7 mode  in accordance   to clear protocols. However,  currently in-hospital  mortality  of MI patients,  complicated  by cardiogenic  shock (CS), remains extremely high and averages 50 %. The formation of a system of highly specialized centers seems to be the most promising opportunity to improve the prognosis of patients  with CS. The article discusses  the world scientific and clinical experience in organizing cardiac shock care centers, the features of their internal structure, as well as the administrative and logistical aspects  of entire system operation.