The high and growing incidence and mortality of patients with heart failure (HF) should receive priority attention when developing an action plan to reduce cardiovascular mortality in the Russian Federation. The article provides an analysis of the implemented elements of HF care in 40 Russian regions (Northwestern, North Caucasian, Volga, Southern Federal districts), some of the best practices, as well as prospects for implementation of the cardiovascular risk management system.

Aim. To identify risk factors for acute decompensated heart failure (ADHF) in patients with type 2 diabetes (T2D).

Material and methods. In the cardiology department, 129 patients with ADHF were registered within 8 months, 59 (45,7%) of them had T2D. The study included 117 ADHF patients who were divided into two groups depending on the presence of T2D: group 1 (n=49; 41,9%)  — patients with T2D, group 2 (n=67; 55,9%) without T2D. The ADHF was verified by rapid progress of hypoperfusion and congestion, which required emergency hospitalization and inotropic and/or intravenous diuretic therapy. In the first 48 hours of hospitalization, echocardiography was performed, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and creatinine were determined; the glomerular filtration rate was estimated.

Results. The incidence of T2D among patients with ADHF was 45,7%. There were following risk factors for ADHF in T2D patients: diabetic ketoacidosis (p=0,002), hypertensive crisis (p=0,017), history of acute coronary syndrome (p=0,048), atrial fibrillation (p=0,030), chronic kidney disease (p=0,003), pneumonia (p=0,035), progression of anemia (p=0,049), low prevalence of beta-blockers use (p=0,001), use of inappropriate antidiabetic drugs for HF patients (sulfonylureas, insulin). ADHF, assessed by NT-proBNP level, was significantly more severe in T2D patients (p=0,001) with pronounced congestion symptoms (p=0,001), which led to an increase in the need for diuretic therapy (p=0,002). Cardiac remodeling in T2D patients with ADHF is characterized mainly by the preserved left ventricular ejection fraction (LVEF), severe LV diastolic dysfunction (LVDD) and LV hypertrophy (LVH).

Conclusion. The development of ADHF in T2D patients is associated with various risk factors and is characterized by severe congestion symptoms, high need for diuretic therapy, mainly preserved LVEF in combination with severe LVDD and LVH. 

Aim. To evaluate the insulin resistance contribution to pathogenesis of left ventricular (LV) remodeling in patients with hypertension (HTN) in combination with obesity and type 2 diabetes (T2D).

Material and methods. The study included 320 patients with stage II-III HTN and stages 1-3B chronic kidney disease (CKD) aged 45-70 years: group 1 (n=102) — HTN patients only, group 2 (n=90)  — patients with HTN and obesity, group 3 (n=96) — patients with HTN, obesity and T2D, group 4 (n=32) — patients with HTN and T2D. The groups were comparable in main clinical and demographic parameters. We performed a clinical examination, assessed cardiac structure, insulin levels and insulin resistance indices. We used nonparametric statistics, multiple regression, stepwise linear discriminant and canonical analyzes. Data are presented as Me [Q25; Q75], where Me is the median, Q25 and Q75-25 and 75 percentiles, respectively.

Results. LV mass index was significantly higher in the group of HTN, obesity and T2D compared with HTN patients only (107,5 [9,5; 125,6] vs 96,0 [85,1; 106,1] g/m2 , respectively). The percentage of patients with LV hypertrophy was significantly higher in groups 2, 3 and 4 compared with group 1, and also in group 3 compared with groups 2 and 4. A stepwise discriminant analysis revealed that BMI increase in HTN±T2D patients was accompanied by an increase in values of metabolic index, triglyceride-to-highdensity-lipoprotein-cholesterol ratio. Canonical analysis showed that an increase in the median values of Insulin Resistance function in all groups was associated with a deterioration in the median values of Cardio function.

Conclusion. The data obtained specifies the LV geometry characteristics, as well as the insulin resistance contribution to pathogenesis of LV remodeling in HTN patients with/without obesity and/or T2D.

Aim. To study the outcomes in hypertensive (HTN) patients receiving a stent for class III angina, depending on concomitant type 2 diabetes (T2D).

Material and methods. The study included 295 patients aged 45 to 75 years. All patients underwent coronary angiography followed by elective stenting. Clinical outcomes were evaluated after outpatient follow-up (average 44 months). Patients were divided into two groups: group 1 — 214 patients with coronary artery disease (CAD) in combination with HTN; group 2 — 81 patients with CAD in combination with HTN and T2D.

Results.In the group of patients without T2D, during the follow-up period, class III angina was observed in 92 patients (43%). The decrease in systolic blood pressure (BP) (SBP) and diastolic BP (DBP) in this subgroup was 18 and 14 mm Hg, respectively (p<0,001); 35 patients (38%) had myocardial infarction (MI). In the group of patients with T2D, class III angina was recorded in 60 patients (74,1%). The decrease in SBP and DBP in this subgroup was 19 and 12 mm Hg, respectively  (p<0,001). There were 58 cases of MI in this subgroup (96,7%).

Conclusion.After stent insertion, patients with CAD, HTN and T2D still reporting class III angina were more likely to have MI than patients without T2D. This indicates a greater contribution of T2D to MI development, despite an equal decrease of SBP in patients with/without T2D.

Aim. To study the opinion of primary care physicians and hypertensive (HTN) outpatients with different compliance rate on factors preventing effective antihypertensive therapy (AHT).

Material and methods. Primary care physicians and HTN outpatients were questioned. Questionnaires for physicians and patients included informative and survey parts, with a list of possible factors aggravated adherence to treatment. The assessment was carried out using visual analogue scale. The patient questionnaire also included questions about AHT and the eight-item Morisky Medication Adherence Scale (MMAS-8). The calculation was carried out with a 95% confidence interval (CI).

Results. The survey involved 298 physicians and 517 patients. Among patients, about 1% had a high compliance rate, 34% — moderate, 65% — low. In all groups, AHT did not significantly differ and was characterized by a low frequency of prescribing fixeddose combinations (27,1%). According to physicians, the most significant and equivalent are the economic aspects of treatment — 7,9±2,1 (95% CI: 7,51-8,38), the need for lifestyle change — 7,9±2,4 (95% CI: 7,37-8,38) and, to a slightly lesser extent, psychological aspects 6,8±2,2 (95% CI: 5,43-6,43). The economic aspects of treatment and need for lifestyle change were also most significant factors according to patients with high (8,8±1,8 (95% CI: 7,23-10,37) and 8,4±1,7 (95% CI: 6,93-9,87), respectively) and low (95% CI: 6,4±3,0 (5,65-7,07) and 6,2±2,8 (95% CI: 5,5-6,82) respectively) compliance rates. For patients with moderate compliance rate, the most significant and almost equivalent factors were the need for lifestyle change — 5,6±3,3 (95% CI: 4,53- 6,71), the need for regular visits — 5,6±3,1 (95% CI: 4,53-6,58) and the need for selfmanagement — 5,6±2,8 (95% CI: 4,63-6,48).

Conclusion. The results obtained make it possible to forecast the compliance rate of patients with HTN, and, therefore, direct more efforts to those with a low rate, thereby increasing the effectiveness of AHT.

Aim. To evaluate the basic clinical and laboratory parameters and their relationship with the 14-year risk of cardiovascular death in individuals with type 2 diabetes (T2D).

Material and methods. A prospective case-control study of a sample of Novosibirsk residents with T2D was performed. An initial examination was conducted as part of the HAPIEE project in 2003-2005. The follow-up period lasted until 2017 and amounted to 13,7±0,7 years. The case group consisted of 145 people (mean age — 62,0±5,7 years) with recorded cardiovascular death. Control group — 272 people (mean age — 57,9±6,6 years) without recorded death as of December 31, 2017. Persons with a history of non-fatal myocardial infarction and/or stroke at the initial examination were excluded. Blood pressure (BP), biochemical, anthropometric and socio-demographic data were determined. Logistic regression models were used to analyze the association of clinical and laboratory parameters with the risk of cardiovascular death.

Results. T2D subjects with recorded cardiovascular death at the initial examination had a longer duration of the disease, higher fasting plasma glucose (FPG) and anthropometric parameters (body mass index (BMI), waist circumference (WC) (in  women)), systolic blood pressure (SBP) and diastolic blood pressure (DBP). In individuals of both sexes, the risk of cardiovascular death increased 2,2 times with WC >95 cm, 2,3 times with an increased WC/HC ratio, 2,2 times with a BMI ≥30 kg/m², 1,9 times with physical activity <3 hours/week, 2 times for smokers and those with a single marital status, 3,5 times for hypertensive people, 2 times with FPG ≥7,5 mmol/L and longer duration of diabetes.

Conclusion. Fourteen-year follow-up revealed that individuals with T2D have associations of cardiovascular death with both conventional risk factors such as hypertension, abdominal obesity, low level of physical activity, smoking, single marital status, and diabetes-related ones — FPG and the duration of diabetes.

This article presents the results of studies on high prevalence of left ventricular noncompaction (LVNC) in patients with secondary hemochromatosis (SH). We also included case reports of patients with SH and LVNC and compared imaging data using modified modern criteria for LVNC and molecular genetic testing (MGT). In  patients with cardiac hemochromatosis, left ventricular noncompaction is noted, the nature of which is most likely secondary. In order to confirm this hypothesis, a prospective observational study, including family screening and MGT, is required.

Aim. To study the effect of various classes of glucose-lowering agents (dipeptidyl peptidase-4 (DPP-4) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors) on the vascular stiffness in patients with type 2 diabetes (T2D) and high cardiovascular risk.

Material and methods. The open-label, prospective 24-week study included 120 patients with T2D and high cardiovascular risk. We evaluated the effect of modern glucose-lowering medications, empagliflozin at a dose of 25 mg/day (SGLT-2 inhibitor) and sitagliptin at a dose of 100 mg/day (DPP-4 inhibitor), on vascular elasticity, central hemodynamic and laboratory parameters.

Results. After 24-week therapy, the target glycated hemoglobin level reached 71% and 80% of patients in the sitagliptin and empagliflozin groups, respectively. In both groups, vascular stiffness and central hemodynamic parameters were improved. However, significant changes were recorded only in the empagliflozin (carotid-femoral pulse wave velocity decreased by 14,4%, augmentation index — by 6%, central pulse pressure — by 7,8%) (p<0,05). Use of sitagliptin was associated with significant improvements in the lipid profile (total cholesterol decreased by 9,5%, triglycerides — by 21%, low density lipoproteins — by 15,1%; high density lipoproteins increased by 15,7%) (p<0,05). In the empagliflozin group, anthropometric parameters were improved (body mass index decreased by 9,1%, waist circumference — by 4,1%) (p<0,05). Patients in both groups had a significant decrease in HOMA-IR index and highly sensitive C-reactive protein: by 34% and 51,6% in the empagliflozin group and by 31,8% and 22,1% in the sitagliptin group, respectively (p<0,05).

Conclusion. The use of empagliflozin is more associated with arterial stiffness decrease in T2D patients with high cardiovascular risk compared with sitagliptin.

The article describes current data on the relationship of renin-angiotensin system and related drugs with the risk of COVID-19 infection and its outcomes. Analysis of the latest publications did not reveal association of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with any risk of an unfavorable outcomes, and there was no data for withdrawal of these drugs.

Heart failure (HF) and type 2 diabetes (T2D) are important multidisciplinary problems both individually and, especially, in combination. The issues of combine effect, as well as modern approaches to the choice of medication remain insufficiently known to practitioners in Russia. The article discusses the epidemiology, pathophysiology and the basic principles of therapy for people with HF and T2D.

The novel coronavirus infection COVID-19 pandemic has spread to more than 180 countries. Cardiovascular patients belong to one of the susceptible population cohorts. There is a peculiar pathogenesis and variety of clinical manifestations of COVID-19, as well as difficulties with early diagnosis. Other unresolved issues are routing, surgery and therapy of such patients and comorbidities. Due to absence of well-defined algorithms and guidelines, the treatment of patients with acute coronary syndrome (ACS) in different countries is carried out differently. Interactions between antiviral and coronary artery disease medications are also not completely clear. Based on the available data, the main organizational and therapeutic approaches for ACS during the COVID-19 pandemic are reflected.

The review is dedicated to such a rare disease as primary cardiac angiosarcoma (PCA). The following imaging methods are used for its diagnosing: transthoracic and transesophageal echocardiography, computed tomography, positron emission tomography and magnetic resonance imaging. To verify the diagnosis, a biopsy with cytological and immunohistochemical analysis is performed. The symptoms of PCA is non-specific and often manifests itself only in the late stages, which leads to a significant deterioration of prognosis. Treatment of PCA requires a multifaceted approach. It mainly involves the achievement of a curative resection (R0 resection). Regarding chemotherapy, neoadjuvant therapy with doxorubicin and ifosfamide is effective. In addition to these agents, cyclophosphamide, anthracycline, vincristine and others are used. Today, the use of targeted therapy with imatinib, sorafenib, pazopanib, and bevacizumab is promising. However, it requires further analysis. The article also describes other therapy methods using a beta-blockers and radiation exposure.

The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD)