Aim. To determine the relationship between the blood aldosterone levels and parameters of carbohydrate metabolism in patients with heart failure (HF) with preserved ejection fraction (HFpEF).

Material and methods. This cross-sectional study included 158 patients with stable HFpEF. HFpEF was established in the presence of symptoms and/or signs of HF, left ventricular ejection fraction >50%, increased blood NT-proBNP levels, and characteristic structural cardiac changes according to echocardiography. The study did not include patients with primary hyperaldosteronism and those taking mineralocorticoid receptor antagonists within the previous 6 weeks. In all patients, the blood aldosterone and carbohydrate metabolism parameters were assessed. The aldosterone levels were determined by the enzyme immunoassay and the concentration of 40-160 pg/ml was considered the reference values. Diabetes was diagnosed in the following cases: history of diabetes, treatment with antidiabetic drugs, blood glucose level ≥7,0 mmol/L in two samples or glycated hemoglobin (HbA_1c) >6,5%. Prediabetes was recorded if the blood glucose level in a patient without diabetes was in the range of ≥5,6 mmol/L and<7,0 mmol/L.

Results. In 99 patients (62,7%, group 1), the aldosterone levels were within the normal range, while in the remaining 59 patients (37,3%, group 2), it exceeded the upper limit. Patients with hyperaldosteronemia compared with those with normal aldosterone levels had significantly higher fasting plasma glucose levels (6,60 (6,00-7,90) mmol/L vs 5,80 (5,25-6,80) mmol/L, p<0,001) and HOMA value (5,86±1,12 vs 4,46±1,02, p=0,01). HbA1c levels did not differ significantly between groups. Patients of the 2^nd group more often suffered from diabetes (39,0% vs 19,2%, p<0,001) and hyperglycemia in general (89,8% vs 61,6%, p=0,011) compared with patients of the 1^st group. Correlation analysis showed a significant relationship between the level of aldosterone and blood glucose (r=0,29), HbA_1c (r=0,17) and HOMA (r=0,23) values. After standardization by age, HF class, body mass index, blood pressure, cholesterol and blood potassium levels in multivariate analysis, the presence of hyperaldosteronemia was significantly correlated with diabetes (odds ratio, 1,64, 95% confidence interval, 1,14-3,32, p=0,013) and hyperglycemia (odds ratio, 2,84, 95% confidence interval, 1,94-14,2, p=0,008). Conclusion. The development of secondary hyperaldosteronism in patients with HFpEF is associated with a significant increase in the risk of hyperglycemia and diabetes.

Aim. To assess the clinical course and cardiac reverse remodeling in patients with heart failure (HF) with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM) therapy.

Material and methods. Fifty-five patients (mean age, 53±11 years, 46 males) with NYHA class II-III HFrEF (ischemic etiology in 73% of patients), sinus rhythm, QRS<130 ms or QRS<150 ms of non-LBBB morphology receiving optimal medical therapy were enrolled into the study. CCM devices were implanted to all patients between October 2016 and September 2017. We assessed the following parameters: hospitalizations and mortality due to decompensated HF; changes in HF class, NTproBNP concentration, peak oxygen consumption, six-minute walk test, left ventricular end-systolic and end-diastolic volumes and ejection fraction (EF), atrial and ventricular arrhythmias. A comparative analysis of the studied parameters was carried out depending on the pacing with one and two ventricular leads, on LVEF value (>25% and <25%) and HF etiology.

Results. CCM therapy was associated with a decrease in HF class (p<0,00004001), HF-related hospitalization rate (p<0,0001001), blood NTproBNP concentration (p<0,018), an increase in peak oxygen consumption during the first year (p<0,006011), as well as a decrease in LV volumes and a LVEF increase (p<0,0001001). The direction of these changes did not depend on the number of ventricular leads and LVEF. The presence of ischemic cardiomyopathy and old myocardial infarction did not affect the disease prognosis, but was associated with a lower change in LV volumes and NTproBNP during 24 months of CCM therapy. LVEF values were significantly higher in the group of patients with HFrEF not associated with coronary artery disease after 12 and 24 months of follow-up.

Conclusion. In the group of patients with class II-III HFrEF, CCM therapy in most patients was associated with improved clinical and hemodynamic status, increased exercise tolerance, decreased HF-related hospitalization rate, positive echocardiographic and NTproBNP changes.

Aim. To study the potential of global strain analysis using two-dimensional speckletracking echocardiography to predict the heart failure (HF) in patients with ST-segment elevation myocardial infarction (STEMI) based on the 6-month follow-up after revascularization.

Material and methods. The study included 114 STEMI patients aged 52 (44; 59) years. Two-dimensional echocardiography was performed with analysis of standard parameters and speckle tracking with analysis of strain and rotational characteristics of the myocardium. Concentration of brain natriuretic peptide was determined. The endpoint was the presence of heart failure (HF) after 6-month follow-up. observation. The analysis of HF risk was carried out using ROC-curves based on 3 criteria. Strain parameters with the maximum sum of sensitivity and specificity were chosen as a cutoff point.

Results. Six months after STEMI, depending on the ejection fraction (EF) value, the patients were divided into 3 groups: group 1 — patients with reduced EF (<40%) (HFrEF); group 2 — with mid-range EF (40-49%) (HfmrEF); group 3 — with preserved EF ≥50% (HFpEF). Strain and rotational characteristics differed between groups (p<0,001 for all). It was found that in the acute period of myocardial infarction, global longitudinal strain (GLS) <9,5% (AUR =0,804, 95% (confidence interval (CI) (0,673; 0,936), p=0,001) and global circumferential strain (GCS) <8,7% (AUR =0,722 (95% CI (0,568; 0,875), p=0,012) predicts the development of HFrEF. These values less than 12,5% (AUR =0,830 (95% CI (0,749; 0,911), p=0,001) and 13% (AUR =0,759 (95% CI (0,664; 0,855), p=0,001) is associated with HFmrEF The Twist had the highest predictive value in relation to HFrEF — 4,2° (AUR =0,998 (95% CI (0,993; 0,100), p=0,001).

Conclusion. GLS, GCS and Twist have high sensitivity and specificity and can be used in wide clinical practice as simple and cost-effective indicators of HF risk.

Aim. To study the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL or lipocalin-2) and cystatin C in patients with heart failure (HF) and myocardial infarction (MI).

Material and methods. Baseline plasma concentrations of NGAL and cystatin C were measured in 119 participants (median age, 50-61 years; men, 101) with HF and primary MI (4-6 weeks old) who underwent percutaneous coronary intervention in the acute period. Adverse cardiovascular events within 1 year were considered as the endpoint.

Results. Patients with elevated NGAL levels were significantly more likely to have adverse events (p<0,001). The optimal cut-off value for NGAL was 18,75 ng/ml (odds ratio, 10, 95% CI, 3,09-32,45; p=0,0001). Multivariate logistic regression showed that NGAL, N-terminal pro-brain natriuretic peptide, left ventricular aneurysm, and SYNTAX score were significant predictors of adverse events. Cystatin C did not affect prognosis in the study cohort.

Conclusion. Increased NGAL levels is a predictor of unfavorable clinical outcome in patients with HF and previous MI.

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.

Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.

Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).

Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.

Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

Aim. To determine the risk of heart failure (HF) in patients with hypertension (HTN) depending on the structure of subclinical target organ damage (TOD).

Material and methods. The study included 234 patients with HTN without signs of HF. The mean age was 45,96±8,54 years. The patients underwent echocardiography with an assessment of myocardial mass index, ejection fraction, left ventricular diastolic function. Volumetric sphygmoplethysmography with determination of cardio-ankle vascular index (CAVI1) and carotid-femoral pulse wave velocity (PWVcf). Cystatin C blood concentration with the calculation of the glomerular filtration rate (GFR) was performed. NT-proBNP blood levels was also determined. Patients were divided into 4 groups depending on the presence and structure of subclinical TOD. The first group consisted of 74 (31,6%) patients without documented subclinical TOD; the second group — 99 (42,3%) patients with one subclinical TOD; the third group — 42 (18,0%) patients with two TOD; the fourth group -19 (8,1%) patients with three TOD.

Results. Patients in the groups differed significantly in blood NT-proBNP concentration (p<0,001). As the amount of TOD increased, NT-proBNP increased above the reference value 125 pg/ml (p=0,010). The odds ratio (OR) and relative risk (RR) of HF, determined by NT-proBNP concentration >125 pg/ml, were significantly associated with the TOD structure compared to the group without confirmed TOD (p=0,035, p=0,21, p=0,044, respectively). Correlation analysis revealed direct relationships between the NT-proBNP level and TOD amount (r=0,56; p<0,005), LVH (r=0,33; p<0,005), cystatin C level (r=0,31; p<0,005), CAVI1 and PWVcf (r=0,23; p<0,005 and r=0,26; p<0,005, respectively).

Conclusion. The risk of HF in patients with hypertension depends on the presence and structure of subclinical TOD. With the involvement of one target organ, OR and RR for HF were 4,23 and 3,74, respectively (95% CI for OR, 1,09-19,19; for RR, 1,08-16,03); with the involvement of two target organs — 5,57 (95% CI, 1,2328,51) and 4,70 (95% CI, 1,21-21,84), respectively; with the multiple TOD — 6,31 (95% CI, 1,4-40,83) and 5,19 (95% CI, 1,04-27,95), respectively.

Aim. To study the relationship of N-terminal pro-brain natriuretic peptide (NT-proBNP) with clinical symptoms, structural and functional cardiac abnormalities in human immunodeficiency virus (HIV)-positive patients with heart failure (HF), as well as to identify risk factors for severe HF.

Material and methods. During the year, 150 HIV-positive patients with typical symptoms and signs of stable HF were examined in the hospital. Among them, HF, confirmed by structural and functional cardiac changes and NT-proBNP increase above 125 pg/ml, was identified in 83 (55,3%) patients. These patients were divided into 3 groups depending on the blood concentration of NT-proBNP: group 1 (n=54) — patients with NT-proBNP of 125-700 pg/ml; group 2 (n=12) — patients with NT-proBNP of 701-1500 pg/ml; group 3 (n=17) — patients with NT-proBNP >1500 pg/ml.

Results. As NT-proBNP increased in HIV-positive patients with HF, the left ventricular (LV) ejection fraction (EF) significantly decreased (p=0,005). Also, the increase in the severity of HF symptoms (p<0,001), prevalence of chronic kidney disease (CKD) (p<0,001), chronic hepatitis B and/or C (p=0,011), prior infective endocarditis (p=0,002), thromboembolic events (p=0,007), chronic obstructive pulmonary disease (p=0,016), pneumonia (p=0,002) and inflammatory diseases during hospitalization (p=0,002), severe thrombocytopenia (p=0,032). We revealed significant differences between the groups in the frequency of decreased cluster of differentiation antigen 4 (CD4) <200 cells/pl (p=0,013).

Conclusion. In HIV-positive patients with clinical symptoms of HF, the prevalence of its verification in accordance with Russian guidelines (2020) was 55,3%. In 62,7% of HIV-positive patients with HF, preserved EF was detected. Among the comorbidities, 9 risk factors of severe HF in HIV-positive patients with NT-proBNP >1500 pg/ml were identified. With CKD and inflammatory diseases during hospitalization, the relative risk of severe HF in patients with HIV infection is increased by more than 6 times, while with thromboembolic events — 5,3 times, infective endocarditis — 4,4 times, pneumonia during hospitalization and severe thrombocytopenia — more than 3,5 times, chronic obstructive pulmonary disease — 2,1 times, chronic hepatitis B and/or C — 1,7 times. As HIV infection progresses (CD4 <200 cells/pL), the risk of severe HF increases 1,6 times.

The differences in mortality rates between Moscow and St. Petersburg require study.

Aim. Ranking and comparison of cardiovascular mortality in Moscow and St. Petersburg in 2015 and 2018.

Material and methods. Data on the population and mortality rates was assessed according to the Brief nomenclature of causes of death of Federal State Statistic Service. Eleven out of 35 nomenclature lines related to cardiovascular disease (CVD) are represented by 4-digit ICD codes, the rest are represented by groups with 3- and/or 4-digit codes. Standardized mortality rates (SMRs) were calculated based on the European standard. Comparison of SMR differences between Moscow and St. Petersburg in 2015 and 2018 was carried out using the nonparametric Wilcoxon test.

Results. The proportion of CVD in all-cause SMR in both cities is about 50%. There were no significant differences in SMR (2018-2015) between Moscow and St. Petersburg for 35 CVDs. The first 3 ranking places in the CVD pattern both in Moscow and St. Petersburg were occupied by CAD, different types of chronic CAD, and stroke. In 2015, their proportion was 58,3% and 48,9% and in 2018, 52,7% and 58,7%. Other causes varied significantly in relation to SMR and ranks in different years, which is probably due to different approaches to determining the code of death cause. The SMR and myocardial infarction contribution to cardiovascular mortality decreased.

Conclusion. Differences in cardiovascular mortality between Moscow and St. Petersburg remain. To understand the mortality causes and to develop effective programs to reduce it, it is necessary to eliminate the identified defects.

Aim. To determine additional diagnostic criteria for class I atrial cardiomyopathy (ACM) in patients with lone atrial fibrillation (AF).

Material and methods. This cross sectional non-randomized clinical study included 170 stable patients <60 years of age, of which 99 patients were selected. The inclusion criteria in the first group were the presence of lone AF with increased left atrial (LAVI) or right atrial volume index according to echocardiography without cardiovascular and pulmonary diseases, hypertension, and diagnostic criteria for heart failure (HF). The inclusion criterion in the second group was combination of AF and HF. The inclusion criterion in the third group was diagnostic criteria for HF (N-terminal pro-brain natriuretic peptide >125 ng/ml) in patients with sinus rhythm. In all patients, the concentration of NT-proBNP, a soluble stimulating growth factor 2 (sST2), as well as creatinine and cystatin C with calculation of the glomerular filtration rate, tissue inhibitor of matrix metalloproteinases-1 (TIMP1), and neutrophil gelatinase associated lipocalin (NGAL) was determined. Non-invasive angiography was performed.

Results. According to ROC analysis, NT-proBNP, TIMP-1, NGAL as markers of class I ACM in patients with lone AF, showed unsatisfactory clinical significance. In patients with ACM and AF, regardless of the presence/ absence of HF, direct moderate relationship between sST2 and LAVI (r=0,470, p=0,012) and direct strong correlation between sST2 and NT-proBNP (r=0,726, p=0,004). Using ROC curve, for all available sST2 values, its diagnostic significance was obtained in the range from 5 to 16 ng/ml (AUC=0,98).

Conclusion. The blood concentration of sST2 in the range from 5 to 16 ng/ml can be considered as an additional diagnostic criterion for class I ACM in patients with lone AF with a sensitivity of 98% and a specificity of 80%.

Aim. To create a model for non-alcoholic fatty liver disease (NAFLD) development at the steatosis stage in visceral obesity in patients with coronary artery disease (CAD) and hypertension (HTN).

Material and methods. The study included male patients with coronary artery disease, stable angina and hypertension: experimental group — 75 patients, control group — 38 patients. All patients underwent an anthropometric assessment, visualization and measurement of the intraabdominal fat thickness (AIFT) and epicardial fat thickness (EFT) by ultrasound, and echocardiography. The liver state was assessed using clinical and functional biochemical tests and ultrasound. Lipid and carbohydrate metabolism parameters was also evaluated. The influence of each of the studied indicators on NAFLD development was determined using the factor and correlation analysis.

Results. We created a mathematical model for predicting the NAFLD at the steatosis stage. Using significant variables (body mass index (BMI), EFT, AIFT, left ventricular posterior wall thickness (LVPWT), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) value), a regression model was created. There was following resulting regression equation: prognostic index K= -24,9+0,81 хBMI+1,06хEFT+0,02хAIGT+0,6хLVPWT-1,07хHOMA-IR. To test the developed model, a double-blind randomized study was performed. At K<9,37, the risk of NAFLD can be regarded as low, at K>15,38 — as high. Values from 9,37 to 15,38 are considered intermediate.

Conclusion. During the study, an original model was developed to calculate the likelihood of NAFLD development. The resulting model with the assessment of risk factors in patients with CAN and HTN with visceral obesity can be used to plan a prevention strategy. Patented invention №2718325RU dated 01.04.2020.

Despite the great interest in the issue of obesity in cardiac surgery patients, its effect on the outcomes surgical treatment of thoracic aortic diseases has hardly been studied.

Aim. To assess the effect of obesity on the results of the aortic arch reconstruction using the frozen elephant trunk (FET) technique.

Material and methods. In the period from March 2012 to May 2020, 84 patients with thoracic aortic diseases were operated on. All patients underwent surgical aortic arch reconstruction using the FET technique. Interventions were performed under moderate hypothermic circulatory arrest (25-28° C) and unilateral cerebral perfusion via innominate artery. In accordance with the body mass index, all patients were divided into 2 groups: <30 kg/m² (group 1, n=56) and >30 kg/m² (group 2, n=28).

Results. Neurological complication rates did not differ between the groups. Respiratory failure requiring tracheostomy and dialysis rate due to acute kidney injury occurred in 28,5% vs 35,7% (p=0,626) and 28,5% vs 17,9% (p=0,273), in patients with obesity and normal body weight, respectively. The reoperation rates due to bleeding was nonsignificantly higher in obese patients (14,3% vs 3,6%, p=0,092). The short-term mortality rate was 9,5% without significant differences in studied groups.

Conclusion. Aortic arch surgery using FET technique has comparable early results in obese and normal body weight patients.

The potential impact on cardiovascular morbidity and mortality have become one of the most important issues of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 may be associated with more frequent development of acute cardiovascular complications, while patients with established cardiovascular diseases are characterized by a higher risk of severe infection and adverse in-hospital outcomes. Due to the spread scale of the pandemic, understanding the long-term cardiovascular consequences of COVID-19 is of no less importance. Inability to extrapolate available international data to the Russian population has led to the initiation of a national multicenter study (registry) of patients recovered from COVID-19 and with concomitant involvement of the cardiovascular system or with baseline severe cardiovascular diseases. The article presents its rationale, design and implications of the results for clinical practice.

Aim. To assess the impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation.

Material and methods. Fifteen Russian medical centers from 5 cities took part in an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), containing questions regarding alterations in cardiovascular procedure volumes resulting from COVID-19 in March-April 2020.

Results. A number of outpatients undergoing cardiac diagnostic procedures was noted in 80% of clinics. Cardiovascular procedure volumes in the period from March 2019 to March 2020 in general decreased by 9,5%, and from March 2019 to April 2020, by 56,5%. Stress electrocardiography decreased by 38,4%, stress echocardiography by 72,5%, stress single-photon emission computed tomography by 66,9%, computed tomography angiography by 49,7%, magnetic resonance imaging by 42,7%, invasive coronary angiography by 40,7%. The decrease in diagnostic procedure volumes in selected regions (Tomsk Oblast, Kemerovo Oblast, Tatarstan) was not so pronounced compared to Moscow and St. Petersburg (-20,7%, -75,2%, -93,8% in April 2020, respectively, p<0,001).

Conclusion. The first wave of the COVID-19 pandemic caused a sharp decrease in the number of diagnostic cardiac procedures in Russia. This has potential longterm implications for patients with cardiovascular disease. Understanding these implications can help guide diagnostic strategies during the ongoing COVID-19 pandemic and minimize the future losses.

Elevated pulse pressure (PP) is the one of simplest and most accessible markers of vascular damage and increased arterial stiffness in hypertension (HTN). To date, an extensive body of evidence has been accumulated in terms of the PP effect on central nervous system (CNS), leading to neuronal damage and death, which contribute to the development and progression of cognitive impairment (CI). Elevated PP violate the blood-brain barrier, can intensify the production of reactive oxygen species in the CNS, lead to endothelial dysfunction, microbleeds and directly stimulate the amyloid beta creation, which is a substrate of Alzheimer’s disease. Due to the important role of increased PP in CI, an important aspect of antihypertensives’ effects is their impact on PP and the ability to reduce it. Among antihypertensives, a single-pill combination of amlodipine/indapamide sustained release deserves special attention, since it has a body of evidence for reducing PP and thereby improving cognitive functioning in patients with HTN, which in turn will improve their quality of life.

Early percutaneous coronary intervention (PCI) and long-term aggressive antithrombotic treatment based on dual antiplatelet therapy (DAPT) are the most important elements in the treatment of patients with acute coronary syndrome (ACS). The most studied and recommended for ACS is the 12-month DAPT (combination of acetylsalicylic acid (ASA) and P2Y₁₂ receptor antagonist). Bleeding events due to DAPT after ACS and after PCI forced the search for approaches aimed at reducing the risk of such complications, especially noticeable when using a powerful blocker of the P2Y₁₂ receptor of platelets. One of the recently identified solutions turned out to be early (1-3 months after the therapy initiation) discontinuation of ASA with continued administration of one antiplatelet agent (P2Y₁₂ receptor antagonist). The article provides arguments in favor of this approach.

Aim. To assess the effect of the sodium-glucose transport protein 2 inhibitor empagliflozin on exercise tolerance and left ventricular (LV) diastolic function in patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes (T2D).

Material and methods. The present prospective, single-center, open-label study included 60 patients with HFpEF and T2D, who were assigned to groups receiving empagliflozin 10 mg/day. or previously taken hypoglycemic therapy (control group). The follow-up period lasted 24 weeks. All patients underwent a 6-minute walk test and rest and stress echocardiography at baseline and at the end of the study.

Results. After 24 weeks. in the empagliflozin group there was an increase in the 6-minute walk test distance by 20 m (95% confidence interval (CI), from 7 to 33 m), a decrease in the early mitral inflow to mitral annulus relaxation velocities (E/e’) ratio by 1,8 (95% CI, from -2,4 to -1,2) and maximum left atrial volume by 2,6 (95% CI, from -4,4 to -0,8) ml/m2, as well as an increase in the diastolic reserve (mitral annulus relaxation velocity increment e’ during exercise increased from 2,2 (95% CI, 1,7 to 2,7) to 3,4 (95% CI, 2,4 to 4,2) cm/s; P<0,01 for all). There were no significant changes in the control group.

Conclusion. In patients with HFpEF and T2D, empagliflozin improves exercise tolerance and LV diastolic function. Large-scale placebo-controlled randomized trials are required to prove these findings.

Aim. To study the effect of levosimendan (LS) on 1-year prognosis in patients with myocardial infarction (MI), complicated with heart failure (HF), and concomitant chronic brain ischemia (CBI).

Material and methods. The study included 182 patients with Q-wave MI, complicated by HF with left ventricular ejection fraction (LVEF)<40%, and concomitant CBI (149 (81,9%) men and 33 (18,1%) women). The median age was 60,4 (53; 69) years. Group I (control) included 49 patients who received standard therapy; group II (experimental) — 133 patients who were injected with LS on days 1-2 of MI. All patients underwent echocardiography, duplex ultrasound of peripheral arteries and were examined by angioneurologist. A year later, the hard endpoints of recurrent MI, angina progression, revascularization, acute decompensated HF, rehospitalizations, strokes, and death were assessed.

Results. According to multivariate regression analysis, LS administered in the acute period of myocardial infarction reduced the risk of hard endpoints (hazard ratio, 0,32,95% confidence interval, 0,2-0,52, p=0,001), but did not affect patient survival.

Conclusion. In patients with MI complicated by left ventricular failure and associated with CBI, LS infusion in the acute period of MI can reduce the risk of adverse cardiovascular events during the year.

The article analyzes the new results of randomized clinical trials on the use of sodium-glucose co-transporter-2 inhibitors in patients with cardiovascular diseases, heart failure with and without type 2 diabetes. The data of the latest studies (EMPEROR reduced, VERTIS CV, SOLOIST-WHF, SCORED) are presented in more detail.

Heart failure (HF) is a global pandemic that is steadily increasing in prevalence. Currently, based on the left ventricular ejection fraction, three types of HF are distinguished. A theory was created that the HF pathophysiology is based on two processes: systolic and diastolic myocardial dysfunction. Due to the heterogeneity of HF, it is necessary to develop methods for differential diagnosis of its types to ensure adequate risk assessment and patientcentered therapy. Taking into account the objectivity, reproducibility, and high sensitivity of biomarkers of injury, inflammation, and myocardial remodeling, these parameters can be used for these purposes. To date, many biological molecules have been identified, such as sST2, Gal-3, GDF-15, FABP, IGFBP, micro-ribonucleic acid, sensitivity and specificity of which are superior to natriuretic peptides and high sensitivity troponins used today, and are already being introduced into clinical practice. At the same time, it is advisable to conduct additional prospective studies for a more objective assessment of diagnostic significance and the potential of its use in routine diagnosis and prognosis of heart failure.

According to current clinical guidelines, the risk of sudden cardiac death (SCD) in patients with heart failure is specified by left ventricular (LV) ejection fraction (EF). We believe that risk stratification and choice of patient management tactics should be based on modern diagnostic techniques aimed at identifying the anatomical and electrophysiological substrate of SCD. Therefore, LVEF alone is not enough to solve such problems. This review presents an analysis of current research on the novel predictors of SCD. The most promising areas include the identification of electrocardiological markers of fatal ventricular arrhythmias, modern ultrasound and magnetic resonance imaging techniques. The importance of electrophysiological tests in the verification of SCD risk is discussed. Based on the literature analysis, we can conclude that only a combination of different factors can significantly increase the diagnostic value of prognostic model and improve the primary prevention of SCD.

The review includes data on the pathogenesis of cardiorenal syndrome (CRS) in patients with heart failure (HF). Renal hypertension has been identified as an important cause of its development and progression. The mechanisms of its formation in patients with low cardiac output are considered. In this setting, renal vasoconstriction, due to neuroendocrine activation, and external parenchymal compression, due to increased intra-abdominal pressure, developed. Both mechanisms were responsible for the decreased glomerular filtration rate. Hypokalemia has often accompanied by CRS. Potassium deficiency aggravated the decrease in cardiac output and provoked arrhythmias. This increased renal hypertension. High doses of furosemide in the treatment of acute decompensated HF sometimes damaged the kidneys due to hypovolemia and hypokalemia. Such side effects of furosemide as a neuroendocrine activation with subsequent vasoconstriction and the development of endothelial dysfunction due to oxidative stress are considered. Two directions of prevention of nephrotoxic effects of the drug are proposed. The proposed prevention methods have shown encouraging results.

Congestion associated with pressure and/or volume overload plays a central role in the pathophysiology, manifestations and prognosis of heart failure, being one of the important aims of its therapy. The current methods for congestion diagnosis, mainly clinical, have low sensitivity and specificity, which can lead to a delay in diagnosis and initiation of treatment.

Over the past decades, novel, more sensitive and specific ultrasound techniques have been developed to detect increased intracardiac pressure and/or volume overload, providing early and accurate diagnosis and facilitating treatment strategies. The review discusses the role of modern investigations for detecting and quantifying congestion, including visualization of the lungs (B-lines), kidneys (intrarenal venous flow) and the venous system (diameter of the inferior vena cava and internal jugular veins), and transient elastography.