Aim. To determine additional diagnostic criteria for atrial cardiomyopathy in patients with type 2 diabetes (T2D) and paroxysmal/persistent atrial fibrillation (AF).

Material and methods. This cross-sectional screening clinical study included 80 patients with AF and T2D, who were divided into 2 groups depending on the left (LAVI) or right atrial volume index (RAVI) according to echocardiography: the first group included 49 patients with increased LAVI, while the second — 31 patients without changes in LAVI and RAVI. Inclusion criteria were presence of paroxysmal or persistent AF, T2D, age up to 65 years. There were following exclusion criteria: current smoking and less than 1 year old, the presence of cardiovascular and pulmonary diseases, heart failure, implanted artificial pacemaker, prior radiofrequency ablation; valvular heart disease and prosthetics; acute myocarditis, infective endocarditis, hypertrophic, dilated, and restrictive cardiomyopathies, storage diseases, severe liver diseases; thyroid disorders; cancer; acute inflammatory and infectious diseases; alcohol abuse, dementia and mental illness.

Results. The groups did not differ significantly in terms of sex, age, cardiovascular risk factors, risk of stroke and bleeding when using anticoagulants, clinical and laboratory parameters, and the structure of drug therapy. The following parameters significant differ between the groups: LAVI (according to study design), mid-regional pro-atrial natriuretic peptide (MR-proANP), glomerular filtration rate (GFR) calculated by creatinine, tissue inhibitor of matrix metalloproteinases 1 (TIMP-1). For MR-proANP, GFR, TIMP-1, ROC curves were created in order to determine its clinical significance and operational characteristics of parameters. GFR, as a diagnostic criterion, showed unsatisfactory clinical significance when constructing the ROC curve: AUC (area under the curve) was 0,38. The MR-proANP of 62,3-85 pmol/L and TIMP-1 of 156 ng/ml and higher allows verification of atrial cardiomyopathy in patients with T2D and AF at AUC of 0,83 (95% confidence interval (CI), 0,73; 0,92) and 0,90 (95% CI, 0,83; 0,98), respectively.

Conclusion. The blood MR-proANP concentration of 62,3-85 pmol/L is diagnostic for atrial cardiomyopathy in patients with T2D and AF with the sensitivity and specificity of 96,8% and 75,5%, respectively, while TIMP-1 values of 156 ng/ml and above had the sensitivity and specificity of 90,3% and 87,8%, respectively.

Aim. To investigate the relationship between abnormal glycemia levels during inpatient treatment for acute myocardial infarction (AMI) in patients with type 2 diabetes (T2D) and long-term prognosis.

Material and methods. The single-center cohort study included patients with AMI and concomitant T2D who were hospitalized consecutively for 200 days. A total of 237 patients were included. The median number of blood glucose measurements during hospitalization was 15 [8; 20] times. Long-term outcome was estimated at 365 days after hospitalization.

Results. The first glycemic value on admission was 13,6±5,9, while the average glycemia during hospitalization was 10,0±3,5 mmol/L. Within 12 follow-up period, 53 deaths were recorded. It was found that exceeding the glycemic threshold of 10,0 mmol/L in more than 45% of measurements during hospitalization was associated with a 3-fold increase in the risk of an unfavorable outcome within 12 months. Predictors of poor glycemic control are insulin therapy before MI and blood glucose at admission >12,1 mmol/L.

Conclusion. Poor glycemic control (>45% of glucose measurements above the threshold of 10,0 mmol/L) during hospitalization for AMI in patients with T2D is associated with an increased risk of in-hospital death and during the next 12 months, including in patients who underwent endovascular treatment.

Aim. To study the prevalence of carbohydrate metabolism disorders in patients with heart failure (HF) hospitalized in the city HF center.

Material and methods. According to the local registry, the study sequentially included 183 patients (99 men and 84 women) hospitalized in the Nizhny Novgorod city HF center from September 1, 2019. The examination and treatment were carried out in accordance with the current clinical guidelines. In the first 48 hours after hospitalization, the concentration of the N-terminal pro-brain natriuretic peptide, soluble stimulating growth factor 2 (sST2), neutrophil gelatinase-associated lipocalin, cystatin C, blood creatinine was determined. The glomerular filtration rate was calculated using the СKDEPI equation. To assess the carbohydrate metabolism disorders, all patients were studied for fasting plasma glucose, glycated hemoglobin (HbA1c) and fructosamine. Statistical data processing was carried out using the R statistics package (R Core Team (2019)).

Results. The incidence of carbohydrate metabolism disorders among patients withdecompensated HF was 75,89%, including previously diagnosed type 2 diabetes in 31,25%, newly diagnosed dysglycemia in 44,64% of patients. Less than one fourth of patients had normal parameters of carbohydrate metabolism according to HbA1c, fructosamine and fasting plasma glucose. The severity of carbohydrate metabolism disorders was significantly correlated with the severity of HF according to the following criteria: 6-minute walk test, HF functional class, sST2 level, and some parameters of cardiac remodeling. Among the criteria used for carbohydrate metabolism disorders, the HbA1c level was most closely associated with the criteria for HF severity.

Conclusion. Carbohydrate metabolism disorders in HF patients are widespread and underdiagnosed during routine examination. The interrelation of carbohydrate metabolism parameters and indicators of HF severity is rationale for active detection of dysglycemia in these patients in order to potentially influence the prognosis.

It has been proven that about half of patients with heart failure (HF) have a preserved the left ventricle (LV) ejection fraction (EF), which complicates early detection of HF. Currently, there is a search for non-invasive methods for diagnosing myocardial fibrosis at the preclinical heart failure to prevent its progression and the appearance of clinical symptoms.

Aim. To study the relationship of LV mechanics with the level of serum myocardial fibrosis markers in patients with epicardial obesity (EO).

Material and methods. The study included 110 men with general obesity. Depending on echocardiographic data, the patients were divided into 2 groups: EO (+) with epicardial fat thickness (EFT) ≥7 mm (n=70); EO (-) with EFT <7 mm (n=40). All patients were studied for serum profibrotic markers (MMP-3, collagen I, collagen III, TGF-β, VEGFA, PICP) using enzyme-linked immunosorbent assay. Speckle-tracking echocardiography was used to study LV mechanics (LV twisting, LV twisting rate, time to peak twist, LV untwisting rate, time to peak untwist). The exclusion criteria were the presence of coronary artery disease, hypertension, type 2 diabetes.

Results. In the group of patients with EO (+), a significant increase in the level of all studied profibrotic markers was revealed. According to the results of speckletracking echocardiography in the EO (+) group, an increase in the LV untwisting rate to -128,31 (-142,0; -118,0) deg/s-1 (p=0,002) and an increase in the time to peak untwist to 476,44 (510,0; 411,0) ms compared to the EO (-) group (p=0,03). A weak significant effect of EFT on LV untwisting rate was revealed in the EO (+) group (r=0,24; p=0,04). In addition, a significant relationship was found between the LV untwisting rate and markers of myocardial fibrosis: MMP-3 (r=0,21; p=0,04) and type III collagen (r=0,26; p=0,03).

Conclusion. Thus, the obtained data suggest that patients with EO have signs of preclinical LV diastolic dysfunction, which are characterized by an increase in LV untwisting rate and level of serum profibrotic factors.

Aim. To determine the blood level of inflammatory markers, parameters characterizing obesity and cardiac remodeling in patients with atrial fibrillation (AF) in combination with metabolic syndrome (MS).

Material and methods. This single-stage case-control study included 677 subjects aged 35 to 65 years: patients with MS (n=407), of which 128 patients with AF; comparison group — patients with AF without MS (n=75); control group — practically healthy subjects without cardiovascular diseases and metabolic disorders (n=195).

Results. It was found that the blood concentration of circulating pro-inflammatory biomarkers in patients with AF and MS is higher than in patients with AF without MS: C-reactive protein (CRP) (4,43 (2,68-4,98) and 2,33 (1,08-4,7) mg/L, p<0,0001), interleukin-6 (IL-6) (2,5 (1,28-5,13) and 1,27 (0,68-2,7) pg/ml, p<0,0001) and tumor necrosis factor-α (TNF-α) (5,18 (2,63-7,32) and 3,42 (2,115,48) pg/ml, p<0,0001). The serum CRP concentration positively correlates with left (ρ=0,451, p<0,0001) and right atrial (ρ=0,412, p<0,000) volumes, as well as with the waist circumference (ρ=0,503, p<0,001) and epicardial fat thickness (ρ=0,550, p<0,001). Plasma IL-6 and serum TNF-α levels correlated to a lesser extent with parameters characterizing atrial remodeling, but had a strong positive relationship with epicardial fat thickness. According to multivariate analysis, it was found that an increase in the epicardial fat thickness had a greater effect on an increase in blood concentration of CRP, IL-6 and TNF-α, in contrast to other parameters characterizing obesity, such as body mass index and waist circumference.

Conclusion. An increase in the blood concentration of proinflammatory biomarkers CRP, IL-6, and TNF-α is associated with cardiac remodeling and epicardial fat thickness in patients with MS and probably has a pathogenetic role in increasing the AF risk in this cohort of patients.

Aim. To determine the expression of adiponectin, leptin and I interleukin-6 (IL-6) in subcutaneous, epicardial and perivascular adipose tissue, depending on the presence of cardiovascular risk factors.

Material and methods. The study included 90 patients with stable coronary artery disease (CAD) who underwent coronary artery bypass grafting. Samples of adipose tissue were obtained during surgery. The levels of matrix ribonucleic acid (mRNA) of the studied adipocytokines were determined in the presence/absence of the main cardiovascular risk factors.

Results. Differences in the expression of genes of the studied adipocytokines in different sex and age groups of patients were revealed, depending on the tissue belonging of adipocytes. Expression of adiponectin in the epicardial and perivascular adipose tissue (EАT and PVAT, respectively), as well as of leptin in the PVAT was less pronounced in men. However, the level of IL-6 mRNA in the subcutaneous adipose tissue (SAT) of men was three times higher than in women, and in the PVAT it was lower. The maximum expression of leptin and IL-6 in the EAT and PVAT was found in persons aged 50-59 years. The presence of dyslipidemia is associated with a decrease in the expression of adiponectin in the EAT, PVAT, and IL-6 in the PVAT. In patients with hypertension (HTN), there was a low level of adiponectin mRNA in the EAT against the background of high leptin levels in the EAT and IL-6 in SAT and EAT. In hypertension with a duration of more than 20 years, there was a decrease in adiponectin expression and an increase in leptin in all types of AT. In smokers, an increase in the expression of adiponectin in the SAT, EAT, PVAT and leptin in the SAT, EAT was found.

Conclusion. Associations of traditional cardiovascular risk factors with imbalance of adipocytokines of local fat depots in patients with CAD were revealed. The detected imbalance is manifested by a decrease in the expression of cardioprotective adiponectin in the EAT, PVAT, an increase in leptin and IL-6, which is an unfavorable sign. The presence of such risk factors as male sex, age of 50-59 years, dyslipidemia and hypertension in patients can enhance atherogenesis and contribute to the further progression of CAD.

Aim. To assess epicardial adipose tissue (EAT) thickness using echocardiography as one of the possible predictors of subclinical carotid atherosclerosis in patients with abdominal obesity in prospective follow-up.

Material and methods. The study included 224 men (mean age, 49,1±2,4 years), without hypertension, carotid atherosclerosis, type 2 diabetes and symptoms of cardiovascular diseases, with abdominal obesity and SCORE risk <5%. The levels of albuminuria, lipid and glucose profiles, C-reactive protein, uric acid, blood creatinine, EAT thickness, ultrasound parameters of abdominal obesity and perivascular adipose tissue (PVAT) were assessed. At the follow-up end (mean duration, 48,2±4,8 months), repeated triplex ultrasound of the brachiocephalic arteries was performed.

Results. Patients with developed carotid atherosclerosis (n=70) had higher baseline values of blood pressure, fasting glycemia, C-reactive protein, as well as a higher incidence of prediabetes, hyperuricemia, and high-grade albuminuria. They were also distinguished by high values of EAT thickness (6,1±0,6 mm vs 5,0±1,0 mm, p <0,001), abdominal visceral to subcutaneous fat ratio (3,1±0,5 vs 2,7±0,6, p <0,05) and carotid extra-media thickness (0,64±0,08 mm vs 0,50±0,11 mm, p <0,01). According to multivariate logistic regression, EAT thickness was characterized by the maximum standardized regression coefficient (0,443, p <0,001), and the total percentage of correct mathematical model classifications was 88,2%. According to the ROC-analysis, the area under the curve was 0,86. With a cut-off value of EAT thickness of 5,9 mm, the sensitivity and specificity of the predictive model were 71,5% and 92,3%, respectively.

Conclusion. EAT thickness assessed by echocardiography, as a marker of the severity of visceral EAT, can serve as a predictor of subclinical carotid atherosclerosis in persons with abdominal obesity and initially low cardiovascular risk according to the SCORE calculator. Patients with verified epicardial visceral obesity require more active preventive measures.

Aim. To study such circulating angiogenesis factors as vascular endothelial growth factor (VEGF-A), hepatocyte growth factor (HGF), insulin-like growth factor (IGF-1), as well as the cytokine profile (IL-1β, TNF-α, IL-6, IL-8, IL-23) and their soluble receptors (SRp55 TNF-α, SR IL-6) in the blood serum of gout patients having various obesity phenotypes.

Material and methods. The study included 112 male patients with intercritical gout. The patients were divided into 2 study groups: the 1st group consisted of 39 patients with a metabolically healthy obesity (MHO) phenotype and body mass index (BMI) ≥25 kg/m²; the 2nd group included 73 people having metabolically unhealthy obesity (MUO) with impaired immune status, hypertension (HTN) and class 1 abdominal obesity. The control group consisted of 25 metabolically healthy subjects with normal body weight. Serum concentration of uric acid, CRP, insulin, leptin, insulin resistance index (HOMA-IR), cytokine status, plasma levels of VEGF-A, HGF, IGF-1 were studied. To assess the left ventricular (LV) diastolic function, tissue Doppler imaging of the mitral annulus was used.

Results. In the group of patients with MUO, an increase of pro-inflammatory cytokines (IL-1β, IL-6, IL-23, TNF-α, SRp55 TNF-α) was revealed, while the level of TNF-α and IL-1β exceeds the control values in 4,7 and 6,8 times, respectively (p <0,05), and in the group of patients with MHO, 1,4 and 1,6 times, respectively (p<0,05). Correlations between VEGF-A and TNF-α (r=0,59, p<0,0001), IL-6 (r=0,68, p<0,001), CRP (r=0,59, p<0,0001), serum uric acid level (r=0,47, p<0,0001), decrease in high-density lipoprotein cholesterol (HDL-C) (r=-0,28, p<0,05) and diastolic blood pressure (r=0,51, p<0,0001) were determined. The concentration of HGF and VEGF-A correlated with BMI (p<0,001). Associations of IGF-1 and HGF with hyperuricemia, carbohydrate metabolism and diastolic remodeling were established.

Conclusion. The relationship between circulating levels of VEGF-A, HGF and IGF-1 with indicators of cytokine status, carbohydrate metabolism and Doppler imaging criteria for LV diastolic dysfunction allows to consider them as additional predictors of unfavorable cardiovascular risk.

Aim. To assess the risk factors and diagnostic significance of the N-terminal probrain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure (ADHF) and diabetic kidney disease (DKD).

Material and methods. A total of 125 patients with ADHF and type 2 diabetes (T2D) were examined. They were divided into 2 groups depending on the presence/ absence of chronic kidney disease (CKD). The first group consisted of 43 (34,4%) patients with DKD, the second — 82 (65,6%) without CKD. The inclusion criterion was the presence of ADHF and T2D. There were following exclusion criteria: cardiogenic shock, pulmonary edema, acute thromboembolic events, type 1 diabetes, prediabetes, acute coronary syndrome, stroke, prior transient ischemic attack (<1 month old), dissecting aneurysm or aortic dissection, acute valvular disorders, major surgery (<1 month old), cardiac trauma, infective endocarditis, acute hepatitis and cirrhosis, terminal CKD, alcohol abuse, non-cardiac edema, cancer, dementia and mental disorders.

Results. With the development of a hypertensive crisis and an increase in diastolic blood pressure >100 mm Hg, the odds ratio (OR) and the relative risk (RR) of ADHF in patients with DKD increases by 5,1 and 4,5 times, 2,5 and 1,8 times, respectively. In the presence of grade III-V premature ventricular contractions, OR and RR of ADHF in patients with DKD were 2,6 and 1,9, respectively. OR and RR of ADHD in patients with DKD and prior stroke or transient ischemic attack were 3,8 and 3,2, respectively. Verification of anemia at a hemoglobin level of 5 mmol/l, the OR of ADHF in patients with DKD increases by 3,7 times, the OR — by 2,3 times. The NT-proBNP >1289 pg/ml is diagnostic for verifying ADHF in DKD patients with the sensitivity of 64,3% and specificity of 93,3%.

Conclusion. Every third patient with ADHF and T2D is diagnosed with DKD. A certain range of risk factors for the development of ADHF in patients with DKD has been identified. As the glomerular filtration rate (GFR) decreases, the NT-proBNP level increases. With a decrease in GFR of 60 ml/min/1,73 m2 in patients with T2D, the diagnostic value of NT-proBNP >1289 pg/ml should be considered to verify ADF.

Aim. To assess the parameters reflecting sarcopenia (body composition, muscle strength, muscle function) in order to determine the effectiveness of metformin in patients with sarcopenia.

Material and methods. Systematic searches of clinical trials were carried out in MEDLINE databases through PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ResearchGate from January 1990 to March 2019. For statistical processing, the R language with the RStudio software was used. The following packages were used: googlesheets4, tidyverse, meta, dmetar, metafor. The metaanalysis included 391 patients with both established for the first time and existing long-term type 2 diabetes (T2D), with prediabetes, impaired glucose tolerance (IGT), as well as patients without impaired glucose metabolism. In comparison groups (194 patients who received metformin and 197 patients who received placebo), the effect of metformin on lean body mass (LBM), fat mass, muscle strength and muscle function was assessed, which made it possible to indirectly evaluate the potential effect of metformin on sarcopenia.

Results. The use of metformin in patients with different glucose metabolism (type 2 diabetes, IGT, prediabetes) did not lead to significant changes in body composition (on average, LBM increased by 0,9 kg (MD, 0,8815; CI (-0,11; 1,87), p=0,0818), fat mass decreased by 0,7% (MD, -0,6856; CI (-1,54; 0,17), p=0,1170), but muscle strength significantly increased by 0,5 kg (SMD, 0,5241, CI (0,2265; 0,8217), p=0,0006).

Conclusion. Meta-analysis has confirmed that the use of metformin has an effect on muscle strength, which makes it possible to consider it for sarcopenia treatment. Unfortunately, a small number of studies have not allowed to analyze the effect of metformin on a number of characteristics: muscle strength, muscle function (walking speed, functional tests). At the moment, a much larger prospective study is needed to form a final opinion on the rationale of metformin therapy in patients with sarcopenia.

People with type 2 diabetes mellitus (T2DM) are at high risk of developing cardiovascular disease (CVD) and kidney disease. This enhanced cardio-renal risk persists despite improvements in care and treatments over the last 20 years. Intensive glucose control alone does not substantially reduce the risk of CVD and end stage kidney disease (ESKD). However, in 2015 the landmark EMPA-REG trial demonstrated for the first time the benefits of Empagliflozin a sodium-glucose co-transporter 2 (SGLT2) inhibitor on CVD events and mortality in people with T2DM. Since this trial several other SGLT2 Inhibitors including Dapagliflozin and Canagliflozin have demonstrated CVD benefits. SGLT2 inhibitors have also demonstrated significant reductions in the risk of hospitalization for heart failure (HHF) and ESKD. As a consequence of this growing evidence, there has been a shift in the focus of care in T2DM from glucose management to preservation of organ function. SGLT2 inhibitors have emerged as key treatment to reduce CVD, HHF and prevent progression of kidney disease. The benefits for reducing HHF and preventing ESKD have been observed in people with and without T2DM in large randomised controlled clinical trials. In T2DM the positive effects of SGLT2 inhibitors occur early and are independent of their glucose lowering effects. It is vital that all clinicians recognise the remarkable benefits of SGLT2 inhibitors and use this important class of drugs promptly and early to prevent CVD, HHF and ESKD.

A review of the efficacy and safety of diuretics in hypertension was carried out from the standpoint of current clinical guidelines. Also, updated data from metaanalyzes of the efficacy and metabolic effects of diuretic therapy were reviewed. Currently, a more differentiated approach to the appointment of a specific diuretic as part of antihypertensive therapy, taking into account the effect on endpoints and metabolic effects, seems relevant.

The increasing prevalence of obesity, accompanied by an increase in the frequency of metabolic disorders, hypertension, associated conditions and diseases, dictates the need to optimize preventive and therapeutic strategies of the health care system, including pharmacological approaches to correcting obesity and the related risk. The evolution of this area led both to the disappearance of drugs that increase the risks of cardiovascular events, cancer, mental disorders or having other pronounced adverse effects, and to the emergence of unique drugs that not only lead to a decrease in body mass index, but also allow multifactorial effect on various components of adiposopathy or visceral obesity, among which glucagon-like peptide-1 receptor agonist liraglutide is currently registered with the indication for obesity. In this regard, the study continues in this regard and other representatives of this class, as well as drugs from sodium-glucose cotransporter-2 inhibitors group. Many other promising pharmacological agents are currently being studied, a review of which is presented in this article.

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation