Aim. To evaluate the dynamics of left atrial volume (LAV), strain (S) during the reservoir phase and strain rate (SR) in patients with paroxysmal and persistent atrial fibrillation (AF), scheduled for catheter radiofrequency ablation (RFA), as well as to compare the predictive value of S and SR as a marker of maintaining sinus rhythm.

Material and methods. A total of 19 patients (men, 11; women, 8) aged 62±10,7 years with AF were included in the study, 13 (67%) of whom had persistent AF, while 6 patients (33%) had paroxysmal AF Two-dimensional and speckle tracking N. Sh. echocardiography (EPIQ 7, Philips) were performed in all patients before ablation and 12 months after RFA.

Results. The patients were divided into 2 groups: group 1 — no recurrent AF after RFA (n=12; 63%); group 2 — recurrent AF after RFA (n=7; 37%). According to 2D echocardiography, the baseline values of LAV and LAV index (LAVI) did not significantly differ between groups 1 and 2: 56,0±12,6 ml and 52,0±23,2 ml (p=0,78); 28,0±7,8 ml/m² and 25,1±13,6 ml/m² (p=0,85), respectively. The initial S values of the LA in the four-chamber (4C-) and two-chamber (2C-) apical views in group 1patients were higher than in those from group 2: 4C-S, 34,3±9,9% and 16,9±4,4% (p=0,0008); 2C-S, 29,2±8,3% and 14,5±4,4% (p=0,0011), respectively. Baseline SR values were higher in group 1 patients compared with group 2 in 4C- and 2C-views: 4C-SR, 2,36±0,37 s^-1 and 1,39±0,50 s-1 (p=0,0013); 2C-SR 2,09±0,39 s^-1 and 1,4±0,53 s^-1 (p=0,0053), respectively. The LAV in group 1 became significantly less after RFA than its initial levels: 56,0±12,6 ml and 47,0±12,1 ml (p=0,008). The LAVI also significantly decreased 12 months after RFA as follows: 28,0±7,8 ml/m² and 22,6±8,3 ml/m² (p=0,02). In group 2, there was no decrease in either LAV or LAVI after 12 months: LAV, 52,0±23,2 ml and 54,0±12,1 ml (p=1,0); LAVI, 25,1±13,6 ml/m² and 30,9±7,6 ml/m² (p=0,3). In group 1, there was no significant change in LA S 12 months after RFA: 4C-S, 34,3±9,9% and 30,3±9,6% (p=0,287); 2C-S, 29,2±8,3% and 28,9±9,1% (p=0,82). In group 2, LA S levels in 4C- and 2C-views did not significantly change depending on the performed RFA procedure: 4C-S, 16,9±4,4% and 17,4±6,2% (p=0,12); 2C-S, 14,5±4,4% and 16,5±6,8% (p=1,0). According to the ROC analysis, the optimal cut-off values for baseline 4C-SR (1,8 s^-1 (AUC=0,958)), 2C-SR (1,75 s^-1 (AUC=0,899)), 4C-S (20,7% (AUC=0,976)), and 2C-S (19,2% (AUC=0,964)) were reliable individual predictors of sinus rhythm maintenance.

Conclusion. A stable sinus rhythm 12 months after the RFA was maintained in patients with higher baseline LA S and SR levels. The baseline LA S and SR values have a high predictive value for AF recurrence in patients after RFA. In patients with effective RFA, LAV and LAVI decreased without changing the S and SR. There was no effect of LA reverse remodeling and improvement in LA S values in patients with recurrent AF after RFA.

Aim. To assess the effect of withdrawing long-term (12 months) CPAP therapy on the course of obstructive sleep apnea (OSA) in patients with moderate to severe disease.

Material and methods. The study included 40 patients with moderate to severe OSA and paroxysmal atrial fibrillation (AF) after surgical treatment. The mean age of the subjects was 59,3+8,2 years. In addition, 55% of patients had obesity. All patients were started on CPAP therapy. After 12 months, CPAP therapy was canceled in the patients who completed the study. Additional cardiorespiratory sleep monitoring was performed 1-2 days after the withdrawal of treatment to assess the severity of sleep-related breathing disorders.

Results. Cancellation of CPAP therapy in all observed cases led to an immediate relapse of OSA. Although the mean value of the apnea/hypopnea index (AHI) decreased from 24 episodes per hour [20; 34] before treatment up to 21 episodes per hour [13; 27] after 12-month CPAP therapy, there was no significant difference before and after therapy. In addition, the statistical analysis showed a transition from more severe OSA degrees to moderate ones, depending on the initial severity of the disease. Correlation analysis demonstrated significant relationships of the OSA severity, the final AHI value and the minimum oxygen level with the patient’s body weight (before and after therapy) (r=0,396, 0,411 and -0,488; r=0,358, 0,398 and -0,44, respectively, p<0,05).

Conclusion. In our study, when the 12-month CPAP therapy was canceled, no complete cure for sleep-related breathing disorders was recorded in any case. OSA recurrence was recorded immediately after discontinuation of CPAP therapy (on days 1-2) and its severity depended on the initial severity of the disease. At present, the continuation of CPAP therapy remains the only way to achieve complete control of OSA as a risk factor for AF.

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.

Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR) <60 ml/ min/1,73 m². Risk of early (hospital or 30-day) death was stratified in accordance with the current 2019 ESC Clinical Guidelines. During the study, we analyzed inpatient mortality and complication rate.

Results. A total of 604 patients (men, 293 (49%); women, 311 (51%)) were in the study. RD was detected in 320 (53%) patients, while severe dysfunction — in 63 (10%) ones. In addition, 71 (12%) patients had high death risk, 364 (61%) — intermediate, 164 (27%) — low. During hospitalization, 107 (18%) patients died, including 32% from the high-risk group, 20% — moderate, and 7% — low. RD in the deceased patients was diagnosed more often, while GFR <50 ml/min/1,73 m² reliably predicted hospital mortality (sensitivity, 67%; specificity, 72%; AUC=0,72; p<0,001). In patients with simplified Pulmonary Embolism Severity Index (sPESI) of 0 and ≥ 1, the presence of RD led to at least a 2-fold increase in mortality. Multivariate Cox regression revealed that RD is a predictor of in-hospital mortality (hazard ratio (HR), 3,41; 95% confidence interval (CI): 2,15-5,41; p<0,001), regardless of the presence of death risk reclassifies, such as high troponin (HR, 1,31; 95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (HR, 1,23; 95% CI: 0,74-2,04; p=0,42).

Conclusion. In patients with PE of the Russian population, there is a high incidence of RD, which is diagnosed in every second patient and is severe in 10% of cases. The presence of RD is associated with a significant increase in in-hospital mortality, while the risk of death increases with a decrease in GFR. The addition of RD, considered as a decrease in the estimated GFR <60 ml/min/1,73 m², to the sPESI improves risk stratification and allows identification of patients at high risk of in-hospital death.

The coronavirus disease 2019 (COVID-19) affects not only the respiratory system, but also the cardiovascular system in 20-28% of cases, causing endothelial dysfunction, vasculitis, hyper- and hypocoagulation, myocarditis, endothelial dysfunction and other adverse effects. The presence of cardiovascular risk factors and diseases has been shown to worsen the disease severity and increase mortality from COVID-19. Recent studies have also found that elevations in some serum cardiovascular biomarkers can stratify the disease severity, in particular rates of hospitalizations to an internal medicine or intensive care unit, intubation, and mortality. They can be divided into markers of damage (TnT/I, creatine phosphokinase (CPK) and CPK-MB, myoglobin, NT-proBNP), coagulation (prothrombin time, fibrinogen and D-dimer), as well as prospective biomarkers for which the available evidence base is limited but there is a pathophysiological rationale (homocysteine and sST2). This review presents studies on the use of above serum biomarkers to stratify the risk of death in patients with COVID-19.

Aim. To study the relationship between symptomatic hypotensive episodes (SHEs) and parameters of self-monitoring of blood pressure (SMPB) in patients with hypertension (HTN).

Material and methods. A total of 77 patients from 40 to 76 years old with HTN were examined. To identify SHEs, an original questionnaire was used. Patients underwent SMBP in the morning and evening, as well as recorded SHE in the diary. The self-monitoring period lasted 4 weeks. Patients without prior myocardial infarction and/or stroke are conventionally called “uncomplicated” HTN, while with cardiovascular events in history — “complicated” HTN.

Results. According to the questionnaire, 48 (62,3%) patients noted SHEs. Uncomplicated HTN was recorded in 19 (51,4%) participants, while complicated one — in 29 (72,5%) (p=0,05). Blood pressure during SHEs was on average higher in patients with complicated HTN than in uncomplicated HTN (103/60 vs 95/60 mm Hg (p=0,05)). With a combination of uncomplicated HTN and SEG, mean systolic blood pressure (SBP) (125,9±10,5 vs 137,9±8,2 mm Hg), evening SBP (125,3±8,1

vs 133,3±10,4 mm Hg), maximum SBP (149,8±11,8 vs 161,7±12,1 mm Hg) in the morning, as well as minimum SBP in the evening (101,8±10,8 vs 113,7±9,7 mm Hg) were lower than in patients without SHEs (p<0,05).

In complicated HTN, an opposite relationship was observed: patients with SHEs had higher mean SBP (133,49±12,4 vs 118,93±15,3 mm Hg), maximum SBP (162,8±11,6 vs 141,7±12,0 mm Hg), and diastolic blood pressure (DBP) (91,5±5,6 vs 83,5±8,8 mm Hg) in the morning (p<0,05), as well as higher variability of morning (11,8±2,1 vs 8,2±2,7 mm Hg) and evening SBP (11,9±4,2 vs 8,6±3,2 mm Hg) compared with patients without SHEs (p<0,05). There were no significant differences in antihypertensive therapy.

Conclusion. More than half of patients with hypertension report SHEs. SHEs in patients without prior myocardial infarction and/or stroke were characterized by lower blood pressure level than in subjects with prior cardiovascular events. Among patients with SHEs without cardiovascular events, the values of morning, evening, and maximum SBP in the morning are lower than in patients without SHEs. In patients with complicated HTN and SHEs, the opposite trend was observed: higher SBP and DBP in the morning, as well as greater variability of morning and evening SBP, in comparison with those without SHEs. These patterns cannot be explained by the antihypertensive drugs taken.

The existing clinical guidelines identify two main approaches to the treatment of patients with ST-segment elevation myocardial infarction: a primary percutaneous coronary intervention and a pharmacoinvasive strategy. Due to the time delays due to various reasons, it is not always easy to perform primary percutaneous coronary intervention timely (<120 minutes). Modern thrombolytic drugs make it easy and safe to apply a pharmacoinvasive strategy to a wide group of patients, improving their prognosis.

The review is devoted to the clinical efficacy of sodium-glucose cotransporter type 2 (SGLT2) inhibitors. Information on the mechanisms of drug action is given, as well as rationale for their use in the management of patients with diabetes and heart failure (HF) is provided. The results of large-scale randomized clinical trials evaluating the efficacy of SGLT2 inhibitors are discussed. We showed the beneficial effect of SGLT-2 inhibitors on the risk of cardiovascular events in patients with type 2 diabetes. In addition, an evidence of the ability of dapagliflozin and empagliflozin to improve the prognosis of patients with HF with reduced ejection fraction without diabetes are presented. The evidence and mechanisms of the nephroprotective action of SGLT2 inhibitors in patients with diabetes and HF are considered.

Any cardiovascular disease leads to heart failure (HF) — a complex clinical syndrome, the course of which is probably specified by the influence of cardiovascular factors on cardiac extracellular matrix (ECM).

The presented literature data indicate that the cardiac ECM is an important pathophysiological link in the onset and progression of HF. The morphological and electrical remodeling negatively affects the systolic and diastolic functions of the heart. Impaired myocardial blood delivery, cellular maladaptation, atrial and ventricular arrhythmias are additional mechanisms of the influence of myocardial fibrosis on HF course.

Understanding this role of ECM and the development of algorithms for verifying the individual status of ECM in cardiovascular patients can provide additional data on the course of HF, help to assess the risk of adverse cardiovascular events and effectively control the ongoing pharmacological and non-drug therapy.

The problem of heart failure (HF) is one of the central problems in modern cardiology due to its high prevalence among the population and high mortality. In turn, sleep-related breathing disorders (SRBD) are widespread in patients with HF and are associated with both the progression of the underlying disease and a decrease in the quality of life. For the first time, periodic breathing, as one of the types of sleep breathing disorders, was described in patients with HF.

Further study of the issue showed a high prevalence of other types of SRBD among patients with HF The article discusses the physiology of sleep breathing monitoring in a healthy person and the pathophysiology of SRBD. The pathogenesis of central sleep apnea and its relationship with HF are discussed in detail. In addition, the mechanisms of the adverse effect of obstructive sleep apnea and HF are highlighted.

Aim. To compare the immediate outcomes and 30-day mortality of in situ bimammary coronary artery bypass grafting (CABG) using two internal thoracic arteries (ITAs) versus a composite grafting.

Material and methods. We searched PubMed, Google Scholar, and Web of Science databases for a period from 1990 to 2020 for studies comparing in situ bimammary CABG versus composite grafts. The PICO search model was used as follows: patient, intervention, comparison, outcomes. The data were derived by two independent researchers and subjected to a meta-analysis using a random effect.

Results. A total of 10 studies were selected for this meta-analysis. Of these, there were 2 randomized controlled trials (n=705), 4 observational propensity score matching studies (n=4267) and 4 unadjusted observational studies (n=3517). With both ITA in situ surgery, fewer distal anastomoses are applied (MD=0,23; 95% confidence interval (CI), 0,15-0,32; p<0,001). But there was no significant difference n myocardial ischemia between groups (3 min with 95% CI, -3,23-9,79; p=0,32). There was no significant difference between groups in the incidence of perioperative stroke (hazard ratio (HR)=0,5; 95% CI; 0,63-1,74; p=0,85 ), myocardial infarction (HR=1,1; 95% CI 0,66-1,85; p=0,71), mediastinitis (HR=0,86; 95% CI; 0,62-1,20; p=0,38), resternotomy due to bleeding (HR=1,29; 95% CI, 0,75-2,21; p=0,36), acute renal injury (HR=1,24; 95% CI, 0, 84-1,84; p=0,29), inhospital mortality (HR=1,08; 95% CI, 0,67-1,75; p=0,75) and 30-day mortality (HR=1,19; 95% CI, 0,81-1,75; p=0,38), but the incidence of postoperative atrial fibrillation was significantly lower in the group with both ITA in situ surgery (RR=1,23 with 95% CI 1,04-1,44; p=0,01).

Conclusion. With composite bimammary CABG, more distal anastomoses with ITA were applied, while the time of myocardial ischemia did not differ between the groups. We found no significant difference in the incidence of perioperative myocardial infarction, stroke, mediastinitis, acute renal injury, resternotomy due to bleeding, inhospital mortality, and 30-day mortality. But at the same time, the HR for postoperative atrial fibrillation was significantly lower in the group with both ITA in situ surgery.

An online meeting of experts held on November 6, 2020 describes the results of EMPA-REG OUTCOME and EMPEROR-Reduced trials on sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin. We analyzed cardiovascular and renal outcomes in patients with and without type 2 diabetes (T2D) receiving empagliflozin. A number of proposals and recommendations have been adopted regarding the further study of the cardiovascular and renal effects of empagliflozin and its practical use in patients with heart failure, regardless of the T2D presence.