Aim. To assess the relationship of various clinical and biological markers of bone metabolism with the progression of coronary artery calcification (CAC) in patients with stable coronary artery disease (CAD) within 5 years after coronary artery bypass grafting (CABG).

Material and methods. This single-center prospective observational study included 111 men with CAD who were hospitalized for elective CABG. In the preoperative period, all patients underwent duplex ultrasound of extracranial arteries (ECA) and multislice computed tomography (MSCT) to assess CAC severity using the Agatston score, as well as densitometry with determination of bone mineral density in the femoral neck, lumbar spine and T-score for them, In all participants, the following bone metabolism biomarkers were studied: calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone. Five years after CABG, ECA duplex ultrasound, MSCT coronary angiography and bone metabolism tests were repeated. Depending on CAC progression (>100 Agatston units (AU)), patients were divided into two groups to identify significant biomarkers and clinical risk factors associated with CAC progression.

Results. For 5 years after CABG, contact with 16 (14,4%) patients was not possible; however, their vital status was assessed (they were alive). Death was recorded in 4 (3,6%) cases (3 — due to myocardial infarction, 1 — due to stroke). In 18 (19,7%) cases, non-fatal endpoints were revealed: angina recurrence after CABG — 16 patients, myocardial infarction — 1 patient, emergency stenting for unstable angina — 1 patient. There were no differences in the incidence of events between the groups with and without CAC progression. According to MSCT 5 years after CABG (n=91 (81,9%)), CAC progression was detected in 60 (65,9%) patients. Multivariate analysis allowed to create a model for predicting the risk of CAC progression, which included following parameters: cathepsin K <16,75 pmol/L (p=0,003) and bone mineral density <0,95 g/cm3 according to femoral neck densitometry before CABG (p=0,016); OPG <3,58 pg/ml (p=0,016) in the postoperative period 5 years after CABG.

Conclusion. Within 5 years after CABG, 65,9% of male patients with stable coronary artery disease have CAC progression, the main predictors of which are low preoperative cathepsin K level (<16,75 pmol/L) and low bone mineral density (<0,95 g/cm3) according to femoral neck densitometry, as well as a low OPG level (<3,58 pg/ml) 5 years after CABG.

Endothelial dysfunction (ED), intima-media thickness (IMT), and atherosclerotic plaques (ASPs) of the carotid arteries (CAs) are considered mutually associated markers of subclinical and clinical atherosclerosis. How true this statement is for older age groups remains unclear.

Aim. To study the relationship of flow-dependent vasodilation (FDV) with CA IMT and ASPs in a population sample over 58 years old.

Material and methods. The study was carried out in a population sample of men and women aged 58-82 years (Novosibirsk, HAPIEE project, n=788, 424 women). CA ultrasound was performed to assess IMT and ASPs. Endothelial function was assessed by postocclusive hyperemia ultrasound test; an increase in brachial artery initial diameter (FDV%) <10% was regarded as ED.

Results. The average IMT in men was 0,95 mm (SD 0,18) and was significantly higher than in women: 0,88 mm (SD 0,17), p<0,001. The average FDV% values in men were 2,7% (SD 7,32), while in women  — 3,2% (SD 7,19) and did not differ significantly by sex. The incidence of ED was 88,2% in men and 85,8% in women. There was no a significant linear relationship between FDV and IMT neither in men (β=-1,76, SD 2,25, p=0,436), nor in women (β=-2,19, SD 2,15, p=0,309). Also, there were no differences in average IMT and ASP frequency in the groups with and without ED among men and women. When divided into age groups, ED was associated with an increase in IMT only in women aged <78 versus women without ED (p=0,047).

Conclusion. In the population sample of 58-82 years old, mutual associations of subclinical markers of atherosclerosis (ED, IMT, ASP of CAs) have not been confirmed. Only in women aged <78 years, ED was associated with an increase in IMT. The results obtained indicate that the treatment approaches proposed for young and middle-aged people may be less effective in old and senile age.

Aim. To assess the severity of myocardial damage and inflammation after radiofrequency ablation in children and adolescents using biochemical markers.

Material and methods. The study included 58 children with tachyarrhythmias (Wolff-Parkinson-White (WPW) syndrome, WPW phenomenon, atrial tachycardia, paroxysmal atrioventricular reciprocating tachycardia, ventricular tachycardia) who underwent catheter ablation from July to October 2019. Before and after surgical treatment (after 2 hours and 5 days), the blood concentrations of myocardial damage and inflammation biomarkers (myoglobin, creatine phosphokinase-MB, interleukin-8, C-reactive protein, tumor necrosis factor alpha, metalloproteinase (MMP)-2, MMP-9, heart-type fatty acid binding protein). During the operation, catheter ablation parameters (power, temperature, application duration), the localization of arrhythmogenic focus and the type of ablation catheter were recorded. Their relationship with changes in the concentration of biochemical markers before and after intervention was studied.

Results. Two hours after the operation, the concentrations of myoglobin, creatine phosphokinase-MB, MMP-9, heart-type fatty acid binding protein were increased several times (p<0,05). Changes in concentrations of interleukin-8, tumor necrosis factor alpha after the operation was not revealed. On the 5th day, elevated levels of cardiac markers returned to baseline values. MMP-9 level also decreased, but was higher than the preoperative level. Using Spearman’s correlation analysis, a direct relationship was revealed between the application duration and heart-type fatty acid binding protein level.

Conclusion. Radiofrequency ablation is a safe method of treating arrhythmias in children and adolescents, since there is low volume of damaged myocardium. There was a slight increase in the level of biochemical markers after ablation (myoglobin, creatine phosphokinase-MB, fatty acid binding protein, MMP-9), incomparable with their rise in acute coronary syndrome, as well as the rapid decrease in the early postoperative period.

Aim. To analyze the factors affecting the accuracy of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) in case of suspected prosthetic valve endocarditis (PVE).

Material and methods. The results of PET/CT performed in 66 patients after heart valve replacement were analyzed: 55 patients with suspected PVE (≥3 months after surgery) and 11 comparison groups without PVE (2 months after surgery). In the group with suspected PVE (n=55) at the time of the study, 27% (15/55) had a normal body temperature, 85% (47/55) — no leukocytosis. In 16% (9/55), the examination was performed from 3 to 6 months after surgery and in 67% (37/55)  — against the background of long-term antibiotic therapy (ABT). The final diagnosis of PVE was made on the basis of clinical (including 6±3 followup), laboratory, instrumental, and intraoperative (n=40) data: confirmed  — in 37 patients; ruled out — in 29 patients. In order to determine the influence of factors on obtaining false PET/CT results, the odds ratio was calculated.

Results. In the group with suspected PVE (n=55), the PET/CT results made it possible to establish and rule out PVE in 92% (34/37) and 67% (12/18) of patients, respectively. In 16% (9/55) of patients, false positive (n=6) and false negative (n=3) results. Thus, the sensitivity, specificity and diagnostic accuracy of PET/CT in the diagnosis of PVE were 92%, 67% and 84%, respectively; positive and negative predictive values — 85% and 80%. The analysis of the odds ratio did not reveal the relationship of low inflammatory activity, the interval between surgery and PET/CT from 3 to 6 months, and long-term ABT before PET/CT with false PET/CT results (p>0,05). In the comparison group without PVE (n=11), 91% (10/11) received false positive PET/CT results, and one patient received a true negative result.

Conclusion. The data obtained indicate the high informative value of PET/CT in the diagnosis of PVE. Interval >2 months between surgery and PET/CT significantly reduces the accuracy of PET/CT results. Other factors analyzed in the presented group did not affect the accuracy of PET/CT results.

Aim. To compare the concentrations of proinflammatory and anti-inflammatory cytokines in patients with myocardial infarction with non-obstructive (MINOCA) and obstructive coronary arteries (MIOCA) in the early postinfarction period and after 1-year follow-up.

Material and methods. The study included 40 patients with myocardial infarction (experimental group, 19 patients; control group, 21 patients). Three (15,7%) patients with diagnosed acute myocarditis were excluded from the final analysis. Blood samples were taken upon admission, on the 2^nd, 4^th and 7^th days from hospitalization, and also after 1-year follow-up. Twenty-three parameters were analyzed using multiplex analysis and the Multiplex Instrument FLEXMAP 3D system (Luminex Corporation), as well as the MILLIPLEX map Human Cytokine/ Chemokine Panel II.

Results. According to multiplex analysis of blood serum of the studied groups, a comparable increase in proinflammatory cytokines CCL-15, CCL-26, CCL-27 in the early postinfarction period and after 1-year follow-up, as well as antiinflammatory and regenerative cytokines CXCL-12, TPO in the early postinfarction period and after 1-year follow-up. In patients with MINOCA, higher concentrations of the following proinflammatory cytokines were determined: IL-16 upon admission (p=0,03), IL-20 on days 2 and 4 of the early postinfarction period (p=0,005 and p = 0.03), as well as CCL-15 on days 4 and 7 (p=0,05 and p=0,02). After 1-year follow-up, among the proinflammatory cytokines, a greater increase in CCL-21 (p=0,02) was noted in the patients of experimental group. Also, in patients with MINOCA, a greater increase in TPO was determined upon admission and on the 2nd day (p=0,02 and p=0,02), SCF — on the 7th day and after 1-year follow-up (p=0,04 and p=0,04), and LIF on the 4th day of early postinfarction period (p=0,007). In contrast, MIOCA patients showed a greater increase in CXCL-12 levels upon admission (p=0,04). At the same time, patients with MINOCA showed a higher level of C-reactive protein on the 1st day, as well as a higher relative monocyte count after 1-year follow-up.

Conclusion. Despite a comparable increase in the cytokines CCL-8, CCL-13, CCL26, CCL-27 in patients of both groups, in patients with MINOCA there was a greater increase in proinflammatory cytokines IL-16, IL-20, CCL-15, CCL-21, and also CXCL-12, LIF, TPO, SCF, which have anti-inflammatory and regenerative activity. After 1 year follow-up, MINOCA patients showed a significant increase in CCL-21 and SCF, with a comparable increase in other proinflammatory cytokines in patients of both groups. A greater increase in proinflammatory cytokines in patients with MINOCA may indicate a more aggressive atherosclerosis course and lead to plaque destabilization followed by ischemic event.

Aim. To assess the significance of changes cystatin C-based estimated glomerular filtration rate (eGFR_cys) in predicting inhospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).

Material and methods. In 133 patients with STEMI, serum creatinine and cystatin C were determined. Creatinine clearance (CrCl) was estimated according to Cockcroft-Gault equation. Creatinine-based estimated glomerular filtration rate (eGFR_cr) was assessed using the MDRD (eGFR_cr_MDRD) and CKD-EPI 2009 (eGFR_cr_CKD-EPI). In addition, eGFR_cys and a combination of serum creatinine and cystatin C (eGFR_cr-cys) was assessed using the CKD-EPI 2012 equation at admission and 24-48 hours after PCI. In the groups of deceased patients and survivors, the studied parameters were compared. Their relationship with imhospital mortality was assessed by logistic regression adjusted for acute kidney injury (AKI) and GRACE risk. To assess the informativeness of identified independent predictors, an ROC analysis was performed.

Results. After PCI, serum creatinine level increased by 9,8%, cystatin C — by 38,2%. CrCl decreased by 9,0%, eGFR_cr_MDRD — by 10,2%, eGFR_cr_CKD-EPI — by 5,2%, eGFR_cys — by 29,5%, eGFR_cr-cys — by 19,3%. AKI was diagnosed in 21 people (15,8%). Among the deceased patients (n=12), compared with the survivors, serum creatinine level was higher at baseline and after PCI, cystatin C — after PCI, eGFR of any calculation method was lower, while AKI developed more often. According to multivariate regression analysis, the eGFRcr-cys after PCI and the GRACE risk score were independent predictors of the endpoint. The area under the ROC curve for eGFR_cr-cys after PCI was 0,835 [0,712-0,958], while the cut-off point was 38 ml/min/1,73 m², below which the odds ratio of developing a fatal outcome was 22,2 with a 95% confidence interval of 5,7- 86,8.

Conclusion. Estimated GFR determined 24-48 h after PCI based on the combination of serum creatinine and cystatin C using the CKD-EPI 2012 equation was an independent predictor of inhospital mortality in STEMI. The cut-off point of this parameter was 38 ml/min/1,73 m², below which the death risk increases significantly. The results indicate the viability of introducing novel methods for assessing renal function based on cystatin C to improve the quality of prediction in STEMI.

Aim. To investigate the relationship between radiological characteristics of epicardial adipose tissue (EAT) and myocardial sympathetic activity, as well as to study their association with late recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA).

Material and methods. This prospective study included 26 people with persistent and long-standing persistent AF scheduled for interventional AF treatment. Before the RFA procedure, all patients underwent cardiac 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy to assess the myocardial sympathetic innervation and contrast-enhanced cardiac multislice computed tomography to assess pulmonary vein anatomy, left atrial volume, and EAT volume. Clinical follow-up, including 12-lead electrocardiography (ECG) and 24-hour ECG monitoring, was carried out 3, 6 and 12 months after RFA.

Results. After the end of follow-up, the patients were divided into two groups: with AF recurrence (group 1, n=8) and without AF recurrence (group 2, n=18). Multivariate logistic analysis found that only the 123I-MIBG washout rate (odds ratio, 1,0943; 95% confidence interval, 1,0138-1,1812) proved to be an independent predictor of late AF recurrence after RFA. ROC analysis revealed that a 123I-MIBG washout rate >21% with a sensitivity of 75% and a specificity of 83,3% (AUC=0,844; p<0,001) predicts late AF recurrence after RFA.

Conclusion. Parameters of myocardial sympathetic activity, assessed by 123I-MIBG myocardial scintigraphy, are associated with late AF recurrence after RFA in patients with persistent and long-standing persistent AF. There were no reliable data confirming associations between myocardial sympathetic innervation and radiological EAT indicators, as well as the effect of the latter on the risk of AF recurrence after RFA.

Aim. To analyze the spectrum of cancer types and baseline cardiovascular comorbidity in patients receiving checkpoint inhibitor therapy.

Material and methods. We performed retrospective analysis of case records of 112 cancer patients (55 men and 57 women) who received checkpoint inhibitor therapy in St. Petersburg hospitals. We analyzed primary tumor localizations, received immunotherapy and the initial comorbid conditions in patients.

Results. The mean age of patients at the time of anticancer therapy initiation was 59,7±12,1 years for men, 57,7±14,1 years for women (p=0,249). The most common indications for immunotherapy were the following localizations: melanoma (34,8%), lungs (21,4%) and urinary system (12,5%). Among women who received checkpoint inhibitors, the lung and gynecologic cancer had the same prevalence (17,5%). The vast majority of patients (85,7%) received antiPD-1 agents, while the anti-CTLA4+anti-PD-1 combination was received by only 8,6% of patients, anti-PD-L1 monotherapy — 5,7%. Before anticancer therapy initiation, 69,6% of patients had prior CVD and/or risk factors. There were following most common comorbid conditions: hypertension — 58,9%, coronary artery disease — 36,6%, heart failure — 24,1%. At the same time, men in comparison with women were more likely to have prior stroke (12,7% vs 1,75%, respectively, p=0,024). There were no other significant sex differences between the incidence of cardiovascular diseases.

Conclusion. Based on current publications describing potential risk factors for cardiovascular complications of cancer immunotherapy with checkpoint inhibitors, among the patients included in this study, 87,5% of patients can be attributed to the high-risk group.

Aim. To assess the features of clinical and hemodynamic characteristics and the severity of coronary involvement in patients with chronic coronary artery disease (CAD) with and without diabetes.

Material and methods. The study included 100 patients with stable CAD, which were divided into two groups: group I (mean age, 57,9-1,04 years, male/female 35/14) — 49 patients with CAD and type 2 diabetes, II — (60,2-0,9 years, 34/17) — 51 patients without SD. Along with behavioral and biological risk factors, clinical and hemodynamic characteristics were analyzed. All patients underwent coronary angiography.

Results. The presence of diabetes in patients with CAD was associated with abdominal obesity and comorbidity of somatic diseases. Among group I patients, electrocardiographic signs of left ventricular hypertrophy, conduction abnormalities, accompanied by a decrease in the left ventricular ejection fraction, impaired diastolic function, and high mean pulmonary artery pressure were significantly more often detected. In patients with CAD and type 2 diabetes, significant right coronary artery (CA) stenoses were more often recorded (39%), while in patients without diabetes, the anterior descending artery was the most susceptible to atherosclerosis. In group I, stenosis of the distal CA third was detected 1,5 times more often (p<0,001), and their diffuse multivessel lesion prevailed by 28% (73% and 45%, respectively, p<0,005). The average SYNTAX score in patients with and without diabetes was 29,2±0,8 vs 22±0,7, respectively (p<0,0005).

Conclusion. In patients with CAD and diabetes, more pronounced atherosclerotic coronary involvement (diffuse multivessel CAD) was revealed, which should be taken into account when planning further treatment. The risk of adverse cardiovascular events will always be present with percutaneous coronary interventions.

According to current clinical guidelines, the risk of life-threatening ventricular tachyarrhythmias (VTAs) in patients with heart failure (HF) is determined by left ventricular ejection fraction (LVEF). The available clinical and experimental data indicate the imperfection of this one-factor approach, which specifies the need to search for new predictors of VTAs. In this prospective study, we performed a comparative analysis of surface electrocardiographic parameters in HF patients with LVEF ≤35% without syncope or sustained ventricular arrhythmias in history, who were implanted with cardioverter defibrillator as a primary prevention of sudden cardiac death. During the two-year follow-up, the primary endpoint (new-onset persistent VTA episode, or VTA/ventricular fibrillation that required electrotherapy) was recorded in 42 patients (25,5%). The secondary endpoint (an increase in LVEF by 5% or more of the initial level against the background of cardiac resynchronization therapy) was more often recorded in the group of patients without VTAs (41 (33%) vs 4 (9,5%), p=0,005). The studied cohort of patients was characterized by a left axis deviation (72%), LV hypertrophy signs (84%), impaired intra-atrial (P wave duration of 120 (101-120) ms) and intraventricular conduction (QRS duration of 140 (110-180) ms), ventricular electrical systole prolongation (QTcor — 465 (438-504) ms). Differences between the groups divided depending on reaching the primary endpoint in terms of the Cornell product, Cornell voltage index and ICEB, as well as the detection rate of complete left bundle branch block morphology had levels of significance close to critical (p=0,09; p=0,05; p=0,1; p=0,09, respectively). The multivariate predictive model included following factors: Cornell product, Tp-Te/ QRS, P wave duration (diagnostic efficiency of the model was 60%: sensitivity, 61,1%, specificity, 59,6%; p=0,007).

Aim. To compare effectiveness of ultrasound, radiological and invasive methods for assessing aortic valve (AV) stenosis.

Material and methods. This study included 33 patients with AV stenosis. The mean age of the patients was 71,8±6,8 years. All patients underwent standard and three-dimensional echocardiography, computed tomography, and cardiac catheterization.

Results. According to two-dimensional echocardiography, the AV area averaged 0,58±0,21 mm², according to cardiac catheterization — 0,61±0,17 mm², according to three-dimensional transesophageal echocardiography — 1,13±0,42 mm², and according to multislice computed tomography 0,88±0,48 mm². The difference between the values was significant (p<0,05).

Conclusion. For routine diagnosis of AV stenosis, two-dimensional echocardiography is the optimal research method. With indications for radical treatment methods, three-dimensional echocardiography or multislice computed tomography should be performed.

Aim. To study predictors of radial artery occlusion (RAO) and ways to prevent it after interventions using radial access.

Material and methods. The study consisted of prospective and retrospective parts. The total number of included patients was 2284. Patients undergoing interventions by radial access in various medical organizations were retrospectively considered. The prospective study included 1284 patients who were subject to interventional treatment. Patients were randomized into two groups as follows: in group 1, hemostasis was performed within 4 hours, in group 2 — >6 hours. All patients underwent a bedside Barbeau test with a pulse oximeter and an ultrasound of access arteries to determine the radial artery patency/occlusion.

Results. The RAO rate in the retrospective part was 21,8%, while in the prospective one — 10,1% with long-term hemostasis and 1,4% with short-term hemostasis (p<0,001). Predictors of RAO were type 2 diabetes (odds ratio (OR), 1,9, 95% confidence interval (CI), 1,1-3,4, p=0,03) and an increase in hemostasis duration by 1 hour (OR, 1,2, 95% CI, 1,1-1,3, p<0,001). When analyzing the retrospective part, the predictors of RAO were body mass index (OR, 1,06, 95% CI, 1,02-1,09, p=0,002), female sex (OR, 0,6, 95% CI, 0,4-0,9, p=0,02), smoking (OR, 1,38, 95% CI, 1-1,91, p=0,047). The administration of statins in different dosages, as well as antihypertensive and anti-ischemic agents, did not have a significant effect on the RAO rate.

Conclusion. The main predictors of RAO were type 2 diabetes, an increase in hemostasis duration, female sex, smoking, and the artery-to-introducer diameter ratio. Taking statins, anti-ischemic and antihypertensive agents does not have a protective effect on RAO rate.

Aim. To analyze the immediate and long-term outcomes of eversion and conventional carotid endarterectomy (CE) with patch angioplasty.

Material and methods. For the period from February 1, 2006 to September 1, 2021, the present retrospective multicenter open comparative study included 25106 patients who underwent CE. Depending on the technique of operation, the following groups were formed: group 1 (n=18362) — eversion CE; group 2 (n=6744) — conventional CE with patch angioplasty. The long-term follow-up period was 124,7±53,8 months.

Results. In the hospital postoperative period, the groups were comparable in incidence of all complications: lethal outcome (group 1: 0,19%, n=36; group 2: 0,17%, n=12; p=0,89; odds ratio (OR) =1,1; 95% confidence interval (CI) =0,57- 2,11); myocardial infarction (MI) (group 1: 0,15%, n=28; group 2: 0,13%, n=9; p=0,87; OR=1,14; 95% CI=0,53-2,42); stroke (group 1: 0,33%, n=62; group 2: 0,4%, n=27; p=0,53; OR=0,84; 95% CI=0,53-1,32); bleeding with hematoma formation (group 1: 0,39%, n=73; group 2: 0,41%, n=28; p=0,93; OR=0,95; 95% CI=0,61-1,48); internal carotid artery (ICA) thrombosis (group 1: 0,05%, n=11; group 2: 0,07%, n=5, p=0,9; OR=0,8; 95% CI=0,28-2,32). In the long-term follow-up, the groups were comparable only in MI incidence: group 1: 0,56%, n=103; group 2: 0,66%, n=45; p=0,37; OR=0,84; 95% CI=0,59-1,19. All other complications were more frequent after conventional CE with patch angioplasty: all-cause death (group 1: 2,7%, n=492; group 2: 9,1%, n=616; p<0,0001; OR=0,27; 95% CI=0,24-0,3); lethal ischemic stroke (group 1: 1,0%, n=180; group 2: 5,5%, n=371; p<0,0001; OR=0,17; 95% CI=0,14-0,21); non-lethal ischemic stroke (group 1: 0,62%, n=114; group 2: 7,0%, n=472; p<0,0001; OR=0,08; 95% CI=0,06-0,1); ICA restenosis >60%, requiring re-revascularization (group 1: 1,6%, n=296; group 2: 12,6%, n=851; p<0,0001; OR=0,11; 95% CI=0,09-0,12). Thus, the composite endpoint (lethal ischemic stroke + non-lethal ischemic stroke + MI) after conventional CE with patch angioplasty was more than 6 times higher than this parameter of eversion CE: group 1: 2,2%, n=397; group 2: 13,2%, n=888; p<0,0001; OR=0,14; 95% CI=0,12-1,16.

Conclusion. Conventional CE with patch angioplasty is not prefer for cerebral revascularization in the presence of hemodynamically significant ICA stenosis due to the high prevalence of deaths, stroke, and ICA restenosis in the long-term follow-up.

Aim. To evaluate the potential of a fixed-dose combination of lisinopril+amlodipine+rosuvastatin (Equamer®) in achieving additional vascular protection in patients with hypertension and high pulse wave velocity (PWV) after severe and very severe coronavirus disease 2019 (COVID-19), complicated by bilateral multisegmental viral pneumonia, with the use of biological therapy, who had not previously received combination antihypertensive therapy.

Material and methods. This 12-week open-label observational study included 30 patients with or without antihypertensive therapy. The patients underwent 24-hour blood pressure monitoring, applanation tonometry (determination of the augmentation index (AI) and central blood pressure (CBP)), PWV measurement, blood laboratory tests (lipid profile, fasting glucose, C-reactive protein, complete blood count, ferritin, fibrinogen, D-dimer, alanine aminotransferase, aspartate aminotransferase, creatinine, uric acid) before and after switch to a fixed-dose combination of lisinopril+amlodipine+rosuvastatin.

Results. At baseline, the patients had an increase in office blood pressure (BP) up to 152,6/89,1 mm Hg. After prescribing a fixed-dose combination of lisinopril+amlodipine+rosuvastatin, there was a decrease in systolic blood pressure (SBP) by 15,8% and diastolic blood pressure (DBP) by 12,2%. According to 24-hour blood pressure monitoring, the decrease in SBP was 15%, DBP — by 9%, PWV — by 23,8%, AI — by 9%, CBP — by 12,4% (p<0,05 for all compared to baseline values). Vascular age (VA) was initially increased to 41,9 years with a chronological age of 35,03 years. After the end of therapy, there was a significant decrease in VA to 36,5 years, low-density lipoproteins by 46,8%, triglycerides by 16,8% and an increase in high-density lipoproteins by 10,7% (p<0,05 for all compared to baseline values). In addition, the levels of C-reactive protein, fibrinogen, D-dimer, glucose, and uric acid significantly decreased.

Conclusion. The fixed-dosed combination of lisinopril+amlodipine+rosuvastatin provides better blood pressure control, improved vascular elasticity parameters (AI, PWV, CBP, decrease in VA), and also improves lipid and carbohydrate metabolism, reduces inflammation in patients with hypertension and hyperlipidemia after severe COVID-19.

Aim. To assess the effect of therapy with sodium glucose co-transporter type 2 inhibitor dapagliflozin in patients with heart failure with reduced ejection fraction (CHrEF) on the state cardiovascular mortality target indicators.

Material and methods. All adult Russian patients with NYHA class II-IV HFrEF (left ventricular ejection fraction ≤40%) were considered as the target population. The characteristics of patients in the study corresponded to those in the Russian Hospital HF Registry (RUS-HFR). The study suggests that the use of dapagliflozin in addition to standard therapy will be expanded by 10% of the patient population annually in 2022-24. Cardiovascular mortality modeling was performed based on the extrapolation of DAPA-HF study result. The number of deaths that can be prevented was calculated when using dapagliflozin in addition to standard therapy. Further, the contribution of prevented deaths with dapagliflozin therapy to the achievement of federal and regional cardiovascular mortality target indicators (1, 2 and 3 years) was calculated.

Results. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF with the expansion of dapagliflozin therapy by 10% of the patient population annually will additionally prevent 1729 cardiovascular death in the first year. This will ensure the implementation of cardiovascular mortality target indicators in Russia in 2022 by 11,8%. In the second year, 3769 cardiovascular deaths will be prevented, which will ensure the implementation of target indicators in 2023 by 17,2%. In the third year, 5465 cardiovascular deaths prevented, which will ensure the implementation of implementation of target indicators in 2024 by 18,7%.

Conclusion. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF will ensure the implementation of implementation of target indicators in 2024 by 18,7%.

Aim. To evaluate the effect of the use of the double antiplatelet therapy (DAT) with ticagrelor compared to DAT with clopidogrel and antithrombotic therapy with acetyl salicylic acid (ASA) in patients with acute coronary syndrome and patients with high coronary risk on the target indicator (CP) of the state program (GP) “Development of Healthcare” and the federal project “Fight against cardiovascular diseases” — reducing mortality from diseases of the circulatory system (BSC).

Material and methods. All adult Russian patients with a diagnosis of ACS eligible for DAT were considered as the target population; in the second and third years, only patients with high coronary risk continued treatment. The calculation of the number of deaths that can be prevented using DAT ticagrelor 90 mg + ASA vs DAT of clopidogrel + ASA within 1st year from the date of diagnosis was based on the clinical efficacy data of the PLATO study. The number of deaths that can be prevented with the use of DAT ticagrelor 60 mg + ASA — instead of ASA monotherapy patients with a history of myocardial infarction was made based in the clinical efficacy results of the PEGASUS study. It was calculated what proportion of the target indicators could be achieved in 2022-24 years by using DAT with ticagrelor instead of clopidogrel or ASA monotherapy.

Results. The use of DAT with ticagrelor vs DAT with clopidogrel or ASA for the treatment of patients with ACS will prevent additional 5389, 5704 and 6012 deaths in 2022-2024, that will ensure the implementation of the CP “reduction of mortality from BSC” GP “Development of healthcare” in the Russian Federation by 36,9%, 26,0% and 20,6% respectively.

Conclusion. The use of DAT with ticagrelor for the treatment of patients with acute coronary syndrome ensure the implementation of the CP “reduction of mortality from BSC” GP “Development of healthcare” in the Russian Federation in 2024 by 20,6%.

The review discusses the problem of anticoagulant therapy for the prevention of stroke and systemic embolism in patients with atrial fibrillation and comorbidities (hypertension, heart defects, including after heart valve surgery, coronary artery disease, diabetes mellitus, chronic kidney disease, gastrointestinal diseases, anemia, cancer), as well as with a high risk of emergency operations and injuries.

In patients with atherosclerotic lesions of two or more systems or multifocal atherosclerosis (MFA), the risks of ischemic events are extremely high. MFA leads not only to cardiovascular outcomes, but also to a decrease in the patient’s quality of life, life expectancy, and in most cases to disability. The prevalence of this pathology and the importance of preventing adverse outcomes are often underestimated. This literature review examines the problem of MFA in the context of key studies on the prevalence, course of multivessel disease and the reduction of the risk of cardiovascular events in this group of patients, with an emphasis on antiplatelet and anticoagulant therapy.

The increase in the prevalence of cardiovascular diseases (CVDs) specifies the importance of their prediction, the need for accurate risk stratification, preventive and treatment interventions. Large medical databases and technologies for their processing in the form of machine learning algorithms that have appeared in recent years have the potential to improve predictive accuracy and personalize treatment approaches to CVDs. The review examines the application of machine learning in predicting and identifying cardiovascular events. The role of this technology both in the calculation of total cardiovascular risk and in the prediction of individual diseases and events is discussed. We compared the predictive accuracy of current risk scores and various machine learning algorithms. The conditions for using machine learning and developing personalized tactics for managing patients with CVDs are analyzed.

Non-obstructive coronary artery disease is generally considered as a favorable type of pathology, however, a number of studies indicate that in non-obstructive atherosclerosis, the risk of such cardiovascular events as myocardial infarction, ischemic stroke, sudden cardiac death and decompensated heart failure cannot be completely ruled out. This may be due to microvascular dysfunction. However, due to the small diameter of vessels, none of the imaging techniques used in clinical practice makes it possible to assess microvascular morphology. To date, the most well-established methods for assessing myocardial perfusion are single-photon emission computed tomography (SPECT) and positron emission tomography (PET). The ability to quantify myocardial blood flow and coronary flow reserve allows SPECT and PET to be the methods of choice for non-invasive diagnosis of microvascular dysfunction. This review is devoted to current data on the clinical significance of radionuclide diagnosis of microvascular dysfunction in patients with non-obstructive coronary artery disease.

Aim. The present study aims to provide a systematic review and meta-analysis to investigate the prognostic role of assessing the severity of myocardial fibrosis using delayed contrast-enhanced magnetic resonance imaging in nonischemic dilated cardiomyopathies.

Material and methods. We searched PubMed, Google Scholar for studies that examined the predictive value of quantifying late gadolinium enhancement (LGE) areas in patients with nonischemic dilated cardiomyopathy. Unadjusted hazard ratios (HR) from studies with similar scoring criteria were pooled for meta-analysis.

Results. Nine studies were retrieved from 782 publications for this systematic review and meta-analysis. In total, 2389 patients (mean age, 51,9 years; mean follow-up, 39,3 months) were included in the analysis. Meta-analysis showed the extent of LGE was associated with an increased risk of arrhythmic end point (HR: 1,09/1% LGE; 95% CI: 1,02-1,18; p=0,01), major adverse cardiovascular events (HR: 1,07/1% LGE; 95% CI: 1,01-1,13; p=0,03) and all-cause mortality (HR: 1,09/1% LGE; 95% CI: 1,04-1,13; p<0,0001).

Conclusion. The severity of LGE by cardiac magnetic resonance predicts arrhythmic events (ventricular arrhythmia and sudden death), major adverse cardiovascular events and all-cause mortality. Assessment of LGE can be used as an effective tool for stratifying risk in patients with nonischemic dilated cardiomyopathy.

Russian Society of Cardiology (RSC)

With the participation: Association of Cardiovascular Surgeons of Russia, Russian Respiratory Society, Federation of Anesthesiologists and Resuscitators, Association of Rheumatologists of Russia, National Congress of Radiation Diagnosticians.