The main objective of secondary prevention measures is to modify key risk factors such as hypertension (HTN) and dyslipidemia in patients with established cardiovascular diseases. Its proper implementation improves both short- and long-term outcomes. Telehealth technologies contributes to faster achievement of target levels and better control of key risk factors.

Aim. To establish a comprehensive personalized follow-up framework for patients recovered from an acute coronary syndrome (ACS) that integrates telehealth software and to test its clinical and patient-centered efficacy.

Material and methods. The three-month follow-up data of 50 patients (50% of planned enrollees; median age, 57 years [53; 61]; males, 84%) who suffered ACS with myocardial revascularization and low-density lipoprotein cholesterol (LDL-C) at least 2,5 mmol/L at admission. We introduced the simple and save telehealth software for home BP monitoring and lipid profiling. The basic demographic, clinical and laboratory characteristics of patients were described, as well as the changes lipid profile, office and home BP over this period was analyzed. The primary endpoint was a change in LDL-C after 3 months. In addition, we also focused on pharmacological therapy and its dynamics, as well as on remote counseling and patient’ experience with the mobile application.

Results. Three months after inclusion, we have noted significant decrease of total cholesterol (-1,67 mmol/L, p<0,0001) and triglycerides (-0,48 mmol/L, p<0,0001). LDL-C changes were also significant (-1,49 mmol/L, adjusted for age, sex and lipid-lowering therapy; p<0,0001) and was associated only with the baseline LDL-C levels (R2=-0,521, p<0,0001). Thirty-nine (78%) patients achieved at least 1 mmol/L drop of LDL-C. Nine of them reached target LDL-C <1,4 mmol/L (and/or a decrease of 50% from baseline). Both high-density lipoprotein cholesterol (-0,48 mmol/l, p=0,348), office and home BP remained mostly unchanged. The proportion of patients with target office BP levels was almost the same (χ²=3,06, p=0,08). Patients who were recommended combined lipid-lowering therapy with cholesterol absorption inhibitor (ezetimibe) were more likely to achieve target LDL-C (χ²=10,95; p=0,003) than those with single agent (67% versus 17%, p=0,003). No differences were found in subgroups of patients in LDL-C reduction. In each patient an average of 15 remote consultations have been performed (from 1 to 54 per patient per 3 moths). Investigators have had to send reminders to 22 patients regarding the need for regular home BP monitoring. The majority of patients treated telehealth software as easy-to-use and user-friendly.

Conclusion. According to the 3-month follow-up of patients after ACS who used the framework integrated with telemonitoring and remote counseling, a positive trend in reducing atherogenic lipid levels was demonstrated, but not in office BP. Only a fifth of patients reached the target LDL-C, but the vast majority had target BP. Despite the fact that the program is convenient to use, almost half of participants require additional reminders from physician on self-monitoring.

Aim. According to data from the Moscow Oblast civil registry office in 2020, to analyze medical certificates of cause of death (MCCD), where the code from “Ischemic heart disease” (IHD) (I20-I25) group is indicated as underlying cause of death (UCD).

Material and methods. A total of 23193 deaths with I20-I25 codes (UCDs) were included. We assessed the prevalence of individual IHD types, the frequency and patterns of complications, the average age of deceased persons, the proportion of women and men, place of death registration.

Results. The average age of the deceased was 73,6±12,5 (men, 68,8±10,5; women, 78,4±12,5; p<0,0001). The proportion of women who died under the age of 70 was <20%, men — >50%. Half of the deaths were registered at home, a third in a hospital, and the rest elsewhere. Taking into account age and sex, inhospital death from myocardial infarction (MI) is recorded 12 times more often than in “other forms of acute IHD”. Chronic forms of IHD were registered in 76,9% of cases; in 47,3%, such IHD form as “Atherosclerotic heart disease” was noted. The proportion of deaths from acute MI and deaths after MI was 37,3%. In 92,1% of MCCDs of “other forms of acute IHD”, “acute coronary insufficiency” is indicated. Differences in the prevalence of various IHD forms between men and women were significant (p<0,0001). In female mortality pattern, there are 3 times less deaths from other (non-MI) acute forms of IHD and almost 2 times less deaths from old myocardial infarction and cardiac aneurysm. As the immediate cause of death, heart failure was indicated in 78,9%, while among those with prior MI — in 91%. In other acute forms of IHD, acute coronary insufficiency was indicated in 89%.

Conclusion. A high proportion of deaths with unspecified acute and chronic forms of IHD as the cause of death, especially in young men, requires a comprehensive study and development by the Russian Society of Cardiology of criteria for death from various IHD forms.

Aim. To determine the incidence, predictors and develop a model for long-term risk stratification of ischemic events in patients with coronary artery disease after coronary bypass surgery.

Material and methods. This retrospective study of the clinical course in patients with diffuse coronary artery disease (CAD) after coronary endarterectomy and bypass grafting surgery. A total of 232 patients were included, while long-term outcomes were assessed in 202 patients. Among them, complete data on clinical status were obtained from survivors (n=191). The median follow-up was 60 (interquartile range, 42; 74) months, while the minimum follow-up — 12 months, the maximum was 96 months. The primary composite endpoint reflecting the unfavorable course of CAD included coronary ischemic events (recurrent angina, myocardial infarction, repeat revascularization), while secondary endpoint — allcause mortality. The factors influencing the development of primary and secondary endpoints were studied.

Results. An unfavorable CAD course was diagnosed in 39 patients (20,4%), while 11 deaths were recorded (5,4%). Univariate analysis demonstrated a significant role of prior myocardial infarction in the increase in mortality rate (p=0,029). Among the factors influencing the CAD course, no significant differences were obtained for any of them. A multivariate analysis was performed to identify a high-risk group for an unfavorable course of diffuse CAD. Independent predictors were identified, the most significant contribution of which was made by multifocal atherosclerosis (odds ratio (OR)=1,99, 95% confidence interval (CI), 0,93-4,21, p=0,072), low adherence to secondary prevention measures (OR=2,21, 95% CI, 0,86-6,89, p=0,128) and diabetes (OR=1,73, 95% CI, 0,79-3,72, p=0,162). Using the results obtained, a prognostic model with high specificity (64%) and moderate sensitivity (53%) was created.

Conclusion. The highest probability of an unfavorable long-term course of diffuse CAD was noted in patients with diabetes, multifocal atherosclerosis, and low adherence to secondary prevention measures. The obtained results make it possible to identify a high-risk group in this cohort of patients, determine the reserve of secondary prevention measures and a direction of actions to improve outcomes.

According to the European Society of Cardiology guidelines, patients with chest pain requires the calculation of pretest probability (PTP) of coronary artery disease (CAD), followed by the identification of diagnostic tactics.

Aim. To analyze the registry of patients with stable CAD in order to assess the frequency of PTP calculation, as well as the validity of diagnostic tactics choice depending on its level.

Material and methods. The data of the registry of patients with stable CAD for the periods from 2012 to 2014 and from 2017 to 2019 were analyzed. We assessed the number of CAD patients, proportion of men, and distribution of patients depending on angina functional class. In addition, data on PTP calculation, as well as distribution of patients and diagnostic strategy selected depending on its value was analyzed. To assess differences (p) in pairwise comparisons, Student’s t-test was used. Differences were considered significant at p<0,05. Statistical analysis was performed using Microsoft Office Excel 2010 (Microsoft, USA) and STATISTICA 6.0 (StatSoft Inc., USA).

Results. In 2017-2019, the number of detected CAD cases and proportion of men increased. In both time periods, an insufficient level of calculating PTP of CAD remains. In patients with intermediate PTP, 15-85% of priority tactics are invasive interventions, and with high PTP, the percentage of invasive methods does not reach the proper level, which does not correspond to modern guidelines for the management of CAD patients and leads to misappropriation of funds and healthcare resources.

Conclusion. According to medical records, PTP can be determined in less than half of patients. In CAD patients with intermediate PTP, non-invasive studies are not carried out in full, since coronary angiography is preferred. In patients with a high PTP, invasive diagnostics is insufficient.

Aim. To assess the impact of calcific aortic stenosis on long-term prognosis in patients with stable coronary artery disease (CAD) included in the PROGNOZ IBS registry.

Material and methods. The analysis included data of patients (n=541; men, 432; women, 109) from the CHD PROGNOSIS registry, in whom diagnosis of CAD was confirmed using coronary angiography during reference hospitalization in the National Medical Research Center for the period from January 1, to December 31, 2007. The mean age of men was 57,5±0,4, women — 60,9±0,9 years. The survival analysis included 504 patients (93%). The mean follow-up period was 7,3±2,19 years. We assessed the presence of calcific aortic stenosis (CAS) according to echocardiography and data on endpoints after 4 and 7 years of follow-up.

Results. CAS according to echocardiography during reference hospitalization was found in 29 patients (5,4%) with a confirmed CAD. After four-year followup, 7 patients (24,1%) died, after 7 years — 15 (51,7%). Fatal and non-fatal cardiovascular events (primary endpoint) after 4 years were revealed in 10 patients (34,5%), and after 7 years, all cardiovascular events were fatal (n=15; 51,7%). In the presence of aortic stenosis, the relative risk (RR) of all-cause death at 4-year follow-up increased by 2,9 times (p<0,01), while at 7-year follow-up — by 3,2 (p<0,0001). The RR for the primary endpoint at 4-year follow-up increased by 2,8 times (p<0,01), while at 7-year follow-up — by 2,3 times (p<0,001). The RR of death in CAS patients at 7-year follow-up was comparable to severe heart failure — 3,3 (p<0,01), stroke — 2,4 (p<0,05) and left main coronary artery stenosis — 2,5 (p<0,0001).

Conclusion. The presence of calcific aortic stenosis had a pronounced negative effect on the long-term prognosis of CAD patients, comparable with those in left main coronary artery stenosis, severe heart failure and stroke.

Aim. To assess the association of anthropometric indices in patients with coronary artery disease (CAD) and obesity and to study their predictive value in the development of adverse cardiovascular events.

Material and methods. The study included 229 patients with CAD (median age, 55±7,56 years). Depending on the presence of obesity according to the World Health Organization criteria (1999), patients were divided into 2 groups. The 1st group included 107 obese patients, while the 2nd group — those without obesity (n=122). The groups were comparable in age. We measured waist (WC) and hip circumference (HC), followed by waist-to-hip ratio and body mass index calculation. The lipid profile parameters were determined by the enzymatic colorimetric method. During the study, the following indices were calculated: body mass index, visceral adiposity index, insulin resistance index, body shape index (BSI), fasting triglyceride (TG)/plasma glucose index, waist-to-height ratio, lipid accumulation product, TG-to-high density lipoprotein cholesterol ratio.

Results. During the follow-up period, adverse cardiovascular events in the 1st group of patients were found in 37 (34,5%) patients, while in the 2nd group, the composite endpoint was revealed in 12,3% of patients. In order to develop a model for predicting the risk of an unfavorable CAD course in obese patients, we performed a logistic regression analysis, which showed that the following were the most significant predictors of unfavorable cardiovascular outcomes: TG/glucose index and BSI.

Conclusion. Thus, of all the considered anthropometric indices, only two were associated with unfavorable CAD course — TG/glucose index and BSI. The data obtained indicate the validity of the search for novel useful obesity indicators with a good predictive value.

Aim. To study visceral adipose tissue (VAT) content in patients with coronary artery disease (CAD) using the bioimpedance analysis, to identify metabolic disorders associated with visceral obesity, and to determine the role of individual risk factors in the formation of coronary artery lesions using modern statistical methods.

Material and methods. A total of 152 patients were examined (women, 66; men, 86). The median age of patients was 63 [55;69] years. This observational study assessed anthropometric parameters, such as height, weight, body mass index, waist circumference, whole-body fat percentage, and specifically VAT mass, as well as the relationship of these parameters with blood levels of triglycerides, high-density lipoprotein cholesterol (HDL-C) and glucose. Height was measured using a metal height meter RM-1 “Diakoms”. Weight, body mass index, wholebody fat percentage, and VAT mass were measured using the Omron BF-508 body composition monitor (Omron, Japan). Epicardial adipose tissue (EAT) thickness was assessed using two-dimensional echocardiography on a Philips Sonos 5500 ultrasound system (Germany).

Results. Bioimpedance analysis revealed a higher VAT content in patients with CAD compared with those without CAD (14 [11;18]% vs 13 [10;14,5]%, respectively (p=0,025)). During the ROC analysis, cut-off values for VAT ≥15% and EAT ≥7,5 mm were identified, associated with a higher risk of CAD. In multivariate analysis, only HDL-C levels were significantly associated with CAD, while at the same time, univariate analysis demonstrated the significance of VAT and EAT in predicting CAD.

Conclusion. The results showed that an increased VAT content and low HDL-C level is associated with the presence of CAD.

Aim. In routine clinical practice, to evaluate the antihypertensive efficacy, 24-hour blood pressure (BP) control, tolerability and effect on arterial stiffness of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril according to office and 24-hour ambulatory BP monitoring (ABPM) in patients with uncontrolled hypertension (HTN) using previous therapy.

Material and methods. The study included 78 both sex outpatients over 18 years of age with essential HTN. The main inclusion criterion was HTN with inadequate BP control against the background of previous combination therapy including amlodipine, indapamide and perindopril as part of free- or fixed-dose combinations of antihypertensive drugs. All patients were prescribed triple FDC of amlodipine/ indapamide/perindopril (Triplixam) in accordance with the medication instruc tions. The patient’s condition was assessed during four follow-up visits: visit 1 — inclu- sion visit, visit 2 — after 4 weeks, visit 3 — after 12 weeks, visit 4 — after 24 weeks. At each visit, achievement of the target BP levels <140/90 mm Hg and <130/80 mm Hg was assessed, as well as the 24-hour BP profile. The dynamics of BP decrease, achievement of target BP values, 24-hour BP profile, and the effect of therapy on arterial stiffness according to ABPM were also assessed.

Results. In the analyzed group of patients, the initial office BP was 160,8± 10,3/91,5±8,1 mm Hg. After 24 weeks, there was a significant BP decrease to 121,3±3,5/73,6±4,2 mm Hg (p<0,001). According to ABPM, an average daytime BP significantly (p<0,001) decreased from 153,9±9,04/8,38±9,18 to 120,3±4,7/73,4±4,7 mm Hg after 24 weeks of amlodipine/indapamide/perindopril FDC therapy. Similar patterns were also found for the average values of nighttime BP. Target BP <140/90 mm Hg after 4 weeks reached the majority (87,2%) of patients, and after 12 weeks, the proportion of pa tients who reached the target BP was 100%.

Conclusion. In hypertensive patients with previous ineffective multiagent therapy, the triple FDC of amlodipine/indapamide/perindopril (Triplixam) provided high antihypertensive efficacy, good tolerability and adherence to therapy, and also demonstrated additional organ protection.

Aim. To determine the effectiveness of thromboelastometry (TEM) and echocardiography for anticoagulant therapy monitoring in patients with COVID-19.

Material and methods. We analyzed treatment regimen of 92 patients with COVID-19. The patients were divided into two groups. In the control group (n=30), anticoagulant therapy with unfractionated heparin (UFH) was carried out under laboratory control of coagulation parameters. In the experimental group (n=62), anticoagulation was maintained by intravenous UFH under control of coagulation, echocardiography (Philips, Epiq 5) and TEM (ROTEM® delta). Echocardiography determined the pulmonary artery acceleration time (AT), mid-systolic notching (SN). The TEM method was used to study external (EXTEM) and internal (INTEM) pathways, differential tests (FIBTEM, HEPTEM) of coagulation. Statistical analysis was performed by calculating non-parametric statistics parameters, comparisons of differences in groups (Mann-Whitney test), area under the curve (AUC), and regression equations.

Results. A high correlation level between echocardiographic and TEM parameters was determined. Their levels associated with a positive prognosis were calculated (AT>113,5 ms., AUC 0,979; p<0,0001; no SN, AUC 0,931; p<0,0001; FIBTEM ML (60 min) >1,12%, AUC 0,971, p<0,0001; INTEM ML (60 min) >2,01%, AUC 0,941, p<0,0001, EXTEM ML (60 min) >1,4%, AUC 0,934, p<0,0001; MCFfib not >26 mm, AUC 0,954; p<0,0001; MCFin not >56,6 mm, AUC 0,938; p<0,0001; MCFex not >47,9 mm, AUC 0,838, p<0,0001). In 33,9% of patients in the experimental group, heparin resistance was detected. In this connection, combined therapy with UFH and direct oral anticoagulants (DOACs) was used, followed by the switch to DOACs. In the control group, artificial ventilation was used in 50% of patients, mortality — 36,6%, myocardial infarction — 13,3%, deep vein thrombosis — 6,6%, pulmonary embolism — 6,6%, while in the experimental group, mechanical ventilation — 12,9%, myocardial infarction — 4,8%, mortality — 8,1%.

Conclusion. The dynamic assessment of echocardiography and TEM parameters made it possible to monitor pulmonary thrombosis processes, significantly reduce complications, the use of artificial ventilation and mortality in COVID-19 patients.

Invasive management of patients with ST- segment elevation acute coronary syndrome (ST-ACS) and non-ST-elevation acute coronary syndrome (NSTE-ACS) is a priority and reflected in the current guidelines for management of this category of patients with a high evidence level (class I, level of evidence A). One of the limitations in invasive strategy is prior coronary artery bypass grafting in patients with multivessel artery coronary disease. This analytical review reflects modern ideas about the features of diagnosis and management of patients with acute coronary syndrome and previous coronary artery bypass surgery, approaches to revascularization from the standpoint of efficiency and safety.

This literature review analyzes current data on the main stages of child’s heart contractility development from prenatal to postnatal period. The presented information will expand the conventional ideas on the age-related cardiovascular physiology in children, supplementing with relevant knowledge about the patterns of left ventricular mechanics, and the mechanisms affecting child’s heart morphology. In addition, we consider the evolutionary feasibility of the simultaneous existence of various left ventricular mechanics models, which ensure the effective cardiac function in the postnatal period. This is very important for the work of neonatologists, pediatricians, pediatric cardiologists and therapists.

Recent research indicates that vitamin D does indeed have a wide range of biological effects beyond its regulating function of bone and mineral homeostasis. Vitamin D deficiency is associated with leading predictors of cardiovascular risk, such as obesity, hypertension, and type 2 diabetes. In addition, it plays a role in the disease progression and worsening of the prognosis in patients with left ventricular hypertrophy, coronary artery disease, heart failure, and chronic kidney disease. An analysis was made of studies aimed at evaluating the efficacy and safety of vitamin D therapy in order to reduce the risk of cardiovascular pathologies, as well as improve the clinical course and outcomes in patients with existing metabolic disorders and cardiovascular diseases.

In recent decades, the problem of coronary artery disease (CAD) accompanied by chronic total occlusion (CTO) has come to the fore in senile patients. The reason for this is the absence of generally accepted management strategies for these groups of patients. The choice of myocardial revascularization method in elderly patients has a fundamental impact on outcomes, but requires additional research. There is no doubt that in recent years, percutaneous coronary intervention (PCI) in CTO has gained a status as the first-choice method for this pathology. The following main reasons are distinguished: development of intravascular imaging; improvement of surgical instruments; development of new approaches to recanalization; increase in the number of experienced surgeons. The use of PCI for CTO in elderly patients is specified by the upward trend in the proportion of senile population worldwide. This review considers the validity and potential of using PCI for CTO in senile patients, as well as its safety, benefits and prospects. For this review, the following databases were used: Medline (PubMed), RSCI (eLIBRARY), Google Scholar.