Aim. To carry out comparative analysis of echocardiographic and electrocardiographic (ECG) data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”).

Material and methods. The study presents the results of a sub-analysis of the international AKTIV registry, which was called AKTIV CARDIO. Data were collected from 9 medical centers in the Russian Federation. AKTIV CARDIO included 973 hospitalized patients, of which 50 patients died during hospitalization.

Results. Comparative analysis of echocardiographic parameters revealed that 4 parameters differed in deceased patients compared to survivors: left ventricular ejection fraction (LVEF), right ventricular end diastolic dimension (RV EDD), right atrial (RA) short axis diameter and pulmonary artery systolic pressure (PASP). RA short axis diameter was higher in deceased patients compared with survivors (38,0 [36,0; 39,0] versus 35,0 [33,0; 38,0] mm, p=0,011). RV EDD was higher in deceased patients than in survivors (3,0 [29,0; 33,0] vs 28,0 [27,0; 32,0] mm, p=0,019). LVEF was lower in deceased patients compared with survivors (55 [52; 55] vs 60 [56; 65]%, p<0,001). PASP was higher in deceased patients compared with survivors (25 [21; 35] vs 20 [19; 25] mm Hg, p=0,006). Correlation analysis found that the largest number of correlations with markers of the infection severity was observed for RA short axis diameter and RV EDD. A comparative analysis of ECG data revealed that in deceased patients, compared with survivors, atrial fibrillation (AF) (21,4% vs 6,06%, p=0,001) and supraventricular premature beats (14,3% vs 3,36%, р=0,004) occurred more often. In addition, deceased patients had longer QTc interval (440 [416; 450] vs 400 [380; 430] ms, p<0,001).

Conclusion. Comparative analysis of echocardiographic data showed that deceased patients have more pronounced right heart remodeling, higher PASP and lower LVEF. Patient survival was related to RV and RA sizes. Right heart enlargement was associated with markers of infection severity. Echocardiographic parameters characterizing the right heart side can probably be independent prognostic factors in the acute COVID-19 period.

Aim. To study the efficacy and tolerability of Sputnik V vaccination in patients with noncommunicable diseases (NCDs) compared with healthy individuals.

Material and methods. The retrospective analysis included data from 800 men and women aged 18 to 90 who were vaccinated from February to May 2021 at the National Medical Research Center for Therapy and Preventive Medicine. Sputnik V (Gam-COVID-Vac, Russia), consisting of two doses, was used as a vaccine. The mean age of the patients was 50,46±13,16 years. Patients were questioned in two stages: before vaccination and after the first dose of vaccination. The following clinical and paraclinical investigations were carried out: saturation assessment, measurement of temperature, blood pressure and heart rate at rest, pharynx examination, auscultation of the heart and respiratory organs. The blood concentration of antibodies (IgM and IgG) was determined after 21 days and 42 days. For analysis, patients were divided into three groups. The first group included healthy individuals (n=238, 29,8%), the second group — patients with one NCD (n=385, 48,1%), and the third group — patients with two or more NCDs (n=177, 22,1%).

Results. The sex composition was comparable in all three groups, while the mean age differed. In the first group, the mean age was 43,93±10,80 years, while in the second and third groups — 50,51±12,55 and 59,12±12,37 years, respectively (p<0,001). Statistical analysis was performed with adjustment for age and sex. The median blood concentration of immunoglobulin G of vaccinated individuals of the cohort after 21 days was within 4,60 [2,00; 8,40]. A comparative analysis of the groups did not reveal significant differences. After 42 days, the median concentration of immunoglobulin G increased by 4 times, which is significant (p<0,001) and amounted to 16,20 [15,80; 16,40]. In the group of healthy individuals, the concentration of immunoglobulin G was significantly higher compared to groups of individuals with one, as well as two or more NCDs. Forty-two days after vaccination, the concentration of immunoglobulin M both in the cohort and in individual groups did not change significantly compared to the level after 21 days. In addition, 47%, 38% and 40% of participants from the first, second and third groups, respectively, reported some symptoms. A temperature increase on average was detected in 13% of vaccinated individuals. The largest number of persons with fever was registered in the group of healthy individuals — 19%, in the group of patients with one NCD — 14%, and in the group with two or more diseases, the temperature increase was the lowest and amounted to 3% (p<0,001). After the first dose, 18,6% of patients reported taking additional drugs as follows: first group — 23,9%, second group — 15,1%, third group — 19,2%. These are mainly analgesic, non-steroidal anti-inflammatory and antihistamine drugs.

Conclusion. Vaccination with Sputnik V increases the immunoglobulin G level in the blood after 42 days by four times compared to after 21 days. This pattern is observed both in the group of healthy individuals and in patients with one, two or more chronic NCDs. Tolerability of vaccination in all groups was comparable and did not lead to visits to healthcare facilities.

Aim. To assess the clinical performance and factors associated with inhospital mortality in patients with coronavirus disease 2019 (COVID-19).

Material and methods. Our results are based on data from hospital charts of inpatients hospitalized in the Asinovskaya District Hospital in the period from March 11, 2020 to December 31, 2020, with a verified COVID-19 by polymerase chain reaction. The study included 151 patients, the median age of which was 66,2 (50- 92) years (women, 91; 60,3%). The study endpoints were following hospitalization outcomes: discharge or death. Depending on the outcomes, the patients were divided into 2 groups: the 1st group included 138 patients (survivors), while the 2nd one included 13 patients (death). To objectify the severity of multimorbidity status, the Charlson comorbidity index was used. The final value was estimated taking into account the patient age by summing the points assigned to a certain nosological entity using a calculator table.

Results. Hypertension was recorded in the majority of patients — 79,5%, chronic kidney disease — in 61,1%. The prevalence of type 2 diabetes and coronary artery disease was high — 31,8% each. Prior myocardial infarction was diagnosed in 11,3% of cases. The prevalence of percutaneous coronary intervention and coronary bypass surgery was 5,3% and 3,3%, respectively. Stroke was detected in 9,3% of participants. Prior chronic pulmonary pathologies in COVID-19 patients were rare (asthma — 3,3%, chronic obstructive pulmonary disease — 2,0%). In order to predict the death risk in COVID-19 patients, a logistic regression analysis was performed, which showed that age and Charlson comorbidity index were the most significant predictors.

Conclusion. Independent factors of inhospital mortality were age and Charlson’s comorbidity index. The risk assessment model will allow clinicians to identify patients with a poor prognosis at an earlier disease stage, thereby reducing mortality by implementing more effective COVID-19 treatment strategies in conditions with limited medical resources.

Aim. To study the features of coronavirus disease 2019 (COVID-19) in patients with different severity of carbohydrate metabolism disorders (CMDs), taking into account the possible role of obesity in the acceleration of clinical and laboratory disorders.

Material and methods. There were 137 consecutive patients admitted to the infectious disease hospital for COVID-19patients. Three 3 groups were formed: group 1 — 42 patients with concomitant type 2 diabetes (T2D); group 2 — 13 patients with concomitant prediabetes; group 3 — 82 patients without concomitant CMDs.

Results. Patients with T2D tended to have a more severe disease course according to the SMRT-CO algorithm (p=0,089), which was associated with the longest hospital stay (p=0,038), the most pronounced (p=0,011) and prolonged (p=0,0001) decrease in oxygen saturation, the maximum percentage of lung injury at the beginning (p=0,094) and at the end (p=0,007) of hospitalization, the greater need for intensive care unit (p=0,050), as well as the highest increase in C-reactive protein and fibrinogen (hypercoagulability and systemic inflammation were noted in all groups). Patients with prediabetes in terms of COVID-19 severity occupied an intermediate position between those with T2D and without CMDs; at the same time, they most often needed the prescription of biological preparations (p=0,001). In the first and second groups, there were larger, compared with the control, proportions of obese people (61,9%, 53,8% and 30,5%, respectively, p=0,003). Prediabetes group had a strong correlation between the severity of viral pneumonitis according to SMRT-CO and the presence of obesity (R=0,69, p=0,009).

Conclusion. In patients with impaired carbohydrate metabolism of any severity, COVID-19 is more severe. At the same time, persons with overt T2D are prone to the most severe COVID-19 course, while patients with prediabetes in terms of disease severity occupy an intermediate position between them and those without CMDs. Obesity is a strong risk factor for severe COVID-19 among patients with initial CMDs (prediabetes), which is partly mediated by prior liver dysfunction associated with the metabolic syndrome. The increase in proinflammatory changes and hypercoagulability is associated with COVID-19 severity in patients with and without CMDs. These disorders had the greatest severity and persistence in patients with T2D.

Aim. To evaluate epicardial adiposity (EA), verified on the basis of epicardial adipose tissue (EAT) thickness according to echocardiography, as a possible predictor of the severity of coronavirus disease 2019 (COVID-19) course in overweight and obese patients in a retrospective analysis of data.

Material and methods. We analyzed data on 165 patients (age, 45,2±4,7 years; men, 67,9%; body mass index, 31,4±3,5 kg/m2) who received outpatient or inpatient treatment for symptomatic COVID-19 in period from March 2020 to November 2021. Patients with diabetes, stage III-V chronic kidney disease and/ or cardiovascular disease were excluded from the analysis, with the exception of hypertension. EA was verified in the case of EAT thickness ≥4,8 mm for persons aged 35-45 years and ≥5,8 mm for persons 46-55 years old.

Results. Patients with EA were characterized by higher hospitalization rates (52,2% vs 9,0%, p<0,01), moderate (56,5% vs 19,7%, p<0,01), high and very high severity (17,4% vs 3,3%, p<0,01) of disease course, lung injury of CT-1, CT-2 and CT-3 (32,6% vs 9,8% (p<0,01), 21,7% vs 7,4% (p<0,05), and 15,2% vs 2,5% (p<0,01), respectively), invasive ventilation (8,7% vs 0,8%, p<0,05) and C-reactive protein >10 mg/l (69,6% vs 21,3%, p<0,01). Predictors of hospitalization for symptomatic COVID-19 according to multivariate logistic regression analysis were age, fasting glycemia, systolic blood pressure, EAT thickness, which was characterized by the highest standardized regression coefficient among other predictors (0,384, p<0,001).

Conclusion. EAT thickness may be one of the predictors of COVID-19 severity in overweight and obese patients. Persons with EA in the case of COVID-19 need more careful monitoring and measures to prevent severe course and complications.

Aim. To study the survival of patients with New York Heart Association (NYHA) class IIIV heart failure (HF) after a coronavirus disease 2019 (COVID-19) and compare it with a group of similar patients without COVID-19, both during and before the pandemic.

Material and methods. A sample of 810 patients with HF of any class was created, who were treated in the HF center at the City Clinical Hospital № 38 in Nizhny Novgorod for the period from March 2019 to March 2020. Patients with NYHA class HF III-IV (n=263) were selected from this sample. The diagnosis was confirmed by echocardiography and chest radiography. At the time of discharge, the 6-minute walk test was <300 meters, while the level of N-terminal pro-brain natriuretic peptide — >300 pg/ml. The group was analyzed from March 2019 to December 2021 with the definition of all-cause mortality depending on prior COVID-19.

Results. During 520-day follow-up, 30,8% of NYHA class III-IV patients died, while 16,0% of patients underwent COVID-19, of which 79,25% of patients died during this period. Mortality among patients without prior COVID-19 was 23,3% (p<0,001). The 30-day mortality among those with COVID-19 was 50,0%, while for the year, this parameter was 71,4% (p<0,001). Among patients without COVID-19 and with class III-IV HF, 4,64% died in the first 30 days, and 20,7% of patients died during the year (p<0,001). The results obtained were compared with the data from the EPOCHA-CHF program from 2002 to 2017.

Conclusion. Mortality among patients with class III-IV HF after COVID-19 was 3,5 times higher compared with those with class III-IV HF without prior COVID-19. During the COVID-19 pandemic, the mortality rate among patients with class III-IV HF without COVID-19 increased by 2,09 times compared with the pre-pandemic period.

Aim. To carry out a comparative analysis of the impact of optimal and suboptimal therapy for noncommunicable diseases (NCDs) at the prehospital stage on the severity and outcomes of coronavirus disease 2019 (COVID-19).

Material and methods. The study included 158 patients hospitalized with a diagnosis of COVID-19 and having one or more concomitant NCDs. Patients were divided into two groups depending on the quality of initial therapy for NCDs: group 1 — patients receiving treatment that does not meet modern clinical guidelines, taking drugs not regularly or not taking them at all (n=100; 63%), and group 2 — patients receiving treatment in accordance with current clinical guidelines, taking regularly prescribed therapy (n=58; 37%). The primary endpoint was inhospital death, while secondary endpoints — duration of fever, length of intensive care unit (ICU) stay, length of hospital stay.

Results. Inhospital mortality was significantly higher in the 1st group of patients compared with the 2nd group (18,0% vs 1,7%, p=0,002). Analysis of secondary endpoints revealed that patients of the 1st group (nonoptimal therapy), in comparison with the 2nd group (optimal therapy), had significantly longer period of fever (10 [7; 12] vs 9 [7; 10] days, p=0,03), longer ICU (0 [0; 3] vs 0 [0; 0] days, p<0,001) and hospital stay (10 [8; 14] vs 8 [7; 11] days, p=0,001).

Conclusion. Patients who received standard NCD therapy before admission to the infectious disease hospital, in accordance with current clinical guidelines and who regularly take drugs, have a more favorable course of COVID-19 at the hospital stage and a lower inhospital mortality rate than patients with suboptimal therapy who are not adherent to treatment or not receiving drugs, but having indications for taking them.

Aim. To assess long-term outcomes within 12 months after hospital treatment of patients with coronavirus disease 2019 (COVID-19) as part of a prospective registry.

Material and methods. Outcomes in the posthospital period were assessed in 827 patients diagnosed with COVID-19 (age, 58,0±14,8 years; men, 51,3%). For periods of 30-60 days, 6 and 12 months after discharge from the hospital, cases of death, nonfatal myocardial infarction (MI) and stroke, hospitalization, acute respiratory viral infections/influenza were assessed. The follow-up period was 13,0±1,5 months.

Results. During the follow-up period, 35 (4,2%) patients died, 6 (0,73%) and 4 (0,48%) cases of MI and stroke were registered. In addition, 142 (17%) patients were hospitalized, while 217 (26,2%) patients had acute respiratory viral infections/ influenza. Factors of age and length of intensive care unit stay were significantly associated (p<0,001) with the risk of all-cause death (hazard ratio (HR)=1,085 per 1 year of life and HR=6,98, respectively), with the risk of composite endpoint (death, non-fatal MI and stroke): HR=1,081 per 1 year of life and HP=4,47. Of the 35 deaths, 11 (31%) were within the first 30 days of follow-up, and 19 (54%) — 90 days after discharge from the hospital. A higher probability of hospitalization was associated with older age (odds ratio (OR)=1,038; p<0,001), while a higher probability of acute respiratory viral infections/influenza was associated with younger age (OR=0,976 per 1 year of life; p<0,001) and female sex (OR=1,414; p=0,03).

Conclusion. A prospective follow-up of 827 patients in the TARGET-VIP registry revealed that 12-month mortality was 4,2%, while more than half of the deaths (54%) were registered in the first 90 days, including 31% — for the first month after discharge from the hospital. The most common events were hospitalizations (17,0%) and acute respiratory viral infections/influenza (26,2%), while the rarest were myocardial infarction (0,73%) and stroke (0,48%). The key factors associated with 12-month mortality in the post-COVID-19 period were older age and intensive care unit stay during the reference hospitalization. A higher readmission rate during the follow-up period was associated with older age, and the prevalence of acute respiratory viral infections /influenza during the follow-up period was associated with younger patients and female sex.

Analysis of cytokine profile markers in conjunction with the clinical manifestations of coronavirus disease 2019 (COVID-19) can provide valuable information about the pathogenetic manifestations of the disease, and therefore, in the future, determine drugs that affect the cytokine storm and have an anti-inflammatory effect.

Aim. To identify correlations between the parameters of the developed cytokine profile and the clinical course in hospitalized patients with COVID-19 of different severity.

Material and methods. The study included 70 hospitalized patients with a confirmed diagnosis of COVID-19, with a mean age of 58 [50;69] years, including 40 men (57%) and 30 women (43%). The average lung involvement according to computed tomography (CT) at admission was CT-2 [1;3]. Peripheral venous blood was taken at admission, which averaged 7 [6; 8] days from the symptom onset. Standard biochemical parameters were studied, as well as 47 cytokines and chemokines using the Multiplex system (Merck KGaA, Darmstadt, Germany).

Results. Correlations was found between the lung involvement degree and the level of IL-8 (r=0,31, p<0,05), IL-15 (r=0,35, p<0,05), IL-18 (r=0,31, p<0,05), MCP-1 (r=0,36, p<0,05), MIG (r=0,50, p<0,05), TNF-α (r=0,41, p<0,05). An inverse correlation was also found in the level of blood oxygen saturation with the same indicators as follows: IL-8 (r=-0,27, p<0,05), IL-15 (r=-0,34, p<0,05), IL-18 (r=-0,31, p<0,05), MCP-1 (r=-0,40, p<0,05), MIG (r=-0,56, p<0,05), TNF-α (r=-0,45, p<0,05). IL-6 levels were significantly elevated in patients with severe COVID-19 (CT3, CT4), while no increase in IL-6 was observed in patients with moderate disease (CT1, CT2). It is noteworthy that in patients with diabetes, the highest values of IL-12, IL-9 were recorded.

Conclusion. Hyperinflammatory syndrome in severe COVID-19 is manifested by high levels of IL-6, MIG, MDC, MCP-1, M-CSF, TNF-α, β, IL-8, IL-18, IL-15. With the CT-1 and CT-2, an increase in only the level of IL-18, IL-8 is noted. The identified patterns prove and make it possible to explain a number of systemic inflammatory changes that occur with COVID-19.

Aim. To carry out a comparative assessment of the clinical status and behavioral risk factors in patients with cardiovascular (CVD) and other noncommunicable diseases (NCDs) in Russia and neighboring countries during quarantine and selfisolation in the context of coronavirus disease 2019 (COVID-19) pandemic.

Material and methods. The study involved patients from Russia, Azerbaijan, Kazakhstan, Lithuania, Kyrgyzstan. A total of 351 men and women aged 30- 69 years with one or more NCDs were included, including hypertension (HTN), coronary artery disease with or without myocardial infarction, type 2 diabetes, chronic obstructive pulmonary disease/ asthma, and cancer that were in quarantine self-isolation. To assess the clinical status and risk factors, patients underwent a questionnaire and examination. The changes in health status was assessed using the EQ-5D questionnaire.

Results. During self-isolation and quarantine, 40% of patients noted a decrease and limitation of physical activity. An increase in food frequency and amount was registered in 35% of individuals. During quarantine, every third patient with HTN had hypertensive crises, and every fifth increased the doses of the drugs taken. In the examined cohort, exertional angina (30%) took second place among NCDs. In the group of Azerbaijan patients, every second had exertional angina, while in the Russian cohort — 33%, and in the Lithuanian group — every fourth patient. In general, health status deterioration among people with angina was noted in 6% of cases. In the examined group, type 2 diabetes was detected in 25% of cases. During quarantine, changes in hypoglycemic therapy were carried out in an average of 34% of patients. COVID-19 was registered in 22% of patients in the examined cohort. The largest number was found in the group from Kazakhstan — 57%, while the second place was taken by the Azerbaijan group — 40%. General condition deterioration was detected in 55% of cases in groups from Azerbaijan and Kazakhstan. In Russia, this was reported by 28,8% of patients, while in the group from Lithuania, every fourth patient noted a worsening of the health status. The lowest deterioration was registered in the Kyrgyzstan group (14%).

Conclusion. During quarantine and self-isolation among patients with NCDs, a decrease in physical activity, an increase in food consumption and smoking was noted. There was health status deterioration in patients with various NCDs, primarily with CVDs, which required therapy changes. Taken together, this was reflected in general condition worsening in patients with chronic NCDs. It is obvious that the development of comprehensive preventive measures in conditions of selfisolation and quarantine is required.

An online expert meeting held on November 17, 2021 reviewed the results of the randomized, double-blind, multinational, parallel-group EMPULSE trial, evaluating the clinical benefit and safety of the sodium-glucose co-transporter-2 inhibitor (SGLT2i) empagliflozin compared with placebo in patients hospitalized with acute decompensated heart failure (ADHF). Patients were included in the study regardless of ejection fraction (EF) and the presence of diabetes and randomized during hospitalization after stabilization. In addition, the EMPULSE trial used a composite result analyzed using a stratified benefit ratio — Win Ratio analysis. There is evidence of clinical benefit of empagliflozin in hospitalized patients with preserved and reduced LVEF, as well as in patients with newly diagnosed ADHF or with acute decompensation of chronic heart failure (CHF) compared with placebo, regardless of type 2 diabetes presence. The importance of the favorable results of the EMPULSE trial and its significance for clinical practice, which implies the early administration of empagliflozin for inpatients, is noted. A number of proposals have been adopted to accelerate the introduction of empagliflozin into clinical practice for patients with ADHF.

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic is an ongoing public health emergency that has caused unprecedented morbidity and mortality. COVID-19 is a disease caused by severe acute respiratory syndromerelated coronavirus 2 (SARS-CoV-2), which affects not only the lungs but also the cardiovascular system. A strong theoretical justification for the multisystem effect of COVID-19 is the close relationship between it and endothelial dysfunction, which, according to expert consensus, is crucial for the pathogenesis and severity of the disease. Endothelial dysfunction is considered as the main pathophysiological process in the severe and/or prolonged course of COVID-19, and is probably the common denominator of many clinical aspects of severe COVID-19. This review presents scientific data on the effect of perindopril and amlodipine in patients with hypertension and/or coronary heart disease and COVID-19 on endothelial function.

The prevalence and mortality due to venous thromboembolism (VTE) occupies a leading position among the population throughout the world. The incidence and severity of VTE increases the older the patient. The emergence of a new group of direct oral anticoagulants significant changed the management of these groups of patients. The article touches upon the problem of choice, efficacy and safety of oral anticoagulants in elderly and senile patients with VTE, in particular in pulmonary embolism (PE). An analysis of randomized clinical trials and prospective cohort studies is given. In addition, rational recommendations are given on the optimal choice of oral anticoagulant in these categories of patients. Apixaban and rivaroxaban are highly effective drugs of choice with a reliable safety profile in patients of the senile age group in the prevention and treatment of VTE, including PE, and apixaban has the most optimal profile and safety class among all other oral anticoagulants when used in elderly and senile patients.

The review aim was to familiarize biomedical professionals with the latest evidence-based data on the effect of sparsely ionizing radiation (X-ray, γ- and β-radiation) on cardiovascular mortality (ICD-9: 390-459; ICD-10: I00-I99), which is especially important during the coronavirus disease 2019 (COVID-19) pandemic due to the increased use of computed tomography (CT) and X-ray procedures. Information is presented on the officially accepted range of radiation doses (very low doses — 0-0,01 Gy, low doses — 0,01-0,1 Gy, moderate doses — 0,1- 1,0 Gy, high doses — over 1 Gy). The evolution of ideas about the effects of radiation on the prevalence of cardiovascular diseases is discussed: from high and very high doses to the declaration in recent years of the possible effect of low doses. The statements from the documents of authoritative radiation organizations (UNSCEAR, ICRP, NCRP, EPA, etc.) are given, according to which the threshold for increasing cardiovascular mortality is 0,5 Gy (range of moderate doses), and there are no epidemiological justifications for the effects of low doses. According to a data for six countries, the maximum cumulative doses from multiple CT scans for COVID-19 diagnosis are one order less than the threshold dose, and the average cumulative doses are two orders less. Data on the absence or low risk of cancer after CT for this reason are also presented.