Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular.

Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021).

Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs.

Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p<0,001) with a comparable proportion of patients receiving antihypertensive therapy (60,7% vs 59,0%, p=0,05) and treatment efficacy (28,7% vs 30,9%, p=0,36). Monotherapy was received in 44,7% of cases, while dual and triple combination therapy — in 30,9% and 14,1%, respectively. The majority of respondents (~90%) did not adjust their antihypertensive therapy during the COVID-19 pandemic.

Conclusion. According to HTN screening in Russia, there is persistent ineffective control of HTN, which may be due to both the worsening pattern of behavioral risk factors, limited access to healthcare during COVID-19, and the inertia of physicians and low adherence of patients due to the asymptomatic HTN course in the majority.

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).

Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.

Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.

Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research.

Aim. To evaluate the level of circulating free nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) in hypertensive patients with high cardiovascular risk.

Material and methods. The study included 70 patients, of which 51 were patients with hypertension (HTN) and 19 were healthy. The study of the level of circulating free nDNA and mtDNA was carried out using quantitative polymerase chain reaction (PCR). Additionally, demographic data, comorbidities, risk factors, heredity, results of complete blood count and biochemical blood tests, electrocardiography and echocardiography were analyzed.

Results. The level of nDNA in HN patients was significantly higher than in healthy patients: Me (LQ; UQ) — 227 (110; 370) copies/mL and 88 (62; 116) copies/ml, respectively (p<0,0001). In hypertensive patients with a very high cardiovascular risk, the level of nDNA and mtDNA was significantly higher compared to healthy participants: 294 (154; 489) copies/ml versus 88 (62; 116) copies/ml, p<0,0001; 56731 (42531; 129375) copies/mL versus 35156 (18325; 54956) copies/mL, p=0,015.

Conclusion. The level of circulating free DNA in hypertensive patients with very high cardiovascular risk is significantly increased, and therefore this parameter can be a cardiovascular risk marker.

Obesity may develop heart failure with preserved ejection fraction, which is based on left ventricular diastolic dysfunction (LV DD). Currently, the search for effective predictors of LV DD is extremely relevant.

Aim. To assess the prognostic value of key and additional metabolic risk factors (RFs), neurohumoral and profibrotic factors in the development of LV DD in obese patients.

Material and methods. The study included 149 men with general obesity. The mean age was 49,7±7,9 years. The inclusion criteria was the presence of class I-III general obesity. The average body mass index was 32,9±3,6 kg/m2. The exclusion criteria were hypertension, coronary atherosclerosis, type 2 diabetes, as well as LV DD according to transthoracic echocardiography. Depending on the presence of epicardial adiposity, patients were divided into two groups: group 1 — epicardial adipose tissue (EAT) thickness ≥7 mm (n=70), group 2 — EAT <7 mm (n=31). In all patients, the following laboratory parameters were determined in blood serum using enzyme immunoassay: type I and III collagen, Procollagen I C-Terminal Propeptide (PICP), matrix metalloproteinase-3 (MMP-3), transforming growth factor β1, vascular endothelial growth factor, tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-10, C-reactive protein (CRP), adiponectin, soluble leptin receptor, leptin, lipid parameters and free fatty acids (FFA). After 4,7±0,3 years, echocardiography was repeated in order to assess LV diastolic function.

Results.  Comparative analysis of metabolic risk factors revealed a significant increase in the level of total cholesterol (p=0,001), low-density lipoprotein cholesterol (LDL-C) (p<0,0001), triglycerides (TGs) (p<0,0001). These groups had no differences in such parameters as high-density lipoprotein cholesterol (p=0,09) and glucose (p=0,12). An increase in the level of such pro-inflammatory cytokines as TNF-α (p<0,0001), CRP (p<0,0001), IL-6 (p<0,0001) in group 1 was revealed, while differences in IL-10 (p=0,34) levels were not significant. In group 1, there was a significant increase in leptin levels (p<0,0001), a decrease in levels of adiponectin (p<0,0001) and leptin receptor (p=0,001). In group 1, an increase in the level of all studied profibrotic factors was revealed. After 4,7±0,3 years, repeated echocardiography revealed that selected groups were comparable in such parameters as A, E, E/A, E/e’, e’, and the peak tricuspid regurgitation velocity. There was a significant difference in left atrial volume index (p=0,0003). LV DD was detected in 20 patients. Binary logistic regression revealed the following most significant predictors of LV DD in obese patients: glucose, LDL-C, triglycerides, leptin receptor, leptin, MMP-3, FFA, PICP, and EAT thickness.

Conclusion. Thus, the following most significant predictors of LV DD in obese patients were identified glucose, LDL-C, triglycerides, leptin receptor, leptin, MMP-3, FFA, PICP, and EAT thickness.

Aim. To determine the features of expression and secretion of plasminogen activator inhibitor-1 (PAI-1) by subcutaneous, epicardial and perivascular adipocytes depending on the complexity of coronary artery disease (CAD).

Material and methods. The study included 86 patients with CAD, including 35 with moderate atherosclerotic lesions of the coronary arteries (CA) (SYNTAX Score ≤22), 22 with severe (SYNTAX Score of 23-31 pints), 29 with extremely severe (SYNTAX Score ≥32). As a comparison group, 52 patients with heart defects were examined. During an elective surgical intervention, adipose tissue (AT) samples were obtained for subsequent cultivation and determination of PAI-1 gene expression and PAI-1 secretion in AT supernatants of various localizations. Statistical analysis was performed using Statistica 10.0.

Results. In CAD, PAI-1 production in all three types of AT and plasma PAI-1 concentration were increased compared with patients with heart defects. Epicardial AT (EAT) in CAD was characterized by the maximum levels of expression and secretion of PAI-1 relative to patients with heart defects and subcutaneous and perivascular (PVAT) fat depots. Moderate coronary involvement (adipose tissue <22) is characterized by the lowest expression and secretion of PAI-1 in all types of AT and plasma concentration of PAI-1. Direct correlations of PAI-1 expression and secretion in EAT and PVAT and plasma PAI-1 level with its secretion in EAT in patients with CAD and heart defects were revealed. A direct correlation between the plasma level of PAI-1 and its secretion in PVAT was found only in CAD.

Conclusion. In CAD, there is not only an increase in the plasma PAI-1 level, but also an increase in the expression of PAI-1 gene and the secretion of PAI-1 in all three types of AT compared with patients with heart defects. PAI-1 expression and secretion in EAT, PAI-1 plasma level, and age are predictors of severe/extremely severe coronary involvement in CAD.

Aim. To develop a model for predicting the subclinical carotid atherosclerosis (SCA) in order to refine cardiovascular risk (CVR) using machine learning methods in overweight and obese patients without hypertension, diabetes and/or cardiovascular disease (CVD).

Material and methods. Anonymized database (DB) Webiomed (2.9 million patients) was used. There were following inclusion criteria: age ≥18 years, body mass index ≥25 kg/m², availability of data on ultrasound of extracranial arteries. Patients with hypertension, diabetes and/or CVD were excluded from the analysis. Data on 5750 patients were selected, of which atherosclerotic plaques were detected in 385 people. The final data set contained information on 447 patients, 197 (44,1%) of which had SCA. Quantitative and categorical traits for model training were taken with 40% occupancy in the database. The number of final traits for machine learning was 28. When creating the model, 3 Random Forest algorithms, AdaBoostClassifier, KNeighborsClassifier and the Scikit-learn library were used. To improve the model performance, the fill missing function was used. The target parameters of the model were given a predictive ability (accuracy) of at least 75%, while the area under the ROC curve was at least 0,75.

Results. The resulting dataset was divided into training and test parts in a ratio of 80:20. Depending on the applied algorithms, the learned model was characterized by a predictive ability of 75-97%, sensitivity of 77-92%, specificity of 80-98%, and area under the ROC-curve of 0,88-0,97. Taking into account the accuracy metrics, the best results were obtained for the model learned by the Random Forest algorithm (95%, 92%, 98% and 0,95, respectively).

Conclusion. The developed model can help a physician make a decision to refer an overweight and obese patient without cardiovascular diseases for ultrasound of extracranial arteries, which contributes to a more accurate CVR stratification. The introduction of such risk stratification algorithms into practice will increase the accuracy and quality of CVR prediction and optimize the system of preventive measures.

Aim. Validation and evaluation of psychometric parameters of the Russian-language version of the Coronary Artery Disease Education Questionnaire II (CADE-Q II) in patients with chronic coronary syndromes (CCSs).

Material and methods. The study involved 303 patients with stable coronary artery disease (CAD) who were hospitalized in the cardiology department in April-November 2021. All patients admitted underwent a standard examination and treatment, adopted in the management of patients with CCSs. In addition, we analyzed socio-demographic parameters (marital status, education level, occupation, disability, income level), quality of life (using SF-36 and SAQ questionnaires), levels of anxiety and depression (HADS scale), personality type D (DS-14 questionnaire), adherence to treatment (four-item Morisky-Green Medication Adherence Scale), Charlson comorbidity index, The Self Care of Coronary Heart Disease Inventory (SC-CHDI), and CADE-Q II. The validation process of new questionnaire was carried out in several stages as follows: translation, pilot testing, reliability assessment, constructive and criterion validity assessment.

Results. Test-retest reliability of the questionnaire’s scales was 0,81, while Cronbach’s alpha varied from 0,613 to 0,877, which indicates its sufficient reliability. The confirmatory factor analysis confirmed the correspondence of the obtained model to the experimental one. The criteria validity of the questionnaire revealed correlation between the scales with the level of patient’s general education (r=0,391, р<0,01), “selfcare confidence” scale of the SC-CHDI (r=0,251, р<0,05), “Vitality” component of the SF-36 (r=0,225-0,284, р<0,05), “Mental Health” component of the SF-36 (r=0,308, р<0,01). In addition, a weak negative relationship was found between the blocks “Physical exercises” and “Psychosocial risks” with age (r=-0,237, p<0.05 and r=-0,229, p<0.05, respectively).

Conclusion. The Russian-language version of the CADE-Q II has sufficient psychometric indicators and is a valid tool for assessing the self-care ability of patients with CAD.

At present, there are no studies on the analysis of the incidence of complications in patients with concomitant lesions of the coronary and internal carotid arteries (ICA) after combined operation of carotid endarterectomy (CE) and coronary artery bypass grafting (CABG) against the background of type 2 diabetes (T2D). However, there is no doubt that this condition can be a predictor of cardiovascular and wound complications during in-hospital and long-term postoperative periods.

Aim. To study in-hospital and long-term outcomes of combined CABG+CE in patients with and without type 2 diabetes.

Material and methods. This multicenter retrospective study for the period from January 2015 to December 2019 included 653 patients with concomitant atherosclerotic lesions of ICA and coronary arteries, who underwent combined CE+CABG. Depending on presence of type 2 diabetes, 2 groups were formed: group 1 (n=183) — patients with type 2 diabetes; group 2 (n=471) — patients without type 2 diabetes. The duration of postoperative follow-up was 37,8±14,9 months.

Results. During hospitalization, significant differences in the incidence of death (group 1 =1,1%; group 2 =1,0%; p=0,97), myocardial infarction (MI) (group 1 =1,1%; group 2 =0,8%; p=0,76), bleeding events (group 1 =1,1%; group 2 =0,8%; p=0,76) were not detected. However, stroke (group 1 =3,8%; group 2 =0,4%; p=0,0008), sternal wound infection and mediastinitis (group 1 =3,3%; group 2 =0,2%; p=0,0006) were significantly more often developed in patients with type 2 diabetes.

In the long-term follow-up period, death (group 1 =6,6%; group 2 =1,1%; p<0,0001), MI (group 1 =4,9%; group 2 =0,8%; p=0,0008), stroke (group 1 =7,7%; group 2 =1,5%; p<0,0001), ICA restenosis (group 1 =8,8%; group 2 =1,6%; p<0,0001), repeated emergency myocardial revascularization (group 1 =7,2%; group 2 =1,5%; p=0,0002), repeated emergency cerebral revascularization (group 1 =8,8%; group 2 =1,6%; p<0,0001) were significantly more often recorded in patients with type 2 diabetes.

Kaplan-Meier curve analysis and its comparison using the log rank test revealed that the death, MI, and stroke were also significantly more often observed in patients with type 2 diabetes (p=0,0007, p=0,003, p<0,0001, respectively).

Conclusion. Patients with type 2 diabetes who are referred for combined CE+CABG are at an increased risk of stroke, sternal wound infection and mediastinitis in the in-hospital postoperative period, as well as all adverse cardiovascular events in the long-term follow-up period.

Aim. To assess the level of various cardiac biomarkers and the volume of epicardial adipose tissue (EAT) in patients with heart failure (HF) depending on the type of atrial fibrillation (AF).

Material and methods. This prospective observational study included 69 patients with symptomatic AF, as well as with manifestations of New York Heart Association (NYHA) class II-III HF. All patients were examined before catheter ablation for AF. The following investigations were performed: echocardiography, computed tomography, myocardial perfusion scintigraphy, immunochemical analysis of cardiac biomarkers (brain natriuretic peptide (BNP), high-sensitivity troponin I (hs-TnI)), as well as biochemical analysis of high-sensitivity C reactive protein (hsCRP). Patients were divided into 2 groups, depending on the AF type, into paroxysmal and non-paroxysmal (persistent and long-standing persistent).

Results. The analysis included 69 patients with various AF types and symptomatic HF. There were significantly more patients with HF confirmed by an elevated BNP level in the group with non-paroxysmal type (27 (71%) vs 5 (16%), p<0,00001). Comparison analysis showed that in group 2 the mean BNP level was significantly higher than in group 1 (135,5 pg/ml [75,2;303,2] vs 40 pg/ml [20,7;56,9], respectively, p<0,00001). The hs-TnI level was higher in group 2 (2,5 [1,7;5,1] vs 1,9 [0,8;3,9], respectively, p=0,19), but there was no significant difference between the groups. The level of hsCRP did not differ in both groups. In group 1, the EAT volume was 139 [117,5;171] vs 169 [130;209,5] in group 2 (p=0,03).

Conclusion. The type of AF plays a role in the interpretation of cardiac specific enzymes, and BNP levels and EAT volume are higher in patients with the non-paroxysmal form.

The introduction of novel biomarkers necessitates their detailed study in patients with different heart failure (HF) phenotypes as part of a personalized approach to assessing the disease severity and predicting outcomes.

Aim. To assessthe activity of following neurohormonal systems: N-terminal probrain natriuretic peptide (NT-proBNP) and galectin-3 in HF with preserved, mildly reduced and reduced ejection fraction (EF).

Material and methods.  In 69 patients with NYHA class II-IV HF,  along with a general clinical examination, the level of NT-proBNP and serum galectin-3 was determined by enzyme immunoassay.

Results. Patients included in the study were divided into 3 groups: preserved EF (HFpEF) — 23 patients, mildly reduced EF (HFmrEF) — 26 patients, and reduced EF (HFrEF) — 20 patients. In patients with HF, the level of galectin-3 did not directly depend on EF, but was associated with NT-proBNP level as follows: there was a tendency to increase the concentration of galectin-3 in the tertile groups of NT-proBNP. Correlation analysis revealed significant feedback (r=-0,41, p<0,05) between galectin-3 and left ventricular EF only in patients with preserved systolic function. In the same group of HFpEF patients, the maximum values of serum galectin-3 indices were noted, reaching 10,5 [6,5; 14,5] ng/ml.

Conclusion. Analysis of neurohormonal activity demonstrated a unidirectional increase in NT-proBNP and galectin-3 in patients with HF, regardless of left ventricular EF, while the maximum values of galetin-3 were observed in patients with HFpEF.

Aim. To analyze level of circulating biomarkers of plasma vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) during 3-month therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24, AO Vertex, Russia), as well as to evaluate the antihypertensive efficacy of a fixed-dose combination of ramipril/indapamide (Konsilar-D24, JSC “Vertex”, Russia) in hypertensive (HTN) patients with type 2 diabetes (T2D).

Material and methods. This prospective open-label study included 44 patients (aged 35 to 60 years) of both sexes with essential grade 1-2 HTN and concomitant compensated T2D, who did not reach the target blood pressure (BP) level using single or dual antihypertensive therapy, as well as patients who did not take antihypertensives. All patients included in the study initially underwent a set of standard clinical, laboratory and functional examinations in accordance with the clinical guidelines for the management of patients with HTN and T2D, as well as an assessment of the level of C-reactive protein, VEGF and TNF-α. Patients were monitored and treated with Konsilar-D24 for 3 months.

Results. In 93,2% of patients, individual target BP values were achieved during the first 2-4 weeks of therapy with a fixed combination of ramipril/indapamide (Konsilar-D24). In the subsequent 3-month follow-up, the average daily BP level in all patients ranged from 129/79 mm Hg to 110/70 mm Hg. Three-month Konsilar-D24 therapy showed a decrease in microalbuminuria: the median values of microalbuminuria decreased by 2 times, and the decrease in the maximum recorded values reached 40% of the baseline. Decrease in mean TNF-α values after 3-month therapy with Konsilar-D24 was 33% of the baseline values, while the maximum recorded values during the specified period decreased by 17%. Decrease in median VEGF values after 3-month Konsilar-D24 therapy was 28%, while the maximum value decreased by 7%, the minimum — by 8%.

Conclusion. Konsilar-D24 improves the prognosis in hypertensive patients not only by reducing BP to target values, but also by reducing the level of VEGF and TNF-α biomarkers that determine the progression of endothelial dysfunction, diabetic retinopathy, and microalbuminuria.

In the presented case report, 36-year-old female patient, who was hospitalized in the rheumatology department, developed thrombotic microangiopathy and sepsis-related coronavirus disease 2019 (COVID-19). In the department, hereditary thrombophilia was revealed: heterozygous polymorphism in the coagulation factor 5 gene (Factor V Leiden). Livedo reticularis. It is known that in October 2020, the patient had COVID-19 with bilateral pneumonitis on chest computed tomography. On examination, dry gangrene of 1, 2, 4, 5 fingers of the right hand, 2 finger of the left hand, as well as 2, 3, 4, 5 fingers of the right and left feet were diagnosed. Necrosis of the nasal tip. Surgery was performed with amputation of the affected fingers and distal feet with autodermoplasty.

Currently, the world experiences an increase in obesity prevalence, resulting in an increase in the incidence of diseases in which it is one of the leading factors, primarily type 2 diabetes and cardiovascular disease. This limits the effectiveness of preventive measures and determines the need to introduce more effective approaches. Evidence of the key role of intestinal peptide hormones (incretins) in the normalization of body weight and metabolic processes after bariatric interventions became the basis for studying pharmacological methods for treating obesity and related complications aimed at the “incretin axis”. In order to achieve greater efficacy compared to monotherapy with glucagon-like peptide-1 (GLP-1) agonists, studies are performed on unimolecular multiagonists developing on the basis of GLP-1 agonists and effecting on various components of the “incretin axis” by competitive activation of numerous receptors, in first of all, receptors for glucose-dependent insulinotropic polypeptide and glucagon. This review analyzes the results of clinical trials and discusses the prospects for introduction of “incretin axis” multi-agonists for patients with visceral obesity syndrome.