Aim. To analyze 20 electrocardiographic (ECG) signs of left bundle branch block (LBBB) before and after septal myectomy in patients with hypertrophic cardio myopathy (HCM) and develop a criterion for proximal LBBB based on the selected signs.

Material and methods. This retrospective non-randomized study included 50 patients with obstructive HCM who underwent septal myectomy. There were following inclusion criteria: QRS width <120 ms before surgery, transaortic access during septal myectomy, and QRS width ≥120 ms in the early postoperative period. For each patient, ECGs were analyzed before septal myectomy and in the first week after surgery. At the same time, 20 ECG signs proposed earlier in the LBBB criteria were independently assessed.

Results. Exsection of a small myocardial area of the basal interventricular septal parts, weighing an average of 4,9±2 grams, led to a significant increase in the QRS width (by 61±14,6 ms) and the prevalence of almost all ECG signs of LBBB. In 100% of cases (n=50), the following signs demonstrated significant dynamics after surgery: (1) midQRS notching or slurring in ≥2 contiguous leads (I, aVL, V1-V2, V5-V6); (2) absence of q wave in V5-V6 and (3) discordant T wave in at least two leads (I, aVL, V5, V6). Based on the design of the study, (4) QRS width ≥120 ms was additionally included. These ECG characteristics were combined into a new criterion for proximal LBBB

Conclusion. A new criterion for proximal LBBB was developed using the pathophysiological model of iatrogenic conduction block of left bundle branch. Further estimation of this criterion on a set of candidates for CRT with heterogeneous level of LBBB is necessary.

Aim. To study the relationship between a decrease in left ventricular (LV) ejection fraction (EF) and conventional electrocardiographic (ECG) signs associated with myocardial structure changes (pathological Q wave, ventricular arrhythmias), and relatively novel and less studied (fragmented QRS (fQRS), early ventricular repolarization (EVR)) and to evaluate their significance for identifying patients with mildly-reduced EF (mrEF).

Material and methods. The study included 148 patients who were treated and examined at the Almazov National Medical Research Center. During the ECG analysis, fQRS, EVR, pathological Q wave, and ventricular arrhythmias (VAs) were assessed. Echocardiography data were analyzed. Statistical processing was carried out, including Fisher and chi-squared test, as well as correlation and ROC analysis.

Results. Depending on the EF level, patients were divided into three groups: group 1 — patients with reduced EF (rEF) (<40%); group 2 — patients with mrEF (40-49%); group 3 — patients with preserved EF (pEF) (>50%). In the 1st group (with rEF), fQRS was registered in 16 (51,6%) patients, in the 2nd (with mrEF) — in 13 (44,8%), in the 3rd (with EF >50%) — in 16 (18,2%). Pathological Q wave was detected in the 1st group (rEF) in 20 (65%) patients, in the 2nd (mrEF) — in 10 (35%); in the 3rd (pEF) — in 15 (18%) (p<0,001). ROC analysis found that fQRS is more important for identifying patients with mrEF. In the 1st group (rEF), EVR was registered in 2 (6,5%) patients, in the 2nd (pEF) — in 2 (6,9%), in the 3rd (EF>50%) — in 11 (12,5%); the differences were not significant (p=0,5). The relationship of EVR, the number of PVCs and the presence of ventricular tachycardia with EF was not revealed.

Conclusion. FQRS is significantly more often observed with a decrease in EF and may be a marker of an mildly-reduced EF. There were no significant correlations between EVR and EF. There was also no relationship between VAs and LV systolic dysfunction.

Aim. To study the characteristics of heart rate variability (HRV) in episodes of paro xysmal atrial fibrillation (AF) and sinus rhythm (SR) during the 24-hour Holter electro cardiographic (ECG) monitoring and to assess the presence and nature of their relationships.

Material  and  methods. We analyzed 37 records of 24-hour Holter ECG monitoring obtained from patients with paroxysmal AF. For analysis, records were selected from the Long Term Atrial Fibrillation database (LTAFDB) (n=26), as well as from the long-term storage database “Myocard-holter” of the Sverdlovsk Regional Clinical Hospital № 1 (n=11). Each record contained at least 120 min of SR and at least 120 min of paroxysmal AF episodes. In addition, 48 HRV indices were calculated independently for SR and for AF episodes, after which the 96 HRV parameters obtained for each record were subjected to exploratory data analysis.

Results. Analysis of HRV in AF paroxysm showed a significant increase in the RMSSD, SD1, pNN50 indices, which confirmed the great importance of parasympathetic influence in the regulation of AF. Despite the fact that single HRV parameters in AF are not directly related to any single parameters in SR, we have shown that the AF is not completely chaotic and independent of the characteristics of baseline HR variability. We found that for some of the HRV indices determined during AF paroxysm (PAF_CVI, PAF_pNN20, PAF_pNN50, PAF_ApEn, PAF_SDNN, PAF_SD2), up to 74% of the variance of these indices can be explained using multivariate linear models, including 4 HRV indices for SR and taken as predictors. It was shown that among all the indices analyzed, only the PAF_HTI, calculated in paroxysmal AF, had a moderate negative correlation with the duration of AF episodes (r=0,60, p<0,01).

Conclusion. It is shown that the study of HRV indices on AF paroxysm has a wide clinical and electrophysiological potential. The paper proposes statistical models that demonstrate the relationship between HRV in SR and in the rhythm of AF episode. The PAF_HTI index, assessed on episodes of AF, showed a relationship with the duration of AF episodes, which suggests the expediency of using HRV characteristics on AF to assess the possibility of SR recovery.

Aim. To develop a protocol for diagnosing exercise-induced arrhythmias and conduction disturbances in children aged 3-6 years without structural heart disease.

Material and methods. The study included 20 patients (11 boys) aged 58,7±2,12 months with ventricular arrhythmias (VA) and/or atrioventricular (AV) block according to single electrocardiographic (ECG) records and/or 24-hour ECG monitoring. All patients underwent a thorough clinical and paraclinical examination, including exercise stress testing using original and Bruce protocols. The termination criteria were the first of following events: achievement of the heart rate set by the study aim; the appearance and/or aggravation of potentially dangerous arrhythmias and conduction disorders (single premature ventricular contraction (PVCs) with increasing frequency, and/or early PVCs, and/or paired PVCs, and/ or ventricular tachycardia (VT), and/or AV block); registration of allorhythmia (bigeminy) within 10 seconds.

Results. The termination criteria using the original protocol were achieved in all patients (n=20, 100%) compared to the standard Bruce protocol (n=5, 25,0%), p<0,001. The number of steps passed was significantly higher using original protocol (5,0 [5,00-6,00]) than when using the standard protocol Bruce 2,0 [2,03,0], p<0,05. Exercise tolerance was significantly higher when using the original protocol than the standard Bruce protocol (p<0,05). The probability of reaching the termination criteria using the original protocol were 116 times greater than using the standard Bruce protocol (odds ratio, 116, 95% confidence interval: 5,932250, p=0,0017). VAs were registered in 20,0% (n=4) of patients using the original protocol, while AV blocks — in 20,0% (n=4). Among the five patients who achieved the termination criteria using the standard Bruce protocol, VAs were recorded in 10,0% (n=2) of patients, while AV blocks — in 5,00% (n=1).

Conclusion. The use of exercise test with an original protocol makes it possible to achieve the termination criteria, increases its information content and diagnostic significance. It makes it possible to determine the nature of VAs and AV conduction dosorders.

Aim. To assess left atrial (LA) strain parameters in candidates for coronary artery bypass grafting (CABG) and to evaluate their possible relationship with newly diagnosed atrial fibrillation (AF) after isolated CABG.

Material and methods. The study Included 70 patients without prior AF (mean age, 65±8 years; men, 80%). Preoperative speckle-tracking echocardiography with an assessment of LA strain was performed. Two following groups were considered: without postoperative AF (POAF) (n=50), with postoperative POAF (n=20). After surgery, daily electrocardiography (ECG), 3-day postoperative continuous ECG monitoring, Holter ECG monitoring on the 4th-5th day after CABG. The median follow-up was 9 (7; 11) days.

Results. Postoperative AF developed in 20/70 (29%) patients. Clinical, demographic and intraoperative parameters of CABG in the groups without and with POAF were comparable. Echocardiographic parameters in the studied groups were also equivalent; LA volume (57,0±8,7 vs 60,0±12,1, respectively), LA size (3,9±0,3 vs 3,9±0,2, respectively). Strain analysis showed its significant decrease in the group with POAF compared to the group without POAF: peak atrial longitudinal strain (PALS) (20,4±3,1 vs 27,8±3,0, respectively), ALS early (8,50±1,5 vs 11,8±1,7, respectively), ALS late (-0,2±0,7 vs -1,0±1,0). ROC analysis established the predictive value of PALS as follows: a value of ≤23,0% with a sensitivity of 90% and a specificity of 78% was a predictor of postoperative AF.

Conclusion. Conventional echocardiographic predictors (LA size and volume) indicating a high risk of POAF cannot correctly assess the risk of newly diagnosed postoperative arrhythmia. AF after CABG is probably associated with the existing subclinical LA dysfunction as a result of structural abnormalities due to coronary artery disease. Our study showed that a decrease in LA strain parameters is associated with POAF. Further studies are needed to evaluate the contribution of speckle-tracking echocardiography to prediction of POAF.

Aim. To assess the development of thromboembolic events in different types of atrial fibrillation (AF), which differ in the maximum time between cardiac cycles.

Material and methods. The main group included 80 patients with permanent AF, while the control one — 88 people without AF. The following investigations were performed: echocardiography, 24-hour electrocardiographic (ECG) monitoring; ultrasound of extracranial arteries, aortic branches, lower limb arteries; sphygmography of the common carotid and posterior tibial arteries. If required, coronary angiography, cerebral angiography, brain computed tomography were performed. According to 24-hour ECG monitoring, all patients of the main group were divided into 2 subgroups (A and B) depending on the maximum time between cardiac cycles in AF: subgroup A (n=42) — patients with a maximum time between cardiac cycles <1,5 seconds, subgroup B (n=38) — ≥1,5. The followup period lasted 1 year. During the follow-up period, the development of arterial thromboembolic events was analyzed.

Results. The patients were comparable in key paraclinical characteristics and comorbidity profile. One-year follow-up period revealed a significantly higher incidence of stroke, transient ischemic attack, myocardial infarction, and distal arterial embolism of lower limb arteries in subgroup B. With an increase in the maximum time between cardiac cycles in AF, an increase in hemodynamic parameters of arterial vessels occurred as both proximal and distal arteries. A similar trend was also observed in the analysis of arterial kinetic parameters.

Conclusion. Not only the fact of AF presence is important for assessing the risk of arterial thromboembolism, but also its features. The most unfavorable for prognosis is AF with a maximum time between cardiac cycles ≥1,5 seconds. An increase in intra-arterial hemodynamic parameters after a long pause between ventricular contractions in AF without intracardiac thrombosis can become a key factor in the development of complications with existing plaques, which can become a source of distal embolism.

Aim. To assess the association between changes in interventricular delay (IVD) and response to cardiac resynchronization therapy (CRT) during 24-month postoperative period in patients with quadripolar left ventricular leads.

Material and methods. This retrospective non-randomized study included data from 48 patients with implanted CRT devices with quadripolar left ventricular (LV) leads, examined 3, 6, 12, 24 months after operation. CRT responders were considered patients with a decrease in end-systolic volume (ESV) by more than 10% compared with preoperative. To test the hypothesis about the rationale for choosing the maximum IVD when installing the LV lead, the group of patients was divided into two subgroups as follows: one with the maximum IVD (IVDmax, n=24), the other — without this condition (n=24).

Results. A correlation was found between changes in IVD and ESV, as well as ejection fraction (EF) in the period of 6, 12 and 24 months after implantation compared to baseline. In the subgroup with IVDmax, the shortening of IVD in the postoperative period is higher at each considered period compared to the second subgroup, and in general, there is a more pronounced decrease in IVD over 24 months. At the same time, 3, 6, 12 months after surgery, patients with IVDmax show a significantly greater decrease in ESV and, accordingly, a greater increase in EF. Prognostic models of CRT response in the long term after implantation were created. Significant predictors were the initial IVD, changes in IVD in the early postoperative period and IVDmax selection. At the same time, not a single factor, taken separately, made it possible to separate responders and non-responders.

Conclusion. A greater shortening of the IVD corresponds to a greater decrease in LV ESV and EDV, as well as a greater increase in EF in the long-term postoperative period. The choice of quadripolar LV lead in accordance with the maximum IVD is accompanied by a decrease in the proportion of non-responders, a more pronounced decrease in electrical ventricular dyssynchrony and an improvement in systolic function.

Aim. To study the structural and functional left heart parameters in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) in order to determine the risk of atrial fibrillation (AF).

Material and methods. The study included 84 patients (men, 37; mean age, 68±8 years) with severe AS and EF >55%. All patients had sinus rhythm and were asymptomatic. Echocardiography was performed to assess longitudinal strain of the left ventricle (LVLS), right ventricle, left atrium (LALS) and the left atrial stiffness (LAS) using the speckle tracking method. Left ventricular mass index (LVMI) and maximum left atrium volume index (LAVI) were also determined. Patients were followed up for 1 year.

Results. AF was reported in 27 (32%) patients, of which 9 (33%) had asymptomatic AF episodes detected by 48-hour electrocardiography. Eighteen (67%) patients with AF felt palpitations. Patients with and without episodes of atrial fibrillation had non-significant differences in LVMI, LAVI, and LVLS. Patients with atrial fibrillation had a lower LALS and a higher LAS compared with patients without atrial fibrillation. Regression analysis revealed that LALS and LAS were independent predictors of AF.

Conclusion. AF develops in about one third of asymptomatic patients with severe AS and normal EF. The development of AF predisposes to the onset of AS symptoms in most patients. LALS and LAS were predictors of AF in these patients. Identification of patients at risk of AF will allow for earlier aortic valve replacement.

Aim. To assess the prognostic role of cardiac biomarkers (galectin-3, soluble ST2 (sST2), and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in risk stratification of adverse cardiovascular events (CVEs) in patients with heart failure (HF) after implantation of an automatic implantable cardioverter-defibrillator (AICD) within 12-month follow-up period.

Material and methods. The study included 57 patients (men, 41; mean age, 65 (59; 68) years) with coronary artery disease and NYHA class II-III HF with left ventricular ejection fraction of 34 [26; 40]%. All patients were implanted with AICD. Serum levels of NT-proBNP, sST2, and galectin-3 were determined by enzyme immunoassay prior to AICD implantation.

Results. It has been established that in order to stratify the risk of unfavorable HF in patients after AICD implantation for 12-month follow-up, all three studied biomarkers can be considered as prognostic factors. Thus, an increase in the level of NT-proBNP ≥1046,6 pg/ml (AUC=0,68; p=0,009), sST2 ≥34,43 ng/ml (AUC=0,78; p<0,0001) and galectin-3 ≥11,6 ng/l (AUC=0,72; p=0,0014) predicts a high risk of adverse CVEs. The combination of sST2 and galectin-3 increased the predictive value of the analysis (AUC=0,84; p<0,0001), while the addition of NTproBNP did not increase the accuracy of risk stratification.

Conclusion. The determination of the combination of galectin-3 and sST2 can potentially help identify a group of patients with HF after AICD implantation with a high risk of adverse CVEs for intensification and optimization of treatment.

Aim. To compare clinical, echocardiographic characteristics and blood biomarkers in patients with nonvalvular atrial fibrillation (AF) depending on the presence of left atrial appendage (LAA) thrombus and to identify independent predictors of LAA thrombosis.

Material and methods. Patients with nonvalvular AF subjected to transesopha geal echocardiography before catheter ablation were divided into 2 groups comparable by sex and age: group 1 (n=45) — with LAA throm bosis; group 2 (n=97) — without LAA thrombosis. The patients underwent transthoracic and transesophageal echocardiography. In addition, the following blood biomarkers were analyzed: NT-proBNP (pg/ml), GDF-15 (pg/ml), TGF-β1 (pg/ml), PIIINP (ng/ml), high-sensitivity C-reactive protein (hsCRP) (mg/l), cystatin C (mg/l).

Results. In group 1, persistent AF, coronary artery disease, heart failure were more often noted. In addition, group 1 patients had higher volume indices of both atria, left ventricular mass index and pulmonary artery systolic pressure, as well as lower left ventricular ejection fraction and blood flow velocity in the LAA. There were no differences in the groups in terms of the mean CHA2DS2VASc score, the proportion of patients taking oral anticoagulants (OAC), and the OAC spectrum. In group 1, higher levels of NT-proBNP (p=0,0001), GDF15 (p=0,0001), PIIINP (p=0,0002) were found with no differences in the levels of TGF-β1, hsCRP and cystatin C. A stepwise logistic regression revealed independent predictors of LAA thrombosis: LA volume index (ml/m²) — odds ratio (OR)=1,084, 95% confidence interval (CI) 1,028-1,143 (p=0,003); GDF15 ≥933 pg/ml — OR=3,054, 95% CI, 1,260-7,403 (p=0,013); PIIINP ≥68 pg/ml — OR=5,865, 95% CI, 2,404-14,308 (p<0,001). There were following model quality parameters: AUC=0,815 (p<0,001), specificity, 74,4%, sensitivity, 72,7%.

Conclusion. In patients with nonvalvular atrial fibrillation taking OAC, serum levels of fibrosis biomarkers PIIINP ≥68 pg/mL and GDF-15 ≥933 pg/mL, along with the left atrial volume index, were independent predictors of LAA thrombosis.

Aim. To study the clinical and electrocardiographic characteristics of exerciseinduced arrhythmias and develop an algorithm for managing patients with exerciseinduced ventricular arrhythmias (VA).

Material and methods. For the period from 2015 to 2019 203 patients with VA during periods of wakefulness were selected from the database of patients who performed Holter monitoring; 167 of them were selected, who underwent a treadmill test (TT) according to the standard Bruce protocol. During TT, the qualitative and quantitative characteristics of VA were assessed. Further examination and treatment were carried out according to the proposed algorithm.

Results. In 80 patients (48% of all those who underwent TT), regardless of VA presence in the pretest, arrhythmias had an exercise nature and appeared and/or progressed during exercise. These patients were included in the present study to assess the causal relationship of VA with any disease. Following the algorithm, coronary artery disease was verified in 15 people, stage I-II hypertension — in 25, and minor heart defects — in 21. Of the remaining 19 patients without association of exercise-induced VA with any disease during the initial examination, 5 patients were diagnosed with arrhythmogenic cardiomyopathy/right ventricular dysplasia during prospective follow-up. In the remaining 14, VAs were considered idiopathic.

Conclusion. The presented algorithm can accelerate both the search for the causes of exercise-induced VA and the choice of personalized treatment.

Aim. To evaluate the effect of catheter ablation on left (LA) and right atria (RA) function in patients with atrial fibrillation.

Material and methods. The study included 28 patients (14 men and 14 women) aged 33 to 72 years (mean age, 57,7±9,9 years) with paroxysmal (n=23) and persistent AF (n=5). All patients underwent radiofrequency ablation (RFA) with pulmonary vein antrum isolation. Before ablation and 3 days after, transthoracic twodimensional echocardiography was performed in sinus rhythm with an assessment of LA reservoir, conduit and booster pump function and RA peak longitudinal strain.

Results. In the studied patients, a significant decrease in the reservoir, conduit and booster pump function of the LA was revealed after RFA, while there was no significant change in RA peak longitudinal strain after catheter ablation. LA reservoir, conduit and booster pump function decreased by 6,45% (p<0,001), 3,59% (p<0,001), 2,85% (p<0,001), respectively, while RA peak longitudinal strain increased by 0,73% (p=0,43).

Conclusion. Catheter ablation has a significant damaging effect on the LA tissue, inhibiting the reservoir, pumping and pipeline functions. At the same time, the contractility of the PP in the early postoperative period improves, but not significantly.

Aim. To study the isolated effect of obstructive sleep apnea (OSA) on left atrial (LA) remodeling in patients with paroxysmal atrial fibrillation (AF) who underwent pulmonary vein (PV) ablation and concomitant severe and moderate OSA.

Material and methods. A subanalysis of echocardiographic data was performed in 50 patients with paroxysmal AF and moderate/severe OSA who underwent PV isolation and were followed up for 12 months (main group, 33; control group, 17). The clinical efficacy of catheter ablation was assessed after the end of the threemonth blind period. The following echocardiographic parameters were included in the subanalysis: anterior-posterior LA dimension, LA volume, LA volume index (LAVI), and pulmonary artery systolic pressure (PASP).

Results. After 12 months, the control group showed a significant increase in the anterior-posterior LA dimension (40,5 (40-42) mm vs 42 (40-45) mm, p=0,037), LA volume (68,5 (58-74,5) ml vs 69 (63-89) ml, p=0,006), LAVI (35,0 (29-37) ml/m² vs 35,5 (32-41,5) ml/m², p=0,005) and PASP (27 (25-30) vs 30 (29-33), p=0,004). Intragroup analysis of patients not receiving continuous positive airway pressure (CPAP) therapy and without recurrent AF did not reveal significant changes in LA size (anterior-posterior LA dimension — 40 (40-42) mm vs 40 (40- 41) mm, p=0,317; LA volume — 63 (58-71) ml vs 64 (61-69) ml, p=0,509; LAVI — 32 (29-36) ml/m² vs 33 (31-34) ml², p=0,509).

Conclusion. In patients with paroxysmal AF and concomitant moderate to severe OSA who underwent AF catheter treatment, the absence of CPAP therapy is not associated with a significant increase in the linear and volume LA dimensions in the absence of AF recurrence.

Aim. To study the clinical efficacy and safety of a personalized exercise program in the rehabilitation of patients with paroxysmal atrial fibrillation (AF) after primary pulmonary vein radiofrequency ablation (RFA).

Material and methods. Patients (n=48) with paroxysmal AF who underwent RFA were randomized into two groups: main (n=24) — patients involved in the exercise program and received standard therapy; control (n=24) — patients received standard therapy. The program included exercise complexes with the calculation of energy consumption, step training and walking. The program lasted 6 months, while the follow-up period — 12 months. All patients in the study underwent a faceto-face learning interview.

Results. After 6-month exercise program, bicycle ergometer test revealed an increase in duration (by 18,6%, p<0,001) and power (by 24,8%, p<0,01) of the load, while these changes were not revealed in the control group. The positive aftereffect of training on these parameters persisted even after the completion of program. Left atrial and left ventricular end-diastolic dimension remained stable in exercise program group and significantly increased in the control group. In contrast to the control group, the following parameters significantly decreased in trained patients after 6 months: body mass index by 2,8% (p<0,05), systolic blood pressure by 2,1% (p<0,05), heart rate by 12,1% (p<0,05), low-density lipoprotein cholesterol concentration by 18,8% (p<0,001), high-sensitivity C-reactive protein by 22,9% (p<0,05), N-terminal pro-brain natriuretic peptide by 28,2% ( p<0,05), aldosterone by 41,5% (p<0,001) and angiotensin II by 41,3%, p<0,05). In addition, in the exercise program group an increase in high-density lipoprotein cholesterol by 20,6% (p<0,05) and physical activity level by 23,8% (p=0,001) was revealed. At the same time, both groups showed a significant decrease in the concentration of fibrinogen and transforming growth factor-β1. After 6 months, in the exercise program group versus the control group, there was a decrease in the number of registered supraventricular premature beats (p<0,01), episodes of supraventricular tachyarrhythmia (p<0,05), including AF (p<0,05).

Conclusion. Involvement of patients with AF after catheter RFA in a cardiac rehabilitation program based on moderate-intensity aerobic training improves exercise tolerance, cardiac function, corrects thrombogenic factors, and reduces the likelihood of arrhythmia recurrence, including AF.

Aim. To determine the possible impact of anxiety and depression disorders on the adherence of patients with atrial fibrillation (AF) to anticoagulant the rapy.

Material and methods. The study included outpatients with AF of any type. After signing the informed consent, patients filled out questionnaires and scales that determined the level of anxiety and personal predisposition (MMAS-8, MMAS-4, SF-36, SHAI, STAI, HADS, NEO-FFI).

Results. A total of 117 outpatients treated for AF were included. The mean age of patients was 74±5 years (men, 38%). Based on MMAS-4 and MMAS-8 results, adherent and non-adherent cohorts of patients were formed. Low adherence group had significantly higher situational anxiety according to STAI (45,9±9,9 vs 41,1±10,7, p=0,045) and depression according to HADS (7,9±3,6 vs 5,9±3,5, p=0,018). SF 36 showed that non-adherent patients had a lower general health (41,6±12,9 vs 52,2±20,0, p=0,01). Five-factor model revealed an association between low compliance and low extraversion (21,3±6,6 vs 26,4±7,2, p=0,002). Pharmacokinetic data on blood concentrations of anticoagulants or its metabolites at the second visit were available in 76 (67%) patients. Assessment of pharmacokinetic and compliance data revealed a moderate direct correlation (Matthews correlation coefficient (MCC), 0,345) and a weak direct correlation with the MMAS-8 (MCC, 0,177). The difference in MMAS-4 and MMAS-8 scores between high and low pharmacokinetic adherence groups was significant on both scales (p=0,011 and 0,015, respectively).

Conclusion. The rationale for widespread introduction of standardized questionnaires and scales (MMAS 4, MMAS 8, STAI, HADS, SF 36, Big 5) was shown in order to early identify patients with low adherence to treatment. The results highlight the need for further study of the contribution of psychiatric disorders to low compliance to anticoagulant therapy.

Aim. To present the clinical characteristics and in-hospital prognosis in patients with pulmonary embolism (PE) and atrial fibrillation (AF).

Material and methods. On the initiative of a working group of physicians, the basic principles of an observational prospective study (SIRENA registry) have been developed.

Results. Among the 660 patients included in the registry, AF was diagnosed in almost every fourth patient — in 22,9% of cases (n=151), which reflects its high incidence in relation to PE. The prevalence of AF corresponded to such conditions as heart failure (HF) (23,2%; n=153), diabetes (15,6%; n=103), and hypertension (HTN) (65,7% n=400). The diagnosis of AF in most patients is based on the history data (n=144; 95,4%), while the first registered AF episode was verified in 7 patients (4,6%). Patients with AF were characterized by older age, significantly higher prevalence of HF (51,2%), HTN (80,8%), chronic kidney disease (18,5%), stroke or transient ischemic attack (23,2%). It is important to note the low prevalence of anticoagulant therapy (15,3%) in the group of patients with previously diagnosed AF (n=144). The prevalence of thrombolytic therapy in patients with AF was significantly lower than among patients without AF (13,9 vs 25,8% (p=0,026)), which is due to contraindications and underdiagnosis of PE. Given the predominantly senile age, high comorbidity rate in patients with AF, as well as the absence of outpatient anticoagulant therapy, in-hospital mortality in patients with PE and AF was 31,1%, and significantly differed from that in those without AF 12,6% (p=0,001). In the general group, post-mortem diagnosis of PE was noted in 7,7% of cases (n=51), of which the proportion of patients with AF was 54,9% (n=28). A possible explanation for the underestimation of PE in AF patients was an erroneous explanation of its manifestations (tachypnea, tachycardia, lower limb edema) due to concomitant HF.

Conclusion. Suspicion for PE in elderly patients with AF and manifestations of HF decompensation, as well as the timely administration of anticoagulant therapy, will prevent both arterial and venous embolism.

Aim. To analyze the incidence of thrombotic events in unvaccinated and GamCOVID-Vac-vaccinated patients with coronavirus disease 2019 (COVID-19).

Material and methods. This prospective study included 316 patients (group 1) vaccinated with two doses of Sputnik V (Gam-COVID-Vac) hospitalized between November 20, 2020 and June 1, 2021 for COVID-19. Group 2 included 754 unvaccinated patients with a positive polymerase chain reaction test for SARSCoV-2.

Results. During inhospital period, deaths were recorded only in unvaccinated patients (group 1 — 0%; group 2 — 10,7% (n=87); p<0,0001). Among unvaccinated patients, the following thrombotic events were more common: upper- extremity deep vein thrombosis (group 1 — 0,63% (n=2); group 2 — 5,4% (n=41); p=0,0003), lower-extremity deep vein thrombosis (group 1 — 2,21% (n=7); group 2 — 11,4% (n=86); p<0,0001), pulmonary embolism (PE) (group 1 — 0%; group 2 — 3,4% (n=26); p=0,0008), lower limb arterial thrombosis followed by thrombectomy (group 1 — 0,31% (n=1); group 2 — 12% (n=91); p <0,0001), lower limb arterial retrombosis after retrombectomy (group 1 — 0,31% (n=1); group 2 — 8,7% (n=66); p<0,0001), lower limb amputation (group 1 — 0%; group 2 — 8,7% (n=66); p<0,0001), composite endpoint (group 1 — 3,8% (n=12); group 2 — 55,2% (n=416); p<0,0001). In the long-term follow-up period (125,5±26,5 days), recurrent COVID-19 developed significantly more often in unvaccinated patients (group 1 — 0,63% (n=2); group 2 — 3,6% (n=24); p=0,007). All arterial and venous thromboses, limb amputations were diagnosed only among unvaccinated patients.

Conclusion. Vaccination with Sputnik V (Gam-COVID-Vak) prevents the severe COVID-19 with the development of deaths, pulmonary embolism, venous and arterial thrombosis.

Early diagnosis of atrial fibrillation (AF) predictors in coronavirus disease 2019 (COVID-19) and the appointment of additional therapy to prevent arrhythmias will improve the prognosis of patients.

Aim. To identify predictors of AF in patients with COVID-19.

Material and methods. This retrospective study included 1473 patients hospitalized with COVID-19. Depending on AF occurrence, the patients were divided into 2 groups as follows: group I included 95 patients with AF episodes during hospitalization; group II consisted of 1378 patients who did not have AF during hospitalization. All patients underwent a complete blood count and urine tests, a biochemical and coagulation blood tests, 12-lead electrocardiography, chest computed tomography (CT), and echocardiography.

Results. Chest CT found that lung tissue involvement in patients of group I was significantly greater than in group II (p<0,05). The number of patients with significant lung involvement >50% (CT-3 and CT-4) was significantly higher in the AF group than in the control group. The average room air oxygen saturation upon admission to the hospital were significantly lower in patients with AF than in the comparison group (p<0,05). Multivariate analysis showed that following factors have a significant effect on AF development in COVID-19 patients: age >60 years, hypertension, coronary artery disease, heart failure, increased left atrial volume, large lung tissue involvement, and increased interleukin- 6 level.

Conclusion. There are two following groups of predictors initiating AF in COVID-19: generally known (older age, cardiovascular disease, increased left atrial volume) and those that determine the severe COVID-19 course (large lung damage and high interleukin-6 levels).

The presence of coronavirus-associated myocarditis remains controversial despite elevations in cardiac troponin and natriuretic peptide in many patients.

Aim. To assess the morphological changes in the myocardium of patients who died due to coronavirus disease 2019 (COVID-19) and compare them with the intravital level of cardiac biomarkers.

Material and methods. A total of 420 hospital charts and 77 autopsies of those who died from COVID-19 were analyzed. In 15 of 77 cases (19%) with histologically suspected myocarditis, an immunohistochemical examination of the myocardium with antibodies to CD3, CD45, CD8, CD68, CD34, Ang1, VWF, VEGF, HLA-DR, MHC1, C1q, VP1 of enteroviruses was performed, and in 8 patients with immunohistochemically confirmed myocarditis (10%) — polymerase chain reaction for SARS-CoV-2.

Results. Hemorrhage, intramural thrombosis, necrosis of non-coronary origin, myocardial infarction and lymphocytic myocarditis were detected in 43%, 10%, 17%, 19% and 10% of cases, respectively, without coronavirus N and E gene sequences in the myocardium. Dysplasia, hyperplasia and hypertrophy of the vascular endothelium, expression of Ang1, VWF, VEGF, MHC1, C1q, VP1 of enteroviruses were determined in 100, 100, 87, 100, 75 and 62% of cases of myocarditis, respectively. There were no significant correlations between inflammatory biomarkers and myocarditis.

Conclusion. The main morphological manifestation of COVID-19 in the myocardium is the so-called endotheliitis with dysplasia and endothelial activation, leading to hemorrhages, intramural thrombosis and necrosis. There is no convincing evidence of a direct involvement of coronavirus in myocarditis induction.

Aim. To evaluate the effectiveness of beta-blockers (BB) in the treatment of idiopathic premature ventricular contractions (PVCs) in children.

Material and methods. BBs were prescribed to 27 children with idiopathic PVCs. In 3 (11,1%) patients, side effects (hypotension, bronchial obstruction) was revealed at the beginning of therapy. A total of 24 children were included in the further study (15 boys (62,5%), 9 girls (37,5%). The mean age was 8,3±5,4 years. Data from anamnesis, electrocardiography (ECG), 24-hour ECG monitoring, and echocardiography were analyzed.

Results. The 24-hour PVC rate was 33,2±17,7 thousand/day or 26,6±13,2%. In 14 (58,3%) children, we recorded paired PVCs, in 3 (12,5%) — multiform, in 10 (41,7%) — runs of non-sustained VT. There were complaints in 7 (29,2%) children. The follow-up period lasted 369,8±119,1 days. Propranolol was received by 17 (70,8%) patients, metoprolol — by 7 (29,2%). The therapy was effective in 11 (45,8%) patients, while ineffective in 13 (54,2%), among which 5 (20,8%) had an increase in the number of PVCs. The effectiveness of BBs was higher in children under the age of 1 year (p=0,043). Propranolol showed greater efficacy than metoprolol (p=0,047). Less efficiency was observed in female patients and those with pathological heart rate turbulence parameters (p=0,04).

Conclusion. The effectiveness of BBs in children with idiopathic PVCs is 45,8%, higher in children aged <1 year and declines with age, decreasing in adolescents to 25%. The use of BBs is limited by non-cardiac side effects in 11,1% of children. Propranolol is more effective than metoprolol.

This article provides an overview of data on the role of hypertension and dyslipidemia as the leading factors determining the clinical course of athero sclerotic diseases. The need for a multifactorial approach to the treatment of patients with multiple risk factors for the progression of such diseases is noted. The article describes the results of large-scale international studies confirming the clinical benefits of combined antihypertensive and lipid-lowering therapy. From the point of view of current clinical guidelines and the available evidence base, the potential for improving adherence to treatment using a combination of anti hypertensive and lipid-lowering drugs are presented. The article discusses the prospects for optimizing the therapy of comorbid patients using a triple fixed-dose combination, including amlodipine, atorvastatin and perindopril.

In this article, we present a case of a patient with a late diagnosis of Fabry disease caused by a pathogenic variant in the GLA gene (p.1287_1288dup), who repeatedly attempted interventional treatment of Wolff-Parkinson-White Syndrome due to characteristic electrocardiographic pattern of ventricular preexcitation and paroxysmal arrhythmias. The proposed pathognomonic signs of the disease will ensure timely diagnosis and the appointment of specific treatment.

Heart failure in Fabry disease (FD) is unfavorable prognostic manifestation and cause of death. Given that the disease is rare in clinical practice, the low awareness of physicians about this pathology leads to its late diagnosis and the lack of pathogenetic therapy.

Aim. To present a clinical picture of the cardiovascular phenotype in FD in order to increase the awareness of doctors about this disease.

Material and methods. In this clinical case, an asymptomatic FD course up to 46 years of age and mani festation in the form of arrhythmia were observed. According to echo car dio graphy, severe left ventricular hypertrophy (myocardial mass index, 214 g/m²) without signs of left ventricular (LV) outflow tract obstruction and left atrial (LA) dilatation were revealed (LA volume index — 47 ml/m²). Right ventricular (RV) and LV systolic function was assessed using two-dimensional speckletracking strain echocardiography. Latent subclinical RV and LV systolic dysfunction was established.

Results.  Tandem mass spectrometry revealed a sharp decrease in alphagalactosidase activity of 0,03 umol/L/h (norm range, 0,80-15,00 umol/L/h), as well as an in creased Lyso-GB3 concentration of 95,18 ng/ml (normal range, 0,05-3,0 ng/ ml). A molecular genetic study of blood samples was carried out. By direct automatic sequencing of the GLA gene, a variant of the c.1229 C>T nucleotide sequence was identified, leading to the replacement of p.Thr4101le in the hemizygous state.

Conclusion. This case shows the possibility and expediency of diagnosing FD in cardiology practice in patients with LV myocardial hypertrophy of unclear etiology, while atypical variants can be diagnosed only by molecular genetic testing.

The article discusses modern approaches and features of management, as well as predicting the risk of complications in patients with cardiac arrhythmias, in particular, atrial fibrillation, and the potential of using conservative and interventional treatment methods for heart failure (HF), taking into account updates and achievements in clinical practice. Epidemiological data, algorithms for managing patients with HF and atrial fibrillation, prevention of thromboembolic events, results of studies comparing the effectiveness of different strategies for atrial fibrillation treatment, catheter ablation compared with drug therapy in patients with HF are presented.

Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC).

Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC).

With the special contribution of the European Heart Rhythm Association (EHRA).

Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).