Control of cardiovascular diseases  (CVDs), which are the cause of premature mortality and high economic  costs,  is one of the priorities of social policy. Human resources are a key link in health system performance.  In Russia, there is a significant geographical  heterogeneity  in the distribution of medical workers and structural disproportions  in certain specialties.  Regional  differences  in the availability of specialists in cardiology system have not been studied enough.

Aim. To perform a comparative benchmark analysis of coverage by specialists involved  in healthcare  provision  to patients with cardiovascular  diseases  in the regions of the Northwestern Federal District (NWFD), identifying regional differences for the period from 2015 to 2019.

Material and methods. To assess the number of specialists involved in providing care to patients with CVDs, data from the federal statistical monitoring forms №30 “Information on a medical organization” for 2015-2019 of the subjects of the Northwestern Federal District were used. Multiple linear regression was used to compare the basic estimated parameters of provision per 10000 population with specialists at the level of district as a whole and in NWFD regions  with data for Russia as a whole. P<0,05 was considered significant.

Results. Among the subjects of Northwestern Federal District, differences  were revealed  in all specialties  of varying severity. While the estimated parameter of provision with cardiologists  in Russia is 0,896 (95%  CI, 0,794-0,998),  there are differences  in the regions in a wide range from -0,446 (Vologda Oblast) to +0,502 (St. Petersburg).  Regional  differences  in the provision of vascular radiology specialists from the basic estimated level for Russia were observed  only in two subjects. At the same time, for all subjects in general, an increase in the indicator from 2015 to 2019 by 0,011 [95% CI, 0,006; 0,016] per year (p<0,001) was observed.  The smallest range of differences was observed for cardiovascular surgeons:  with a baseline  estimate  in Russia of 0,158 [95% CI, 0,140; 0,176] the range of differences was from -0,086 to +0,198. For emergency  medicine paramedic, the largest number of subjects with positive values of the statistical correction of the average relative to Russia was noted (7 out of 11 regions). For neurologists and intensivists, on the contrary, the largest number of subjects with negative values (7 out of 11 regions)  was revealed.  Structural staff disproportions in cardiology care system were revealed.

Conclusion. In the NWFD, in general, coverage  by specialists involved in health-care provision for CVD are higher than the estimated base level for Russia. However,  their uneven distribution within the district and its subjects is observed. The demonstrated mathematical approach to assessing staff differences  at the subject or district level can be used to develop measures to achieve the goals of the regional health personnel policy.

Aim. To study associations of rs2464196 and rs11212617 polymorphisms with the development of myocardial infarction (MI) in combination with type 2 diabetes  (T2D).

Material and methods. The study included two groups: main group (n=115) — patients with prior myocardial infarction and T2D, comparison  group (n=116) — patients with myocardial  infarction without T2D, hospitalized  from December 1, 2018 to December  31, 2019 at the Regional Vascular Center № 1 of the City Clinical Hospital № 1. Participants were comparable in sex and age. Patients underwent  clinical and instrumental investigations,  a genetic test for single nucleotide polymorphisms, which showed associations with the development  of MI and T2D according to genome-wide  association study (GWAS): rs2464196 of the HNF1A  gene, rs11212617 of the ATM gene.

Results. Carriage of the AA genotype of the HNF1A  rs2464196 polymorphism was found to be associated MI in combination with T2D in the general group (odds  ratio (OR), 3,180, 95% confidence interval (CI), 1,206-8,387, p=0,015). After division of the group by sex, significant differences  remained only in women (OR=9,706, 95% CI, 1,188-79,325, p=0,011).

Conclusion. The data obtained can make it possible to identify a priority group of patients for personalized prevention of cardiovascular diseases.

Sortilin is an important molecular protein involved in lipid metabolism, atherosclerosis,  and aortic valve calcification. Sortilin presumably regulates the PCSK9 signaling pathways.

Aim. To study correlations of sortilin and PCSK9 with atherosclerosis  development in hypertensive  patients.

Material and methods. The study included 161 patients aged 30 to 65 years. We performed collection of complaints and anamnesis, physical examination, blood biochemical  test with the determination of total cholesterol, low-density lipoprotein cholesterol,  triglycerides, blood glucose,  serum creatinine with estimation of glomerular  filtration rate. Serum PCSK9,  sortilin and interleukins 8, 10 were determined by enzyme-linked immunosorbent assay. The following investigations were also performed:  electrocardiography,  echocardiography,  extracranial artery ultrasound, coronary angiography.

Results. Sortilin levels (b=2,37; odds ratio (OR),  10,74; 95% CI, 1,05-109,47, p=0,045), IL-8 (b=-2,42; OR, 9,74; 95% CI, 0,01-0,81, p=0,032), age (b=0,21; OR, 1,24; 95% CI, 1,12-1,37, p<0,001)  were identified  as independent predictors of coronary atherosclerosis  with a sensitivity of 87% and a specificity of 70%. PCSK9 (b=0,005; OR, 1,00; 95% CI, 1,00-1,01, p=0,038) and IL-8 (b= -0,33; OR, 0,72; 95% CI, 0,55-0,94, p=0,014) were identified as independent predictors of carotid atherosclerosis  with a sensitivity of 75% and a specificity of 71%.

Conclusion. In addition  to non-invasive imaging, the determination of atherosclerosis biomarkers can make a significant contribution to the diagnosis and prediction of carotid and coronary atherosclerosis  progression.  It is noteworthy that not only PCSK9, but also sortilin can be a potential therapeutic target. Further large-scale studies are needed.

Aim. To validate the SIRENA score  in assessing the risk of inhospital mortality in patients with pulmonary embolism (PE) in an independent sample.

Material and methods. This retrospective, single-center study was based on the Samara Regional Cardiology Center. The risk of inhospital mortality was assessed using the SIRENA score, which includes such parameters as left ventricular ejection fraction <40%,  immobilization in prior 12 months, creatinine clearance <50 ml/min, syncope, cyanosis on admission. For each positive sign, 1 point is assigned. Low risk is set at score of 0-1, high — ≥2.

Results. The study included 452 patients with PE hospitalized from 2004 to 2019, of which 221 (48,9%) were men (mean age, 60,0 years (50,5-70,0)).  With SIRENA score of 0, 1, 2, 3, and 4, inhospital mortality was 4,1%, 10,8%, 18,8%, 40,0%, and 100%, respectively. Mortality at SIRENA low risk (<2) was 7,1%, and at high risk (≥2) — 20,5% (odds ratio (OR), 3,34; 95% confidence interval (CI), 1,74-6,43; p<0,001).  The predictive sensitivity and specificity for inhospital mortality for the SIRENA score were 70,5% and 60,8%, respectively. Area under the ROC-curve for the SIRENA score was 0,71 (95% CI, 0,63-0,79), while for Simplified Pulmonary Embolism Severity Index (sPESI) — 0,69 (95%  CI, 0,60-0,77).  With high risk on both scales (sPESI and SIRENA), inhospital mortality was 24,2% (OR, 4,09, 95% CI, 2,07-8,09; p<0,001).

Conclusion. On an independent sample, the SIRENA score  showed  a high predictive ability in predicting adverse outcomes in patients with PE with a sensitivity of 70,5% and a specificity of 60,8% (AUC=0,71, 95% CI, 0,63-0,79), comparable with the sPESI.

Aim. To assess hemodynamic response to active standing test (AST) with beat-to-beat blood pressure (BP) monitoring, their association with office BP and symptoms of orthostatic intolerance in patients with heart failure (HF).

Material and methods. Outpatient HF patients with documented  left ventricular ejection  fraction <40%, followed   up in a HF center  and receiving optimal medical therapy, underwent AST with beat-to-beat  non-invasive BP monitoring.

Hemodynamic response was assessed according to the European Federation of Autonomic Societies criteria.

Results. The study included 87 patients (mean age, 57±10 years; men, 76%). Normal hemodynamic response to orthostatic stress was observed  in 36 (41,4%) patients. Pathological response prevailed during the first minute of orthostatic stress — initial orthostatic hypotension (OH) (n=29, 33,3%) and delayed BP recovery (n=18, 20,7%).  Classical OH was detected  in 4 (4,6%)  patients. There was no orthostatic hypertension, defined as an increase in systolic BP (SBP) ≥20 mm Hg. According to office BP, hypotension was observed in 19 (21,8%) patients (SBP <90 mm Hg in 4 patients and 90-100 mm Hg in 15), hypertension (SBP >140 mm Hg) in 11 (12,6%) patients. Pathological response to orthostatic stress were more often observed  in office  SBP >140 mm Hg compared  to SBP ≤140 mmHg (90,9% and 53,9%, p=0,020).

Orthostatic intolerance was noted in 43 (49,4%) patients and were not associated with the level of office SBP (p=0,398) or pathological responses to orthostatic stress (p=0,758 for initial OH and p=0,248  for delayed  BP recovery).

Conclusion. The pathological hemodynamic response in AST with beat-to-beat BP monitoring in ambulatory patients with HF is most often represented  by initial OH and delayed BP recovery associated  with office SBP >140 mmHg. The frequency of symptoms of orthostatic intolerance did not differ between groups depending on the presence of an inadequate response to orthostatic stress.

Aim. Iron has a protective effect on cardiomyocytes during hypoxia, while iron deficiency (ID) directly affects its function, disrupting mitochondrial respiration, reducing their contractility and relaxation. Some studies have shown that ID is a predictor of adverse outcomes  in patients with acute coronary syndrome (ACS).  However, the impact of ID and its treatment, quality of life and prognosis of patients with ID and myocardial infarction (MI) has not been fully established. The study aim is to determine the effectiveness of intravenous ferric carboxymaltose  (FCM) compared  with oral iron (ferrous sulfate) in relation to left ventricular (LV) systolic function, assessed by echocardiography.

Material and methods. This open-label, prospective, randomized study includes 360 patients  with or without ID who were  hospitalized  with acute  myocardial infarction (MI).  Patients with ID will be randomized (1:1) to intravenous FCM and oral ferrous sulfate therapy. Treatment in groups will be started at the time of hospitalization. Patients without ID will form the control group.  The follow-up period for patients will be 1 year. The primary endpoint was a reduction  in LV wall motion score  index (WMSI) in the FCM group compared  to the ferrous sulfate group. The key secondary endpoint is a composite endpoint of cardiovascular death, non-fatal MI and stroke, and hospitalization for decompensated heart failure.

Conclusion. The OPERA-MI study will determine the effect  of ID treatment with intravenous FCM compared  with oral ferrous sulfate on WMSI, which reflects LV systolic function.

Coronary artery (CA) anomalies are a group of congenital heart defects  with a diverse clinical performance, from lifelong asymptomatic to severe consequences such as sudden cardiac death. In some cases,  CA anomalies become  an incidental finding during echocardiography.  If there is a suspicion of CA anomaly, a radiographic investigation (computed tomography (CT) angiography or magnetic resonance imaging) should be performed to clarify the anatomy and indications for surgical correction.

A case of diagnosing a tubular structure with hyperechoic  walls in mitral valve projection during echocardiography  is presented. The performed CT angiography confirmed the abnormal origin of circumflex artery from the right sinus of Valsalva with its retroaortic course. This echocardiographic  sign is described in the English-language literature as Retroaortic Anomalous Coronary sign (RAC-sign).

The article discusses a rare case of successful replacement of the aortic valve, ascending  aorta and arch in a patient with dextrocardia  in the context  of situs inversus totalis. Situs inversus is a rare variant of normal anatomy  in which the major visceral organs are mirrored from their normal positions.

Iron deficiency  (ID) is one of the most common  comorbidities  in patients with heart failure (HF). ID is a strong independent predictor of outcomes  in HF patients. ID reduces  quality of life, exercise  tolerance,  and survival in patients with HF, regardless of anemia status. The latest 2021 guidelines recommend  initiating ID treatment at a ferritin <100 µg/L, or 100 to 299 µg/L, when transferrin saturation is less than 20%. The FAIR-HF and CONFIRM-HF studies have shown improvements in symptoms,  quality of life, and functional status in patients with stable HF and ID after intravenous administration of ferric carboxymaltose (FCM). Moreover, the results of these studies showed a reduced  risk of hospitalization for HF, which was later confirmed  in a subsequent  meta-analysis. Finally, the AFFIRM-AHF study, which evaluated the effect of FCM administration on outcomes  in patients hospitalized for acute HF/acute decompensated  HF, found a significant reduction in HF-related readmissions among patients treated with FCM.

The review presents the results of studies on the problems of increasing the efficiency of rational  physical  activity  within the concept of comprehensive secondary  prevention of myocardial  infarction. The aspects of insufficient adherence of specialists and patients to rehabilitation methods were discussed; possible safe exercise modes after infarction and available monitoring methods were given. We also described the potential characteristics of physical training, taking into account the initial clinical severity  and completeness of revascularization after myocardial infarction. In addition, the need for socio-economic,  as well as informational support of the state and healthcare system has been updated.