Aim. To compare structural and functional left ventricular (LV) changes in the early period of myocardial infarction (MI) within 20 years on the basis of the Emergency Cardiology Department of the Cardiology Research Institute (Tomsk).

Material and methods. The study included two groups of patients who were treated at different periods of time with an interval of 20 years. Group 1 included 83 patients who had ST-segment elevation MI (STEMI) in 1997-1999, while group 2 — 83 patients with STEMI from 2019-2020. Echocardiography was performed during the first 72 hours from hospitalization and on the 7-10^th day. Depending on the increase in LV end-diastolic volume (EDV) by >15% by the 7-10^th day, the patients were divided into 2 subgroups: with remodeling (LVR+) and without remodeling (LVR-).

Results. Patients of the 2^nd group were older, with a larger proportion of females and with a high incidence of risk factors for coronary artery disease compared with patients of the 1st group. In the early postinfarction period among patients of the 2^nd group, acute LV aneurysm, early postinfarction angina and Dressler syndrome developed less frequently. The proportion of adverse LV remodeling in patients of the 1st group was higher (32,8% vs 17%), and while the percentage of reverse remodeling was lower (10% vs 24%), p<0,05. Comparison of the absolute values of LV EDV, end-systolic volume (ESV) and ejection fraction (EF) at baseline and after 7 days, as well as their increase showed higher intensity of post-infarction remodeling in group 1 patients. In patients of the 1^st group, there was a progression of LV remodeling (Me ΔEDV — 12,2%) with a deterioration in LV contractility by the 7^th day (Me ΔESV — 14%), while in patients of the 2nd group during the first 7 days of MI, there were more stable LV EDV and ESV (p>0,05) and an increase in LVEF (p=0,03) before discharge.

Conclusion. In the present era of primary percutaneous coronary intervention and pharmacological treatment of MI, early adverse LV remodeling develops less frequently and is characterized by less pronounced left heart dilatation.

Aim. To carry out a comparative analysis of left ventricular (LV) strain parameters, determined by the two-dimensional strain imaging in patients with heart failure (HF) with LV ejection fraction (EF) ≤35%, depending on the origin of HF.

Material and methods. The study included 133 patients with NYHA class 3-4 HF with LVEF ≤35%, taking optimal therapy. Based on the HF origin, 2 following groups of patients were formed: ischemic cardiomyopathy (ICM) (n=70), nonischemic cardiomyopathy (NICM) (n=63). All patients underwent speckle-tracking echocardiography.

Results. All patients included in the study showed significant alterations in longitudinal strain parameters in most myocardial segments, most pronounced in the basal and middle parts of the LV. Comparative analysis of the peak systolic longitudinal strain showed the worst characteristics in patients with ICM were found in the apical segments (p=0,008), and in patients with NICM, in the basal segments of the LV (p=0,046). The studied groups had comparable LV global longitudinal and circumferential strain (p=0,26; p=0,67; respectively).

Conclusion. Groups of patients with HF of ischemic and non-ischemic origin, despite comparable LVEF values, differ in the distribution of the decrease in local longitudinal strain of LV segments. The worst strain characteristics in patients with ICM and NICM are detected in LV apical and basal segments, respectively.

Aim. To evaluate the initial concentration of calciprotein particles (CPPs), which are scavengers of excessive calcium and phosphate, in patients with cardiovascular disease and in patients with chronic kidney disease as compared with the healthy volunteers.

Material and methods. The study included 308 individuals as follows: 1) 88 participants of the PURE study without hemodynamically relevant carotid athero scle rosis and symptomatic coronary atherosclerosis; 2) 88 patients with cere brovascular disease (CVD) who required carotid endarterectomy; 3) 88 pa tients with coronary artery disease (CAD) who required percutaneous coronary intervention or coronary artery bypass graft surgery; 4) 63 patients with stage 5 chronic kidney disease (CKD). We measured following mineral homeostasis parameters: total and ionized calcium, phosphate, total protein, albumin, and fetuin-A. Then, we determined a baseline serum CPP concentration by flow cytometry using a fluorescent-labeled bisphosphonate OsteoSense 680EX. Results. In comparison with other patients, healthy volunteers had the highest serum CPP concentration (249 CPPs/µL), indicating the retained ability to compensate mineral homeostasis disturbances by aggregation of excessive calcium and pho sphate with acidic proteins (mineral chaperones). Reduced serum CPP concentration in patients with CVD (170 CPPs/µL), CAD (139 CPPs/µL), and stage 5 CKD (193-203 CPPs/µL) showed impaired aggregation of excessive serum calcium and phosphate, which was also reflected by an increased level of blood ionized calcium.

Conclusion. Patients with CVD, CAD, and stage 5 CKD have lower serum CPP concentration than healthy individuals. In combination with elevated ionized calcium and reduced albumin, this suggests the depletion of calcium binding buffers in the serum of patients with cardiovascular and renal diseases.

Aim. To compare the expression of enzymes of the ceramide de novo synthesis pathway in cardiac adipose tissue (AT) and blood vessels of patients with coronary artery disease (CAD) and acquired heart defects.

Material and methods. The study included 20 patients with CAD and 18 patients with aortic stenosis/regurgitation. Biopsies of subcutaneous, epicardial, perivascular AT (SCAT, EAT, PVAT, respectively) were obtained during surgery. Quantitative PCR test was used to evaluate the gene expression of de novo ceramide synthesis enzymes (serine palmitoyltransferase C1 and C2: SPTLC1, SPTLC2; ceramide synthase 1-6: CERS1-6; dihydroceramide desaturase: DEGS1). Statistical analysis was performed using GraphPad Prism 8 (GraphPad Software).

Results. Patients with CAD were characterized by a higher level of mRNA SPTLC1 in SCAT and EAT, SPTLC2, CERS1, producing C18 ceramides, CERS5 and CERS6, generating C14-C16 ceramides in EAT, CERS2 — in SCAT, producing long-chain ceramides C20-C24, CERS4, synthesizing very long-chain ceamides C18-C20. In PVAT, a high expression of CERS4 and CERS3, which synthesizes very long-chain ceramides C26 and higher, was revealed. DEGS1 expression was highest in SCAT and EAT. In patients with heart defects, there was a high expression of CERS3 in PVAT, CERS4 in EAT and PVAT, DEGS1 in EAT. The mRNA level of SPTLC1 in SCAT and EAT, SPTLC2 in EAT, CERS2 in all studied AT, CERS4 and 5 in EAT, DEGS1 in SCAT and EAT among patients with CAD was higher than in the comparison group.

Conclusion. Regional fat depots of the heart differed in the level of expression of enzymes of the ceramide de novo synthesis pathway. The results obtained indicate the activation of ceramide synthesis along this pathway in predominantly epicardial adipocytes in coronary pathology, which may contribute to the accumulation of long-chain ceramides in the AT of this localization.

Aim. To assess the association of glycemic control (achievement of an individual target glycated hemoglobin level) with the outcomes of elective percutaneous coronary interventions in patients with type 2 diabetes (T2D).

Material and methods. This cohort observational study included 74 patients with a median age of 61 (57; 64) years. There were 49% of men with a previously established T2D, who had indications for elective primary percutaneous coronary intervention (PCI) for stable coronary artery disease. At inclusion in the study and after 1 month, the concentration of fasting blood glucose, glycated hemoglobin (HbA_1c), fructosamine, and serum creatinine were determined. Plasma glucose levels were determined using the hexokinase method. HbA_1c level was determined by immunoturbidimetry on a Konelab 30i chemistry analyzer. The concentration of fructosamine was determined by the kinetic colorimetric assay on a Konelab 30i chemistry analyzer. Statistical processing was carried out using the Statistica 10.0 program from StatSoft, Inc. (USA).

Results. At the time of enrollment, 31% of participants had not achieved the target glycated hemoglobin level against the background of nonoptimal hypoglycemic therapy in most cases. A total of 18 (25%) following adverse cardiovascular events were registered within 12 months after PCI: 11 (15%) patients developed acute coronary syndrome; among them, 6 (8%) patients had stent restenosis according to coronary angiography, 4 (6%) patients — progression of atherosclerosis, which required repeated PCI with stenting of another vessel, 2 (3%) patients — cerebrovascular accident, and 3 (4%) patients were hospitalized due to de compensated heart failure. According to multivariate logistic regression, only the HbA_1c level was a predictor of adverse outcomes during the year after PCI — a 1% increase in HbA_1c level increased the risk of adverse outcomes by 1,79 times (odds ratio, 1,79, 95% confidence interval, 1,06-3,02, p=0,028). Poor glycemic control 1 month before PCI increased the risk of cardiovascular events by 4,04 times over the next year, while non-target HbA_1c level immediately before PCI increased the risk of adverse outcomes by 4,7 times, and 5 months after PCI, by 7,34 times.

Conclusion. The significance of non-target glycated hemoglobin level for adverse outcomes during the year after elective PCI against the background of T2D was established with an increase in the negative effect as long-term (after myocardial revascularization) maintenance of poor glycemic control.

Aim. To identify predictors of rethrombosis and death in patients with coronavirus disease (COVID-19) after thrombectomy for acute lower limb ischemia.

Material and methods. For the period from April 2020 to January 2022, 189 pa tients with acute arterial lower limb thrombosis and acute lower limb ischemia were included in this study. In all cases, a positive polymerase chain reaction test for SARS-CoV-2 was obtained. According to chest multislice computed tomography, bilateral multisegmental pneumonia was identified as follows: 76 patients — grade 2 (25-50% of lung tissue involvement); 52 patients — grade 3 (50-75%); 61 patients — grade 4 (>75%). Breathing was carried out as follows: in 88 patients — spontaneous; in 42 — with oxygen administration by nasal cannula; 26 — non-invasive ventilation; 33 had artificial ventilation. All acute arterial thromboses developed within the hospital at 4,5±1,5 days after hospitalization. The time between the onset to diagnosis verification was 27,8±5,0 min. The revascularization strategy was established by a multidisciplinary team meeting. The interval between the development of acute ischemia symptoms and surgery was 45,9±6,3 minutes. Thrombectomy was performed according to the standard technique, under local and/or intravenous anesthesia, using 3F-7F Fogarty catheters.

Results. Retrombosis developed in 80,4% of cases 6,4±5,1 hours after surgery. In 59,8% of cases, retrombectomy turned out to be ineffective and the patient underwent limb amputation. In 65,6% of patients, a death was established due to multiple organ dysfunction. Among them, limb amputation was performed in 103 patients. Binary logistic regression identified following predictors of retrombosis/ death: age over 70 years (odds ratio (OR), 30,73; 95% confidence interval (CI), 11,52-33,7), obesity (OR, 15,53; 95% CI, 6,41-78,19), diabetes (OR 14,21; 95% CI, 5,86-49,21), vasopressor support (OR 8,55; 95% CI, 4,94-17,93), mechanical ventilation (OR 7,39; 95% CI, 4,81-16,52).

Conclusion. Predictors of retrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy are age over 70 years, obesity, diabetes, vasopressor support, and mechanical ventilation.

Aim. To determine the value of various risk factors for predicting the myocardial infarction (MI) during carotid endarterectomy in high-risk patients with coronary artery disease (CAD).

Material and methods. The single-center cohort prospective study included 204 high-risk patients with CAD who required carotid endarterectomy (CEA). Before surgery, all patients underwent treatment of CAD, and all patients were clinically stabilized. The first step was CEA. Clinical and diagnostic factors associated with the risk of perioperative MI were studied. There were following end points of the study: stroke, MI, death due to MI. The diagnosis of MI was established when there was a combination of an increase in cTn-I troponin above the 99th percentile upper reference limit with electrocardiographic manifestations of myocardial ischemia, or with chest pain or equivalent symptoms consistent with myocardial ischemia.

Results. There were no strokes. There were no deaths due to MI. Perioperative MI developed in 8 (3,9%) patients. There were following most significant predictors of perioperative MI: severe impairment of local left ventricular (LV) contractility (hazard ratio (HR), 13,57; 95% confidence interval (CI), 1,427-124,782, p<0,05) and a decrease in left ventricular ejection fraction <50% (HR, 10,909; 95% CI, 1,052-271,229, p<0,05). However, following factors were insignificant for predicting perioperative MI (p>0,05): SYNTAX score, prior cerebrovascular accident, myocardial infarction, insulin-dependent diabetes mellitus, obesity, chronic obstructive pulmonary disease.

Conclusion. In high-risk patients with CAD, severe impairment of local LV contractility and global LV systolic dysfunction are the most significant risk factors for perioperative MI during CEA.

Aim. To analyze the comorbidity structure in patients with ascending thoracic aortic aneurysm (TAA) in the Siberian Federal District (SFD).

Material and methods. The study included 163 patients (114 men (56,8±12,1 years) and 49 women (59,4±10,4 years)) with ascending TAA, who underwent open surgical treatment at the Cardiology Research Institute of the Tomsk National Research Medical Center. Concomitant pathologies were assessed on the basis of anamnesis and paraclinical investigations. Comparison of the prevalence of concomitant diseases in the group of patients with ascending TAA between men and women, as well as between patients ascending TAA in the SFD, other groups of patients with this pathology, population samples and patients with other cardiovascular diseases was performed using the χ² test or Fisher’s exact test in the Statistiсa 12 program.

Results. In patients with ascending TAA, hypertension (67,5%), bicuspid aortic valve (44,2%), coronary artery disease (38,6%), arrhythmia (31,3%), and heart failure (27,6%). Atherosclerosis of the aorta, coronary and carotid arteries occur with a prevalence of 12,9%, 16,6% and 5,5%, respectively. Among other forms of pathologies, the most common are connective tissue dysplasia (65,6%), obesity (12,3%), and chronic obstructive bronchitis (9,8%). In men with ascending TAA, myocardial infarction and atrial fibrillation are detected more often than women (11,4% and 20,2% vs 2% and 6,1%; p<0,05), and in women — carotid atherosclerosis and impaired cerebral circulation (12,2% and 18,4% vs 2,6% and 5,3%, p<0,05). Compared to other compared groups, aortic, coronary and carotid atherosclerosis, myocardial infarction, stroke, and type 2 diabetes were less frequently recorded in patients with ascending TAA in the SFD.

Conclusion. Patients with ascending TAA in the SFD are characterized by a complex structure of comorbidity, including both cardiovascular pathologies and related risk factors, and other pathologies, including diseases of the lungs, kidneys, gastrointestinal tract, infectious and cancer diseases. To confirm the presence of inverse comorbidity between ascending TAA, atherosclerosis of other location, and type 2 diabetes, large-scale epidemiological, morphological, and molecular genetic studies are needed, which will reveal the fundamental mechanisms underlying it.

Aim. To evaluate the prevalence of oral anticoagulant therapy at the outpatient and inpatient stages in patients hospitalized with ischemic stroke.

Material and methods. This open observational prospective real-world study included 114 patients with atrial fibrillation (AF) hospitalized with confirmed stroke.

Results. Only 26,3% of patients with AF hospitalized with a confirmed diagnosis of ischemic stroke took anticoagulants (70% — direct oral anticoagulants (DOACs), 30% — warfarin). At the same time, among those taking warfarin, only one patient had normal international normalized ratio (INR) at the time of hospitalization (INR 2,6). In all other cases, the INR was <2. Of the 105 patients discharged at the outpatient stage, 93 (88,6%) patients were prescribed anticoagulants, and in most cases — DOACs (89 (84,8%)). 4 (3,8%) patients insisted on continuing warfarin therapy. There were following reasons for not prescribing DOACs: 4 (33,3%) patients were diagnosed with acute peptic ulcer during hospitalization, 2 (16,7%) — hemorrhagic transformation of the ischemic focus.

Conclusion. One of the common reasons for stroke in outpatients with AF is the refusal to take oral anticoagulants or insufficient INR control when taking warfarin.

Aim. To study parameters of left ventricular (LV) strain and heart rate variability (HRV) in patients with ST-segment elevation myocardial infarction (STEMI) in various variants of postinfarction receiving high-dose atorvastatin therapy.

Material and methods. The study included 96 patients with STEMI. All patients underwent two-dimensional speckle tracking echocardiography and 24-hour electrocardiographic monitoring with HRV analysis. The included individuals were divided into groups without pathological LV remodeling (R (-), n=57) and with pathological post-infarction LV remodeling (R (+), n=39), the criterion for which was an increase in end-diastolic and/or end-systolic volume >20% and >15%, respectively. Further, depending on the achievement of target low-density lipoprotein cholesterol (LDL-C) (1,5 mmol/l and/or a decrease of more than 50%), the following subgroups were identified: 17 (43,6%) people, who reached target LDL-C levels (group 1), 22 (56,4%) patients, who did not reach target LDL-C levels (group 2). Similar subgroups were identified in the R (-) group as follows: 28 (49,1%) people, who reached target LDL-C levels (group 3) and 29 (50,9%) people, who did not reach target LDL-C levels (group 4).

Results. Starting from the 12^th week of follow-up, worsening of global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain (p<0,01) was registered in group 2. In group 1, worsening of these parameters was registered only by the 48th week (p<0,01). In group 3, an increase in GLS was revealed by the 48^th week (p=0,001), GCS and GRS — by the 12^th week (p<0,05). In group 4, favorable changes were observed only in GLS and GCS by the 48^th week (p<0,01). A significant change in HRV parameters was observed in group 3. By the 48^th week, there was an increase in temporal indicators (SDNN, SDNNi, SDANN, RMSSD, pNN50) (p<0,0001) and total spectrum power (p=0,0001) due to an increase in all frequency indicators (p<0,001), while the index of autonomic balance L/H decreased by 33% (p=0,002). In group 4, only SDNN, SDANN and pNN50 (p<0,05), as well as the total spectrum power (p=0,001) increased, but no change in frequencies. According to intergroup analysis in the acute period of STEMI, group 4 patients had higher HRV than in group 3 (p<0,05).

Conclusion. High-dose atorvastatin therapy improves LV strain characteristics and autonomic balance during the rehabilitation period after STEMI.

Aim. To search early signs of cardiotoxicity in patients receiving anticancer therapy and evaluate the effectiveness of cardioprotection with an angiotensin-converting enzyme inhibitor, beta-blocker and myocardial cytoprotector.

Material and methods. The study included 98 patients with high and very high risk of cardiotoxicity according to the Mayo Clinic scale (USA). Cancer patients with hypertension were offered cardioprotective treatment with a fixed-dose combination of perindopril and bisoprolol, and patients with very high risk and concomitant coronary artery disease additionally trimetazidine.

The patients were divided into 2 following groups: the experimental group (n=50), where patients were prescribed cardioprotective therapy, and the control group (n=48), which consisted of patients who refused or had contraindications to cardioprotection. All patients underwent an examination, including the collection of complaints and anamnesis, physical examination, electrocardiography and echocardiography with an assessment of left ventricular (LV) global longitudinal strain before chemotherapy and 1, 3, 6, 9 and 12 months after initiation of anticancer therapy.

Results. In patients of the control group, by the end of the follow-up, the left atrial volume index and LV end-diastolic volume index significantly increased. In the main group, these indicators did not change significantly. In the control group, by the final visit, the LV ejection fraction significantly decreased in comparison with the initial value and the value in the first group. After 6, 9 and 12 months, there was a significant decrease in the LV global longitudinal strain in the control group, while in the main group this indicator remained within the normal range. The mortality rate in the control group was significantly higher (15% vs 2% in the experimental group). In the experimental group, cardiotoxic complications occurred in 28%, while in the control group — in 78% of patients.

Conclusion. The study demonstrated the significant importance of cardiac monitoring and primary drug prevention of cardiotoxicity of anticancer therapy. A sig nificant deterioration in LV systolic function was shown in patients with a high and very high risk of cardiotoxicity who did not receive cardioprotective therapy, while its high efficiency was demonstrated in patients of the experimental group.

Often, transthoracic echocardiography in obese patients reveals normal indicators of intracardiac hemodynamics and heart geometry. Can the clinician determine the risk of cardiovascular events and proper management in such patients based on the data obtained? Do many overweight patients really have no cardiac abnormalities, or they simply could not be detected? New capabilities of transthoracic echocardiography make it possible to detect abnormalities in the early stages of the disease, even in the absence of clinical manifestations. Thus, the inclusion of additional parameters in the standard protocol of echocardiography in obese patients will most accurately determine the management tactics and prognosis, thereby reducing the risk of unfavorable outcomes.

The article is devoted to the analysis of the current status of nuclear cardiology in the Russian Federation. The data on the number of facilities performing radionuclide investigations for the diagnosis and monitoring of the treatment of cardiovascular diseases, their staffing and equipment are given. The statistics of the conducted nuclear cardiology tests for 2018-2020 are given, as well as their methods, features and diagnostic significance are described.

A search was made for publications on modern methods for determining cardiovascular risk in young people with positive family history for early cardiovascular events. The use of various screening options allows timely identification of patients with heterozygous familial hypercholesterolemia who have a high cardiovascular risk. The most effective method is cascade screening. Cardiovascular risk assessment systems that include a family history of early cardiovascular events and lipid profiles in individuals under 40 years of age provide prevention of atherosclerosis. In the diagnosis of risk, the lipoprotein (a) is of particular clinical importance, elevated concentrations of which are associated with a high risk of vascular damage and an unfavorable course of atherosclerosis.