The coronavirus disease 2019 (COVID-19) pandemic has shown the need for the development of telemedicine technologies, especially remote follow-up using vital sign telemonitoring. In the Russian Federation, this approach is also justified by the remoteness factor with a shortage of medical workers in distant areas of the country.

Aim. To study the potential of remote monitoring in outpatients discharged after acute decompensated heart failure and acute coronary syndrome.

Material and methods. The study included 392 patients randomized to active follow-up groups with remote blood pressure (BP) monitoring (group 1, n=197) and standard management (group 2, n=195). The follow-up period lasted 3 months.

Results. During the follow-up period, patients managed with BP and heart rate telemonitoring tended to decrease in systolic BP from 132 (interquartile range (IQR), 121-139) mm Hg up to 125 (IQR, 115-130) mm Hg (p=ns). On the contrary, the 2nd group patients had a slight increase in systolic BP from 127 (IQR, 115-137) mm Hg up to 132 (IQR, 124-142) mm Hg (p=ns).

The patients of group 2 were more likely to receive diuretics and nitrates after 3-month follow-up, which can be considered a negative factor. This may indicate no improvement in the course of heart failure and chronic coronary artery disease with the absence of therapy correction over time.

During follow-up, four patients from group 1 were hospitalized due to decompensated heart failure or an episode of acute coronary syndrome with a total duration of 30 days, compared with 13 hospitalizations for the same reasons in group 2 (p=0,027; OR 3,4; 95% CI 1,1-10,8). In total, six patients died during the follow-up period in group 1, and eleven patients died in group 2 (p=0,226; OR 1,9; 95% CI 0,7-5,3). At the same time, three patients in the 1st group and one patient from the 2nd group died during the follow-up period due to COVID-19. Thus, cardiovascular mortality consisted of 3 and 10 patients in groups 1 and 2, respectively (p=0,052; OR 3,5; 95% CI 0,9-12,9).

Conclusion. Three-month remote management of patients after decompensated heart failure or acute coronary syndrome, including BP monitoring, showed a significant reduction in the hospitalization rate and a trend towards a decrease in cardiovascular mortality.

Aim. To determine the role of biomarkers in predicting atrial fibrillation (AF) recurrence within 12 months after radiofrequency ablation (RFA) in patients with metabolic syndrome (MS).

Material and methods. The study included 245 patients with AF aged 35 to 65 years: patients without MS components (n=32), with 1-2 MS components (n=62) and patients with 3 or more MS components (n=153). All patients underwent a comprehensive clinical and anamnestic, anthropometric, laboratory and echocardiographic examinations. The prospective follow-up for 12 months included 135 patients with AF who underwent RFA.

Results. It was found that the presence of 3 or more MS components increased the risk of AF recurrence by 4,1 times within 12 months after RFA (relative risk (RR) =4,1, 95% CI 2,19-7,65, p<0,0001). According to binomial logistic regression, epicardial fat thickness (EFT) (OR =3,71, 95% CI 2,12-6,73, p=0,00001), the severity of left atrial fibrosis (OR =1,48, 95% CI 1,03-1,78, p=0,0006), concentrations of galectin-3 (OR =1,31, 95% CI 1,12-1,51, p=0,0001) and GDF-15 (OR =1,11, 95% CI 1,02-1,18, p=0,0002) in patients with AF and MS increase the risk of AF recurrence after RFA. For galectin-3, GDF-15, and EFT, using ROC analysis, the following threshold values were established, the excess of which had the greatest effect on the risk of AF recurrence after RFA in patients with MS: galectin-3 >11,0 ng/ml (RR =3,43, 95% CI 1,79-6,58, p=0,0001), GDF-15 >1380,7 pg/ml (RR =2,84, 95% CI 1,81-4,46, p<0,0001) and EFT >6,4 mm (RR =4,50, 95% CI 2,32-8,71, p<0,0001). In patients with excess of all three biomarker thresholds, the total risk of AF recurrence in patients with MS within 12 months after RFA increases by 3,2 times (RR =3,16, 95% CI 1,97-5,11, p<0,00001).

Conclusion. The risk of AF recurrence within 12 months after RFA in patients with three or more MS components is higher than in patients with 1-2 MS components. An increase in the blood concentration of profibrogenic biomarkers galectin-3, GDF-15 and an increase in the thickness of epicardial adipose tissue is associated with an increased risk of AF recurrence in patients with MS, and these biomarkers are likely to play a significant role in predicting recurrent episodes of AF after RFA.

Aim. To analyze the efficacy and safety of the percutaneous transfemoral puncture technique for TEVAR (thoracis endovascular aortic repair).

Material and methods. The retrospective study included 89 patients with aortic pathologies, for whom endovascular repair was performed: 51 patients (57%) with aortic dissection (type I DeBakey — 30 cases (58,8%) and type III — 21 (41,2%)), 38 (43%) patients with aortic aneurism. 82% of patients were male, the median age was 57 years (minimum age 17 years, maximum age 75 years). All patients were divided into two groups: in the first group (48 patients) endovascular aortic repair was performed under endotracheal anesthesia with open femoral exposure of the common femoral artery (CFA), in the second group (41 patients) — by percutaneous puncture method under local anesthesia. Technical and clinical aspects of procedures were analyzed.

Results. Technical success of endovascular repair was achieved in 100% cases in both groups. The duration of the operation in the group with percutaneous access was statically significantly shorter (120 (94-150) minutes vs 87(60-120) minutes, p=0,001). Also, the time spent by patients in the intensive care unit and the period of hospitalization (18 (14-22) hours versus 1 (0-3) hours, p=0,001; 5 (4-6) days versus 4 (3-5) days, p=0,03) was shorter. In the open access group 2 (4,2%) patients developed access-related complications - acute thrombosis of the common femoral artery and hematoma of the postoperative wound, which required additional surgical aid - thrombectomy from the CFA, the second patient had evacuation of the hematoma of the postoperative wound. Cite-related complications in the second group were not observed. No major complications including neurological deficits and hospital mortality were observed in both groups.

Conclusions. Thoracic endovascular aortic repair (TEVAR) using percutaneous access under local anesthesia in stable patients has proven to be safe and effective. The operation time is significantly reduced and this approach in most cases eliminates the need for the patient to stay in the intensive care unit in the early postoperative period. Possibility of early mobilization of the patient appears with reducing of the duration of hospitalization.

Unified approaches to ensuring the chain of survival can improve the patient’s prognosis both in out-of-hospital and in-hospital cardiac arrest.

Aim. To discuss practical issues of introducing a program for the availability of automated external defibrillation in a cancer center.

Material and methods. For four years, our healthcare facility has been implementing a training program for basic and advanced life support according to the European Resuscitation Council standards, combined with the creation and development of an infrastructure for the availability of automatic defibrillation. A roadmap and infrastructure were developed for the project implementation.

Results. In 2018-2022, 229 employees (114 doctors, 85 nurses and 30 nonmedical workers) were trained under the basic life support program. Fifteen defibrillators were placed in various units. During the specified period, first aid in case of sudden cardiac arrest using an automated external defibrillator before the resuscitation team arrival was independently provided by doctors and nurses of departments three times. To implement training in the continuous education system, the curriculum has passed the examination and accreditation in the edu. rosminzdrav system.

Conclusion. The development and implementation of such initiatives requires significant organizational and methodological work, including continuous education system. However, in our opinion, this is an extremely useful tool for improving the safety and quality of medical care.

Currently, multi-slice computed tomography (MSCT) coronary angiography is a leader in the diagnosis of coronary artery disease in patients with non-ST elevation acute coronary syndrome of low or moderate risk. High coronary calcium score (CCS) obtained by MSCT indicate a high probability of obstructive coronary artery disease. In the presented case of an 83-year-old patient with unstable angina, the CCS was 1394, and hemodynamically significant stenoses were detected. However, according to selective coronary angiography, no hemodynamically significant coronary lesions were found. High CCS suggests poor image quality in MSCT coronary angiography. High CCS is detected in most people over 70 years of age. Obviously, in this patient, a high CCS is mainly determined by age. Most studies on CCS did not include patients over 80 years of age. When deciding whether to perform MSCT coronary angiography, it is necessary to take into account the individual characteristics of a particular patient, which may affect the interpretation of results.

Spontaneous coronary artery dissection is a rare disease that threatens the patient life. Often this pathology complicates the course of pregnancy or the postpartum period. The rare occurrence and difficulties in diagnosis are the reason for the lack of data and the impossibility of developing a single algorithm for diagnosing and treating spontaneous coronary artery dissection.

The article provides a brief literature review and a case report of spontaneous coronary artery dissection in the postpartum period, and discusses a number of aspects of treatment tactics.

Aim. To conduct a systematic review and meta-analysis of the efficacy and safety of combined oral anticoagulant therapy with vitamin K antagonists (VKA) and antiplatelet therapy with aspirin compared with VKA monotherapy in patients after mechanical valve replacement.

Material and methods. We searched the PubMed, Google Scholar databases for studies comparing the risk of thromboembolic events, major bleeding, and mortality in VKA monotherapy versus combined aspirin and VKA therapy in patients with mechanical valve replacement.

Results. Eight randomized clinical trials were selected for this systematic review and meta-analysis. In total, 4082 patients were included in the analysis (mean age, 50,8 years, men — 2484 (60,9%)). A meta-analysis showed that the addition of aspirin to VKA, compared with VKA monotherapy, significantly reduced the incidence of thromboembolic events (odds ratio (OR) 0,47; 95% confidence interval (CI): 0,33-0,67; p<0,0001) and mortality (OR 0,58; 95% CI: 0,38-0,88; p=0,01). The risk of major bleeding in the aspirin plus VKA group compared with VKA monotherapy tended to increase, without reaching a significant difference (OR 1,41; 95% CI: 0,99-2,01; p=0,06).

Conclusion. The addition of aspirin to VKA, compared with VKA monotherapy, reduces the risk of systemic embolism and death in patients after mechanical valve replacement. At the same time, the risk of major bleeding did not differ between the groups.

Currently, thrombolytic therapy (TLT) for pulmonary embolism (PE) is recommended only for patients with high-risk PE. At the same time, in real practice, TLT is often performed in hemodynamically stable patients. The main contradiction arises due to the different risk-benefit ratio of TLT in comparison with anticoagulant monotherapy.

Aim. To assess the benefits of TLT, compared with unfractionated heparin (UFH) monotherapy, in hemodynamically stable patients with PE in reducing mortality, recurrence of PE and risk of bleeding.

Material and methods. Randomized controlled trials were searched in PubMed, Embase, and Cochrane Library databases. Of the 3050 publications found, 100 papers were selected for a detailed study. As a result of detailed analysis, 7 randomized clinical trials (n=1611) remained according to established criteria.

Results. TLT in hemodynamically stable patients with PE, in comparison with UFH, showed a tendency to decrease in the inhospital death rate: 2,39% vs 3,68 (odds ratio (OR): 0,73; 95% confidence interval (СI): 0,34-1,57), and a decrease in the composite endpoint (death and/or recurrent PE): 3,14% vs 5,15% (OR: 0,61; CI: 0,37-1,01). There was a significant increase in the number of major bleeding: 8,81% vs 2,70% (OR: 3,35; 95% CI: 2,06-5,45). TLT in hemodynamically stable patients with PE to a greater extent can reduce the pulmonary blood pressure, perfusion defects according to lung scintigraphy, as well as the need for therapy intensification. However, the heterogeneity of studies and the small number of participants require caution when interpreting their results.

Conclusion. TLT in patients with PE and stable hemodynamics tends to reduce mortality and/or recurrence of PE, but increases the incidence of major bleeding. Further studies need to determine the phenotypes of hemodynamically stable patients with PE who would benefit from TLT.

Aim. To conduct a systematic review and meta-analysis in order to evaluate the prognostic value of left ventricular global longitudinal strain (LV GLS) and LV mechanical dispersion (LVMD) in ischemic and nonischemic cardiomyopathy.

Material and methods. We searched PubMed, Google Scholar and Embase for studies on the prognostic value of LV GLS and LVMD in ischemic and nonischemic cardiomyopathy. Hazard ratios (HR) from included studies were pooled for metaanalysis.

Results. Twelve studies were selected from 314 publications for this systematic review and meta-analysis. In total, 2624 patients (mean age, 57,3 years; mean follow-up, 40,8 months) were included in the analysis. Meta-analysis showed that decreased LV GLS was associated with an increased risk of ventricular arrhythmias (VAs) (adjusted HR: 1,10 per 1% of GLS; 95% CI: 1,01-1,19; p=0,03) and major adverse cardiovascular events (MACE): adjusted HR: 1,22 per 1% of GLS; 95% CI: 1,11-1,33; p<0,0001). Patients with VAs had greater LVMD than those without it (weighted mean difference, 33,69 ms; 95% CI: -41,32 to -26,05; p<0,0001). Each 10 ms increment of LVMD was significantly and independently associated with VA episodes (adjusted HR: 1,18; 95% CI: 1,08-1,29; p=0,0002).

Conclusions. LV GLS and LVMD assessed using speckle tracking provides important predictive value and can be used as an effective tool for stratifying risk in patients with ischemic and nonischemic cardiomyopathy.

Arrhythmogenic cardiomyopathy (ACM) is a rare genetic disease characterized by the development of life-threatening ventricular arrhythmias and impaired ventricular systolic function due to fibrofatty infiltration of the myocardium. Currently, the Task Force 2010 criteria and the Padua criteria are proposed for the diagnosis of this disease. However, despite the multiparametric approach, there are certain limitations of the presented algorithms for disease establishment, especially in children. Carrying out such high-tech diagnostic methods as endomyocardial biopsy and magnetic resonance imaging is extremely difficult in the pediatric population. In this regard, the study and application of electrocardiography becomes extremely relevant in children. In addition, there are no data on the features of ventricular arrhythmias in ACM in the pediatric population. In this systematic review with meta-analysis, we studied the features of ventricular arrhythmias and electrocardiographic parameters in various ACM types.

The review analyzes the global agenda on mutational status of genes associated with adverse cardiovascular events of arrhythmic type. Whole exome sequencing will identify a risk group for the likelihood of early or delayed cardiovascular events of arrhythmic type, especially among patients receiving anticancer therapy with cardiotoxic drugs. The dedicated up-to-date panel of genetic polymorphisms will provide an opportunity to optimize management of patients, based on not only clinical, paraclinical and anamnestic data.

Up-to-date data on the problem of takotsubo cardiomyopathy, including key issues of epidemiology, clinical presentation, diagnostic criteria, and general pathophysiological mechanisms of the disease is presented in review.

Up-to-date data on the problem of takotsubo cardiomyopathy, including data on the clinical manifestations, diagnostic algorithm and treatment approaches, as well as the prognosis of possible complications is presented in review.