Aim. To study the effect of high-dose combined lipid-lowering therapy (statins + ezetimibe vs statins + PCSK9 inhibitors) on plaque vulnerability assessed using multimodal imaging (coronary computed tomography angiography (CCTA) and optical coherence tomography, as well as biomarkers in patients with acute coronary syndrome (ACS).
Material and methods. This open, prospective, randomized, single-center study will include 120 patients admitted urgently with an ACS. All patients will undergo percutaneous coronary intervention of the infarct-related artery, as well as intracoronary imaging using optical coherence tomography of one or two noninfarct-related arteries. During hospitalization, patients will receive standard therapy for ACS according to clinical guidelines, while statins will initially be prescribed at a maximum dosage of atorvastatin 80 mg/rosuvastatin 40 mg.
Patients who showed high compliance and did not reach the target low-density lipoprotein cholesterol (LDL-C) values (≤1,4 mmol/l) 1 month after myocardial infarction/unstable angina at the second visit will be randomized into two groups. Patients of group 1 will receive PCSK9 inhibitors (alirocumab 150 mg by subcutaneous injection once every 2 weeks or evolocumab 140 mg by subcutaneous injection once every 2 weeks) in addition to maximum statin therapy (atorvastatin 80 mg/rosuvastatin 40 mg), while group 2 participants will take ezetimibe at a dose of 10 mg in combination with the maximum dose of statins. In addition, at the second visit, patients will undergo CCTA, assess the cardio-ankle vascular index (CAVI) index and laboratory tests (complete blood count (neutrophil-to-lymphocyte ratio NLR), lipid profile, alanine aminotransferase (ALT), aspartate aminotransferase (AST), Troponin I, Galectin-3, high-sensitivity C-reactive protein (hs-CRP), metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), neutrophil gelatinase-associated lipocalin (NGAL). Total follow-up will last 52 weeks. At the final visit, patients will undergo CCTA, assessment of the CAVI index and laboratory status (NLR, lipid profile, ALT, AST), Troponin I, Galectin-3, hs-CRP, MMP-9, TIMP-1, NGAL).
Primary endpoint: reduction in plaque vulnerability according CCTA in non-infarct-related coronary arteries Secondary endpoints: death, stent thrombosis/restenosis, non-fatal myocardial infarction, readmissions with progressive angina, repeat revascularization; changes of the lipid profile (total cholesterol, LDL-C, high-density lipoprotein cholesterol, triglycerides) against the background of maximum combination therapy with statin + PCSK9 inhibitors or statin + ezetimibe; changes of the biomarkers of cardiac injury (Troponin I), inflammation (NLR, hs-CRP, NGAL, Galectin-3) and matrix remodeling (MMP-9, TIMP-1).
Conclusion. Our study will allow for the first time to compare and evaluate the effect of both PCSK9 inhibitors and ezetimibe in combination with high-dose statin therapy on reducing the plaque vulnerability according to CCTA in non-infarction-related coronary arteries in patients with ACS undergoing percutaneous coronary intervention, as well as to evaluate the diagnostic value of inflammatory biomarkers (NLR, hs-CRP, NGAL, Galectin-3) and matrix remodeling (MMP-9, TIMP-1).

Aim. To study the prevalence and severity of left ventricular hypertrophy (LVH), its relationship with fibroblast growth factor (FGF23) in patients with resistant hypertension (RH) depending on the effectiveness of multiagent antihypertensive therapy.
Material and methods. The study included 92 patients diagnosed with RH. All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, general laboratory tests, and the serum FGF23 level was determined.
Results. According to ABPM results, patients were divided into following groups: 1^st — controlled RH (n=44) and 2^nd — uncontrolled (n=48) RH. The groups were comparable in sex, age, main clinical and anthropometric parameters. In group 2, the main parameters of ABPM were higher. There were no differences in general laboratory tests, In the group of uncontrolled RH, the level of FGF23 was higher — 11,7 [8,5; 15,4] pmol/ml vs 9,2 [7,1; 11,6] pmol/ml in the 1^st group (p=0,0036). According to echocardiography, a comparable violation of left ventricular (LV) diastolic function, an increase in left atrial size, LV mass (LVM) and LVM index were found. In patients of the 2^nd group, large values of interventricular septal thickness were revealed — 1,3 [1,2; 1,4] cm vs 1,2 [1,1; 1,3] cm in the 1^st group (p=0, 0043) and relative LV wall thickness (LVWT) — 0,50 [0,48; 0,53] vs, 0,45 [0,43; 0,50] in the 1^st group (p<0,0001). In the 1^st and 2^nd groups, concentric LVH was more common (18 (41%) patients in the 1^st and 26 (54,1%) in the 2^nd (p=0,044) groups) than eccentric LVH (15 (34,1%) and 13 (27,1%) patients in the 1^st and 2^nd groups, respectively). Correlation analysis revealed a positive relationship between pulse pressure and HTN duration (r=48, p=0,02) and FGF23 level (r=0,62, p=0,004). The LVM index was positively associated with the diastolic pressure-time index (BP) (r=51, p=0,02). A positive correlation was found between relative LVWT and pulse pressure (r=0,64, p=0,02) and a negative relationship with the duration of regular antihypertensive therapy (r=47, p=0,04), A strong relationship was found between LVEF and FGF23 levels (r=0,75, p=0,005).
Conclusion. For patients with uncontrolled resistant hypertension, an increase in pulse pressure and myocardial remodeling in the form of concentric hypertrophy are more characteristic. FGF23 is significantly higher in uncontrolled RH and is positively associated with pulse pressure and relative LVWT.

Aim. To evaluate the prevalence of arrhythmias in patients undergoing chronic hemodialysis, to characterize the arrhythmia types in relation to the dialysis procedure and to determine their relationship with clinical findings and echocardiographic characteristics.
Material and methods. The study involved 152 patients with kidney failure undergoing chronic hemodialysis. All patients underwent an assessment of dialysis parameters, collection of clinical data, and 48-hour Holter monitoring. In addition, 93 patients underwent an echocardiography with an assessment of left ventricular (LV) mass index, LV ejection fraction, left atrial (LA) volume index, E/e’, cardiac output and preload, which was defined as increased LV filling pressure (E/e’ >12) and LA enlargement (LA volume index >30 ml/m²).
Results. Among the 152 examined patients, premature supraventricular and ventricular contractions (PVCs) were observed in almost all patients, while 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation (AF) in 8,6% of patients, paroxysmal AF in 3,9%, nonsustained ventricular tachycardia in 19,7%, bradycardia in 4,6%, second-degree atrioventricular block in 1,3% and third-degree atrioventricular block among 2,6%. PVCs were more common on dialysis days, while tachyarrhythmias were more common during dialysis and in the immediate post- dialysis period. Older age (odds ratio (OR) 10 years older, 1,53; 95% confidence interval (CI): 1,15-2,03; P=0,003), lower cardiac output (OR 1 L/min more, 0,66; 95% CI: 0,44-1,00; P=0,05) were independently associated with clinically relevant arrhythmias.
Conclusion. In patients on chronic hemodialysis, older age, increased preload and lower cardiac output are independently associated with clinically relevant arrhythmias. In addition, a positive association between increased LV mass index and AF episodes has been demonstrated. Lower cardiac output had positive correlation with AF and ventricular arrhythmias.

The paper presents a description of the diagnosis and treatment of takotsubo syndrome in a patient with paroxysmal atrial fibrillation after electrical cardioversion. A case report clearly reflects the need for an integrated diagnostic approach to verify the diagnosis using dynamic echocardiography, electrocardiography, angiographic and tomographic investigations. The complexity of differential diagnosis in this case was an atypical variant of myocardial dysfunction. Follow-up made it possible to track the clinical improvement of the patient and the almost complete normalization of myocardial contractility in terms characteristic of takotsubo syndrome.

Apical hypertrophic cardiomyopathy (HCM) or Yamaguchi syndrome is a relatively rare subtype of HCM characterized by a left ventricular apex localization of the hypertrophy. In this case, chest pain can be erroneously interpreted as a manifestation of coronary artery disease. This article presents two cases of apical HCM in patients admitted with a diagnosis of acute coronary syndrome. Electrocardiogram revealed repolarization disorder and giant T wave inversion (up to 10 mm) in the precordial leads. Transthoracic echocardiography revealed local symmetric hypertrophy of the left ventricular apex, which made it possible to diagnose apical HCM. The coronary arteries in both patients were intact. The presented cases demonstrate a variant of apical HCM with chest pain as the leading clinical syndrome, which can often be the cause of overdiagnosis of acute coronary syndrome.

Arrhythmogenic cardiomyopathy (ACM) is a progressive disease with a high risk of sudden cardiac death (SCD), which is very rare in the pediatric population.
Aim. To study the clinical course, outcomes and prognosis in various ACM phenotypes in pediatric patients.
Material and methods. During the initial selection, 144 publications were found in the PubMed database. From the initially identified results, an analysis of 7 works was carried out.
Results. Positive family history for ACM was revealed in 90% of cases. Every second patient had symptoms of the disease (49,2% (95% confidence interval (CI): 19,3-79,1)). Frequent clinical manifestations of ACM were palpitations, heart failure symptoms, and syncope. The incidence of SCD and sudden cardiac arrest was 7,1% (95% CI: 1,7-12,4) and 5,1% (95% CI: 1,5-8,7), respectively. Implantation of an implantable-cardioverter defibrillator was performed in 40% of cases.
Conclusion. We did not reveal any specificity of clinical signs depending on ACM phenotype. However, an earlier onset and an unfavorable course are characteristic of non-classical ACM types. ACM is characterized by a high risk of SCD, so it is extremely important to make a timely diagnosis.

A number of studies have demonstrated the negative impact of iron deficiency (ID) on the prognosis and course of heart failure. The prevalence of patients with coronary artery disease (CAD) in these studies was 39,4-65%, while the proportion of patients who had myocardial infarction reached 60%. The effect of ID on CAD course requires further study. The aim of this review was to analyze the available data on the effect of ID on heart function, quality of life, and prognosis in patients with CAD. This literature review analyzed 359 publications and systematized information on ID prevalence in patients with CAD, pathophysiological effects of ID on the function and structure of cardiomyocytes, the impact of ID on the course, prognosis, and quality of life in patients with CAD. The influence of ID and its correction on cardiomyocytes and left ventricular systolic function were studied.