The article reflects information for cardiologists, cardiac surgeons, doctors pro­gramming implanted antiarrhythmic devices, employees and residents of the depart­ments of cardiology and cardiac surgery. Most often, we choose a model of an implantable cardioverter-defibrillator (ICD) strictly individually for each patient, based on the anamnesis characteristics, safety and highest efficiency of ICD systems offered on the market. With each new ICD model, manufacturing companies strive to minimize the number of implantable components and develop better algorithms to discriminate between atrial tachyarrhythmias and true ventricular tachyarrhythmias. However, the risk of inappropriate ICD therapy still remains high. Thus, attending physicians and cardiologists programming implantable antiarrhythmic devices often face difficulties in correcting ICD settings and planning further treatment of a patient with shocks caused by atrial tachyarrhythmias. The authors sought to form an idea about the features of a single-chamber ICD recording atrial potentials using a floating dipole, as well as the advantages of the DX system over classical single-chamber ICD systems, and to define a type of a patient for whom this implantable system would be the best choice preventing sudden cardiac death.

The article discusses the results of modern studies evaluating the effectiveness of drug therapy for heart failure with reduced ejection fraction (HFrEF). Modern approaches to a comprehensive evaluation of data obtained in various randomized clinical trials (RCTs) are presented. The role of methods for presenting the RCT results is considered, as well as the difference between hazard ratio and relative risk is clarified. Expert opinions are discussed about the limitations of simplified approaches to comparing the results of large RCTs, which are based only on comparisons of hazard ratio without taking consideration of patient characteristics, study duration, and the absolute number of adverse outcomes that developed. Information is provided on the role of accounting for multiple comparisons in assessing clinical outcomes in RCTs. The article compares the VICTORIA results on the study of vericiguat in patients with a recent episode of HFrEF decompensation with RCTs on the evaluation of the effects of drugs that are part of standard therapy.

Aim. To analyze clinical and paraclinical data in patients with documented cardiac sarcoidosis, outlining the key points of diagnosis and selection of the optimal treatment.

Material and methods. For the period from 2016 to 2021, 63 patients (50,4±14,1 years) were included in the cohort study on negotiability. Based on a standard examination, 15 patients (41±13 years old) were selected, who continued the examination to confirm the diagnosis of cardiac sarcoidosis. Contrast-enhanced cardiac magnetic resonance imaging (MRI) was performed in 10 patients, while endomyocardial biopsy in 7 patients. All patients underwent 18F-fluorodeoxyglucose positron emission tomography (PET).

Results. The most common (53%) electrocardiographic abnormality was right bundle branch block. Ventricular arrhythmias and high-grade atrioventricular block were recorded mainly in patients with documented activity. Regional contractility disorders were predominantly detected in patients with cardiac fibrosis. Delayed contrast enhancement according to cardiac MRI was recorded mainly intramurally in the interventricular septum and subepicardial area of left ventricular (LV) lateral wall. When analyzing the PET results, we found the predominant radiopharmaceutical accumulation in the interventricular septum (56%), lateral (44%) and anterior (33%) LV walls. There was no significant improvement in global LV contractility against the background of immunosuppressive therapy, especially in patients with reduced ejection fraction: initially 49,2±10,1% vs 46,9±14,9% during therapy (p=0,658).

Conclusion. A certain apprehensive attitude of the doctor and adherence to the algorithm for early diagnosis of cardiac sarcoidosis allows minimizing the risks of fatal cardiovascular events. On the contrary, in the case of late diagnosis, even the use of aggressive immunosuppressive therapy does not lead to an improvement in global myocardial contractility, and fibrosis zones can cause life-threatening bradyarrhythmias and ventricular arrhythmias.

Aim. To compare data on the features of spleen macrophage composition in pa­tients with fatal myocardial infarction (MI) and in patients from the control group without cardiovascular disease (CVD).

Material and methods. The study included patients with fatal MI (n=30) and control group (n=5) — persons without CVD who died from injuries not compatible with life. Macrophage infiltration of spleen and myocardium fragments taken during autopsy was assessed by immunohistochemistry using macrophage markers CD68, CD163, CD206, stabilin-1.

Results. There were following number of cells studied by us in the red pulp (RP) in patients with MI: CD163+, 906 (661; 1101), CD68+, 898 (807; 1049), stabilin-1+, 811 (531; 966), CD206+, 11 (9; 19); control group: CD163+, 400 (315; 513), CD68+, 40 (37; 45), stabilin-1+, 186 (107; 206), CD206+, 80 (70; 84). The content of all cells in the RP in patients with MI was high and prevailed over their number in the control group, while only the CD206+ concentration was inferior in number; in the control group, CD163+ cells predominated (p<0,05). There were following number of cells in the white pulp (WP): CD68+, 312 (260; 348), stabilin-1+, 59 (40; 123), CD163+, 29 (17; 56), CD206+, 2 (1; 5) in the group with MI; CD68+, 3 (1; 4), stabilin-1+, 3 (2; 3), CD163+, 23 (1; 48), CD206+, 1 (1; 2) in the control group. In persons with MI, CD68+ cells dominated in WP, while in the control group — CD163+ (p<0,05). The minimum and comparable in WP in both groups was the number of CD206+ cells (p<0,05), which correlated in the control group with the level of stabilin-1+ and CD206+ cells (r=-0,9, p=0,003) and in patients with MI — with the level of CD206+ cells in the myocardium (r=0,6, p=0,004).

Conclusion. The dominance of CD163+ cells in all functional spleen areas in the control group and CD68+ cells in patients with MI was revealed. The only cell type, the content of which in the control group prevailed over that in MI in RP and correlated in WP with its myocardial concentration, was CD206+.

Aim. To identify risk factors for low adherence and develop a scale for its pre­diction. To evaluate the association of the predictive score with actual low adherence according to the 8-item Morisky Medication Adherence Scale, self-drug withdrawal, and adverse outcomes in patients with atrial fibrillation (AF).

Material and methods. The study included patients with AF and a high risk of thromboembolic events according to the CHA2DS2-VASc scale, who were hospitalized from January 2011 to December 2017. Potential risk factors for non-adherence, selected from the literature, were tested in a multivariate regression analysis followed by the development of an adherence prediction scale. The asso­ciation of predicted low adherence with actual adherence was assessed.

Results. The study included 199 patients. The analysis identified following predictors of low adherence: low income, history of bleeding, prior stroke, 4 positive responses to the adherence questionnaire, warfarin. Based on these predictors, a scale for predicting adherence was developed, while a threshold value of 3 points was identified (sensitivity, 90,2%, specificity, 98,4%). A significant association of low predicted adherence on the developed scale with actual adherence and adverse outcomes was demonstrated.

Conclusion. We have developed a scale for predicting adherence to anticoagulant therapy, and also determined its threshold value. In case of a high risk of low adherence, clinicians should try to increase adherence in order to prevent comp­lications.

Aim. To estimate the prevalence of ischemic stroke (IS) and the appointment of anticoagulant therapy in patients with atrial fibrillation (AF) depending on body mass index (BMI) as part of a retrospective analysis of big data from certain subjects of the Russian Federation using artificial intelligence technologies.

Material and methods. The information was obtained from the Webiomed predictive analytics platform, which includes depersonalized data from electronic health records of patients in 6 Russian constituent, extracted using artificial intelligence technologies. Individuals with AF aged ≥18 years were selected with available data on BMI of 18,5-60,0 kg/m² inclusive (n=56003; men, 41,0%; age, 67,4±14,5 years, CHA2DS2-VASc score, 3,4±1,8). The following BMI ranges were identified: 18,5-21,9 kg/m², 22,0-24,9 kg/m² (taken as a reference), 25,0-29,9 kg/m², 30,0-34,9 kg/m², 35,0-39,9 kg/m² and 40,0-60,0 kg/m². The indicators were analyzed in age ranges (≤64 years, 65-74 years, ≥75 years) separately among men and women.

Results. Among men ≤64 years of age, patients with overweight and class 2 obesity were characterized by a significantly higher incidence of IS. Among women ≤64 years, a significantly higher frequency of IS was found in subgroups with overweight and class 1-3 obesity, while among women aged 65-74 years — in a subgroup with a BMI of 18,5-21,9 kg/m². Patients aged ≥75 years showed an insignificant trend towards the maximum frequency of IS with a BMI of 18,5-21,9 kg/m². A higher frequency of anticoagulant therapy prescription was found in subgroups with overweight and class 1-3 obesity; in most age and sex subgroups, the differences are significant. A significantly lower frequency of anticoagulant therapy prescription to persons ≥75 years of age with a BMI of 18,5-21,9 kg/m² was noted.

Conclusion. The study showed a significant BMI paradox in the context of the relationship between the frequency of IS and BMI value in patients with AF. A higher incidence of IS in persons ≤64 years of age with a BMI ≥25 kg/m² compared with pa­tients with normal weight may be an additional argument for establishing an inde­pen­-
dent prognostic role of obesity in the development of thromboembolic events in AF.

Aim. To compare disturbances of the ascending aorta (AA) biomechanics in pa­­tients with moderate dilatation and aneurysm using segmental aortic strain ultrasound.

Material and methods. Fifteen patients with moderate AA dilatation (40-49 mm), 17 patients with AA aneurysm (≥50 mm) and 11 healthy volunteers (AA<40 mm) were examined using 2D multiplane transesophageal echocardiography (TEE). The entire thoracic aorta (TA) was assessed. Using 2D speckle-tracking TEE, global peak systolic circumferential strain (GCS, %), global peak systolic circumferential strain normalized to pulse pressure (GCS/PP) and aortic stiffness (β2) index at 4 TA levels (sinuses of Valsalva, sinotubular junction, mid-ascending aorta, descending aorta) were calculated.

Results. In healthy volunteers with TA diameter of 26,6 mm (25,2; 28,4) unidi­rec­tional uniform GCS of 9,7% (8,4; 11,7), GCS/PP of 18,4 (14,9; 2,.6) and uniform aortic stiffness (β2) 5,9 (4,8; 6,7) in all TA segments were revealed. There was a pro­portionally significant decrease in deformation parameters up to negative values and an increase of the ascending aortic wall stiffness from the aortic annulus to the descending aorta with a maximum in the highest dilatation zone in patients with moderate dilatation and aneurysm. Moreover, in these patients aortic wall strain and stiffness did not differ in all TA segments (p>0,05). The AA diameter in maximum dilatation zone in patients with aneurysm was significantly higher than in patients with moderate dilatation — 52 mm (51; 55) versus 47 mm (45; 48), p<0,001, respectively. An inverse correlation between the AA diameter in maximum dilatation zone and aortic strain (GCS: r=-0,61; p<0.001 and GCS/PP: r=-0,62; p<0,001) and a direct correlation with the aortic stiffness (β2) index (r=0,56; p<0,05) were revealed.

Conclusion. Assessment of the aortic biomechanics along with the AA diameter has an independent diagnostic value when choosing an individual surgical strategy in patients with moderate dilatation and AA aneurysm.

Aim. To assess short-to-mid-term clinical and echocardiographic outcomes and identify factors associated with pulmonary arterial hypertension (PAH) in patients older than 60 years.

Material and methods. Retrospective single-center study of 51 consecutive patients (mean age 63,3±3,2 years, 76% females) undergoing percutaneous ASD closure. Functional status, right ventricular (RV) remodeling and pulmonary artery systolic pressure (PASP) was assessed before and 24 hours after the procedure, at 6 months and 12 months.

Results. The mean ASD size was 21,8±4,4 mm. Compared to before procedure, at 24 hours a significant improvement of NYHA class (NYHA II-III 7 (13,7%) vs. 34 (66,7%) patients, p<0,0001, respectively), RV size (26,9±5,7 vs. 31,3±5,7 mm, p<0,0001, respectively) and PASP (26,9±5,7 vs. 50,4±14,2 mm Hg, p<0,001) was detected. At 1 year, RV size and PASP decreased to 22±4,6 mm, p<0,0001 and 33,8±10,8 mm Hg, p<0,0001, respectively, compared to before ASD closure, PAH remained in 10 (19,6%) patients. Pre-intervention PASP ≥57,5 mm Hg was an independent predictor of residual PAH at 1 year (odds ratio 1,31, 95% confidence interval (CI) 1,04-1,67, p=0,024; c-statistics 0,939, 95% CI 0,865-1,0, p<0,001, sensitivity 80%, specificity 92,6%).

Conclusion. Percutaneous ASD closure in elderly patients was associated with regression of RV size and PASP, as well as symptomatic improvement in the short- and medium-term. Pre-intervention PASP was an independent predictor associated with residual PAH after one year.

The classifications of the World Health Organization, the European Society of Car­-
diology and the American Heart Association indicate the existence of several pheno­types of myocardial non-compaction (MnC) with specific structural and func­tional abnormalities. The MnC+dilated cardiomyopathy (DCM) phenotype is considered one of the most severe variants. Disputes continue about whether to regard MnC as an independent disease or as a consequence of DCM and heart failure. In other words, MnC remains one of the most mysterious heart diseases. As an illustration of MnC+DCM phenotype, the authors offer a case of a patient with cardiovascular disease from her youth, but maintained a satisfactory state of health and performance until her old age. Symptoms of arrhythmia and heart failure with massive pericardial effusion were first described in her at the age of 66, which is uncharacteristic for this MnC phenotype. Attention is drawn to the difficulties of differential diagnosis of MnC due to the non-specificity of clinical performance, the role of echocardiography in the recognition of the disease and predictors of its unfavorable outcome. The fact that the patient, even when typical signs of MnC were detected during echocardiography, initially had coronary artery disease as the main diagnosis, indicates the relevance of publishing another case report on this rare pathology in order to improve the awareness of cardiologists and general practitioners.

Aortic stenosis is one of the most common valvular heart defects that occurs in patients with oncology after radiation therapy and requires surgical treatment. However, this group of patients has a higher risk of intra- and postoperative complications, and therefore the most optimal method of surgical treatment of aortic stenosis in such a cohort of patients is transcatheter aortic valve implan­tation (TAVI).

Brief description. Forty-six-year old woman entered the Almazov National Medi­cal Research Center with a clinical picture of severe aortic stenosis. At a young age, the patient was diagnosed with lymphogranulomatosis, or Hodgkin’s disease, for which radiation therapy was performed, which was complicated in the long term by valvular pathology. After a thorough examination, a high intraoperative risk for the patient was determined by the cardiac team and endovascular treatment of severe aortic stenosis was performed. The postoperative period was complicated by the development of complete atrioventricular block, which caused the implantation of a permanent dual-chamber pacemaker.

Discussion. The presented case is an example of successful surgical treatment of aortic stenosis associated with previous radiation therapy for Hodgkin’s disease in a patient.

Conclusion. Endovascular aortic valve implantation is a promising approach to the treatment of patients with post-radiation aortic stenosis, since it is associated with unfavorable anatomical and clinical risk factors for surgical valve replacement. Despite their younger age, these patients represent a category of higher surgical risk. Therefore, additional attention should be paid to the planning of the procedure and the prevention of the main TAVI risks.

According to recommendations of ESC 2020-year, de-escalation of therapy with a P2Y12 receptor inhibitor (transition from prasugrel or ticagrelor to clopidogrel) It can be considered as an alternative strategy of dual antiplatelet therapy (DAPT) for patients with acute coronary syndrome (ACS) who are unsuitable for the use of a strong platelet inhibitor.

De-escalation can be performed based on an individual clinical evaluation under the supervision of platelet function testing or CYP2C19 genotyping, depending on the patient’s risk profile and the availability of appropriate diagnostic methods. The optimal dosage of strong P2Y12 receptor inhibitors, such as ticagrelor or prasugrel is not entirely clear and is especially difficult to define for patients of Asian nationality.

The article describes a clinical case of antiplatelet therapy de-escalation, particularly a dose reduction of the potent P2Y12 receptor inhibitor ticagrelor in a patient after percutaneous coronary intervention (PCI) with a high risk of bleeding based on platelet function determination and genetic testing. A 47-year-old patient of Kazakh nationality was hospitalized with gastrointestinal bleeding.

Given bleeding type 3 by BARC (Bleeding Academic Research Consortium) associated with DAPT, it was decided to apply a strategy to de-escalate antiplatelet therapy under the control of platelet function testing (PFT) and genetic testing.

In this case, replacement of ticagrelor with the weak P2Y12 receptor inhibitor clopidogrel was not possible as the patient appeared to be a carrier of the CYP2C19*2 polymorphism contributing to loss of function of the cytochrome P-450(CYP) enzyme.

In the practice of pediatric cardiology, situations are possible when a child with congenital heart disease cannot be subjected to radical or even hemodynamic surgery. As a rule, such severe heart defects are combined with other genetic anomalies, which ultimately lead to the palliative status of the newborn. This situa­tion is a serious ethical and psychological challenge for medical workers in both the antenatal and postnatal periods. In the proposed article, we present a case of a child with congenital heart disease, which was part of frontonasal dysplasia due to ZSWIM6 gene mutation. This observation illustrates a number of ethical and psychological problems, difficult decisions and communication questions that are typical for such a difficult life situation as the birth of a terminally ill child. The example is illustrative in general for the ethical problems of a disabling congenital disease, which can be encountered in the practice of a pediatric cardiologist. From a broader perspective, the example illustrates uncertainty as an inevitable component of medical decision making and informing the patient (his legal representatives).

This review presents epidemiological data on the effect of sex hormones and reproductive status on the level of blood pressure (BP) and the incidence of es­sential hypertension (EHT) in women. The role of estrogen deprivation and hyper­androgenism in the development of EHT in peri- and postmenopause is discussed. The main mechanisms of EHT in periand postmenopausal women: sympathetic and renin-angiotensin-aldosterone system hyperactivity, salt-sensitivity, high prevalence of abdominal obesity, metabolic syndrome, left ventricular hypertrophy, left atrial dilatation and high risk of atrial fibrillation, stroke and heart failure with preserved left ventricle ejection fraction. Data on the efficacy and tolerability of the main classes of antihypertensive drugs in women is presented. We discussed the mechanisms of selective I1-imidazoline receptor agonists and the results of cohort studies of moxonidine monotherapy and its combination with other antihypertensive drugs and hormonal menopausal therapy in peri- and post­menopausal women. Moxonidine reduces high blood pressure in peri- and postmenopausal women and has a beneficial effect on metabolic syndrome components, but is also effective in patients with hypertensive crises, especially with sympathetic hyperactivity.

The article presents the results of a 20-year follow-up of patients in the ASCOT Legacy study, indicating that antihypertensive and lipid-lowering therapy reduces mortality in patients with hypertension and high cardiovascular risk in the long term. In the group of patients treated with amlodipine compared with the β-blocker atenolol, there was a decrease in mean systolic and diastolic blood pressure (BP), as well as a long-term improve in the form of a decrease in the prevalence of cardiovascular events and mortality due to stroke. An important feature of therapy based on amlodipine was the reduction in BP variability. The article reflects the results of major studies that determine the possibility and effectiveness of early prescription of combined antihypertensive and lipid-lowering therapy.

Russian Society of Cardiology, National Society of Preventive Cardiology

The Russian Society of Cardiology (RKO)

With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians