Aim. To evaluate the effect of 5-hydroxymethyluracil on the dynamics of angiogenic growth factors in the perioperative period of surgical myocardial revascularization.

Material and methods. This prospective, randomized, single-center study included two following groups: experimental group — 25 patients in the perioperative period of coronary artery bypass grafting (5 days before and 14 days after surgery) receiving 5-hydroxymethyluracil (at a dose of 500 mg 3 times a day) in addition to standard therapy; control group — 25 patients receiving standard therapy. The groups were comparable in terms of sex, age, main clinical and functional characteristics and features of surgical intervention. In patients, quantitative indicators of angiogenic growth factors in peripheral blood taken 5 days before and 14 days after surgery were studied by enzyme immunoassay: human vascular endothelial growth factor A (VEGF-A), human hepatocyte growth factor (hHGF), insulin-like factor growth 1 (IGF-1) and basic fibroblast growth factor (bFGF).

Results. In the experimental group of patients, while taking 5-hydroxymethyluracil, there was a significant increase in the peripheral blood concentration of following growth factors compared with the control group: VEGF-A by 26,90% (p=0,0246), IGF-1 by 44,89% (p=0,0011), bFGF by 60,0% (p=0,0006). The hHGF concentration also turned out to be higher by 19,90%, but did not reach the level of statistical significance (p=0,2836).

Conclusion. The use of 5-hydroxymethyluracil, a representative of pyrimidines, in the perioperative period of surgical myocardial revascularization leads to a significant increase in peripheral blood of such angiogenic growth factors as VEGF-A, IGF-1, and bFGF.

The burnout syndrome among healthcare professionals is a headline problem in the world, as it leads to poor health of medical workers, affects patient satisfaction with health care and the healthcare system as a whole. At the same time, existing preventive measures can improve the well-being of staff.

Aim. To study the prevalence of professional burnout syndrome among practicing cardiologists in the Russian Federation (RF).

Material and methods. This cross-sectional study was carried out using the method of online anonymous surveying. The inclusion criterion was the current practical activity in the RF. The study involved 452 cardiologists from 8 federal districts (women; n=377, 83,4%), 48,2% of which worked in a hospital. Occupational burnout was assessed using the Maslach Burnout Inventory (MBI) questionnaire in the Russian language adaptation for healthcare workers by N. E. Vodopyanova and E. S. Starchenkova. The score was calculated on three subscales (emotional exhaustion, depersonalization, personal accomplishment), the maximum score for the subscales was 54, 30 and 48, respectively. The personal accomplishment subscale is the opposite as follows: the higher the score, the less the symptom severity. Additionally, demographic parameters, working conditions, the desire to change job and field of activity were taken into account. Regression analysis was used to establish associations of burnout with factors.

Results. The median score of the emotional exhaustion subscale was 29,5 (23,0; 35,0) points, depersonalization — 12,0 (8,0; 16,0) and personal accomplishment — 32,0 (28,0; 37,0). Men had higher depersonalization score than women as follows: 15,0 (10,0; 18,0) vs 11,0 (8,0; 15,0), p=0,001. High degrees of emotional exhaustion and depersonalization (burnout) were found in 235 (52%) cardiologists, while all three symptoms simultaneously — in 132 (29,2%) doctors. There were no symptoms of burnout in 84 (18,6%) cardiologists. A high degree of burnout was associated with a desire to change job (p<0,001).

Conclusion. A high prevalence of professional burnout among practicing cardiologists in the RF was revealed, which, in turn, is associated with the desire to change job or occupation.

Aim. To identify and study the nature of sleep-related breathing disorders (SBDs) in a cohort of hospitalized patients with heart failure (HF) with reduced and mildly reduced ejection fraction (EF), as well as to clarify the relationship between SBD type, etiology and severity of HF.

Material and methods. The study included 117 patients with HF with reduced and mildly reduced ejection fraction hospitalized at the National Medical Research Center for Therapy and Preventive Medicine from 2019 to 2021. All patients underwent clinical and paraclinical examination, including cardiorespiratory sleep study. Patients were divided into three groups according to the type and severity of SBD: no or mild SBD, predominantly with obstructive sleep apnea (OSA) and predominantly with central sleep apnea (CSA). Severity of SBD and clinical data were compared between these groups.

Results. A total of 5 patients (4,27%) did not have any SBDs, while 47 (40,17%) were diagnosed with CSA, and 65 (55,56%) — OSA of varying severity. The proportions of patients with moderate and severe CSA and OSA differed insignificantly and amounted to 35,9% (n=42) and 44,4% (n=52), respectively. There were following proportions of diseases related to HF: coronary artery disease (41,88%), nonischemic cardiomyopathy (26,5%), arrhythmogenic cardiomyopathy (15,38%) and other causes (16,24%) (hypertension, myocarditis, heart defects). We found that reduced EF <40%, end-diastolic volume >210 ml, and ventricular ectopy (>300 extrasystoles/day) were associated with CSA, and body mass index >30 kg/m² was traditionally associated with OSA.

Conclusion. More than half of HF patients with reduced and mildly reduced EF have SBDs. Decreased LVEF and ventricular ectopic activity are associated with CSA, while increased body mass index is associated with OSA. Consideration of SBD risk factors may improve patient phenotyping for individualized therapy.

Echinococcosis refers is a chronic disease caused by tapeworms of the order Cyclophyllidea. Echinococcal cysts increase in size slowly and are often asymptomatic, and the symptoms of cardiac echinococcosis are nonspecific, which in turn can make diagnosis difficult. Early diagnosis and surgical treatment of this disease is crucial to prevent severe complications. Considering that the heart is affected extremely rarely, we want to demonstrate the successful surgical treatment.

Infiltrative cardiomyopathies are a group of diseases characterized by the deposition of abnormal substances in heart tissues, which leads to thickening of the walls or dilation of chambers with a secondary decrease in wall thickness and the development of diastolic, less often systolic, ventricular dysfunction. Most often, these are progressive diseases that, in the absence of adequate therapy, have an unfavorable prognosis. Clinical manifestations of infiltrative cardiac diseases are variable, which often leads to diagnostic difficulties and errors. In most cases, specific laboratory and morphological tests are required to confirm or clarify the diagnosis. Early diagnosis is critical to initiating therapy and improving patient prognosis. This article provides characteristic signs and symptoms, the so-called "red flags", making it possible to suspect infiltrative cardiomyopathies, diagnose them at an early stage and start life-saving therapy.

Aim. To evaluate the literature data on the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) in the prevention of postoperative atrial fibrillation (POAF) in elective cardiac surgery, including onor off-pump coronary artery bypass grafting and/or valve replacement and/or repair.

Material and methods. The search for studies was carried out using the PubMed database and Google Scholar from 2005 to January 31, 2022. From the initially identified search results, 19 articles were analyzed. The design of articles corresponded to randomized clinical trials. Omega-3 PUFAs was selected as an interventional effect. The studies were to include, as an end point, the assessment of new POAF cases in the early period after open heart surgery.

Results. The meta-analysis included 15 studies with 3980 patients, of which 1992 (50,0%) patients took omega-3 PUFAs. POAF occurred in 587 (29,5%) patients receiving omega-3 PUFAs and 679 (34,2%) patients on standard therapy (hazard ratio, 0,8, 0,68-0,93, p=0,004). There is a variation in effect size for POAF patients in the presented randomized clinical trials relative to the axis of the central trend and heterogeneity of studies with a significant number of patients included (I²=51%, p=0,01).

Conclusion. Our systematic review and meta-analysis showed the effectiveness of omega-3 PUFAs in the prevention of POAF during open heart surgery.

Aim. To conduct a systematic review and meta-analysis to compare clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) using conventional coronary angiography (CAG) or fractional flow reserve (FFR)-guided PCI. In addition, FFR-guided PCI and PCI guided with instantaneous wave-free ratio (iFR) were compared.

Material and methods. PubMed, Google Scholar databases were searched for studies comparing clinical outcomes in patients with CAD undergoing CAG-guided or FFR/iFR-guided PCI. Dichotomous data analysis was presented as odds ratio (OR) with 95% confidence interval (CI). Adjusted hazard ratio (HR) values from studies with similar evaluation criteria were pooled for meta-analysis.

Results. Six randomized controlled trials (RCTs) from 184 publications were selected for this systematic review and meta-analysis. A total of 2193 patients (mean age, 64,2 years, mean follow-up, 28,0 months) were included. Analysis of RCTs showed that CAG-guided and FFR-guided PCI did not have a significant difference in the incidence of major adverse cardiovascular events (MACE) (OR: 0,78; 95% CI: 0,61-1,00; p=0,05; I²=0%), all-cause death (OR: 0,86; 95% CI: 0,51-1,44; p=0,57; I²=0%) or emergency revascularization (OR: 0,69, 95% CI: 0,46-1,04, p=0,08, I²=0%). However, FFR-guided PCI was associated with a reduced risk of subsequent MI compared with CAG-guided PCI (OR: 0,70; 95% CI: 0,50-0,99; p=0,04; I²=0%). In addition to the results of previous RCTs, we conducted a metaanalysis of 3 observational studies. In total, the CAG-guided and FFR-guided PCI groups included 165012 and 11450 patients, respectively. A meta-analysis showed that FFR-guided PCI was associated with a reduced risk of all-cause mortality (HR: 0,74; 95% CI: 0,63-0,87; P=0,0003) and MI (HR: 0,75; 95% CI: 0,61-0,94; p=0,01). In addition, there was no significant difference between iFRand FFR-guided PCI in terms of MACE (OR: 0,97; 95% CI: 0,76-1,23; p=0,81), all-cause mortality (OR: 0,66; 95% CI: 0,40-1,10; p=0,11), MI (OR: 0,83; 95% CI: 0,56-1,24; p=0,37) or emergency repeated revascularization (OR: 1,16; 95% CI: 0,85-1,58; p=0,34).

Conclusion. FFR-guided PCI is associated with a reduced risk of all-cause mortality and subsequent MI compared with CAG-guided PCI. At the same time, the iFR-guided PCI is not inferior to the FFR-guided method in terms of MACE rate.

Patients with pulmonary hypertension (PH) associated with left heart disease usually have a complex comorbidity status and a postcapillary component of PH. The presence and identification of a combined post-/precapillary PH in a cohort of patients with left heart disease is reflected in the more pronounced structural and functional right ventricular changes due to higher pulmonary vascular resistance. Patients with combined post-/ precapillary PH have reduced exercise tolerance and PH phenotype similar to pulmonary arterial hypertension. Detection of combined PH is critical as it may influence the prognosis and management of patients. This review presents modern prognosis markers for patients with PH due to left heart disease, which can be used in clinical practice. The results of randomized clinical trials and pilot studies on the expansion of treatment options in group 2 patients, including the use of PAH-specific agents, were analyzed. The prospects for the treatment of this cohort of patients are discussed.

Left ventricular global function index (LVGFI) is a novel indicator for assessing LV function, considering the main components of cardiac remodeling, obtained using magnetic resonance imaging and echocardiography. Works with the assessment of normal LVGFI values were analyzed. The review provides data on the diagnostic and prognostic efficacy of LVGFI in various cardiovascular diseases, such as heart failure, myocardial infarction, cardiomyopathy, and amyloidosis. Examples of LVGFI calculation in healthy patients and in those with listed pathologies are also presented.

Cardiogenic shock is the leading cause of death among patients with acute coronary syndrome. This pathology is characterized by high rates of inhospital and annual mortality. In Russian literature, data on the prevalence, diagnosis and treatment of patients with cardiogenic shock are limited. Therefore, the main aim of this publication is to increase the awareness of specialists about modern approaches to the diagnosis and treatment of this condition. This review discusses in detail the main causes of cardiogenic shock, aspects of pathophysiology, modern classification, diagnosis, and algorithms for pharmacological and non-drug therapy in patients with cardiogenic shock.