Heart failure (HF) is a global health problem. Despite advances in the development of effective treatments for patients with heart failure, morbidity and mortality from remain high, and the prognosis is poor. However, there is potential to improve outcomes in HF patients with current disease-modifying therapy. Planning needs and resources, assessing the effectiveness of care for HF patients in clinical practice requires high-quality epidemiological data. Previously performed Russian observational studies of HF were characterized by relatively small sample sizes, inclusion of patients in only one or a few regions, strict selection criteria, single-stage design, or short follow-up. The rationale and design of the all-Russian prospective observational multicenter registry study "PRIORITET-CHF", which included 20000 patients with HF throughout the Russian Federation, is presented. The main aims of the study are to (1) describe baseline clinical and demographic characteristics in outpatients with HF in the Russian Federation and (2) characterize routine therapy and evaluate the compliance of treatment for HF with reduced ejection fraction with current clinical guidelines.

Aim. To study the mortality rate of acute decompensated heart failure (ADHF) in patients with heart failure with reduced ejection fraction (HFrEF) within a year after implantation of cardioverter-defibrillator (ICD), to evaluate the potential of its prediction using transthoracic echocardiography.

Material and methods. The study included 384 patients with NYHA class 3-4 heart failure with left ventricular ejection fraction (LVEF) ≤35%, who were scheduled for ICD implantation for the primary prevention of sudden cardiac death (SCD). After ICD implantation, enrolled patients were followed up for a year to record the primary endpoint of death due to ADHF.

Results. During the 1-year follow-up, the primary endpoint was recorded in 38 patients (10%). A univariate logistic regression identified 14 echocardiographic parameters with the highest predictive potential (p<0,1) associated with the studied endpoint. Based on multivariate regression analysis, a prognostic model was developed, which included three factors with the highest statistical significance: LVEF, right atrial (RA) medial-lateral size, and pulmonary artery systolic pressure. The diagnostic efficiency of the model was 78,7% (sensitivity, 82,4%; specificity, 78,3%). A decrease in LVEF ≤28% and an increase in (RA) medial-lateral size ≥3,9 cm were found to be independent predictors of the studied endpoint.

Conclusion. Approximately 10% of HFrEF patients selected for ICD implantation for primary prevention of SCD die due to ADHF during the 1-year follow-up. Transthoracic echocardiography has potential to predict this outcome.

Aim. To estimate the incidence of chronic kidney disease (CKD) and develop a calculator to estimate the CKD probability in patients with myocardial infarction (MI) and acute kidney injury (AKI).

Material and methods. A total of 193 patients with MI aged 34-79 years were examined: 123 patients with MI and signs of AKI, 70 patients without AKI. In all patients, the levels of C-reactive protein, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), microalbuminuria (MA), creatinine, and glomerular filtration rate (GFR) were determined. In the presence of AKI criteria on the 3rd day and at discharge, the level of kidney injury molecule-1 (KIM-1) molecule and interleukin-18 was examined in the urine. Six months after discharge, GFR was assessed over time. Patients of both groups underwent coronary angiography with stenting of infarct-related artery.

Results. The GFR at admission in patients with AKI was lower than in the group without AKI with normal creatinine levels. Following correlations between AKI and markers of cardiovascular events were revealed: KIM-1 and NT-proBNP (r=0,29 p=0,031), GFR and NT-proBNP (r=-0,22 p=0,015), NT-proBNP and IL-18 (r=0,18 p=0,045), MA with troponin I and CRP (r=0,20 p=0,048 and r=0,29 p=0,001). After six months, persistent renal function decline was more frequently diagnosed in patients with acute MI and AKI on index hospitalization. An equation for a multifactorial model for CKD risk was created: P(CKD)=exp(z)/(1+exp(z)), z=-1,113092e+01 — 4,082006e-02 * troponin I + 8,553826e-04 * NT-proBNP (discharge) + 1,620188e-01 * age + 3,411724e-02 * systolic blood pressure -7,753111e-03 * MA. ROC analysis revealed the most reliable sensitivity of 83% and specificity of 88,2% for the threshold value of CKD probability of 86,1%.

Conclusion. Patients with MI and AKI have a significant risk of CKD within 6 months after ACS. The created mathematical model and calculator determine the likelihood of CKD.

Aim. Development of models for predicting in-hospital mortality (IHM) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) based on multivariate logistic regression (MLR).

Material and methods. This retrospective cohort study of 4735 electronic health records of patients (3249 men and 1486 women) with STEMI aged 26 to 93 years with a median of 63 years who underwent PCI was performed. Two groups of persons were identified, the first of which consisted of 321 (6,8%) patients who died in the hospital, while the second — 4413 (93,2%) patients with a favorable PCI outcome. To develop predictive models, univariate logistic regression (ULR) and MLR were used. Model accuracy was assessed using 3 following metrics: area under the ROC curve (AUC), sensitivity, and specificity. The end point was represented by the IHM score in STEMI patients after PCI.

Results. Statistical analysis made it possible to identify factors that are linearly associated with IHM. ULR was used to determine their weight coefficients characterizing the predictive potential. IHM predictive algorithms based on GRACE scale predictors, represented both by ULR model and by 5 factors in continuous MLR model, had acceptable predictive accuracy (AUC — 0,83 and 0,86, respectively). The MLR model had the best quality metrics, the structure of which, in addition to 5 GRACE factors, included left ventricular ejection fraction (LVEF) parameters and white blood cell (WBC) count (AUC — 0,93, sensitivity — 0,87, specificity — 0,86) . The greatest contribution to endpoint was associated with the Killip class and LVEF, and the smallest contribution was associated with WBC and the age of patients.

Conclusion. The predictive accuracy of the developed MLR models was higher than that of the GRACE score. The model with the structure represented by 5 fac­tors GRACE, LV EF and WBC had the highest quality metrics.

Aim. To determine the prognostic significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and soluble ST2 (sST2) in patients with post-myocardial infarction heart failure after a coronavirus disease 2019 (COVID-19)

Material and methods. Three following groups were formed: in patients of group I (main), who underwent inpatient treatment for COVID-19, the cause of heart failure (HF) was prior Q-wave myocardial infarction; in patients of group II (comparison) without COVID-19, the cause of HF was prior Q-wave myocardial infarction; Group III (comparison) — patients with HF of ischemic origin without postinfarction cardiosclerosis and COVID-19. Statistical processing was carried out using the software package IBM SPSS Statistics Version 26.0.

Results. The patients of all three groups included in the present study were comparable. After 6 months in group I, HF course worsening was recorded. In patients of groups I and II, an increase in NYHA HF class from 2 to 3 and 4 was recorded, in contrast to patients of group III, among whom the number of patients with class 3 HF decreased by 25% due to compensation to class 2. Patients of the studied groups, who had elevated serum levels of NT-proBNP and sST2, had more pronounced structural and functional myocardial disorders than patients with normal levels of these biomarkers. Using analysis of adverse cardiovascular events, such as recurrent myocardial infarction, cerebrovascular accident, hospitalization due to coronary artery disease, decompensated HF, which required hospitalization, a predictive model was developed using a neural network. There were following most important factors of the developed model: age, level of NT-proBNP and sST2, lung involvement according to computed tomography.

Conclusion. Modern biomarkers NT-proBNP and sST2 have sufficient predictive value to determine the risk of adverse events in HF.

Aim. To study the relationship of coronary microvascular dysfunction (CMD) with the levels of pro- and anti-inflammatory biomarkers in patients with preserved ejection fraction (LVEF) and non-obstructive coronary artery disease (CAD).

Material and methods. The study included 118 patients (70 men, mean age, 62,0 [58,0; 69,0] years) with preserved LVEF (62 [59; 64] %) and non-obstructive CAD. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), interleukin-1β, 6, and 10 were assessed initially by enzyme immunoassay. Coronary flow reserve (CFR) was assessed by dynamic single photon emission computed tomography. CFR ≤2 was a CMD marker.

Results. Patients were divided into groups depending on CMD presence: group 1 included patients with CMD (n=45), and group 2 was the control group and included patients without CMD (n=73). HsCRP concentrations were 1,8 times higher (p=0,011) in group 1 compared to group 2. Interleukin-6 levels did not differ significantly between groups (p=0,842), while interleukin-10 concentrations were lower by 21,7 % (p=0,048), and interleukin-1β was 2,7 times higher (p=0,046) in group 1 compared to group 2. According to ROC analysis, hsCRP concentration ≥4,8 g/l (AUC=0,655; p=0,012), and NT-proBNP ≥950,6 pg/ml (AUC=0,792; p<0,001) were identified as markers associated with CMD in patients with non-obstructive CAD, while levels of interleukin-1β, 6 and 10 showed no diagnostic significance. Multivariate regression analysis showed that diastolic dysfunction (odds ratio, 3,27; 95% confidence interval, 2,26-5,64; p<0,001) and NT-proBNP ≥950,6 pg/ml (odds ratio, 2,07; 95% confidence interval, 1,56-4,12; p=0,023) were independent factors associated with CMD.

Conclusion. We established that in patients with non-obstructive CAD, the pre­sence of CMD is associated with a higher expression of pro-inflammatory markers and a decrease in the expression of an anti-inflammatory marker, which may confirm the fact that chronic inflammation is one of CMD pathogenesis links.

Aim. To compare two methods for the determination of N-terminal pro-brain natriuretic peptide (NT-proBNP) and soluble ST2 (sST2): rapid immunochemical methods and standard enzyme immunoassay (ELISA), as well as to determine the possibility of rapid tests for determining these biomarkers in acute myocardial infarction (AMI).

Material and methods. This open, non-randomized, single-center observational study included 41 patients: 20 with non-ST-elevation myocardial infarction (non-STEMI) and 21 with ST-elevation myocardial infarction (STEMI), without cardiogenic shock and active inflammatory process. During hospitalization, all patients underwent the level of NT-proBNP using an immunological fluorometric analyzer AQT90 FLEX (Radiometer, Germany) and sST2 immunological method for assessing lateral flow using an ASPECT Reader™ T2 analyzer (Critical diagnostics, USA). Then, studies of these biomarkers by standard ELISA were delayed.

Results. The Spearman correlation coefficient for rapid NT-proBNP and NT-proBNP-ELISA was 0,5937 (p=0,00000087). At the same time, the proportion of patients with an NT-proBNP level >300 pg/ml in the rapid test was significantly higher than in the ELISA: 90% vs 44% (p<0,05). In a comparative analysis of two methods for sST2, the Spearman correlation coefficient for rapid sST2 and sST2-ELISA is 0,9561 (p=0,0000007). The proportions of patients with sST2 >35 ng/ml with rapid and ELISA methods did not differ significantly and amounted to 53 and 55%. Rapid NT-proBNP were significantly different between Killip I and Killip III (p=0,043): Me=1375,00 (669,00; 3140,00) vs Me=3660,00 (1815,00; 6890,00). There were no significant changes in the rapid sST2 level depending on Killip class.

Conclusion. Correlations were found between rapid and ELISA methods in patients with AMI: medium in strength for NT-proBNP and strong for sST2. The proportion of patients with NT-proBNP levels >300 pg/mL in the rapid test was significantly higher than in the ELISA. Therefore, a conversion formula is needed, for which the available data are insufficient. The proportion of patients with sST2 >35 ng/ml in the rapid and ELISA methods did not differ significantly. A direct relationship between the level of rapid NT-proBNP and Killip class was found. No dependence of the level of rapid sST2 on Killip class was found.

Aim. To analyze the effect of exercise on cerebral hemodynamics in borderline ste­­nosis of internal carotid artery (ICA) (40-69%) in asymptomatic patients.

Material and methods. The study included 120 patients: group I (n=40) — without signs of carotid bifurcation atherosclerosis; II (40) — with hemo­dynamically insignificant stenosis of ICA (40-69%): IIA — with ICA stenosis of 40-59% (18); IIB — 60-69% (22); III (40) — with hemodynamically significant stenosis of ICA (≥70%, without occlusion). All patients underwent following investigations: blood coagulation and lipid profile tests; doppler ultrasound of extracranial vessels, sphygmography of the common carotid artery (CCA), brain computed tomography, transcranial doppler ultrasound, cycle ergometer stress echocardiography with determination of ICA stenosis hemo­dynamics.

Results. In most (29 (72,5%)) patients of group II, stress test revealed a de­crease in ICA flow, CCA kinetics according to sphygmography compared with group I, as well as a direct correlation between the degree of stenosis and a blood flow decrease. The indicators approached the data of group III patients.

Conclusion. With stenosis of the ICA (40-69%), when a submaximal heart rate (HR) is reached, a functional hemodynamically significant stenosis of the ICA develops. An additional indication for carotid endarterectomy is a combination of 40-69% stenosis and functional hemodynamically significant stenosis when submaximal heart rate is reached. Patients with ICA stenosis (40-69%) require a stress test to assess functional hemodynamically significant stenosis when submaximal heart rate is reached.

Aim. To analyze the right ventricular (RV) functionality in a cohort of heterogeneous cardiac surgical patients with left-sided valvular heart disease and determine the contribution of RV dysfunction in the complicated postoperative period according to echocardiography.

Material and methods. A single-center prospective study of patients with left heart defects operated on in 2022 was conducted. Age ranged was 20-81 years, with a median age of 58 years. The study was conducted on a PHILIPS EPIQ CVx system using an X5-1 probe.

Results. To estimate the risk of a complicated postoperative period depending on various indicators of RV systolic function assessment, ROC-analysis was performed. The ROC curve of the RV free wall longitudinal strain (RV FW LS) was characterized by the highest AUC value among other RV functional measures, equal to 0,81±0,06 (95% confidence interval (CI): 0,68-0,93), p<0,001. A value of 20% was selected as the cut-off point of RV FW LS for predicting a complicated postoperative period. The RV FW LS <20% was 19,2 times more likely to develop a complicated course (95% CI: 5,64 to 65,50), compared with the RV FW LS group ≥20%; p<0,05. The odds of heart failure (HF) in the RV FW LS <20% group were 22,78 times higher (95% CI: 5,90 to 88,04), compared with the RV FW LS ≥20% group; p<0,05.

Conclusion. The RV FW LS <20% can be considered an independent predictor of complicated postoperative period with a multiple increase in the risk of complications, mainly the risk of heart failure. The assessment of RV FW LS can significantly help in risk stratification, being the reason for the reclassification of a number of patients in the high-risk group with a possible modification of surgical strategy.

Aim. To assess the impact of frailty syndrome (FS) on the risk of myocardial infarction (MI) and atrial fibrillation (AF) in people aged ≥65 years.

Material and methods. A prospective cohort study of a random sample of a free-living population aged ≥65 years (n=611). Measurement of blood pressure, analysis of therapy, chronic comorbidities, laboratory tests, comprehensive geriatric assessment were performed.

Results. FS is associated with an increased risk of MI and AF at 2,5 years of follow-up (odds ratio (OR), 3,195, 95% confidence interval (CI), 1,129-9,042; OR, 1,609, 95% CI, 1,013-2,555, respectively). Additional risk factors for MI and AF were high levels of C-reactive protein, type 2 diabetes, and blood pressure.

Conclusion. FS was one of the risk factors for MI and AF during 2,5-year follow-up. Common pathogenetic mechanisms for FS and cardiovascular disease, such as chronic inflammation and insulin resistance, may explain the increased risk of MI and AF in patients with FS. Hypertension retains significance in increasing the risk of MI in patients with FS, which must be taken into account when prescribing antihypertensive therapy. FS screening can be used to assess the risk of cardio­vascular events in the elderly and senile age.

Aim. To study cardiac hemodynamic disorders in patients 3, 6 and 12 months after coronavirus disease 2019 (COVID-19).

Material and methods. Sixty-six patients with bilateral pneumonia (mean age, 36,1 years), treated for COVID-19, underwent echocardiography, Doppler ultrasound of hepatolienal blood flow vessels after 3, 6, 12 months. Patients were divided into groups based on computed tomography (CT) data: group 1 — 21 patients with CT1, group 2 — 25 patients with CT2, group 3 — 20 patients with CT 3-4. In the 3rd group, 60% of patients had excessive weight. IBM SPSS Statistics Version 25.0 was used.

Results. Three months after the disease in all groups, there was a impairment of diastolic parameters studied on the tricuspid valve. Patients of the 3rd group had pulmonary hypertension, an increase in splenic vein diameter, and the spleen area. After 6 and 12 months. in all groups, there was an improvement in right ventricular diastolic filling. In group 3, pulmonary artery systolic pressure after 6 months decreased by 6,0 (3,7; 6,5)% (p=0,03), after 1 year by another 8,6 (5,4; 9,1)% (p=0,017). The diameter of the inferior vena cava after 6 months decreased by 4,8 (2,0; 10,2)%, and a year later by another 5,0 (4,4; 6,1)% (p=0,001); the splenic vein diameter decreased after 6 months by 7,3 (3,2; 10,4)% (p=0,005). The left ventricular (LV) global systolic strain reduced after 3, 6 and 12 months.

Conclusion. All patients 3 months after COVID-19 had cardiac hemodynamic disorders, which further by 6 and 12 months tend to normalize right ventricular diastolic filling. In patients with CT 3-4, by 12 months after the disease, normalization of pulmonary artery systolic pressure was also noted, a decrease in the diameter of the inferior vena cava and splenic veins, and a decrease in the global LV systolic strain persisted.

Aim. To evaluate the severity of coronary atherosclerosis and its association with biochemical markers of fibrosis in patients with coronary artery disease (CAD) and resistant hypertension (RHT).

Material and methods. The study included 39 patients with CAD and RHT. All patients underwent 24-hour blood pressure (BP) monitoring, office BP numbers were measured. Laboratory diagnostics included routine tests, as well as determination of serum lipocalin, plasma concentration of matrix metalloproteinases 2 and 9 (­MMP-2, MMP-9), tissue inhibitor of matrix metalloproteinases-1 (TIMP 1). Coronary atherosclerosis in patients was assessed retrospectively according to medical records with an assessment of the protocols of invasive coronary angiography and multislice computed tomography, performed no more than a year ago from the moment of inclusion in the study with no clinical signs of CAD progression. Obstructive atherosclerosis was considered a coronary artery narrowing by more than 50%.

Results. Considering the results of previous coronary angiography, the patients were divided into two groups. In the first group (n=20), coronary artery stenosis was <50%, in the second (n=19) >50% (p<0,05). The compared groups of patients were comparable in sex, age, duration of hypertension, blood pressure level, and the number of antihypertensive drugs taken. There were no differences in blood lipid profile, basal glycemia, uric acid levels, and the frequency of previous cerebral accidents. However, the incidence of diabetes in group 2 was significantly higher (p<0,05). Additionally, there was a significant difference in serum levels of lipocalin and MMP-2 with higher values of these indicators in patients with coronary atherosclerosis stenosis (p=0,02).

Conclusion. In patients with RHT with symptoms and signs of myocardial ische­­mia, the incidence of obstructive coronary atherosclerosis according to coronary angiography is 50%. Diabetes in this category of patients indicates a more frequent obstruction of coronary bed. An increase in the level of MMP-2 and lipocalin in this category of patients is associated with more severe coronary damage and can be considered as an indirect indicator of obstructive coronary atherosclerosis.

The use of an artificial circulation and endovascular technologies in the treatment of liver metastases of uveal melanoma is a highly relevant area. Uveal melanoma is a rare cancer from the uveal tract of the eye. The liver is the most common site of metastasis and is affected in 70-90% of cases, being the only site of metastasis in about 50% of cases. Survival ranges from two to three months. This literature review describes the following methods of treatment of liver metastases of uveal melanoma using a heart-lung machine: arterial (arterio-caval), portal (porto-caval), arterio-porto-caval, retrograde arterio-portal. Special attention is paid to the endovascular method of treatment.

Literature sources were searched in the following electronic libraries: elibrary.ru, pubmed.ncbi.nlm.nih.gov, researchgate.net.

Aim. To evaluate the cost-effectiveness of empagliflozin therapy in patients with heart failure (HF) across the ejection fraction (EF) range in the Russian Fe­­deration.

Material and methods. An analysis of the cost of HF management was carried out and an analytical decision-making model was built in MS Excel, which makes it possible estimating the costs of HF management with empagliflozin from the state position.

Results. Taking into account the direct costs of adverse events, as well as indirect costs, the potential economic benefit of empagliflozin use for 766028 HF patients with low EF could be RUB 7,6-7,8 billion per year of therapy, while for 5790280 patients with HF with moderately reduced and preserved EF — RUB 27,6-29,6 billion per year of therapy. The potential economic benefit of empagliflozin for 664960 patients with HF immediately after hospitalization for an HF exacerbation could be RUB 1,4-1,6 billion per year of therapy, allowing to prevent 69438 deaths and 60822 repeated exacerbations of HF.

Conclusion. Empagliflozin is the optimal regimen for the treatment of patients with HF across the entire EF range, both with and without type 2 diabetes, both in terms of clinical efficacy of treatment and economic feasibility.

High rates of cardiovascular (CV) morbidity and mortality dictates the need to determine approaches to therapy that would reduce complications rate and improve patient’s prognosis. High-intensity statin therapy is an integral part of the treatment of patients with high and very high cardiovascular risk. At the same time, there is a large cohort of patients who would benefit from moderate intensity statin therapy. In the present article we have summarized available data on hypolipidemic effects, pleiotropic effects and role of moderate intensity statin therapy, atorvastatin particularly, in reding the risk of major adverse cardiac events.