The impact of adverse factors in the early life can affect the rate of vascular aging in adulthood and be passed on to the next generations.

Aim. To study the characteristics of arterial stiffness and vascular aging phenotypes in two generations of descendants (children and grandchildren) of the siege of Leningrad survivors, compared to a control group.

Material and methods. Residents of the siege of Leningrad who experienced famine during early childhood in the Great Patriotic War (19411944) underwent examination between 2009 and 2014. In 2020-2021, 76 descendants of Leningrad siege survivors, aged 18 to 63 years (children — 54 (first generation) and grandchildren — 22 (second generation)), without diagnosed cardiovascular diseases, were examined. Questioning, measurement of blood pressure (BP) and biochemical blood tests were carried out. The cardio-ankle vascular index (CAVI) was determined using the VaSera VS-1500 system (Fukuda Denshi, Japan). Carotid-femoral pulse wave velocity (cfPWV) was assessed using applanation tonometry (SphygmoCor, AtCor, Australia). The phenomenon of supernormal vascular aging was diagnosed with cfPWV £10^th percentile of the reference European population, normal vascular aging with cfPWV of 10^th-90^th percentiles, and early vascular aging with cfPWV ³90^th percentile, taking into account age and BP (MattaceRaso F et al., 2010). Several control respondents from the ESSE-RF study (St. Petersburg residents aged 25-64 years) were selected for each descendant, considering generation, sex, age, and BMI. The statistical significance of results was adjusted for multiple comparisons.

Results. The average age of descendants of Leningrad blockade survivors was 50 [36,7-55,0] years, which was comparable to the controls, who were 51 [37,5-55,0] years old (p=0,44). The proportion of men in the samples was also comparable — 43,4% vs 42,3% (p=0,88). The cfPWV values were similar in the study and control groups (p=0,4). Only CAVI values were lower in descendants compared to controls, with significant differences observed only in the first generation, regardless of sex (men — 7,6 [7,1;8,3] in the experimental group vs 8,6 [7,6;9,3] in the control group, p=0,02; women — 7,2 [6,7;7,8] in the experimental group vs 7,8 [7,3;8,2] in the control group, p=0,03). The phenotype of early vascular aging was found only in one participant from the experimental group, while the phenomenon of supernormal vascular aging was significantly more prevalent in the age group of 40-49 years in descendants of Leningrad blockade survivors compared to the control group — 25% vs 0% (p=0,01).

Conclusion. Only in the first generation of descendants of Leningrad blockade survivors, a favorable pattern of arterial stiffness and a tendency towards a higher prevalence of supernormal vascular aging were observed compared to the control group.

Aim. To study brain magnetic resonance imaging (MRI) changes in patients with resistant hypertension (HTN) after renal denervation (RD) and its cerebral protection effectiveness.

Material and methods. The study included 111 patients, of whom 50 were men (45%) and 61 were women (55%), who underwent RD. The mean number of antihypertensive drugs taken regularly was 4,1±1,1. All patients underwent brain MRI and 24-hour ambulatory blood pressure monitoring before and after renal denervation. The data were statistically processed using Statistica 10,0 software.

Results. After RD, a pronounced antihypertensive effect was observed with a significant reduction in systolic and diastolic blood pressure by 10,3/5,5 and 13,1/7,3 mm Hg at 6 and 12 months, respectively. Office blood pressure, daytime, and nighttime blood pressure levels also decreased (p<0,001). According to MRI data after RD, a decrease in the relative number of patients with I and II degree cerebrospinal fluid circulation changes and an increase in the proportion of patients without detected pathology were noted, but no significant difference in the obtained results was found. A decrease in the linear dimensions of brain ventricles was observed, including a reduction in the size of the left posterior horn of the lateral ventricle (p=0,03) and the third ventricle diameter (p=0,02) at 6 months after RD. At 12 months, the sizes of the anterior horn (p=0,04) and left lateral ventricle body (p=0,017) decreased. A positive effect of RD on the linear dimensions of cerebrospinal fluid system was noted, manifested by a decrease in the mean size of frontal subarachnoid spaces (p=0,028). No significant changes in the frequency and degree of focal lesions and lacunar infarcts were observed after RD (p>0,05).

Conclusion. RD contributes to a significant decrease in blood pressure levels and exerts a cerebral protective effect by reducing lateral brain ventricles, subarachnoid spaces, and absence of ischemia progression and intracranial hypertension after intervention.

Aim. To study the features of 12-lead electrocardiography (ECG) in patients with critical aortic stenosis referred for transcatheter aortic valve implantation.

Material and methods. The study included 50 patients aged 76,6±6,5 years. The presence of intraventricular block, voltage criteria for left ventricular hypertrophy (LVH), fragmented QRS complex, and repolarization alternans were assessed on the ECG. The frontal QRS-T angle (fQRS-Ta) was estimated as the absolute value of the difference between the QRS axis and T wave axis.

Results. Intraventricular blocks were present in 10 (20%) patients: 8 (36%) patients with pulmonary hypertension (PH), 2 (7%) patients without PH (p=0,028). Voltage criteria for LVH were present in 24 (60%) patients. In the presence of voltage criteria for LVH, the mean aortic valve gradient, the left ventricular mass index (LVMI) and the aortic valve area (AVA) were significantly greater. Fragmented QRS complex in the chest leads was more common in patients with past myocardial infarction, intraventricular block, with PH. Strain pattern was present in 9 (23%) patients, while nonspecific repolarization changes — in 27 (67%) patients. Patients with strain pattern had significantly higher mean pressure gradient and more often had PH. Correlations were found between fQRS-Ta and mean pressure gradient (r=0,39; p=0,005), AVA (r=-0,40; p=0,004), LVMI (r=0,30; p=0,03). The fQRS-Ta was significantly greater in the presence of PH — 128±48^o, while without PH — 97±49^o (p=0,03).

Conclusion. In the studied group of patients with aortic stenosis, intraventricular block, fragmented QRS in the chest leads, strain pattern were more common in the presence of PH. In the presence of voltage criteria for LVH, LVMI, mean pressure gradient were significantly greater, while AVA — lower. The fQRS-Ta was significantly greater in the presence of intraventricular blocks, PH, as well as orrelated with mean pressure gradient and AVA.

Sudden cardiac death (SCD) is a major medical, economic and social problem. Survival after SCD remains low. Its leading mechanism is fatal ventricular tachyarrhythmias. The only highly effective aid remains an implantable cardioverter defibrillator (ICD). According to modern concepts, myocardial fibrosis (MF) is the leading cause of life-threatening ventricular arrhythmias. Magnetic resonance imaging (MRI) has become the standard for non-invasive MF imaging and one of the leading methods for its quantification, which is why this method is recommended for determining indications for ICD implantation. MRI can show the scar location, which should be taken into account when placing the lead, and determine its size, which predicts the effectiveness of ICD implantation. Identification of MF in patients with life-threatening ventricular arrhythmias is an important area of research aimed at identifying the risk of SCD. Delayed contrast-enhanced MRI can be considered as a marker to improve SCD risk stratification.

Introduction. Sepsis is a life-threatening organ failure caused by the body’s dysregulated response to infection. The prevalence of sepsis-induced cardiomyopathy (SICM) in patients with sepsis ranges from 10 to 70%, while there are no special sections on SICM in the known resuscitation manuals. There is also a lack of large clinical trials evaluating the effectiveness of SICM treatment.

Case. A 59-year-old patient was urgently hospitalized in the intensive care unit with shock of unknown origin. Emergency coronary angiography revealed no coronary obstruction. Two hours after admission, asystole was recorded with effective cardiopulmonary resuscitation, mechanical ventilation, infusion of inotropic and vasopressor drugs. The patient was diagnosed with leukocytosis up to 19*10⁹/l, procalcitonin >0,5 ng/ml. Subsequently, stage 2 acute kidney injury, pneumonia, acute respiratory distress syndrome, sepsis, SICM, combined shock (cardiogenic, septic) were diagnosed. Antibiotic and hemosorption therapy using a CytoSorb column were started. On the 6^th day, there was a improvement of hemodynamic parameters, a decrease in the rate of vasopressor infusion, and normalization of the left ventricular ejection fraction. The condition has stabilized with further favorable changes.

Discussion. Despite the wide prevalence and high mortality in SICM, this condition is not well described in the literature, and there are no clear diagnostic criteria and treatment algorithms. This case demonstrates the effective treatment of SICM at the stage when the prognosis of patients becomes extremely unfavorable, reaching 90% mortality.

Conclusion. This case demonstrates the effective treatment of SICM as an element of multiple organ failure, in the outcome of sepsis, using efferent methods, when the prognosis becomes extremely unfavorable. Personalized approach and management of these patients is critical to improve disease outcomes.

Primary cardiac tumors are histologically heterogeneous and grow from the heart tissues. Their diagnosis is difficult due to the absence of pathognomonic signs, as well as the possibility of a long asymptomatic course. The authors present a case of late diagnosis of heart tumor in a young man, occurring under the guise of constrictive pericarditis with rapidly progressive heart failure, which ended in death 3 months after the first clinical symptoms. According to the autopsy, the histological picture and immunophenotype of the tumor corresponded to angiosarcoma.

Aim. To identify risk factors for atrial fibrillation (AF) in patients with aortic and mitral defects after surgical treatment.

Material and methods. A total of 112 patients with aortic and mitral defects (excluding patients with mitral stenosis) were examined: 90 men and 22 women aged 18 to 72 years (median age, 51(35;57) years). Patients were examined initially before and after surgery (in terms of 8-14 days and after 12-36 months). The peak left atrial (LA) longitudinal strain (PALS) was determined at LA reservoir phase. The following endpoints were chosen: the presence of AF and atrial flutter (AFL) in the shortand long-term period after surgery, repeated hospitalization for arrhythmias. Patients were divided into 2 groups: group 1 — patients with a favorable prognosis, group 2 — patients with AF and AFL after surgery. The mean values were compared by the independent Student’s t test, while the rank sum — by the Mann-Whitney test. ROC analysis was used.

Results. Baseline LA volume index (LAVI) >44,4 ml/m² increased the risk of AF after surgery (AUC=0,6±0,07, p<0,05, relative risk (RR) — 2,34 (confidence interval (CI), 0,8-6,88). LA volumes were within the normal range in the group without arrhythmias. A decrease in the initial threshold level of LA PALS <27,5% increased the risk of AF as in the shortand long-term postoperative period (AUC=0,659±0,08, p<0,01, RR — 1,19 (CI, 3,38-31,4). In the AF group, PALS decreased after surgery and did not increase in the long-term period (28±7,5% at baseline, 19±6,2% after surgery, 21±8,3% in the long-term period, (p=0,04 and p=0, 23, respectively). Left ventricular ejection fraction affected the AF development only in the early period after surgery (AUC=0,71±0,049, p<0,008, RR — 2,21 (CI, 1,27-3,87).

Conclusion. The development of AF was influenced by LAVI, LA PALS, while in the early postoperative surgery period — ejection fraction.

Aim. To identify significant echocardiographic parameters in the screening assessment of long-term outcomes of inferior wall myocardial infarction (MI) with primary percutaneous coronary intervention (PCI) using a logistic regression model.

Material and methods. The study included the examination results of 144 people with inferior wall MI with primary PCI at admission, discharge and 6, 12, 24 months after discharge. Logistic regression analysis to identify screening outcomes of inferior wall MI included 184 variables, including 131 echocardiographic signs. Analysis of variance was performed using the ANOVA Type II method. The model quality was assessed using the likelihood ratio test and the Akaike criterion.

Results. In patients with inferior wall MI and primary PCI, adverse outcomes were observed in 59,7% of cases in the form of repeated myocardial infarction and PCI, coronary artery bypass grafting, the development of stage 2 chronic heart failure, and/or rehospitalizations. For the long-term prognosis of inferior wall MI, in addition to left ventricular ejection fraction, mitral E/A, left atrial volume index and wall motion score index (WMSI), the following echocardiographic predictors were assessed: tricuspid S’ and e’, circumferential strain of the medial level, longitudinal strain of the apical and basal left ventricular levels, longitudinal strain of the segments included in the blood supply area of the circumflex artery.

Conclusion. Echocardiographic parameters using Doppler and speckle-tracking technology have proven to be significant in screening outcomes of acute inferior wall MI with PCI.

Aim. To study the prevalence of elevated concentrations of lipoprotein (a) (Lp(a)) and apolipoprotein B (apoB) associated with high cardiovascular risk in a random sample of the adult Krasnoyarsk population.

Material and methods. Lp(a) and apoB concentrations were determined by the immunochemiluminescent method using an automated modular Cobas 8000 platform with biochemical module c702 (Roche Diagnostic, Switzerland). We examined 263 people aged 18 to 58 who agreed to expand the standard screening by Lp(a) and apoB determination.

Results. We found that high and very high levels of Lp(a) are found in 12,9% of the examined, while in women the median value was significantly higher than in men (p=0,044). In addition, 11,4% of study participants had high apoB values, regardless of sex; 3,4% of the subjects had a combination of elevated levels of ap B and Lp(a).

Conclusion. Screening for Lp(a) and apoB reveals dyslipidemia associated with high cardiovascular risk in 24,3% of working-age people

Aim. To conduct a systematic review and meta-analysis to investigate the prognostic role of left atrial (LA) strain assessment using speckle-tracking echocardiography to predict postoperative atrial fibrillation (POAF) in patients undergoing coronary bypass grafting (CABG).

Material and methods. We searched the PubMed (Medline) and Google Scholar databases for studies investigating LA strain measures obtained by speckle tracking echocardiography as predictors of POAF in patients after CABG. To determine the difference in the weighted average LA strain parameters, an analysis was made of the global LA strain, peak atrial longitudinal strain (PALS), left atrial conduit strain (LACS) and left atrial contractile strain (LACtS). Odds ratio (OR) values were received from multivariate models reporting association between PALS and POAF and described as pooled estimates with 95% confidence intervals (CI).

Results. Twelve studies from 404 publications were selected for this systematic review and meta-analysis. A total of 1093 patients were included in the analysis, with a mean age of 60,5 years. A meta-analysis showed that patients with POAF had lower global LA strain than patients without POAF (difference in weighted values, 5,03%; 95% CI: -6,89 to -3,16; p<0,001). In addition, patients with POAF had lower PALS, LACS and LACtS; the difference in weighted values was 9,90% (95% CI: -12,95 to -6,85; p<0,001), 4,17% (95% CI: -6,05 to -2,29; p<0,001) and 6,1 7% (95% CI: -12,01 to -0,33; p=0,04), respectively. Moreover, in a pooled odds ratio (OR) analysis, PALS was found to be an independent predictor of POAF (OR: 0,88 for every 1% increase in PALS; 95% CI: 0,82–0,94; p<0,0001).

Conclusion. Assessment of LA strain using speckle-tracking echocardiography provides important additional information for predicting POAF in patients undergoing isolated CABG.

The article presents three clinical reviews of isolated hepatic perfusion using a heart-lung machine. The probability of postoperative complications was retrospectively assessed using risk stratification programs for adverse outcomes. The conclusion is made about the effectiveness of the presented software.

The review provides basic information on the effect of therapeutic hypothermia on myocardial ischemia, as well as analyzes experimental and clinical studies on therapeutic hypothermia in myocardial infarction. The results of comparison of general body hypothermia and local myocardial hypothermia are discussed. The ways of further studies of this technology in myocardial infarction are outlined.

Coronavirus disease 2019 (COVID-19) is a disease characterized by diverse clinical manifestations, the severity of which can vary from asymptomatic to extremely severe. At this stage, the urgent task is the early detection of reliable markers of its severity in the acute period of infection and possible changes that cause symptoms in the post-COVID period. The severe COVID-19 is associated with extensive damage to the lungs, pulmonary vessels, and cardiovascular system. In this regard, it seems natural to study the problem of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in patients with COVID-19, and their significance for assessing the severity of the condition and prognosis. Also important is the availability of reliable non-invasive diagnostics. This review presents data on the incidence of PH and RVD and their potential significance in patients with COVID-19. We have analyzed literature sources in the eLIBRARY, PubMed/MEDLINE, ScienceDirect and ProQuest databases.

The article presents a case of myocardial lesion associated with a coronavirus disease 2019 (COVID-19). The clinical course of the disease demonstrates the complexity of differential diagnosis. The importance of using modern imaging techniques (cardiac magnetic resonance imaging) in addition to standard examination methods is emphasized.

Left ventricular (LV) thrombosis is a common complication of heart failure with reduced LV ejection fraction and can be a source of systemic embolism. The material presents the case of a 76-year-old woman with a history of myocardial infarction, LV aneurysm, coronary bypass surgery, who was admitted to the hospital with ischemic vertebrobasilar stroke. One month prior to present hospitalization, the patient was admitted to the hospital with transient complete atrioventricular block, underwent coronary artery stenting for stable angina pectoris with a drug-eluting stent, and was subsequently diagnosed with coronavirus disease 2019 (COVID-19), which required further inpatient treatment. Despite dual antithrombotic therapy (antiplatelet+anticoagulant) taken after discharge from the hospital, the patient was diagnosed with a floating thrombus in the apical LV aneurysm. Recurrent conduction disorders (transient atrioventricular block) required temporary pacing until the thrombus elements floated, after which a dual-chamber pacemaker was implanted. The main feature of this case is the formation of a floating thrombus in the LV aneurysm  11 years after myocardial infarction against the background of COVID-19 and anticoagulant therapy with direct oral anticoagulants. At the moment, there is still no unique opinion on the choice of anticoagulant therapy in patients with COVID-19 and a complicated cardiovascular history. In such cases, the anticoagulant regimen should be determined by a multidisciplinary team, taking into account the risks of thrombosis and bleeding.