The article discusses the classification of heart failure (HF). A novel HF classification and its advantages over the existing ones are shown. Variants of approximate diagnoses are given in accordance with the novel HF classification.

Cardiovascular diseases (CVDs) are the leading threat to the population health in the Russian Federation (RF), ranking first in the mortality structure. Demonstration of the economic impact of CVD is a rationale for investing in prevention and treatment. The economic damage caused by CVD in 2016 in the RF amounted to RUB 2,7 trillion, which is equivalent to 3,2% of gross domestic product (GDP). In the structure of damage by diseases, coronary artery disease occupies a leading position — RUB 1 trillion or 1,3% of GDP, while cerebrovascular diseases, stroke and myocardial infarction — RUB 560, 424 and 213,2 billion, respectively. Evaluation of cardiovascular prevention measures is not an easy task because the effect develops over a significant period of time. At the same time, various processes can affect the effect. The RF analysis showed that the potential economic effect from anti-tobacco and anti-alcohol measures, reducing salt consumption and increasing physical activity will be RUB 8,1 trillion in labor productivity increase over 15 years (equivalent to 7,8% of GDP in 2018), with most of the effect from the prevention of CVD deaths. Analyzing the economic impact of CVDs, preventive and curative measures provide a rationale for investment and is an important step in making informed decisions.

Aim. To study the impact of the availability of emergency and specialized, including high-tech, medical services for patients with acute coronary syndrome on mortality in Russia.

Material and methods. We used the cointegration of time series characterizing mortality from acute coronary syndrome (ACS) and following parameters for the availability of emergency and specialized, including high-tech, care for ACS in Russia for the period from 2016 to 2021 according to the "Monitoring of interventions to reduce mortality from coronary artery disease": the proportion of ambulance visits for ACS with response time <20 minutes; the proportion of patients with ST-elevation ACS (STE-ACS) hospitalized within 12 hours from symptom onset; proportion of patients with STE-ACS admitted to hospital within 2 hours of symptom onset; proportion of patients with ACS admitted to specialized departments; proportion of patients with STE-ACS with prehospital thrombolysis; proportion of patients with STE-ACS with thrombolysis; proportion of patients with STE-ACS who underwent percutaneous coronary intervention (PCI); proportion of patients with non-ST-elevation ACS (NSTE-ACS) who underwent PCI; the proportion of patients with STE-ACS admitted before 12 hours from the onset of symptoms who underwent PCI; proportion of patients with ACS who underwent coronary artery bypass grafting. To rank the availability indicators, the elasticity (E) coefficient was used, which characterizes the strength of the relationship between the factor and the result, which shows the change in the result value per 1% change in the factor.

Results. According to contribution decrement to reducing mortality, the factors of health care availibility for patients with ACS-STE were arranged as follows (coefficient of elasticity and determination (R²) is indicated in brackets): "The proportion of patients with ACS-STE who underwent PCI" (E=1,5%; R²=0,60), "Proportion of patients with STE-ACS with prehospital thrombolysis" (E=1,1%; R²=0,91), "Proportion of patients with STE-ACS with thrombolysis" (E=1,0%; R²=0,96 ), "Proportion of patients with STE-ACS admitted before 12 h who underwent PCI" (E=0,9%; R²=0,94), "Proportion of patients with STE-ACS admitted to hospital before 12 h from the symptom onset" (E=0,5%; R²=0,97), "Proportion of patients with STE-ACS hospitalized <2 hours from the symptom onset" (E=0,2%; R²=0,95). A significant resource in reducing mortality in ACS is the reduction in ambulance response time in ACS (E=2,3%; R²=0,87) and compliance with specialized hospitalization of patients with ACS (E=1,8%; R²=0,73), but in reducing mortality in NSTE-ACS, the proportion of patients with NSTE-ACS who underwent PCI (E=1,7%; R²=0,72).

Conclusion. An analysis of the impact of the availability of emergency and specialized, including high-tech, medical services for patients with ACS in Russia showed that the greatest contribution to mortality reduction in STE-ACS is made by time reduction in PCI and an increase in the use of thrombolytic therapy, mainly at the prehospital stage, in NSTE-ACS — an increase in the number of PCIs, and in ACS in general, strict compliance with specialized hospitalization of patients and a reduction in ambulance response time in ACS.

The article publishes data on the history of the All-Russian Scientific Society of Cardiology and the Russian Journal of Cardiology for the period of 1991-2001, which are closely related and reflect the development of domestic cardiology at turn of the century.

Aim. To compare cardiac magnetic resonance imaging (MRI) parameters with known prognosis determinants in patients with pulmonary hypertension (PH).

Material and methods. This prospective single-center study included 60 patients with PH aged 21-72 years. Cardiac MRI, right heart catheterization, echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP) and 6-minute walk test (6MWT) were assessed at baseline.

Results. Significant correlations between invasive hemodynamic parameters, NTproBNP and cardiac MRI parameters were confirmed. There were no significant correlations between the right ventricular (RV) contractility, RV volume and 6MWT distance, the functional class of PH. Cardiac MRI values allowed us to reliably separate patients at low risk from those at intermediate and high risk according to the 2015 ESC/ERS score. According to multivariate regression analysis, the right ventricular end systolic volume index >54 ml/m² (hazard ratio, 0,2; 95% confidence interval, 0,05-0,9; p=0,004) and class 3-4 PH (hazard ratio, 0,2; 95% confidence interval, 0,07-0,8; p=0,026) remained independent predictors of mortality.

Conclusion. The use of cardiac MRI in low-risk patients can significantly improve the early detection of right ventricular myocardial dysfunction and contribute to the timely optimization of PH-specific therapy. During monitoring patients with PH, cardiac MRI has the potential to reduce the need for repeated invasive investigations.

Aim. To obtain extended data on the impact of collateral circulation on the recovery of left ventricular (LV) function after recanalization of chronic coronary total occlusion (CTO), especially in patients with reduced left ventricle ejection fraction (LVEF).

Material and methods. This single-center, prospective, non-randomized study included 20 patients with single-vessel CTO with reduced LVEF (<50%), confirmed by magnetic resonance imaging (MRI), who underwent successful recanalization. All patients were divided into 2 groups depending on the severity of collateral circulation. After 1, 3 and 6 months, MRI was repeated to assess LV function recovery.

Results. All patients had prior myocardial infarction, while in 70% of cases — in the area of the occluded artery. A previous attempt to recanalize CTO was noted in 30%. The mean baseline LVEF according to echocardiography was 38,80±6,72%. The most common target vessel was the right coronary artery (n=17, 85%), followed by the circumflex and anterior descending arteries — 1 (5%) and 2 (10%) patients, respectively. In the group with high collateral circulation, the initial LVEF according to MRI was higher compared to the group with mild collateral circulation (35,8±7,33% vs 30,7±8,82%, p=0,17). After 6 months, MRI showed significant changes in end-diastolic volume (from 226±71,1 ml to 203±55,2 ml) and LV endsystolic volume (from 153±72,8 ml to 118±57,6 ml), as well as mean increase in LVEF by 3,3%, 4,8% and 5,2% at 1, 3 and 6 months, respectively (p=0,01 compared with baseline). The predictors of LVEF recovery in multivariate regression analysis were the initial LVEF according to MRI, and the filling rate of distal CTO bed on coronary angiography (R²=0,63).

Conclusion. Successful percutaneous coronary intervention with CTO improves LV function in patients with ischemic cardiomyopathy, regardless of the degree of collateral circulation. LV function recovery generally occurs within 3 months after revascularization.

Aim. To determine the incidence and predictors of cardiovascular events in onpump cardiac operations in modern practice.

Material and methods. The study included 200 patients who underwent various elective cardiac surgical interventions. Cardiovascular events (CVEs) were determined within 30 days from the operation, according to medical records and autopsy protocols. We identified major CVEs (cardiovascular death, stroke, myocardial infarction) and minor CVEs (angina pectoris, significant ventricular arrhythmias, atrial fibrillation or flutter episodes, AV conduction disorders, etc.). A comprehensive preoperative examination was performed, including an extended echocardiography protocol and coronary angiography.

Results. In 101 patients (50,05%), various CVEs were identified: 4,0% had major CVEs and 46,05% had minor CVEs and various non-cardiac complications, while perioperative mortality was 2,0%. Most ischemic CVEs, as well as most intracardiac conduction disorders, were registered during the first 3 days after surgery. In contrast, episodes of atrial fibrillation/flutter occurred 2-7 days after the intervention. There were following preoperative examination parameters with the highest prognostic value: history of heart failure, age >65 years, history of myocardial infarction, occlusion of at least one coronary artery, and diabetes.

Conclusion. The data obtained indicate the high efficiency of current surgical and anesthetic technologies, which lead to relatively low risk of severe and fatal events. The parameters of the preoperative examination, which determine the increased risk of intervention, are highlighted.

The European Society of Cardiology (ESC) 2019 guidelines propose a novel diagnostic algorithm for examining stable patients with suspected coronary artery disease (CAD). In retrospective analysis of previous studies, a new pretest probability scale was validated and a method for assessing clinical probability of obstructive CAD was proposed, taking into account risk factors and coronary artery calcium score. The results were studied in the EURECA multicenter registry, and the ESC-2019 diagnostic algorithm was compared with other known algorithms. The review details the results of these recently published studies, emphasizing the role of calcium score assessment in identifying low-risk patients for obstructive CAD. The review also considers publications using computed tomography coronary angiography as a "gatekeeper" among patients selected for invasive coronary angiography. The results obtained showed the effectiveness of novel diagnostic strategies in increasing the detection rate of obstructive CAD. However, clinical outcomes of any diagnostic algorithm are few and require further study, as well as their cost-effectiveness.

Arrhythmias occur both in the acute coronavirus disease 2019 (COVID-19) and in the post-acute period, which may be associated with the long-term SARS-CoV-2 persistence. In a case report, patient with primary dilated cardiomyopathy, an implanted cardioverter-defibrillator, recurrent ventricular arrhythmias, and an electrical storm are presented. The patient was repeatedly hospitalized in a city hospital, where electrical cardioversion, antiarrhythmic therapy, radiofrequency ablation of recurrent ventricular tachycardia regions, including emergency ("lifesaving") combined catheter radiofrequency destruction of the electrical storm substrate, was performed. Subsequently, against the background of ongoing postoperative therapy, massive pulmonary embolism (PE) suddenly developed, which led to the death. Autopsy established that the cause of the patient’s death was massive pulmonary embolism; SARS-CoV-2 and enterovirus was detected in the myocardium. Based on an autopsy study, the patient was diagnosed with primary dilated cardiomyopathy with secondary active chronic lymphocytic myocarditis.