Aim. To assess the compliance of the management of patients with heart failure (HF) with quality criteria (QC) for health care, including discharge instructions for patients.

Material and methods. Hospitalizations of patients aged over 18 years with HF (ICD 10 code — I50.x) during the period from January 1, 2019 to October 1, 2020 were randomly selected from the "Chronic Heart Failure" registry of St. Petersburg. Discharge and post-mortem summaries were assessed for compliance with the quality criteria listed in the 2020 Russian Chronic Heart Failure guidelines.

Results. The study included 553 patients (women, 71,1%, mean age, 82,0±9 years, comorbidities: hypertension — 99,1%, coronary artery disease — 97,6%, chronic kidney disease — 53,2%, diabetes — 32,6%). Electrocardiography (QC № 1) was performed in 94,2% of patients, chest radiography (QC № 2) 91,7%, echocardiography (QC № 3) — 81,0%, but the results were not always informative. The exact ejection fraction (EF) value was reported in 55,4% of patients. Laboratory examination corresponded to QC № 4-6 in 20,3% of cases and was performed in 53,3-94,9%. Natriuretic peptides (NPs) were not determined (QC № 7-0%).

The completeness of intravenous therapy (QC № 8) was not assessed due to insufficient physical examination data.

Oral therapy (QC № 9) was prescribed frequently as follows: renin-angiotensinaldosterone system inhibitors (RAASo) — 93,3%, beta blockers (BBs) — 85,4%, mineralocorticoid receptor antagonists (MRAs) — 78,7%. However, triple RAAS+BB+MRA therapy was carried out in 54,1% of HF cases with EF <50% and no contraindications.

Diet was recommended in 87,1% of summaries, water-salt regimen — 53,3%, drug titration — 8,2%. The date of visit to outpatient cardiologist was indicated in 10,0%.

Conclusion. With the exception of NP assessment, the scope of paraclinical studies corresponded to the QC in the majority of patients. Optimal therapy was prescribed to 54,1% of patients with EF <50%. An early outpatient visit after discharge was indicated in 10,0% of summaries.

Aim. To evaluate the accuracy of virtual stenting in predicting the physiological effect of percutaneous coronary intervention (PCI) for multilevel coronary artery disease (CAD).

Material and methods. In order to define PCI strategy, 34 patients with multilevel CAD underwent assessment of instantaneous wave-free ratio (iFR) with mapping. Using the virtual stenting, predicted iFR (priFR) was assessed. After stent implantation, the factual iFR (fiFR) was re-assessed. A discrepancy between the priFR and fiFR by 0,03 was considered the threshold level of a significant difference and "poor agreement" criterion between measurements.

Results. Mean iFR before PCI was 0,77±0,11; after PCI, this indicator increased significantly and amounted to 0,94±0,04 (p<0,001). Comparison of the predicted and factual iFR revealed that the difference did not significantly depend on the value (rxy=-0,183; p=0,300), and mean difference between measurements was 0,013 (standard deviation, ±0,019), which indicates no systematic discrepancy and good comparability of the studied methods. In addition, correlation analysis of priFR and fiFR revealed a significant strong (Chaddock scale) direct relationship (r=0,854; p<0,001). Independent predictors of "poor agreement" were heart rate and systolic blood pressure before surgery. Discrepancy in decisions on the choice of stented lesions and the required number of stents based on coronary angiography (CAG) and MRI occurred in 21 patients (62%) and 16 patients (47%), respectively. After iFR measurement, there was a significant decrease in the mean length of affected segment (from 61,82±19,68 mm (CAG) and 49,15±19,19 mm (iFR)), which made it possible to significantly reduce the number of implanted stents from 1,91±0,57 (CAG) to 1,50±0,56 (p=0,001).

Conclusion. Mapping the iFR and virtual stenting technology makes it possible to revise the classification of coronary lesions by length, which leads to a significant reduction in the number of implanted stents and the length of stented segment. High correlation between priFR and fiFR achieved in our study indicates the high accuracy of virtual stenting in predicting the physiological effect of stenting.

Aim. To analyze the immediate outcomes of reinterventions after Ross procedure.

Material and methods. From April 2009 to December 2022, 224 Ross operations in adults were performed at the Federal Center for Cardiovascular Surgery. The retrospective study included 17 patients who required repeated interventions (14 men/3 women). The mean age of the patients was 38±11 years, with a minimum age of 21 and a maximum of 54 years. A history of infective endocarditis was revealed in 4 (23,5%) patients, hypertension — in 3 (17,6%) patients. Of the 17 included patients, 15 patients underwent the classic Ross operation ("full root replacement"), while 2 — a modified technique (1 — wrapping with aorta, 1 — wrapping with a Dacron graft). Annulus enhancement was previously performed in 3 patients.

Results. Interventions on the pulmonary autograft and homograft were performed in 16 and 4 cases, respectively. The main indication for pulmonary autograft intervention was aortic regurgitation in 15 cases, and neoaortic aneurysm in 14 cases. In 3 patients, there was pulmonary homograft stenosis, while in 1 case — thrombosis. Two patients required interventions on other valves: 1 — mitral valve stenosis, 1 — severe tricuspid regurgitation. Mean reoperation, cardiopulmonary bypass and myocardial ischemia time were 289±62, 126±35 and 98±22 min, respectively. Combined interventions were performed in 6 cases. David valve-sparing procedure was performed in 9 patients, Bentall-de Bono technique — in 3, aortic valve repair — in 2, mechanical aortic valve replacement — in 2, supracoronary ascending aorta replacement — in 2, pulmonary homograft replacement — in 2, pulmonary homograft thrombectomy — in 1, pulmonary homograft repair — in 1 patient, mitral valve replacement — in 1 patient, tricuspid valve repair — in 1 patient. One patient required resternotomy for bleeding. There were no postoperative complications (perioperative myocardial infarction, acute kidney injury, stroke, sternal infection, cardiac tamponade) and deaths. The median length of stay in intensive care unit was 21 [16-23] hours.

Conclusion. Reoperations after the Ross procedure may be required for different pathologies, but all can be performed surgically with a high safety in experienced operator.

Aim. To analyze the prognostic value of the Dutch Lipid Clinic Network (DLCN) and Simon Broome Register (SBR) screening criteria for familial hypercholesterolemia (FH) in men and women with dyslipidemia.

Material and methods. The study included 1233 patients with dyslipidemia.

Biomaterial samples from 421 patients were studied using Next Generation Sequencing (NGS) to identify FH-associated genes. Statistical analysis was carried out using the StatTech v program. 3.1.6 (OOO Stattekh, Russia).

Results. The most significant factors for predicting the FH in men are the level of low-density lipoprotein cholesterol (LDL-C) (1,77 times), positive family history for coronary artery disease (CAD) (6,26 times), multivessel coronary artery disease (4,05 times); in women before menopause — LDL-C (1,77 times per 1 mmol/l) and/or family history of coronary artery disease (3,31 times), in menopausal women — total cholesterol level (1,79 times per 1 mmol/l), coronary artery disease (6,52 times) and/or family history of stroke (6,04 times), xanthomas (4,24 times). Acute myocardial infarction and/or coronary stenting, arcus senilis, extracranial artery atherosclerosis did not prove to be prognostically significant for FH diagnosis.

Conclusion. Diagnostic criteria for potential FH vary among patient populations. Its diagnostic significance depends on sex, and in women, reproductive status.

Aim. To evaluate the effectiveness and safety of an invasive approach in patients with ST-segment elevation myocardial infarction (STEMI) aged 90 years and older.

Material and methods. This retrospective single-center study was conducted at the V. P. Polyakov Samara Regional Clinical Cardiology Dispensary. In 20132020, 104 patients aged 90 years and older were hospitalized with a diagnosis of STEMI. The mean age of patients was 91,7 years (90-100), while the proportion of women was 67,3%. Patients included in the analysis were divided into groups of conservative treatment (n=81, mean age, 91,9 (90-100) years, women 70,4%) and invasive management (coronary angiography + percutaneous coronary intervention (PCI)) (n=23, mean age, 91,0 (90-94) years, women, 56,5%).

Results. The groups were comparable in basic characteristics. In-hospital mortality in the conservative strategy group was 48,1% vs 17,4% in the invasive management group (p=0,009; odds ratio (OR) 3,35; 95% confidence interval (CI) 1,23-9,15). During the first year after discharge, 25,9% (n=21) died in the conservative strategy group and 30,4% (n=7) in the invasive strategy group (p=0,79; OR 0,85; 95% CI 0,42-1,75). In total (during the hospitalization period and within 1 year after discharge), 60 people (74,1%) died in the conservative strategy group, while in the invasive treatment group — 11 (47,8%) (p=0,02; OR 3,11; 95% CI 1,19-8,11). Life expectancy in patients with STEMI aged 90 years and older after discharge from hospital was 83,95 days for the conservative strategy group and 103,85 days for the invasive strategy group (p=0,67).

Conclusion. The data obtained in our study support primary PCI as a treatment strategy for patients with STEMI aged 90 years and older.

Due to the large number of complications and decreased quality of life after coronavirus disease (COVID-19), physical and psychological rehabilitation of patients is relevant. However, the effectiveness of rehabilitation on endpoints has not yet been demonstrated.

Aim. To determine the effectiveness of different rehabilitation options in hospitalized patients with COVID-19 on the development of long-term adverse cardiovascular events 1 year after discharge.

Material and methods. In a single-center, non-randomized observational study, 3 groups of patients were formed after hospitalization with COVID-19: I — with telemedicine rehabilitation (n=118), II — with rehabilitation in a specialized department (n=46) and III — without rehabilitation (n=175). After 1-year followup, groups were compared regarding following endpoints: cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, atrial fibrillation and cardiovascular hospitalization. Propensity score matching analysis was used to optimize differences between comparison groups.

Results. Rehabilitation after hospitalization of patients with COVID-19, both in the hospital and remotely for 1 year, helps to reduce cardiovascular hospitalization rate. In addition, remote rehabilitation reduces cardiovascular mortality.

Conclusion. Both rehabilitation options reduce the incidence of cardiovascular hospitalization compared to no rehabilitation.

The novelty of the 2023 National Guidelines for Lipid Metabolism Disorders is presented regarding the categorization of cardiovascular risk, target and optimal levels of blood lipids, diagnosis and therapeutic approaches to the treatment of dyslipidemia.

This year, new domestic recommendations for assessing and correcting the risk of cardiac complications during non-cardiac surgery have been published. These guidelines provide simple and practical key messages to facilitate decision-making in real-life clinical practice. The proposed algorithm for the management of patients before non-cardiac operations, focused on integral risk assessment, assessment of functional status and biomarkers. This review provides a summary of perioperative drug therapy, management of the most common CVDs, and focuses on specific care based on the risk of the patient's preexisting clinical conditions. Finally, the document includes practical recommendations for the management of postoperative complications, and also includes a new section on perioperative myocardial infarction/injury.

A case report is devoted to the successful management of a 33-year-old patient with subacute infective endocarditis of the tricuspid valve and pacemaker, as well as chronic thromboembolic pulmonary hypertension. There were following therapy stages: 1) pharmacotherapy — antimicrobial agents, treatment of heart failure, pulmonary hypertension; 2) an interventional approach — tricuspid valve replacement with chamber sanitation, pacemaker explantation, endocardial lead removal from the right heart, implantation of a pacemaker with an epicardial lead system and 3) delayed balloon pulmonary angioplasty.

Among various diagnostic methods, echocardiography (EchoCG) is most often used to identify Takotsubo syndrome. Left ventricular apical ballooning and the absence of permanent local contractility disturbances makes it possible to confirm the diagnosis. Currently, the available literature provides insufficient data on longitudinal strain (LS) of various cardiac chambers in this condition. The current case report demonstrates complete restoration of left heart LS within 1 month with its initial significant decrease.

People who survive an episode of pulmonary embolism have an increased risk of developing chronic complications despite curative anticoagulant treatment. The association of dyspnoea, low functional capacity, right heart failure, chronic thromboembolic pulmonary hypertension, or chronic thromboembolic pulmonary disease is part of the notion of post-pulmonary embolic syndrome (PPES). The symptoms can be limiting, substantially affecting the quality of life. To improve the overall health outcomes of patients with acute pulmonary embolism, adequate measures to diagnose it and strategies to prevent long-term outcomes of pulmonary embolism are essential.

The objective of this study is to provide a definition of PPES and review the most recommended patient-reported outcome measures (PROMs) for assessing the functionality of these patients.

We searched PubMed for papers from the last 5 years that contain the terms: postpulmonary embolism syndrome; symptoms; PROMs; score; quality of life; dyspnea. Repetitive publications were excluded. The data from the publications have been summarized in this descriptive overview.

Hypertension (HTN) is widespread among middle-aged and elderly people, including those doing sports. For the first time in 2020, the European Society of Cardiology guidelines on sports cardiology and exercise in patients with cardiovascular disease included adult and elderly patients in a separate group. However, this is a heterogeneous category of patients, including everyone over 35 years of age. Therefore, admittance of athletes to training and competitions still remains at the discretion of physician.

Aim. To assess the relationship and mutual influence of hypertension, other cardiovascular risk factors and sports in middle-aged and elderly people.

Material and methods. Our narrative review is based on 50 articles published on Pubmed, Scopus, Web of Science and eLIBRARY.ru, selected using the keywords "veteran athletes", "arterial hypertension", "cardiovascular risk", "physical activity". Related papers over the past 5 years were evaluated.

Results. Currently, there is a trend toward an increase in the number of veteran athletes whose problems are not reflected in guidelines on sports and exercise.

Conclusion. In the future, large randomized studies are needed to assess the response of blood pressure (BP) to intense exercise, as well as to determine the normal BP response and clear strategy to manage this category of people, depending on the presence of hypertension.