Aim. To perform a dynamic assessment and comparative analysis of non-invasive parameters of myocardial function in patients with Q-wave and non-Q-wave myocardial infarction (MI) during 24-week follow-up after revascularization.

Material and methods. A total of 95 patients with acute MI were included. On days 7-9 and after 24 weeks, speckle tracking echocardiography was performed with assessment of global longitudinal (GLS), global circumferential (GCS) and global radial strain (GRS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE).

Results. Taking into account the presence/absence of the Q wave, the subjects were divided into two groups: Q-wave MI — 66 patients (69,5%), non-Q-wave MI — 29 (30,5%) people. In the Q-wave MI group, by the 24^th week, most parameters of myocardial performance were significantly lower than in the comparison group. In group 1, GWE was 93 (87; 96)% vs 96 (91; 97)% (p=0,04) in group 2; GWI — 1429±444,1 and 1653,3±385,84 mm Hg %, respectively (p=0,02). The GCW level in the Q-wave MI group was 1640±477,8 mm Hg % vs 1852,9±440,88 mm Hg % in the non-Q-wave MI group (p=0,04). Subsequently, a favorable increase in GLS (p=0,01), GWI (p=0,04), GWE (p=0,01), GCW (p=0,03) was revealed in the non-Q-wave MI group.

Conclusion. The results obtained suggest that non-invasive parameters of myocardial performance can be used to assess transient ischemic dysfunction due to myocardial stunning, expressed to varying severity in patients with Q-wave MI and non-Q-wave MI.

Aim. To study the relationship between the clinical course of myocardial infarction (MI) with changes in left ventricular (LV) geometry and myocardial accumulation of the somatostatin analogue 99mTc-octreotide according to cardiac single-photon emission computed tomography (SPECT).

Material and methods. This pilot, cohort, prospective study included 14 patients aged 37 to 72 years with primary anterior ST-segment elevation MI. Patients underwent a general clinical examination, 3-fold determination of high-sensitivity C-reactive protein (hsCRP), echocardiography on days 1-3, cardiac SPECT with 99mTc-octreotide on days 6-7 from MI onset. Statistical analysis was performed using STATISTICA 10.0, StatSoft, USA.

Results. In 10 of 14 patients, 99mTc-octreotide accumulation in LV involvement area was recorded. The accumulation analysis showed varying intensity. This made it possible to form two subgroups with high and low accumulation of 99mTc-octreotide (heart-to-cavity LV ratio more and less than 1,5, respectively).

Clinical characteristics and MI course, length of hospital stay did not differ between the subgroups. Occlusion of the infarct-related coronary artery (in 5 (62,5%) vs 0 (0%) patients, p=0,016) was more common in the group with increased versus decreased accumulation of 99mTc-octreotide, respectively.

Laboratory analysis showed a significant increase in hsCRP upon admission in patients with increased vs decreased accumulation of 99mTc-octreotide — 31,6 mg/l (10,45-42,05) vs 6,5 mg/l (3,2-11,8), p=0,043, respectively.

A significant increase in end-diastolic and end-systolic LV volumes was established. There were an increase in LV sphericity index and local contractility disruption index along with a decrease in LV ejection fraction in the subgroup with high vs reduced accumulation of 99mTc-octreotide (47,5% (45,5-51,5) vs 57,5% (54-59), p=0,020) in the damage zone, respectively. In addition, a predictive relationship between the increase in LV end-diastolic volume and the severity of 99mTc-octreotide accumulation was found (R²=0,601, F-ratio=16,562, p=0,002).

Conclusion. An increase in hsCRP and early initiation of LV remodeling after primary anterior ST-segment elevation MI is accompanied by a pronounced accumulation of 99mTc-octreotide in the damage zone, detected using cardiac SPECT, as a result of systemic and local, in our opinion, macrophage-mediated post-infarction inflammation.

Aim. To study the features of psycho-emotional status and its clinical and prognostic significance in patients with type 1 and 2 myocardial infarction (MI).

Material and methods. Of the 1293 patients hospitalized at the District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery" with a diagnosis of acute coronary syndrome, 277 (21,4%) patients with confirmed MI were consecutively included in the observational study. There were 194 (15,0%) patients with type 1 MI (MI1) and 83 (6,4%) with type 2 MI (MI2). MI types were determined based on the IV Universal Definition of Myocardial Infarction (UDMI). During the hospital period, type D personality was identified using the Russian version of the Type D scale-14 (DS-14), while the presence and severity of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Follow-up was conducted through outpatient visits, telephone or email interviews for 12 months after discharge. Patients' adherence to drug therapy was assessed using 8-item Morisky Medication Adherence Scale, and quality of life (QoL) using Short Form Medical Outcomes Study (SF-36) questionnaire.

Results. During the hospital period, in the group of patients with MI2, patients with type D personality were more often identified compared with MI1 (30 (36,1%) vs 55 (28,3%), p<0,05). Patients with MI2 had a significantly higher subclinical level of anxiety (34 (41,0%) vs 43 (22,2%), p=0,002), expressed level of anxiety (10 (12,1%) vs 12 (6,2%), p=0,011), as well as a significant level of depression (13 (15,7%) vs 14 (7,2%), p=0,03). At the same time, in patients with type D, regardless of MI type, subclinical levels of anxiety and depression were significantly expressed (63 (74,1%) vs 14 (7,3%) (p<0,001) and 58 (68,2%) vs 25 (13,0%) (p<0,001)). There were no significant differences in inhospital complications between the MI1 and MI2 groups depending on type D personality. After 12-month follow-up, patients with the distressed personality type had higher rate of all-cause death (5 (7,2%) vs 5 (1,6%), p<0,05 without type D), rehospitalization for decompensated heart failure (8 (11,5%) vs 9 (4,8%), p=0,04). Patients with type D were less adherent to drug therapy compared to patients without type D (30 (43,4%) vs 9 (4,8%) p=0,001, respectively), and they had lower QoL scores.

Conclusion. Type D personality, the presence of anxiety and depression, high all-cause mortality and rehospitalization rate of decompensated heart failure were more often observed in MI2 compared to MI1, as well as in patients with type D, regardless of MI type. Low adherence to drug therapy and poor quality of life, regardless of MI type, were also associated with the type D personality.

Aim. To evaluate the predictive potential of complete blood count (CBC) and coronary involvement parameters for predicting inhospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).

Material and methods. This single-center cohort retrospective study was conducted using data from 4677 electronic medical records of patients with STEMI (3203 men and 1474 women). Two groups of people were identified: group 1 — 318 (6,8%) patients who died in hospital; group 2 — 4359 (93,2%) patients with a favorable outcome. The degree of influence of predictors on the end point was determined by the Shapley method.

Results. The best quality metrics had a model with structure included, in addition to 7 CBC factors, indicators of three-vessel coronary involvement, left coronary artery remodeling and coronary perfusion after PCI with the TIMI score <2 (AUC — 0,845, sensitivity — 0,78, specificity — 0,786) . The greatest contribution to the implementation of the end point was associated with the level of hemoglobin, white blood cells, immune-inflammatory index and neutrophils >75,4%. Coronary artery parameters had a less noticeable effect on inhospital mortality, and the minimal effect was plateletcrit >0,22%, lymphocytes <13,3% and erythrocyte sedimentation rate.

Conclusion. This multivariate logistic regression model based on a combination of CBC indicators and indicators characterizing the coronary system has high predictive accuracy, which determines the prospects for its further use as one of the available risk assessment tools in clinical practice.

Introduction. In the Russian literature, we have not found data on the combination of takotsubo syndrome (TTS) and left atrial (LA) myxoma. The work analyzed our own clinical case. TTS is diagnosed in 1,0-2,5% of patients hospitalized with suspected acute coronary syndrome (ACS). Primary cardiac tumors occur in cardiology with a frequency of up to 0,2%. The most common of them are LA myxoma.

Brief description. The patient was admitted to the clinic with suspected ACS. During the diagnostic search, both ACS and acute myocarditis were ruled out. An incidental finding during an echocardiographic study was LA myxoma.

Discussion. Due to a stressful situation, the patient developed symptoms similar to myocardial infarction. Based on coronary angiography data (normal coronary arteries, rapid restoration of myocardial contractility, no characteristic myocardial changes, myocardial infarction and acute myocarditis were excluded and TTS was established. LA myxoma was an unexpected finding.

Myxoma may contribute to TTS, presumably through central mechanisms regulating the activity of the cardiovascular system. Also important is the systemic inflammation caused by myxoma, which reduces the threshold for the development of Takotsubo cardiomyopathy in response to stress factors.

Aim. To study the changes of biventricular contractile function depending on the types of left ventricular involvement according to the speckle tracking echocardiography (STE).

Material and methods. Of the 380 patients from the Prospective Registry of People Survived COVID-19 Pneumonia, the study included 85 patients, which can be followed-up — 3 months (visit 1) and 12 months (visit 2) after COVID-19 pneumonia (men — 68,2%; mean age — 50,6±10,9 years).

At visit 2, patients with diffuse left ventricle (LV) involvement according to STE (visual involvement of ≥4 segments of the same LV level) comprised group I (n=27), patients with regional LV involvement (≥3 segments corresponding to anterior, circumflex or right coronary arteries) — group II (n=39), patients without visual LV involvement — group III (n=19).

Results. The groups were comparable in main clinical, functional and echocardiographic (conventional) parameters 3 and 12 months after COVID-19 pneumonia, with the exception of sex and body mass index. STE in group I showed a significant decrease in global longitudinal strain (GLS) (-18,0±2,0% at visit 1 and -16,9±1,4% at visit 2, p=0,025) and LS of all LV levels; in group II — an increase in right ventricular free wall strain (RV FWS) (-22,8±3,2% and -24,0±2,6%, respectively, p=0,006); in group III — an increase in GLS (-19,3±2,3% and -21,2±1,9%, p=0,005), LS of basal and medium LV levels, RV FWS (-23,3±2,9% and -25,0±3,0%, p=0,033). In group I, a significant increase in affected LV segments was revealed (7,0 [5,0;9,0] and 9,0 [7,0;10,0], p=0,010), while in group III there was a decrease in their number (5,0 [3,0;6,0] and 10,0 [1,0;2,0], p<0,001). According to logistic regression, LV basal LS at visit 1 (odds ratio 0,420; 95% confidence interval 0,273-0,644; p<0,001) had an independent association with diffuse LV involvement at visit 2. When it decreases, <15,8% sensitivity and the specificity of this model in predicting diffuse LV involvement was 74,1% and 74,1%, respectively (AUC=0,807; p<0,001).

Conclusion. Patients with diffuse LV involvement according to STE are characterized by suppression of global biventricular contractile function during 1-year follow-up.

Aim. To evaluate the potential of shear wave elastography to determine the duration of lower extremity deep vein thrombosis, the effectiveness of direct anticoagulation and patient management strategy.

Material and methods. Duplex lower extremity vein scanning, supplemented by shear wave elastography with determination of the average, minimum and maximum Young's modulus, was performed in 98 patients with acute, subacute and chronic thrombosis of the iliac and femoral veins on days 1, 3 and 6 of hospitalization. Based on the coefficient of determination (R²) of the median Young's modulus of a venous thrombus at different stages of thrombosis, the significance of its changes was assessed. Diagnostic information content of Young's modulus was calculated by comparing with the histological data of 17 blood clots removed during surgery.

Results. As the age of both iliac and femoral vein thrombus increased, the median of the maximum, average and minimum Young's modulus at all stages of thrombosis steadily increased (R²=0,99). The median of the average Young's modulus at the acute stage was determined to be <17 kPa; at the subacute stage — in the range of 17-32 kPa and chronic — >32 kPa. According to shear wave elastography, in patients with acute and subacute stages of thrombosis, by the 6^th day of anticoagulant therapy, the thrombus stiffness increased (R²=0,91-0,96), while in the chronic thrombosis group only a tendency to decrease was observed. The diagnostic information value of studying a thrombus using shear wave elastography relative to its histological examination turned out to be sufficient for use in clinical practice. In acute femoral vein thrombosis, the indication for radical treatment was the average Young's modulus ≤8,1 kPa, the minimum Young's modulus ≤1,7 kPa (sensitivity, specificity, positive and negative predictive values varied in the range of 64,3-88,9%); in subacute — ≤23,0 kPa and ≤11,3 kPa, respectively (55,6-100%).

Conclusion. The results indicate that the diagnostic information value of shear wave elastography indicators is sufficient to determine the stage of lower extremity deep vein thrombosis in clinical practice.

Aim. To analyze the use in clinical practice of intravascular coronary assessment methods based on two-year data from the Russian Registry on the Use of Intravascular Imaging and Physiology.

Material and methods. Since 2021, the Russian Registry on the Use of Intravascular Imaging and Physiology has included data from 7967 studies in 3932 patients, of which 3086 (38,7%) were studies of intravascular physiology. In 2021, 13 branches from 9 cities participated in the registry, in 2022 — 20 branches from 11 cities. For chronic coronary artery disease, 2484 (80,5%) studies were performed, for acute coronary syndrome (ACS) — 598 (19,4%).

Results. In 2022, the registry included 1,9 times more intravascular functional studies compared to 2021. The contribution of different clinics was uneven — 75,7% of studies were performed in three departments. The use of non-hyperemic indexes prevailed over hyperemic ones (58%), and in ACS they were used three times more often. All coronary arteries were examined, most often the anterior descending artery. As a primary diagnosis, 1968 (63,8%) studies were performed, while for the purpose of dynamic control — 122 (3,9%), at the surgical stage — 996 (32,3%). In 85,5% (n=2638) of observations, the functional assessment of stenosis hemodynamic significance directly influenced the treatment tactics.

Conclusion. The registry data indicate the significant role of functional methods among intravascular diagnostic options in the practice of domestic clinics participating in the registry. The registry demonstrated their use as a primary diagnosis 2 times more often than for coronary artery stenting. Some indications for the active use of intravascular physiology methods (in acute coronary syndrome, left coronary artery involvement) are currently controversial and require further research.

Aim. To evaluate the early and long-term outcomes of heart transplantation (HT) at the Research Institute of the S. V. Ochapovsky Regional Clinical Hospital № 1.

Material and methods. On the basis of the Research Institute of the S. V. Ochapovsky Regional Clinical Hospital № 1 from March 2010 to March 2023, 230 HTs were carried out. Among the patients, men predominated 86% (n=198), women — 14% (n=32). The mean age was 48,3±11,7 years. The reason for HT in 42,6% (n=98) was ischemic cardiomyopathy (ICM), in 40% (n=92) — dilated cardiomyopathy (DCM), while 17,4% were operated on for another cardiac pathology (n=40). All recipients underwent immunological examination, endomyocardial biopsy (EMB), 2D-speckle-tracking echocardiography (2D-STE), transthoracic echocardiography (TTE), coronary angiography (CAG), as well as a number of studies for early diagnosis of possible cancer complications.

Results. Acute rejection during the first three years was detected in 77 recipients (42,5%), of which cellular rejection (grade ≥2, 3) and humoral rejection was verified in 49 and 28 recipients, respectively. During the entire follow-up period, de novo anti-human leukocyte antigen (HLA) antibodies were detected in 34 recipients in the posttransplantation period, of which 50% (n=17) and 35% (n=12) were diagnosed with humoral and cellular rejection, respectively. Of the 34 patients with anti-HLA antibodies, 11 (32%) died. All of them died due to a humoral rejection. The survival rate of patients with antibodies was lower (59%) than in patients without antibodies (66%), p=0,023. The annual survival rate of all patients after transplantation in our center was 83,1% (during the first year after transplantation, 30 and 9 patients died due to an acute rejection and infectious complications, respectively).

Conclusion. Since the introduction and modification of immunosuppressive therapy regimens, tremendous progress has occurred, and the incidence of acute cellular rejection has decreased. However, the risk of humoral rejection and long-term complications remains one of the main reasons for graft failure.

Aim. To study the association of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and monocyte chemoattractant protein-1 (MCP-1) levels with vital exhaustion (VE) among men and women aged 25-44 years in Novosibirsk.

Material and methods. At the Research Institute of Internal and Preventive Medicine (Novosibirsk), during 2013-2016, a cross-sectional survey of a random representative sample of people aged 25-44 years in one of the typical districts of Novosibirsk was carried out. A total of 975 individuals were examined (403 men, 530 women). The response rate was 71%. General examination and history collection were carried out according to standard methods included in the WHO program "MONICA-psychosocial (MOPSY)". All study participants completed the Maastricht Vital Exhaustion Questionnaire (MQ).

Results. High and medium VE prevailed among women (15,7% and 40,6%) than among men (5,5% and 32,8%) (p<0,001). Median serum levels of IL-6 were high VE among both sexes 1,41 [0,70;4,60] pg/ml, compared with medium VE 1,20 [0,65;2,90] pg/ml, and low VE 1,12 [0,58;2,32] pg/ml (p<0,01), and among women with high VE 1,53 [0,72;4,33] pg/ml, compared with medium VE 1,14 [0,63;2,36] pg/ml and low VE 0,95 [0,50;1,98] pg/ml (p<0,05). Serum TNF-α was higher among women with high VE (6,01±3,23 pg/ml) than with medium VE (5,63±4,16 pg/ml) and low VE (4,95±2,85 pg/ml) (p=0,025). Mean serum MCP-1 levels among both sexes, men and women, were higher with high VE (324,55±161,89 pg/ml, 270,75±107,92 pg/ml and 338,81±171,1 pg/ml) than with medium (251,78±123,4 pg/ml, 262,46±134,9 pg/ml and 245,22±115,61 pg/ml), and low VE (227,59±101,03 pg/ml, 234,51±104,53 pg/ml and 220,17±96,81 pg/ml) (p<0,001).

Conclusion. An increase in the average levels of inflammation biochemical markers (IL-6, TNF-α, MCP-1) was established in individuals 25-44 years old with a high VE.

Aim. To assess vascular age (VA) and the main cardiovascular risk factors (chronological age, body mass index (BMI), carotid-femoral pulse wave velocity (PWV), blood pressure (BP)) in women in the Moscow region.

Material and methods. We assessed BP levels, BMI, PWV, and also calculate vascular age for women participating in the forum. BMI was calculated using the Quetelet index as weight divided by height squared (BMI=kg/m²). BP levels were measured in a sitting position three times on both arms, with the highest result recorded. PWV and vascular age were calculated using AngioScan01. The association between anthropometric measures, vascular stiffness, and VA differences was examined using multivariate linear regression, adjusting for traditional cardiovascular risk factors. Intergroup (systolic blood pressure <140 mm Hg and ≥140 mm Hg) comparisons of PWV and VA difference from actual were performed using a modified Welch's t-test.

Results. The study involved 260 women. The mean age was 44,92±0,85 years (95% confidence interval (CI) 43,27-46,57), mean vascular age — 45,90±1,01 (95% CI 43,91-47,89), mean BMI — 23,383±0,66 kg/m² (95% CI 22,046-24,720). Mean systolic BP was 127,63±1,89 mm Hg (95% CI 123,89-131,36), diastolic BP 80,031±0,93 (95% CI 78,20-81,86), mean PWV was 11,38±0,16 m/sec (95% CI 11,05-11,70). Analysis of the VA difference between women with BMI <25 kg/m² (BMI1, n=93) and ≥25 kg/m² (BMI2, n=67) revealed a significant difference in the calculated VA values (p=0,0002) between groups.

Conclusion. Modern young women have high rates of vascular stiffness, which may determine the increase in morbidity and mortality rates in the working-age female population. The VA indicator predicts cardiovascular events and can be considered as an effective screening method for assessing cardiovascular risk, which is especially important for young patients.

Aim. To evaluate the influence and changes of clinical and water-electrolyte parameters on the risk of cardiovascular events in the early period after decompensated heart failure (HF) in patients with type 2 diabetes (T2D), taking into account the influence of standard diuretic therapy and diuretic therapy in combination with sodium-glucose cotransporter 2 (SGLT-2) inhibitors.

Material and methods. The study included 119 patients with type 2 diabetes and class III-IV HF. The duration of diagnosed HF at the time of enrollment was 6,9±1,1 years.

Patients who met the inclusion criteria at the time of hospital admission were randomized into a group of standard therapy for decompensated HF (control group) and a group of combined diuretic therapy — loop diuretics + SGLT-2 inhibitors (main group).

Results. Against the background of combined diuretic therapy with SGLT-2 inhibitors, a significant increase in diuresis was achieved, starting from the 2^nd day: on day 2 — in the main group 1,342,83±159,74 ml/day and 1,250,17±134,53 ml/day in the control group (p=0,001, 95% confidence interval (CI)), on day 3, in the main — 1,895,17±249,95 ml/day, and in the control — 1,723,78±252,49 ml/day (p=0,004, 95% CI), on day 4, in the main — 2,382,50±246,29 ml/day and in the control — 2,124,83±2,86,44 ml/day (p=0,000002, 95% CI), on day 5, in the main — 2,785,50±282,38 ml/day and in the control group 2,458,39±273,36 ml/day (p<0,001, 95% CI).

A comparison of the two groups showed a significant increase in natriuresis in the main group on day 5 (+111,1±10,54 ml) compared to the control (+75,53±15,01 ml, p<0,001, 95% CI). Extracellular fluid volume, determined by bioelectrical impedance analysis on day 5, decreased significantly higher when taking SGLT-2 inhibitors: in the main group the decrease was by 5,48±2,19 kg, in the control group — by 2,92±0,73 kg (p=0,02, 95% CI), On day 5, we revealed a significant inverse relationship between natriuresis level and extracellular fluid volume (r=0,217, p=0,018). Dapagliflozin (D), like empagliflozin (E), significantly and equally increases the level of natriuresis (D +108,25±13,56 mmol/day, p<0,001, E +112,52±8,50, p=0,00009) and reduces the extracellular fluid volume (D -5,05±1,46 kg, p<0,001, E -5,69±2,47, p<0,001) on day 5.

Conclusion. In patients with type 2 diabetes hospitalized for decompensated HF, therapy with SGLT-2 inhibitors + loop diuretics lead to a significantly greater diuresis, natriuresis and a greater decrease in extracellular fluid volume. A significant inverse relationship was found between the extracellular fluid volume and natriuresis level on day 5. Dapagliflozin effectiveness in edema, assessed by natriuresis level on day of treatment, is identical to the empagliflozin.

The review summarizes and analyzes the available literature to provide information to clinicians about the best treatment strategies for type 2 diabetes in stable coronary artery disease. This data should help health care professionals make decisions in routine practice. 2023 European and Russian guidelines on type 2 diabetes suggest giving preference to glucose-lowering agents with proven benefits for the cardiovascular system, followed by drugs with proven safety for the cardiovascular system.