The combination of hypertension and chronic kidney disease is a stage of the cardiovascular-renal-metabolic continuum and associated with adverse cardiovas­cular and renal outcomes. Epidemiological aspects, accessible screening algorithm within outpatient monitoring, availability of modern cardiac and renal protective strategies make it possible to select this high-risk group as a priority for the implementation of effective targeted primary prevention and maintaining the trend of reducing cardiovascular morbidity and mortality in the medium- and long-term.

The effectiveness of blood pressure control can be increased with the use of single-pill combinations. When choosing an agent, the evidence of its components should be focused. The selection criteria are not only the direct effects of reducing blood pressure, but also organ protection and the impact on prognosis. Perindopril and indapamide have many years of experience in use in a wide range of patients and are used with the same effectiveness in the treatment of hypertension in young and elder­ly patients, in normal-weight and obese people, as tools for the primary prevention of myocardial infarction and stroke, and also as a way to prevent recurrent events.

The article provides data on the advantages of perindopril and indapamide, the potential of its single-pill combination, the pleiotropic and organ protective properties of this drug. We systematized results of related studies and reflected the main conclusions. Attention is paid to the latest data on the long-term effect of indapamide therapy on the risk of cardiovascular events.

The article is devoted to a detailed analysis of the action of various drugs used in the treatment of hypertension and atherogenic dyslipidemia, depending on their ability to dissolve in fatty media (lipophilicity). The authors analyze connection between the lipophilicity level of drugs and their pharmacokinetics, drug-drug interactions, the manifestations of clinical effects and organ protection, as well as their ability to influence the prognosis of comorbid patients. Using angiotensin-converting enzyme inhibitors, calcium channel blockers, and statins as examples, the authors explain the practical significance of pharmacological parameters such as plasma protein binding and distribution volume, and also develop an un­derstanding of the importance of its routine use in order to obtain clinical bene­fits for patients.

The aim of the review was to identify current barriers, "paradoxes", in the treatment of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS), based on a critical analysis of modern studies and identified evidence gaps.

NSTE-ACS can be considered from the perspective of the following paradoxes: the risk-treatment paradox; risk stratification paradox; scope and timing of dual antiplatelet therapy; paradox of insufficient benefit of invasive treatment; age and comorbidity; tactics for multi-vessel coronary artery disease.

A review of publications indexed in the Pubmed and Russian Science Citation Index (RSCI) databases was carried out. The search depth was 10 years (from 2013 to 2023). The search resulted in 328 studies, of which 45 were used to write the final review.

Aim. To study the features of treatment of patients with various types of coronary artery disease (CAD) and type 2 diabetes (T2D) at various healthcare stages.

Material and methods. The comparative clinical study included 412 patients of both sexes with acute and chronic coronary artery disease. Depending on the glycemic status and CAD type, patients were divided into four subgroups: subgroup 1a (n=100, 56,6±0,96 years, male/female 67/33) — with acute CAD and T2D; subgroup 1b (n=106, 58,7±1,01 years, male/female 75/31) — with acute CAD without T2D; subgroup 2a (n=102, 57,9±1,04 years, male/female 72/30) — with chronic CAD and T2D; subgroup 2b (n=104, 60,2±0,9 years, 69/35) — with chronic CAD without T2D. The selection and mean doses of standard and hypoglycemic therapy were analyzed.

Results. Initially, 86% and 81% of patients with diabetes in subgroups 1a and 2a adhered to glucose-lowering therapy. Among patients with chronic CAD, more than 1/4 (26,4%) received insulin therapy versus 2% in the group of patients with acute coronary syndrome (ACS) and diabetes. After discharge from hospital, oral hypoglycemic therapy was prescribed to 74% of patients with ACS and 48% of patients with chronic CAD. The prescription of insulin therapy for people with ACS increased 5 times (up to 10% of the total number of patients with ACS and T2D). By the time of hospital admission, 70% and 71,5% of patients with ACS and chronic CAD with diabetes received acetylsalicylic acid as an antiplatelet agent, respectively. During hospitalization, all patients with acute CAD were prescribed dual antiplatelet therapy, as well as triple antiplatelet therapy in the case of atrial fibrillation/flutter. It is noteworthy that in the group of patients with chronic CAD, less than 70% received statins. In patients with chronic CAD and diabetes, this parameter was even lower, amounting to 59,8%. At the outpatient stage, all patients, with the exception of the group with chronic CAD without diabetes, took beta-blockers (up to 65%). In the hospital, the use of beta blockers increased to 95%. During inpatient treatment, angiotensin-converting enzyme inhibitors and sartans were prescribed 1,5-2 times more often than in the prehospital stage.

Conclusion. The study indicates insufficient prescription of standard CAD and glucose-lowering therapy. Careful inpatient selection of therapy requires continuity at the outpatient stage.

Aim. To analyze the lipid profile changes during the acute phase of coronavirus disease 2019 (COVID-19) and within 12 months after discharge from the hospital (post-Covid period) in comparison with the lipid profile of patients before COVID-19.

Material and methods. The subanalysis of the registry was carried out as follows: clinical investigators in each of the centers included patients in the AKTIV registry selected from the database patients who met three following criteria: (1) availability of lipid profile test no more than 60 days before COVID-19; (2) availability of lipid profile test during the acute period; (3) availability of lipid profile test within 6-12 months after discharge from the hospital.

Results. In patients after COVID-19, a decrease in the levels of all lipid profile parameters in the acute COVID-19 phase and their subsequent increase were found.

In the post-COVID-19 period, 25,7% of patients experienced an increase in lipid profile parameters (increased levels of total cholesterol (TC) and/or cholesterol, low-density lipoproteins and/or triglycerides and/or cholesterol excluding high-density lipoproteins by ≥0,5 mmol/l) despite the fact that lipid-lowering therapy in these patients was at least no worse than in patients without lipid profile changes.

Multivariate analysis found that such variables as age (direct relationship), body mass index (direct relationship), estimated glomerular filtration rate in the acute phase (inverse relationship) and cholesterol level excluding high-density lipoproteins in the acute period (inverse relationship), as well as heart failure, obesity and cytokine storm in the acute COVID-19 phase are independent predictors of an increase in one or more lipid parameters by ≥0,5 mmol/l over 6-12 months of post-COVID-19 period.

Conclusion. COVID-19 likely contributes to the onset and/or progression of lipid metabolism disorders in COVID-19 survivors (Eurasian population).

Aim. To evaluate cardiovascular risk factors as predictors of the post-coronavirus disease 2019 (COVID-19) syndrome.

Material and methods. This prospective cohort study included adult patients admitted to a university hospital with a clinically or laboratory-confirmed diagnosis of COVID-19. A number of cardiovascular risk factors were assessed at admission, including the Cardio-Ankle Vascular Index (CAVI). After hospital discharge, patients were observed for 6 months. Then, data on the course of the post-COVID-19 period was collected from electronic medical records and discharge summaries. Two following outcomes were assessed: the development of post-COVID-19 syndrome and the development of newly diagnosed diseases or worsening of existing chronic diseases in the post-COVID-19 period.

Multivariable logistic regression was used to assess the association between potential predictors and outcomes, and odds ratios (OR) with 95% confidence intervals (95% CI) were calculated to assess the association strength. The statistical significance level was p<0,05.

Results. The final analysis included 125 patients (68 (54,4%) women). The median age was 59,0 [50,5, 71,0] years. Post-COVID-19 syndrome was diagnosed in 32,8% of patients. The most common symptoms were weakness (19,2%), headaches (11,2%) and shortness of breath (10,4%). In multivariate analysis, CAVI ≥9,5, increased systolic blood pressure (SBP) and glomerular filtration rate (GFR) on admission were associated with the post-COVID-19 syndrome, with an OR of 2,415 (95% CI 1,174-2,846), 1,045 (95% CI 1,010-1,082), 0,971 (95% CI 0,946-0,998), respectively. Age (OR 1,056, 95% CI 1,009-1,105) and body mass index (OR 1,132, 95% CI 1,027-1,248) were associated with newly diagnosed diseases or worsening of existing chronic diseases in the post-COVID-19 period.

Conclusion. Objective indicators such as SBP, CAVI and GFR may be predictors of post-COVID-19 syndrome, and age and body mass index are associated with the unfavorable course of chronic diseases in the post-COVID-19 period.

Aim. To investigate the polymorphic variants of IL10, FGF2, VEGFD, TRAIL, SELE, TNFA and TNFβ genes in patients with primary ST-segment elevation myocardial infarction (MI) (STEMI) and to evaluate their association with late post-infarction cardiac remodeling.

Material and methods. The study includes 74 patients age 61±10,7 years with primary STEMI. Percutaneous coronary intervention with restoration of infarct-related artery patency was performed in all patients after 60 (40; 80) minutes since admission to the hospital. Serum levels of fibroblast growth factor (FGF), interleukin-10 (IL-10), tumor necrosis factor family cytokines (TNF-α, TNF-β and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)) were measured with the Multiplex Instrument FLEXMAP 3D system (Luminex Corporation) and the MILLIPLEX Human Cytokine/Chemokine Panel II on the 1st, 7th day of early post-MI period and after 6 and 12 months. The late adverse cardiac remodeling was determined after 12 months of long-term post-MI period according to 2D echo­cardiography. The increase in left ventricular end-diastolic volume by 15% or more by 12 months was considered late adverse cardiac remodeling. The patients were genotyped by 16 single-nucleotide polymorphisms (SNPs) in the TNFβ, TNF, Il10, TNFRSF1B, VEGFD, TRAIL, FGF2, SELE genes.

Results. Adverse cardiac remodeling occurred in 19 patients (25,7%). The genetic association analysis revealed the significant association of rs1800629 TNFA (χ²=4,748; p=0,029), rs5353 SELE (χ²=10,85; p=0,004) and rs6632528 VEGFD (χ²=8,127; p=0,017) with an increased risk of STEMI. Higher concentration of IL-10 was detected on the 7th day of MI (p=0,05) and 6 months later (p=0,028) in A/T rs3024492 genotype carriers, as well as FGF in T/T rs13122694 genotype carriers by the 6th month after the event (p=0,04). The dependence of the main LV indicators on the distribution of polymorphism genotypes rs3024492 IL10, rs13122694 FGF2 and rs4830939 VGEFD was discovered. In the first 24 hours of MI in rs3024492 IL10 heterozygotes, LV contractile function was worse in comparison with T/T genotype carriers. Also, carriers of the T/T rs13122694 FGF2 genotype were distinguished by higher LV ejection fraction, longitudinal global LV deformation and lower of LV end-systolic index in the early post-infarction period. In the long-term post-infarction period, T/T rs4830939 VEGFD carriers differed in a greater LV dilation than carriers of the C/C and C/T genotypes.

Conclusion. The study showed the contribution of polymorphism of the inflammation system genes to a predisposition to STEMI — both at the levels of phenotype and individual signs.

Aim. To study the relationship between the presence and size of microvascular obstruction (MVO) and the prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) within one year.

Material and methods. The study included 50 patients with a first STEMI who underwent PPCI on the infarct-related artery. After 3-7 days and 12 months, contrast-enhanced cardiac magnetic resonance imaging was performed to assess left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and MVOs. After 12 months, patients were rehospitalized and prognosis was assessed based on data on cardiovascular events.

Results. Patients with MVO had a significantly lower LVEF in the acute period of MI (44,1±10,6%) compared to patients without MVO (52,9±10,5%), p=0,0209, as well as during reassessment after a year (44,8±11,1%) compared with patients without MVO (58,9±8,0%), p=0,0004. A significant inverse correlation was found between LVEF in the initial and repeat examination and MVO size in the initial examination as follows: ρ=-0,42 (95% confidence interval (CI): -0,66 — -0,12, p=0,008) and ρ=-0,61 (95% CI: -0,78 — -0,34, p=0,0001). There was also a significant inverse correlation between LVEF and MVO size at reassessment, ρ=-0,40 (95% CI: -0,65 — -0,07, p=0,0205). A significant direct correlation was identified between MVO size in the acute MI period and LVEDV one year later, ρ=0,35 (95% CI: 0,02-0,62, p=0,0409). The development of a left ventricular (LV) aneurysm was registered in 40% of patients with MVO during the initial study and was not registered among patients without MVO (p=0,0039).

Conclusion. MVOs was associated with post-infarction LV aneurysm. An increase in MVO size correlated with a decrease in LVEF and an increase in LVEDV both in the acute period and one year after MI.

Aim. To assess the rate of adverse cardiovascular events (a combination of non-fatal myocardial infarction (MI), non-fatal stroke, cardiovascular death) within 12 months after MI in patients who were followed up in outpatient clinics in Moscow after the hospital discharge, as well as its association with antiplatelet therapy.

Material and methods. This observational multicenter, open-label, prospective study that consecutively included patients after MI and came for further treatment and observation to the clinic after the hospital discharge, subject to providing informed consent. Data were obtained at four scheduled visits (an inclusion visit and 3 follow-up visits — 3, 6 and 12 months after the event). An analysis was carried out in the context of various antiplatelet therapy.

Results. The study included 1576 patients in 27 Moscow clinics (mean age, 62,2±11,1 years; men — 69%; ST-segment elevation MI — 57,7%, non-ST elevation MI — 42,3%). At the time of study inclusion, 47,2% of patients received dual antiplatelet therapy with clopidogrel, 4,2% — prasugrel, 48,6% — ticagrelor, with a mean duration of 11,2 months. Incidence of adverse cardiovascular events over 12-month follow-up rate was low and amounted to 3,4% (cumulative incidence, 0,038). This indicator was significantly lower in the subgroup of patients who underwent percutaneous coronary intervention compared with patients who received conservative therapy for MI (p=0,0002).

Conclusion. The study demonstrated a low incidence of adverse cardiovascular events over 12 months in patients followed up in outpatient clinics in Moscow after an MI, while percutaneous coronary intervention for MI was associated with a lower incidence of adverse cardiovascular events compared with conservative therapy.

Aim. To identify factors influencing inhospital mortality in patients with myocardial infarction aged ≥75.

Material and methods. We performed a retrospective analysis of medical records of all patients aged ≥75 years hospitalized from January 1, 2020 to December 31, 2021 with a diagnosis of myocardial infarction (I21, ICD-10), assessment of comorbidities, clinical performance, laboratory and treatment data and their impact on the outcome of hospitalization.

Results. Inhospital mortality was 22,2%. The mean age of discharged and deceased patients was 81 [79; 84] and 82 [79; 85] years, respectively (p=0,12). Cardiogenic shock on admission (hazard ratio (HR) 31,28; 95% confidence interval (CI) 5,7-171,53; p<0,001), degree 2-3 atrioventricular block (HR 4,67; 95% CI 1,02-21,38; p=0,04), as well as a GRACE score ≥166 for non-ST-segment elevation acute coronary syndrome (HR 7,19; 95% CI 1,01-51,43; p<0,001) showed an unfavorable effect on prognosis.

Conclusion. Cardiogenic shock, degree 2-3 atrioventricular block, and a GRACE score ≥166 for patients with non-ST-segment elevation acute coronary syndrome are factors that increase inhospital mortality in patients aged ≥75 years.

The applicability of the left ventricular global function index (LVGFI) and its deriva­tive, determined by echocardiography, to distinguish clinical phenotypes in a cohort of patients with heart failure with preserved ejection fraction (HFpEF) is unknown.

Aim. To evaluate the differential diagnostic potential of LVGFI and its derivative when phenotyping outpatients aged ≥60 years with HFpEF.

Material and methods. A total of 140 outpatients (men, 43%) aged 73 (67-78) years with functional class II-IV HFpEF were included in the study. The follow-up period was 34 (22-36) months.

Results. LVGFI was 22,4 (19,4-24,6)%, while derivative index of LVGFI — 283,9 (248,9-332,2) ml. There were 18 (12,9%) deaths. The threshold value for predicting death for LVGFI was ≤21,4%, for derivative index of LVGFI — ≥303,6 ml. Based on cluster membership and mortality analysis, two following risk groups for death of patients with HFpEF were identified: a relatively low-risk (group 1) and moderate (group 2) risk group (mortality within 34 months ~25%). Group 1 was represented by patients, predominantly male, with class II HFpEF, coronary artery disease (CAD) and prior myocardial infarction (MI), concentric hypertrophy, a significant LV mass increase, a high frequency of bendopnea, lower LVGFI and higher derivative index of LVGFI. Group 2 was represented by patients, predominantly female, with class II HF, a history of CAD and myocardial infarction, concentric hypertrophy and concentric remodeling, a moderate LV mass increase, a relatively low frequency of bendopnea, higher LVGFI and lower derivative index of LVGFI. Based on the data obtained, an algorithm was developed to determine the risk of death in patients with HFpEF.

Conclusion. LVGFI and its derivative index can be used in phenotyping patients with HFpEF. The developed algorithm for determining the death risk makes it possible to identify outpatients with HFpEF who need intensified therapy and observation by a general practitioner and cardiologist in order to reduce the risk of an unfavorable prognosis.

Aim. To analyze clinical and anamnestic factors associated with the risk of acute decompensated heart failure (ADHF) in patients with an implanted cardioverter-defibrillator (ICD) with the development of a prognostic model based on the Kuzbass registry of patients with ICD.

Material and methods. Prospective follow-up of 260 patients with reduced left ventricular ejection fraction (age 59 (53; 66) years, 214 (82,3%) men) from the Kuzbass registry of patients with ICD. Of them, 156 (60%) patients had ischemic cardiomyopathy, while the rest had non-ischemic cardiomyopathy. The mean follow-up period was 4,2±2,3 years after ICD implantation. The following basic information about patients were assessed: demographic data, social status, history of the underlying disease, concomitant diseases, vital signs, standard clinical and paraclinical parameters, drug therapy. During the follow-up period, all cases of ADHF and death were analyzed.

Results. A total of 54 (20,8%) patients died, of which 48 (88,9%) died due to ADHF. During the follow-up period, 34 patients were hospitalized for ADHF, of which 13 (38,2%) died. Thirty-five (13,5%) patients died in the prehospital stage due to ADHF that developed against the background of the underlying disease (10 (27%) had dilated cardiomyopathy, 1 (2,8%) — rheumatic mitral valve disease, 24 (68,6%) — ischemic cardiomyopathy). Thus, a total of 69 cases of ADHF were registered, which accounted for 26,5% of the total group. Mortality in general group from ADHF was 18,5%. According to the Kaplan-Meier curve, most deaths occurred during the first 1,5 years of follow-up.

The regression model for predicting the ADHF risk included left atrium size (p=0,05), male sex (p=0,001), NYHA class (p=0,0001), left ventricular ejection fraction <40% (p=0,0001), no intake of renin-angiotensin-aldosterone system inhibitors (p=0,007) and amiodarone (p=0,028). The area under the ROC curve (AUC), sensitivity and specificity of the created model was 0,8, 69,2% and 80%, respectively.

Conclusion. A set of routine clinical and anamnestic factors has been identified that makes it possible to predict the risk of ADHF in patients with ICDs, which must be taken into account before making a decision to implant the device. Particular attention should be paid to mandatory therapy for heart failure, as the main modifiable risk factor for ADHF.

Aim. To compare the incidence of postoperative cognitive dysfunction and neuropsychological changes in the early postoperative period of coronary artery bypass grafting (CABG) in patients who underwent two versions of multitask cognitive training, which involved various cognitive and motor tasks, as well as in a control group.

Material and methods. The study included 100 patients after elective CABG. All patients were randomly divided into three following groups: cognitive training (CT) 1 (postural balance combined with mental arithmetic, verbal fluency, and unusual object use tasks) (n=30), CT 2 (simple visual-motor response combined with task on mental arithmetic, verbal fluency and unusual object use) (n=35) and without training (standard postoperative therapy) (n=35). All patients underwent extensive neuropsychological testing before CABG. Reexamination with assessment of postoperative cognitive dysfunction (POCD) was carried out on days 2-3 and upon completion of 5-7 days of training or on days 11-12 after CABG.

Results. The presence of POCD on days 2-3 was found in 100% of patients in the study groups. On days 11-12 of CABG, POCD persisted in 17 people (56,7%) from the CT 1 group, in 24 (68,6%) from the CT 2 group, and in 28 (80%) patients in the control group. Significant differences were obtained in the POCD prevalence in the CT 1 and control groups (odds ratio =3,06; 95% confidence interval: 1,02-9,18, p=0,04), but not CT 2 and control groups (odds ratio =1,83; 95% confidence interval: 0,64-5,47, p=0,28).

Conclusion. Multitask training using a combination of postural balance and mental arithmetic tasks, verbal fluency, and unusual object use had a greater effect in reducing the POCD incidence in patients after CABG compared with standard postoperative care. The results of this study may be used to develop cognitive rehabilitation programs in cardiology and cardiac surgery.

Aim. To analyze the relationship of low blood potassium concentration before surgery with the risk of postoperative atrial fibrillation (POAF).

Material and methods. Data were collected and analyzed from patients admitted to the intensive care unit after cardiac surgery between January 2023 and June 2023. During the study period, 691 patients were operated on. Of these, 96 (13,9%) patients developed POAF, which made up group A (mean age 68,3±10,0). Control group B of patients with sinus rhythm was formed using a random generator and consisted of 96 patients with a mean age of 63,5±8,3.

Results. The median time to onset of arrhythmia was 39,0 (29,2-51,0) hours. The blood potassium concentration one hour before surgery was significantly reduced in patients who developed arrhythmia compared with the control group (p<0,001) and averaged 3,4±0,4 mmol/L. To determine the sensitivity and specificity of the association of hypokalemia with POAF, we used a confirmatory statistical method, namely constructing ROC curves (AUC 0,640 (95% confidence interval: 0,562-0,718; p<0,001)).

Conclusion. This study demonstrated the association of low preoperative blood potassium concentrations with the risk of POAF. Electrolyte concentrations alone cannot fully explain the risk of arrhythmia. However, optimizing electrolyte balance and, in particular, maintaining potassium concentrations >4,5 mmol/L may prevent the atrial fibrillation in some patients.