Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).

Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.

Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.

Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

Aim. To evaluate the diagnostic and prognostic value of circulating mature and aging neutrophils in relation to hypoechoic carotid plaques and short-term progression of carotid and multifocal atherosclerosis.

Material and methods. The study included 200 patients (89 males and 111 fe­males), aged 40-64 years. All patients underwent duplex ultrasound of the carotid and lower extremity arteries at the first visit and at a repeat visit after 12-24 months. Ultrasound morphology of carotid plaques was assessed using greyscale median analysis. Phenotyping and differentiation of neutrophil subpopulations was carried out using flow cytometry.

Results. The absolute and relative number of mature neutrophils directly correlated with ultrasound indicators of carotid atherosclerosis, while the number of aging neutrophils — with the degree of lower extremity artery stenosis. Patients with hypoechoic carotid plaques were characterized by a significantly higher absolute number of mature neutrophils (p=0,0340). An increase in the number of mature neutrophils over 3023,0 cells/μL made it possible to predict the hypoechoic carotid plaques with a sensitivity of 75,0% and a specificity of 69,5%. Patients with carotid atherosclerosis progression had a higher absolute number of mature neutrophils (p=0,0140), as did patients with progression of multifocal atherosclerosis (p=0,0162). An increase in the number of mature neutrophils more than 3223,0 cells/μL was associated with an increase in the relative risk of polyvascular disease progression by 3,09 times (95% confidence interval, 1,34-7,17; p=0,0082) after adjustment for baseline cardiovascular disease risk.

Conclusion. Among patients aged 40-64 years, increased numbers of circulating mature neutrophils are associated with an increased carotid plaque burden and hypoechoic carotid plaques. An increase in the number of mature neutrophils over 3223,0 cells/μL was associated with a 3,09-fold increase in the relative risk of polyvascular disease after adjustment for baseline cardiovascular risk.

Patients with polyvascular disease (PVD), involving two or more vascular beds, are a difficult group for cardiologists, cardiovascular surgeons and endovascular surgeons. The relevance of the problem is due to its widespread prevalence, rapid progression, and comorbidity, which worsens the prognosis in this cohort of patients. The problem of selecting the optimal revascularization tactics remains unresolved. The results of original research on this problem are analyzed. The need for an individual multidisciplinary approach to determine the best revascularization strategy is demonstrated. The use of various methods of optimal therapy, open and endovascular surgery in each specific case is the most acceptable tactic.

Aim. To study the relationship of lipitension and cardiometabolic risk (CMR) factors in young people.

Material and methods. The case-control study on general obesity (GO) (overweight — 33,3%, GO — 33,3%) included 191 patients (Me=35,0 [30,0-39,0] years; F/M=97(50,8%)/94(49,2%)) without cardiometabolic diseases, comparable by sex and age. The prevalence and characteristics of lipitension were studied, taking into account the features of dyslipidemia and increased blood pressure (BP). Depending on the presence of lipitension, 2 groups were identified in which the CMR factors were studied: GO and abdominal obesity (AO), visceral fat, prediabetes, insulin resistance, increased C-reactive protein (CRP), hyperuricemia, glomerular filtration rate changes. Data were processed using SPSS Statistics 26.

Results. Overall, the incidence of increased BP was 36,1%, hypertension (HTN) — 16,2%, and dyslipidemia — 73,3%. Lipitension was diagnosed in 25,1% of patients. At the same time, increased BP and HTN without combination with dyslipidemia were detected less frequently (13,1% and 5,2%, respectively). Dyslipidemia without increased BP and HTN, on the contrary, is more common (48,2%). Lipitension is more often diagnosed in men than in women — 32 (66,7%) and 16 (33,3%), p=0,005; [odds ratio=2,6; 95% confidence interval: 1,32-5,18]. In patients with lipitension, 43,8% were diagnosed with HTN, while the remaining 56,2% had BP ≥130/85 mm Hg. In the structure of dyslipidemia in lipitension, 79,2% had abnormalities in ≥2 lipid parameters, of which increased levels of low-density lipoprotein cholesterol (LDL-C) and hypercholesterolemia (78,3%) were most often detected. Persons with lipitension more often had AO (31,2%), increased glycated hemoglobin (HbA1c) >6% (39%) and insulin resistance (36,2%) than those without lipitension (p=0,026, p=0,018, p=0,044, respectively). With lipitension, a higher level of visceral fat (Me=8 [6-9] units) and HbA1c (Me=5,6 [5,1-6,0]%) was established than without it (Me=6 [4-9]U and Me=5,4 [5,1-5,9]%, respectively p=0,000 and p=0,018).

Conclusion. Increased BP and HTN are more often found in combination with dyslipidemia than as an independent risk factor. In lipitension, the largest number of patients had ≥2 lipid metabolism disorders, most often represented by increased LDL-C and hypercholesterolemia. The presence of lipitension was associated with AO, increased HbA1c, and insulin resistance.

Aim. To study the effect of 48-week therapy with atorvastatin and ezetimibe on laboratory parameters, structural and functional arterial characteristics and heart failure markers in the post-infarction period.

Material and methods. A total of 87 patients with acute myocardial infarction were included. In the first 24 hours, atorvastatin 80 mg/day was prescribed. During hospitalization, after 5-6, 24, 48 weeks, clinical and paraclinical examinations were performed. In the level of low-density lipoprotein cholesterol (LDL-C) >1,4 mmol/l and the decrease <50% at one of the follow-up visits, ezetimibe 10 mg/day was additionally prescribed.

Results. Eighty participants (93%) completed the study. Patients were divided into following groups: group 1 (n=32) — atorvastatin monotherapy; group 2 (n=49) — ezetimibe and atorvastatin therapy. In group 1, LDL-C decreased after 48 weeks by 53% (p<0,001), while in group 2 by 63,2% (p<0,001). According to carotid ultrasound in group 2, a decrease in the intima media thickness after 24 and 48 weeks was revealed by 9,1% (p<0,001) and 10,5% (p<0,001) compared to the baseline value, while in group 1 — by 4,5% only on the 24th week (p=0,012). When analyzing endothelial function, there was an increase in flow-dependent vasodilation only in group 2 from 9,1 (5,6; 11,8)% to 14,3±6,8% after 48 weeks (p<0,001). With the addition of ezetimibe, there was a regression of the N-terminal pro-brain natriuretic peptide after 24 weeks by 69,6% (p=0,005), after 48 weeks — by 72,4% (p=0,009). In group 2, it decreased by 75,5% by the end of follow-up (p=0,010).

Conclusion. The results rationale adding ezetimibe to statins in very high-risk patients due to the most pronounced lipid lowering effect, improvement of the structural and functional properties of the common carotid arteries, endothelial function and clinical and laboratory heart failure markers.

Aim. To identify predictors of cardiovascular events (CVEs) in patients with heart failure (HF) and P. aeruginosa pneumonia.

Material and methods. The study included 92 patients with HF with mildly reduced or reduced ejection fraction and nosocomial pneumonia. Based on sputum or bronchoalveolar lavage microbiological examination, patients were divided into 2 following groups: group I — 51 patients with HF and P. aeruginosa pneumonia, group II — 41 patients with HF and pneumonia caused by other pathogens (Staphylococcus aureus, Streptococcus pneumoniae). During the hospital stay, the following morbidities were assessed: cardiovascular death, acute coronary syndrome, non-fatal cerebrovascular accident, pulmonary embolism, lower extremity venous thrombosis.

Results. CVEs were significantly more often observed in patients with HF and P. aeruginosa pneumonia — 30 (58,8%) than in patients with HF and pneumonia caused by S. aureus or S. pneumoniae — 5 (12,1%). Complete blood count in group I patients revealed a decrease in hemoglobin level to 114 [95; 133] g/l, when compared with patients in group II — 139 [118; 150] g/l (p<0,001) and an increase in white blood cell count (10,2×10⁹/l and 6,96×10⁹/l, respectively (p<0,001)). A biochemical blood test in group I patients revealed a significant increase in C-reactive protein (CRP) of 105 [60; 191] and 18 [14; 55,1] mg/l (p<0,001). Patients with P. aeruginosa pneumonia had more widespread lung involvement than patients with pneumonia of other etiologies.

Conclusion. There are following most significant predictors of cardiovascular events in patients with HF and P. aeruginosa pneumonia: decreased LVEF <40% (relative risk (RR) 1,833; 95% confidence interval (CI) 1,188-3,400; p=0,005), white blood cell count >11×10⁹/l (RR 2,412; 95% CI 1,399-4,158; p=0,048), CRP >133 mg/l (RR 3,115; 95% CI 1,611-6,025; p<0,001) and hypoproteinemia <57 g/l (RR 5,225; 95% CI 1,249-21,854; p=0,012).

Aim. The high prevalence of obesity in a cohort of patients with heart failure and mildly reduced ejection fraction (HFmrEF) determines the relevance of clarifying the role of biomarkers and autonomic imbalance in myocardial remodeling, taking into account metabolic risk factors.

Material and methods. We examined 19 men with postinfarction cardiosclerosis and class II HFmrEF (median age 62 years), overweight/class I-II obesity, type 2 diabetes in 53/47%, 48% of cases, respectively, who received therapy. The biomarker panel included N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3, pro-collagen I C-terminal propeptide (PICP), N-terminal propeptide of procollagen type III (PIIINP), C-terminal telopeptide of type I collagen, matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix proteinase-1 (TIMP-1), leptin and adiponectin. Heart rate variability (HRV) and turbulence were obtained using 24-hour Holter monitoring. We assessed the time and frequency domains of HRV (24 h) and 5 min recordings of wakefulness at rest, calculated TO (turbulence onset) and TS (turbulence slope).

Results. Significant positive associations of leptin and TIMP-1 levels with left ventricular hypertrophy markers were confirmed. Positive correlations of peak e' with following HRV indicators were revealed: SDNN (r=0,68; p=0,02) and RMSSD (r=0,69; p=0,003). Lower TS values were associated with higher index parameters of left ventricular mass (p<0,05 for all). Associations of biomarkers with autonomic nervous system (ANS) were observed: MMP-9 with RMSSD (r=0,54) and pNN50 (r=0,51); TIMP-1 with TO (r=0,46); PICP/PIIINP ratio with HFn (5 min) (r=-0,49); NT-proBNP/adiponectin ratio with SDNN (r=-0,49); leptin level with TS (r=-0,54) (p<0,05 for all).

Conclusion. In patients with HFmrEF of ischemic origin and additional metabolic risks, serum biomarkers of fibrosis, adipokines, and ANS parameters are associated mainly with markers of increased left ventricular filling pressure. The study results predetermine the further search for potential risk-stratification markers of unfavorable myocardial remodeling and prognosis in large samples of patients with metabolic deviations and HF with EF >40% against the background of modern drug therapy.

Aim. To identify the relationship of different albuminuria levels with paraclinical signs of congestion on admission and discharge and with the prognosis of acute decompensated heart failure (ADHF).

Material and methods. Patients hospitalized with ADHF were included. Albuminu­ria level was assessed on admission and discharge. Patients were divided into groups according to albuminuria level (A1, A2, A3) according to KDIGO guidelines. Among the congestion parameters, the following were assessed: N-terminal pro-brain natriuretic peptide (NT-proBNP), lung ultrasound examination (BLUE protocol), venous congestion according to the VExUS ultrasound protocol (inferior vena cava, portal, hepatic and renal veins). The primary endpoint was a composite of all-cause death and rehospitalization for ADHF within 180 days of discharge.

Results. The final analysis included 180 patients. The prevalence of A1, A2 and A3 albuminuria at admission was 50%, 39%, 11%, respectively. A greater degree of albu­minuria was associated with worse renal function at admission and discharge. Pati­ents with increased albuminuria on admission had higher NT-proBNP and a greater number of B-lines on pulmonary ultrasound in on admission and discharge, and a higher degree of complex venous congestion and renal vein congestion on VExUS on admission. A3 albuminuria at admission and discharge was associated with an increased risk of poor long-term prognosis (hazard ratio (HR) 3,551; 95% confidence interval (CI) 1,593-7,914; p=0,002), (HR 4,362; 95% CI 1,623-11,726; p=0,004).

Conclusion. In patients with ADHF, the albuminuria level on admission is associated with the severity of congestion upon admission and discharge. A3 albuminuria at admission and at discharge is a predictor of long-term poor prognosis within 180 days after discharge.

Aim. To characterize patients with acute non-ST elevation myocardial infarction (NSTEMI) hospitalized in Russian hospitals, study their anamnestic, demographic and clinical characteristics, treatment features and hospital outcomes, as well as compare data from previous Russian and foreign registries of acute coronary syndrome.

Material and methods. Russian Registry of Acute Myocardial Infarction (REGION-IM) is a multicenter prospective observational study. The case report form contains demographic and anamnestic data, as well as the following information about the present MI: timing of symptom onset, first contact with medical personnel and admission to the hospital; data from coronary angiography (CAG) and percutaneous coronary intervention (PCI), therapy, hospitalization outcomes.

Results. In total, for the period from November 1, 2020 to June 30, 2023, the study included 3253 patients with STEMI from 73 hospitals (30 vascular surgery departments, 17 of which are equipped with angiographic system, and 43 regional vascular surgery centers) from 45 constituent entities of the Russian Federation. There were 55% of high-risk patients. CAG was performed in 83,73% of patients. In 81%, CAG was performed ≤24 hours from hospitalization. PCI was performed in 62% of patients with NSTEMI. Median onset-to-balloon time was 27 hours [10;77]. The median door-to-balloon time was 5 hours [1;20]. Inhospital mortality was 3%. In the group with CAG, compared with the group without CAG, inhospital mortality was lower (2% and 6%, respectively; p<0,05). In patients with a higher risk according to the GRACE, CRUSADE and ARC-HBR scales, CAG was performed less frequently.

Conclusion. In patients with NSTEMI in Russian regions, there is a high frequency of CAG and PCI, including in the early stages. Inhospital mortality is low, especially in the invasive treatment group, and corresponds to data from international registries. In severely ill patients, revascularization is performed less frequently than in low-risk patients. There is room for increasing the prescription rate of modern effective anticoagulants and antiplatelet agents. In general, the quality of treatment for NSTEMI patients has improved in recent years.

Aim. To study the associations of the left atrial epicardial fat (LAEF) thickness with the thrombosis prevalence and left atrial appendage (LAA) flow velocity in patients with persistent non-valvular atrial fibrillation (AF).

Material and methods. Transesophageal echocardiography in 475 patients with persistent non-valvular AF (men 58,9%, age 64,0 (58,3-70,0) years) assessed LAA flow velocity, interatrial septum and left lateral ridge thickness. Their average thickness was used to estimate the LAEF volume.

Results. LAA thrombus was detected in 42 (8,8%) patients. LAA flow velocity without thrombus was 32,0 (26,0-39,0) cm/s, with thrombus — 20,0 (14,0-25,8) cm/s (p<0,0001). Depending on the LAEF thickness, patients were divided into 3 tertile groups: group 1 (n=168) — 5,6-7,4 mm, group 2 (n=154) — 7,45-8,2 mm, group 3 (n=153) — 8,25-10,9 mm. In group 1, no thrombus was detected, in group 2, thrombus was detected in 2 (1,3%) patients, in group 3 — in 40 (26,0%) patients (p<0,0001). In the absence of LAA thrombus, flow velocity in the selected groups did not differ (32,0 (26,0-39,0) cm/s, 31,0 (26,0-7,8) cm/s and 31,5 (25,0-40,0) cm/s, (p=0,9514)).

Conclusion. EFL thickness, calculated as the average of interatrial septum and left lateral ridge thickness, can be used to study the relationship between epicardial obesity and LAA thrombosis in patients with AF. In patients with persistent non-valvular AF with a LAEF thickness >8,2 mm, LAA thrombosis occurs more than 40 times more often than in patients with a lower LAEF thickness. The influence of LAEF thickness on LAA flow velocity was not revealed in the pre­sent study.

Aim. To study the changes of left ventricular (LV) contractile function in patients with severe mitral valve (MV) insufficiency with assessment of global longitudinal strain (GLS) indicators and LV myocardial function after the mitral transcatheter edge-to-edge repair (TEER) within 12-month follow-up.

Material and methods. The study consisted of 43 patients with severe mitral regurgitation (MR) as follows: 23 patients with functional MR (FMR), 20 patients with degenerative MR (DMR). A comprehensive echocardiographic study, including speckle tracking echocardiography, was performed at baseline, 4-5 days, 6 and 12 months after TEER. Standard structural and functional indicators of the LV, LV GLS and myocardial performance parameters were assessed.

Results. The early postoperative period (4-5 days) was characterized by a decrease in global constructive work (GCW) (FMR group — from 977 [684; 1253] to 857 [736; 1488] mm Hg%, (p=0,038); DMR group — from 1458 [1283; 1848] to 1350 [1010; 1488] mm Hg% (p=0,011)), an increase in global wasted work (GWW) (FMR group — from 177 [130; 280] to 336 [242; 388] mm Hg% (p=0,004); DMR group — from 128 [81; 172] to 216 [164; 279] mm Hg% (p=0,043)), which was accompanied by a decrease in myocardial efficiency (FMR group — from 81,5 [77; 87] to 76 [73; 79]%, (p=0,021); DMR group — from 90 [85; 93] to 82 [79; 85]% (p=0,018)). After 12-month follow-up, there was a significant increase in GCW relative to the initial values in both cohorts of patients as follows: FMR group — to 1128 [890; 1711] mm Hg% (p=0,048); DMR group — to 1818 [1478; 2034] mm Hg% (p<0,001). There was also an increase in GWW in the FMR group to 255 [214; 363] mm Hg% (p=0,024) and in the DMR group to 230 [140; 270] mm Hg% (p=0,043). There were no significant improvement of LV GLS in both groups.

Conclusion. The early postoperative period after TEER was characterized by a temporary deterioration in all LV performance parameters, which recovered by 6 and 12 months of follow-up. Myocardial function restoration by one year of follow-up was noted due to an increase in GCW. LV GLS and ejection fraction did not change significantly by 1 year of follow-up compared to baseline values.

Aim. To develop and validate a machine learning model designed to identify suspected pulmonary embolism (PE) based on various clinical features from electronic health records (EHRs) of out- and inpatients.

Material and methods. Data from 19730 patients from 7 Russian regions were taken for analysis. EHR data were analyzed for the period from March 21, 2007 to February 4, 2022. Complaints, clinical and laboratory data, and concomitant diseases were used as diagnostic signs. PE was diagnosed in 1379 patients. Diagnosis of PE was based on ICD-10 codes. Seven machine learning algorithms were applied to diagnose pulmonary embolism: XGBoost, LightGBM, CatBoost, Logistic Regression, MLP Classifier, Random Forest Classifier, Gradient Boosting Classifier.

Results. The Gradient Boosting Classifier-based model was selected for further prospective testing with the sensitivity of 0,899 (95% confidence interval (CI), 0,864-0,932), specificity of 0,875 (95% CI, 0,863-0,86), area under the ROC curve of 0,952 (95% CI, 0,938-0,964). The following signs had the greatest prediction value: cough, respiratory disorders, blood creatinine, body temperature, general weakness, heart rate, respiratory rate, edema, antihypertensive therapy, saturation and age.

Conclusion. The model is designed for the initial encounter of patients with complaints and suspected PE, regardless of the type of care.

Within five years after myocardial infarction (MI), a third of patients have secondary major adverse cardiovascular events (MACEs). The first randomized clinical trials to show the effectiveness of anti-inflammatory strategies in the prevention of MACEs are CANTOS, COLCOT and LoDoCo2. These studies have identified an effective therapeutic target — the NLRP3 inflammasome. The results of COLCOT and LoDoCo2 led to colchicine becoming the first anti-inflammatory drug to be included in clinical guidelines for the treatment of patients with coronary artery disease (CAD). However, considering colchicine in routine clinical practice requires the cardiologist to have knowledge of the basic molecular mechanisms of inflammation in cardiovascular diseases. The review discusses current data on inflammation and the NLRP3 inflammasome in the pathogenesis of CAD and MI, results and issues of their application in clinical cardiology.

Ischemic cardiovascular events (ischemic stroke, myocardial infarction) are the most common complications of cardiovascular diseases. One of the leading mechanisms of these complications is atherosclerosis. Lipids play an important role in plaque development. Recently, the lipidome has been of greatest interest, since it may have a prognostic value in atherosclerosis development. With an increase in the circulation of proatherogenic lipidomic biomarkers, the risk of atheroscle­rosis destabilization and ischemic complications increases.

The conducted studies made it possible to create additional risk stratification scales, for example, Cardiovascular Event Risk Test (CERT) 1 and 2. They make it possible to estimate the residual risk in patients taking statins. The lipidome examination in extracranial artery atherosclerosis can identify those plaques that have signs of instability, and therefore are dangerous for ischemic stroke development.

The review describes the features of plasma lipidome in various cardiovascular diseases associated with atherosclerosis.