Long QT syndrome (LQTS) assessment is based on the QT/ÖRR equation (the so-called Bazett's formula) and calculating the corrected QT (QTc). However, this formula reliably estimates the QT interval in the heart rate range (HR) of 60-90 bpm, which makes it difficult to diagnose LQTS in patients with sinus bradycardia, typical of this disease.

Aim. To improve the LQTS diagnosis in patients with sinus bradycardia using the handgrip strength test.

Material and methods. A total of 188 patients aged 5-53 years (16 [13;17]) were examined: group I — 40 healthy children aged 9-17 years (14 [12;16]); group II — 98 athletes with sinus bradycardia <60 bpm aged 16 [16;17] years; group III — 50 patients with LQTS aged 5-53 years (12 [10;16]). The handgrip strength test consisted of regular rhythmic compression of a hand expander with a resistance of 20 kg until the heart rate increased >60 bpm. The patients had an electrocardiogram recorded twice before and after the handgrip test. Heart rate, QT and QTc intervals were analyzed.

Results. In all groups, after using the expander, there was a significant increase in heart rate, QT interval shortening and QTc interval prolongation. QTc interval prolongation after the handgrip test >460 ms was a highly sensitive marker of LQTS (Se 96%, Sp 60%).

Conclusion. Proposed handgrip test for sinus bradycardia makes it possible to increase heart rate, which ensures a more correct use of the Bazett's formula for assessing the corrected QT interval (QTc). QTc interval prolongation over 460 ms after the handgrip test is a highly sensitive additional marker for identifying patients with LQTS.

This article presents the new data of the 2023 European Society of Cardiology guidelines for the management of patients with acute and chronic heart failure, discussing key aspects, including their basic principles, recommendations for pharmacological and non-pharmacological treatment. In addition, their potential impact on the management of patients with heart failure was described.

Introduction. We present a case of type 1 Kounis syndrome in a patient with recurrent myocardial infarction with non-obstructive coronary arteries (MINOCA) due to allergic coronary vasospasm. Awareness of doctors about this pathology will allow identifying the MINOCA causes and prescribing pathogenetic treatment.

Brief description. A 51-year-old woman with aspirin-exacerbated respiratory disease (asthma, rhinosinusitis with nasal polyposis, aspirin hypersensitivity, eosinophilia) without cardiovascular risk factors developed three recurrent myocardial infarctions against the background of vasospastic angina over a 6-month period. Despite the typical clinical performance, stable ST segment elevation, unchanged coronary arteries on coronary angiography, the vasospastic MI was not immediately established. The patient received long-term treatment for type 1 MI, including beta-blockers. Recurrent MI occurred against the background of an asthma attack. During the second and third hospitalization for MI, coronary angiography revealed a spasm of the right coronary artery, which completely resolved with the nitroglycerin administration. Intracoronary ultrasound made it possible to rule out atherosclerotic involvement of the infarct-related artery. Subsequently, microvascular angina developed, which was confirmed by positron emission tomography. Vasospastic angina in combination with microvascular angina, MIBOCA with asthma attacks, were regarded as type 1 Kounis syndrome. Over the next 2 years, the patient received pathogenetic treatment, and no recurrent cardiovascular events were observed.

Discussion. Lack of awareness about Kounis syndrome led to incomplete examination of the patient with MIBOCA and the prescription of pathogenetically unreasonable tehrapy, which could contribute to recurrent MI within 6 months.

The article presents a case of immunoglobulin light chain amyloidosis with cardiac involvement without typical noncardiac manifestations. A complex diagnostic search for the cause of newly diagnosed pulmonary hypertension is described. Aspects of differential diagnosis in invasive hemodynamic assessment of pulmonary circulation and echocardiographic data are discussed. A special case feature is involvement of the hearing organ, which is very rare.

Introduction. Ventricular arrhythmias are a risk factor for sudden cardiac death. Abnormalities of cardiac rhythm and conduction may be the only subjective manifestation of isolated cardiac sarcoidosis, which occurs in 25% of the total number of patients with this disease.

Brief description. We present a case of isolated cardiac sarcoidosis in a young female patient, the main clinical manifestation of which was attacks of palpitations caused by ventricular tachycardia and episodes of cardiogenic shock without a cardiovascular history. Echocardiography and contrast-enhanced cardiac magnetic resonance imaging (MRI) revealed asymmetric left ventricular hypertrophy and focal myocardial masses. Cardiac tumor and sarcoidosis were suspected. The final diagnosis was based on the results of histological and immunohistochemical analysis of endomyocardial biopsies documenting sarcoidosis. No systemic manifestations of sarcoidosis were found.

Discussion. The case demonstrates the potential of a comprehensive paraclinical study in the diagnosis of cardiac sarcoidosis and its differential diagnosis with other cardiac pathologies.

Conclusion. Cardiac sarcoidosis is difficult to diagnose and requires histological verification in patients with LV hypertrophy and arrhythmias, and physicians should be aware about this rare disease with unfavorable prognosis without specific treatment.

Introduction. Constrictive pericarditis is a long-term consequence of any pathological process developing in the pericardium due to fibrinous thickening and calcification of its layers, which prevents normal cardiac diastolic filling. One of its forms is transient constrictive pericarditis, which resolves after anti-inflammatory therapy.

Brief description. A 19-year-old man with Bruton disease was admitted to the clinic with complaints of severe weakness, shortness of breath at rest, cough, chest pain, hyperthermia to 38⁰ C, decreased blood pressure to 80/60 mm Hg, and abdominal distension. During the initial echocardiography, the results did not raise serious suspicions. However, given the rather specific interventricular septum motion, pericardial constriction was suspected.

Discussion. During the additional examination, echocardiography made it possible to verify constrictive pericarditis, which was subsequently confirmed by heart catheterization. Due to significant immunoglobulin level deviations, a decision was made to resume immunoglobulin replacement therapy, followed by a clinical status reassessment.

The article presents a clinical description of a patient with constrictive pericarditis, which was a manifestation of Bruton disease. During follow-up, resolution of constriction was noted with resumption of immunoglobulin replacement therapy.

Fibromuscular dysplasia (FD) is a segmental, non-inflammatory and non-atherosclerotic disease of vascular smooth muscle of unknown etiology, which leads to stenosis of smalland medium-sized arteries. The choice of surgical treatment tactics for renal artery FD depends on the severity of clinical manifestations and the response to the conservative drug treatment used. Young age, female sex, high blood pressure with failure to achieve target values with therapy, as well as the absence of atherosclerotic involvement of other arterial systems gives reason to suspect renal artery FD. According to modern guidelines, the invasive treatment of hemodynamically significant renal artery stenoses includes transluminal drug-eluting balloon angioplasty. In this disease, renal artery stenting is not recommended. However, stent implantation is required if balloon angioplasty did not give the optimal result or in case of periprocedural complications, such as arterial dissection. Open reconstructive surgery is indicated for complex anatomy of the related artery, macroaneurysms in which stent grafts are ineffective, refractory intimal fibroplastic lesions, increased risk of endovascular treatment, or after unsuccessful endovascular intervention. The article presents a case of a young patient with renal artery FD, renovascular arterial hypertension, who successfully underwent renal artery transluminal drugeluting balloon angioplasty.

The article describes a case of the fourth consecutive emergency thrombectomy for popliteal and tibial artery thrombosis, followed by femoral distal popliteal bypass with a reversed vein in a patient with I. I. Zatevakhin grade 2B acute limb ischemia. The cause of repeated thrombosis type VI popliteal artery entrapment syndrome.

Currently, recommendations have been developed for the treatment of patients with pulmonary embolism. However, the optimal management tactics for such patients in the presence of right heart thrombosis remains a matter of argument. Timely detection of right heart thrombosis can influence the choice of treatment tactics, which will help reduce the risk of adverse outcomes. The article presents three clinical cases with different clinical course options and management strategies that take into account risk factors and prognosis.

A review of the recent literature examines novel concepts in blood pressure variability (BPV) and their possible clinical significance. In our opinion, two approaches are promising, in which the underlying pathophysiological processes are considered in the form of a simple linear and more complex nonlinear model. Moreover, both approaches have a specific practical implementation as follows: the first — in the form of a scale, the second — in the form of new BPV parameters. The scale is intended to assess the severity of systemic hemodynamic atherothrombotic syndrome, which is the result of the synergistic interaction of vascular damage and hemodynamic stress accumulating over a long time. Novel indicators describe the beat-to-beat BPV, reflecting the preservation of regulatory mechanisms. The literature analysis also allowed us to suggest possible ways to improve these concepts.

The review systematizes the latest data on renal denervation (RDN) potential in the treatment of pathologies associated with sympathetic hyperactivation. Despite the controversial results obtained at the beginning of its clinical application, the antihypertensive effect and safety of RDN were subsequently convincingly proven in a number of large randomized studies, which is reflected in current clinical guidelines. Study of RDN effect on the course of resistant hypertension, positive effects on other conditions associated with sympathetic hyperactivation were also identified. In particular, on the course of chronic kidney disease, chronic heart failure, as well as on the decrease of the frequency of paroxysmal atrial fibrillation and ventricular arrhythmia episodes, which ultimately may help for wider method implementation in routine clinical practice. For a long time, many studies have been aimed at identifying the effect of RDN on carbohydrate metabolism and improving the diabetes control. However, despite this, this issue still remains open and the possible future prospects for using RDN to improve the control and prognosis of diabetes in patients with this pathology are currently unclear.

As technology improves, the number of transcatheter aortic valve implantation (TAVI) procedures performed is steadily increasing. Due to the comparable outcomes with surgical treatment of aortic stenosis, TAVI is increasingly being performed in a group of younger patients. In this connection, there is an increasing need for a reasonable approach to assessing the severity of concomitant coronary lesions. Non-invasive studies in this group of patients have low sensitivity and specificity in identifying significant coronary narrowing. In addition, the use of stress testing is limited by the risks of potential complications due to the severity of patients with critical aortic stenosis. The assessment of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), which has become widespread in isolated coronary heart disease (CAD), in the case of a combination of CAD with aortic stenosis, requires careful study and analysis. The literature review shows that today there are the first results of using the assessment of coronary physiology to determine indications for myocardial revascularization in patients with aortic stenosis. New threshold values of FFR and iFR applicable for patients in this group are considered. The results of literature data indicate the need for large randomized studies to better understand the method capabilities and develop the most optimal approach to the treatment of TAVI candidates with concomitant CAD.

Aim. The study aimed to conduct a systematic review and meta-analysis of randomized clinical trials (RCTs) to determine the effect of pulmonary vein isolation (PVI) on the prognosis of patients with atrial fibrillation (AF) and chronic heart failure with reduced ejection fraction (HFrEF).

Material and methods. We searched PubMed (MEDLINE), Google Scholar, and the Cochrane Library databases for studies that compared PVI with a conservative rhythm/heart rate (HR) control strategy in patients with AF and HFrEF. The primary endpoint in the major RCTs examining the effect of PVI on the prognosis of patients with HFrEF was a composite endpoint of all-cause mortality or HF-related hospitalization. Hazard ratios (HRs) based on Cox regression analysis were used as the baseline survival rates for the meta-analysis. To determine the weighted mean differences in improvement in left ventricular ejection fraction (LVEF) in the PVI and non-PVI groups, a pooled analysis of the mean LVEF changes with standard deviations taking into account the number of subjects in the compared groups was performed.

Results. For this systematic review, 11 studies were selected from 2216 publications, which included 2379 patients. Three RCTs (n=968) were subjected to meta-analysis on time-to-event outcomes. The average follow-up period was 34 months. According to the meta-analysis, PVI was associated with a significant reduction in the risk of composite endpoint (HR: 0,53; 95% confidence interval (CI): 0,33-0,85; p=0,009). In addition, PVI compared with drug rhythm/rate control was associated with a significant reduction in the all-cause mortality risk (HR: 0,55; 95% CI: 0,34-0,89; p=0,01). Finally, a meta-analysis of 10 RCTs (n=1516) found a significant improvement in LVEF compared with drug rhythm/HR control or atrioventricular node ablation with biventricular pacing. The weighted mean difference in the LVEF change over time after 6-12-month follow-up was 5,25% (95% CI: 4,03-6,47; p<0,001).

Conclusion. PVI in patients with AF and HFrEF compared with drug rhythm/HR control is associated with a significant reduction in the risk of all-cause mortality and HF-related hospitalization and a greater improvement in LVEF compared with baseline.