In the absence of templates of formulating clinical diagnoses of HF after discharge from the hospital in the Russian Ministry of Health’s clinical guidelines for ST-ele­vation myocardial infarction (MI), non-ST-elevation acute coronary syndrome, and heart failure (CHF), this article proposes various options for formulating a HF diagnosis during this period. The guidelines are based on the new 2024 classification of HF by the Russian Society of Cardiology, which distinguishes between pre-HF and newly diagnosed HF, the diagnosis of which should be established starting 29 days after the index MI.

Heart failure with mildly reduced and preserved ejection fraction is a serious problem in modern healthcare due to its high prevalence, unfavorable prognosis, and significant limitations in optimal therapy. This article represents the re­solution of an expert panel devoted to the prospects for finerenone use in heart failure with a left ventricular ejection fraction ≥40%, based on the results of the FINEARTS-HF phase III randomized clinical trial. The data obtained demonstrate a high efficacy and safety profile for finerenone in this patient group, which rationales including this drug in widespread clinical practice for the treatment of sym­ptomatic heart failure with a left ventricular ejection fraction ≥40% after registration of the appropriate indication.

Aim. To identify the clinical features of the comorbidity of heart failure (HF) and osteoporosis in elderly women seen in primary care.

Material and methods. The study included 53 female patients aged 60 years and older (72 [68; 79] years) observed by a general practitioner. The study cohort was strati­fied into two following groups based on HF: HF group (n=24, 45%) and comparison group (n=29, 55%). All patients underwent a 10-year fracture risk assessment using the Fracture Risk Assessment Tool and dual-energy X-ray absorptiometry. The Clinical Assessment Scale, Charlson Comorbidity Index, Age Is No Barrier Questionnaire, Falls Efficacy Scale, and the Get Up and Go Test were used for clinical evaluation.

Results. The patient groups were comparable by age (p=0,184). Osteoporosis was significantly more frequently detected in patients with HF, according to densitometry data, compared to the group without HF (45,8% vs 17,2%; p=0,05). Patients with HF were characterized by lower body mass index (BMI), higher comorbidity, and more severe geriatric status impairments, including fear of falls (p=0,024) and mobility impairment (p<0,001). According to densitometry data, female patients with HF had lower bone mineral density (BMD) (p=0,020) and left hip T-score after adjusting for BMI (p=0,033). In multivariate logistic regression analysis, independent factors associated with osteoporosis were lower BMI (odds ratio (OR) 0,83; 95% confidence interval (CI) 0,71-0,97) and HF (OR 0,14; 95% CI 0,04-0,54).

Conclusion. HF is associated with an increased risk of comorbidities, including BMD disorders. In the present study, osteoporosis in women was associated with lower BMI and HF, which retained independent significance in multivariate analysis. The obtained data emphasize the importance of a comprehensive assessment of somatic status in the management of patients with HF.

Aim. To assess the count and phenotype of circulating neutrophils in patients with varying severity of heart failure with preserved ejection fraction (HFpEF).

Material and methods. The study included 42 patients with HFpEF (men, 43%; median age, 73 years); 15 asymptomatic patients (men, 67%; median age, 60 years) formed the control group. Total neutrophil (CD11b+CD66b+) and activated degranulating neutrophil counts (CD11bhighCD66bhigh) were determined in peri­pheral blood samples using direct immunofluorescence and flow cytometry. Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and plasma C-reactive protein (CRP) concentrations were measured using commercial enzyme-linked immunosorbent assay kits.

Results. Patients with HFpEF were older and had worse functional status compared to controls. Fifteen patients with HFpEF had early-stage disease (increased left ventricular (LV) filling pressure (FP) only during exercise), while 27 had advanced di­sease (increased LVFP at rest). In the HFpEF group, the absolute neutrophil count in the blood was higher compared to the control (4,0 (3,2; 5,3) vs, 3,0 (2,8; 4,3) thousand/μl, p=0,027), mainly due to activated neutrophils (0,74 (0,38; 1,27) vs 0,37 (0,29; 0,72) thousand/μl, p=0,038). The total neutrophil count and the number of activated cells were significantly higher in severe HFpEF compared to the initial disease stage, and in HFpEF patients with NT-proBNP levels above the median (≥318 pg/ml). The predictive value of the absolute neutrophil count and the number of activated cells for HFpEF detection exceeded the CRP value (according to ROC analysis, AUC 0,69 (95% confidence interval (CI) 0,54-0,84), p=0,025 and 0,69 (95% CI 0,54-0,83), p=0,021, respectively, versus 0,64 (95% CI 0,48-0,79), p=0,078). With a combination of an increased blood count of neutrophil granulocytes and an increased CRP level, the odds of HFpEF tended to increase (odds ratio=5,3 at 95% CI 0,85-32,4, p=0,074).

Conclusion. The absolute count of circulating neutrophils, including activated cells, characterizes the severity of HFpEF. The obtained results confirm the contribution of innate immunity to disease development.

Aim. To assess overall and inhospital mortality from myocardial infarction (MI) in the subjects of the Russian Federation for the period of 2014-2023.

Material and methods. Rosstat data for 2014 to 2023 were obtained. Calculations were performed using the program (registration certificate dated September 30, 2016, № 201666114). The European Standard Population (1976) was used to calculate the standardized mortality rate (SMR) per 100,000 population. Inhospital mortality was calculated as the ratio of death rate to hospital discharge rate per year based on data from Federal Statistical Monitoring Form № 14.

Results. The SMR rate per 100,000 people in Russia due to myocardial infarction decreased from 34,85 to 23,24 per 100,000 people (p<0,0001); inhospital mortality — from 15 to 10,2% (p<0,0001). The coefficient of variation for regional SMR rates in 2014 was 45,6%, and in 2023-52,8%; inhospital mortality — 27,8% and 26,4%. The proportion of in-hospital deaths from myocardial infarction decreased from 57,3 to 48% of the total death rate (in 2023, the regional minimum was 21%, and the maximum — 83%). No region recorded an annual increase or decrease in the SMR and inhospital mortality from 2014 to 2023. When comparing 2023 with 2014, the SMR and inhospital mortality decreased in 68 regions; in 3 regions, both the SMR and inhospital mortality increased; in 7 regions, the SMR increased and inhospital mortality decreased; and in 4 regions, the SMR decreased and inhospital mortality increased.

Conclusion. Over the past 10 years, Russia has recorded a decrease in SMR and inhospital mortality rate from myocardial infarction. However, significant interregio­nal differences in these rates and their changes, as well as an increase in the proportion of out-of-hospital deaths, may be related to both the organization of care and statistical recording practices. This requires additional research aimed at establishing the true causes of these differences. These studies should form the basis for improving management and treatment measures.

Aim. To study predictors of acute left ventricular failure in patients with newly diagnosed acute ST-segment elevation myocardial infarction (STEMI) of the left ventricular (LV) anterior wall during hospitalization.

Material and methods. A total of 150 patients with newly diagnosed STEMI within the first 24 hours were included. The study was conducted in accordance with Good Clinical Practice and Declaration of Helsinki standards. The protocol was approved by the Ethics Committee. Study participants signed informed consent. Clinical and laboratory data, sST2 levels, and echocardiographic parameters were analyzed. The risk of in-hospital mortality was assessed using the GRACE score. Patients were divided into groups based on the severity of acute heart failure according to the T. Killip classification. Patient data were assessed during hospitalization and discharge. Statistical analysis was performed using Statistica 10.0 for Windows. Differences were considered significant at p<0,05.

Results. A patient profile was described with STEMI of the anterior LV wall complicated by acute left ventricular failure: mean age, 68,7 years; body mass index, 33,0 kg/m²; waist circumference, 94,56 cm; GRACE score, 208,22. Lipid metabolism disorders and elevated early markers of myocardial necrosis were identified regardless of acute heart failure severity. Over inpatient treatment of patients with Killip III-IV STEMI, we revealed an increase in sST2 during the first day of disease and a persistence of 2,2 times above normal at discharge. Echocardiographic features in patients with STEMI of the anterior LV wall are described.

Conclusion. Predicting acute left ventricular failure in patients with STEMI of the anterior LV wall during inpatient treatment will allow for timely modification of treatment strategies, which may subsequently impact prognosis.

Aim. To study the informative value of invasive coronary physiology indices (fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR)) and to evaluate the safety of papaverine as a hyperemic agent to determine the hemodyna­mic significance of stenoses in non-infarction-related arteries (non-IRA) in patients with ST-seg­ment elevation myocardial infarction (STEMI) during the index procedure after primary percutaneous coronary intervention (PPCI).

Material and methods. This single-center prospective study included 32 patients over 18 years of age with STEMI and 50-85% stenosis in 38 non-IRA. After PPCI of the infarction-related artery, iFR, contrast-enhanced FFR, and (if there were no contraindications) FFR with papaverine were measured. Rehospitalization was performed 30-45 days later with follow-up coronary angiography and reassessment of physiological parameters. Statistical analysis included Spearman’s rank order coefficient (SRCC), intraclass correlation (ICC), Cohen’s kappa coefficient, Bland-Altman analysis, and McNemar’s test (α=0,05).

Results. Analysis of 38 non-IRAs (36 FFR tests with papaverine) demonstrated high reproducibility as follows: iFR — ρ=0,94 (p<0,001), ICC=0,95 (95% confidence interval (CI) 0,91-0,97), κ=0,73; clinical decision variance — 13,2%, without systematic bias (p=0,655); FFR — ρ=0,91 (p<0,001), ICC=0,92 (95% CI 0,85-0,96), κ=0,77; variance — 11,1% (p=1,000). All decision changes were noted in the range of borderline values (iFR 0,85-0,93; FFR 0,78-0,83). When measu­ring FFR, contraindications to papaverine administration were strictly taken into account, including hypotension (≤110/70 mm Hg) and prolonged QT (≥450 ms). Therefore, in 2 of 32 patients, only iFR was determined in 2 non-IRAs. In 30 patients, after papaverine administration to determine FFR in 36 non-IRAs, no compli­cations were observed.

Conclusion. FFR with papaverine and iFR can be safely and informatively used to assess the hemodynamic significance of non-IRA stenoses in hemodynamically stable patients during the first 24 hours after STEMI. The high stability of these parameters during repeated measurements confirms their suitability for dynamic monitoring. Borderline values require careful interpretation and possible use of additional ischemia verification methods.

Aim. To study the association of inflammatory and hematological indices with subclinical kidney damage in patients with hypertension (HTN).

Material and methods. The study included 135 patients with grade 1-2 HTN and ineffective blood pressure control (≥140/90 mm Hg), with an average age of 51,53±6,88 years. Patients underwent a complete blood count with estimation of hematological indices (systemic inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, and monocyte-to-high-density lipoprotein cholesterol ratio (MHR)). A blood biochemical test to determine high-sensitivity C-reactive protein and cystatin C, and estimate glomerular filtration rate (GFR) calculated based on creatinine and cystatin C using the CKD-EPI equation (2021) was performed. An enzyme-linked immunosorbent assay to determine serum concentrations of interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-alpha.

Results. In the study group, the estimated GFR was 85,37 (78,38-95,74) ml/min/1,73 m², and the proportion of patients with elevated cystatin C levels was 74,07%. Correlation analysis revealed a positive association between cystatin C and IL-6 (r=0,22; p=0,036) and MHR (r=0,23; p=0,008), while the estimated GFR was negatively associated with MHR (r=-0,27; p=0,02). In patients with HTN, blood cystatin C and creatinine levels were higher with MHR >0,5 (p=0,044 and p=0,013, respectively), according to cluster analysis. An increase in the hematological index MHR >0,5 in combination with two or three factors, such as smoking, HTN duration ≥4 years, and NLR >1,4, was associated with blood cystatin C levels above refe­rence values in 100% of the patients studied.

Conclusion. In patients with HTN, a positive association was found between cystatin C, IL-6, MHR. A negative association was found between the estimated GFR and MHR. An MHR greater than 0,5 may indicate subclinical kidney damage in patients with HTN. Further study of the role of nonspecific inflammatory markers, including hematological indices, in predicting kidney damage is needed to improve risk stratification in patients with HTN.

Aim. To conduct a dynamic analysis of echocardiographic data in comparison with clinical data in patients with hypertension (HTN) 3, 12, and 25 months after COVID-19 lung injury.

Material and methods. Eighty-five patients with HTN after COVID-19 lung injury were examined 3, 12, and 25 months after discharge (follow-up points 1, 2, and 3, respectively). Echocardiography was performed to determine left ventricular global longitudinal strain (LVGLS). LVGLS ≥-18% was considered reduced.

Results. 66 patients (77,6%) were vaccinated against COVID-19, including 23 (27,1%) who were re-vaccinated. Twenty-five percent of patients had re-infection with COVID-19 (all with mild symptoms). Between points 1 and 2, body mass index significantly increased (29,7±3,8 vs 30,7±4,1 kg/m2, p<0,001), while the incidence of stage 2 HTN due to newly diagnosed target organ damage increased between points 2 and 3. LV ejection fraction was normal in all patients. Mean LVGLS values varied within the normal range without significant changes, but the proportion of patients with reduced LVGLS at point 2 increased from 21% to 36% and decreased to 16% at point 3 (p=0,006), suggesting restoration of LV systolic function in the majority of patients. Signs of grade 1 LV diastolic dysfunction (decreased early diastolic mitral annulus velocity, ratio of early diastolic transmitral flow to early diastolic mitral annulus velocity) were consistently demonstrated in 34% to 56% of patients. Signs of eleva­ted pulmonary vascular resistance (PVR) persisted in 38% of patients by the end of follow-up. Univariate logistic regression revealed no associations between signs of diastolic dysfunction and elevated PVR with vaccination and recurrent COVID-19.

Conclusion. Two years after COVID-19 lung injury, LV systolic function is restored in most patients with hypertension. Signs of LV diastolic dysfunction and elevated PVR are not associated with vaccination or recurrent COVID-19 and persist in 34% to 56% and 18% of patients, respectively.

Aim. To evaluate the efficacy and safety of Ethacizine in patients with paroxysmal atrial fibrillation based on remote electrocardiographic monitoring data.

Material and methods. A total of 400 patients were included in this pilot, non-randomized prospective study. They received Ethacizine at a dose of 50 mg 2-3 times daily for 5 weeks to control sinus rhythm. Heart rate, electrocardiographic parame­ters, and the incidence of cardiac arrhythmias were monitored during therapy.

Results. Among patients with available data for each week of the study (n=141), a reduction in the incidence of cardiac arrhythmias was observed with Ethacizine treatment, reaching statistical significance at week 5 of therapy compared with weeks 1, 2, and 3 (p=0,027, p=0,022, and p=0,032, respectively). A favorable safety profile was also noted, based on the absence of significant electrocardiographic deviations and the absence of an increase in the incidence of cardiac arrhythmias after 5-week therapy compared with baseline data.

Conclusion. This study demonstrated a reduction in the incidence of cardiac arrhythmias and the safety of Ethacizine in patients with paroxysmal atrial fibrillation using remote electrocardiographic monitoring.

Atrial fibrillation remains a key public health problem due to the steadily increasing incidence and risk of severe events. The aim of this study was to conduct a comprehensive review of the current epidemiology of atrial fibrillation, analyze the evolution of risk stratification methods and diagnostic algorithms, assess the problem of left atrial appendage thrombosis in the era of direct oral anticoagulants. In addition, we systematized international management practices for patients with this condition taking direct oral anticoa­gulants to inform further research into solutions and improved treatment approaches.

Aim. To determine the value of intravascular ultrasound (IVUS) in improving the dia­gnostic accuracy of detecting plaque prolapse and reducing the risk of cerebral ischemic complications of endovascular carotid revascularization.

Material and methods. Data from 173 patients who underwent endovascular carotid intervention were analyzed. The study group (n=85) included procedures using subtraction angiography and IVUS, while the control group (n=88) — procedures using subtraction angiography only. The incidence of protrusion detection, angiographic, and clinical outcomes in the intraoperative, early, and late postope­rative periods were analyzed.

Results. IVUS provided a 2667-fold higher detection rate of plaque prolapse compared with subtraction angiography (95% confidence interval: 1,009-7,051, p<0,05). The overall protrusion rate was 9,82% (n=17). Embolic debris in cerebral protective devices was detected in 37,5% of patients with single-layer stents and in 9,4% with dual-layer stents (p<0,001). The cumulative incidence of cerebral ischemic events in the study group was 1,2% versus 6,8% in the control group, reflecting a clinically significant 5,8-fold reduction (p=0,118).

Conclusion. IVUS in endovascular carotid interventions significantly increa­ses the detection rate of plaque prolapse not visualized by standard angiography and helps reduce the incidence of cerebral ischemic events. This technique re­presents an important tool for the prevention of embolic events.

Aim. To develop and validate a model for venous thromboembolism (VTE) risk assessment during the inpatient antitumor treatment in patients with central nervous system glial tumors.

Material and methods. The retrospective group included 186 patients whose data were obtained from the heath information system for the period 2019-2021 and used to develop the model. The testing sample consisted of 111 patients prospectively enrolled in the study. The model was validated on an external sample of 56 patients with gliomas. The model was constructed using multivariate logistic regression.

Results. The resulting model for VTE risk assessment included the follo­wing risk factors: central paresis of one or both lower extremities, which is a manifestation of focal neurological deficit caused by the tumor; elevated D-dimer; decreased absolute platelet count; age over 63 years; and a history of radiation therapy. The area under the curve of the resulting model was 90,8% in the training sample, 82,9% in the testing sample, and 79,3% in the external validation sample.

Conclusion. The developed and tested VTE risk model for inpatient period in patients with gliomas appears promising for subsequent clinical trials evaluating the effectiveness of personalized thromboprophylaxis.

Aim. To discuss a new method for predicting cardiovascular toxicity of chemotherapy and targeted therapy based on echocardiographic changes of left atrial volume index (LAVI).

Material and methods. This prospective observational study was conducted at the Department of Hospital Internal Medicine № 1 of the Russian University of Medicine. The study included 149 cancer patients aged 18 to 80 years receiving antitumor treatment and at high and very high risk of cardiovascular toxicity, as defined by the Mayo Clinic (USA) score. All study participants underwent a clinical and paraclinical examination, including a patient history and complaint collection, physical examination, 12-lead electrocardiography (ECG), two-dimensional echocardiography to determine left ventricular systolic global longitudinal strain, 12-lead 24-hour ECG monitoring, and 24-hour blood pressure monitoring before the start of antitumor therapy and at 1, 3, 6, 9, and 12 months after the start of antitumor treatment. Throughout the monitoring period, the emergence of previously absent cardiovascular lesions was monitored.

Results. During the 12-month follow-up, 76 (51%) study participants were found to have various manifestations of cardiovascular toxicity. An analysis of echocardio­graphy results in patients with developed cardiovascular complications revealed left atrial dilation with an increase in LAVI to >34 ml/m². ROC analysis and the Kaplan-Meier estimator revealed that an LAVI ≥34 ml/m² corresponds to an increased risk of cardiovascular complications, including death in cancer patients.

Conclusion. The obtained results provide internists, cardiologists, and oncologists with an easily accessible and reproducible echocardiography indicator (LAVI) that can accurately cardiovascular toxicity after antitumor therapy. Based on the above, the authors submitted an application to the Federal Institute of Industrial Property and received a patent for the invention.

Aim. To evaluate the incidence, profile, and predictors of cardiotoxicity associa­ted with anti-HER2 therapy in patients with newly diagnosed HER2-positive breast cancer receiving modern anthracycline-free regimens.

Material and methods. The prospective study included 133 patients primarily receiving the TCHP regimen (taxanes, carboplatin, trastuzumab, pertuzumab). The pre-treatment examination protocol and then every 3 months during antitumor therapy included echocardiography with assessment of global left ventricular longitudinal strain, determination of natriuretic peptide and high-sensitivity troponin I, and risk stratification using the HFA-ICOS score.

Results. Complications developed in 11 patients (8%). The most common complications were hypertension (HTN) destabilization, hydropericardium, and subclinical myocardial injury. The HFA-ICOS score demonstrated low sensitivity (27%). In multivariate analysis, left ventricular mass index (LVMI) was the only independent predictor of cardiotoxicity (odds ratio=1,037 per 1 g/m²; 95% confidence interval: 1,010-1,064; p=0,007). A LVMI cutoff value of ≥83,5 g/m² had a sensitivity of 64% and a specificity of 74%. HTN control was the key modifiable risk factor as follows: achieving target blood pressure before treatment was associated with a more than fivefold reduction in the risk of complications (odds ratio=0,20; 95% confidence interval: 0,03-1,15; p=0,087).

Conclusion. With anthracycline-free therapy, the profile of complications is dominated by HTN destabilization, hydropericardium, and subclinical myocardial injury. The HFA-ICOS score has limited prognostic value. These results suggest that LVMI should be considered as a parameter in the initial cardio-oncology evaluation to improve risk stratification.

Aim. To study the profile and long-term changes of recommended markers of cardiotoxicity (high-sensitivity troponin I (hs-TnI), N-terminal pro-brain natriuretic peptide (NT-proBNP)), markers of endothelial dysfunction (endothelin-1 (ET-1)), systemic inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)) and left ventri­cular (LV) structural and functional characteristics in patients with lymphomas 12 months after the start of multiagent chemotherapy, as well as to evaluate the relationship between the obtained data.

Material and methods. The study included patients with newly diagnosed lymphomas (n=30) as follows: 18 men (60%); mean age — 52 [36; 64] years. Hodgkin lymphoma was diagnosed in 8 patients (26,7%), non-Hodgkin lymphomas — in 22 (73,3%). All patients underwent an assessment of laboratory markers (hs-TnI, NT-proBNP, ET-1, CRP, IL-6) and LV structural and functional parameters using speckle tracking echocardiography at baseline and 12 months after the start of treatment.

Results. After 12 months from the start of chemotherapy, no significant changes in the levels of hs-TnI and NT-proBNP were noted. A significant decrease in the le­vels of CRP and IL-6 was observed as follows: from 5,94 [2,98; 34,00] mg/L to 1,31 [0,85; 5,98] mg/L (p=0,002) and from 12,20 [9,95; 12,75] pg/ml to 5,87 [4,7; 7,04] pg/ml (p=0,05), respectively. A significant increase in the median ET-1 level was also noted as follows: 3,46 [2,39; 4,12] ng/ml initially and 11,26 [7,02; 15,5] ng/ml after 12 months (p<0,001). According to echocardiography data, reliable chan­ges of the parameters of LV diastolic function were revealed: a decrease in E/A (p<0,001), an increase in E/e’ (p<0,001), an increase in isovolumic relaxation time (p<0,001) and left atrial volume index (LAVI) (p<0,001). A moderate correlation was found between the ET-1 level and the LAVI (r=0,5; p=0,031) and E/A (r=0,6; p=0,02) values. ROC curve analysis demonstrated the significance of the baseline ET-1 level as a predictor of a E/A decrease (AUC — 0,827±0,096; 95% CI: 0,638-1,000) and LV global longitudinal strain (AUC — 0,747±0,094; 95% CI: 0,563-0,932) after 12-month follow-up.

Conclusion. The obtained data suggest the development of diastolic dysfunction (DD) during the first year after the initiation of chemotherapy in patients with lymphomas. The identified relationship between ET-1 levels and diastolic dysfunction parameters allows us to consider ET-1 as a potential predictor of LV DD in these patients, necessitating their monitoring before and long-term after chemotherapy. In the context of the search for the most effective methods for preventing and predicting cardiovascular toxicity after antitumor therapy, it seems appropriate to further study the relationship between endothelial dysfunction, diastolic dysfunction, heart failure with preserved ejection fraction, and other long-term cardiovascular events in cancer patients after treatment.