Physician training requires a unified approach to the content of educational programs across the country’s various medical universities in order to standardize the vo­lume of knowledge that underlies professional skills, abilities, and competencies. To improve the preparation of medical students for practice, creation of a unified educational program for studying the interdisciplinary concept of cardiovascular-renal-hepatic-metabolic (CRHM) syndrome within the General Medicine program is discussed. This article presents methodological materials allowing pedagogical explanation of the concept, pathogenesis, characteristics of cardiometabolic risk factors, and individual components of CHRM syndrome in fundamental and clinical departments using the end-to-end learning principle. In this regard, the role of fundamental disciplines lies in shaping the curriculum in accordance with the needs of clinical practice. Special attention is given to teaching diagnostic criteria for the syndrome and a set of personalized preventive measures depending on the stage and phenotype of CHRM syndrome. It is proposed to emphasize the transition from target organs to a unified metabolic phenotype, taking into account the multi-vector nature of CHRM syndrome processes. The inclusion of the CHRM syndrome in the curricula of the Oncology, Neurology, Rheumatology, and Obstetrics and Gynecology disciplines appears promising, allowing future practicing physicians to perceive this concept holistically and systemically.

Aim. To improve the quality of high-tech health care provided to patients with atrial fibrillation (AF) by performing left atrial appendage (LAA) resection with an endoscopic stapler during thoracoscopic isolation of left atrial (LA) arrhythmogenic zones.

Material and methods. This article presents the surgical outcomes of patients with AF who underwent LAA resection with an endoscopic stapler during thoracoscopic isolation of LA arrhythmogenic zones. The stapler is a device suturing tissue with staples followed by resection. The treatment period lasted 2023-2025. The outcomes were assessed in 2025. Ninety-two patients were treated, with LAA resection performed in 43 (47%). Thus, two groups of patients were formed: group 1 — patients who underwent LAA resection; group 2 — patients who did not undergo LAA resection.

Results. All LAA resections performed with an endoscopic stapler were not accompanied by any complications during the procedure, as well as cardiac strokes in all patients during this follow-up period. The study demonstrates the freedom from AF recurrence in patients in the endoscopic LAA resection group.

Conclusion. LAA resection is an important component of thoracoscopic ablation aimed at preventing stroke and thromboembolic events in patients with AF. The use of an endoscopic stapler allows for LAA resection with mini­mal risk of complications, significantly increasing the effectiveness of radiofrequency ablation.

Aim. To compare the procedural, inhospital, and mid-term outcomes of two stra­tegies for preparing coronary artery calcification.

Material and methods. A clinical analysis of treatment outcomes was performed in 88 patients with severe coronary artery calcification who underwent surgery between 2022 and 2024. Percutaneous coronary intervention with stenting was performed. Patients were randomized 1:1 to calcification preparation using a combining rotational atherectomy with cutting balloon angioplasty or rotational athe­rectomy with high-pressure balloon angioplasty. Two patients (2,2%) underwent surgery for unstable angina, and 86 (97,8%) patients had stable angina. We assessed the procedure technical success, the need to modify the lesion pre­paration strategy, periprocedural complications, and the inhospital and 30-day postoperative periods.

Results. Technical success was achieved in 100% of cases in both study groups. However, in 8 patients (18%) who did not achieve optimal calcification preparation criteria, rotational atherectomy and a high-pressure balloon preparation were switched to combining rotational atherectomy with cutting balloon angioplasty. The radial artery was the most common access for endovascular intervention (78,4% of cases). Periprocedural myocardial infarction was not recorded. In all cases, patients were managed conservatively in the postoperative period, and repeat intervention was not required.

Conclusion. Combining rotational atherectomy with cutting balloon angioplasty demonstrates comparable safety and efficacy to rotational atherectomy combined with a high-pressure balloon angioplasty. Intravascular ultrasound is a key factor in optimizing treatment strategy and deciding whether to switch strategies. This method can be used as a primary strategy for calcification modification, as well as when high-pressure balloon angioplasty is ineffective.

Aim. To compare the long-term outcomes of non-resection and resection techniques for mitral valve (MV) repair for prolapse.

Material and methods. This retrospective study included 75 patients as follows: 60 patients in the non-resection group (mean age 57 (49;64) years; 21 women), and 15 patients in the resection group (mean age 57 (48;67) years; 4 women). Preoperatively, patients had severe mitral regurgitation (MR) (ERO 43,5 (31;50) mm²), 96% of whom had functional class II-III. Propensity score matching was performed based on retrospective recruitment. The mean follow-up period was 8,2 (±2,5) years. The Vivid E95 ultrasound system (GE Healthcare) with EchoPAC (version 204) was used for examination.

Results. Both groups had comparable ultrasound parameters of mitral leaflets and annulus with bigger ring size implantation tendency in non-resection group (32±1,7 mm vs. 30,8±1,8 mm, р=0,07). Also the groups were comparable in volume and functional characteristics of left ventricle. However, there was a difference bet­ween groups in left atrial strain during cardiac cycle as follows: 22,5 (13;26)% vs. 14,5 (12;16)% in reservoir phase, р=0,04; -13,5 (-10;-19)% versus -10 (-9;-13)% in conduit phase, р=0,03; -6,5 (-3;-10)% vs. -4 (-2;-6)% in contractile phase, р=0,04 in non-resection and resection groups, respectively. Significant difference was detected in non-planar angle (171 (164;177) deg. — 162 (158;169) deg., р=0,02) and cardiac index (4,2 (3,7;4,7) l/min/m² — 3,8 (3,4;4,1) l/min/m², р=0,03). No MR grade >2 was detected (38,6% — MR grade 1, 5% — MR grade 2).

Conclusion. Non-resection and resection reconstructive techniques are comparable in postoperative parameters of mitral leaflets, annulus and left ventricle with bigger ring size implantation tendency in non-resection group. Left ventricular parameters were also comparable. However, in the late postoperative period, there were differences in the functional state of the left atrium, non-planar angle, and cardiac index, which requires further study.

Aim. To evaluate short-term clinical and procedural outcomes in patients with post-infarction ventricular septal rupture (PIVSR).

Material and methods. This single-center, retrospective, non-randomized, observational cohort study included patients with PIVSR admitted to the Chazov National Medical Research Center of Cardiology in Moscow between 2019 and 2025. The analysis was conducted according to the type of procedure performed. The primary endpoint was any-cause inhospital mortality, with secondary endpoints including inhospital cardiovascular mortality and the rate of technical and procedural success after curative treatment.

Results. In the period 2019-2025, the study included 94 patients with PIVSR (mean age, 68,5±12 years women, 56,4%). Open surgical repair was performed in 35,1% (33/94) of patients, while percutaneous closure (PC) — in 50,0% (47/94), conservative treatment — in 12,8% (12/94), and heart transplantation or implantation of a long-term left ventricular assist device with immediate open surgical repair. Secondary open surgical repair after PC was performed in 14,9% (7/47) of patients. Cardiogenic shock occurred in 62,8% (59/94) of patients: in the open surgical repair group — in 36,4% (12/33), in the PC group — in 83% (39/47). Mechanical circulatory support was used in 53,2% (50/94) of cases. Any-cause inhospital mortality was 53,3% (49/92): 74,5% (35/47) with PC, and 21,2% (7/33) with open surgical repair, and 58,3% (7/12) with conservative treatment. In the general group, 34,8% (32/92) of patients died from cardiovascular causes. In the open surgical repair and PC groups, technical success was achieved in 97,5% and 87,2%, and procedural success — in 72,7% and 51,1%, respectively.

Conclusion. Approximately half of patients with PIVSR survive to discharge with a comprehensive treatment approach. In our center’s experience, various curative treatment methods complement each other and are used in patient populations with different clinical severity. The results highlight the need for further research aimed at optimizing the strategy, specifically the choice of intervention type and timing, and the use of mechanical circulatory support.

Aim. To characterize the phenotypic characteristics and diagnostic principles of va­rious variants of amyloid cardiomyopathy based on local registry data.

Material and methods. From 2017 to 2025, 195 patients with suspected cardiac amyloidosis were examined. The diagnosis was verified in 103 patients. Transthyretin (ATTR) amyloidosis was diagnosed in 63 patients (61,2%), and light-chain (AL) amyloidosis — in 40 patients (38,8%). Most patients with ATTR amyloidosis (79%) were diagnosed using a noninvasive algorithm, including bone scintigraphy with radiopharmaceutical and hematological tests to rule out AL amyloidosis.

Results. Patients with wild-type ATTR (ATTRwt) were older and had a higher prevalence of hypertension, while patients with AL amyloidosis were younger. Class III-IV heart failure was more common in the ATTRwt and AL groups compared to ATTRv amyloidosis (41%, 53%, and 21%, respectively, p<0,05). The highest prevalence of arrhythmias was observed in patients with ATTRwt as follows: atrial fibrillation occurred in 83% of patients; episodes of ventricular tachycardia — in 41%. Peripheral nervous system involvement was more prevalent in the ATTRv group (85%) compared to ATTRwt (38%) and AL (28%) amyloidosis (p=0,0001). Compared with the ATTRwt and ATTRv groups, proteinuria was more common in patients with AL amyloidosis (14%, 24%, and 68%, p<0,0001). According to scintigraphy data, Perugini grade 2/3 technetium pyrophosphate accumulation was observed in 61 patients (100% of those examined) with ATTR amyloidosis and 5 (26% of those examined) with AL amyloidosis. Three patients with ATTR amyloidosis had paraprotein in the serum or urine, necessitating morphological verification of the dia­gnosis. Heart failure therapy primarily consists of mineralocorticoid receptor antagonists and loop diuretics, as well as low-dose beta-blockers. Renin-angiotensin system blockers were prescribed in low doses and were received by less than 30% of patients in both groups.

Conclusion. Despite the high prevalence of AL amyloidosis, transthyretin amylo­idosis appears to be the predominant cause of cardiology consultations. The high mortality rate associated with AL amyloidosis cannot be ruled out as an influence on registry studies of various types of amyloidosis. A noninvasive algorithm, inclu­ding bone scan and hematological tests, has proven high diagnostic value in verifying the diagnosis of ATTR amyloidosis. However, if laboratory testing reveals abnormalities, morphological verification of the diagnosis is indicated. Given the restrictive physiology, standard therapy for heart failure in amyloid cardiomyopathy requires significant modification.

Aim. Using modeling, to evaluate the economic rationale of using quadruple the­rapy in the Russian population.

Material and methods. Based on clinical trials on the effectiveness of combination therapy in patients with heart failure with reduced ejection fraction (HFrEF), a Markov model with 5- and 10-year time horizons and a cycle duration of 1 month was constructed. The analysis was conducted from the perspective of the state taxpayer. Three following strategies were compared: triple therapy (angiotensin-converting enzyme (ACE) inhibitors, beta-blockers (BBs), and aldosterone anta­gonists (AAs)); quadruple therapy with ACE inhibitors (ACE inhibitors, BBs, AAs, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors); and quadruple therapy with angiotensin receptor-neprilysin inhibitors (ARNIs) (ARNIs, BBs, AAs, and SGLT-2 inhibitors). Based on clinical and epidemiological data, the number of patients with HFrEF eligible for the federal medicine assistance program was estimated.

Results. Over a 5-year period, quadruple therapy compared with triple therapy was associated with a 10% and 22% reduction in mortality, a 16% and 23% reduction in heart failure hospitalizations, and a 74% and 81% reduction in emergency room visits for ACE inhibitor- and ARNI-based regimens, respectively. The additional costs per quality-adjusted life year gained were RUB838,900 for quadruple therapy with ACE inhibitors, RUB1,201,600 for ARNI-based regimens, and RUB1,529,500 when comparing the two quadruple therapy options. Over a 10-year period, the figures decreased to RUB533,000, RUB761,600, and RUB959,200, respectively. All values were significantly below the wil­lingness-to-pay threshold for the Russian Federation (RUB4,129,400). Sensitivity analysis confirmed the sustainability of the results. The number of patients with HFrEF potentially covered by all components of quadruple therapy under medicine assistance programs was 186,200, including 112,200 under the cardiovascular disease control program.

Conclusion. Quadruple therapy is an economically viable alternative to triple the­rapy, providing a significant reduction in mortality in patients with HFrEF, most pronounced with ARNI. Existing government programs can already ensure access to quadruple therapy for a significant proportion of patients.

Cardiovascular disease (CVD) remains a leading global health problem, re­quiring ongoing research into interventions that can reduce its impact. Data from the Anglo-Scandinavian Cardiovascular Outcomes Trial (ASCOT) have significantly contributed to the evidence base supporting the statin role in the primary prevention of CVD. A 16-year follow-up study demonstrated that atorvastatin in combination with antihypertensive therapy reduces cardiovascular mortality. The ASCOT-Legacy study, meanwhile, ana­lyzed 20-year follow-up, taking into account both nonfatal and fatal cardiovascular outcomes, and also examined the long-term effects of early initiation of moderate-intensity atorvastatin.

Aim. Based on a single-center clinical experience, to evaluate the procedural features and outcomes of ultrasound-assisted catheter-directed thrombolysis using the EkoSonic system (EKOS, Boston Scientific, USA) in patients with pulmonary embolism (PE), primarily intermediate-high and high-risk.

Material and methods. We retrospectively analyzed a total of 19 patients with PE hospitalized at the Davydovsky City Clinical Hospital (Moscow) in 2025-2026. They underwent ultrasound-assisted catheter-directed thrombolysis using the EKOS system. The diagnosis of PE was confirmed using multislice computed tomography pulmonary angiography. There were following inclusion criteria: Pulmonary Embolism Severity Index (PESI) score ≥III and/or a Simplified Pulmonary Embolism Severity Index (sPESI) score ≥1, combined with right ventricular dysfunction and elevated cardiac biomarkers. Treatment efficacy was determined by changes in clinical and echocardiographic parameters. Safety was assessed by the incidence of bleeding events, recurrent PE, and in-hospital mortality.

Results. Ultrasound-assisted catheter-directed thrombolysis resulted in a significant reduction in right heart overload in all patients. Right ventricle to left ventricle basal diameter ratio decreased from 1,1±0,2 to 0,9±0,1 (p=0,001), pulmonary artery systolic pressure — from 56,9±9,8 to 42,4±9,1 mm Hg (p<0,001), right ventricle basal diameter — from 46,2±6,6 to 40,8±4,6 mm (p<0,001). Along with the echocardiographic changes, an improvement in the clinical condition of patients was observed with a mMRC dyspnea score decrease from 3,0 [3,0; 3,5] to 1,0 [1,0; 2,0] (p<0,001). The duration of ultrasound-assisted catheter-directed thrombolysis was 8,0 [8,0; 8,0] h with a total alteplase dose of 15,5±3,9 mg. During the hospital stay, no deaths, recurrent PE, or major or clinically significant minor bleeding events were recorded.

Conclusion. The experience demonstrates the EKOS system safety in selected patients with PE, primarily at intermediate-high and high risk, and allows us to highlight key aspects of patient selection, procedure implementation, and perioperative management.

Distal radial access (DRA) is promoted to reduce the incidence of radial artery occlusion (RAO) after interventional coronary procedures while preserving the be­nefits of the classic radial artery approach. Despite the rapid adoption of this technique, the clinical utility of DRA in various clinical scenarios (coronary angiography, elective percutaneous coronary intervention (PCI), acute coronary syndrome, and primary PCI for ST-segment elevation myocardial infarction) remained heterogeneous due to differences in surgeon experience, hemostasis protocols, and occlusion verification methods.

Aim. To systematically search and critically analyze randomized clinical trials (RCTs) of DRA in interventional coronary interventions over the past 20 years, with a separate description of excluded non-randomized sources and se­condary reviews.

Material and methods. A search was performed using the PRISMA 2020 criteria in PubMed, Web of Science, Google Scholar, and eLIBRARY. A supplementary search of reference lists and ClinicalTrials.gov was also conducted. The main synthesis included only RCTs in adult patients comparing DRA with traditional radial access for coronary angioplasty and/or PCI. Retrospective studies, case-control studies, case reports, and secondary reviews were excluded from the primary synthesis but were reflected in separate tables.

Results. The qualitative synthesis included 15 RCTs, and the quantitative meta-ana­lysis included 12 RCTs with an extractable number of events for RAO. In the pooled analysis, DRA significantly reduced the risk of RAO compared with the traditional approach (RR 0,29; 95% CI 0,21-0,40; I2=4,1%) but was associated with a higher probability of access conversion/failure (RR 2,59; 95% CI 1,34-5,00).

Conclusions. The most consistent advantage of DRA was observed in reducing hemostasis time and incidence of RAO, especially in studies with Doppler verification and standardized (patent) hemostasis. For primary PCI of STEMI, DRA appears feasible in experienced centers. However, it should not prolong the time to reperfusion and requires readiness for rapid conversion to the traditional radial or femoral approach.

Hypertension (HTN) in young men is associated with a high arrhythmia risk due to myocardial remodeling, impaired autonomic regulation, and metabolic disturban­ces. Analysis of current data shows that this group of patients frequently experien­ces sinus tachycardia, supraventricular and ventricular premature beats, and paro­xysmal atrial fibrillation. Early detection of arrhythmias in young men with HTN can reduce the risk of sudden cardiac death and the progression of cardiovascular complications. Effective arrhythmia diagnosis includes standard electrocardio­graphy, 24-hour cardiac monitoring, exercise testing, and 2D speckle tracking echocardiography. In complex cases, transesophageal left atrial pacing, cardiac magne­tic resonance ima­ging, and intracardiac electrophysiological studies are used. The use of artificial intelligence for analyzing electrocardiographic signals is becoming a promising approach.

The purpose of this review is to analyze and systematize exis­ting know­ledge about the need for early diagnosis of latent cardiac arrhythmias and various diagnostic methods for cardiac arrhythmias in young hypertensive men.

Aim. To analyze legal acts governing the management of primary health care (PHC) to patients with chronic ischemic heart disease (CIHD) in the Russian Federation.

Material and methods. From January 1, 2026, to February 1, 2026, we performed an analysis and systematization of data on the specifics of PHC management to patients with CIHD, as contained in the legal acts of the Russian Federation. CIHD was defined as diseases falling under category I25 of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Fifty-one regulatory legal acts of the Russian Federation were analyzed, a full list of which is available at https://org.gnicpm.ru/npa-2.

Analytical, comparative, and content analysis methods were used. The results were compiled, adjusted, and systematized in Microsoft Office Excel 2016 spreadsheets.

Results. The study identified key aspects of the legal framework gover­ning the management of PHC to patients with CIHD, depending on the reason for their visit to healthcare organizations (MOs) or their structural divisions, based on current regulatory legal acts. The analyzed regulatory legal acts identified a number of unresolved issues regarding equipment standards for individual structural units of PHC organizations, requirements for informing patients with CIHD in PHC organizations, and certain aspects of managing emergency and elective care during outpatient appointments (examinations, consultations) for patients with CIHD.

Conclusion. Based on the analysis, promising areas for improving legal regulation, expanding guarantees of accessibility and quality of PHC for patients with CIHD, enhancing the effectiveness of regulatory procedures, and improving the control system were identified. The data obtained highlight the need for further development of the regulatory framework to enhance the effectiveness of public policy in protecting the health of patients with cardiovascular diseases, and CIHD in particular.

Russian Society of Cardiology (RSC)

With the participation of: the Eurasian Association of Internists (EAT), the Russian Scientific Medical Society of Internists (RNMOT), the Russian Society of Pathologists, the Russian Society of Radiologists and Radiologists (RORR)

Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation

Russian Society of Cardiology (RSC)

With the participation of: the Association of Cardiovascular Surgeons of Russia (ASSH), the Russian Scientific Medical Society of Internists, the All-Russian Scientific and Practical Society of Epidemiologists, Microbiologists and Parasitologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, the Russian Society of Nuclear Medicine, the All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing (VNOA)

Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation (04.12.2025)