Aim. To study the association of the QT interval with C-reactive protein (CRP) in combination with cardiometabolic risk factors and coronary artery disease (CAD) in a sample of Novosibirsk residents.

Material and methods. The study included 1042 Novosibirsk residents (men, 510 (48,9%)), aged 35-74 years (as part of the ESSERF3 study). The examination program included blood sampling, collection of demographic and social data, anthropometry, blood pressure measurement, and electrocardiography. CRP threshold value was considered to be ≥5 mg/l. CAD and its categories were established by Rose GA questionnaire and electrocardiogram assessment according to the Minnesota Code. The QT interval was measured in lead V5.

Results. The QTc interval correlates with age, waist circumference, systolic blood pressure, triglycerides, blood glucose, and CRP. The QTc interval was directly and independently associated with age, female sex, blood pressure ≥140/90 mm Hg, fasting plasma glucose ≥6,1 mmol/L, CRP ≥5 mg/L, and CAD. The standardized QTc interval was longer in individuals with CRP ≥5 mg/L than in individuals with CRP <5 mg/L (400,71 [404,43; 397,05] vs, 393,98 [396,17; 391,80] ms).

Conclusion. In Novosibirsk residents, the QTc interval is associated with elevated CRP levels regardless of the presence of CAD and other cardiometabolic risk factors.

Aim. To assess the prognostic role of the level of novel systemic inflammation biomarkers in predicting atrial fibrillation (AF) recurrence after the primary cryoballoon pulmonary vein (PV) isolation.

Material and methods. The study included 239 people (mean age, 61 years) who underwent the primary cryoballoon PV isolation. The mean follow-up period was 20 months. The primary endpoint was AF recurrence in the long-term period. The initial levels of systemic inflammation markers were studied.

Results. A total of 167 patients remained under follow-up for >1 year, which was 70% of the initial number of selected patients. Of these, the primary endpoint was detected in 63 patients, while 104 patients remained recurrence-free. Between the groups with and without AF recurrence, there were significant differences in the levels of following markers: Systemic Inflammation Response Index (SIRI) — 0,91 (0,67; 1,1) vs 0,76 (0,55; 1,05), p=0,018; Systemic Inflammation Index (SII) — 410,5 (309,6; 565,1) vs 350,95 (257,1; 462,8), p=0,008, Neutrophilto-Lymphocytes Ratio (NLR) — 1,8 (1,5; 2,5) vs 1,6 (1,3; 2), p=0,002. According to the ROC analysis, the following threshold values of AF recurrence-associated markers were obtained: SIRI >0,841, SII >365,83, NLR >1,6. In the multivariate Cox regression model, SII and NLR remained significant predictors of recurrence.

Conclusion. The SIRI, SII and NLR indices have predictive value for AF recurrence after interventional treatment and can be used to improve the effectiveness of cryoballoon PV isolation.

Aim. To analyze a complex of cardiac markers, adipocytokines, heat shock proteins (HSPs) and extracellular matrix remodeling biomarkers in patients with acute decompensated heart failure with preserved ejection fraction (ADHFpEF) depending on the presence and degree of obesity.

Material and methods. A total of 151 patients with ADHFpEF aged 47-95 years were divided into 2 following groups: main group — 85 patients with ADHFpEF and obesity (body mass index ≥30 kg/m²); comparison group — 66 patients with ADHFpEF without obesity (body mass index <30 kg/m²) as the comparison group. The level of biochemical blood parameters was determined using routine biochemical methods on BS800M1 (Mindray, China) and Maglumi 2000 (Snibe, China) systems, as well as by the enzyme immunoassay using a Multiskan FC photometer (Thermo, USA) and reagent kits from Vector-Best (Russia), Ray-Biotech (USA), Cloud-Clone (China), DBC (Canada) and Biovendor (Czech Republic).

Results. In patients with ADHFpEF and obesity, significantly highermedian leptin levels and leptin/adiponectin ratio were found than in patients with ADHFpEF without obesity, while adiponectin and HSP70 levels in obesity were significantly lower. The median [Q25-Q75] HSP27 concentration in morbid obesity was 4,7 [1,2-24,2] ng/ml and was statistically significantly higher than in patients with class I and II obesity — 1,3 [0,3-2,7] and 0,6 [0,3-1,3] ng/ml, respectively. In patients with ADHFpEF with epicardial fat thickness ≥5 mm, not only higher leptin concentration and leptin/adiponectin ratio were found, but also increased blood myoglobin levels.

Conclusion. We revealed a number of obesity-related serum biochemical features in patients with ADHFpEF, including differences in the main adipocytokine complex parameters, as well as cellular stress biomarkers — HSP27 and HSP70. This may indicate the involvement of obesity in heart failure pathogenesis and the pathophysiological processes in heart failure decompensation.

Aim. To assess the rate of a combined endpoint (fatal and non-fatal cardiovascular events) and the contribution of cardiovascular risk factors to its development in Kemerovo Oblast population.

Material and methods. A clinical and epidemiological prospective study was conducted in the Kemerovo Oblast at the Research Institute for Complex Issues of Cardiovascular Diseases. The first stage (20172019) was inclusion of respondents and examination (n=1600). Prospective stage (2020-2021) included re-examination after 3 years sical inactivity, and smoking. The composite endpoint (CEP) included fatal and non-fatal cardiovascular events.

Results. Individuals with CEP were characterized by higher cardiome obesity (OR=2,12, p=0,001), abdominal obesity (OR=2,65, p=0,001) and carbohydrate metabolism disorders (OR=1,88, p=0,001) were associated with the risk of CEP. Taking into account the significance criterion (Wald), the CEP probability over a 3-year period was determined by the following variables: age (Wald test 32,8), abdominal obesity (Wald criterion 19,3), hypercholesterolemia (Wald criterion 8,8) and obesity (Wald criterion 7,3).

Conclusion. The study results emphasized the role of regional factors in the risk of adverse cardiovascular events, justifying the need for similar studies in other Russian regions.

Aim. To justify the need to shift priorities in the allocation of health care resources by the analysis of volumes and results of providing high-tech health care in cardiovascular surgery.

Material and methods. The sources of information were federal statistical monitoring forms, the European Health Information Portal of the World Health Organization, compulsory health insurance (CHI) registries, annual reports of the Federal CHI Fund, population mortality data from the C51 form of Rosstat, and the Federal Laws "On the Federal Budget". Descriptive statistics methods and regression analysis were used.

Results. Due to a significant increase in the number of expensive endovascular coronary interventions in recent years, the Russian Federation has achieved a leading position in the world in providing the population with this type of high-tech health care. At the same time, the target indicators of the federal project on cardiovascular diseases to reduce MI mortality have not been achieved. Every year, <70% of expensive coronary artery stenting interventions are performed on the same individuals, while more than half of deaths from MI occur outside a medical facility. In addition, the proportion of working age people dying from MI is increasing. The program of state guarantees for free health care in 2025 for the first time established standard hospitalization rate for high-tech care for myocardial infarction. It is 1,5 times higher than the actual hospitalization rates with this diagnosis, which indicates the impossibility of their real implementation.

Conclusion. The volumes and growth rates of endovascular coronary interventions in Russia do not correspond to the budgetary capabilities of the country's financial system and do not have the expected positive impact on public health. Priorities in the allocation of health care resources should be shifted — from increasing the volume of high-tech medical care to strengthening primary health care services, which implies a political choice and requires long-term commitment to this course.

Aim. To compare the efficacy and safety of two variants of long-term multiagent antithrombotic therapy in patients with multifocal atherosclerosis as follows: a combination of acetylsalicylic acid (ASA) with rivaroxaban 2,5 mg 2 times a day or with clopidogrel 75 mg 1 time per day.

Material and methods. The study is based on the prospective REGATA-1 registry, ClinicalTrials NCT04347200 (1500 patients with stable coronary artery disease (CAD)). A total of 311 patients (241 men, median age 66 years [60; 72]) with multivessel CAD in combination with peripheral artery disease were selected. Depending on the decision of clinicians, the patients were distributed into two groups for following open-label administration in addition to ASA: rivaroxaban at a dose of 2,5 mg 2 times a day (n=109) or clopidogrel 75 mg/day (n=202). Thrombotic events (TEs) (major ischemic events and unscheduled revascularization of any vascular system, as well as major bleeding (BARC 3-5)) were analyzed. In addition, clinically significant bleeding (BARC 2) was taken into account.

Results. The median follow-up period was 13 months [interquartile range 11; 21]. During the 24-month follow-up period, TEs were registered in 26 (8,4%) patients. TEs were registered significantly more often in the clopidogrel group — 11,4 vs 2,8% (p=0,009). According to the regression analysis, prior myocardial infarction and the use of clopidogrel rather than rivaroxaban as part of multiagent therapy increase the risk of thromboembolism by 3 and 4 times, respectively. All major bleedings (BARC 3) with the frequency of 2,8% were registered in the rivaroxaban group. There were no fatal bleedings. Clinically significant BARC 2 bleedings were more often registered in the rivaroxaban group — 13,8 vs, 4,5% (p=0,006). Bleeding of this type did not affect the prognosis and was not a reason for refusing to take antithrombotic therapy.

Conclusion. In patients with multifocal atherosclerosis, the use of rivaroxaban as the second agent of antithrombotic therapy compared with clopidogrel may be associated with a better clinical benefit, determined by the sum of thromboembolism and major bleedings.

Aim. To assess the impact of a clinical decision support system (CDSS) aimed at increasing physician compliance with clinical guidelines on heart failure (HF) in real-world practice in order to improve the effectiveness of managing this category of patients and clinical outcomes in pilot Russian regions.

Material and methods. As part of the retrospective multicenter study SPHERA-HF, data of electronic health records from 49 medical facilities in three Russia regions were analyzed. The study participants were divided into inpatient and outpatient cohorts. The main inclusion criterion was a history of HF diagnosis. The features of patient management in real-world practice were studied before and after the implementation of the CDSS.

Results. The study included 66166 patients. After CDSS imple neprilysin inhibitors in patients with HF with reduced ejection fraction increased in the in-hospital cohort from 32,9% to 52,3% (p<0,05); in the outpatient cohort from 24,2% to 45,3% (p<0,05). There was an increase in the prescription rate of quadruple therapy at discharge in the inhospital cohort from 22,3% to 32,6% (p<0,05); at the initiation visit in the outpatient cohort from 24,6% to 42,9% (p<0,05). There was a decrease in the number of rehospitalizations for cardiovascular diseases in the inhospital cohort from 26,9% to 20,1% (p<0,05).

Conclusion. The study results indicate a positive impact of CDSS introduction on managing patients with HF.

Aim. To study the prognostic value of electrocardiogram (ECG) contour analysis parameters in patients with novel coronavirus infection (COronaVIrus Disease 2019, COVID-19).

Material and methods. A total of 110 people diagnosed with corona-virus disease 2019 (COVID-19) were included in the study. Paraclinical research data were studied as possible predictors of COVID-19 severity. Particular attention was paid to the characteristics of the P wave, QRS complex, and T wave areas in various ECG leads assessed upon admission of patients to the hospital. Statistical analysis was performed using Statistica 12, StatTech v. 4.7.1. Differences were considered significant at p<0,05.

Results. A prognostic model was developed to determine the probability of severe COVID-19. The following parameters were included in the model: QRS complex area in lead III, QRS complex area in lead AVF and the level of C-reactive protein upon admission to the hospital. The sensitivity and specificity of the resulting prognostic model were 71,4 and 94,7%, respectively.

Conclusion. To assess the ECG changes, a new technology should be used — contour analysis along with qualitative, semi-quantitative and quantitative methods for assessing the parameters.

Aim. To evaluate the role of intravascular ultrasound (IVUS) in performing percutaneous coronary interventions (PCI) with minimal contrast enhancement in patients with acute coronary syndrome (ACS).

Material and methods. The single-center retrospective study included 269 patients with nonST-segment elevation ACS (NSTE-ACS) who underwent coronary artery stenting. Patients were divided into three following groups: group 1 — angiography-guided PCI (n=100), group 2 — PCI with IVUS use (n=100), and group 3 — PCI with the combined use of IVUS and minimal contrast agent administration (n=69). The primary analysis included the assessment of contrast agent volume during PCI, the changes of creatinine level, glomerular filtration rate, and the incidence of acute kidney injury in patients with NSTE-ACS.

Results. The smallest contrast agent amount (73,3±5,1 ml) was administered to patients in group 3, where PCI was accompanied by the combined use of IVUS and minimal contrast agent administration (analysis of variance [ANOVA]; p<0,001, with Tukey's post-hoc test). There were no significant differences between the groups in the changes of creatinine clearance and glomerular filtration rate.

Conclusion. Quantitative parameters of average contrast agent administration during PCI in the angiographic and IVUS control groups were identified. Some renal function parameters in these groups were assessed. The effectiveness of the combined use of IVUS and minimal contrast agent administration in patients with NSTE-ACS was shown.

Acquired valvular heart defects are a rapidly growing cause of increased global cardiovascular morbidity and mortality with a diverse and changing geographic distribution. In addition to the direct impact on intracardiac hemodynamics, heart valve defects cause various arrhythmias. Studies have shown that even minor changes in the structure and function of the valves, in particular, mitral valve prolapse, can lead to life-threatening arrhythmias. The article discusses the most common types of valvular heart disease among adults, epidemiological issues, pathogenesis features, and modern views on their correction. Arrhythmias associated with valvular heart defects, the potential of their drug and non-drug therapy in the light of modern research are analyzed.

Aim. To determine the potential of using acoustic voice analysis parameters in diagnosis of noncommunicable diseases (NCDs).

Material and methods. The information search was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the PubMed, Google Scholar, Clinical Trials, Cyberleninka and eLibrary databases. Four publications, including six studies, were selected for the final analysis of full-text articles. These studies included acoustic voice analysis in diabetes type 1 and 2, asthma, chronic obstructive pulmonary disease, pneumonia. The meta-analysis assessed changes in voice frequency (Jitter) and amplitude (Shimmer) in patients with NCDs compared to healthy volunteers.

Results. The meta-analysis based on Jitter and Shimmer included 203 patients with NCDs and 132 healthy volunteers. Jitter in patients with NCDs was significantly higher compared to patients without diseases (standardized mean difference 2,23, 0,83-3,62, I2=97,03%, p=0,002). Shimmer in patients with the diseases under study also turned out to be significantly higher compared to patients without diseases (standardized mean difference 0,81, 0,11-1,52, I2=91,06%, p=0,024).

Conclusion. The current systematic review and meta-analysis demonstrated the possibility of using acoustic voice analysis in the diagnosis of NCDs.

Familial hypercholesterolemia (FH) is one of the most common monogenic diseases in humans, most often caused by defects in the low-density lipoprotein receptor (LDLR) gene. Early diagnosis of FH makes it possible to prevent cardiovascular diseases. We present a case of the detection of a seven-nucleotide deletion c.925_931del in the LDLR gene in a family from Petrozavodsk. This deletion is associated with high levels of total plasma cholesterol and low-density lipoprotein cholesterol. The second variant of the nucleotide sequence of the LDLR gene c.58G>A, detected in the same family, did not segregate with hypercholesterolemia. The detected deletion is the cause of FH, and the conducted cascade analysis made it possible to establish a diagnosis of FH in the sister, nephew, daughter and granddaughter of the proband and to rule out this diagnosis in the grandson.

Transcatheter aortic valve implantation (TAVI) is an effective and safe method for treating aortic stenosis (AS), especially in patients at high surgical risk. With the improvement of the quality and increase in life expectancy of the population, comorbid patients with critical AS will increasingly be encountered in practice, for whom TAVI will be the main method of surgical treatment. Despite the achieved successes in the management of patients with cardiovascular diseases, their cotinuous progression can lead to de novo atherosclerotic lesions or restenosis in the previously stented coronary segment. The design of prosthetic aortic valves used in TAVI can impose a number of technical limitations when repeated coronary interventions are necessary. This article presents a case of successful endovascular treatment of multivessel coronary artery disease guided by intravascular coronary flow assessment in a comorbid patient after TAVI.