Aim. To assess the effect of psychological distress on platelet morphology depending on the severity of mixed anxiety-depressive disorder (MADD) in patients with coronary artery disease (CAD).

Material and methods. The study included 112 patients (mean age — 60,9±1,46 years), 84 of whom were diagnosed with CAD, class II-III angina of effort and stage I-III hypertension. The assessment of psychoemotional status and type D personality was carried out using the Hospital Anxiety and Depression Scale (HADS) and the Type D Scale-14 (DS14), respectively. The detection of platelet phenotype was performed on a high-tech XN-1000 hematology analyzer using flow cytometry.

Results. Participants were divided into two groups: group I (n=40) — patients with MADD; group II (n=44) — patients without anxiety and depression. Assessment of the interconnected effect of MADD and psychological distress on the platelet profile in patients with CAD revealed differences between groups by the platelet morphology. The average platelet count (PLT) in patients of group I was 312,1±17,17x10⁹/L, and in patients with type D personality — 316,7±17,54x10⁹/L, which significantly prevailed the same parameter in comparison group — 220,4±1,48x109/L (p<0,001). The average platelet distribution width (PDW) was significantly higher in group I compared with group II (17,0±0,94 fL vs 13,6±0,76 fL (p<0,05)). The mean platelet volume (MPV) in patients of group I (11,3±0,42) was significantly higher than in the comparison and control groups: 9,7±0,23 and 8,7±0,28 fL, respectively (p<06001). According to logistic regression, the independent predictors of increased platelet aggregation in cardiac patients were depression

Conclusion. Increased functional activity of platelets in patients with CAD and hypertension is due to the effect of MADD associated with type D personality.

Aim. Comparative analysis of the diagnostic effectiveness of onedimensional (1-D) and three-dimensional (3-D) non-invasive methods for coronary fractional flow reserve (FFR) assessment based on the coronary computed tomography angiography (CCTA).

Material and methods. We carried out a retrospective analysis of CCTA data for 13 patients (men — 9, mean age — 61,07±9,73). In the original research, coronary FFR of those patients was evaluated using the original 3-D HeartFlow® Analysis followed by a standard invasive FFR assessment. We estimated coronary FFR using the 1-D algorithm of the Laboratory of Mathematical Modeling (Sechenov University) and compared the diagnostic effectiveness of these methods.

Results. In per-vessel analysis, the sensitivity and specificity of the 3-D approach were 90,91% (95% confidence interval (CI) 62,26-99,53) and 20% (95% CI 0,01026-62,46, p>0,9999), respectively; in per-patient analysis — 90% (95% CI 59,58-99,49) and 0% (95% CI 0-56,15, p>0,9999), respectively; area under the ROC curve was 93,75% (95% CI 80,26-100), p=2,0431e-10. For the 1-D approach, the same parameters in per-patient analysis were 88,89 % (95% CI 56,50-99,43) and 25% (95% CI 0,01282-69,94, p>0,9999), respectively; in per-vessel analysis — 100% (95% CI 72,25-100) and 33,33% (95% CI 0,05923-70, p=0,1250), respectively; area under the ROC curve was 84,54% (95% CI 63,93-100), p=0,001. Spearman’s rank correlation coefficient between the 3-D and 1-D techniques was 0,7326 (95% CI 0,35810,9041), p=0,0017.

Conclusion. Although we have obtained lower values of area under the ROC curve, the sensitivity and specificity of experimental approach, as well as the correlation coefficient between models were rather high. However, further studies with higher statistical power are required.

Aim. To assess the dynamics of the main echocardiographic parameters in patients with chronic obstructive pulmonary disease (COPD) and early-stage chronic kidney disease (CKD) taking native vitamin D.

Material and methods. The study included 264 patients, which were divided into two groups: experimental group (n=135) — patients with stage 2-4 COPD (men, mean age — 72,2±3,8 years, mean disease duration — 23,1±3,4 years); control group (n=136) — patients with stage 2-4 COPD, comparable in age and sex. Patients of both groups were divided into 4 subgroups depending on forced expiratory volume in 1 second and vitamin D levels. In the experimental group, native vitamin D therapy was performed according to regimen that maintains its level >34,3 ng/ml during the year; in the control group — according to the Russian Association of Endocrinologists guidelines. Echocardiography was performed for all patients at the beginning and end of the study.

Results. In all subgroups of the experimental group, a statistically significant increase in the left ventricular ejection fraction was revealed (p<0,05); in patients with moderate COPD (GOLD 2) and vitamin D deficiency and patients with severe and very severe COPD (GOLD 3,4) and vitamin D insufficiency of the experimental group, we observed a significant decrease in the end-systolic dimension, average left atrial size and increase in stroke volume and stroke volume index, as well as normalization of the left ventricular geometry (p<0,05). In the control group after 12 months, no significant changes were detected.

Conclusion. Maintaining of vitamin D level >34,3 ng/ml for 12 months in patients with COPD and early-stage CKD was associated with a significant improvement in myocardial remodeling. This indicates an improvement in cardiovascular adaptation and function.

Aim. To assess the effectiveness of catheter ablation in paroxysmal atrial fibrillation (AF) in patients with moderate/severe obstructive sleep apnea (OSA) with/without use of continuous positive airway pressure (CPAP) therapy (>4 hours per night).

Material and methods. A total of 60 patients with paroxysmal AF and moderate/severe OSA after catheter pulmonary vein isolation were randomized into 2 groups (2:1 ratio): CPAP group (n=40) and control group (n=20). The follow-up period was 12 months and included visits after 3, 6 and 12 months. The effectiveness of catheter ablation was assessed after the 3-month blind period.

Results. Freedom from arrhythmia in patients with CPAP therapy was documented in 82,9% and was significantly more common compared with the control group — 47,5% (p=0,032). Concurrent hypertension was a predictor of arrhythmia recurrence (odds ratio 24,1; 95% confidence interval 2,2-261,2).

Conclusion. Treatment of OSA with CPAP therapy improves the effectiveness of catheter ablation in paroxysmal AF during a 12-month follow-up.

Aim. To assess the relationship of the population’s adherence to a healthy lifestyle (HLS) with socio-demographics and to carry out a comparative analysis of adherence according to ESSE-RF-1 and ESSE-RF-2 studies.

Material and methods. This study was conducted as part of a multicenter epidemiological study ESSE-RF-2 in 4 regions of Russia (n=5897). The following components of HLS were considered: non-smoking, adequate consumption of fruits and vegetables, salt intake, regular physical activity, and low alcohol consumption. According to the combination of components, “high”, “adequate” and “low” adherence to HLS were distinguished. The socio-demographics included gender, age, region, residence (urban/rural), marital status, educational status, income. To compare the results with other studies, the data obtained were standardized according to the 1976 European Standard Population age structure.

Results. Initial data on adherence to healthy lifestyle were as follows: high adherence — 21,9%, adequate — 34,5%, low — 43,6%. We observed the following prevalence of low adherence components: excessive salt intake (50,5%), insufficient consumption of fruits and vegetables (37,5%), smoking (22,7%), low physical activity (19,6%), excessive alcohol consumption (4,9%). High adherence to HLS was associated with female gender, older age, urban residence, high educational status, absence of family. In addition, the combined effects of socio-demographics on adherence to HLS were revealed. In particular, we analyzed the effect of high educational status with other characteristics (gender, age, residence), which acted both as a protective and negative factor. A comparative analysis of ESSE-RF-1 and ESSE-RF-2 data showed significant differences in the prevalence of adherence to HLS, which may be due to both methodological differences of studies and a true change in adherence to HLS.

Conclusion. High adherence to HLS is detected only in every fifth adult of the studied regions. Low adherence to HLS is associated with a number of socio-demographic characteristics of the population and is specified mainly by the high prevalence of unhealthy diet and, to a lesser extent, low physical activity and smoking.

Aim. To assess the prevalence, structure, and features of aspirin-induced gastroduodenal lesions in patients with chronic coronary artery disease (CAD) and outline therapeutic options.

Material and methods. The study included 340 patients with chronic CAD who received long-term low-dose acetylsalicylic acid (ASA) therapy. The diagnosis of chronic CAD was verified using a complex examination with selective coronary angiography (SCA). Further, esophagogastroduodenoscopy was performed in patients with chronic CAD to diagnose aspirin-induced gastroduodenal lesions. We also assessed their prevalence and structure. An endogenous prostaglandin-inducer rebamipide (300 mg daily) in combination with a proton pump inhibitor (PPI) pantoprazole were used to treat aspirin-induced gastroduodenal lesions. The comparison group consisted of patients with chronic CAD who received only pantoprazole. To clarify the pathogenesis of aspirin-induced gastroduodenal lesions before and after treatment, the levels of following serum pro-inflammatory cytokines were determined: interleukin-6 (IL-6), interleukin-1-beta (IL-1β), tumor necrosis factor alpha (TNF-α). The control group consisted of
patients with chronic CAD and without signs of gastrointestinal lesions. Statistical processing was carried out using Statistica 10.0 software package.

Results. Aspirin-induced gastroduodenal lesions were recorded in 15% of patients. Results of esophagogastroduodenoscopy revealed that gastric erosions of body and antrum prevailed among aspirin-induced lesions. The level of pro-inflammatory cytokines in these patients was significantly higher than in patients of control group. Therapy with PPI resulted in a positive endoscopic response in 19 of 25 patients and a slight decrease in cytokines. Combination of PPI with rebamipide led to mucosal reconstruction in all subjects and a statistically significant decrease in levels of serum pro-inflammatory cytokines. 

Conclusion. The current study showed aspects of development and possible therapeutic options in aspirin-induced gastrointestinal lesions in patients with chronic CAD.

Aim. To study the activity of pro-inflammatory cytokines in patients with coronary artery disease (CAD) associated with obstructive sleep apnea (OSA), depending on the type of antiplatelet therapy.

Material and methods. The study included 148 patients with stable CAD, 30% (n=44) of whom had mild OSA, 10% (n=14) — moderate and severe OSA. There were 60% (n=90) of patients without OSA. Pro-inflammatory activity of cytokines was assessed by the level of interleukins (IL): IL- 1β, IL-6, IL-10.

Results. Using dual antiplatelet therapy, there were no differences in aggregation activity of platelets (spontaneous and induced by 0,1 pM ADP) in patients with and without OSA. This indicates the synergism and potentiation of the antiplatelet effect of clopidogrel and acetylsalicylic acid (ASA). Patients with moderate and severe OSA and stable CAD had higher levels of IL- 1β and IL-6 compared with patients without OSA. Antiplatelet therapy, especially dual one, had an anti-inflammatory effect, which was reflected in lower values of pro-inflammatory IL both in patients with and without OSA.

Conclusion. Patients with moderate and severe OSA and stable CAD had higher levels of pro-inflammatory IL (IL- 1β, IL-6) compared with patients without OSA. The combined use of clopidogrel and ASA potentiates antiplatelet and anti-inflammatory effects. This is reflected in lower values of pro-inflammatory IL and lower aggregation activity of platelets in patients with stable CAD, regardless of OSA.

Aim. A comparative analysis of the acquisition pattern of the renin-angiotensin-aldosterone system inhibitors for the treatment of cardiovascular diseases in subjects of the Far Eastern Federal District.

Material and methods. We used marketing data of pharmacy organizations (n=122) in 2019 in the Khabarovsk Krai (KK), Sakhalin Oblast (SO), and Primorsky Krai (PK). Intra-group analysis, price segmentation, and statistical analysis (Kruskal-Wallis test, Spearman’s correlation coefficient, factor analysis) were performed.

Results. Angiotensin II receptor blockers (ARBs) are characterized by relatively low levels of sales in KK — 7,67%, in SO — 8,45%, and in PK — 9,75%. Angiotensin-converting enzyme (ACE) inhibitors remain one of the most used cardiovascular medications. In KK, their total share of sales is 28,9%, in SO — 31,12%, in PK — 26,93%. The leaders were losartan and enalapril. There were no significant differences in the distribution of sales between regions.

Conclusion. Recently registered medicines (azilsartan, olmesar-tan, irbesartan, eprosartan), as well as substances with a narrow assortment/without generic drugs (zofenopril, quinapril, fozinopril), are more often characterized by low sales. The maximum sales of most popular ARBs (losartan, valsartan, candesartan) accrue to the price segment of 100-500 rubles. The most popular international nonproprietary names of the ACE inhibitors (captopril, lisino-pril, enalapril) are characterized by high sales in price segments <100 rubles.

Heart failure with preserved ejection fraction (CHpEF) is a common but difficult to diagnose disease. CHpEF is associated with comorbidity, therefore, the symptoms are not always specific, which often leads to a long-term diagnostic process and the inability to treat the underlying disease and prevent its complications. The most affordable and cost-effective imaging method for the CHpEF diagnosis is transthoracic echocardiography. Diagnosis algorithms for HFpEF were first systematized and published in 2019, which will improve patient management and prevent the serious complications.

Currently, the concept of atherosclerosis has undergone a number of changes. On the one hand, carotid atherosclerosis, like femoral, is a disease that must be treated directly, and on the other hand, it is a modifier of cardiovascular risk. This review is devoted to aspects of cardiovascular risk stratification depending on the severity and progression of carotid and femoral artery atherosclerosis.

In modern medical practice, contrast-induced nephropathy (CIN) is an urgent problem in patients with acute coronary syndrome that underwent percutaneous interventions. It worsens prognosis, increases the number of cardiovascular complications and the length of hospital stay. Despite the use of modern radiocontrast agents, the incidence of CIN can increase in a certain patients up to 50%. Risk factors for CIN can be associated both with the patient and directly with the x-ray procedures. The diagnosis is mainly based on the pre- and postprocedural determination of creatinine. However, more modern biomarkers of kidney injury can be used at present, which allow diagnosing the acute kidney injury as soon as possible. A huge role is played not only by treatment, but also by the prevention of CIN, which consists in the timely identification of high-risk patients. The current study presents the main points of pathogenesis, methods for diagnosing CIN, as well as methods for its prevention and treatment in patients with acute coronary syndrome.

The review presents the results of meta-analyzes and systematic reviews on the impact of treatment adherence to quality of life, rehospitalization and mortality rates in patients with heart failure with reduced ejection fraction. Attention is paid to the physicians’ adherence to current clinical guidelines. The modern capabilities of home telemonitoring programs to ensure the continuity of care for heart failure patients and their impact on patient compliance with the physicians’ recommendations are considered. We analyzed the factors of reducing compliance of heart failure patients and approaches aimed at increasing it, associated with a more favorable clinical course of heart failure, a decrease in the hospitalization frequency and mortality rates.

In recent decades, population aging has created many problems for the health care system. Along with the main risk factors, including the frequency and severity of comorbidities, elderly patients are subject to changes associated with the aging. It leads to a high probability of adverse events and make it difficult to stratify the risk of patients undergoing cardiac surgery. This review presents data on the preoperative risk stratification in elderly surgical patients.

Endovascular management of femoropopliteal lesions has proven effective. A large number of publications indicates the relevance and prospects of this method. The article presents an analysis of studies over the past 5 years about different treatment techniques, the use of cytostatics coated balloons and stents. Ways to improve the outcomes of femoro-popliteal bypass surgery are proposed.