Despite modern advances in performing percutaneous coronary interventions, refractory no-reflow remains a serious problem that worsens in-hospital and long-term prognosis. Low-dose adrenaline may exhibit potent beta-receptor agonist properties that mediate coronary vasodilation.

Aim. To evaluate the efficacy and safety of intracoronary administration of epinephrine and verapamil, as well as their combination, compared with standard treatment in patients with ST-segment elevation myocardial infarction (STEMI) and refractory no-reflow during percutaneous coronary interventions.

Material and methods. Patients with STEMI and refractory no-reflow will be randomized into 4 groups: standard therapy, intracoronary adrenaline, intracoronary verapamil, intracoronary epinephrine + verapamil. All patients will be assessed for epicardial blood flow using the Thrombolysis in Myocardial Infarction (TIMI) and Myocardial Blush Grade (MBG) scales, peak troponin levels, ST segment changes, echocardiography, magnetic roesnance imaging, and dynamic single photon emission computed tomography.

Results. Based on the pharmacodynamic effects of epinephrine and verapamil, their combination is expected to have a more potent vasodilating effect.

Conclusion. If the Intracoronary administration of EPInephrine and VERapamil in the refractory no-reflow phenomenon (EPIVER) study will be successful, a novel, more effective method for managing refractory no-reflow phenomenon will appear. This will ensure better preservation of left ventricular systolic function, as well as improve the prognosis and clinical course of the disease.

Aim. To study of the relationship between cardiovascular risk factors and biological vascular age.

Material and methods. The biological vascular age was estimated using models based on the arterial wall parameters. Using multiple logistic and linear regression, we studied the relationship between the biological vascular age and cardiovascular risk factors in 143 people without cardiovascular disease (CVD). Persons with a positive difference between the vascular and chronological age were assigned to the “old” vascular group, and persons with no or negative difference between the vascular and chronological age were assigned to the “young” vascular group.

Results. Linear regression in the “young” vascular group showed an inverse relationship between the difference between the vascular and chronological age with the levels of low-density lipoprotein cholesterol (p=0,001; β±SE=-1,67±0,47), triglycerides (p=0,017; β±SE=-1,66±0,68), urea (p=0,025; β±SE=-0,89±0,39) and insulin resistance index (p=0,001; β±SE=-1,22±0,36). In the “old” vascular group, a direct relationship was found between the difference between the vascular and chronological age and central systolic blood pressure (p=0,015; β±SE=0,10±0,04). According to logistic regression, the likelihood of having “old” vessels increased by 1,23 times with an increase in blood glucose levels by 0,5 mmol/l (p=0,044; odds ratio (OR)=1,23; 95% confidence interval (CI): 1,011,51), the presence of hypertension (p=0,034; OR=3,11; 95% CI: 1,09-8,86) and type 2 diabetes (p=0,025; OR=3,61; 95% CI: 1,1711,09), as well as decreased by 2 times with an increase in high-density lipoprotein cholesterol by 0,3 mmol/l (p=0,003; OR=0,5; 95% CI: 0,32-0,79).

Conclusion. The difference between the biological vascular age and chronological age is associated with traditional CVD risk factors.

Aim. To conduct a comparative assessment of the short-term prognosis in patients with ST-segment elevation acute coronary syndrome (STE-ACS) without percutaneous coronary intervention (PCI) based on the Global Registry of Acute Cardiac Events (GRACE), Thrombolysis In Myocardial Infarction (TIMI), RECORD, PREdicting risk of Death In Cardiac disease Tool (PREDICT) scales and to ident ify the most significant markers of fatal and non-fatal complications.

Material and methods. Eighty-two STE-ACS patients without PCI were examined. Risk assessment was carried out using the GRACE, TIMI, RECORD, and PREDICT scales. Outcomes were assessed 30 days after markers. To assess the predictive value of above scales, sensitivity (Se) and specificity (Sp), as well as relative risk with a 95% confidence interval, were calculated.

Results. Comparative analysis of the prognosis of developing fatal complications in STE-ACS patients without PCI revealed the following predictive characteristics of scales: GRAСE — Se=1,000, Sp=0,54, χ²=25,763 (p<0,001); PREDICT — Se=0,281, Sp=0,96, χ²=20,297 (p<0,001); TIMI — Se=0,75, Sp=0,94, χ²=51,985 (p<0,001); RECORD — Se=1,000, Sp=0,48, χ²=21,716 (p<0,001). Regarding the development of non-fatal complications, the following data was obtained: GRACE — Se=0,680, Sp=0,760, χ²=9,970 (p<0,01); PREDICT — Se=0,080, Sp=1,000, χ²=4,167 (р>0,05); TIMI — Se=0,120, Sp=1,000, χ²=8,171 (р<0,05); RECORD — Se=0,680, Sp=0,640, χ²=5,128 (р<0,05). The most significant criteria for developing fatal and non-fatal complications were identified as follows: Killip class II acute heart failure, systolic blood pressure <100 mm Hg, age >65 years, stage ≥II A chronic heart failure, ST elevation ≥1 mm at admission, ejection fraction ≤<40%.

Conclusion. A comparative evaluation of the 30-day prognostic significance of short-term scales (GRACE, RECORD, TIMI, PREDICT) in STE-ACS patients without PCI showed an ambiguous prognosis for developing both fatal and non-fatal complications. High sensitivity rates for predicting fatal complications were revealed in the GRACE and RECORD scales (100 and 100%, respectively) relative to the TIMI and PREDICT (75 and 28,1%, respectively), as well as for non-fatal complications in the GRACE and RECORD (68% for both) scales relative to the TIMI and PREDICT (12 and 8%, respectively).

Aim. To evaluate the relationship between the salt intake (NaCl) and the clinical and hemodynamic parameters in patients with hypertrophic cardiomyopathy (HCM).

Material and methods. Forty four patients with HCM (mean age, 60,4±15,3 years) were examined. Particular attention was paid to intraventricular obstruction and hypovolemic syncope. NaCl consumption was estimated by 24-hour urine sodium test.

Results. An inverse correlation was found between syncope and 24-hour natriuresis (r=-0,3, p=0,04). At 24-hour natriuresis <50 mmol/day,  syncope was more common (p=0,02): odds ratio (OR), 12,3 (95% confidence interval (CI): 1,3-121,3, p=0,03), as well as <65 mmol/day (p=0,04): OR, 8,3 (95% CI: 1,13-60,3; p=0,04). At higher 24-hour urine sodium values, no reduction in syncope risk was recorded. A correlation was found between low values of left ventricular (LV) stroke volume index (SVI) (<26 ml/m2) and 24-hour urine sodium (<50 mmol/day) (r=0,5, p=0,01). An inverse correlation was observed between LV SVI and syncope at 24-hour natriuresis <50 mmol/day (r=-0,9; p=0,05). An inverse relationship was found between the intraventricular obstruction and 24-hour urine sodium (r=-0,4, p=0,01). The prevalence of obstruction increased as natriuresis decreased: at 120 mmol/day, OR was 4,3 (95% CI: 1,01-18,6, p=0,048), at 110 mmol/day, OR — 4,6 (95% CI: 1,218,1, p=0,03), and at 100 mmol/day, OR — 4,0 (95% CI: 1,1-11,7, p=0,04). An increase in 24-hour urine sodium >130 mmol/day was not followed by a further decrease in obstruction prevalence.

Conclusion. To reduce the obstruction risk, the optimal 24-hour urine sodium level is ≥130 mmol/day (NaCl, 7,5 g/day). To reduce the syncope risk, regardless of obstruction presence, the optimal level of 24-hour natriuresis is ≥65 mmol/day (NaCl, 3,8 g/day).

Aim. To develop and perform comparative assessment of the accuracy of models for predicting 5-year mortality risks according to the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study in Primorsky Krai.

Material and methods. The study included 2131 people (1257 women and 874 men) aged 23-67 years with a median of 47 years (95% confidence interval [46; 48]). The study protocol included measurement of blood pressure (BP), heart rate (HR), waist circumference, hip circumference, and waist-to-hip ratio (WHR). The following blood biochemical parameters: total cholesterol (TC), low and high density lipoprotein cholesterol, triglycerides, apolipoproteins AI and B, lipoprotein(a), N-terminal pro-brain natriuretic peptide (NT-proNBP), D-dimer, fibrinogen, C-reactive protein (CRP), glucose, creatinine, uric acid. The study endpoint was 5-year all-cause death (2013-2018). The group of deceased patients during this period consisted of 42 (2%) people, while those continued the study — 2089 (98%). The χ2, Fisher and MannWhitney tests, univariate logistic regression (LR) were used for data processing and analysis. To build predictive models, we used following machine learning (ML) methods: multivariate LR, Weibull regression, and stochastic gradient boosting.

Results. The prognostic models developed on the ML basis, using parameters of age, sex, smoking, systolic blood pressure (SBP) and TC level in their structure, had higher quality metrics than Systematic COronary Risk Evaluation (SCORE) system. The inclusion of CRP, glucose, NT-proNBP, and heart rate into the predictors increased the accuracy of all models with the maximum rise in quality metrics in the multivariate LR model. Predictive potential of other factors (WHR, lipid profile, fibrinogen, D-dimer, etc.) was low and did not improve the prediction quality. An analysis of the influence degree of individual predictors on the mortality rate indicated the prevailing contribution of five factors as follows: age, levels of TC, NT-proNBP, CRP, and glucose. A less noticeable effect was associated with the level of HR, SBP and smoking, while the contribution of sex was minimal.

Conclusion. The use of modern ML methods increases the accuracy of predictive models and provides a higher efficiency of risk stratification, especially among individuals with a low and moderate death risk from cardiovascular diseases.

Aim. To determine the association of single nucleotide polymorphism (SNP) -1562C>T (rs3918242) in the matrix metalloproteinase 9 (MMP-9) gene in hypertensive (HTN) in individuals of European and South Asian ethnicity of Primorsky Krai and Sakhalin Oblast.

Material and methods. The analysis of conventional and additional risk factors for cardiovascular diseases (35 parameters) in 377 people as a part of regional stage of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study (2014-2019), of whom 240 people of European (Slavic) and 137 people of South Asian (Korean, second- and third-generation immigrants) ethnicity. Substitutions in the MMP-9 gene -1562C>T (rs3918242) was identified by real-time polymerase chain reaction using TaqMan technology.

Results. Compared to Koreans, the Slavs have a higher blood pressure (p=0,002). There were no significant differences between ethnic groups (p=0,07) in cardiovascular risk levels using the Systematic Coronary Risk Evaluation (SCORE). Significant differences (p=0,003) were determined in cardiovascular risk levels for healthy Koreans and HTN patients. It was shown that among patients with HTN, the pulse wave velocity exceeded the recommended values in 22,2% of Europeans and in 46,6% of Koreans (p=0,003). The number of hypertensive Europeans and minor MMP-9 rs3918242 T allele exceeded 2,6 times the number of healthy persons (odds ratio, 4,7; 95% confidence interval: 1,1 -7,8 (p=0,03)). MMP-9 rs3918242 T allele in Koreans of the Sakhalin Oblast was not associated with HTN (odds ratio, 0,81; 95% confidence interval: 0,12-5,54 (p=0,83)). Moreover, in South Asian population, heterozygous carriers of T allele prevailed, which significantly (p=0,002) differed from Europeans, who, in general, had a homozygous CC genotype.

Conclusion. In Far Eastern Federal District, SNPs in the MMP-9 C-1562T gene were found mainly in hypertensive patients of European ethnicity, while in Koreans, a significant relationship between the carriage of minor T allele in this gene and the presence of HTN was not established.

Aim. To study the plasma profiles of circulating extracellular microribonucleic acids (miRNAs), potentially including in pathogenesis of cardiovascular diseases, in patients with atrial fibrillation (AF) in combination with hypertension (HTN) or coronary artery disease (CAD).

Material and methods. The study included patients with AF in combi  nation with HTN (n=21) or CAD (n=10), as well as following control groups: patients with uncomplicated HTN without AF (n=28), patients with stable CAD without AF (n=10) and healthy individuals (n=30). MiRNA samples were isolated from blood plasma of the study participants. MiRNAs were detected by TaqMan quantitative polymerase chain reaction assay. The relative plasma levels of five candidate miRNAs were estimated relative to the reference miR-16-5p.

Results. Among the analyzed circulating plasma miRNAs, a higher level of miR-320a-3p was associated with AF, while increased levels of miR 146a-5p and miR-21-5p are potentially associated with presence of both AF and CAD.

Conclusion. Differences were found in the plasma miRNA profiles (miR-21-5p, miR-320a-3p, miR-146a-5p) between patients with AF, regardless of concomitant disease (CAD or HTN), and healthy individuals in the control group.

Aim. To assess the adaptive potential of cardiovascular system in female population of the Russian Arctic territory and its relationship with sex hormones and dopamine levels.

Material and methods. The study involved 253 women living in European North (Arkhangelsk Oblast) and Asian North (Yamalo-Nenets Autonomous Okrug), who were divided into groups of fertile (n=58 and n=70, respectively) and postmenopausal women (n=59 and n=66, respectively). Enzyme immunoassay of serum was used to determine the levels of follicle-stimulating and luteinizing hormones (LH), progesterone, prolactin, total and free testosterone, estradiol, sex hormone-binding globulin. In plasma, dopamine level was identified. Adaptive potential (AP) was estimated according to R. M. Baevsky method.

Results. A significant disadaptation was revealed in residents of Asian North compared to European North as follows: the proportion of persons with poor adaptation increases from 16% in European North to 26% in Asian North in fertile women, while the proportion of persons with adaptation failure increases from 9 to 23% in postmenopausal women. The strongest relationships between hormonal parameters and AP level were found in postmenopausal women: in European North, adaptation impairment is associated with higher levels of testosterone at lower concentrations of follicle-stimulating hormone, LH and sex hormone-binding globulin; in Asian North, adaptation failure is associated with lower values of LH, prolactin, testosterone, and dopamine.

Conclusion. A greater AP impairment, which characterizes cardiovascular system adaptation, was noted among Asian North residents. We revealed significant relationships between cardiovascular function and hormonal parameters. In European North residents, poor adaptation is associated with a more androgenic sex hormone profile, while in Asian North — with lower values of LH, prolactin, testosterone and dopamine.

The article discusses a new approach to assessing cardiovascular risk in clinical practice, presented in the European guidelines 2021. Two novel risk charts (SCORE2 and SCORE2-OP) have been proposed that have undergone significant revision and require significant changes in primary care practice. It has been suggested that in modern conditions their practical introduction is premature, since the healthcare system is not ready for renewal. Therefore, time is needed to adapt it to the practical healthcare conditions and to revise the medical screening protocols, which will require financial costs. The implementation of these recommendations should be taken responsibly so as not to harm the existing system of preventive care.

Currently, obesity has become one of the most serious public health problems. It takes millions of lives worldwide every year due to its association with numerous diseases and leads to significant social and economic losses. It is generally accepted that obesity is the result of the interaction of genes and environment, and the predisposition to it lies in our evolutionary past. This review discusses the role of adipose tissue in human evolution, the factors specifying a person’s predisposition to obesity, the main hypotheses for obesity origin, and potential prevention and treatment strategies arising from them. The evolutionary significance of visceral adipose tissue and some ethnic and sex characteristics associated with its distribution are also considered.

Rationalization of dietary behavior in patients after myocardial infarction is the subject of numerous discussions. Despite the proven preventive effect of a healthy diet and the benefits of certain foods in cardiovascular diseases, this type of intervention is still underused. The aim of this review was to analyze current approaches to modifying the nutrition of patients within the secondary prevention of myocardial infarction. For this, 903 publications from PubMed/MEDLINE database over the past 5 years were studied. The Mediterranean diet demonstrated the highest efficacy and safety in preventing athero-thrombotic events among existing dietary patterns. However, its wide reproducibility in different regions is associated with a number of limitations. Government programs to modify and support a healthy diet beyond the conventional low-cholesterol diet may be promising in secondary prevention, especially if patients are properly monitored and motivated.

The review analyzes modern criteria for early diagnosis of renal damage in hypertensive patients. Based on numerous studies, the role of impaired renal function markers and renal artery Doppler ultrasound in the diagnosis of hypertensive nephropathy is indicated. A search was made for the relationship between laboratory criteria for kidney damage and renal Doppler ultrasound characteristics in hypertensive patients. In addition, the importance of revealing intrarenal hemodynamic disorders in the early diagnosis of hypertensive nephropathy was established.

Effective secondary prevention of ischemic stroke in patients with atrial fibrillation (AF) implies long-term oral anticoagulant therapy. It has been proven that the use of direct oral anticoagulants (DOACs) is more effective, safer and more convenient for a patient than vitamin K antagonists. However, the selection of most effective and safe DOAC represented without direct comparisons in randomized controlled trials (RCTs) cannot be reliable due to the inevitable differences in the cohorts of studied patients and differences in methodological approaches. It should be noted that the population of patients in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) in terms of basic characteristics was as close as possible to the Russian population of AF patients compared with study populations of other DOACs. Of great importance for ensuring the overall benefit from DOACs is the possibility of comprehensive protection of the elderly patient with AF. This approach, along with the risk of recurrent stroke and possible bleeding events, takes into account other risks that can significantly worsen the prognosis and health of a patient with AF, such as the risk of coronary events, impairment of renal function, and cognitive impairment that can lead to low adherence to treatment. Rivaroxaban therapy makes it possible to simultaneously reduce the listed risks, providing comprehensive protection for an elderly patient with AF.

Intravascular imaging of vulnerable plaques in vivo has great potential for predicting coronary events. Currently, there are several methods of intravascular imaging, which make it possible to verify the components of the plaque and, accordingly, its vulnerability. The most common are virtual-histology intravascular ultrasound and optical coherence tomography. Several studies have shown that these imaging techniques can stratify the risk of adverse cardiovascular events, as well as assess the effectiveness of drug therapy. This article will describe the advantages and disadvantages of intravascular ultrasound and optical coherence tomography in identifying vulnerable coronary lesions.

The reform of higher education is directly related to the solution of problems arising in the medical education system. The article describes the activities of the Section for the development of educational activities of therapeutic departments within the framework of the Russian Society for the Prevention of Noncommunicable Diseases, created to unite qualified teachers of medical education in solving problems of improving the efficiency of the process of training medical personnel in the specialty “Therapy”. The article discusses the organization of the project of the Russian Society for the Prevention of Noncommunicable Diseases on additional issues of the scientific and practical journal “Cardiovascular Therapy and Prevention. Professional education”, as well as the activities of the Section.