Aim. To perform a comparative assessment of the clinical and demographic characteristics of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and health care quality during the coronavirus disease 2019 (COVID-19) pandemic.

Material and methods. Data obtained from medical records were used. Statistical processing was performed using the Statistica 10.0 software package. The analysis included patients with NSTE-ACS treated in 2020 (n=524) and 2019 (n=395). The group for further analysis consisted of patients with non-ST elevation myocardial infarction treated in 2020 (n=233) compared to 2019 (n=221).

Results. An increase in the relative number of patients with unstable angina in the NSTE-ACS group was revealed. COVID-19 was verified in 5,5% of patients with NSTE-ACS. Of these, pneumonia was diagnosed in 10 (34,5%) patients, while 11 (37,9%) patients were transferred to pulmonary hospitals. The remaining 18 (62,1%) patients were discharged for outpatient treatment. Infected patients had a higher risk of in-hospital mortality according to the Global Registry of Acute Coronary Events (GRACE) score relative to general cohort of patients — 2,0 (1,0; 9,0) vs 1,0 (0,8; 3,0) (p=0,04). In addition, 215 (92,3%) patients underwent invasive coronary angiography, which is higher than in 2019 (78,7%) (p<0,001). An increase in revascularization prevalence in patients ≥75 years old was found (p=0,01).

Conclusion. COVID-19 pandemic has led to a change in the clinical characteristics of patients, while not having a significant impact on the scope of endovascular interventions and health care quality for patients with NSTE-ACS in the emergency cardiology department.

Aim. To assess the prevalence and structure of upper gastrointestinal (GI) lesions, as well as the factors associated with their development, in patients with lower extremity peripheral artery disease (PAD).

Material and methods. This retrospective analysis of medical records with lower extremity PAD includes data from 258 patients. All patients underwent multislice computed tomography angiography of abdominal aortic visceral branches and lower limb arteries, as well as esophagogastroduodenoscopy.

Results. Endoscopic evidence of upper GI lesions was detected in 164 (63,6%) patients. In particular, gastroduodenal erosions and ulcers were observed in 57,8% of patients. All patients were divided into two groups: group I — 149 (57,8%) patients with gastroduodenal erosions and ulcers, group II  — 109 (42,2%) patients without it. In group I patients, a higher incidence of mesenteric artery disease was recorded  — 61,7 vs 43,1% (p=0,003). An independent factor associated with the development of gastroduodenal erosions and ulcers in patients with PAD is mesenteric artery disease (relative risk: 4,43; 95% confidence interval: 1,15-17,12 (p=0,031)).

Conclusion. In patients with lower extremity PAD, upper GI diseases (63,6%) occur with a high frequency, while gastroduodenal erosions and ulcers was observed in 90,9% of them. The factors associated with the development of erosions and ulcers in patients with lower extremity PAD include mesenteric artery atherosclerosis.

Aim. To study the parameters of transit time flow measurement (TTFM) for coronary bypass grafts in patients with diffuse lesions with different diameter of target coronary arteries.

Material and methods. The study included 150 patients with diffuse coronary artery disease. All patients underwent microscope-assisted coronary artery bypass grafting (CABG), during which the TTFM parameters were evaluated. Depending on the diameter of target coronary arteries, patients were divided into 3 groups: group 1 included grafts to arteries ≤1 mm (n=101), group 2 — 1-1,5 mm (n=138), group 3 — ≥1,5 mm (n=308). Comparative analysis of TTFM parameters was performed.

Results. Mostly participants were male (76%); mean age was 62,9±7,6 years. During hospitalization, we recorded 1 death, 2 perioperative myocardial infarctions (1,3%) and 1 cerebrovascular accident (0,7%). TTFM analysis showed the worst hemodynamic parameters and a higher rate of suboptimal function in group 1; blood flow parameters were comparable in groups 2 and 3. The additional analysis in group 1 and combined groups 2 and 3 allows us to make an opinion about the negative impact of coronary artery diameter less than 1 mm on optimal blood flow through the grafts (odds ratio=2,1, 95% confidence interval, 1,2-3,8, p=0,011).

Conclusion. Diffuse coronary atherosclerosis with a diameter of target coronary arteries less than 1 mm significantly increase the risk of suboptimal graft function that requires considering more aggressive secondary prevention. TTFM demonstrate high effectiveness of microscope-assisted CABG in target coronary artery diameter of 1-1,5 mm and higher.

Aim. To study myocardial remodeling in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) against the background of cardiac contractility modulation (CCM) therapy.

Material and methods. In a group of 100 patients with HFrEF and AF, transthoracic echocardiography was performed before CCM device implantation and after 2, 6 and 12 months. All patients received longterm optimal medical therapy for HF before surgery.

Results. Against the background of CCM therapy, there was a  significant increase in left ventricular (LV) ejection fraction, a decrease in LV volume and linear dimensions, a decrease in left atrial volume in patients with coronary and non-coronary HFrEF, with an initial LVEF < and >35%, and also regardless of AF type.

Conclusion. CCM therapy in patients with HFrEF and AF led to favorable myocardial remodeling changes. Further study of CCM effect on  echocardiographic parameters in randomized clinical trials is needed.

Aim. To study the role of duplex ultrasound (DU) of carotid and lower extremity arteries in the restratification of cardiovascular risk (CVR) and changing the indications for lipid-lowering therapy.

Material and methods. The study included 291 patients aged 40-64 years without established atherosclerotic cardiovascular diseases. All patients underwent DU of carotid and.

Results. Carotid DU make it possible to restratify 140 (65,7%) patients with low/moderate CVR (out of 213) into the category of high/very high CVR. Lower extremity artery DU resulted in the restratification of 101 (47,4%) patients with low/moderate CVR (out of 213) into the category of high/very high CVR. The use of a multifocal ultrasound technique demonstrated the highest restratification power and allowed 161 (75,6%) patients (out of 213) to be assigned to the high/very high CVR group. The use of peripheral arterial DU led to an increase in the number of high-risk patients by 2,33-3,02 times. The proportion of persons with indications for lipid-lowering therapy increased from 50 (21,0%) patients to 170 (71,4%).

Conclusion. In patients aged 40-64 years without established atherosclerotic cardiovascular diseases, the use of DU of carotid and lower extremity arteries made it possible to classify 75,6% of patients with low/moderate CVR in the group of patients with high and very high CVR. According to CVR reclassification, the proportion of patients with indications for lipid-lowering therapy increased from 21,0 to 71,4% of patients.

Aim. To evaluate the relationship between lipid-lowering and antiplatelet therapy and the incidence of cerebral microembolism and related complications in open and endovascular revascularization of the carotid arteries (CA).

Material and methods. This single-center study involved patients with internal CA stenosis. The patients were divided into 2 groups depending on the surgery type performed: carotid endarterectomy (CEA)  — 163 patients; CA stenting (CAS)  — 71 patients. All patients underwent intraoperative transcranial Doppler monitoring to register cerebral embolism during CAS and CE.

Results. In CAS, microembolism episodes were observed in 66,2% vs 22,1% of patients in the CEA group (p=0,04), the largest number of which was recorded during catheterization of the internal CA and embolic filter installation (p=0,000). There were no significant differences between the groups in terms of the stroke incidence. In 8 patients in the CAS group and 1 patient in the CEA group, a transient ischemic attack was observed within 30 days after surgery (p=4x10-4 ). Intraoperative embolism was a predictor of a neurological event in the early postoperative period (odds ratio (OR), 33,08; 95% confidence interval (CI): 3,49-56,37 (p6 months before surgery reduces the likelihood of embolism by 4 times (OR 0,25; 95% CI: 0,11-0,58 (p=0,001), while lipid-lowering and antiplatelet therapy combination — by 12,5 times (OR, 0,08; 95% CI: 0,01-0,40 (p=0,001)).

Conclusion. Preoperative antiplatelet and statin therapy reduces the likelihood of embolism during the CA revascularization procedure.

Aim. To evaluate the role of a cardiologist in telehealth counseling of cancer patients at the federal oncology center.

Material and methods. This retrospective study was conducted based on the materials of 215 telehealth consultations on cardiooncology, performed in the period from January 2019 to September 2021. Data on referrals to a cardiologist (cardio-oncologist) from various Russian regions and consultants’ answers were analyzed, taking into account the following data: region, sex, age of a patient, cancer type, stage, participation of other consultants, type of cardiovascular disease, the need for additional information and features of treatment  — surgery, chemotherapy, radiation therapy. Risk was stratified based on a checklist including the main risk factors for cardiotoxicity. The recommendations of consultants for monitoring patients, as well as drug therapy prescriptions, were analyzed.

Results. The most common cancer sites in patients referred for telehealth consultations on cardio-oncology were lungs, larynx and trachea, colon and rectum, kidneys and bladder, ovaries and uterus, and stomach. Cardiologists consulted together with oncologists  — surgeons, medical oncologists, as well as anesthesiologists and radiation oncologists. The most common cardiovascular diseases were hypertension  — 80,9% of patients, heart failure  — 60%, arrhythmias — 41,6% and coronary heart disease — 37,7%. From 71 to 80,3%, 15,6-21% and 3,9-7,8% of patients had preserved, mid-range and reduced left ventricular ejection fraction. In 47,6-66,7% of cases, consultants required additional information. Based on risk stratification of cardiotoxicity of anticancer treatment, 118 (81,9%) patients out of 144 were classified as high and very high risk. Most patients were recommended cardioprotective therapy, which most often included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers  — 43,1-53,1%, beta-blockers  — 44,8-58,6%, and statins  — 22,4-38,3%. An algorithm for creating a request for a cardio-oncology telehealth consultation has been developed.

Conclusion. The important role of cardio-oncology telehealth consultations in the work of the federal oncology center is demonstrated. Consulting cardiologists are part of a single multidisciplinary team of specialists and must act taking into account the characteristics of cancer and antitumor therapy prescribed by oncologists.

A wide variety of non-pulmonary manifestations of a coronavirus disease 2019 (COVID-19) has enriched clinical performance of cardiac diseases with atypical symptoms. Two COVID-19 cases are presented, where sinus bradycardia and syncope, which are rare in COVID-19, were the leading ones after the infection. The patients had no prior cardiovascular diseases, while the examination did not detected neurological pathology and myocarditis. Echocardiography showed relatively small pericardial effusion, which is supposed to be a cause of the symptoms as the diagnosis to exclude. A local buildup of inflammatory fluid around the sinus node and extensive ganglion plexuses around the atria can possibly affect the automatism and chronotropic compensation in addition to the myocardial inflammation. As part of the treatment against the hydropericardium syndrome, the symptoms disappeared, without reoccurring within subsequent 6-month follow-up. The third clinical case regards the pandemic outbreak, when we could not even suspect that the systemic inflammation would persist for many months after COVID-19 and radiofrequency ablation can lead to sudden cardiac death.

A case report of ventricular tachycardia (VT) treatment in a patient after myocardial infarction using non-invasive real-time electrophysiological mapping is presented. This clinical observation demonstrates the diagnostic possibilities of non-invasive mapping in the treatment of VT with hemodynamic instability. Non-invasive mapping can be used as a method for visualizing the early activation and slow conduction zones in hemodynamically instable VT, when effective endocardial mapping is not possible.

We described a case report of transcatheter aortic valve replacement in conditions when the aortic stenosis anatomy does not make it possible to perform retrograde left ventricular catheterization, and the patient’s condition severity does not allow performing transapical or surgical aortic valve replacement. The presented technique of interatrial septal puncture with antegrade passage of the guidewire through the mitral and aortic valves and the venoarterial looping demonstrates an elegant way to solve this clinical situation, and can be adopted by specialists performing transcatheter interventions in severe aortic stenosis.

This case report describes a patient with a rare cerebrovascular pathology — Moyamoya disease. The disease was manifested by acute hemorrhagic stroke.

The spread and consequences of the coronavirus disease 2019 (COVID-19) pandemic are currently one of the most pressing public health challenges in the world. Despite the fact that experience accumulates in the treatment and monitoring of COVID-19 patients, certain aspects are still a clinical dilemma. In particular, this regarded the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during the pandemic, both as a symptomatic treatment of infection, and in patients with comorbidities requiring NSAID. A series of studies did not establish evidence of the risk of infection and complications from NSAID therapy in COVID-19. At the same time, the practitioner should take into account the risk of specific NSAID-associated complications, which also remain relevant during the COVID-19 pandemic. This resolution focuses on the evolution of ideas about NSAID use and safety in COVID-19, and also emphasizes the particular relevance of their use for a number of clinical situations.

In practice, a doctor constantly deals with difficult ethical situations, which requires optimal decisions. From weighing risks and benefits of an intervention to the need to change patient values in order to achieve prevention goals and increase compliance, questions of good and bad in a given situation are inevitable. At the same time, the deontological imperative, that is, ethical codes and moral authorities, indicate what is right, but do not provide information on how to achieve the right. In each situation, decisions are made by the individual, and it is the individual’s competence to make optimal decisions that requires development. Ethical training of doctors, both in the university period and in continuous education, will allow achieving the best results in working with patients, while not wasting mental resources and not leading to professional burnout.

In September 2021, the Russian Society for the Prevention of Noncommunicable Diseases published a practical guideline “Promoting the research results using infographic tools and graphical summaries”, which describes data visualization in research articles. The use of infographics in scientific articles becomes more and more popular. Therefore, researchers began to ask more often: how to create a graphical summary or a short presentation with the research results? The article outlines the basic principles of graphical data representation that will help authors in preparing publications.