Aim. To analyze the demographic, socio-economic and behavioral factors associated with awareness and passage of medical screening among the hypertension adults from Arkhangelsk and Novosibirsk.

Material and methods. The database was formed as part of the Know Your Heart study (2015-2018, Arkhangelsk, Novosibirsk, n=4504). For the present study, 2216 people with hypertension were selected. Binary logistic regression was used to determine the factors associated with awareness of ongoing medical screening and active participation in them.

Results. The analysis determined that 82,5% of the hypertensive residents of Arkhangelsk and Novosibirsk aged 35-69 years old are aware of the medical screening, and 51,4% have passed (are going to pass) it. General factors associated both with greater awareness of ongoing preventive measures and with greater participation in them are female sex and contacts with doctors during the year. From the point of view of awareness, such a factor as the average income level turned out to be significant, while the absence of a permanent employment and the pension status were associated with the passage of medical screening.

Conclusion. The awareness of the hypertensive residents of Arkhangelsk and Novosibirsk about the medical screening was 82,5%. The coverage level is still low. The identified factors associated with greater awareness of the medical screening and more active participation showed that medical specialists should be more attentive to the men working in urban areas with a low income level. More active work is also needed to involve in preventive contacts those persons who are not in constant contact with the healthcare system. This requires the consolidated work of various institutions and departments, including the media.

Recently, the use of telemedicine technologies (TMT) in the healthcare has gained great importance. TMT is one of the ways to increase the healthcare availability, including in patients with high blood pressure (BP). Office BP measurement and 24-hour BP monitoring are not accurate enough to study natural or induced BP changes over long periods of time. For the selection of antihypertensive drugs and the diagnosis of hypertension (HTN) in patients with an emotionally unstable personality type, as well as in the differential diagnosis of normotension, preHTN, BP selfmonitoring comes first. The use of BP self-monitoring for the diagnosis, selection of therapy, assessment of adherence and effectiveness of treatment of HTN is more effective with remote, socalled telemetric, dynamic BP monitoring. The article presents world experience in the effective use of dynamic remote BP monitoring using TMT.

Aim. To study the predictive ability of the NEWS2, 4C Mortality Score, COVID-GRAM and qSOFA scales in predicting clinical outcomes in patients with severe coronavirus disease 2019 (COVID-19) hospitalized in a multidisciplinary hospital.

Material and methods. The pilot retrospective cohort study used data from 90 patients (52 — intensive care unit subgroup, 38 — general unit subgroup) with a confirmed diagnosis of COVID-19 hospitalized in the O.M. Filatov City Clinical Hospital № 15 (Moscow) from January to March 2021.

Results. The probability of a positive outcome of the disease significantly negatively correlates with the patient’s age (R=-0,514; p=0,0002). The best correlation with the COVID-19 outcome had a 4C Mortality Score (R=0,836; p=0,0001). Logistic regression revealed a significant dependence of the “outcome” and “age” parameters with the greatest accuracy in the form of age subgroups according to the World Health Organization classification with odds ratio (OR) of 4,29 (p=0,0001). As a result of ROC analysis, the best predictive ability of disease outcomes was shown for the 4C Mortality Score (area under curve (AUC)=0,878; 95% confidence interval (CI): 0,782- 0,975 (p=0,00001)) and COVID-GRAM (AUC=0,807; 95% CI: 0,720- 0,895 (p=0,00001)); taking into account the division of patients into age subgroups, optimal predictive tools were obtained: in subgroups 18-44 years old and 45-59 years old  — the 4С Mortality Score (AUC=0,892, 95% CI: 0,762-0,980 (p=0,002) and AUC=0,853, 95% CI: 0,784-0,961 (p=0,0014), respectively); in the subgroup 60-74 years old — the COVID-GRAM (AUC=0,833, 95% CI: 0,682-0,990 (p=0,038)); in subgroups 75-90 years and >90 years  — NEWS2 (AUC=0,958, 95% CI: 0,807-1,0 (p=0,002) and AUC=0,818, 95% CI: 0,713-0,996 (p=0,006), respectively). ROC analysis showed that the age of 70 years is the threshold value, above which the probability of an unfavorable COVID-19 outcome increases significantly (OR=11,63; 95% CI: 9,72- 12,06 (p=0,0052)).

Conclusion. The pilot study showed the significance of predicting the hospitalization outcome of patients with severe COVID-19. The 4C Mortality Score and COVID-GRAM scales had the best predictive accuracy. The specificity and sensitivity of the scores depended on the age of a patient. The age of 70 years was the threshold value at which the risk of an adverse outcome increased significantly. Based on the data obtained, it is planned to study the problem of predicting the disease course, taking into account the severity of COVID-19.

Aim. To assess the relationship between fibrosis markers and structural and functional parameters in patients with various types of hypertrophic cardiomyopathy (HCM).

Material and methods. This prospective comparative non-randomized study included 49 patients with HCM. Patients were divided into 3 groups according to the disease course: group 1  — stable course (n=12; men, 8 (67%), mean age ‒ 41±12 years); group 2 — progressive course (n=26; men, men, 16 (61%). mean age — 57±11 years); group 3 — patients with atrial fibrillation (AF) (n=11; men, 4 (36%), mean age — 63±6 years). Patients underwent standard clinical and paraclinical investigations. The levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were determined in all patients using enzyme-linked immunosorbent assay in blood serum.

Results. In all patients with HCM, elevated levels of MMP-9 and TIMP-1 are noted compared to the reference values. In group 1, the MMP-9 level [Me (Q1; Q3)] was 226 (201;271) ng/ml; TIMP-1 — 410 (267;488) ng/ml; in group 2, the MMP-9 level was 236 (187;285) ng/ml; TIMP-1 — 421 (321;499) ng/ml. In the course with AF, the MMP-9 level was 260 (228;296) ng/ml, while TIMP-1 — 381,5 (305;466) ng/ml; no significant difference was revealed (p=0,59; p=0,90, respectively). A correlation was found between age and MMP-9 levels, as well as between MMP-9 levels and left atrial volume (p=0,034; p=0,035, respectively).

Conclusion. The high activity of matrix metalloproteinases and their tissue inhibitors reflects enhanced fibrosis and myocardial remodeling in HCM, which is especially characteristic of patients with AF.

Aim. To assess the relationship between the levels of angiogenesis markers and various heart failure (HF) phenotypes in patients with class II-IV HF of ischemic origin.

Material and methods. This cross-sectional cohort study was based on the clinical departments of the National Medical Research Center for Therapy and Preventive Medicine. The study involved 180 patients aged 30-85 years with class II-IV HF of ischemic origin as follows with (n=90) and without (n=90) metabolic syndrome (MS). All patients included in the study signed an informed consent to personal data processing, participation in a clinical trial and consent to blood biobanking. All patients were divided into three groups: HF with reduced ejection fraction (HFrEF)  — left ventricular (LV) EF <40%, HF with mildly reduced EF (HFmrEF) — LVEF from 40 to 49%, HF with preserved EF (HFpEF)  — LVEF >49%. In addition to the standard paraclinical investigations, angiogenesis markers were analyzed with the determination of transforming growth factor β (TGF-β), vascular endothelial growth factor A (VEGF-A), pentraxin-3 (PTX-3). Statistical analysis was performed using Microsoft Office Excel, STATISTICA 10.0 software packages (Statsoft, USA).

Results. Transthoracic echocardiography determined that 74 (41,1%) patients had LVEF <50%, while 71 (39,4%)  — <40%. For the group of patients with HFpEF, there was an association with an increase in TGF-β ≥7,2 ng/ml (p=0,011). The threshold level of PTX-3 ≥55 ng/ml is associated with the development of HFpEF (p=0,001). For the HFmrEF phenotype, the threshold values of VEGF-A, TGF-β and PTX-3 were determined, which did not reach the significance level. However, an upward trend in VEGF-A >200 ng/ml was noted (p=0,052). In HFrEF patients, a threshold value of VEGF-A >195 ng/ml (p=0,001) associated with reduced LVEF was determined.

Conclusion. Thus, the present work showed the relevance of using PTX-3, VEGF-A and TGF-β as additional markers for assessing the HF course. So, patients with HFpEF had increased levels of PTX-3 and TGF-β, while patients with HFmrEF and HFrEF  — increased VEGF-A values. Determination of the level of these angiogenesis markers should be used to improve the efficiency of diagnosis and treatment of patients with various class II-IV HF phenotypes.

Aim. To carry out a comparative assessment of cardiovascular risk (CVR) in people aged 40-49 years of European and Korean ethnicity with a single residence area using the Systematic Coronary Risk Evaluation (SCORE) and SCORE2 scales.

Material and methods. We examined 397 and 50 apparently healthy individuals of the European (EEG) and Korean (KEG) ethnic groups, respectively, who were evaluated for CVR according to the SCORE and SCORE2 charts.

Results. According to the SCORE system, the median CVR in the EEG was 0 [0-0] vs 0 [0-1]% in the KEG (p<0,001), while from a clinical point of view, the groups did not differ from each other. The SCORE2 system demonstrated more significant clinical results as follows: the median risk in EEG individuals was 5 [3-8]%, which corresponds to a high CVR for this age group, and 8 [4-11]% in KEG individuals, which corresponds to a very high CVR (p=0,011). CVR assessment in apparently healthy individuals is decisive in considering the preventive measures. According to the SCORE system, 97,5% and 96% of apparently healthy EEG and KEG individuals, respectively, are classified as low and moderate risk. High and very high risk when using this system was determined in 2,5 and 4% among Europeans and Koreans, respectively. However, using the SCORE2 system, only 10,3% of Europeans were classified as low/ moderate risk, and among ethnic Koreans — 8%. At the same time, the category of high and very high risk was designated, respectively, for 63,7 and 25,9% in the EEG and 40 and 52% in the KEG, respectively. It has been established that according to the SCORE2 system, more than half of Koreans aged 40-49 already have a very high CVR, which significantly distinguishes this group from the European population.

Conclusion. The SCORE2 system has a more differentiated approach in determining individual CVR. The SCORE2 assessment of non-high density lipoprotein cholesterol levels makes it more personalized for use in different ethnic populations.

Aim. To study the relationship of lipid metabolism disorders (overweight, general and abdominal obesity (AO)) with the development of fatal and non-fatal cardiovascular events (CVEs) among residents of the Chui region of the Kyrgyz Republic of varying sex and ethnicity.

Material and methods. This study was performed as part of the international prospective epidemiological project “Interepid”. The total follow-up period was 7 years. Vital status at the end of the follow-up period was monitored in 1096 respondents from 1341 initial cohorts. Response rate was 82,1%. As an endpoint, the analysis included cases of fatal and non-fatal CVEs. The prevalence of events was assessed by survival analysis methods (Cox proportional hazard regression model, parametric survival models, Kaplan-Meier estimator).

Results. In total, 181 (16,44%) cases of fatal and non-fatal CVEs were recorded during the follow-up period. In individuals with normal body weight, the incidence of CVEs was 10%. In overweight persons, it increased and reached 17,99% (p<0,001), while in those with obesity — 24,5% (p<0.0001). An increase in CVE rate with an increase in body mass index was recorded in all analyzed subgroups (men, women, Russians, Kyrgyz). Cox regression model with a logistic regression analysis made it possible to confirm the independent role of general and AO in the development of fatal and non-fatal cardiac and cerebral accidents in both ethnic groups in women, but not in men.

Conclusion. An increase in body mass index >25 kg/m2 and the presence of AO are independent risk factors for fatal and non-fatal CVEs in the analyzed cohort of residents of the Chui region in women (but not men) of both ethnic groups.

The changing structure of food consumption requires updating the nutrition assessment tool, taking into account modern dietary patterns.

Aim. To develop, evaluate the validity and reproducibility of semiquantitative food frequency questionnaire (FFQ) for the adult population.

Material and methods. The FFQ questionnaire was developed as part of the Russian part of the international Prospective Urban and Rural Epidemiological (PURE) study. To compare the quantitative parameters of the energy and nutritional value of diet, the validation used data on the actual nutrition of 294 men and women aged 25-65 years, collected by 2 methods: 24-hour dietary recall (24hDR) — 4 surveys per year (1 time per season) and the developed FFQ — 2 surveys: initially (FFQ1) and after 12 months (FFQ2).

Results. The minimum mean values for the vast majority of nutrients were recorded by the 24hDR method, while higher values — by FFQ2, and maximum values  — by FFQ1. Pearson’s correlation coefficients ranged from 0,19 (retinol equivalent) to 0,53 (cholesterol), showing a moderate relationship between the two methods. After crossclassification, the proportion of subjects assigned to the same quartile of 24hDR and FFQ2 nutrient profile ranged from 26,9% (β-carotene) to 43,5% (cholesterol), and those assigned to opposite quartiles ranged from 3,1% (cholesterol) to 11,2% (retinol equivalent), indicating good agreement between these methods. The Bland-Altman plots showed slightly overestimated FFQ2 scores for total carbohydrate, protein, and dietary calories. The Pearson correlation between FFQ1 and FFQ2 values ranged from 0,46 to 0,82. The intraclass correlation showed the questionnaire reproducibility coefficients lower than the Pearson correlation. However, most of them remained at a value of >0,60.

Conclusion. The results showed predominantly moderate validity and good reproducibility of the modern FFQ version, which allows it to be used to assess nutrition in the adult population with estimation of the energy and nutritional value of diet in the protocols of Russian epidemiological, preventive and clinical studies.

Aim. To study the tolerability, safety, pharmacokinetics (PK) and pharmacodynamics of single intravenous infusions of Angipur in healthy male volunteers.

Material and methods. The Phase I trial included 20 healthy male volunteers (mean age, 30,8±7,7 years; mean body weight, 77,4±12,1 kg). Angipur (0,02% concentrate for solution for infusion) was administered to every subject in single doses 0,015, 0,05, 0,09 mg/kg for 3 consecutive days. Volunteers were divided in 6 groups (1, 1, 3, 5, 5, 5); every following group was recruited only after the previous one finished the study. The following were assessed: rate and severity of adverse events (AEs), key PK parameters of Angipur and its antiplatelet activity by impedance aggregometry.

Results. No moderate or severe AEs, as well as no serious AEs were reported according to obtained data of clinical and laboratory monitoring of healthy subjects. Totally 6 mild AEs were registered in 4 subjects. Four AEs (mild hematological deviations and episode of nose bleed) were classified as possibly related to study drug and 1 AE (positive fecal occult blood test)  — probably related. Key PK parameters of Angipur in single intravenous doses 0,015, 0,05 и  0,09 mg/kg were determined as follows: C_max — 12,44±4,689, 46,10±14,295, 92,48±33,896 ng/ml; Vd  — 304,01±55,300, 299,67±64,244, 252,96±47,790 l; T1_/2  — 6,72±1,290, 6,84±2,341, 6,06±2,287 h; Cl  — 32,19±6,919, 32,29±8,357, 31,55±10,113 l/h, respectively. Dose proportionality (linear PK) for parameters Cmax, AUC_0-t and AUC_0-∞ was established. Dose-dependent reduction of ADP-induced platelet aggregation degree and area under curve was revealed at period of 15 min to 2-4 h after Angipur infusion in doses 0,05 and 0,09 mg/kg.

Conclusion. Results of phase I clinical trial demonstrated good tolerability of single intravenous infusions of Angipur (0,015, 0,05 и 0,09 mg/kg) in healthy subjects. We determined key PK parameters and indicated dose-dependent antiplatelet activity of Angipur.

Patients at high cardiovascular risk, older people with cardiovascular comorbidities, as well as those with hypertension and familial hypercholesterolemia are more susceptible to severe coronavirus disease 2019 (COVID-19). Such patients are likely to be at increased long-term atherothrombotic risk after COVID-19. The renin-angiotensinaldosterone system (RAAS) not only plays a key role in the development and progression of cardiovascular diseases, but is also responsible for the penetration of the Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) into the cells of target organs and the development of infection. Given that RAAS inhibitors and statins increase the expression of angiotensin-converting enzyme type 2 receptors, concerns were initially raised about their possible adverse effect on COVID-19 course. However, at present, we have data from large-scale, including randomized clinical trials and meta-analyses, confirming the organ protective effects of RAAS inhibitors and statins by reducing the inflammation severity and fibrosis in tissues. The review attempted to assess the potential role of these drugs in the management of SARS-CoV-2-infected patients and their impact on the development of complications.

Introduction. In recent years, there has been a trend towards an increase in the use of mechanical ventilation (MV) in patients with acute myocardial infarction and cardiogenic shock. Probably, currently there is an underdiagnosis of acute respiratory distress syndrome (ARDS) against the background of cardiogenic pulmonary edema, which does not allow timely use of effective treatment strategies. We propose to use the pulmonary shunt fraction (Qs/Qt) as an additional diagnostic method.

Case. A 70-year-old male patient entered the сardiovascular intensive care unit with acute ST-segment elevation myocardial infarction complicated by cardiogenic shock. Emergency percutaneous coronary intervention 50 minutes after hospitalization allowed revascularization of the infarct-related coronary artery and 1:1 intra-aortic balloon counterpulsation was initiated. Against the background of non-invasive ventilation, paraclinical signs of severe respiratory failure persisted  — S/F (SpO₂/FiO₂): 108, PaO₂/FiO₂ (Horowitz index): 78-103, Qs/Qt: 27,3-48,3%). Therefore, MV was started. According to the obtained data (24 hours from the admission), severe ARDS was verified. Renal replacement therapy session was started for non-renal indications. On the 4th day of hospitalization, therapy improved the patient’s condition. A  63-hour session of renal replacement therapy was completed. Against the background of gradual weaning from mechanical ventilation, the patient was extubated.

Conclusion. In the above case, the use of shunt fraction (Qs/Qt) contributed to the earliest possible verification of ARDS before the onset of full-scale clinical picture, an increase in biochemical markers and X-ray abnormalities, which made it possible to start targeted therapy in a timely manner.

Atrial fibrillation (AF) after coronary bypass surgery is recorded in 20- 60% of patients and increase the early and long-term postoperative mortality. The aim of the review is to analyze the studies on causal relationships between damaging factors and the development of myocardial inflammation at each stage of surgical treatment in patients with multivessel coronary artery disease. In the review, myocardial inflammation is considered from the point of view of a continuum  — a chronic process that originates from the coronary endothelium damage and continuously proceeds within the AF pathogenesis after coronary bypass surgery. For the first time, the concept of inflammatory continuum for postoperative AF is introduced. The review discusses the main and latest laboratory and instrumental markers of local and systemic inflammatory response, which are informative in terms of severity and promising for improving approaches to the diagnosis and prevention of postoperative AF. The review was prepared using available materials from Russian and foreign library databases (PubMed, Medline, Web of Science and Cochrane Library). The search depth was >25 years since 1996. Based on the analysis of available studies, we concluded that inflammation is not just evidence of AF, but plays a causal role in its pathogenesis at each stage of surgical myocardial revascularization.