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The data indicate differences in the adverse outcomes of chronic heart failure (CHF) in both ischemic (ICMP) and non-ischemic origins. The knowledge of the structural and functional myocardial state, especially of the left ventricle (LV), is insufficient for accurate risk stratification of unfavorable events in different etiopathogenetic forms of CHF.

Aim. To make a comparative analysis of echocardiographic characteristics of CHF patients with reduced LV ejection fraction (EF) ≤35% depending on the origin of CHF.

Material and methods. 498 patients of CHF 3-4 functional class of NYHA (New-York Heart Association) with EF ≤35% taking optimal drug 

therapy were included in the study. Based on the etiology of CHF, two groups of patients with CHF of ischemic genesis (n=254) and dilated cardiomyopathy (DCMP, n=244) were formed. Two-dimensional echocardiography techniques in Band M-mode, color Doppler, and tissue Doppler imaging were carried out.

Results. Patients with ICMP and DCMP had the same pattern of LV remodeling (mainly on the type of eccentric hypertrophy), but they reliably differed in the basic parameters of LV architectonics: endsystolic and end-diastolic dimensions, LV volume, LV myocardial mass and values of these indicators, indexed by body surface area. DCMP patients had a higher value of medial-lateral dimension and volume of left atrial, pathological mitral and tricuspid regurgitation was registered more often.

Conclusion. It was found that left heart dimensions and volumes of DCMP patients exceed similar parameters in patients with ICMP. The possible association of the results with future adverse outcomes of CHF demands further research.

Aim. To study the relationship between the abundance of the genera in the gut microbiota (GM) and levels of serum biomarkers of chronic systemic inflammation and endotoxemia in patients with HFpEF.

Material and methods. The composition of GM among 42 patients with HFpEF (men, 57,1%) was assessed by 16S rRNA sequencing. The median age was 67,0 years, interquartile range [64,0; 71,5] years. Correlation and multivariate regression analysis (with adjustments for sex and age) of relationships between the relative abundance of intestinal bacteria and the concentrations of serum biomarkers including high-sensitivity C-reactive protein (hsCRP), interleukins (IL) 1β and 6, the soluble suppressor of tumorigenicity (sST2), and the level of lipopolysaccharide (LPS) was carried out.

Results. According to multivariate regression analysis, the relative abundance of Haemophilus was directly related to the concentration of IL-1β (odds ratio (ОR) 32,37, 95% confidence interval (CI) 2,071237,69, p=0,025), Coriobacteriaceae (unclassified) — with IL-6 (ОR 6,27, (1,42-36,74), p=0,024), Porphyromonadaceae (unclassified) — with sST2 (ОR 5,96, (1,33-34,39), p=0,028), and the relative abundance of the genera Pseudomonas (ОR 7,09, (1,45-42,39), p=0,020), Parasutterella (ОR 4,55, (1,07-22,76), p=0,047) and Clostridiaceae (unclassified) (ОR 4,85, (1,06-24,7), p=0,045) was directly associated with LPS levels.

Conclusion. In patients with HFpEF, the relative abundance of some GM genera (e.g., Haemophilus, Coriobacteriaceae (unclassified), Porphyromonadaceae (unclassified), Pseudomonas, Parasutterella, Clostridiaceae (unclassified)) is statistically significantly associated with the concentration of biomarkers of chronic systemic inflammation and endotoxemia.

Aim. To study the signs of instability of atherosclerotic plaques (ASP) in the carotid arteries in elderly patients with acute coronary syndrome (ACS) in the comparative aspect of duplex ultrasound scanning (DUS) and computed tomography angiography (CT).

Material and methods. 27 patients with ACS (75 years and over) were included in the study. The signs of instability of ASP were assessed according to DUS and CT.

Results. The signs of instability of ASP according to DUS were detected in 85,7%, according to CT — in 84,6%. The following signs were detected with DUS and CT: the presence of irregular plaque surface including signs of ulceration — 6,4 and 11,6% (p=0,021), positive remodeling — 3,8 and 3,8% (p=0,998), signs of local calcification — 23 and 25,9% (p=0,536), heterogenous structure — 55,1 and 46,8% (p=0,045), hypoechogenic component and low-density areas — 11,5 and 11,6% (p= 0,998). The correlation analysis showed high comparability of DUS and CT: irregular plaque surface with ulceration (K=0,624, p=0,02), positive remodeling (K=1, p<0,001), calcification (K=0,858, p<0,001), heterogenous structure (K=0,754, p<0,001), the presence of hypoechogenic component and low-density areas (K=1, p<0,001).

Conclusion. The study of elderly patients with ACS found high comparability of DUS and CT in the definition of the signs of instability of ASP in the carotid arteries. It is possible to use DUS as a routine method for assessing carotid atherosclerosis in patients of this group, which can reduce the risk of complications during CT, shorten the examination time, and minimize economic costs.

Aim. To compare the effectiveness of telmisartan and perindopril in the treatment of elderly patients with arterial hypertension (AH) and metabolic syndrome (MS) who have suffered ischemic stroke (IS).

Material and methods. 92 elderly patients with AH and MS who underwent IS (mean 68±4 years) were examined. Patients were randomly divided into pharmacotherapy groups: 47 patients took telmisartan (80 mg/day) and 45 — perindopril (10 mg/day). Fasting plasma glucose levels, insulin, leptin, total cholesterol, triglycerides, highand lowdensity lipoprotein cholesterol were determined, the HOMA-IR index was calculated, and daily monitoring was performed. Statistical processing was carried out using STATISTICA 10,0. The indicators are presented in the form of the median, interquartile ranges of Me (Q25%; Q75%), and mean ±SD. The comparison was carried out using the Wilcoxon rank criterion. The differences are significant at p<0,05.

Results. After 12 months of observation in the telmisartan group, there was a significant decrease in the average daily systolic blood pressure (ВРs) from 152 (146; 156) to 129 (125; 134) mm Hg (p<0,01) and diastolic blood pressure from 89 (83; 96) to 76 (72; 84) mm Hg (p<0,05); reduction of НOMА-IR from 4,1 (3,3; 5,0) to 3,2 (2,7; 3,6) units (p<0,01), leptin from 14,3 (10,2; 17,7) to 11,7 (10,8; 13,6) ng/ml (p<0,01), triglycerides from 2,25 (1,90; 2,53) up to 2,05 (1,84; 2,05) mmol/l (p<0,05). In the perindopril group, ВРs decreased from 149 (144; 154) to 137 (131; 142) mm Hg (p<0,05), НOMА-IR (p=0,059), leptin from 14,4 (10,3; 18,0) to 13,0 (12,3; 13,8) ng/ml (p<0,05), triglycerides (p=0,056).

Conclusion. Elderly patients with hypertension on the background of MS and a history of IS had significantly decreased ВРs and ВРd (according to the results of daily monitoring) after 12 months of telmisartan pharmacotherapy, decreased insulin resistance and the level of leptin and triglycerides in the blood serum.

Aim. To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) using the liver obesity index — FLI (Fatty Liver Index), and to study its associations with socio-demographic indicators and behavioral risk factors for NAFLD.

Material and methods. The data from the multicenter ESSE-RF study (Epidemiology of cardiovascular diseases in the regions of the Russian Federation) — samples from the unorganized male and female population aged 25-64 years were used. 5,161 respondents were included, of which 2,275 (44,1%) were men. To assess the prevalence of NAFLD, the liver obesity index FLI was used, calculated according to the formula by Bedogni G, et al. (2006). A high FLI index ≥60 was considered a predictor of liver steatosis.

Results. High FLI ≥60 was detected in 38,5% of men and 26,6% of women. Multivariate analysis of associations of high FLI index in men and women showed a strong relationship with age: men — odds ratio (OR) 5,01, 95% confidence interval (CI): 3,82-6,59 (p<0,0001) and women — OR 8,58, 95% CI: 6,39-11,64 (p<0,0001), living in rural areas: men — OR 1,32, 95% CI: 1,06-1,63 (p=0,011) and women — OR 1,4, 95% CI: 1,15-1,71 (p=0,001). The FLI index ≥60 was significantly associated with low physical activity (p=0,001) in men and current smoking in women (p=0,013).

Conclusion. A high FLI index ≥60 is most common among men, significantly associated with age, living in rural areas, currently smoking women, and low physical activity men. Higher education, in relation to FLI ≥60, had a protective effect on women.

Corporate health programs are a common measure for the primary and secondary prevention of chronic non-communicable diseases.

Aim. To study the first implementation results of a Targeted comprehensive program to reduce morbidity and prevent mortality from circulatory system diseases and early cancer detection in employees of JSC "Russian Railways" for the period from 2019 to 2023.

Material and methods. The study used a survey of employees of locomotive crews (RLC), which was conducted twice: in the summer of 2018 and February-March 2021. The survey was conducted using a specially designed questionnaire that takes into account the health status of drivers and their assistants, production, and non-production risk factors. In 2018, 10476 questionnaires were collected (>7% of employees), and in 2021 — 14403 questionnaires (>10% of employees). The age structure of railways has not changed, which made it possible to analyze the frequency of occurrence of risk factors in dynamics.

Results. In general, the mention of the RLC of the interfering effect of the noise factor, uncomfortable temperature, and undesirable odors in the driver’s cabin decreased for JSC "Russian Railways". The number of smokers on the South-Eastern Railway significantly increased during the study period. The number of people consuming insufficient amounts of vegetables and fruits has increased on the Far Eastern, West Siberian, Krasnoyarsk, and Volga railways. The frequency of workers’ meals at fast food restaurants has increased on the Southeastern Railway. The number of people with a good commitment to the basic principles of a healthy lifestyle has increased on the East Siberian, Trans-Baikal, West Siberian, Kuibyshev, Oktyabrskaya, Sverdlovsk, North Caucasian, and South Ural railways.

Conclusion. The conducted research has shown the effectiveness of the initial stage of the implementation of the corporate program to reduce morbidity and prevent mortality from diseases of the circulatory system in RLC. The heterogeneity of the results for different railways was revealed. 

Aim. To assess the adherence to prescribed treatment and the stability of the effect achieved after 3 months to improve the quality of therapy in patients with stable coronary heart disease after 12 months of follow-up. Material and methods. 73 patients with confirmed stable coronary heart disease were included in the study. The study included 3 patient visits: an initial treatment visit (V0) with an assessment of baseline blood pressure (BP), low-density lipoprotein cholesterol (LDL cholesterol), patient adherence to therapy and with therapy correction; a repeat visit (V1) after 3 months — an assessment of the quality of therapy received by the patient and achievement of the target BP and LDL cholesterol, a visit after 12 months (V2) with an assessment of the results achieved, the therapy received and adherence to treatment. 57 patients (47 men and 10 women) were examined at the V2 visit. 14 (19,2%) patients withdrew their consent to participate in the study after the initial treatment (visit V0), 1 patient died due to cancer, 1 patient died due to cardiovascular disease. The response was 80,8%.

Results. After the visit of repeated correction of therapy (V1) after 9 months of follow-up, a high frequency of drug therapy was observed, including 59% of patients taking medications of 4 main groups according to clinical recommendations. Among patients with arterial hypertension, there is a preservation of the result of achieving the target level of blood pressure (87% of patients), a statistically insignificant decrease in the frequency of achieving the target level of LDL cholesterol to 44,2% compared with the previous result of 53,7%. There was a tendency to improve the overall absolute adherence (increase by 10%, p=0,2) of patients to treatment.

Conclusions. The possibility of constant contact of the patient with the doctor of the specialized cardiological unit of the scientific center and timely correction of the therapy allowed to maintain the achieved results and increase the overall adherence of patients to treatment.

The paper provides a brief overview of the modern possibilities of using a smartphone as a diagnostic device of a wide profile. In some cases, additional specialized attachments are required. In others, the diagnostic algorithm uses only standard cameras, a microphone and various built-in smartphone sensors. The development of the smartphone integration into the healthcare system is modern, relevant and very promising, given the widespread use of smartphones among the global population.

An important place in the structure of cardiovascular morbidity is occupied by myocardial infarction (MI), especially complicated MI, including complicated by the formation of left ventricular (LV) aneurysm. The latter is a very formidable complication and leads to such life-threatening conditions as ventricular arrhythmias, heart failure, thromboembolism. The purpose of the review is to analyze the publications of foreign and Russian authors on risk factors, outcomes and treatment of patients with postinfarction LV aneurysm. Attention is paid to the role of registers in the study of this problem, as well as the analysis of literature data on the prevalence of such a complication as MI during the COVID-19 pandemic (COrona VIrus Disease 2019). It is shown that the registers of acute coronary syndrome, as a rule, do not contain separate data on patients with a formed LV aneurysm, risk factors for its development and outcomes in this group of patients. Postinfarction LV aneurysm can form only after transmural MI; therefore, it is important to keep records of patients diagnosed with transmural MI, primarily in the form of a register.

Shortness of breath is a common debilitating and limiting the quality of life symptom, which leads to frequent requests for medical help. The review summarizes data on the causes of shortness of breath in stable patients with suspected coronary heart disease (CHD), with an established diagnosis of CHD, as well as in patients with other cardiovascular diseases. PubMed, Science Direct, Google Scholar, and eLibrary search platforms were used for the selection of publications, the review includes publications from 2009 to 2021. Patients with suspected coronary artery disease complaining of shortness of breath, in addition to myocardial ischemia, not always associated with stenosing atherosclerosis of the coronary arteries. The following causes of shortness of breath are described: bronchial obstruction, psychogenic hyperventilation, and depression. When studying patients with other cardiovascular diseases, the causes of shortness of breath turned out to be even more diverse: transient myocardial ischemia (including in cases where the cause of shortness of breath initially appears to be non-ischemic), chronic heart failure, cardiac arrhythmias, pathology of the heart valves, thyroid dysfunction, lung diseases, obesity, anemia, etc. Thus, despite the limited evidence, it is obvious that in the presence of paroxysmal dyspnea in patients with stable coronary heart disease, its causes are more diverse than transient myocardial ischemia.

Arterial hypertension (AH) is a leading risk factor for the development of cardiovascular, cerebrovascular, and renal diseases, which are among the top 10 most common causes of death in the world. The etiology of hypertension has not been fully elucidated, but it has been established that endothelial dysfunction is the most significant pathogenetic link in the formation and progression of the disease. The data obtained in the last 10-15 years on endothelial glycocalyx (eGC) studies indicate that endothelial dysfunction is preceded 

by destabilization and shedding of eGC with the appearance of its soluble components in the blood, which is equivalent to a process that can be designated as eGC dysfunction. Signs of eGC dysfunction are expressed in the development of hypertension, diseases of the cardiovascular system, and their complications. The purpose of this review is to analyze and substantiate the pathophysiological role of eGC dysfunction in hypertension and cardiovascular diseases and to describe approaches for its assessment and pharmacological correction. Abstracts and full-size articles of 425 publications in Pubmed/MEDLINE databases over 20 years were studied. The review discusses the role of eGC in the regulation of vascular tone, endothelial barrier function, and anti-adhesive properties of eGC. Modifications of eGC under the influence of pro-inflammatory stimuli, changes in eGC with age, and with increased salt load are considered. The aspect associated with eGC dysfunction in atherosclerosis, hyperglycemia and hypertension is covered. Assessment of eGC dysfunction is difficult but can be performed by indirect methods, in particular by detecting eGC components in blood. A brief description of the main approaches to pharmacoprevention and pharmacocorrection of hypertension is given from the position of exposure effects on eGC, which currently has more a fundamental than practical orientation. This opens up great opportunities for clinical studies of eGC dysfunction for the prevention and treatment of hypertension and justifies a new direction in the clinical pharmacology of antihypertensive drugs.