Aim. To study the predictors of adverse events in hypertensive (HTN) patients, including those with chronic respiratory diseases (CRDs).

Material and methods. Regression analysis evaluated clinical and anamnestic data and blood pressure (BP) in outpatients with stage II-III HTN (n=156): 49 patients had asthma, 20 — chronic obstructive pulmonary disease; age — 63,4±8,8 years, women — 72,4%, followup duration 29,3±8,0 months. The outcomes included in the composite primary endpoint (EP) were registered in 32 patients (death, major cardiovascular events and complications), while the secondary EPs were registered in 57 patients (hospitalizations, emergency calls, temporary disability due to cardiovascular disease/CRD, hypertensive crisis, exacerbation of CRD, pneumonia, respiratory failure), and tertiary EP — in 76 (other significant diseases/conditions, including increased blood pressure without hypertensive crisis, requiring correction of regular therapy).

Results. Predictors of primary EPs were the decrease level of nocturnal diastolic BP (DBP) (β=-5,335, p=0,026), nocturnal DBP variability (β=1,796, p=0,007), blood leukocyte level (β=0,241, p=0,039); secondary EPs — systolic blood pressure ≥170 mm Hg in history (β=1,305-1,641, p=0,037-0,017), statin use (β=-0,997, p=0,037), CRD (β=0,734, p=0,023), blood platelet level (β=-0,008, p=0,022); tertiary EPs — only CRD (β=1,082, p<0,0001).

Conclusion. Patients with HTN need complex multifactorial prevention. It is necessary to improve the control of office and ambulatory blood pressure, blood lipids, especially in the presence of CRD, to improve the control of CRDs themselves. The method of 24-hour blood pressure monitoring should be used more often in routine practice, including assessing the degree of nocturnal blood pressure reduction and its variability.

Aim. To determine the clinical profile of a patient with stable coronary artery disease (CAD) and impaired muscle status.

Material and methods. The study included 387 patients with stable CAD who had indications for open myocardial revascularization. Quantification of muscle tissue was carried out using computed tomography. Comparative analysis of clinical and anamnestic characteristics of groups of patients with sarcopenia (n=152) and those with normal muscle status (n=235) was performed.

Results. Signs of sarcopenia were found in 39,3% of patients with stable CAD. In the group of sarcopenia and the group with normal muscle status, there was a predominance of males — 86,2 and 64,7% (p=0,01), the presence of hypercholesterolemia — 51,3 and 31,1% (p=0,02), type 2 diabetes — 21,1 and 28,1% (p=0,06), multivessel CAD — 25,6 and 17,8% of cases (p=0,018), respectively. In sarcopenia, a 4 times longer history of diabetes was noted (p=0,01) and a 2,3 times longer duration of CAD (p=0,03). The prevalence of obesity in sarcopenia was 3,4 times less (p=0,003). Correlation analysis showed the relationship of muscle status with age (r=-0,674; p=0,002), duration of CAD history (r=-0,582; p=0,001) and diabetes (r=-0,748; p<0,001).

Conclusion. The clinical and anamnestic profile of a patient with stable CAD and sarcopenia is characterized by an association of decreased muscle mass with male sex, hypercholesterolemia, multivessel coronary CAD, a long-term history of type 2 diabetes and angina.

Aim. To evaluate the medical treatment of patients with cardiovascular disease (CVD) during the first year of follow-up after hospitalization for coronavirus disease 2019 (COVID-19) in a prospective registry.

Material and methods. The material for the study was obtained from the database of the TARGET-VIP inhospital registry. The registry included 1130 people. Of 863 patients discharged from the hospital with a diagnosis of COVID-19, 473 (548%) patients with CVD were selected, and 31 (40,8%) patients were selected from 76 patients in whom the diagnosis of COVID-19 was not confirmed with CVD.

Results. At the stage of discharge from the hospital, the quality of therapy for CVD was insufficient on average, the frequency of proper prescriptions was 59,5%. During the first year, there was a significant trend towards a decrease in the prevalence of antihypertensive therapy for hypertension (p=0,018), anticoagulants for atrial fibrillation (p<0,001) and an increase in prescribing angiotensinconverting enzyme inhibitors/angiotensin receptor blockers for heart failure (p=0,037). The average prevalence of prescribing proper cardiovascular pharmacotherapy after 30-60 days and 6 months of follow-up was significantly less than at discharge from the hospital. In both groups of patients, when comparing the average frequency of compliance with proper prescriptions at all follow-up periods, as well as when comparing these indicators between groups, no significant differences were found, with the exception of the stage of 30-60 days after discharge from the hospital (p=0,009).

Conclusion. In the TARGET-VIP registry after discharge from the hospital, the prevalence of proper appointments for CVD was insufficient. During the first year of observation, patients with CVD showed a significant decrease in the frequency of proper prescription of antihypertensive therapy for hypertension and anticoagulants for atrial fibrillation. When comparing groups of patients with confirmed and non-confirmed COVID-19, a higher average rate of adherence to proper prescriptions was found in patients with confirmed COVID-19. However, significant differences were found only 30-60 days after discharge.

During the spread of an increasing number of new variants of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2), it is extremely important not only to assess the immunogenicity and efficacy, butalso the safety of various combinations of vaccines. Excessive immune response and associated signs and symptoms may occur with varying frequency as expected from the use of vaccines.

Aim. To compare the reactogenicity of various (heterologous and homologous) vaccination regimens in a prospective observational study.

Material and methods. In individuals aged ≥18 years, in the absence of contraindications to vaccination, two types of vaccines were used at primary vaccination and revaccination: Gam-COVID-Vac and CoviVac: group I (n=97) — Gam-COVID-Vac at each stage of primary and booster vaccination ; group II (n=7) — Gam-COVID-Vck at each stage of primary vaccination, CoviVac at each stage of revaccination; group III (n=42) — CoviVac at each stage of primary vaccination, Gam-COVID-Vac at each stage of revaccination; group IV (n=38) — CoviVac at each stage of primary and secondary vaccination. In all participants, the dynamics of IgG to SARS-CoV-2 spike glycoprotein receptor-binding domain and T-cell immunity to SARS-CoV-2 were determined over time. To control the plasma hemostasis, the method of dynamic thrombophotometry was used. Local and systemic adverse events were assessed.

Results. The number of vaccinated individuals with a rise in body temperature above 37⁰ C after the 1^st stage of revaccination was significantly (p<0,05) more in group I (37,5%) and group II (57,1%) compared with vaccinated persons of IV group. At the same time, after the 2^nd stage of revaccination, in general, a smaller percentage of vaccinated persons with hyperthermia was noted. In group I, a higher percentage of persons (22,9%) complaining of the appearance of weakness after stage I of revaccination was noted compared to vaccinated persons of group IV — 5,2%. An increase in the fibrin clot growth rate was noted in group III at the stage of revaccination.

Conclusion. The use of various revaccination schemes (homologous and heterologous) was not associated with the development of serious adverse events. The resulting local and systemic reactions were shortlived and did not require hospitalization. More pronounced systemic reactions were noted in the form of a short-term fever and weakness when using the Gam-COVID-Vac. No cases of arterial or venous thrombosis were registered during the follow-up period.

Aim. To evaluate the changes of the N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in patients with sinus tachycardia after coronavirus disease 2019 (COVID-19) during ivabradine monotherapy or in combination with β-blockers (BBs) compared to BB monotherapy.

Material and methods. This randomized comparative study included 90 patients discharged from the hospital after an acute period of COVID-19. The main group (n=60) included patients who received ivabradine monotherapy or in combination with BB in addition to standard therapy, while the control group (n=30) — standard therapy in combination with BB. The follow-up period lasted 24 weeks. Serum NT-proBNP concentration was determined by enzyme immunoassay at the first and last visit (0 and 24 weeks). Statistical processing was performed using STATISTICA 8.0 software. The level of statistical significance was p<0,05.

Results. A significant decrease in heart rate (HR) and NT-proBNP concentration was noted in both groups. The achievement rate of maximum recommended BB doses was 9,1% in the main group and 20% in the control group. Among individuals who did not achieve the maximum recommended doses of BB, the HR and NT-proBNP concentration were significantly higher in the control group as follows: 72 [66; 75] vs 68 [66; 75] bpm (p=0,028) and 55,5 [47,3; 88,8] vs 43,3 [31,0; 55,5] pg/ml, respectively (p=0,041).

Conclusion. We showed that therapy with ivabradine and betablockers helps to reduce the level of NT-proBNP against the background of HR decrease in patients after COVID-19, and ivabradine allows to achieve a more pronounced decrease in heart rate and NT-proBNP level in patients with failure to achieve the maximum recommended BB doses.

Surgical interventions, accompanied by a subclavian vein cannulation, are associated with the risk of pneumothorax. Timely detection of this condition reduces the risk of secondary complications. An effective and promising method for the early detection of pneumothorax is lung ultrasound.

Aim. To evaluate the routine bedside use of focused lung ultrasound in the early postoperative period in patients after surgical interventions accompanied by subclavian vein cannulation.

Material and methods. This retrospective analysis of 304 case records of patients after surgical interventions accompanied by subclavian vein cannulation was carried out. Patients underwent lung auscultation, lung ultrasound according to the Bedside Lung Ultrasound in Emergency (BLUE) protocol 1 and 6 hours after surgery, or unscheduled with a saturation decrease <90%, the appearance of shortness of breath and/or chest pain. When pneumothorax signs were detected, patients underwent an emergency chest x-ray, and an elective x-ray was performed 1 day after the intervention.

Results. 304 case records were analyzed, lung ultrasound was performed in 187 (61,5%) men and 117 (38,5%) women. In 8 (2,63%) patients, 1 hour after surgery, an A-profile without lung sliding was detected. In 3 (0,99%) patients, auscultatory breathing weakening was noted, complaints of discomfort and pain during inspiration were noted by 5 (1,64%) patients. In all 8 patients, the diagnosis was confirmed by x-ray. In 5 (1,64%) patients, a mild pneumothorax was detected, which did not require drainage, while 3 patients underwent pleural drainage.

Conclusion. Focused lung ultrasound using the BLUE protocol significantly improves the safety profile of patients after subclavian vein puncture, providing high levels of sensitivity and specificity in detecting pneumothorax.

The use of available systems for obtaining structured data from primary medical information is based on the use of various technologies, including digital transformation of primary data for the formation of electronic health records. The purpose of the work was to outline the structure and benefits of using the RuPatient electronic health record (EHR), created to automate the work with medical data, digital character recognition and building an algorithm for communicating with patients. The created RuPatient EHR automates the processing of medical documents using image digitization and optical character recognition and the formation of a database. The developed program code that combines modules into a single web service is registered as intellectual property. The web service is a client-server application with the ability to access the interface through a browser from a smartphone, tablet, laptop, and personal computer. The service contains an interface part (Frontend), a functional part, with the possibility of expanding with separate modules (Backend), and databases for storing information about patients. The developed service provides standardization and digitalization of documents of patient-doctor visits and is a tool for convenient remote communication between a patient and a doctor via the built-in chat. The RuPatient EHR serves as a convenient tool for standardizing medical information in digital form and is designed to help the doctor and the patient in organizing treatment and preventive interaction.

Aim. To develop study design and analyze the characteristics of a cohort of patients with cardiac manifestations of Fabry disease (FD) in order to study the possibilities of electrocardiography (ECG) telemonitoring for screening for cardiac arrhythmias (CA), requiring a change in therapeutic tactics.

Material and methods. This prospective cohort study included 11 patients (8 men and 3 women) with documented FD, with cardiac complaints and ECG signs of heart involvement. For ECG telemonitoring, non-invasive digital event recorders ECG Dongle (Nordavind-Dubna, Russia) were used. Primary endpoint was registration of CA requiring a change in therapeutic tactics (implantation of a pacemaker/defibrillator-cardioverter/prescribing anticoagulants). Secondary endpoint was dynamics of monitored parameters for operational correction of the therapeutic regimen.

Results. The cohort of patients is predominantly male (73/27%; mean age, 41±13,7 years). At the time of inclusion, 8 (73%) patients received enzyme replacement therapy for 4-73 months. Most patients are active Internet users, are aware of telemedicine possibilities and are interested in remote monitoring. The main complaints were related to cardiac function interruptions, palpitations, and chest discomfort. Left ventricular hypertrophy was diagnosed on ECG in 7 (64%) patients. Echocardiography revealed symmetrical left ventricular hypertrophy in 5 patients, asymmetric interventricular septal hypertrophy in 2 patients. Other echocardiographic abnormalities included valvular heart disease (mitral and tricuspid valve prolapse with mitral and tricuspid regurgitation, presence of supplemental chords) and aortic root dilatation. Initially, the ECG was dominated by sinus rhythm (n=10); 1 patient had documented ventricular tachycardia, 4 patients had single and coupled ventricular premature contractions; supraventricular tachycardia and premature contractions in 2 patients. Four patients had a PR interval shortening without signs of accessory pathways, 1 patient — Wolff-Parkinson-White syndrome, 1 patient — prolonged QTc interval.

Conclusion. For effective management of FD, additional multicenter studies are required to develop algorithms for making tactical decisions in the process of cardiac monitoring, taking into account the characteristics of the cardiovascular manifestations of this disease. The article proposes a technology for telemedicine cardiac monitoring using ECG event recorders for outpatient CA screening.

Thrombophlebitis of the superficial lower limb veins is one of the most common complications of chronic vein disease. Nowadays a long-term (at least 45 days) subcutaneous injection of fondaparinux sodium or heparin in combination with elastic compression of the limb is recommended for treatment of superficial vein thrombosis with a moderate risk of thrombus propagation to deep venous system. However, long-term use of anticoagulants is not always possible and sometimes contraindicated. Endovenous laser ablation (EVLA) around thrombus-free junction of great or small saphenous veins without subsequent long-term use of anticoagulants seems to be a promising intervention for treatment of acute thrombophlebitis of varicose superficial veins.

The prospective single-center randomized open-label clinical trial was dedicated for comparison the efficacy and safety of three following treatments options for patients with acute thrombosis of the varicose great saphenous vein and location of thrombi in the trunk and/ or its large inflows: EVLA close to saphenous vein junction without anticoagulation, EVLA and 7 days of anticoagulation and noninvasive treatment with anticoagulation for 45 days (subcutaneous injections of the fondaparinux 2,5 mg). Class 2 compression stockings are used in all patients. Adverse outcomes are recorded at 7, 45 and 90 days after randomization. These include the progression of superficial vein thrombosis, recurrent superficial vein thrombosis, thrombosis involvement of the superficial segment of the perforating vein up to the fascia, deep vein thrombosis according to compression ultrasound, and pulmonary embolism with symptoms. Bleedings according to the World Society of Thrombosis and Hemostasis and the Academic Research Consortium classification as well other complications are also recorded. The first 30 patients included in the study have a low incidence of venous thrombosis risk factors and localization of the thrombus relatively far from the saphenofemoral junction. EVLA resulted in persistent cessation of venous blood flow at the intervention site. New episodes of venous thrombosis were noted only in the group of medical treatment — deep vein thrombosis of the contralateral tibia 5 days after stopping of 45-day treatment with fondaparinux and thrombus in the recanalized inflow of the great saphenous vein without involving its trunk at the 21st day after stopping of 45-day injection of fondaparinux. There were no complications in the area of intervention and bleedings.

Aim. To assess mortality rates due to acute types of coronary artery disease (CAD) in five-year age groups (20-85+ years) and the contribution to all-cause mortality in 2019-2020.

Material and methods. From the Center for Demographic Research of the Russian Economic School, data on all-cause and acute CAD mortality rates were selected (codes: I21.0-9; I22.0-9; I20, I24.1-9) in five-year age groups (from 20-24 years to the group 85+ inclusive) of men and women per 1 million population in 2019 and 2020. The contribution (in %) of acute types of CAD to all-cause mortality, the contribution of each disease to mortality, and the ratio of male/female mortality rates were determined.

Results. The contribution of all acute types of CAD to all-cause mortality among men of different 5-year age groups ranges from 1,2 to 7,9% (50-54 years), among women from 0,9 to 5,5% (65-69 years) and has the character parabolic dependence on age. In each subsequent 5-year age groups, mortality rates due to acute CAD is higher compared to the previous one. However, in age groups up to 60 years, the share of "other forms of acute CAD" prevails (from 51% to 100%), and after 60 years — myocardial infarction (MI) (from 56% to 78%). For all acute types of CAD in 2019-2020, mortality rate among men is higher than among women: a maximum of 25 times from recurrent MI in age group of 40-44 years in 2020; 7 times — from acute MI in age group of 40-44 years in 2019; and 4,5 times from "other forms of acute CAD" in age group of 50-54 years in 2019. In 2020, compared to 2019, there was an increase in mortality from all acute CAD, with the exception of age group of 25-29 years among women and 20-34 years among men.

Conclusion. The identified structural age-sex features of mortality from acute CAD may be due to approaches to diagnosis and identification of various CAD forms as the cause of death and require the creation in the Russian Federation of a methodological protocol or algorithm for determining the cause of death of various acute types of CAD.

Aim. To study the relationship of socio-demographic factors with lipidlowering therapy in primary health care.

Material and methods. This cross-sectional noncomparative study on the prevalence of hypercholesterolemia (ARGO study) included patients aged ≥0 years who visited primary care physicians and cardiologists in the period 2013-2014 with diagnoses of stable coronary artery disease, hypertension, peripheral artery disease, carotid atherosclerosis, aortic aneurysm or having any type of revascularization or ischemic stroke in history. The study, which was conducted in 59 Russian cities, involved 768 doctors from 217 polyclinics.

Results. The analysis included 18273 patients. Of the total number of patients, 7829 (42,9%) people took statins, while 10421 (57,1%) people did not receive it. The maximum percentage of statin use was in the age group of 70-79 years — 52,12%, and the minimum in the age group of 30-39 years — 13,24% (p<0,001). Most often, statins were taken by people with disabilities — 67,67%, and least often, by working people — 32,59% (p<0,001). In terms of marital status, widowed persons were significantly more likely to take statins, 50,36% (p<0,001); least of all in the group, single persons — 32,29%, while in the group of divorced persons, statins were taken by 37,76%, and in the group of married — 43,07%. According to the education level, patients with secondary professional education are the most adherent to statin treatment — 43,75%, while patients with incomplete secondary education were the least likely to take statins — 41,26% (p<0,054).

Conclusion. Taking into account the socio-demographic factors that a person has when prescribing treatment will help develop a strategy for interacting with the patient and will help improve the quality and effectiveness of therapy in this group of patients.

Expert Council: Drapkina O. M., Vavilova T. V., Karpov Yu. A., Kobalava Zh. D., Lomakin N. V., Martynov A. I., Roitman E. V., Sychev D. A.
Scientific communities: the Russian Society for the Prevention of Non-Communicable Diseases (ROPNIZ), the Russian Scientific Medical Society of Therapists (RNMOT), the Russian Antithrombotic Forum (RAF), the National Association for Thrombosis and Hemostasis (NATH).

Statins have diabetogenic properties. Pitavastatin is currently considered the only drug in this group that combines high lipid-correcting activity with the absence of a negative effect on carbohydrate metabolism. The article presents a case of correction of carbohydrate metabolism indicators against the background of pitavastatin therapy in a patient with dyslipidemia and impaired fasting glycemia. The optimal algorithms for the examination and treatment of such patients are discussed on the example of this patient.

Cardiac involvement in sarcoidosis is difficult to diagnose due to the asymptomatic course in 95% of cases, the inaccessibility and low information content of a heart biopsy, the absence of pathological disorders in routine examination methods or their non-specificity. At the same time, it is cardiac sarcoidosis, along with damage to the nervous system, that is the main cause of mortality in sarcoidosis. Early diagnosis is of decisive importance for preventing complications associated with heart involvement and choosing the right treatment tactics. The positron emission tomography-computed tomography (PET-CT) is a method that can help the doctor in assessing the prevalence of sarcoidosis and verifying latent localizations in patients with a morphologically confirmed disease. The article describes a case of the use of PET/CT for the diagnosis of cardiac sarcoidosis.

Aim. To estimate the detection rate of heart failure (HF), using various diagnosis criteria, among patients aftr 12 months after hospital treatment for coronavirus disease 2019 (COVID-19).

Material and methods. The study included 185 patients from the TARGET-VIP registry who came for a visit 12 months after hospitalization for COVID-19. To identify HF with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction (EF), the European Society of Cardiology (ESC) criteria (2016 and 2021) were used. To identify HF with preserved EF (HFpEF), we used the ESC criteria (2016 and 2021), as well as the 2018 Russian guidelines and H2FPEF score.

Results. In the analyzed group, there were no patients with EF <40%, while one patient had EF of 48% and 184 patients — ≥50%. The patient with EF of 48% was not diagnosed with HF due to the absence of HF signs and symptoms. The presence of HFpEF was confirmed in 31,4% of patients according to 2018 Russian criteria and 2021 ESC criteria (first version of the diagnosis), in 12,5% according to the 2016 ESC criteria, 11% according to ESC 2021 criteria (second version of the diagnosis) and in 2,2% on the H2FPEF score. The proportion of HF diagnosed for the first time according to the 2016 ESC criteria was 78% of the total number of HF cases.

Conclusion. Among the examined patients 12 months after hospital treatment for COVID-19, there were no cases of HFrEF and HFmrEF. The proportion of HFpEF cases, depending on the diagnostic criteria used, varied significantly from 2,2 to 31,4%. The previously established diagnosis of HF was confirmed in 83% of cases at a visit 12 months after discharge from the hospital. Using the 2016 ESC criteria and the corresponding 2020 Russian Society of Cardiology guidelines, the proportion of newly diagnosed HF was 78% of all patients.

Aim. To study the effect of catheter-based sympathetic renal denervation (RDN) by radiofrequency ablation on glucose metabolism in patients with type 2 diabetes and uncontrolled hypertension.

Material and methods. Sixty patients were randomly assigned in a 1:1 ratio to the RDN group and the control group. Radiofrequency ablation was performed through the femoral access using a Symplicity Spyral™ renal denervation system (Medtronic, USA).

Results. The technical success was 100%. There were no any complications. During the follow-up period, patients in the RDN group showed a significant decrease in the average level of glycated hemoglobin — from 7,9  (6,83-8,35) to 6,85 (6,12-7,10)%  (p<0,001) and basal glycemia — from 9,5 (7,17-10,28) to 7,55 (6,43-8,95) mmol/l (p<0,001) with no significant changes in the control group. Changes in glucose levels and the degree of insulin resistance correlated with a decrease in office systolic blood pressure (r=0,36, p=0,005). After 6-month follow-up period in the RDN group, along with a significant decrease in the HOMA-IR by 1,92 (p<0,001), the average high-density lipoprotein cholesterol level also significantly increased by 0,17 mmol/l (p<0,001), and mean triglyceride level decreased by -0,55 mmol/l (p<0,001).

Conclusion. The study results confirm the hypothesis of pleiotropic effects of RDN in patients with comorbid pathology associated with central sympathetic nervous system hyperactivity (diabetes, hypertension, dyslipidemia).

Aim. To determine the incidence of left atrial (LA) and/or LA appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation (AF) (NAF) or atrial flutter (AFL) on transesophageal echocardiography (TEE) before elective catheter ablation (CA) or cardioversion (CV) and characterize the predictors of LA/LAA thrombosis among the indicators available in the routine practice of cardiologists and general practitioners.

Material and methods. In this retrospective, single-center, casecontrol study, the medical records of 1994 patients with NAF or AFL for the period 2014-2019, who underwent TEE before CA or elective CV, were analyzed. A thrombus in the LA/LAA was detected in 33 (1,6%) of them. For the comparison group, 167 patients were randomly selected without LA/LAA thrombosis. Demographic, anamnestic and clinical parameters, transthoracic echocardiography data, and laboratory results were analyzed as potential predictors of LA/LAA thrombosis.

Results. Patients with LA/LAA thrombosis were older (mean age, 64,8±1,6 vs 59,4±10,8 (p=0,01), more often had persistent or longstanding persistent AF, hypertension, heart failure, enlarged LA, lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate, as well as more severe symptoms according to the modified European Heart Rhythm Association (EHRA) score and a higher CHA2DS2-VASc score (median, 4,0 vs 2,0; p=0,0001). Oral anticoagulants were taken by 88% of patients; there were no significant differences in the presence and composition of anticoagulant therapy between the groups. Functional class (FC) according to the modified EHRA score (odds ratio (OR), 5,4; 95% confidence interval (CI): 1,9814,96; p=0,001) and LVEF were independent predictors of LA/LAA thrombosis (OR, 0,87; 95% CI: 0,80-0,95; p=0,002). For EHRA class 3-4, the OR was 5,1; 95% CI: 2,3-11,4 (p<0,0001), for LVEF <48% — 7,4; 95% CI: 1,2-46,7 (p=0,03). For EHRA class 3-4, the sensitivity for LA/LAA thrombosis was 93,7%, specificity — 71,9%, positive predictive value — 50,0%, negative predictive value — 87,6%; for LVEF <48% — 66,7, 32,3, 31,9 and 91,6%, respectively.

Conclusion. In the studied group of patients with NAF or AFL, without severe structural heart disease and severe concomitant diseases, most of whom received oral anticoagulants, LA/LAA thrombosis at TEE before elective CA or CV was detected in 1,6% of cases. Among the indicators available in routine medical practice, the severity of arrhythmia symptoms, assessed by the modified EHRA score, and lower LVEF were independent predictors of LA/LAA thrombosis.

Treatment of patients with combined coronary and carotid artery atherosclerosis is a difficult task due to the increased risk of surgical intervention in this cohort of patients. Lack of timely treatment can lead to a decrease in the quality of life of patients, as well as to death. In some cases with combined coronary and carotid artery atherosclerosis, the choice of surgical intervention may depend on vascular bed involvement. In a case report, open surgery was associated with a very high risk of perioperative complications; so the only way of myocardial revascularization was minimally invasive endovascular surgery. The article presents a case of the treatment of a patient with a combined multivessel coronary and bilateral carotid artery atherosclerosis.

Left ventricular non-compaction (LVNC) is a rare, genetically and phenotypically heterogeneous disease, which is often accompanied by diagnostic difficulties.

Aim. To demonstrate several generations of a family with LVNC with various clinical and phenotypic manifestations of the disease (dilated and isolated types of LVNC) with an identified rs397516387 variant of the TPM1 gene.

Material and methods. Based on the multicenter registry "Myocardial Non-compaction", a family with a familial form of LVNC was selected. Next generation sequencing (NGS) was performed on an Ion S5 system (Thermo Fisher Scientific, USA) using Ampliseq technology. Variant was verified using Sanger sequencing on an Applied Biosystem 3500 Genetic Analyzer (Thermo Fisher Scientific, USA). For clinical interpretation, variants in the genes associated with LVNC with a minor allele frequency <0,1% were selected in the gnomAD database (v2.1.1). Results. Variant rs397516387 was found in 5 family members, including the proband. Further examination revealed LVNC in 2 additional family members. The proband and the proband’s uncle had a dilated type of LVNC, and the proband’s mother had an isolated type.

Conclusion. The paper presents several generations of a family with different phenotypic manifestations of LVNC and rs397516387 variant in the TPM1 gene. The beginning of genetic screening from a proband, a thorough collection of a family history and further detailed genetic screening of relatives led to the identification of rs397516387 variant in 4 more family members, which in turn made it possible to conduct an additional examination to confirm the diagnosis and prescribe timely drug therapy.

Aim. To demonstrate two generations of a family with a progressive course of left ventricular non-compaction (LVNC) and the presence of a RBM20 gene variant.

Material and methods. Based on the multicenter registry of patients with LVNC, a family with LVNC with a dilated phenotype was selected at the National Medical Research Center for Therapy and Preventive Medicine. Next generation sequencing was performed on a Nextseq 550 systen (Illumina, USA). For clinical interpretation, nucleotide sequence variants in the genes associated with LVNC development were selected according to the available literature data, with frequencies <0,5% in the gnomAD database. The identified variants were verified using Sanger sequencing on an Applied Biosystem 3500 Genetic Analyzer (Thermo Fisher Scientific, USA).

Results. The article presents the results of clinical, paraclinical and molecular genetic studies of two generations of a family diagnosed with LVNC with a dilated phenotype and the progression of isolated LVNC to a dilated type. As a result of a molecular genetic study, all family members with the LVNC were found to have a likely pathogenic variant in the RBM20 NP_001127835.2:p.Pro638Leu (rs267607003) gene. RBM20 is a key splicing regulator that controls the processing of several important transcripts predominantly expressed in striated muscle, especially cardiac tissue. RBM20 gene variants can lead to disruption of splicing at several points and, as a result, to cardiomyopathy progression. Most known pathogenic RBM20 variants are associated with dilated cardiomyopathy; however, a number of studies have found RBM20 gene variants in patients with LVNC. The segregation of nucleotide sequence variant with symptoms in two generations testifies in favor of the association of the detected variant with LVNC development.

Conclusion. Currently, the boundaries of the cardiomyopathy genetics are expanding. Pathogenic and likely pathogenic RBM20 gene variants are associated primarily with a dilated phenotype and a high risk of sudden cardiac death. The article presents the results of a survey of two generations of a family with LVNC and progressive myocardial remodeling.

The development of novel technologies using elements of artificial intelligence (AI) in medicine is addressed to practical clinical implementation and provision of key issues, including improvement in the use of routine clinical data, aimed at practical relevance, standardization, confidentiality and patient safety.

Aim. To evaluate the effectiveness of the RuPatient electronic heart record (EHR) system in real clinical practice for extracting and structuring medical data.

Material and methods. Extraction and recognition of data using EHR from various following sources: outpatient records, statements, routine medical reports, epicrisis and other structured and unstructured medical information based on the developed technology of intelligent text analytics, optical character recognition, for specified words and phrases, and the use of machine learning elements. A particular criterion for evaluating the effectiveness of EHR is the time spent on filling out electronic medical records compared to real clinical practice.

Results. The time of entering and processing information by the recognition system of medical documentation included in the RuPatient EHR was shorter than in standard practice (20,3±1,4 minutes, 25,1±1,5 minutes, respectively, p<0,001), the average time of recognition of documents was 30±4,3 seconds. During the ROC analysis, we determined that the threshold value that allows high accuracy to recognize images of discharge epicrisis using the RuPatient system was 83,5% with an area under the curve (AUC) value of 0,76.

Conclusions. The developed RuPatient EHR has a medical documentation recognition module for creating structured data based on AI technology elements and can be used in creating an electronic medical history and accumulation of structured data for the implementation of tasks for the practical and scientific use of big data and AI projects in medicine. When using the RuPatient system, the burden on medical staff during document management can be reduced and access to primary medical information simplified.

Aim. To provide data on the diagnostic and prognostic value of questionnaire survey for post-COVID-19 syndrome during screening and regular medical check-ups of employees, as well as preventive medical examinations.

Material and methods. This single-center cross-sectional comparative study involved 1120 people (92,1% of the general population — all employees of the organization), including 195 men (67,3% of the general population) and 925 women (79,5% of the general population). All participants filled out the post-COVID-19 syndrome (PS) detection questionnaire, the Hospital Anxiety and Depression Scale and the QAA-25p Adherence Assessment Questionnaire. Potential adherence to treatment was calculated using the SCOPA software. Statistical processing was performed using tools adapted for medical and biomedical research (Python language; Sklearn, NumPy, Pandas libraries) and Statistica 6.13 (StatSoft Inc., USA).

Results. As a result, 47% of respondents noted at least one symptom that reduces the quality of life and/or performance efficacy. In all subsamples, women reported symptoms more frequently than men. The most informative indicators associated with post-COVID-19 syndrome are age (Mann-Whitney U test, p=0,042), number of PS symptoms (Mann-Whitney U test, p=0,001), severity of PS symptom (Mann-Whitney U test, p= 0,004) and adherence to health care (Kruskal-Wallis H test, p=0,021). An increased level of anxiety is associated with all the analyzed symptoms, depression level with 6 symptoms, age with 5 symptoms, insufficient compliance with 3 symptoms.

Conclusion. PS questionnaire should be included in a comprehensive survey program of persons undergoing medical examinations. It is necessary to develop algorithms for the treatment and diagnosis of patients that take into account the number and severity of individual symptoms separately for men and women with consideration to their COVID-19 epidemiological status, as well as age and markers of anxiety, depression, and adherence to treatment.

Along with efficacy and safety, it is extremely important to study the severity of humoral and cellular immunity during not only vaccination, but also revaccination against the Severe Acute Respiratory Syndromerelated CoronaVirus 2 (SARS-CoV-2).

Aim. To compare the immunogenicity (humoral and cellular immunity) of various (heterologous and homologous) revaccination regimens against coronavirus disease 2019 (COVID-19) in a prospective observational study.

Material and methods. In individuals aged ≥18 years, in the absence of contraindications to vaccination, two following types of vaccines were used for primary vaccination and revaccination: Gam-COVIDVac and CoviVac. Group I patients received Gam-COVID-Vac at each stage of primary and secondary vaccination; patients of group II — Gam-COVID-Vac at each stage of primary vaccination, CoviVac at each stage of re-vaccination; patients of group III — CoviVac at each stage of primary vaccination and Gam-COVID-Vac at each stage of revaccination; patients of group IV — CoviVac at each stage of primary and secondary vaccination. All participants (at each stage of vaccination, revaccination and 12 months after the primary vaccination) were determined the level of IgG to the receptor-binding domain of SARS-CoV-2 spike (S) protein and T-cell immunity to SARSCoV-2.

Results. The maximum level of IgG at the second stage of revaccination was observed in groups I and III. In addition, in groups I, III and IV, a significant (p<0,0001) increase in IgG level by the second stage of revaccination was noted, the most pronounced in group III. In addition, there was a significantly (p<0,05) higher level of IgG at I and II stages of revaccination (Visit 3 and 4) among those vaccinated with Gam-COVID-Vac — 520 and 540 BAU/ml, respectively, compared with group IV vaccinated with CoviVac — 467 and 478 BAU/ml, respectively. The maximum and significant increase in active T-cells by the second stage of revaccination (Visit 4) was noted in groups I (p<0,0001) and III (p<0,0022) of vaccinated individuals, where it amounted to 11 and 12, respectively, which allows to consider the result positive (>8). At the same time, the level of active T cells responding to SARS-CoV-2 nucleocapsid Ag stimulation by Visit 4 (stage II of revaccination) was noted in groups II (14,5) and IV (12).

Conclusion. The use of the Gam-COVID-Vac vaccine as a booster dose in both homologous and heterologous vaccination regimens against the SARS-CoV-2 virus is most effective for stimulation and humoral and T-cell post-vaccination response.

Aim. To study the two-year survival rate of patients with various types of cerebrovascular accident according to the outpatient part of the REGION-M registry.

Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of stroke or transient ischemic attack (TIA). Of these, 514 (75,1%) patients had an ischemic stroke, 52 (7,6%) — a hemorrhagic stroke, and 118 (17,2%) — a TIA.

Results. The lowest two-year mortality (11%) was observed in patients who underwent TIA (p<0,001) compared with ischemic and hemorrhagic stroke. The relative risk of death for ischemic stroke was 2,0 (95% confidence interval (CI): 1,13-3,55) (p<0,05), and for hemorrhagic stroke — 2,51 (95% CI: 1, 22-5,15) (p<0,05) relative to patients with TIA. Mortality in patients with ischemic or hemorrhagic stroke did not differ significantly — 32,3 and 36,6% (p>0,05). The mean age of patients who underwent TIA was significantly less than the age of patients with hemorrhagic or ischemic stroke. With increasing age, the survival of patients significantly worsened in all types of strokes. In addition, multivariate analysis adjusted for age showed remained significant effect of the stroke type on survival as follows: the relative risk of death for ischemic and hemorrhagic stroke was 1,99 (95% CI: 1,12-3,53) (p<0,05) and 2,45 (95% CI: 1,19-5,02) (p<0,05).

Conclusion. Mortality in patients with stroke was significantly lower after TIA than in any type of stroke and did not differ between subgroups of patients with ischemic and hemorrhagic stroke.

Despite significant progress in the development of novel methods for the prevention and treatment of cardiovascular diseases, their prevalence remains high, which is largely due to low adherence of patients to drug and non-drug preventive interventions. Motivational counseling (MC) is a unique technology that makes it possible to activate the patient’s desire to change their behavior towards a healthy one. The review presents an analysis of the literature on MC technology and the possibilities of its application in cardiology practice. Research data show the effectiveness of MC in improving the nutrition profile, physical activity, weight loss, smoking cessation, control of glycated hemoglobin in patients with diabetes, improving outcomes in patients with heart failure, increasing adherence to therapy, etc. Conducting MC using telemedicine technologies seems promising. The training of specialists is of paramount importance, since the effectiveness of this type of counseling largely depends on the accuracy of the consultant’s adherence to the essence and technologies of MC.

The redistribution of body composition components in heart failure (CHF) is an urgent and poorly understood issue. Despite the significant impact of a decrease in muscle mass, redistribution of fat mass on the course and prognosis of HF, body composition is rarely taken into account in the treatment of this disease. In this regard, the purpose of this review was to systematize the available data and draw the attention of clinicians to this problem. The data presented in the review make it possible to consider the components of body composition as controllable factors, the normalization of which improves the prognosis in patients with HF. The study of pathophysiological mechanisms for the development of body composition anomalies in HF will make it possible to search for new therapeutic targets. Assessment of body composition will make it possible to develop an individual strategy for the treatment of HF, including a set of non-drug measures.

Hypertension (HTN) is a leading risk factor for the development of cardiovascular diseases. In recent decades, the rapid development of genetic tests, in particular genome-wide association study (GWAS), has made it possible to identify hundreds of nucleotide sequence variants associated with the development of HTN. One approach to improve the predictive power of genetic testing is to combine information about many nucleotide sequence variants into a single risk assessment system, often referred to as a genetic risk score. Within the framework of this review, the most significant publications on the study of the genetic risk score for HTN will be considered, and the features of their development and application will be discussed.

Currently, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is the gold standard for diagnosing hypertension (HTN) and evaluating the effectiveness of antihypertensive therapy. The method provides information about some BP parameters that cannot be obtained in any other way. ABPM is reasonable in any patient with a documented increase in BP, especially if specific BP phenotypes are suspected: white coat HTN and masked HTN. Antihypertensive therapy under the ABPM, on average, is more economical and is not associated with overprescribing of drugs and their combinations. Based on the ABPM data, calculating a number of additional indicators of the 24-hour BP profile is possible, but their scope is still limited to the research field. In the conclusion on ABPM data, the results of office BP measurement and antihypertensive therapy should be indicated.