Coronary artery disease is the most common cause of death world­wide. On­pump coronary artery bypass grafting and cardioplegia remains the gold standard for the treatment of multivessel coronary disease. However, this method of surgical treatment has a number of perioperative complications, the most common of which is post­operative cognitive dysfunction (POCD).

Aim. To develop a mathematical model for predicting the binary outcome "presence/absence of POCD deterioration" using Mini­Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) for timely prevention of cognitive impairment in the early postoperative period.

Material and methods. The study included 180 patients with coronary artery disease with stable angina who underwent on­pump coronary artery bypass grafting. The patients’ age [Me (Q25­-Q75)] was 62 [56­-67] years. After the operation, all patients were divided into 2 groups: 108 patients without POCD and 72 patients with cognitive deficit of various severity. The study was conducted in three stages: stage I — 2 days before surgery; stage II — during the operation; stage III — 7 days after the operation. Assessment of cognitive status using FAB, MMSE tests was carried out at stages I and III. At the second stage, biochemical parameters were assessed: in arterial blood — lactate and hemoglobin levels, in venous blood — pH, partial pressure of carbon dioxide (pCO₂, mm Hg) and partial pressure of oxygen (pO₂, mm Hg), as well as the duration of operation, cardiopulmonary bypass and myocardial anoxia. Discriminant analysis was used to develop a mathematical model for predicting a binary outcome.

Results. Two groups of the most informative indicators were identified that were included in prediction algorithms for binary outcomes "presence/absence of negative dynamics of POCD" for MMSE and FAB. Group 1 included perioperative MMSE values, atrial fibrillation before surgery, cardiopulmonary bypass time and pO₂. Group 2 included cardiopulmonary bypass time and intraoperative venous pH.

Conclusion. Mathematical models have been developed for predicting the binary outcome "presence/absence of POCD deterioration" ac­cording to the MMSE and FAB cognitive tests, which make it possible to assess the possibility of postoperative cognitive dysfunction. The proposed algorithms are implemented using spreadsheets and a computer program.

Aim. To study cardiovascular risk factors, clinical manifestations and management of myocardial infarction (MI) in elderly and long­living patients depending on geriatric status.

Material and methods. Out of 92 patients with MI (mean age, 81,6±4,2), 3 following groups were formed: "frailty" — 35 (38,0%), "prefrailty" — 16 (17,4%), and "no frailty" — 41 (44,6%). The following questionnaires were used: Age Is Not a Hindrance, Mini Nutritional Assessment (MNA), Barthel Index for Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, balance test, Gait Speed Test, Timed Up and Go test, grip test, Mini Mental State Examination (MMSE), Clock Drawing Test, Geriatric Depression Scale.

Results. Frailty probability in patients is higher in the presence of obesity, type 2 diabetes, a decrease in glomerular filtration rate (GFR) <60 ml/min/1,73 m², a stroke, and heart failure. In the event of clinical manifestations of acute coronary syndrome (ACS), patients without frailty sought medical assistance earlier (in the first 2 hours — 26,8% of patients (χ²=7,8, p=0,005). Most patients with prefrailty and frailty called an ambulance later, but in the first 12 hours — 68,8 and 74,3%, respectively (χ²=15,6, p=0,012). The prevalence of thrombolysis is 23,2%, percutaneous coronary intervention — 30,4% and did not depend on geriatric status. The probability of multivessel disease is higher in patients with or at risk of malnutrition. The main hemodynamic parameters, echocardiography, laboratory parameters in patients with MI did not depend on geriatric status. According to the STOPP/START criteria, frail patients with more often received nonrecommended inhospital medicines.

Conclusion. Frailty in patients with MI was associated with multiple cardiovascular risk factors, later medical assistance, and more frequent non-recommended treatment.

Aim. To analyze Barthel Index of Activities of Daily Living (ADL) in elderly patients with hypertension (HTN) and frailty 6 months after non-ST segment elevation myocardial infarction non-STEMI).

Material and methods. ADL was studied in 114 elderly patients (60-74 years old) with non-STEMI, HN and frailty and 80 patients of the same age with non-STEMI and HTN, but without frailty. ADL was determined 6 months after suffering non-STEMI.

Results. ADL in patients with frailty was reduced to a greater extent (55,8 [52,4-57,9]) than in non-frail patients (72,9 [70,3-78,6]) (p<0,01). According to factor analysis, ADL reduction in frail patients compared with non-frail patients was mainly due to bed-chair transfer — 6,4 [6,2- 6,8] vs 9,8 [8,1-11,5] (p<0,001), walking test — 8,1 [8,0-8,5] vs 10,6 [9,4-12,7] (p<0,001), stair climbing — 5,3 [5,1-5,7] vs 7,4 [6,8-8,9] (p<0,001). ADL in patients with frailty and blood pressure (BP) <160/100 mm Hg was 62,1 [60,3-69,9], which is significantly higher than in frail patients with BP ≥160/100 mm Hg (48,0 [36,3-53,2]) (p<0,01).

Conclusion. In frail patients aged 60-74 years, compared with non- frail patients, 6 months after non-STEMI, ADL was significantly lower in such components as stair climbing, walking, and bed-chair transfer. In patients with frailty and BP <160/100 mm Hg, ADL is significantly higher than in patients with higher blood pressure.

Aim. To study modifiable risk factors for cardiovascular disease (CVD) among rail transport workers, depending on the place of work: Russian Railways and Moscow Metro.

Material and methods. The study involved 2638 workers of locomotive crews: 778 persons worked at Russian Railways, 1860 — Moscow Metro. The workers were offered a questionnaire assessing general data, features of medical activity, and lifestyle. The collection and processing of data was carried out using Microsoft Excel and Statistica programs.

Results. The studied groups were comparable in age structure. Slightly above 40% of respondents in both groups currently smoked, while ~70% did not eat enough vegetables. Workers of Russian Railways were 2 times more likely to drink alcohol ≥2 times a week and 1,2 times more likely to eat at fast food restaurants. Also, ~40% of participants in both groups often or always added salt to food, almost 20% did not engage in athletics. Workers of Russian Railways were less physically active. Moscow Metro workers ate less regularly and did not consume enough fruit. The average body mass index of both groups corresponded to overweight.

Conclusion. The leading behavioral risk factors for CVD in rail transport workers are insufficient consumption of vegetables and fruits, low physical activity, and smoking. The obtained results will allow to improve the guidelines for lifestyle modification of rail transport workers, to develop and refine corporate programs for primary CVD prevention.

Aim. To establish the factors associated with iron deficiency (ID) in pa- tients with heart failure (HF).

Material and methods. We examined 294 patients with NYHA class II-IV HF as follows: 213 — with ID, 81 — without ID. All patients underwent a clinical examination, collection of medical history taking into account the presence, duration and severity of comorbidities, drug history, echocardiography, complete blood count, serum iron, ferritin, transferrin, transferrin saturation, soluble transferrin receptors, hepcidin, erythropoietin, and routine laboratory tests. In addition, we determined the presence and severity of asthenia, anxiety, and depression.

Results. Twenty-nine clinical, laboratory and echocardiographic parameters were established, which had significant differences in patients with and without ID and significant correlations with ID. Determining the odds ratio for these 29 parameters revealed 7 factors significantly associated with ID in patients with HF. Using multivariate logistic regression, a significant cumulative effect of these factors on the ID risk was established.

Conclusion. ID in patients with HF is associated with age, class II-IV HF, elevated hepcidin levels, duration of hypertension and diabetes, history of using angiotensin-converting enzyme inhibitors and novel oral anticoagulants for >1 year.

The incidence of congenital heart defects (CHDs) reaches 1% of all newborns. Of particular importance is the group of heart defects without a family history and chromosomal disorders, which makes up>80% of all CHDs. These heart defects can be designated as sporadic CHDs, and their etiology and pathogenesis continue to be studied.

Aim. To study the association of cytokine and Toll-like receptor (TLR) genes with CHDs in children.

Material and methods. We examined 188 children with sporadic (without family history) CHDs (main group) and 103 healthy children without CHDs (control group). Genotyping was performed by real-time polymerase chain reaction (PCR).

Results. Sporadic CHDs, in general, and septal CHDs, in particular, are formed on similar intergenic associations that determine the dysregulation of the proliferation and differentiation of progenitor cells of the cardiovascular system. Probably, one of the molecular mechanisms for sporadic septal CHDs may be the inefficiency of intracellular signaling pathways for Nuclear Factor kappa B (NF-κB) due to the primary deficiency of membrane heterodimers TLR1/TLR6, TLR2/TLR6, and TLR1/TLR2.

Conclusion. Data on altered proinflammatory potential in the group of sporadic septal CHDs should be taken into account in the postnatal period when conducting cardiac surgery.

Aim. To determine the structural and functional characteristics of the myocardium in young people with different levels of physical activity (PA).

Material and methods. The study included 108 young people without cardiovascular diseases. Seventy-two people were professional endurance athletes (Group A) and 36 were non-athletes (Group non-A). Anthropometric data were evaluated. Transthoracic echocardiography and assessment of left ventricular (LV) longitudinal, radial and circumferential strain, as well as LV twisting, were performed. PA level in non-A group was determined using International Physical Activity Questionnaire (IPAQ).

Results. PA level <600 MET-min/week was revealed in 22,3% of participants, moderate PA (from 600 to 1500 MET-min/week) — in 41,7%, and high (3000 MET-min/week) — in 36% of participants of inactive, moderately active and highly active subgroups, respectively. Group A daily PA level was ~15000 MET-min/week. In non-A group, there were no significant differences in echocardiographic parameters in subgroups with different PA levels. Significant differences with group A were revealed. LV diastolic function was within the normal range in all subgroups. The E/A ratio was higher in subgroups with higher PA (maximum in subgroup A). Significant differences were observed between inactive (p=0,027) and athletes/moderately active (p=0,017) subgroups. Longitudinal, radial and circular strain characteristics did not differ in A and non-A groups and were within normal range.

Conclusion. In young people without cardiovascular diseases with PA ranges from extremely low to those recommended by WHO, the structural and functional myocardial characteristics were within age normal range and significantly differed from those of professional athletes. In professional athletes, these parameters also remained within the age normal range. Myocardial strain characteristics were within the normal range in all participants

The development of guidelines for the detection and further management of patients with anxiety for outpatient physicians is relevant due to the high incidence of anxiety disorders in patients with non-communicable diseases, including cardiovascular diseases, deterioration in quality of life and an increase in adverse outcomes in patients with anxiety. In addition, there is an insufficient awareness of outpatient doctors about the importance of diagnosing and treating anxiety disorders. The aim was to present original "Algorithms for the Management of Patients with Anxiety in the Internist’s Practice" for the detection and timely treatment of anxiety disorders in the routine practice of an internal medicine doctor. The algorithms are intended for internal medicine specialists working in primary outpatient healthcare, as well as for residents.

Aim. To evaluate the clinical characteristics and frequency of prescribed anticoagulant therapy for patients with atrial fibrillation (AF) and heart failure (HF) in subjects of the Russian Federation based on a retrospective big data analysis using artificial intelligence technologies.

Material and methods. For retrospective analysis, information was obtained from the Webiomed predictive analytics platform, which includes depersonalized data from electronic health records of outand/ or inpatients in 6 subjects of the Russian Federation, extracted using artificial intelligence technologies. From the database of patients with AF (n=144431), a group of individuals (n=20970) with an established diagnosis of HF and information on left ventricular ejection fraction (LVEF) was selected.

Results. Patients with AF and HF (men, 43,7%; age 72,1±13,2 years; LVEF, 58,9±11,0%) had a history of smoking in 36,6% of cases, hypertension — in 86,7%, type 2 diabetes — in 26,6%, gout — in 2,7%, stage III and IV-V chronic kidney disease — in 50,9 and 15,6%, lower limb peripheral arterial disease — in 15,8%. The incidence of ischemic stroke, LV myocardial infarction and pulmonary embolism was 8,8, 14,7 and 2,4%, respectively. Anticoagulants, including direct oral ones, were administered to patients with AF and HF in 62,5% and 32,0% of cases, respectively. The frequency of their appointment did not significantly differ depending on LVEF.

Conclusion. Patients with AF and HF are characterized by significant comorbidity, a higher incidence of cardiovascular events compared with the group of individuals with AF without HF, and an unsatisfactory percentage of anticoagulant therapy.

Aim. To evaluate the effectiveness of a novel approach to follow-up monitoring of patients with lower extremity peripheral artery disease (PAD) using telemedicine technologies.

Material and methods. The study included 175 patients (mean age, 68,1±7,7 years). Two following groups of patients were formed: the main group (n=86), which used an optimized monitoring program using telemedicine techniques, and the control group (n=89), which assumed traditional monitoring by a cardiologist and a vascular surgeon. The mean follow-up period was 11,77±1,5 months. The optimized monitoring program included the implementation of audio communication with patients by an employee with a secondary medical education with an assessment of the current health status according to original unified questionnaire, with the definition of personalized management tactics. At the primary and final stages, the patient underwent an assessment of clinical and anamnestic data, mental and cognitive status, and compliance.

Results. At the final stage, uncompensated hypertension was revealed in 36,0% and 49,4% (p=0,0001), smoking — in 30,6% and 42,9% (p=0,05) in the main and control group, respectively. In the main group, a greater pain-free walking distance was revealed — 625,8±395,3 m (control group — 443±417 m (p=0,013)). The average systolic blood pressure was 125,2±10,2 mm Hg and 138,8±15,8 mm Hg (p=0,0001) in the main and control group, respectively. In the control group, a greater number of patients with a high level of personal and situational anxiety were revealed (p=0,05). In the main group, a higher level of adherence to therapy was established at the final study stage (p=0,001).

Conclusion. The optimized monitoring program for patients with limited mobility is effective and can be implemented in practical healthcare for patients with lower extremity PAD.

In an ever-changing information flow on coronavirus disease 2019 (COVID-19) pandemic, we describe a case series of mitral valve chordal rupture (MVCR) in non-comorbid middle-aged men that occurred over a period of 3 to 5 weeks after Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection. With significant advances in the prevention of acute rheumatic fever, the treatment of bacterial endocarditis and acute coronary syndrome, acute mitral regurgitation has become a relatively rare diagnosis. During the pandemic, there has been a surge in the incidence of spontaneous MVCR, and new data on the problem are accumulating. The presented case series are united by the fact that the infection symptoms were mild, followed by signs of probable endomyocarditis, unrecognized in time, and acute mitral valve regurgitation developed against the background of physical provocation (exercise and cough). Two patients had previously been diagnosed with mitral valve prolapse (myxomatous degeneration and connective tissue disease). Two patients were successfully operated on in different clinics. The described cases emphasize that the consequences of inflammation persistence may be more severe than the primary viral damage, which determines the importance of a comprehensive examination and long-term follow-up. To date, the differential diagnosis of patients with sudden onset of dyspnea and chest pain associated with an infectious process should include MVCR.

Bioprosthetic valve dysfunction represent a serious drawback that limits the wider clinical use of these medical devices for valvular heart disease surgery. Modern studies describe the view of pathophysiologists on this problem as a multifactorial multi-stage process that causes irreversible changes in bioprosthesis components, ultimately leading to its dysfunction. However, in addition to under- standing the causes and manifestations of prosthetic valve dys- function, an applied question arises about the treatment strategies — determining the most attenuated and accessible low-risk method/ device. The aim of this review was to analyze and systematize current literature data on methods and designs used in repeated surgical and transcatheter interventions on heart valves.