Failure to achieve blood pressure targets and insufficient control are important cardiology problems that remain relevant despite well-defined and generally available modern algorithms for the treatment of hypertension (HTN) and the availability of effective antihypertensive drugs. The level of hypertension control in Russia remains quite low and is 14,1% for men and 30,9% for women. The generally recognized most important factor determining the low blood pressure control is non-compliance with antihypertensive therapy, which, in turn, determines the high percentage of uncontrolled HTN among patients. The review discusses the most common causes of low adherence to treatment. Particular attention is paid to the doctor’s ability to remove barriers to adherence and errors in the choice of therapy, including insufficient prescribing of fixed-dose combinations. The review presents a modern view on the significance of combined antihypertensive therapy. Atten­tion is focused on fixed-dose combinations of antihypertensives, the use of which significantly increases adherence to therapy, and the unique properties and effectiveness of lisinopril, amlodipine and indapamide are described.

Aim. To compare the efficacy and safety of chemical cardioversion (CCV) with refralon and amiodarone in patients with paroxysmal atrial fibril­lation and flutter (AF/AFL).

Material and methods. Fifty five patients (mean age, 65±11 years) with paroxysmal AF/AFL were included. All patients underwent a preliminary examination to rule out contraindications to CCV. Further, patients were randomized into groups of refralon (n=30) and amiodarone (n=28), respectively. CCV with refralon was carried out as follows: administration in doses of 5-5-10-10 µg/kg at intervals of 15 minutes. Patients of the second group were intravenously injected with amiodarone at a dose of 5 mg/kg of body weight for 20-60 minutes, depending on the drug tolerability. If AF/AFL persists after 60 minutes, infusion of amio­darone 100 mg/hour until restoration of sinus rhythm (SR) or reaching a dose of 1200 mg/day. Treatment efficacy was assessed by SR reco­very, absence of AF/AFL recurrence, and arrhythmia relief time, and safety was assessed by detection of ventricular arrhythmogenic effects, bradyarrhythmias, blood pressure reduction, and QT interval prolongation. The follow-up period lasted 24 hours.

Results. SR was restored in 96,7% (n=29) of patients in the refralon group, of which 56,7% (n=17) after a dose of 5 mcg/kg. In the amio­darone group, SR was restored in 57,1% (n=16) of patients (p<0,001). The arrhythmia relief time in the refralon group was 14 [7;23] min, while in the amiodarone group — 150 [82;240] min (p<0,001). There were no significant differences in the incidence of bradyarrhythmias, lowering blood pressure, and QT prolongation in the groups.

Conclusion. Refralon demonstrates a higher efficiency and lower time to AF/AFL relief compared with amiodarone, while in most patients, SR recovery occurs after the administration of the lowest doses, which ensures CCV safety.

Aim. To assess the relationship between the left atrial (LA) and pul­monary vein (PV) effective refractory period and the development of early atrial fibrillation (AF) recurrence after radiofrequency pul­monary vein isolation (PVI).

Material and methods. The study included 35 patients with persistent AF refractory to antiarrhythmic therapy (AAT). In all patients, LA and PV effective refractory period (ERP) was assessed, followed by radiofrequency antral PVI. Depending on the ERP values, the patients were divided into 2 groups. Group 1 (n=15) included patients with mean LA and PV ERP values ≥240 ms, while group 2 (n=20) consisted of patients with mean LA and PV ERP values <240 ms. The evaluation of early AF recurrence, depending on the obtained ERP values, was carried out in the first 3 months.

Results. We obtained following ERP values: group 1 — LA (LA ap­ pendage) 252±8,9 ms; left superior PV (LSPV) — 252±12,1 ms; left inferior PV (LIPV) — 257,3±8,15 ms; right superior PV (RSPV) — 254,6±11,3 ms; right inferior PV (RIPV) — 260±9,05 ms; group 2 — LA 230±12,1 ms; LSPV — 205±10,5 ms; LIPV — 186,6±22,05 ms; RSPV — 212,2±14 ms; RIPV — 218,8±11,1 ms. During the 3-month follow-up of group 1 patients, there were no recurrences after PVI. Group 2 had 7 early AF recurrences. Correlation analysis revealed a significant inversely proportional relationship (-0,349; p=0,03) between ERP values and the recurrence rate in the groups.

Conclusion. The first results demonstrate an inversely proportional relationship between the mean PV and LA ERP and the development of early AF recurrence, which makes it possible to consider the PV and LA ERP <240 ms as a likely predictor of early AF recurrence. However, this fact requires the study continuation with an increase in the sample and an appropriate statistical analysis.

Aim. To evaluate the detection rate of carotid artery stenosis (CAS) based on the diagnosis code according to the International Clas­sification of Diseases of 10th revision (ICD-10), used in appointment card for carotid duplex ultrasound.

Material and methods. To conduct this study, the Duplex-2013 registry database was used, which sequentially included 2548 patients. When referring to carotid duplex ultrasound, all patients indicated the ICD-10 diagnosis code as the main reason for seeking medical help. The study assessed the presence and severity of CAS, the probability of CAS, taking into account age, sex, and referral diagnosis according to ICD-10.

Results. According to the results of a univariate analysis, the following referral diagnoses were associated with the identification of CAS by two criteria (stenosis ≥20 and ≥50%): generalized/peripheral atherosclerosis (GPA) — odds ratio (OR), 6,54; 95% confidence interval (CI): 2,71-18,89 (p<0,001) and OR, 11,91; 95% CI: 6,17-22,75 (p<0,001), postinfarction cardiosclerosis — OR, 5,63; 95% CI: 2,62-13,6 (p<0,001) and OR, 3,08; 95% CI: 1,39-6,28 (p=0,004), CAS — OR, 3,26; 95% CI: 2,08-5,27 (p<0,001) and OR, 2,29; 95% CI: 1,25-3,96 (p=0,006) and hypertension, OR, 2,2; 95% CI: 1,87-2,58 (p<0,0001) and OR, 1,45; 95% CI: 1,07-1,97 (p=0,02). Taking into account age and sex, the probability of CAS detection (>20%) is associated with HTN — OR, 1,43; 95% CI: 1,19-1,71 (p<0,001), postinfarction cardiosclerosis — OR, 2,89; 95% CI: 1,20-6,94 (p=0,01) and GPA — OR, 4,52; 95% CI: 1,65-12,35 (p=0,003); CAS >50% — acute myocardial infarction — OR, 8,45; 95% CI: 1,32-53,97 (p=0,02) and GPA — OR, 9,82; 95% CI: 4,81-20,04 (p<0,001).

Conclusion. Certain groups of referral diagnoses (ICD-10 codes) are associated with a higher probability of CAS. The obtained data needs to be refined in order to optimize routing and referral for carotid duplex ultrasound.

Aim. Based on the results of a sociological survey of patients, to assess quality and availability of health care for cardiovascular diseases (CVDs) in 2020-2021 in the Russian Federation.

Material and methods. In August-September 2021, 5159 patients with CVDs from 76 Russian regions were interviewed. Questionnaire (Google form) assessed the change in health care provision over the past two years, the availability of medicine provision, the prevalence and reasons for discontinuation of treatment, as well as the difficulties faced by patients.

Results. Improvement in health care provision were assessed by 47,6% of the surveyed patients with CVD, worsening — by 16,6%, and 23,7% did not noted any changes. Improvements regarded diagnosis promptness (29%) and timeliness of treatment (28,5%), availability of subsidized medicines (25%) and better patient routing (21%). However, 37% of respondents did not see any improvements in health care system, or found it difficult to answer. The acute problem of access to diagnostics was considered by 24%, inaccessibility of subsidized medicines — by 17%. In addition, 24% of respondents had difficulties in obtaining specialized cardiology care in the polyclinic and 18% had difficulty in obtaining high-quality medical rehabilitation for CVD.

Conclusion. In order to increase public satisfaction with the quality of care, public awareness on health maintenance and patients’ rights to receive care should be improved. In addition, possible barriers to obtaining health care should be eliminated, while consultative and diagnostic assistance and subsidized drug provision should be facilitated for receiving.

Aim. To compare clinical characteristics of patients with atrial fibrillation (AF) depending on renal filtration function based on a retrospective analysis of data in individual subjects of the Russian Federation (RF).

Material and methods. The information was taken from the Webiomed predictive analytics platform, including 80775 patients with AF (men, 42,5%, mean age, 70,0±14,3 years) who underwent outpatient and/or inpatient treatment in medical organizations in 6 Russian subjects in 2016-2019 with data on blood creatinine levels. For comparative analysis, the ranges of estimated glomerular filtration rate (eGFR) were selected: ≥60 ml/min/1,73 m², 30–59 ml/min/1,73 m², and <30 ml/min/1,73 m².

Results. The analysis showed that 45128 (55,9%) patients were characterized by eGFR <60 ml/min/1,73 m², of which in 35212 (78%) patients eGFR was in the range of 30-59 ml/min/1,73 m², in 9916 (22%) — <30 ml/min/1,73 m². Patients with eGFR <60 ml/min/1,73 m² compared with those with eGFR ≥60 ml/min/1,73 m² were older (75,4±10,9 vs 63,0±15,2 years, p<0,001), had higher incidence of ischemic stroke (IS) (10,9 vs 6,5%, p<0,001), myocardial infarction (MI) (11,5 vs 7,7%, p<0,001) and intracranial hemorrhage (ICH) (1,0 vs 0,7%, p<0,01), as well as higher rate of anticoagulant therapy (ACT) (47,0 vs 33,2%, p<0,001). Men and women with eGFR of 30-59 and <30 ml/min/1,73 m² in the age ranges ≤64 years and 65-74 years had a higher incidence of IS and MI compared with patients with eGFR ≥60 ml/min/173 m². The frequency of ICH on warfarin compared with direct oral anticoagulants was significantly higher in the subgroup with eGFR of 30-59 ml/min/1,73 m² (1,1 vs 0,7%, p<0,01).

Conclusion. Patients with AF and eGFR <60 ml/min/1,73 m² are charac­terized by greater comorbidity, a higher incidence of IS, MI and ICH compared with patients with AF and eGFR ≥60 ml/min/1,73 m², while ACT prescription rate as of 2016-2019 in some Russian subjects was unsatisfactory. This emphasizes the need to optimize risk stratification, ACT and algorithms for the prevention of athero­thrombotic events, as well as the development of nephro­protective strategies to reduce the rate of progression of renal dys­function in this cohort of patients.

Aim. To evaluate the diagnostic significance of myocardial contrast stress echocardiography (MCSE) and multimodal contrast stress echocardiography (MMSE) with dosed exercise in detecting hemo­dynamically significant coronary artery stenosis in patients with stable coronary heart disease (CAD) without impaired regional left ventricular contractility at rest.

Material and methods. MCSE and MMSE were performed in 61 pa­­tients with suspected or stable CAD (mean age, 62,9±8,9 years). All patients underwent coronary angiography. During MCSE, perfusion and regional contractility were assessed. With MMSE, regional contractility was assessed. Sensitivity, specificity, and positive (LR+) and negative (LR-) likelihood ratios for MCSE and MMSE were assessed in com­parison with coronary angiography.

Results. The sensitivity of MCSE with perfusion assessment was 82% (CI, 67-92%) with specificity of 70% (35-92%), LR+ — 2,74, LR- — 0,26. Sensitivity of MCSE with assessment of perfusion and regional contractility was 67% (50-81%) with specificity of 90% (65-99%), LR+ — 6,67, LR- — 0,37. The sensitivity of MCSE with an estimate of regional contractility of 74% (58-87%) with a specificity of 90% (56-98%), LR+ — 7,4, LR- — 0,28. The sensitivity of MMSE in the mode of cavitary and myocardial contrasting was 72% (55-85%) with a specificity of 90% (56-99%), LR+ — 7,18, LR- — 0,31.

Conclusion. MCSE with an assessment of regional contractility and MMSE are of diagnostic importance in the detection of CAD, a positive result of which increases the post-test probability of hemodynamically significant coronary artery stenosis. A positive result of MCSE with dosed exercise with isolated perfusion assessment does not have a diagnostically significant effect on the post-test probability of CAD.

The pathological processes associated with obesity are based on impaired energy homeostasis, as well as excessive endocrine and paracrine activity of adipose tissue, leading to inflammation and hormonal imbalance, which is accompanied by the secretion of a wide range of compounds affecting key body processes. One of the indirect methods for assessing the adipose tissue abnormalities is the measurement of the concentration of cytokines, growth factors, as well as a class of specific compounds — adipokines specific to adipose tissue. The study of circulating biomarkers makes it possible to assess their association with the risk of complications, metabolic obesity, and other clinical and functional features. Such markers include adipokines (leptin, adiponectin, apelin, resistin, omentin, visfatin, chemerin, lipocalin, etc.), inflammation biomarkers, heat shock proteins, which are discussed in detail in this review in the context of their use in obesity and concomitant diseases.

The article presents current data on the choice of antihypertensives from the standpoint of patient-centered medicine. The advantages of combined initial therapy includes high medical adherence, achievement of target blood pressure, and organ protection. Data on the effectiveness of a fixed-dose combination of an angiotensin-converting enzyme inhibitor and a thiazide-like diuretic, in particular, the most commonly used angiotensin-converting enzyme inhibitor lisinopril and long-acting indapamide, are presented. This combination is not only highly effective, but also metabolically neutral, which allows it to be used in patients with obesity, diabetes, and liver diseases. Data are presented on the new favorable effects of lisinopril and indapamide, in particular, on the effect of indapamide on the intestinal microbiota. The potential advantages of this combination as an initial therapy for hypertension in Russian patients are described.

Epigenetic therapy for cardiovascular disease (CVD) has received increased attention from the medical community in recent years. Evidence of this is the fact that more and more controlled clinical trials evaluate the beneficial effects of: 1) direct epigenetic drugs, for example, apabetalone, and 2) repurposed drugs with possible indirect epigenetic action, for example, metformin, statins, sodium-glucose transport protein 2 (SGLT2) inhibitors and omega-3 polyunsaturated fatty acids (PUFAs) in CVD, including heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Apabetalone is the first and unique direct-acting epigenetic drug tested in patients with CVD, and the BETonMACE study showed a reduction in first hospitalization for HF (at any EF) and CVD mortality in patients with type 2 diabetes (T2D) and recent acute coronary syndrome, suggesting a possible role for this drug in secondary prevention. Patients with HFpEF appear to benefit from the addition of metformin and SGLT2 inhibitors to standard statin therapy due to their ability to reduce the death risk. In contrast, hydralazine with or without isosorbide dinitrate produced no beneficial effects. In HFrEF, metformin and SGLT2 inhibitors may reduce the risk of HF and death, while clinical trials with statins have mixed results. PUFA supplementation was associated with a significant reduction in car­diovascular risk in both HFrEF and HFpEF. However, definitive data on the benefits of direct and indirect epigenetic therapy for CVD can only be obtained from large clinical trials in the future. The purpose of this review was to provide updated information on epigenetic therapy for CVD obtained from clinical trials.