Aim. To compare standardized mortality rates (SMR) from acute types of coronary artery disease (CAD) and sudden cardiac death (SCD) with an assessment of their regional variability in the Russian Federation in 2019-2021.

Material and methods. Rosstat data on the average annual population and the number of deaths in one-year age groups for 2019-2021 in 82 Russian subjects from acute types of CAD and SCD were analyzed using following ICD-10 codes: I21.0-9 (acute primary) myocardial in­­farction (MI), I22.0-9 (recurrent MI), I20, I24.1-9 (other forms of acute coronary artery disease), I46.1 (SCD). SMR was calculated based on the European standard per 100,000 population. Average regional SMR values (M±SD), coefficients of variation (СV), nonparametric Wilcoxon T-test with Bonferroni adjustment were calculated (differences were considered significant at р<0,05).

Results. The average regional values of SMR from the sum of causes (acute types of CAD and SCD for 2019, 2020 and 2021) did not change significantly and amounted to 52,3±33,72; 53,84±36,17; 53,58±34,55, respectively. The annual increase in the average regional SMR for this period was noted from acute MI — 23,59±11,01; 24,85±10,92; 25,73±11,38, and other OF CAD — 19,47±26,17, 19,78±27,45; 20,54±26,79, respectively, in 2019, 2020 and 2021. A significant decrease in SMR occurred only from recurrent MI: from 7,19±5,38 to 6,97±5,97 in 2019-2020 (p=0,048) and to 4,99±4,25 in 2021 (p=0,023 to 2020). In 18 constituent entities of the Russian Federation, an annual decrease in SMR was noted, and in the rest — multidirectional changes. The increase in SMR from acute MI took place in 23 subjects of the Russian Federation with a minimum CV in 2020 and 2021 (44%). The maximum CV for SMD was recorded in 2021 (169%).

Conclusion. Mortality from acute types of CAD and SMD for 2019-2021 in the Russian Federation was characterized by a stable level and high regional variability. The problem of improving the criteria for establishing acute types of CAD and SMD as the initial cause of death remains relevant in the absence or insufficiency of data for universal criteria for MI.

Aim. To study clinical and paraclinical parameters and lesions of the coronary bed in patients with acute types of coronary artery disease (CAD) and type 2 diabetes (T2D).

Material and methods. The study included 102 patients of both sexes with acute CAD. Patients were analyzed in two following groups: the first (mean age, 56,6±0,96 years, men/women 34/16) consisted of 50 patients with acute coronary syndrome (ACS) and type 2 diabetes, the second (mean age, 58,7±1,01 years, men/women 37/15) — 52 patients without T2D. Along with the assessment of behavioral and biological risk factors for CVD, clinical and hemodynamic parameters and the results of coronary angiography were analyzed.

Results. In patients with ACS and T2D, the duration of T2D was 5,6±3,7 years. Somatic comorbidities were registered in 74% in the first group, and in 53,8% in the second. According to echocardiography, in the group of people with ACS and T2D, the left ventricular ejection fraction was lower, and the mean pulmonary artery pressure was higher compared to the group without T2D. Stenosis of the distal coronary artery third in patients with T2D occurred in 78% of cases, and in patients without T2D — in 42%; the differences were significant (p<0,001). Diffuse CAD also prevailed in the first group and amounted to 58%, and in the second — 27%. The SYNTAX score was higher in patients with T2D compared with the group of people without T2D — 29,2 and 22%, respectively (p<0,001).

Conclusion. In patients with ACS and T2D, the prevalence of pulmonary hypertension and left ventricular systolic dysfunction was revealed. The features of the coronary flow in patients with T2D with ACS were predominantly the distal type of lesion, as well as an increased risk of angioplasty complications, assessed using the SYNTAX score.

Growth differentiation factor 15 (GDF-15) is a circulating protein that is associated with various pathological conditions.

Aim. To study the relationship between the level of GDF-15 and labo­ratory, clinical and functional parameters of patients with coronary artery disease (CAD).

Material and methods. All patients with coronary artery disease under­went a general clinical examination, coronary angiography, extrac­ranial artery ultrasound examination, echocardiography, deter­mi­nation of the serum level of GDF-15 (ng/ml) and matrix metal­lopro­teinase 9 (ng/ml). Statistical processing of the obtained results was carried out using the Statistica 10.0 software.

Results. The study included 88 people (55 men and 33 women), 78 of whom were patients with an established diagnosis of CAD and 10 were healthy volunteers (control group). In the group of CAD patients, the median level of GDF-15 was 4,98 ng/ml [3,15; 8,24], while in the cont­rol group — 1,95 ng/ml [0,01; 2,45]. An association of GDF-15 con­centration with the age of patients was found (r=0,44; p<0,001). There was a direct correlation between the level of GDF-15 and interventricular septal thickness (r=0,33; p<0,05), heart failure stage (Strazhesko-Vasilenko classification) (r=0,23; p<0,05), the concentration of matrix metal­loproteinase 9 (r=0,24; p<0,05), carotid intima-media thickness (r=0,28; p<0,05), the number of coronary arteries that required revas­cularization during coronary artery bypass grafting (r=0,52; p<0,05), and multifocal atherosclerosis (r=0,23; p<0,05). In patients with athero­sclerotic lesions in 2 or 3 vascular beds, the level of GDF-15 was signifi­cantly higher than in patients with CAD (p<0,05).

Conclusion. The results obtained demonstrate the value of GDF-15 as a potential marker of atherosclerotic vascular changes, the severity of myocardial hypertrophy, and the severity of heart failure.

Aim. The study of the structural and functional properties of arteries in patients after a coronavirus disease 2019.

Material and methods. The study included 113 people: 45 people who were examined before the start of the COVID-19 pandemic, healthy individuals who had COVID-19 (n=44), 24 patients with hypertension (HTN) in combination with prior COVID-19. In the individuals included in the study, the blood tests were performed, while the carotid arteries were evaluated using high-RF signal technology, applanation tonometry, volume sphygmography, and a test with post-occlusive reactive hyperemia were performed.

Results. According to the study of carotid arteries, significant differences were registered between groups of healthy individuals (with and without a history of COVID-19) and HTN patients after COVID-19. According to the applanation tonometry in patients with hypertension and COVID-19 in history, aortic pressure and carotid-femoral pulse wave velocity significantly exceeded those in cohorts of individuals without cardiovascular diseases. According to the results of volume sphygmography in the group of patients after COVID-19, signs of early vascular aging were revealed, and the maximum values of these indicators were recorded in the group of hypertensive patients.

Conclusion. The results obtained in the course of this study make it possible to state an increase in the arterial stiffness in people after COVID-19, which can be regarded as a sign of early vascular aging.

Aim. To study the potential of predicting thrombosis of the left atrium (LA) and/or LA appendage (LAA) before catheter ablation (CA) or elective cardioversion in patients with nonvalvular atrial fibrillation (NAF) or atrial flutter (AFL) using indicators available in routine practice.

Material and methods. In this single-center retrospective study, the medical records of 1994 patients with nAF or AFL for the period 2014-2019 were analyzed, who underwent transesophageal echocardiography before CA or elective CV. LA/LAA thrombus was found in 33 (1,6%) patients. For the comparison group, 167 patients were randomly selected without LA/LAA thrombosis. Demographic, anamnestic, clinical, laboratory data, results of transthoracic echocardiography, as well as the CHA₂DS₂-VASc-RAF (CHA₂DS₂-VASc plus 2 points for an estimated glomerular filtration rate <56 ml/min/1,73 m², 4 points for persistent AF (lasting >7 days), 10 points for persistent AF).

Results. The mean age of the patients was 60,3±10,9 years (men, 55%). There were more patients with NAF (87,5%), hospitalized for CV (84,0%). Multivariate analysis revealed that the severity of symptoms associated with arrhythmia was associated with the detection of a LA/LAA thrombus (odds ratio (OR) for EHRA class 3-4 14,29 at 95% confidence interval (CI): 3,3-61,8; p<0,0001), left ventricular ejection fraction <48% (OR, 7,83; 95% CI: 1,2-53,05; p=0,035) and total CHA₂DS₂-VASc-RAF score (OR, 1,29 at 95% CI: 1,08-1,5; p=0,004). Sup­ple­mentation of the CHA2DS2-VASc-RAF with new independent predictors of LA/LAA thrombosis did not lead to a significant increase in the area under the characteristic curve, which was 0,83 (95% CI: 0,76-0,91) and 0,87 (95% CI: 0,80-0,94), respectively (p=0,13). The OR of LA/LAA thrombosis with a total score CHA₂DS₂-VASc-RAF >3 was 12,8 (95% CI: 3,8-43,9; p<0,0001), while the sensitivity, specificity, positive and negative predictive value — 90,6, 57,1, 30,2 and 96,7% respectively. The OR of thrombosis of LA/LAA with a CHA₂DS₂-VASc-RAF score >8 was 25,8 (95% CI: 5,9-112,3; p<0,0001), while sensitivity, specificity, positive and negative predictive value — 93,5, 64,0, 34,9 and 97,9%, respectively.

Conclusion. When predicting LA/LAA thrombosis, detected during transesophageal echocardiography before CA or elective CV in patients with NAF or AFL who did not have a pronounced structural heart pathology and severe concomitant diseases, taking into account the severity of symptoms associated with arrhythmia and a reduced left ventricular ejection fraction (<48%) in addition to the risk stratification scale for LA/LAA thrombosis CHA₂DS₂-VASc-RAF did not lead to an increase in the area under the characteristic curve, but made it possible to increase the OR of LA/LAA thrombosis detection by 2 times and increase the sensitivity, specificity, positive and negative predictive value.

Aim. To determine the clinical, morphological, and biochemical pre­dictors of substrate-specific, non-vein-dependent atrial fibrillation (AF) by morphological and immunological examinations in patients with recurrent AF after pulmonary vein (PV) isolation.

Material and methods. The study included 100 people (58 men and 42 women) with paroxysmal (n=89) and persistent (n=11) AF with a mean age of 58,2±9,4 years. After the primary operation, 15 people withdrew from the study due to refusal of reintervention, and 1 person withdrew due to suppuration of loop recorder bed and its explantation. A total of 100 patients underwent primary cryoballoon PV isolation with myocardial biopsy from the interventricular and interatrial septa, while 60 patients had subsequent hematoxylin-eosin and Van Gieson stains. Also, 100 patients were simultaneously implanted with ECG loop recorders for AF monitoring and blood was taken (before the intervention) for subsequent analysis of inflammation markers and antimyocardial antibodies. Patients underwent clinical observation during the year (visits after 3, 6, 12 months). Patients with relapses were referred for repeat electrophysiological examination and segmental ablation if PV ruptures were detected. After repeated intervention, the follow-up period was extended for a year with the same schedule of visits. According Two groups of patients were formed: without relapses (vein-dependent AF, group I) and with relapses (non-vein-dependent AF, group II), despite the achieved PV isolation as a result of 1 or 2 operations.

Results. An analysis of morphological changes showed that an increase in AF recurrence risk by an average of 6,14 times (95% confidence interval: 1,14-47,6 (p=0,0462)) is associated with stage 2 interventricular septal fibrosis. Lymphocyte infiltration of the interventricular septum was associated with higher AF recurrence by an average of 9 times (95% confidence interval: 0,89-95,37) (p=0,0519).

Among the laboratory parameters, a significantly higher concentration of the N-terminal pro-brain natriuretic peptide and a significantly lower concentration of antimyocardial antibodies were found in the group of patients with recurrent AF after LV isolation (p=0,0101).

Conclusion. Inflammatory myocardium changes are an important link in the pathogenesis of AF and are associated with its recurrence.

Aim. To assess the significance of troponin I (hs-cTnI) for cardio­vascular risk stratification in a population of Russian working-age men and women of.

Material and methods. The data of 13976 men and women aged 25-64 from the ESSE-RF1 and ESSE-RF2 multicenter studies were analyzed. The examination included following points: standard questionnaire, measurements of height, weight, waist circumference, body mass index, blood pressure, pulse rate, biochemical tests. The level of hs-cTnI in blood serum samples stored at -70^оC in the Biobank of the National Medical Research Center for Therapy and Preventive Medicine was determined by chemiluminescent immunoassay analysis. Individual cardiovascular risk was calculated using the SCORE scale: values <1% — low risk; 1-4% — moderate, 5-9% — high and ≥10% very high. Similar to the BiomarCaRE study, participants were divided into 3 sex-adjusted cTnI levels: men <6, 6 to 12, and >12 pg/ml; women <4, 4 to 10, and >10 pg/ml. We analyzed following hard endpoints: cardiovascular death or non-fatal myocardial infarction, and composite endpoint: the same and stroke.

Results. The prospective analysis of the relationship between troponin levels and endpoints and composite endpoints showed that in participants without prior CVD, hs-cTnI levels >12 pg/ml in men and >10 pg/ml in women are associated with an increased risk of endpoints and composite endpoints by 3,39 (1,91-6,03) and 2,69 (1,6-4,52) times (p<0,001), respectively. Similarly to BiomarCaRE, the SCORE-calculated risk reclassification was validated by adding the hs-cTnI value. The net reclassification improvement index (NRI) for endpoints and composite endpoints was 13% and 11% (p<0,001), respectively. Among men, the reclassification for NRI composite endpoints was more accurate than among women: 19% and 11%, respectively.

Conclusion. The hs-cTnI level is an independent predictor of myo­cardial infarction, stroke, and death from CVD in people aged 35-64 years without prior CVD. Adding the hs-cTnI level to the SCORE model makes the risk prediction more accurate.

Aim. To compare survival at a 30-year follow-up in the populations of Russia and USA.

Material and methods. From the Russian studies of 1975-1982, 14728 men and 6140 women aged 18-71 years were included, with follow-up until 2017 (501016 person-years of follow-up). In addition, 2265 men and 2345 women aged 18-71 years from the US population (The Third National Health and Nutrition Examination Survey) were compared with survey data in 1988-1994, with mortality follow-up until 2019 (115523 person-years of follow-up). Kaplan-Meier curves were created in groups of men and women aged 18-29, 30-39, 40-49, 50-59, 60-71 years old. All-cause death was taken into account as an outcome. We analyzed the prevalence of a number of cardiovascular risk factors.

Results. Comparison of Kaplan-Meier curves in Russia and USA shows significant differences in all five age groups of men; in Russia the prognosis was worse (p=0,000). In women, significant differences of the same direction appear only at the age of ≥60 years (p=0,003). Comparison of the prevalence of risk factors showed that in Russia hypertension occurs several times more often than in the United States, while the differences are significant in all age groups of men and women.

Conclusion. At a 30-year follow-up, the prognosis for Russia is worse compared to the United States for all age groups of men and for women >60 years of age.

Aim. To assess the features of diagnosing heart failure with preserved ejection fraction (HFpEF) using echocardiographic markers and diastolic stress test (DST) according to a survey of ultrasound and functional diagnostics specialists in the Russian Federation.

Materials and methods. As part of the study, an anonymous survey of 155 ultrasound and functional diagnostic specialists from various Russian regions was conducted. We proposed to answer whether they routinely assess certain echocardiographic parameters necessary for diagnosing HFpEF. The specialists also indicated whether they conduct DST and whether they have the opportunity to refer the patient to this study.

Results. A frequency analysis of the responses received was carried out. In routine practice, 83,2% of specialists measure the left ventricular (LV) ejection fraction by Simpson method, 76,1% — by Teichholz method. In addition, 80% of responders analyses LV mass index, 76,1% — relative LV wall thickness, 60% — tricuspid annular plane systolic excursion, 56,8% — left atrial volume index, 51.6% — E/e´ ratio, 94,8% — pulmonary artery systolic pressure, left ventricular global longitudinal strain — 16,1%, 7,7% — left atrial longitudinal strain. Also, 9,7% of specialists conduct DST on their own, while 41,3% have the opportunity to refer patients.

Conclusion. The low assessment rate of some ultrasonic HFpEF mar­kers and DST among functional diagnostics specialists in the Russian Federation reduces the detection rate of HFpEF. It is necessary to develop diagnostic algorithms based mainly on clinical and anam­nestic data and available for use by doctors of any specialty.

Aim. To evaluate the impact of cardiac resynchronization therapy (CRT) on the risk of sustained ventricular tachyarrhythmias (VT) in patients with heart failure (HF) with a implantable cardioverter-defibrillator (ICD) for the primary prevention of sudden cardiac death.

Material and methods. This single-center prospective clinical study included 470 patients (men, 84%) with HF at the age of 57 (51-62) years with a left ventricular ejection fraction (LVEF) of 29 (25-33)%. There were following exclusion criteria: indications for cardiac surgery, known channelopathies, previously registered VT. Depending on intraventricular conduction disorders, dual-chamber ICDs (42%) or CRT-D (58%) were implanted. After ICD implantation, patients were followed up for 24 months to register the end point — a first-time sustained paroxysm of VT detected by the ICD. A positive response to CRT was established in the case of an increase in LVEF by ≥5% of the initial level.

Results. A total of 388 patients underwent full postoperative follow-up. The studied arrhythmic endpoint occurred on average 21 (0,6) months after implantation in 104 patients (27%) with higher frequency in the ICD group. However, the differences in the VT rate in the study groups were statistically unreliable (30% in the ICD group versus 24% in the CRT-D group, p=0,142). It was found that the VT rate was reliably lower in CRT-responders (118 patients, 53%): 15% compared to 32% in the group of inefficient CRT. A 5% increase in the LFEF reduced the probability of VT occurrence by 3 times (odds ratio [OR]=0,34; 95% of CI: 0,13-0,86; p=002). Significant modification of arrhythmic risk was verified by increasing LFEF to 36-40% (OR=0,72; 95% CI: 0,63-0,82; p=0,04).

Conclusion. The results obtained indicate that effective CRT has the potential to modify arrhythmic risk in patients with HF, especially with an increase in LVEF to the level of 36-40%.

Despite advances in diagnosis and treatment, heart failure (HF) still remains one of the unsolved problems of modern cardiology. The appearance and progression of HF is preceded by the development of maladaptive myocardial remodeling. In this regard, the search for new molecules for therapeutic action aimed at preventing myocardial remodeling is of undoubted interest. In this context, the galaninergic system seems to be a promising target. To date, evidence has been accumulated that activation of the galaninergic system leads to an increase in cardiomyocyte protection in the early stages after myocardial injury. It has been shown that galaninergic cascades can influence myocardial remodeling, including cell death, cardiomyocyte hypertrophy, and fibrosis. Various experimental models of heart damage showed that under stress conditions and the action of galanin and its derivatives, carbohydrate metabolism in cardiomyocytes improved, oxidative stress decreased due to antioxidant effect, and hyperproduction of reactive oxygen species by mitochondria decreased. Data were also obtained that galaninergic cascades prevent cardiomycyte hypertrophy by suppressing the expression of some fetal genes. This review article describes the currently studied cellular and molecular effects of galanin on the cardiovascular system, as well as data on the role of the galaninergic system in the pathogenesis of myocardial remodeling.