Aim. To study the functional state of the terminal arteries and arterioles of the skin using photoplethysmography (PPG) in men with hypertension (HTN) of low and moderate cardiovascular risk (CVR) and to identify morphofunctional diagnostic criteria associated with HTN.

Material and methods. A total of 118 healthy men (30-60 years old) underwent clinical and biochemical blood tests, PPG, ultrasound of cardiac and main arteries, 24-hour blood pressure monitoring. According to 24-hour blood pressure monitoring, two groups were formed: the control group — 59 normotensive men, HTN group — 59 men with HTN.

Results. According to the PPG data, men with HN had higher normalized augmentation index (Alp75) (3,8 and -5,25%; (p<0,005)), stiffness index (SI) (7,6 and 7,35 m/s) (p<0,05) and reflection index (RI) (36,5 and 28,4%) (p<0,005), respectively. According to multivariate analysis, an increase in RI ≥30,6% (odds ratio, 4,6; p=0,0476) and SI ≥7,9 m/s (odds ratio, 3,69; p=0,019) was significantly associated with HTN. A regression model has been developed that includes age ≥35 years, RI ≥30,6% and SI ≥7,9 m/s, which allows predicting HTN in men with low and moderate cardiovascular risk with a sensitivity of 78% and a specificity of 62,1%.

Conclusion. Men with HTN of low and moderate CVR are characterized by an increase in vascular stiffness, tone of smooth muscle cells, terminal muscular arteries and arterioles, and an increase in pulse wave velocity. The developed model can be used to predict hypertension in these patients and determine indications for further examination.

Aim. To create and train a neural network (NN) of a predictive personalized model of pharmacotherapy choice in patients with heart failure with mildly reduced ejection fraction (HFmrEF) of ischemic origin.

Material and methods. The study included 170 people with HFmrEF of ischemic origin, who on the background standard pharmacotherapy, received a beta-blocker (BB) or BB+mineralocorticoid receptor antagonist eplerenone (EP): bisoprolol (BIS); BIS+EP; nebivolol (NEB); NEB+EP. Patients underwent echocardiography and were analyzed for serum aldosterone (AL), tumor necrosis factor-α (TNF-α), matrix metalloproteinase 9 (MMP-9). To create the NN model, the following approximate predictive function of parameters was used: age, AL, TNF-α, MMP-9, sphericity index (SI), type of pharmacotherapy. The result of this function is a parameter vector: AL, TNF-α, MMP-9, SI and quality of life (QOL). The designed NN model is implemented in the Matlab software package for solving machine learning and Data Science problems. The NN model is represented as a connected graph and NN function. Dichotomous analysis was used to compare the effect of treatment types in pairs. For intergroup comparison of therapy, the Wilcoxon W test method. The critical significance (p) was considered <0,05.

Results. As a result of model inference, the predicted clinical parameters of patients were obtained, depending on the influence of pharmacotherapy type on the levels of AL, TNF-α, MMP-9, and SI. Function approximation of the distribution was constructed. Determination coefficient R2 of approximating functions was ≥0,92. The calculated values for the BIS therapy groups were obtained; BIS+EP — 169,59, 82,30, 15,26 and 52,92; NEB — 186,42, 87,65, 16,10 and 57,22; NEB+EP — 171,17, 71,90, 14,22 and 58,68, respectively. There were following mean values in the vector of initial states (before therapy): AL, MMP-9, TNF-α, and QOL — 205,84, 174,16, 18,32, and 50,71, respectively. The greatest negative changes of AL, MMP-9, TNF-α (p<0,05) was observed in the NEP+EP group.

Conclusion. In the course of the study, using artificial intelligence, a predictive model of a personalized approach to pharmacotherapy choice in patients with HFmrEF of ischemic origin was developed and trained. It has been established that NEP+EP therapy has the greatest effect.

Aim. Retrospective analysis of the clinical characteristics of elderly patients with atrial fibrillation (AF) and long-livers in individual subjects of the Russian Federation using artificial intelligence.

Material and methods. The information was obtained from the Webiomed predictive analytics platform. The main database included 144431 patients with AF who received care in medical organizations in 6 constituent entities of the Russian Federation in the period 2016-2019. Of these, 56830 (39,3%) persons were aged ≥75 years: 47595 aged 75-89 years, 9235 aged ≥90 years.

Results. Patients with AF aged ≥75 years compared with persons aged 18-74 years were characterized by a significantly higher incidence of hypertension, type 2 diabetes, estimated glomerular filtration rate <60 ml/min/1,73 m², heart failure and peripheral atherosclerosis, thromboembolic (TEE), atherothrombotic and hemorrhagic events. The prescription rate of anticoagulant therapy (ACT) was 29,6% and was lower (p<0,001) compared with a subgroup of people with AF aged 1874 years with a high risk of TEE (41,2%). Among patients with AF aged ≥75 years, in 9,4% of cases, no additional (in relation to age and sex) CHA2DS2-VASc points were found, and in 1/3 of individuals there was only one additional points. With an increase CHA2DS2-VASc score in these patients, the ACT prescription rate increased from 13 to 55,5%. The prescription rate of acetylsalicylic acid was 12,8%. Only 33% of people with AF aged ≥75 years who had an ischemic stroke were prescribed ACT.

Conclusion. The retrospective analysis indicates a high proportion of people aged ≥75 years in the structure of all patients with AF. This group is characterized by a significant comorbidity, a high TEE risk, hemorrhagic and atherothrombotic events. At the same time, the ACT prescription rate as of 2016-2019 in individual subjects of the Russian Federation did not meet the requirements of the clinical guidelines.

Aim. To study the level of high-sensitivity C-reactive protein (hsCRP) before coronary artery bypass surgery (CABG) and on days 7-10, as well as to assess the association of perioperative changes in hsCRP with the risk of postoperative atrial fibrillation (POAF).

Material and methods. The study included 80 patients (71 (88,75%) men) who underwent an elective CABG in Cardiac Surgery Department of Sklifosovsky Research Institute of Emergency Medicine. The first episode of POAF was considered an episode of arrhythmia, registered by electrocardiography (ECG), Holter monitoring (HM) or bedside cardiac monitor in the intensive care unit. Depending on the development of atrial fibrillation in the postoperative period, patients were divided into 2 following groups: patients with POAF (n=20), patients without POAF (n=60). The serum level of hsCRP was studied twice: before surgery and 7-10 after CABG in patients of both groups.

Results. Both groups did not differ significantly in the initial concentration of hsCRP (p=0,802). In the postoperative period, patients in both groups showed a significant increase in hsCRP compared with the initial concentration — up to 39,1 [19,6; 64,0] mg/l in the POAF group (p<0,001) and up to 29,3 [19,7; 45,6] mg/l in the group without POAF (p=0,001), but the difference between the groups was not significant (p=0,338). Serum hsCRP concentration at 7-10 days after CABG in patients of both groups was significantly higher than the baseline (p<0,001). However, no association between POAF risk and hsCRP concentration was found (p>0,05).

Conclusion. In patients after CABG, on days 7-10, there is a significantly higher level of hsCRP compared with the initial concentration. There were no significant differences in the level of hsCRP between patients with and without POAF. The POAF of is not associated with an initially elevated level of hsCRP and hsCRP level on days 7-10 after CABG.

Aim. To study the long-term survival of patients with cerebrovascular accident, depending on sex and age.

Material and methods. The outpatient part of the REGION-M registry (patients with cerebrovascular accident, hospitalized in a Moscow hospital) included 684 patients assigned to the City Polyclinic № 64 (Moscow), discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a diagnosis of stroke, which were divided into 5 age groups: group 1 — ≤50 years, n=72 (10,5%), group 2 — 51-60 years old, n=122 (17,8%), group 3 — 61-70 years old, n=156 (22,8%), group 4 — 71-80 years old, n=185 (27,0%) and group 5 — ≥81 years old, n=149 (21,8%). The survival of patients was assessed at the 2nd and 3rd stages after 4,2 (2,4-5,6) and 5,5 (2,4-7,0) years.

Results. The mortality of patients in the long-term follow-up period significantly increased with age. There were following mortality rate for stages 2 and 3 stages: 18-50 years old — 8,3 and 22,2%, 51-60 years old — 18 and 36,9%, 61-70 years old — 41 and 56,4%, 71-80 years old — 54,1 and 73%, >81 years — 76,5 and 87,9% (p<0,0001 for all groups). At stages 2 and 3, mortality among men was higher than among women in groups 2-4, below in group 1 and did not differ in the oldest age group. In multivariate analysis, the following factors had prognostic significance: age — hazard ratio (HR) of death, 1,035 (95% confidence interval (CI): 1,029-1,041, p=0,001), sex — HR, 0,720 (95% CI: 0,43-0,123, p=0,001) and disability before stroke — HR, 0,999 (95% CI: 0,998-1,000, p=0,002).

Conclusion. In long-term follow-up, the mortality of patients with cerebrovascular accident was significantly higher in older age groups, as well as among men.

Familial hypercholesterolemia (FH) is one of the most common monogenic diseases that leads to the early development of atherosclerosis and is characterized by a poor prognosis. However, only about 1% of FH cases are diagnosed in Russia. The aim of this study was to determine the genetic defect in the FH family and conduct DNA diagnostics in the proband relatives. The study was performed on blood samples obtained with the informed consent of the patients. Polymerase chain reaction and polyacrylamide gel electrophoresis were used. We report c.683_684insCTGCAAGGA CAAATCTGACGA pathogenic variant of the low-density lipoprotein receptor (LDLR) gene for the first time in Russia and demonstrate its cosegregation in a family with high blood cholesterol. The c.683_684in sCTGCAAGGACAAATCTGACGA insertion is considered as a probable cause of FH.

Dextrocardia is a rare anatomical anomaly in which the heart resides on the right side. Difficulties in diagnosing coronary pathology in this group of patients can significantly delay the diagnosis and worsen the treatment prognosis. This article presents a rare case of emergency percutaneous coronary intervention for acute ST-segment elevation myocardial infarction in a patient with dextrocardia and left common carotid artery arising from the brachiocephalic trunk. Taking into account the technical difficulties, the option of common femoral artery access during emergency percutaneous coronary intervention for STsegment elevation myocardial infarction in patients with dextrocardia or other anomalies in the location of internal organs and great vessels without confirmed earlier coronary anatomy.

Сritical limb ischemia (CLI) is becoming more and more common among patients worldwide. This is a comorbid condition, which is accompanied by chronic pain, sometimes trophic ulcers and gangrene, as well as a decrease in the quality of life. Despite the chronic nature of ischemia, the absence of treatment is accompanied by a high incidence of limb amputation and death. Patients with lower limb atherosclerosis had the higher risk of cardiovascular events and death. This publication proposes to consider minimally invasive interventional arterial revascularization in a 63-year-old patient with intermittent claudication, stage III critical limb ischemia, with a history of bilateral superficial femoral artery (SFA) stenting. Control lower limb angiography showed bilateral SFA occlusion and thrombosis. Taking into account the restenosis of the previously implanted stent, JET+PCB strategy was considered: first stage — rotational atherectomy followed by SFA angioplasty with a drug-eluting balloon catheter. The correct choice of minimally invasive surgery method in combination with non-pharmacological (smoking cessation, training walking) and pharmacological methods made it possible to restore viability and preserve the lower limb without negative consequences for the patient's health.

Aim. To study the safety and efficacy of Angipure in acute ST-segment elevation coronary syndrome (STE-ACS) and high-risk percutaneous transluminal coronary angioplasty (PTCA) compared with eptifibatide.

Material and methods. The study included 157 patients with STE-ACS. High-risk PTCA included massive or total coronary artery thrombosis, noreflow/slow-reflow phenomenon, and acute stent thrombosis. Fifty-five people received Angipure at a dose of 0,72 mg/kg, 52 — at a dose of 0,40 mg/kg, while 50 patients received eptifibatide (Integrilin). We conducted clinical and laboratory studies, electrocardiography (ECG), coronary angiography.

Results. According to the criteria "Frequency and severity of hemorrhagic events, including hemorrhagic stroke", "Frequency, severity of other adverse events", there were no differences in safety between Angipure at doses of 0,40 and 0,72 mg/kg and eptifibatide. Complaints, clinical symptoms, vital signs, complete blood count, biochemical and coagulation tests, ECG in patients of different groups were similar and had unidirectional dynamics. The use of Angipure or eptifibatide was considered effective if no adverse outcomes (death, recurrent acute ischemic event, need for urgent revascularization) were observed within 30 days. There were no lethal outcomes. One repeated acute ischemic event was registered in each group. In groups of patients receiving Angipure 0,40 mg/kg and eptifibatide, urgent revascularization was required once each.

Conclusion. Angipure and eptifibatide have similar safety and efficacy.

The aim of the review was to analyze the antihypertensive efficacy and safety of sacubitril/valsartan combination, a representative of a new class of angiotensin receptor-neprilysin inhibitors (ARNIs), in patients with hypertension (HTN) according to clinical trials, including randomized, and meta-analyses. Randomized clinical trials conducted in different age, ethnic and clinical cohorts of HTN patients, as well as meta-analyses showed a more significant antihypertensive effect of sacubitril/valsartan compared with monotherapy with angiotensin II receptor blockers, confirmed by office blood pressure (BP) and 24-hour BP monitoring. At grade 1-2 HTN, sacubitril/valsartan showed greater reduction in systolic and diastolic blood pressure by ~5/2 mm Hg compared to valsartan or olmesartan according to 8-12-week studies. A dose-dependent effect of sacubitril/valsartan was established. A favorable experience was obtained with sacubitril/ valsartan use in various clinical variants of HTN (refractory HTN, isolated systolic HTN in the elderly, HTN in combination with heart failure, with chronic kidney disease), as well as the successful use of sac/vals in combination with other antihypertensive drugs. In long-term studies (52 weeks) in elderly patients with HTN, the positive effects of sacubitril/valsartan in reducing central aortic pressure, systolic blood pressure at night and a decrease in pulse pressure have been shown. Several meta-analyses have shown similar tolerability profiles compared to controls and no increased risk of adverse events.

Thrombus aspiration has not shown significant advantages over routine percutaneous coronary intervention in reducing the incidence of major adverse cardiovascular events (MACEs) in the general heterogeneous population of patients with ST-segment elevation myocardial infarction (STEMI). However, it is still practically used in cases of massive coronary artery thrombosis. This review presents the results of studies on thrombus aspiration in patients with STEMI with a focus on favorable outcomes. According to the literature data, thrombus aspiration proved to be effective in following groups of STEMI patients: 1) patients with hyperglycemia; 2) patients with high D-dimer levels; 3) elderly and frail patients. In order to assess the effectiveness of reperfusion, only angiographic characteristics are still used in routine practice, while multimodal imaging methods have not yet become widespread. Moreover, optimal and unified thrombus aspiration protocols have not yet been developed.

The guidelines describe a dashboard designed to monitor and analyze associations of socio-economic and environmental inequality of regions with health indicators.

The guidelines are addressed to managers and employees of health authorities, managers and employees of medical prevention centers, primary care physicians, and also as a teaching material for students of higher medical education institutions, residents and graduate students.

The guidelines contain data on modern approaches to blood pressure assessment, the basic rules for its measurement, data interpretation, making conclusion, including with combined evaluation of clinical and ambulatory measurement data. Information on the diagnosis of hypertension, evaluation of the effectiveness of antihypertensive therapy using clinical and ambulatory blood pressure measurement, both with their separate and combined use, is reflected. Aspects related to the measurement of blood pressure when standing and the diagnosis of hypotension are briefly covered. The guidelines are intended for primary care physicians (internists, general practitioners, cardiologists, neurologists and other specialists), students of medical universities and postgraduate education institutions.