Aim. To establish the prevalence and markers of masked hypertension (HTN) in apparently healthy young people.

Material and methods. The cross-sectional study included young people (20-30 years old) with health group I or II, with clinical blood pressure (BP) <140/90 mm Hg. All participants underwent 24-hour blood pressure monitoring, assessment of traditional cardiovascular risk factors and ways of coping with stress.

Results. A total of 347 participants were included (mean age, 22 (21-23) years; male, 101 (29,1%)). After 24-hour blood pressure monitoring, masked HTN was detected in 46 (13,3%) participants. Multivariate analysis found following markers of masked HTN: office systolic blood pressure (adjusted odds ratio (AOR) 1,109; p<0,001), resting heart rate (AOR 1,051; p=0,021), body mass index ≥25 kg/m² (AOR 2,345; p=0,039), two models of coping with stress — distancing (AOR 1,071; p=0,001) and self-control (AOR 0,951; p=0,012). These parameters are included in the formula for calculating the masked HTN probability.

Conclusion. Masked HTN occurs in 13,3% of apparently healthy young people. Associations of masked HTN with strategies for coping with stress have been established, which allows them to be regarded as novel markers of masked HTN. The method described in the article makes it possible to identify masked HTN with a high probability in young people.

Aim. To study the relationship between the amount of epicardial left atrial fat and left atrial mechanical dispersion (LAMD) in hypertensive patients with persistent atrial fibrillation (AF) and without cardiac arrhythmias.

Material and methods. The main group included 100 hypertensive patients with persistent AF, who underwent transesophageal echo cardiography (TEE) before the elective cardioversion, and transthoracic echocardiography (TTE) after cardioversion and disappearance of atrial stunning. The control group included 24 hypertensive patients without cardiac arrhythmias, who underwent TEE for other indication. The thickness of atrial septum and left lateral ridge was measured by TEE. The average thickness of these structures was designated as left atrial fat. The time to peak of longitudinal myocardial strain in 6 left atrium segments was determined by speckle-tracking echocardiography. LAMD was calculated as a percentage of the standard deviation of the obtained values to cardiac cycle duration.

Results. The median left atrial fat thickness in the main and control groups was 8,03 [6,78; 8,95] and 5,23 [4,48; 5,80] mm (p<0,0001), median LAMD — 2,68 [2,41; 2,83] and 0,95 [0,62; 1,11]% (p<0,0001). There was a positive correlation between left atrial fat thickness and LAMD in the main group (r=0,556; p<0,0001). This relationship did not reach the level of statistical significance in the control group, (r=0,358; p=0,0860). There was no independent relationship between body mass index and left atrial fat thickness in the patients (r=0,027; p=0,7651).

Conclusion. In hypertensive patients with persistent AF, compared with patients without rhythm disturbances, the average values of left atrial fat thickness and LAMD are significantly higher. The increase in left atrial fat thickness is associated with the increase in LAMD in hypertensive patients with AF. There was no correlation between left atrial fat thickness and LAMD in hypertensive patients without rhythm disturbances. There was no effect of body mass index on left atrial fat thickness in the present study.

Aim. To evaluate the relationship between the level of galectin-3 (Gal-3) and left ventricular (LV) structural and functional characteristics in coronary artery disease (CAD) with NYHA class I-III heart failure (HF) with and without type 2 diabetes (T2D) and chronic kidney disease (CKD).

Material and methods. We examined 120 patients (men — 68,3%) with coronary artery disease and class I-III HF, divided into 3 groups: group 1 — patients without T2D and CKD (n=40), group 2 — with CKD without T2D (n=40), group 3 — with T2D and CKD (n=40). The Gal-3 level was determined using the enzyme immunoassay, and LV global longitudinal strain (GLS) was determined using the speckle tracking method.

Results. In patients with coronary artery disease and CKD, including T2D, Gal-3 was higher (p=0,048) (in group 1 — 12,55 [10,60;23,05], in group 2 — 16,60 [11,75;23,95], in group 3 — 16,90 [11,90;25,15] ng/ ml) and more closely correlated with volume parameters, LV ejection fraction and the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e'). Grade 2 diastolic dysfunction (DD) in group 1 was in 10%, in group 2 — in 47,5%, in group 3 — in 60% of patients. The groups did not differ in GLS (p=0,087).

Conclusion. An increase in Gal-3 concentration with worsening HF and correlations between the biomarker level and volume parameters, LV mass index, LV ejection fraction, GLS and diastolic dysfunction indicate its important role in the development of myocardial remodeling and fibrosis.

Aim. To determine the relationship between the serum level of neu-regulin-1 (NRG-1) and the severity of coronary artery (CA) atherosclerosis and clinical and paraclinical characteristics of patients with coronary artery disease (CAD).

Material and methods. The study included 264 people, of which 220 were patients diagnosed with coronary CAD. The patients underwent coronary angiography using the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score and echocardiography. The patients were divided into groups according to SYNTAX score: group 1 — with moderate CA atherosclerosis (≤22 (n=124); group 2 — with severe CA atherosclerosis (23-32) (n=53); group 3 — with extremely severe CA atherosclerosis (≥33) (n=43). Group 4 was represented by healthy volunteers (n=44). All subjects underwent a study of the serum NRG-1 (ng/ml) level. Statistical processing of the results was carried out using Statistica 10.0 software. Differences were considered significant at p<0,05.

Results. Significantly higher NRG-1 values were obtained in the control group compared to patients with CAD (p<0,001). An inverse correlation was found between the NRG-1 concentration and the severity of CA atherosclerosis (p<0,001). A decrease in NRG-1 concentration is associated with a high functional class of = heart failure (p<0,01) and low left ventricular ejection fraction (p<0,001). The significance of NRG-1 differences between groups of patients with a history of myocardial infarction (p<0,001), angina pectoris (p<0,01), permanent atrial fibrillation (p<0,01), chronic left ventricular aneurysm (p<0,01) and repeated myocardial infarction (p<0,05) in comparison with patients without these pathologies.

Conclusion. The identified correlations between the NRG-1 concentration and CAD, as well as the clinical and paraclinical characteristics of patients, makes it possible to consider NRG-1 as a reliable biomarker of CA and heart failure severity and may form the basis for the development of novel diagnostic approaches.

Aim. To assess the changes of mortality from acute coronary artery disease (CAD) in the Russian regions during the coronavirus disease 2019 (COVID-19) pandemic in 2020-2022 in comparison with the prepandemic period (2017-2019).

Material and methods. Rosstat data on the average annual population and mortality rate in one-year age groups for 82 regions Russian were used. In the brief Nomenclature of Causes of Death of Rosstat, the codes of the International Classification of Diseases, 10^th revision (ICD-10) are grouped as follows: I21.0-9 (acute primary) myocardial infarction (MI), I22.0-9 (recurrent MI), I20, I24.1-9 (other types of acute coronary artery disease), U07.1 and U07.2 (coronavirus disease 2019 (COVID-19)). The regional average standardized mortality rates (SMR; M±SD) were calculated using the European population standard using the direct standardization method per 100 thousand population. Comparisons were made using the nonparametric Wilcoxon t-test (differences were considered significant at p<0,05).

Results. A decrease in the regional average SMR (per 100 thousand population) in the pandemic compared to the pre-pandemic period was revealed: from the sum of all acute CAD types — from 51,24±31,98 to 50,21±33,38 and from repeated MI — from 7,65±5,42 to 4,80±4,84; increase in SMR from acute MI — from 24,00±10,1 to 25,57±11,55, from other acute CAD types — from 19,58±25,23 to 19,83±26,21. Significant regional variability was noted in both the dynamics of the SMR from three acute CAD types, as well as the minimum and maximum SMR. Only in 2 regions in the pandemic period there was an increase in SMR from each of the three acute CAD types compared to the pre-pandemic period. In 18 regions, there was a decrease in SMR from each of the three forms, and in the rest, multidirectional changes were noted. There was no correlation between SMR for COVID-19 and SMR for acute CAD (r=0,034; p=0,76).

Conclusion. The COVID-19 pandemic did not have a significant impact on the regional average SMR from acute CAD. The significant decrease in SMR from recurrent MI is likely due to choice of the initial cause of death.

Aim. To analyze risk factors for sarcopenia in atherosclerosis involvement of target organs in patients with type 2 diabetes (T2D).

Material and methods. The study included 84 patients with T2D, divided into groups according to the 2019 criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). All patients were surveyed using a 36-item short-form health survey (SF-36), Sarcopenia and Quality of Life (SarQoL), Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F), grip test, 4-meter walk test, bioelectrical impedance analysis, 24-hour blood pressure monitoring and cardiac ultrasound. Differences were considered significant at p<0,05.

Results. Patients with sarcopenia have lower levels of fat, muscle, cell mass, appendicular mass index, fluid, protein, and minerals. In the group with sarcopenia, higher levels of total cholesterol, low-density lipoprotein cholesterol, glycated hemoglobin, and hypocalcemia were detected. Triglyceride levels were high in those with presarcopenia. In the same group, unstable blood pressure, increased myocardial mass and severe lower limb atherosclerosis were recorded.

Conclusion. Sarcopenia is one of the important medical and social problems and is accompanied by unfavorable outcomes. The combination of sarcopenia and T2D can contribute to the rapid development of macro- and microangiopathy and increase the cardiovascular risk.

Aim. To study the relationship between the structural and functional left ventricular (LV) parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with type 2 diabetes (T2D) without clinical manifestations of cardiovascular diseases, as well as to evaluate the possibility of their use for early diagnosis of subclinical LV dysfunction.

Material and methods. Data from 120 patients of both sexes aged 45-75 years (57,11±7,9 years) were analyzed. They were divided into three following groups: 1st — with T2D (n=47), 2nd — with prediabetes (n=20), 3rd — control (n=53). All participants underwent transthoracic echocardiography with assessment of the linear and volumetric heart dimensions, systolic and diastolic LV function. Speckle tracking echocardiography was analyzed with calculation of LV global longitudinal strain (GLS). The blood levels of NT-proBNP and inflammatory markers were determined (high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-6).

Results. According to echocardiography, patients with carbohydrate metabolism disorders revealed significantly higher LV mass values, LV posterior wall thickness, and relative wall thickness in comparison with the control group. Transmitral flow parameters, as well as tissue Doppler sonography, in the T2D and prediabetes groups were significantly different from those in the control group. GLS in the groups of patients with carbohydrate metabolism disorders was lower than in the control group (p=0,001). The level of NT-proBNP was significantly higher in the T2D and prediabetes groups compared to the control group, while in all three groups it did not exceed normal values (p<0,001). A higher level of NT-proBNP was associated with hypertension — odds ratio (OR) 3,64 [1,02-13,04] (p=0,005), a decrease in LV ejection fraction — OR 1,25 [1,06-1 ,47] (p=0,007), concentric hypertrophy — OR 4,84 [1,43-16,41] (p=0,011) and decreased GLS — OR 1,85 [1,62-2,06] (p=0,005), an increase in the ratio of early and late diastolic transmitral flow (E/A) — OR 0,01 [0,008-0,416] (p=0,024) and isovolumic relaxation time (IVRT) — OR 1,08 [1,03-1,14] (p=0,03). The sensitivity and specificity of NT-proBNP as a test for predicting GLS reduction <-18% were 86 and 27%, respectively. The hsCRP level, within the reference values, was significantly higher in the T2D and prediabetes groups compared to the control group (p<0,001) and demonstrated a direct linear relationship with E/A, IVRT, early diastolic deceleration time (p<0,05). A higher level of hsCRP was significantly associated with diastolic dysfunction — OR 1,16 [1,02-1,32] (p=0,023), as well as with a GLS decrease <-18% — OR 1,58 [1,12-4,65] (p=0,03).

Conclusion. In patients with T2D without clinical manifestations of cardiovascular disease, the presence of concentric LV myocardial hypertrophy, LV diastolic dysfunction and decreased GLS (<-18%) is associated with higher blood levels of NT-proBNP and hsCRP. However, in all cases, the levels of biomarkers do not exceed the reference values, which does not allow their use in the early diagnosis of subclinical LV dysfunction in T2D.

The author comments on the significance and place of meta-analyses in modern evidence-based medicine, primarily in cardiology. The history of meta-analyses is briefly described. The main limitations of meta-analyses are reviewed. Examples are given where meta-analyses on the same problem had directly opposite results. The importance of meta-analyses in identifying side effects of drugs is discussed. The possibility of manipulating the results of meta-analyses is demonstrated. The significance of meta-analyses is currently being assessed through the example of the coronavirus pandemic, when different meta-analyses assessed the effectiveness and safety of the same drugs differently.

The author concludes that meta-analyses should be excluded from level I evidence and given a more modest role in the hierarchy of evidence.

Aim. To evaluate any cardiovascular abnormalities in the postoperative period, their prevalence and impact on the course of postoperative period in patients after non-cardiac surgery, which underwent postoperative examinations of cardiovascular system.

Material and methods. The study included 2937 patients. The assessed end points were postoperative cardiovascular events (CVEs). Along with major adverse cardiovascular events (MACE), we analyzed any cardiovascular abnormalities in the postoperative period as follows: electrocardiographic ST-T abnormalities, acute or decompensated heart failure (HF), arrhythmias, episodes of hypotension or hypertension, bleeding, thromboembolic events (TEEs), cerebrovascular events, postoperative delirium. Any CVEs constituted the any cardiovascular events' (ACVEs) group. Statistical analysis was carried out using the StatTech v program. 3.1.6 (OOO Stattekh, Russia).

Results. Any postoperative complications according to the Clavien-Dindo classification were 54,7%, while grade 1 — 33,9%, grade 2 — 20,3%, grade 3 — 1 case, grade 4 — 0,4%, grade 5 — 0,1%. MACEs developed in 0,2% of cases. ACVEs amounted to 13,3%, including 2,3% — ST-T abnormalities, 6,3% — significant systolic blood pressure changes, 2,6% — arrhythmias, 0,7% — HF, 2,4% — bleeding, 1,1% — TEEs, 0,3% — delirium. In addition, 67 (17,5%) patients had ≥2 CVEs. Comparison of the length of hospital stay of patients with ACVEs, in particular with MACEs, ECG ST-T abnormalities, HF, arrhythmia, episodes of hypotension or hypertension, bleeding, TEEs, cerebrovascular events, delirium, with groups of patients without such complications revealed significant differences. ACVEs accounted for 1/4 of all postoperative complications and 2/3 of complications of grades 2-5.

Conclusion. We expanded the concept of CVEs, united the totality of any cardiovascular abnormalities in the postoperative period, emphasized not only their clinical significance, but also the economic feasibility of taking into account ACVEs.