Aim. Management of hypertension, a major cause of mortality worldwide, is difficult, with adherence a common problem. The present study aimed to estimate the long-term clinical outcomes associated with different treatment pathways in people with hypertension in Russia.

Material and methods. Outcomes were projected over 10 years using a microsimulation model. Four treatment pathways (current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents [start low and go slow, SLGS], free choice combination with multiple pills (FCC) and combination therapy in a single pill (SPC)) were evaluated based on the Global Burden of Disease 2017 dataset. Clinical outcomes were simulated for 1,000,000 individuals for each pathway.

Results. Long-term projections associated SPC therapy with reductions in mortality (4.9%), disability-adjusted life years (DALYs, 5.2%), and incidence of complications (including chronic kidney disease, stroke and ischemic heart disease, 9.2%) versus CTP, with greater reductions in all outcomes versus SLGS and FCC. SPC was projected to save 1,193 DALYs compared with CTP over 10 years. Adherence was identified as a key driver in the analysis.

Conclusion. Based on 10-year projections, combination therapies (including SPC and FCC) appear likely to reduce the burden of hypertension compared with conventional treatment options in Russia.

Aim. To study risk factors for in-hospital mortality in patients with acute myocardial infarction (MI) with ST-segment elevation (STEMI) aged ≥75 years.

Material and methods. This retrospective analysis analyzed medical records of 174 patients aged ≥75 years hospitalized at the regional cardiology clinic due to STEMI in 2020-2021. There were 52 (29,9%) men. The median age for all patients was 81 [79; 85] year.

Results. Inhospital mortality was 24,1%. Binary logistic regression revealed the following factors increasing the risk of inhospital mortality: cardiogenic shock (CS) — odds ratio (OR) 39,04; 95% confidence interval (CI): 8,87-171,74 (p<0,001); ventricular tachycardia (VT) — OR=60,52; 95% CI: 5,21-703,45 (p=0,001); white blood cell (WBC) count — for each increase by 1×10⁹/l — OR=1,15; 95% CI: 1,05-1,26 (p=0,002). At the same time, history of heart failure (CHF) reduced the death risk (OR=0,04; 95% CI: 0,009-0,21 (p<0,001)). Classification tree found that 100% mortality was predicted in patients with CS and without diabetes and a history of MI and in patients with pulmonary edema and without CS, VT and HF. Mortality of 83,3% was predicted in patients without CS and without VT with a history of HF, WBC count ≥14,5×10⁹/L and body mass index ≤23,7 kg/m². In addition, mortality of 75,0% was predicted in patients without CS, but with VT, as well as in patients with CS without diabetes and with a history of MI. In patients with CABG and diabetes, the predicted mortality rate was 50,0%.

Conclusion. The strongest factors associated with the risk of inhospital death were CS, VT, and high WBC count. The positive effect on the prognosis of pre-existing diseases, in particular HF, is apparently associated with the protective effect of previously taken therapy. This assumption needs to be confirmed based on prospective studies.

Aim. To assess the contribution of Pseudomonas aeruginosa pneumonia to the development of cardiovascular events in patients with heart failure (HF).

Material and methods. The study included 219 patients who were divided into a group of patients with pneumonia caused by P. aeruginosa (Group I) and a group of patients with pneumonia caused by S. aureus, S. pneumoniae (Group II). All patients underwent chest computed tomography (CT), blood tests, echocardiography, electrocardiography (ECG), 24-hour Holter ECG monitoring, pulse oximetry (SpO₂), and Doppler ultrasound of the lower limb veins.

Results. According to the study, cardiovascular events were more often observed in the group of patients with P. aeruginosa pneumonia as follows: death from cardiovascular events was registered in 11,4% of patients in group I and 0% of patients in group II (p=0,001); acute coronary syndrome — in 8,7 vs 0% (p=0,002), lower limb thrombosis — in 14 vs 1,9% (p=0,001). The occurrence of P. aeruginosa pneumonia in patients with HF increased the cardiovascular death risk by 8,8 times (95% confidence interval (CI): 1,2-65,7; p=0,005), acute coronary syndrome — in 8,0 times (95% CI: 1,1-60,2; p=0,014), lower limb thrombosis — in 9,6 times (95% CI: 1,3-71,2; p=0,004).

Conclusion. Patients with HF and P. aeruginosa pneumonia are at greater risk of cardiovascular events than patients with pneumonia caused by S. pneumonia and S. aureus.

Aim. To study biomarkers of inflammation in overweight and obese individuals.

Material and methods. A total of 180 people with overweight or obesity were included. Anthropometric and biochemical parameters were determined in all patients. The concentrations of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, IL-10, and tumor necrosis factor alpha (TNF-α) were studied.

Results. The following significant correlations have been established: IL-6 — with the levels of central aortic pressure, systolic and diastolic blood pressure (BP), heart rate (HR), levels of glucose, uric acid, low-density lipoprotein cholesterol (LDL-C); TNF-α — with concentrations of uric acid, triglycerides, cystatin C, creatinine and glomerular filtration rate; CRP — with body mass index, diastolic BP, heart rate, levels of uric acid, LDL-C, cystatin C. A significant correlation of IL-6, IL-10 and TNF-α with the proteinuria level was established.

Conclusion. In individuals with overweight or obesity, a direct correlation was found between serum concentrations of IL-6 and levels of BP, heart rate, lipids, carbohydrates, uric acid and proteinuria. In overweight or obesity, the serum TNF-α level has a direct correlation with hyperuricemia, hyperfibrinogenemia, hypertriglyceridemia, proteinuria and reduced renal filtration function, and the level of CRP is associated with an increase in diastolic BP, heart rate, uric acid, fibrinogen, LDL-C and cystatin C.

Aim. To analyze contrast-enhanced cardiac magnetic resonance imaging (MRI) in patients with phenotypic manifestations of left ventricular non-compaction (LVNC) and related genetic mutations, as well as to determine the relationship between mutations and types of left ventricular (LV) remodeling and with a number of other morphological and functional cardiac parameters.

Material and methods. From the registry of patients with LVNC and their relatives, patients with morphological signs of LVNC and 4 related mutations (MYH7, MYBPC3, TTN, and desmin genes (DES, DSG2, DSP and DSC2)). All patients underwent contrast-enhanced cardiac MRI, based on which the type of LV remodeling was determined.

Results. The study included 44 patients who, according to genetic analysis, had mutations in sarcomeric genes responsible for LVNC development. In each patient, the type of LV remodeling was determined based on cardiac MRI results. We found that if patients with LVNC have mutations in the MYBPC3 and TTN genes, the chance of LV dilatation remodeling is significantly higher. On the contrary, in the presence of a DES gene mutation, the probability of this LV remodeling is lower, and milder morphological manifestations of LVNC are noted.

Conclusion. The combination of cardiac MRI data and genetic analysis improves the morphological and functional stratification of patients with LVNC.

Aim. To analyze the associations of exhaustion, as a marker of chronic social stress, with smoking in a random representative sample of people aged 25-44 years in Novosibirsk.

Material and methods. In Research Institute of Internal and Preventive Medicine — branch of the Institute of Cytology and Genetics, in 2013-2016, a study of a random representative sample of people aged 25-44 years in one of the Novosibirsk districts was conducted (registration № FWNR-2024-0002). A total of 975 individuals were examined, of which 427 men and 548 women. The response rate was >70%. Assessment of exhaustion level and attitude towards smoking was carried out according to standard methods of the World Health Organization's MONICA-psychosocial (MOPSY) program protocol.

Results. Among people aged 25-44 years, 38,3% of men and 56,1% of women had exhaustion (χ²=40,744; df=2, p<0,001). Among people of both sexes aged 25-44 years, 58,9% were smokers, of which 27,1% stopped smoking, while 31,8% continued to smoke. Among men, 72,7% smoked, 29% stopped smoking and 43,7% continued smoking. Among women, 48,4% smoked, 25,6% stopped smoking, and 22,8% continued smoking (χ²=72,374; df=5, p<0,001). Among people of both sexes aged 25-44 years with a high exhaustion, 10,5% tried to change their smoking status, but unsuccessfully (χ²=20,708; df=10, p<0,05), and among women — 7,2% (χ²=27,117; df=10, p<0,05). Among those who tried unsuccessfully to change their smoking status (10,1%), "some events annoyed more now than before" (χ²=20,053; df=10, p<0,05). Women who smoke (33%), as well as women who smoke but quit for a while (21,2%) "wanted to die at times" (χ²=20,040; df=10, p<0,05). Among those who smoke, but quit for some time, both among people of both sexes 25-44 years old (14,7%) (χ²=22,783; df=10, p<0,05) and among men (16,1%) (χ²=19,593; df=10, p<0,05) and women (14%) (χ²=20,734; df=10, p<0,05) individually, more often "there was a feeling that recently life requires more strength than is left." Men who tried unsuccessfully to change their smoking status were (13,8%) more often "woke up feeling exhausted and tired" (χ²=19,713; df=10, p<0,05).

Conclusion. We found that people with a high exhaustion have greater dependence on smoking.

According to the Federal State Statistics Service of Russia, from 1970 to 2019, cardiovascular diseases remain one of the main causes of death in Russia. To date, the relationship between cardiovascular mortality and deprivation in Russia remains insufficiently studied.

Aim. To identify the relationship between regional deprivation and cardiovascular mortality among the adult population of Russia.

Material and methods. The Russian deprivation index was used to measure the deprivation level. The index indicators were obtained from official Rosstat statistics and the All-Russian Population Census for 2010. Cardiovascular mortality by age (five-year groups) and sex in the constituent entities of Russia from 2006 to 2012 was obtained from the Russian database on fertility and mortality of the Center for Demographic Research of the Russian Economic School.

Results. The fully adjusted model showed a reduction in mortality (Mortality Rate Ratio (MRR), 0,93; 95% confidence interval: 0,91-0,94) in regions with the greatest overall deprivation compared to the least deprived regions. There is a decrease in mortality in the most socially deprived regions compared to the least deprived ones. The fully adjusted model showed a trend toward increased mortality across levels of economic deprivation (from less deprived (Q2) to more deprived (Q3 and Q4) compared to least deprived regions (Q1)). Our study showed an increase in mortality in the most environmentally deprived regions — MRR, 1,02; 95% confidence interval: 1,00-1,04.

Conclusion. The study established a link between general, social, economic and environmental deprivation and cardiovascular mortality.

The state of the heart after a coronavirus disease 2019 (COVID-19, coronavirus disease 2019) is very diverse and in some cases requires a complex differential diagnosis. We described a 35-year-old smoking male patient who, by the end of the first month after COVID-19, developed left ventricular dysfunction with decrease in ejection fraction to 25-30% and persistent left bundle branch block (LBBB). Echocardiography also detected local contractility disorders. A significant increase in blood anticardiac antibody titers was noted. Myocardial biopsy revealed active lymphocytic myocarditis, coronavirus ribonucleic acid, while coronary angiography revealed extensive stenosis of the anterior interventricular artery. On the first day after balloon angioplasty and stenting, the disappearance of LBBB block was noted with the appearance of deep negative T waves in the precordial leads, which did not allow ruling out a previous myocardial infarction. As a result of treatment of heart failure and steroid therapy, the structural and functional cardiac parameters and the electrocardiography were completely normalized by the end of the second year of treatment. Only a transient LBBB remained at high loads. Cardiac computed tomography after 2 years showed no delayed contrast agent accumulation in the myocardium, and coronary stenosis up to 30%.

The mechanisms of complex myocardial and coronary damage (including the role of coronaritis in the atherosclerosis progression) after COVID-19 are discussed.

According to the recent World Health Organization statistics, cardiovascular disease (CVD) is one of the leading causes of high mortality worldwide. While obesity is a major and persistent risk factor for CVD, the cause of this condition, the pathological molecular connection between peripheral fat depots and the heart, remains poorly understood. The aim of this review is to introduce the reader to the metabolic activity of epicardial adipose tissue (EAT), the consequences of excessive epicardial fat accumulation and the development of heart failure (HF).

EAT is visceral adipose tissue that is in direct contact with the myocardium and coronary vessels and can influence cardiac function through both mechanical effects and more subtle paracrine molecular mechanisms. HF with preserved ejection fraction (HFpEF) is closely associated with obesity and patterns in fat distribution. Excessive amounts of EAT are associated with abnormal hemodynamics in HFpEF, with the potential for direct mechanical effects on the heart causing a constriction-like effect and local myocardial remodeling effects resulting from the secretion of inflammatory mediators. However, patients with excess EAT tend to have more subcutaneous adipose tissue, making it difficult to determine a cause-and-effect relationship between epicardial fat and HFpEF. This review provides evidence that excess EAT is an important part of HFpEF pathogenesis.

The variety of mechanisms of development and progression of heart failure (CHF) and sarcopenic obesity is reflected in changes in the concentrations of various biomarkers, one of which is high-sensitivity C-reactive protein (hsCRP). Its importance in the implementation of various stages of HF pathogenesis and its impact on the patient’s condition support the interest of researchers in studying this marker. It is known that HF is one of the pathogenetic factors leading to sarcopenia, which in turn aggravates the severity of these conditions. The purpose of this study is to analyze modern publications devoted to the role of hsCRP in the pathogenesis of HF and sarcopenic obesity, as well as to assess the relationship between hsCRP and the disease severity, prognosis for HF, sarcopenic obesity, and their combination.

Pulmonary arterial hypertension (PAH) associated with portal hypertension, or portopulmonary hypertension, is a severe, life-threatening complication of portal hypertension and/or portocaval shunt surgery. Congenital portocaval shunts (CPSSs) are rare vascular anomalies of the portal system, leading to severe pathophysiological reactions and multisystem damage, including PAH, liver nodules, cognitive, metabolic, immune, hematological and hormonal disorders. Severe cardiopulmonary complications are detected in more than a third of patients with CPSSs, which is the main cause of their death. The article describes the pathophysiology, clinical characteristics, diagnostic features and possibilities of modern targeted therapy for CPSS-associated PAH. Patients with CPSS-associated PAH require comprehensive specialized care in an expert center. For long-term successful management of patients, continuous targeted therapy for PAH, in combination with surgical treatment of CPSSs, is crucial.