Aim. To analyze the interactions between heat shock proteins (HSPs) (HSP27, HSP70 and cardiovascular HSP — cvHSP) serum levels and acute decompensated heart failure (HF) and signs of venous congestion in patients with preserved ejection fraction (HFpEF).

Material and methods. The study included 80 patients with HFpEF aged from 50 to 85 years: 60 with acute decompensated HF and 20 with stable HFpEF. HSP levels were estimated with the enzyme immunoassay method using AssayPro (USA) and Cloud-­Clone (PRC/USA) reagent kits with detection on a Multiskan FC photometer.

Results. The medians of HSP27, HSP 70 and cvHSP in the acute decompensated HFpEF group were significantly higher than in the stable HFpEF group. In the decompensated HFpEF group with mild congestion, the medians of HSP27 (0,58 ng/ml) and cvHSP (905 pg/ml) were significantly lower than in the group of patients with moderate or severe congestion (1,67 ng/ml and 1028 pg/ml, respectively). The medians of HSP27 and cvHSP in the group with ≥3 B-lines in one lung segment were significantly higher than the medians in the group with <3 B-lines by 3,6 times and 1,2 times, respectively.

Conclusion. Higher serum levels of HSP27, HSP70 and cvHSP are associated with the acute decompensated HFpEF. HSP27 and cvHSP levels are positively associated with the severity of congestion assessed by VExUS and B-lines.

Aim. To evaluate the relationship between markers of inflammation and matrix remodeling and criteria for a vulnerable plaque according to multislice computed tomography (MSCT) coronary angiography, as well as lipid profile parameters in patients with acute coronary syndrome (ACS).

Material and methods. This prospective single-center study included 125 patients admitted urgently with ACS. All patients underwent percutaneous coronary intervention of the infarct-related artery. In ad­dition, in all patients, there were plaques in one or two non-infarct-related arteries with stenosis <50%. ACS was treated according to clinical guidelines, including statin therapy at the maximum dosage. After 1 month, all patients underwent MSCT coronary angiography to detect vulnerable plaques, as well as assessment of the lipid profile, and following biomarkers of inflammation and matrix remodeling: metalloproteinase-9 with its inhibitor type 1 (MMP-9 and TIMP-1), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL).

Results. Of the 125 patients, myocardial infarction (MI) was diagnosed in 94 people (75%). Criteria for the plaque vulnerability according to MSCT were identified in 55 (44%) patients, of which positive remodeling was detected in 35 patients, a low-density area (LDA) in 30, and punctate calcifications (PCs) in 11. Gal-3 concentration was significantly higher without LDA — 35,4 (8,6; 65,0) ng/ml, in comparison with the group of patients in whom this criterion was detected and was 16,1 (5,9; 27,4) ng/ml (p=0,006). In the absence of PCs, the Gal-3 concentration was >34,0 (8,6; 61,0) vs 5,9 (2,8; 25,4) ng/ml in the group with PCs (p=0,046). The regression model including the MMP-9, TIMP-1, NGAL, Gal-3 in identifying vulnerable plaques was found to be significant (p<0,001).

Conclusion. Criteria for vulnerable plaque in patients after ACS have a significant relationship with markers of inflammation and matrix remo­deling.

Aim. To study the risk of type 2 diabetes (T2D) using the Finnish Diabetes Risk Score (FINDRISC) and its contribution to all-cause mortality and cardiovascular events in the Russian population aged ­25-64 years.

Material and methods. Data from cross-sectional studies ESSE-RF and ESSE-RF2 are included. The random sample was formed using the Kish method. Response was ~80%. The modular questionnaire in­cluded socio-demographic variables, medical history, and main risk factors for noncommunicable diseases. Blood was collected from the antecubital vein on an empty stomach. Biochemical parameters were determined in the clinical diagnostic laboratory of the National Medical Research Center for Therapy and Preventive Medicine. The presence of T2D was determined by questionnaire and/or fasting plasma glucose level ≥7,0 mmol/L. Obesity was defined as a body mass index of ≥30,0 kg/m²; abdominal obesity was defined as a waist circumference of ≥102 cm in men and ≥88 cm in women. FINDRISC risk was graduated as follow: low (<7), slight (7-11), moderate (12-14), high (15-20), very high (>20). Persons with diabetes and pregnant women were excluded. The final sample included 26418 people (10268 men and 16150 women). From 14 regions, ESSE-RF and ESSE-RF2 formed a prospective follow-up cohort (n=22812), median follow-up — 7,5 years). Statistical processing was performed using the open-source statistical programming language and environ­ment R (version 4.1).

Results. A fifth of people aged 25-64 years are at ≥ moderate risk of T2D. The rate of FINDRISC ≥15 was 10,1% (women 12,4% vs men 6,4%, p<0,001); ≥12 points — 23,7%. A close relationship was found between impaired fasting glucose and the risk of T2D with FINDRISC ≥15 and ≥12 (p<0,001). Survival worsens for FINDRISC ≥12 and ≥15, with the worst survival rates in individuals with T2D (p<0,001). The likelihood of cardiovascular events consistently increases with FINDRISC ≥12, ≥15, and T2D. In the Cox model, only T2D is significant for all-cause mortality; FINDRISC ≥15 and T2D are significant for the cardiovascular and combined endpoints.

Conclusion. An important task of the medical community is to identify individuals at risk of T2D at the population level. Early prevention of T2D risk factors can delay or prevent both T2D and cardiovascular events.

Aim. To analyze early disorders of carbohydrate metabolism and insulin resistance (IR) at different compliance levels in young people.

Material and methods. Ninety-four patients (45 men/49 women; median (Me)=33 [28,7-38] years) were examined. This prospective observational study used data of the questionnaire of the quantitative assessment of the adherence to treatment (QAA-25), fasting plas­ma glucose levels, oral glucose tolerance test, levels of glycated hemo­globin (HbA_1c), insulin and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Statistical processing was carried out in IBM SPSS Statistics 26.

Results. Only 15,8% had high adherence to medical support, 8,9% — lifestyle modification (LM) and general compliance, 10,9% — drug therapy. The means for most types of adherences were in the low range. In the low and medium LM groups, over 18 months the number of patients with elevated HbA_1c levels increased from 7,1 to 18,8% (p=0,021) and IR from 12% to 31,8% (p=0,000). In patients with low overall LM compared to high ones, the probability of HbA_1c increase raised by 5,5 times, and hyperinsulinemia by 1,16 times.

Conclusion. In an 18-month prospective study, young adults with low compliance levels showed an increase in the incidence of hyper­insulinemia, IR, and prediabetes.

Aim. A comprehensive study of sedentary lifestyle in young people at different levels: awareness of the connection between physical activity and the risk of cardiovascular diseases, self-assessment of physical activity and impartial evaluation of cardiorespiratory endurance.

Material and methods. The study included 112 students aged 18 to 24 years without verified noncommunicable diseases, who filled out the "Questionnaire for individuals aged <65 years to identify noncommunicable diseases, risk factors for their development, consumption of narcotic drugs and psychotropic substances without prescription" and an additional questionnaire with open questions about cardiovascular risk factors. In addition, participants underwent the Harvard step test.

Results. The level of cardiorespiratory endurance was not associated with sex and age in our sample. There was also no significant association between a high Harvard step test score and a positive response to the question about moderate or brisk walking >30 min/day. A positive response about training (3 times/week) in 3/4 of cases identified young people with average and high cardiorespiratory endurance.

Conclusion. The study results indicate a fairly high awareness of students about the dangers of physical inactivity. The data obtained can form the basis for research to optimize methods for assessing the physical activity of young people, used as part of the first stage of medical examination.

Aim. To study the frequency and clinical characteristics of ectopic obesity in patients with different body weights and hypertension (HTN).

Material and methods. The study included 326 patients (145 men and 181 women, mean age 63±8 years). Patients underwent chest and retroperitoneal space computed tomography with calculation of the volumes of perivascular adipose tissue (AT) (PVAT), pericardial AT (PAT) and perirenal fat thickness (PFT) using specialized software QCT Pro Tissue Composition Module (Mindways Software, USA). PAT volume ≥3,2 cm³, PVAT volume ≥0,4 cm³, PFT ≥1,91 cm were considered criteria for pericardial (PCO), perivascular (PVO) and perirenal (PRO) obesity.

Results. When studying the prevalence of ectopic (EO) and abdominal (AO) obesity phenotypes, patients were divided into groups: 1) with isolated EO without AO (n=17), 2) with PCO and AO (n=31), 3) with PVO and AO (n=22), 4) with PRO and AO (n=33), 5) with mixed EO (PKO+PVO, or PKO+PRO, or PVO+PRO, or PKO+PVO+PRO) and AO, 6) with isolated AO without EO (n=74), 7) without obesity (n=32). Isolated EO was significantly more common in individuals with normal and overweight compared to patients with obesity: 8,9 and 12 vs 1,1% (p=0,001), respectively. The prevalence of the mixed EO+AO phenotype in obese patients was significantly higher than in patients with normal and overweight as follows: 41,7 vs 19,6 and 21,7% (p=0,001), respectively. In patients with HTN, PVO+AO was significantly more common compared to patients without HTN as follows: 12,8 vs 3% (p=0,001), respectively.

Conclusion. The study results indicate the heterogeneity of the distribution of obesity phenotypes in people with different body mass index, which emphasizes the importance of taking into account all its variants, including EO, for timely and adequate cardiovascular risk assessment.

Aim. To assess the incidence and timing of subclinical cardiac dysfunction associated with therapy for HER2-positive locally advanced or metastatic breast cancer, and to analyze the difference in time from significant reduction in left ventricular (LV) global longitudinal strain (GLS) to significant reduction in LV ejection fraction (LVEF) (cardiotoxicity "echo-loop").

Material and methods. A total of 187 women 58±11 years without baseline cardiac dysfunction with verified HER2-positive locally advanced or metastatic breast cancer who received sequential adjuvant therapy with doxorubicin+cyclophosphamide, docetaxel+trastuzumab and trastuzumab monotherapy were followed up in 4 centers in four countries within 12 months with regular (every 3 weeks) speckle-tracking echocardiographic monitoring.

Results. Subclinical cardiac dysfunction associated with breast cancer therapy (CTRCD) appears in each block of therapy after the first course. Its frequency increases significantly after each subsequent course compared to the previous one. By the end of the 4th course in each block of therapy, subclinical CTRCD is noted from 24,6% (almost every 4th patient in the chemotherapy block) to 32,6-33,7% (almost every 3rd patient in the chemotherapy and targeted therapy blocks). In 24 out of 25 cases of severe subclinical CTRCD (96%) with a fall in LVEF <40%, a decrease in LV GLS >15% was preceded. The time difference from a decrease in LV GLS to a decrease in LVEF <40% (cardiotoxicity "echo loop”) ranges from 5 to 16 weeks depending on the cancer therapy option.

Conclusion. Until recently, the period of identified moderate subclini­cal cardiac dysfunction was not used to prescribe therapy for the pre­vention and treatment of cardiotoxicity. Enhanced speckle-tracking echo­cardiographic monitoring may reduce the incidence of severe sub­clinical and overt clinical cardiac dysfunction. Guidelines for car­diotoxicity monitoring should be reviewed to reduce the incidence of se­vere cardiac complications of cancer therapy.

In recent years, plastic has been widely used in various anthropic activity fields, but its waste pollutes the environment. Under the influence of chemical processes, it decomposes micro- and nanoplas­tics, which enter the human body in various ways. New experimental studies indicate that they can cause a number of cardiovascular disorders, including endothelial cell dysfunction and induction of oxi­dative processes.

The article examines the impact of environmental pollution with microplastics on the development of cardiovascular diseases. It is clear that new data on this new risk factor are accumulating and further clinical studies are required.

The author brings out opinion on the prognostic role of recurrent myo­cardial infarction (MI) at the present time. For many years, recurrent MI was considered one of the most severe complications of primary MI. Differences in the official and scientific definition of recurrent MI are examined. These differences are the reason for the ambiguous assessment of the prevalence and prognostic role of recurrent MI. Ana­lysis of the literature data makes it possible to conclude that recurrent MI is still accompanied by significantly higher mortality rates, both in the acute phase and in the long term, compared to primary MI. The main factors determining the unfavorable prognosis of life after recurrent MI are analyzed. It is noted that modern clinical guidelines do not contain data on the specifics of treatment for recurrent MI. Specific methods for the treatment of recurrent myocardial infarction should be developed.

The article presents a validated prognostic score (SCORE2-Diabetes) developed by a group of European researchers in collaboration with the European Society of Cardiology (ESC) for 10-year cardiovascular risk in type 2 diabetes (T2D) in Europe. The SCORE2-Diabetes risk calculator was developed based on the SCORE2 algorithms using data from patients with T2D and no prior cardiovascular disease (CVD). The authors developed a novel risk model that takes into account sex, age, age at diagnosis of T2D, glycated hemoglobin level, estimated glomerular filtration rate, smoking, systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol levels, based on cardiovascular morbidity rate in 4 regions of Europe. The model included 38602 cases of CVD and showed good discrimination and calculation improvement compared to SCORE2 (change in C-index from 0,009 to 0,031) depending on the T2D-related factors. The authors consider adaptation of the SCORE2-Diabetes risk model to modern populations, including in the Russian Federation. Comparative analysis with similar models, assessing the advantages and disadvantages of various CVD risk models in patients with T2D is presented.

Conclusion. SCORE2-Diabetes improves the identification of in­dividuals at higher cardiovascular risk in Europe based on new validated data from the European region.

The article focuses on important issues of methodology for studying venous outflow from the head and neck, emphasizing the importance of this problem for early diagnosis due to the long-term asymptomatic course of venous circulation disorders. The features of the head and neck venous circulation are presented. We outlined the difficulties in studying venous outflow in the clinic. The results of Russian and foreign studies on venous outflow assessment using various methods are presented, while attention is focused on non-invasive diagnostics using ultrasound. In addition, we present our original research data on venous outflow assessment during verticalization in patients with internal carotid arterial stenosis.

Introduction. Currently, there is an active search for approaches to the treatment of patients with intracranial artery (ICA) stenosis and recurrent ischemic stroke with aggressive therapy. To date, evidence has been received of the benefits of ICA stenting in combination with drug therapy. It has been shown that invasive treatment is not inferior in effectiveness and treatment outcomes to therapy. Intravascular ultrasound (IVUS) can provide valuable information regarding the morphology of ICA lesions and improve the outcome of ICA stenting.

Description. After successful endovascular thrombus removal, a patient with recurrent acute ischemic stroke underwent elective IVUS-guided stenting of the hard-to-reach communicating and cavernous intracranial segments of the internal carotid artery, which made it possible to assess the detailed morphology and select the optimal stent size.

Conclusion. A clinical example demonstrates the IVUS potential in the invasive diagnosis of ICA pathology for stenting or balloon angioplasty. ICA IVUS will provide the necessary information for neurointervention specialists to perform highly effective and optimal endovascular interventions on the ICA, similar to percutaneous coronary intervention. This will also reduce the risk of adverse intra- and postoperative events, and will allow identifying patients at high surgical risk.

Due to high information value, intravascular imaging methods are now increasingly used during percutaneous coronary interventions. These methods make it possible to optimize coronary interventions and reduce the risk of both early and long-term complications associated with the technical aspects of revascularization. This article presents a case of successful intravascular ultrasound-guided treatment of a female patient with subtotal lesion of the proximal part of anterior interventricular artery under. Primary intervention in the early postoperative period was complicated by clinically significant plaque protrusion through the stent cells, which required revision coronary angiography and optical coherence tomography to select the optimal volume of intervention and monitor outcome.

Management of multimorbid patients is challenging, despite advances in pharmacotherapy and widespread use of surgical treatment. The combination of diseases such as coronary artery disease leading to heart failure, hypertension, type 2 diabetes and chronic kidney disease requires an individualized approach to the patient. Adjuvant non-invasive therapies could facilitate the management of such patients. In addition, the use of longer-term non-pharmacological treatment is associated with prolonged follow-up by medical personnel, which can improve patient adherence to therapy and, thus, their quality of life.

This article presents a case of long-term follow-up and complex management of a patient with multimorbid pathology, including heart failure of ischemic etiology, with the addition of enhanced external counterpulsation in intermittent mode to therapy.

The guidelines describe the management of follow-up monitoring of second health status group persons, who have a high and very high cardiovascular risk. The following are presented: action sequence and follow-up content in this category of patients, recommendations for dealing with patients with risk factors (smoking, sedentary lifestyle, unhealthy diet, excess body weight). Examples of medical records are provided. Reminders for patients are presented, including in the event of acute coronary syndrome and cerebrovascular accident. Recommendations and algorithm for remote questioning and consultation are presented.

Guidelines are intended for doctors and paramedics of departments of medical prevention and health centers, paramedics of rural health posts.

The materials presented can also be used by local doctors (internists, general practitioners, paramedics at rural health posts and health centers) when conducting preventive counseling for patients with risk factors of nonommunicable diseases, and when working with them to modify risk factors.