Aim. To study the features of 24-hour ambulatory blood pressure (BP) monitoring (ABPM) in patients with hypertension (HTN) and comorbid pathologies within the hospital registry of a multidisciplinary medical center.

Material and methods. The study was carried out within the GARANT hospital registry. This registry included 5781 patients. The HTN in the electronic patient record was revealed in 4725 (81,7%) patients (age 65,5±11,3 years, men 51,7%). Of these, ABPM was performed in 16,8% of patients (HTN+ABPM), 83,2% were in the comparison group (HTN without ABPM). The characteristics of patients in these groups were compared and ABPM feasibility was assessed.

Results. In the HTN+ABPM group compared with the HTN without ABPM group, the mean age of patients was 63,9±13,9 vs 65,8±10,7 (p<0,01), women — 59,1 vs 46,1% (p<0,01), the mean number of cardiovascular diseases — 2,15±1,16 vs 2,68±1,16 (p<0,01), the mean number of non-cardiac diseases — 2,92±1,35 vs 2, 61±1,37 (p<0,01), office systolic and diastolic BP — 146,7±22,1/83,9±11,6 vs 136,9±19,7/79,2±10,4 mm Hg (p<0,01), respectively. The predominant blood pressure phenotype in the HTN+ABPM group is white coat hypertension (including during treatment) (49,2%). According to linear regression, the white coat effect is significantly positively associated with age, female sex, and negatively associated with prior myocardial infarction.

Conclusion. The GARANT registry results revealed that in-hospital ABPM was more often performed on younger people, mainly women, with less severe cardiovascular multimorbidity. These patients were characterized by a higher level of office BP upon admission to hospital and a higher prevalence of HTN as the only cardiovascular disease. Carrying out ABPM in patients included in the registry seems justified.

Aim. To investigate the association of 10 circulating plasma microRNAs with collateral flow degree in chronic total occlusion (CTO) patients with coronary artery disease (CAD).

Materials and methods. Plasma expression levels of 10 circulating miRNAs were measured by real-time PCR using Taqman technology in a sample of 43 subjects. The study included patients with CAD and CTO with good (n=13) or poor (n=10) coronary collateral circulation (CCC) based on Rentrop classification and a control group of patients without significant coronary stenosis (n=20).

Results. Significant differences in expression levels were found for 7 circulating miRNAs in patients with CTO and good CCC and for 5 microRNAs in the combined group of patients with CTO compared to the control group. Among the 7 microRNAs, decreased expression of hsa-miR-126-5p, hsa-miR-146a-5p, hsa-miR-155-5p, hsa-miR-15b-5p, hsa-miR-21-5p, hsa-miR-23a-3p and increased expression of hsa-miR-451a were detected. For the first time, we showed that the level of 2 microRNAs (hsa-miR-23a-3p, hsa-miR-21-5p) is significantly reduced and the level of hsa-miR-451a is increased in patients with CAD with good CCC.

Conclusion. Plasma microRNAs with significant differences obtained can be used for further studies on a larger sample size as candidate biomarkers for assessing the severity of ССС in the presence of CTO.

Aim. To assess the dynamics and structure of coronary artery disease (CAD) mortality rates in the Russian Federation (RF) and a number of regions.

Material and methods. The study analyzed the dynamics of the mortality structure and the reliability of CAD mortality rates in the Russian Federation and a number of regions before and during the coronavirus disease 2019 (COVID-19) pandemic. For the analysis, statistical data of the Russian Ministry of Health and Rosstat C52 tables for 2019-2022 were used. The study used statistical and analytical methods. MSOffice Excel 2019 was used for data processing. The correct coding of death causes was determined by expert analysis.

Results. In the Russian Federation and the regions studied in 2019-2022, there was no general trend due to territorial differences in the dynamics of CAD mortality rates and the proportion of acute and chronic CAD forms. An expert assessment in the studied Russian regions revealed errors in the preparation of medical certificate of cause of death. A decrease in the proportion of acute CAD types was noted in the Russian Federation as a whole, as well as in the Samara, Kaliningrad, and Tula regions, and an increase in the Belgorod and Tomsk regions. A decrease in the proportion of chronic CAD forms was noted in the Tula region, and an increase in the Russian Federation as a whole, Samara, Kaliningrad, Tomsk and Belgorod regions. An expert assessment in the studied regions revealed the following peculiarities in death certificates: the proportion of certificates with three completed lines of part 1 of paragraph 22 ranges from 11,1 to 30,3%.

Conclusion. The high CAD mortality rate in the studied regions is associated mainly with errors in the selection of chronic CAD forms as the initial cause of death. Differences in mortality rates from CAD in a number of regions are associated with the incorrect selection, most often, of chronic forms as the initial cause of death before and after the COVID-19 pandemic.

Aim. To study the effectiveness of virtual reality (VR) relaxation to correct symptoms of depression, anxiety, emotional and cognitive disorders in patients with heart failure (HF).

Material and methods. The study included 100 patients with HF aged 21 to 83 years. A main group of 58 people was randomly selected, each of whom received a course of 5 daily VR sessions of a relaxation program. Patients in the control group underwent VR sessions containing distracting visual images without a relaxation program. During the study, mental status of all patients was assessed using questionnaires sensitive to the cognitive and emotional areas.

Results. After completing five daily VR sessions with a relaxation program, patients with HF noted a decrease in stress (p=0,031) and improved sleep (p=0,002), and 2 days after completing the VR course — improved well-being (p=0,006), mood (p=0,001), sleep (p=0,003) and decreased stress (p=0,005). In addition, patients in the main group had improved daily activities (p=0,004), pain/discomfort (p=0,007), anxiety/depression (p=0,016) and general well-being (p=0,009).

Conclusion. VR relaxation is effective for reducing stress, improving mental status and cognitive functioning in patients with HF.

Aim. Comparative analysis of two groups of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) in age subgroups 60-74 years (elderly patients) and 75 years and older (senile patients); comparison of the coronary angiography (CAG) performance rate with percutaneous coronary intervention (PCI) consideration and time to intervention; evaluation of comorbidities associated with PCI non-performance in clinical practice in the selected subgroups of patients.

Material and methods. The study included 580 patients aged 60 years and older (60-74 years (elderly patient group) and 75 years and older (senile patient group)), hospitalized at the regional vascular center of City Clinical Hospital in Moscow during the period from January 01, 2021 to December 31, 2022 with the diagnosis of NSTE-ACS. The decision to perform CAG with possible PCI was made by hospital physicians in the routine order of daily clinical practice. Statistical analysis was performed in Microsoft Excel 19.

Results. In the group of senile patients, there was a comparatively higher percentage of women, patients with a final diagnosis of myocardial infarction, prevalence of anemia, chronic and Killip class ≥II acute heart failure, atrial fibrillation, and stage ≥3 chronic kidney disease. CAG/PCI was performed in the elderly patient group in 91,5% of cases, which was more frequent compared to the senile patient group, where the intervention was performed in 85% of cases (p=0,015). Mostly, CAG/PCI in both groups was performed within the first day of hospital admission. Anemia was significantly more common in patients aged 60-74 years in the conservative strategy groups, and aortic stenosis was more common in those aged 75 years and older. In any age group with non-performance of CAG/PCI, a significant frequency of in-hospital mortality was observed.

Conclusion. Patients with NSTE-ACS of elderly and senile age included in the study predominantly underwent invasive treatment within the first day of hospitalization. The elderly and senile age patient groups differed in the prevalence of revascularization, comorbidities and in-hospital outcomes, and did not differ in the time and treatment strategy. The subgroups with interventional treatment more often had a favorable in-hospital outcome.

Aim. To characterize the association between cardiovascular risk factors and clinical and paraclinical variables with the severity of concomitant carotid and subclavian atherosclerosis in patients with acute coronary syndrome (ACS).

Material and methods. Patients with ACS of any type, having obstructive coronary artery disease (CAD) confirmed by coronary angiography, underwent an ultrasound of the carotid and subclavian arteries with quantitative plaque assessment. The most important clinical, echocardiographic, angiographic and laboratory variables that contribute to atherosclerosis and/or affect the cardiovascular prognosis were evaluated. In patients with ACS considered ad the CAD onset, retrospective calculation of Systematic Coronary Risk Evaluation2 (SCORE2) score was performed.

Results. A total of 312 patients aged 64 (56, 72) years (male, 69,2%) were studied. The detection rate of carotid/subclavian plaque was 86% and was higher in patients with more severe CAD — 79,4, 87,0, 92,6% in patients with 1-, 2- and 3-vessel disease respectively (p=0,027). However, 20% of patients with 2-/3-vessel CAD had no carotid/ subclavian atherosclerosis. Most of the traditional cardiovascular risk factors and other studied echocardiographic, angiographic, laboratory variables, as well as SCORE2 in patients with CAD onset did not demonstrate independent association with the severity of carotid/ subclavian atherosclerosis. The variability of the total plaque area (TPA) was explained by related multifactor regression model only to a small extent, R²=13%. Age (β 0,76, 95% CI 0,24-1,29, p=0,004), glomerular filtration rate (β -0,44, 95% CI -0,76 — -0,13, p=0,006); peripheral artery disease (β 19,50, 95% CI 1,63-37,37, p=0,033) demonstrated a significant independent association with TPA.

Conclusion. In patients with ACS, only age, glomerular filtration rate and history of peripheral artery disease demonstrated the independent associations with carotid/subclavian atherosclerotic burden. Assessed variables explained 13% of TPA variability.

Aim. To assess the prognostic value of current scales and indices for risk stratification of any surgical and cardiovascular complications (CVC) in patients undergoing non-cardiac surgical interventions.

Material and methods. This single-center cohort retrospective study was conducted in patients who underwent non-cardiac surgery in 2018 and 2020. Surgical postoperative complications (POCs) were assessed according to the Clavien-Dindo classification. CVCs included any cardio-vascular events (CVEs), major adverse cardiac events (MACE), ST-T abnormalities on the electrocardiogram (ECG), decompensated heart failure (HF), arrhythmias, episodes of hypotension or hypertension, delirium, bleeding, thromboembolic events (TEEs). Risk stratification of POCs was carried out using recommended prognostic scales and indices. Their prognostic significance was assessed using ROC analysis with assessment of the area under the curve (AUC).

Results. POC risk stratification was performed in 2937 patients. There was following prognostic value of scales and indices: Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score — AUC of 0,990, 0,808, 0,825, 0,841, 0,808, 0,793, 0,701, 0,776, 0,744 in predicting Clavien-Dindo grade 5, 4, HF, delirium, TEEs, MACE, ST-T abnormalities, arrhythmias, bleeding, respectively; Surgical Outcome Risk Tool (SORT) — AUC of 0,973, 0,740, 0,890, 0,763, 0,721, 0,716, 0,700 in predicting Clavien-Dindo grade 5, 4, delirium, MACE, HF, arrhythmia, TEEs, respectively; American Society of Anesthesiologists (ASA) — AUC of 0,648, 0,600, 0,658 for HF, ST-T abnormalities, arrhythmias, respectively; Charlson comorbidity index — AUC of 0,819, 0,950, 0,789, 0,788, 0,706, 0,771, 0,898 in predicting Clavien-Dindo grade 5, 4, MACE, HF, ST-T abnormalities, arrhythmias, delirium; surgical risk score associated with the risk of cardiac events — AUC of 0,989, 0,887, 0,728 for Clavien-Dindo grade 3, 5, MACE, respectively; reconstructed Revised Cardiac Risk Index (rRCRI) — AUC of 0,916 and 0,979, 0,762, 0,741, 0,737 in predicting Clavien-Dindo grade 3, 5, HF, arrhythmia, delirium, respectively; National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) — AUC of 0,705, 0,757, 0,718 for arrhythmia, delirium, TEEs, respectively; total cardiovascular risk according to 2022 European Society of Cardiology (ESC) guidelines — AUC of 0,942, 0,726, 0,701, 0,748, 0,785 for Clavien-Dindo grade 5, MACE, ST-T abnormalities, arrhythmias, delirium, respectively; Caprini score — AUC of 0,718 and Venous ThromboEmbolism and Bleeding (VTE-Bleed) — AUC of 0,722 in predicting TEEs; simplified Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS) index — AUC of 0,729 for stratification of bleeding. In assessment of total risk of Clavien-Dindo surgical complications and any CVEs, none of the scales showed a predictive value of >0,7.

Conclusion. Any CVE stratification requires improvement of current tools and development of novel prognostic tools.

Aim. To evaluate the potential of qualitative and semi-quantitative analysis of stress adenosine triphosphate perfusion cardiac magnetic resonance imaging (MRI) in patients with obstructive coronary artery disease (CAD) with stenosis ≥50%.

Material and methods. Cardiac adenosine triphosphate perfusion stress MRI was performed in 49 patients with suspected or diagnosed CAD. The images were assessed qualitatively and semi-quantitatively. A zone of reduced signal intensity during the first passage of a contrast bolus with stress was taken as a stress-induced perfusion defect. Semiquantitative analysis was based on the construction of signal intensity curves of the contrast agent entering the left ventricular cavity and into the myocardium.

Results. The detection of stress-induced perfusion defects according to cardiac stress MRI was significantly associated with coronary artery stenosis ≥50% (p<0,001) with sensitivity and specificity of 74,3 and 59,8%, respectively. The median myocardial perfusion reserve index (MPRI) was significantly lower in areas of coronary artery blood supply systems with stenosis ≥50% (1,25 [1,14-1,56]) than in areas with stenosis <50% (1,44 [1,21-1,70] (p=0,034). MPRI ≤1,33 in the areas of the coronary artery blood supply suggests coronary artery stenosis ≥50% (sensitivity, 64,52%, specificity, 63,95%; area under the curve =0,629±0,056; (0,519-0,738) (p=0,034)). An inverse relationship was established between the mean global MPRI and the number of stress-induced myocardial perfusion defects (r=-0,502, p<0,001).

Conclusion. The developed technique of a semi-quantitative analysis with MPRI determination is effective in identifying obstructive CAD with stenosis ≥50% in addition to qualitative analysis.

Aim. To study the in-hospital outcomes of patients with residual shunt (RS) through the occluder and identify predictors of its formation after endovascular patent foramen ovale (PFO) closure.

Material and methods. We analyzed the data of 276 patients who underwent endovascular PFO closure for the period 2018-2023 at the Chazov National Medical Research Center. All patients underwent a scope of examinations that complied with clinical recommendations. RS in the postoperative period was assessed based on Transesophageal echocardiogram bubble study. Univariate regression analysis revealed RS predictors.

Results. RS in the postoperative period was visualized in 50 patients, who, in terms of the incidence of in-hospital complications, were comparable to 226 patients without RS (p>0,05). Univariate regression analysis revealed the following indicators associated with postoperative RS: implantation of the Amplatzer PFO or Figulla Flex UNI occluder (odds ratio (OR) 8,87; 95% confidence interval (CI): 3,09-25,49), Chiari network (OR 8,26; 95% CI: 1,91-35,81), Olivares-Reyes class >3 interatrial septum aneurysm (OR 2,37; 95% CI: 1,27-4,43), as well as LAVi ≥34 ml/m² (OR 4,01; 95% CI: 1,33-12,09) (p<0,05).

Conclusion. The use of Amplatzer PFO or Figulla Flex UNI occluders, the presence of a Chiari network, signs of left atrium dilatation, and Olivares-Reyes class >3 aneurysm were significant RS predictors.

Aim. To study the effect of extended-release (XR) metformin on humoral cardiometabolic markers and lipid peroxidation parameters in patients with heart failure with preserved ejection fraction (HFpEF), prediabetes and abdominal obesity (AO).

Material and methods. The study included 64 people (men – 50%, median age – 58 [55,25; 59,75] years) with HFpEF, prediabetes and AO. All patients (groups A and B) received optimal therapy for HFpEF. In group A (n=32), metformin XR 1000-1500 mg/day was additionally prescribed. A general clinical examination was carried out, determining the level of soluble interleukin 33 receptor (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), the initial level of malondialdehyde (MDA) in low-density lipoproteins (LDL) and their resistance to oxidation with copper ions initially and after 6 months.

Results. In group A, a decrease in NT-proBNP by 3,7% (p <0,001) was recorded. In group B, NT-proBNP values increased by 2,7% (p=0,013) compared to baseline levels. The decrease in NT-proBNP in the metformin group was accompanied by a decrease in hsCRP levels by 31% (p<0,001). No changes in sST2 concentration were demonstrated in either group. The level of MDA in LDL after 6-month metformin therapy became lower by 20% (p=0,002) relative to the initial value. When assessing the resistance to LDL oxidation with copper ions, the MDA content did not differ from the initial value. In group B, the initial MDA content in LDL increased by 3,7% (p=0,002) and after incubation with copper ions increased by 31,8% (p<0,001).

Conclusion. In patients with prediabetes, HFpEF and AO, 6-month metformin XR + optimal HFpEF therapy was associated with a decrease in NT-proBNP, as well as the severity of oxidative stress in the form of a decrease in the concentration of MDA in LDL and the serum level of hsCRP. 

Peripartum cardiomyopathy is a rare disease that occurs in late pregnancy and early postpartum, manifesting as rapidly progressive heart failure. To save the mother’s life, quick diagnosis, correct routing and pathogenetic treatment is required. The demonstrated case shows a detailed childbirth situation, which could provoke peripartum cardiomyopathy in a 36-year-old woman with subclinical hypothyroidism, rapid recognition of the clinical situation with the correct treatment tactics, which helped not only to stabilize the patient’s condition, but also to completely restore the left ventricular contractile function. Practitioners are interested in following the tactics of drug treatment in the intensive care unit and further at the outpatient stage using a specific clinical example.