Material and methods. One hundred patients with functional class III-IV CAD, stage I-IIa heart failure with LV ejection fraction (EF) >40%, successful coronary artery bypass grafting, SYNTAX Score of 33. During hospitalization, echocardiography, matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), monocyte chemoattractant protein 1 (MCP-1) were studied, while systemic immune-inflammation index (SII) was estimated. After 6 months, echocardiography revealed a group of patients with a decrease in LVEF.

Results. The following factors of decreased LVEF were identified: type 2 diabetes, chronic kidney disease (p<0,001), >4 comorbid diseases (r=-0,597, p<0,001), increase in SII by 44,6% (p<0,001), MMP-9 by 62% (p<0,001), MCP-1 by 55,1% (p<0,001), TIMP-1 by 45,8% (p<0,001). An inverse relationship was found between LVEF and the level of SII (r=-0,626, p<0,001), MCP-1 (r=-0,747, p<0,001), MMP-9 (r=-0,718, p<0,001). There were following threshold values for predicting a decrease in LVEF: SII — 356,43, MMP-9 — 318,7 ng/ml, MCP-1 — 459,6 pg/ml.

Conclusion. There are following markers of decreased LVEF in patients with CAD 6 months after successful coronary artery bypass surgery: type 2 diabetes, chronic kidney disease, >4 comorbid diseases, SII, MMP-9 and MCP-1 with a threshold value of 356,43, 318,7 ng/ml and 459,6 pg/ml, respectively.

Aim. To evaluate the role of cardiopulmonary system assessment in a group of patients with pulmonary hypertension (PH) associated with ischemic heart failure (HF) with the right ventricular-pulmonary arterial (RV-PA) coupling.

Material and methods. Forty stable patients were examined. The patients were divided into 3 groups depending on the left ventricle ejection fraction (LVEF). PH was established by using expert transthoracic echocardiography. RV-PA coupling was calculated by 2 following ways: as tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio and as TAPSE´Pulmonary Artery Aceleration Time (pACT) multiplication.

Results. The patients included in the study were mainly men (73,8%), functional class PH II-III (95,2%), stage IIB CHF (62%). The highest values of TAPSE (18,6±3 mm) and RV-PA coupling (0,64±0,42 mm/mm Hg) were found in the patients with preserved LVEF. In the general cohort, high level of NT-proBNP corresponds to reduced values of RVPA coupling (r_s=-0,563) and TAPSE (r_s=-0,666; p<0,01). The severity of PH directly affects the level of NT-proBNP (p<0,01). As the stage of HF and PH functional class increases, the indicators of PASP, inferior vena cava diameter and NT-proBNP level significantly increase, as well as TAPSE and RV-PA coupling decrease (p<0,05). Different calculating methods of RV-PA coupling has a strong correlation (r_s=0,832; p<0,01).

Conclusion. The right heart and RV-PA coupling assessment in patients with ischemic HF of origin is of significant value for the early diagnosis of PH and timely clinical decision-making.

Aim. To study the long-term effect of complex therapy with enhanced external counterpulsation (EECP) on clinical parameters and outcomes in patients with stable coronary artery disease (CAD) complicated by heart failure (HF).

Material and methods. The randomized trial EXCEL (Long-term Effects of enhanced eXternal CountErpuLsation; NCT05913778) included 118 patients with stable CAD complicated by New-York Heart Association (NYHA) class II-III HF, who were randomized into group 1 (n=59) receiving optimal therapy and EECP (35 hours, 2 courses/ year) or group 2 (n=59) receiving optimal therapy and EECP (35 hours, 1 course/year). The 6-minute walk test (6MWT), clinical status, quality of life (MLHFQ questionnaire), N-terminal pro-brain natriuretic peptide (NT-proBNP) level, left ventricular ejection fraction, and clinical outcomes were assessed annually.

Results. In both groups, improvement of HF functional class, clinical status, exercise tolerance, NT-proBNP level, and quality of life were noted. Primary endpoint (increase in 6MWT distance >20%) in groups 1 and 2 was recorded in 100 and 79,7% of patients, respectively (p<0,001), while composite endpoint (myocardial infarction, revascularization, all-cause death, hospitalization for HF, new cases of atrial fibrillation, type 2 diabetes, stage 3-5 chronic kidney disease) in 18,6 and 52,5%, respectively. The odds ratio for primary and composite endpoint in group 1 was 0,207 (95% confidence interval: 0,090-0,475; p<0,001) and 0,032 (95% confidence interval 0,002-0,553; p=0,018).

Conclusion. The EXCEL study demonstrated a stable favorable effect of EECP in patients with HF complicated by CAD on clinical indicators and outcomes, which were significantly more pronounced in the group with 2 courses of EECP (70 hours) per year compared to a single annual course.

Aim. To identify the main clinical and paraclinical characteristics of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) of various risk groups for adverse ischemic events, as well as to describe the in-hospital outcomes of the disease.

Material and methods. The retrospective analysis included 600 patients who were hospitalized at the regional vascular center from January 2019 to January 2021 with a diagnosis of NSTE-ACS.

Results. Patients were stratified into very high — 208 (34,7%), high — 196 (32,7%), moderate — 108 (18%) and low — 88 (14,6%) risk groups. In the highand very high-risk groups, patients were older, characterized by a significant comorbidity index, increased bleeding risk, decreased left ventricular ejection fraction and glomerular filtration rate in comparison with patients of other groups (p<0,05). Very highrisk patients were characterized by associated clinical conditions, predominantly infectious diseases and decompensated heart failure. Unfavorable outcome of hospitalization was observed in 44 (7,3%) patients. The death probability in the very high-risk group (33; 15,9%) was higher than in the low-risk group (2; 2,3%) (Odds ratio 8,1 (95% confidence interval: 1,9-34,6); p=0,01). Regardless of the risk degree, there was a high (53,5%) likelihood of completing invasive coronary angiography as a diagnostic procedure. Most of the observed complications as a result of invasive coronary angiography were characteristic of the high(18,3%) and very high-risk groups (21,5%).

Conclusion. NSTE-ACS patients at very high/high risk of adverse ischemic events represent a heterogeneous group with cardiac and noncardiac pathologies with high comorbidity and bleeding risks, decreased left ventricular ejection fraction and glomerular filtration rate, and associated clinical conditions.

Aim. To identify whether the addition of red blood cell distribution width (RDW) could improve the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 in patients with acute myocardial infarction (AMI).

Material and methods. This prospective observational study included 577 AMI patients who underwent coronary angiography within 24 hours after symptom onset. Admission RDW was measured as part of the automated complete blood count. GRACE 2.0 score at admission was calculated. The clinical endpoint was 18-month all-cause mortality. Logistic regression analysis was used to identify predictive values of RDW. Area under the receiver-operator characteristic (ROC) curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the increment of predictive value for the combination of RDW with GRACE 2.0 score in predicting clinical adverse outcome.

Results. The median age of patients was 65 (interquartile range: 56-74) years, while 60,7% were male. During 18-month follow-up, 66 patients (11,4%) died. RDW was positively correlated with GRACE 2.0 score (r=0,16, p<0,001). Multivariate analysis showed that both GRACE 2.0 score and RDW were independent predictors of 18-month mortality (odds ratio 1,025; 95% confidence interval [CI] 1,013-1,037; p<0,001; and 1,298; 1,087-1,551; p=0,004; respectively). The AUC for predicting 18-month mortality of GRACE 2.0 score, RDW and their combination was 0,795 (95% CI: 0,734-0,856), 0,708 (95% CI: 0,642-0,775) and 0,826 (95% CI: 0,775-0,876), respectively. Addition of RDW in the GRACE 2.0 score enhanced NRI (0,428; p=0,0009) and IDI (0,014; p=0,002).

Conclusion. Baseline RDW levels at admission was associated with 18-month mortality in patients with AMI. The inclusion of RDW into GRACE 2.0 score enables more accurate prediction of long-term risk of death compared with GRACE 2.0 score alone.

Aim. To characterize cardiac damage in myotonic dystrophy type 1 (MD1), which is the most common form of hereditary primary muscular pathology in adults.

Material and methods. Forty-eight patients with MD1 (31 men, 17 women, mean age 39,2±9,3 years) underwent clinical examination, neuropsychological examination, lipid profile assessment, electrocardiography (ECG), Holter ECG monitoring, and echocar-diography. Four clinical cases are presented that demonstrate clear cardiac manifestations of MD1.

Results. The patients did not complain of arrhythmias or chest pain, while 7 (14,6%) had complaints of exercise shortness of breath. Cardiac conduction disorders occurred in 18 (37,5%) patients, which were represented by firstand second-degree atrioventricular (AV) block, his bundle and intraventricular conduction disturbances. According to Holter monitoring, heart rate <60 bpm was recorded in 46 (95,8%) patients, of which 2 (4,2%) were <30 bpm. One (2.1%) patient had atrial fibrillation. According to echocardiography, ventricular enlargement was detected in 3 (6,3%) patients, and atrial enlargement — in 8 (16,7%). None of the patients had an ejection fraction <50%.

Conclusion. Cardiac involvement is a common manifestation of MD1. Full cardiac examination can help not only improve the quality of life of patients, but also avoid possible side effects of the prescribed treatment. 

Aim. To identify potential and limitations of secondary prevention of noncommunicable diseases in outpatient clinics of various Russian cities.

Material and methods. Outpatient physicians from 16 Russian cities took part in the cross-sectional study. A total of 545 general practitioners took part in the survey. The survey was carried out using a previously prepared questionnaire at the National Medical Research Center for Therapy and Preventive Medicine. It consisted of 11 blocks of questions, including sex and age characteristics, the prevalence of various diseases, adherence to therapy, preferential provision of medications, consultation assistance by hospital-based physicians and coverage of doctors and nursing staff. Answers were offered in several gradations to each question. Depending on the population, cities were divided into 4 following subgroups: population >2 million people (Moscow and St. Petersburg), population of 1-2 million people (Samara, Rostov-onDon, Krasnodar, Krasnoyarsk, Omsk), population of 0,4-1 million people (Vladivostok, Ulyanovsk, Penza, Kursk, Kirov, Tomsk) and population <400 thousand people (Nalchik, Saransk, Ivanovo).

Results. In all Russian cities, among men visited a clinic, 37% were people in the age range of 50-60 years. Second place was taken by men aged 60-65 years (30%). Most often, patients present with chronic coronary artery disease (39%), followed by type 2 diabetes (22,6%). Patients present with symptoms of heart failure in 17,7% of cases. Cancer account for 11,5% in the structure of visits. A similar frequency was found for chronic obstructive pulmonary diseases (9,2%). Every third patient is partially adherent to drug correction; partial non-adherence is detected 2 times less, while complete nonadherence is <3%. On average, 67% of doctors from different cities declare 75% achievement of target levels of risk factors, while one in five declare 50% achievement of recommended indicators. In most cases, physicians report minor problems during hospitalization. Every fifth doctor reported no problems, while every tenth respondent noted difficulties in hospitalizing patients. In every second case, partial staffing is noted. Moreover, a comparable trend is observed among doctors and nursing staff. In megacities and small towns the situation is somewhat better compared to cities with a population of 0,4 to 2 million.

Conclusion. To optimize the secondary prevention of noncommunicable diseases, a number of measures at the outpatient healthcare level should be taken. This includes educational work on adherence to drug and non-drug treatment correction, expanding coverage of preferential medication provision, improving interaction with hospitalbased doctors and coverage of doctors and nursing staff.

Health literacy (HL), including related vaccination, is an important health determinant. For the working population, it helps to maintain and improve their ability to work. Despite the clear benefits of vaccination, vaccine confidence has recently declined worldwide, which may lead to decreased vaccination coverage and a renewal of infectious diseases. Based on this, increasing the level of public health, including vaccination issues, is one of the preventive medicine tasks. Staff groups seem to be an effective place for implementing measures to improve the health and vaccination prevention of the working population.

Aim. To assess the level of public health, including vaccination issues, among the working Russian population using digital technologies.

Material and methods. The study was conducted online and included employees filling out a questionnaire on their own. The results were posted on the Atria digital platform, which is a tool for assessing and implementing corporate programs to improve employee health. HL was assessed using the updated 2019 Health Literacy Survey Questionnaire (HLS₁₉-Q) adapted into Russian and validated. The study lasted 18 months (from December 2022 to May 2024).

Results. A total of 58357 employees took part in the study on the Atria digital platform to assess the public health level, of which 47044 (80,6%) were women. In general, workers had a predominantly excellent HL (n=39637, 67,9%), while in women it was 69,4% (n=32644). The insufficient HL varied slightly among workers of different age groups. The fewest workers with an excellent HL were recorded in the age group of 40-49 years (65,4%, n=11857), and the most among workers >60 years old (74,2%, n=3573). The study found that 43,3% of men and 56,2% of women are vaccinated against influenza annually. Among those workers who are vaccinated against influenza annually, the highest HL rate was recorded among workers >60 years of age (63,4%, n=4188), and the lowest among workers <30 years of age (48,2%, n=4992). Workers with an excellent HL are predominantly vaccinated against influenza annually (77,8%, n=21306).

Conclusion. For the first time in the Russian Federation, a study was conducted to assess the HL level, including vaccination issues, among workers using digital technologies. The results obtained indicate that further measures are needed to increase the HL level of workers, including in terms of vaccination. Based on research data, methodological documents and corporate programs aimed at improving the current situation should be developed and implemented. 

Aim. To study the associations of the Tpeak-Tend interval (TpTe) with components of metabolic syndrome (MS) in a sample of Novosibirsk residents.

Material and methods. The study included 1042 residents of Novosibirsk (510 (48,9%) men) aged 35-74 years. The examination included the collection of demographic and social data, anthropometry, blood pressure (BP) measurement, and electrocardiography (ECG). MS was determined according to the 2013 criteria. The TpTe interval from the peak, as the maximum positive or negative T wave deviation, to the end of the T wave, was measured manually in lead V₅. The corrected TpTe (cTpTe) interval was used in the study.

Results. The cTpTe is inversely associated with female sex (B 3,390, 95% confidence interval (CI): (-5,516-2,504), p=0,001). The cTpTe interval is associated with a blood pressure (BP) ≥140/90 mm Hg (B 3,154, 95% CI: (1,614-4,688), p=0,001), low-density lipoprotein cholesterol (LDL-C) >3,0 mmol/l (B 1,818, 95% CI: (0,409-3,544), p=0,030), regardless of other MS components, sex and age. The cTpTe interval was higher in individuals with BP ≥140/90 mm Hg compared with individuals with BP <140/90 mm Hg (69,08 95% CI: 67,59-70,66 vs 65,93 95% CI: 64,60-67,24; p=0,001), and in persons with LDL-C >3,0 mmol/l (68,41 95% CI: 67,11-69,63 vs 66,60 95% CI: 65,02-68,23; p=0,023), compared with individuals with LDL-C <3,0 mmol/l.

Conclusion. The cTpTe interval, considered as an indicator of transmural dispersion of ventricular repolarization, is shorter in women than in men and is associated with hypertension and atherogenic dyslipidemia, regardless of other MS components.

Aim. To study 12-month dynamics of residual shunt (RS) closure after endovascular patent foramen ovale (PFO) closure.

Material and methods. We analyzed the data of 80 patients who underwent endovascular PFO closure at the Chazov National Medical Research Center for Cardiovascular Diseases in the period 2018-2023. All patients underwent a full range of examinations in accordance with current clinical guidelines. The severity of RS immediately after occluder implantation, as well as after 1, 6 and 12 months post-intervention assessment was based on transesophageal echocardiogram bubble study at the control visit.

Results. In the postoperative period, RS was visualized in 17,5% (n=14) of patients. Discharge was significant in 7,5% (n=6) of patients. One month after the intervention, residual significant discharge persisted in 10,0% (n=8) of patients. After 6 months, RS was visualized in 2,5% (n=2) of patients, and after 12 months, only in one patient (1,3%). The proportion of patients with RS 1 month after the intervention decreased to 42,9%, after 6 months to 85,7%, and after 12 months to 92,9% (p<0,05).

Conclusion. Most patients with RS after endovascular intervention for PFO are characterized by complete endocardialization of the occluder and PFO closure within the first year.

The issues of diagnosis and treatment of hypertension (HTN), as well as the prevention of its complications, are an urgent problem in cardiology. On June 21, 2023, the Journal of Hypertension published guidelines on HTN from the European Society of Hypertension (ESH), which were first presented to the public at the annual European Hypertension Meetings on June 24, 2023 in Milan. This publication describes the highlights and key updates of the guidelines and outlines its clinical significance. Russian experts also discussed current problems of pathogenesis, diagnosis and treatment of HTN. 

Fever of unknown origin (FUO), despite the wide diagnostic potential of modern medicine, remains a difficult problem for clinicians. Often, making a correct diagnosis requires a comprehensive examination of the patient, as well as the joint work of doctors from different specialties.

A 57-year-old male patient was hospitalized due to an episode of loss of consciousness, unmotivated weight loss and daily evening temperature rises to 38-39^о C, accompanied by chills and increased sweating. Previously, he was examined by a general practitioner, a cardiologist, and repeatedly by a hematologist. There was no evidence of an infectious disease, arrhythmias, multiple myeloma, lymphoproliferative disorders. Monoclonal gammopathy of undetermined significance (MGUS) was diagnosed. Blood tests revealed neutrophilia (9800 cells/ μl) and moderate anemia. The patient was hospitalized to determine the FUO cause. Heart auscultation revealed a systolic murmur in the mitral valve, which was previously absent. Echocardiography revealed a mobile masses on the mitral valve, severe mitral regurgitation, and therefore infective endocarditis was diagnosed. Empirical antibiotic therapy with ceftriaxone and levofloxacin was administered. Further blood culture revealed growth of a HACEK representative Aggregatibacter actinomycetemcomitans, sensitive to both drugs. Examination established the odontogenic nature of endocarditis. During treatment, stable normothermia and significant blood count improvement were achieved. However, fluoroquinolone therapy led to tendinopathy. Due to persistent grade 3 mitral regurgitation, the patient underwent routine mitral valve replacement. Further follow-up revealed satisfactory condition of the patient.

A feature of this case is the atypical course of infective endocarditis, occurring under a hematological mask, which made its diagnosis difficult. When examining a FUO patient, infective endocarditis should be included in the range of possible causes, taking into account not only the typical clinical picture, but also the numerous masks of this disease.

Anomalous coronary origin is a rarely diagnosed condition, the first manifestation of which may be sudden cardiac death. Diagnosis of this pathology, as well as other cardiac and coronary anomalies, is based on imaging diagnostic methods. Transthoracic echocardiography is the most accessible screening method to describe the retroaortic anomalous coronary (RAC) sign. However, due to the low detection rate of this condition and the suboptimal sensitivity of echocardiography, anomalous aortic origin often remains undiagnosed. This article presents the diagnosis of an anomalous origin of the left coronary artery through echocardiography and computed tomography in an elderly patient who had previously been observed for a long time for other cardiovascular diseases. With this case report, we want to emphasize the importance of awareness about congenital coronary artery pathology for the timely routing of patients and providing proper care.

The world is searching for new simple and economically available gender-specific markers to improve cardiovascular risk stratification in women. The aim of this review was to analyze the association of mammographic density (MD) with cardiovascular disease (CVD). In low MD, i.e., high relative mammary gland fat content, there is a higher incidence of the main risk factors for CVD: hypertension, hyperlipidemia, hyperglycemia, excess body weight, as well as an increase in the volume of fat depots, visceral and ectopic fat. Low MD is associated with a higher 10-year risk of adverse cardiovascular events such as coronary artery disease, stroke, peripheral arterial disease, revascularization, and heart failure, and may serve as a predictor of their development. Including MD in the Framingham Risk Score model improves its accuracy. Identification of low MD, as a marker of high cardiovascular risk, allows the use of mammography for early detection and prevention of the two most dangerous diseases among the female population — breast cancer and CVD. 

The prevalence of heart failure with preserved ejection fraction (HFpEF) is relentlessly increasing, especially in women. Therefore, an important task is search for novel markers and early predictors of the disease. Evaluation of the association between physiological factors and complications of pregnancy and the development both early and longterm heart failure (HF) is also a substantial question. The younger women cohort is of particular interest because of the high prevalence of HFpEF among women in Russia. The purpose of the review is to assess gender differences in the HF, as well as to summarize the results of studies on the association of adverse pregnancy outcomes and development of HFpEF. The article describes the gender characteristics of the development of various HF types. We considered the morphofunctional, neurohumoral and age factors associated with the HF development in women, as well as the differences in the influence of the leading risk factors for HF between men and women. Particular attention is paid to the role of pregnancy factors in the development of various HF types. The following HF development variants in women have been identified: early (peripartum) and late (diagnosed in postmenopause). The pathophysiological mechanisms of the impact of extragenital pregnancy complications on HF development are described separately. Particular attention is paid to studying the relationship between pregnancy complications and HFpEF development in the long-term prognosis, as the most characteristic form of HF for women. The leading pregnancy complications associated with HFpEF development in postmenopause are hypertensive disorders (including preeclampsia and eclampsia) and gestational diabetes mellitus. A wider study of the association of pregnancy complications with HFpEF in a woman’s future is necessary to identify new mechanisms for its development.

Response to an expert opinion on the article "Association between cardiovascular mortality and deprivation in the adult population of Russia", published in the Cardiovascular Therapy and Prevention 2024;23(3):3903, contains comments and explanations for a better understanding of issues raised in expert opinion.