Aim. To assess the quality of treatment of patients with myocardial infarction (MI) and early carbohydrate metabolism disorders as part of outpatient follow-up.

Material and methods. The study was conducted within the outpatient registry of patients after myocardial infarction PROFILE-MI, which included all patients who visited a cardiologist at Moscow City  Polyclinic № 9 after myocardial infarction from March 1, 2014 to June 30, 2015. A total of 160 people were included as follows: 106 (66,2%) men and 54 (33,8%) women; mean age, 70,4±10,8 (from 39 to 87) years. Visits were carried out every 2 months. Fasting plasma glucose levels were assessed. The follow-up lasted 1 year. Patients with carbohydrate metabolism disorders 68 (42,5%) were divided into 3 following groups: 1: patients with a history of type 2 diabetes (T2D) or diagnosed at the inpatient stage — 45 (28%); 2: patients with a history of impaired glucose tolerance (IGT) or diagnosed at the inpatient stage — 6 (4%); 3: patients without T2D or IGT (n=109), in whom impaired fasting glycemia was recorded for the first time at the outpatient stage — 17 (16%). The prescription rate of metformin was assessed in all groups.

Results. There were 23 (14,4%) patients with early carbohydrate metabolism disorders included in the registry. In group 3, there were significantly more men than in groups 1 and 2 — 76,5 vs 42 and 33% (p<0,001), and the mean age of 59,8±11,9 years was lower — 64,04±11,4 and 72,5±6,8 years (p=0,033), respectively. In this group, there were no smoking patients (p=0,007), fewer obese patients (18 vs 44 and 33%), but more overweight individuals compared to group 1 (47 vs 40%). In addition, burdened heredity (47 vs 64 and 67%), hypertension (65 vs 84 and 100%) were less frequently registered, respectively. The proportion of patients with a history of coronary artery disease was lower in group 3 compared to group 1 and amounted to 29 vs 47% (p=0,012). During the follow-up period, the prevalence of blood glucose testing did not exceed 44%. Metformin was prescribed only to patients of group 1 upon discharge from the hospital — 3 (6,7%), while metformin therapy was not prescribed to patients of groups 2 and 3. 

Conclusion. According to the PROFILE-MI registry, the total prevalence of early carbohydrate metabolism disorders among patients with a history of MI was quite high and amounted to 14,4%. This category of patients had a less complicated cardiovascular history. In real-world practice, metformin was not prescribed to patients with early carbohydrate metabolism disorders.

Aim. To study the associations between the level of systemic inflammation markers in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and the severity of infarct-related artery (IRA) involvement according to coronary angiography.

Material and methods. The data of 236 patients hospitalized with a diagnosis of NSTEMI in the regional vascular center in Odintsovo from April 2021 to February 2023 were analyzed. All patients underwent examinations in accordance with clinical guidelines. Based on laboratory tests, the level of following inflammatory markers was assessed: leukocytes, high-sensitivity C-reactive protein (hsCRP), fibrinogen. During coronary angiography, the IRA involvement was assessed according to American College of Cardiology/American  Heart Association classification. The relationship of inflammatory markers with complicated involvement was assessed in a binary logistic regression model.

Results. Depending on the severity of the IRA involvement, the patients were divided into 2 following groups: group 1 included 166 patients with complicated IRA involvement (type B-C), group 2 — 70 patients without complicated IRA involvement (type A). Patients in both groups were comparable in terms of troponin I levels upon admission (p>0,05). Inflammatory markers were significantly higher in group 1 (p≲0,05). Fatal outcome was observed in 4,2% (n=7) of cases in group 1 and in 2,9% (n=2) in group 2 (p=0,62). Levels of hsCRP (odds ratio (OR) 1,19) and fibrinogen (OR 7,96) were associated with the probability of type B-C IRA lesion (p<0,001).

Conclusion. Patients with NSTEMI and complicated IRA lesions are characterized by elevated levels of systemic inflammation markers. Higher levels of hsCRP and fibrinogen were significantly associated with type B and C lesions.

Aim. To identify main predictors of fatal outcome based on the regional database of patients with myocardial infarction (MI) or unstable angina (UA).

Material and methods. The retrospective study included 1515 patients with UA and MI, which accounted for 55,3% of patients treated in the period 2012-2016. The median follow-up was 62 [36; 71] months. The criterion for a complicated course of coronary artery disease (CAD) is fatal outcome. Group 1 included 238 patients with fatal outcome of CAD, while group 2 — 1277 patients with favorable outcome. All obtained data were structured as an Excel file. Variables available to most medical institutions (except coronary angiography data) were extracted from medical records. For automatic feature extraction, we used an ensemble machine learning algorithm developed by Yandex — CatBoost (Categorical Boosting).

Results. Mortality over 62-month follow-up was 15,4%. The study used 47 quantitative and qualitative (categorical) features. The filter feature selection identified significant quantitative characteristics, including age, left ventricular (LV) ejection fraction (EF), glomerular filtration rate, creatinine, body mass index, height, weight, body surface area (BSA), red blood cells, hemoglobin, glucose, total cholesterol (TC), lowdensity lipoprotein cholesterol, high-density lipoprotein cholesterol, heart rate, LV end-diastolic volume index, LV end-systolic volume index, pulmonary artery systolic pressure. There were following categorical variables: heart failure (HF), heart failure Killip class, old myocardial infarction, comorbidity, chronic kidney disease, angina pectoris, diabetes, atrial fibrillation, positive troponins, S-T deviation, coronary angiography, percutaneous coronary intervention, nosological unit (UA, anterior or inferior MI). An automatic feature selection using a machine learning algorithm identified the following most significant features determining the probability of death: age, LVEF, BSA, creatinine level, systolic blood pressure, HF, comorbidity, nosological unit.

Conclusion. Forty-seven available clinical features were selected from the medical records of patients with MI and UA. There were 8 following most significant parameters for predicting a fatal outcome according to machine selection results: age, LVEF, BSA, creatinine level, systolic blood pressure, HF, comorbidity, nosological unit.

Aim. To develop an approach to reduce the frequency of urgent coronary and peripheral revascularization by influencing modifiable risk factors.

Material and methods. A cohort of patients with coronary artery disease (n=218; 63±10,9 years, 54% men) who underwent coronary angiography (CAG), including stenting. A number of routine anthropometric and biochemical parameters were analyzed in all patients. Statistical analysis was performed using Statistica version 8.0 and SPSS IBM statistics 23 software using ROC analysis, binomial logistic regression, 2´2 contingency tables and Pearson c2 for hypothesis testing.

Results. A combination of noninvasive parameters associated with the maximum relative risk (RR) of coronary and peripheral artery revascularization over the 3 years after CAG was identified (RR=15 (95% confidence interval (CI): 5,96-36,5, p=0,001), compared with other possible combinations of the studied parameters. This combination included waist circumference with a limit of 89 cm, smoking status, and four following biochemical markers: C-reactive protein with a limit of 3,4 mg/l, glucose with a limit of 7,6 mmol/l, insulin with a limit of 10 μU/ml, and low-density lipoprotein cholesterol with a limit of 2,9 mmol/l.

Conclusion. A scale-table of the relative risk (RR) of coronary and peripheral revascularization over the 3 years after elective diagnostic CAG. The scale-table demonstrates the possibility of managing the risk of coronary and peripheral revascularization after CAG and motivating the patient to modify risk factors.

Aim. To study the role of life-purpose orientations in patients with coronary artery disease (CAD) in the context of their clinical characteristics.

Material and methods. The study included 286 people, including 242 patients with an established diagnosis of CAD and 44 healthy volunteers (control group). Patients underwent coronary angiography and echocardiography. In order to determine the axiological and conative orientations of the individual, the Life-Purpose Orientations questionnaire by D. A. Leontiev was used.

Results. No differences in life meaningfulness level were found between CAD patients and healthy respondents (p>0,05). The patients admitted for elective cardiac surgery had lower life-purpose indicators compared to the patients hospitalized for conservative therapy (p<0,05). Lower values were found for the overall life meaningfulness, "goals in life" and "life process" scales in patients with permanent atrial fibrillation (p<0,05), as well as for the "locus of self-control" and "locus of life control" scales in patients with paroxysmal atrial fibrillation (p<0,05) compared to patients with sinus rhythm. In patients with chronic left ventricular aneurysm, lower life meaningfulness values were also noted (p<0,05) than in individuals without it. An inverse correlation was obtained between the age of the subjects and most questionnaire indicators of life-purpose orientations (p<0,05).

Conclusion. Analysis of the obtained data showed the significance of the subjective experience of disease symptoms for patients with CAD. 

Aim. To study the clinical efficacy of renal denervation (RDN) in patients with resistant hypertension (RH), type 2 diabetes (T2D) and coronary artery disease (CAD) after endovascular revascularization.

Material and methods. The prospective, non-randomized, controlled, single-center study included 75 patients with true RH, T2D and CAD after complete endovascular revascularization. The participants were 

distributed in a 1:1,5 ratio into the RDN group and the control group. RDN was performed through femoral vascular access with a Spyral catheter (Medtronic, USA). The follow-up period was 24 months. The primary endpoint was the change in mean 24-hour arterial pressure (BP). The secondary endpoint was the assessment of the incidence of adverse cardiovascular and cerebral events. Changes in paraclinical parameters and drug therapy were also assessed.

Results. In the RDN group, mean 24-hour systolic BP decreased from 158 [144;167] to 147 [137;156] mm Hg (p<0,05) and diastolic BP from 97 [82;112] to 89 [75;101] mm Hg (p<0,05); glycated hemoglobin — from 7,6 [6,9;8,4] to 6,6 [6,2;7,2]% (p<0,05). In the RDN group, a decrease in the number of antihypertensive drugs taken was noted due to diuretic therapy discontinuation (p<0,05). The rate of major adverse cardiovascular events was 26,7% in the RDN group and 24,4% in the control group. The mean average value of late lumen loss of the stented segment according to quantitative coronary angiographic analysis (qualitative comparative analysis, QCA) was 24,7% in the RDN group and 28,1% in the control group. The incidence of de novo stenosis was 23,3% in the RDN group and 22,2% in the control group. There were no differences between the groups. The glomerular filtration rate in both groups did not change significantly and remained stable.

Conclusion. The study results confirm the favorable pleiotropic effects and safety of RDN in polymorbid patients with a combination of RH, T2D and CAD with the total sympathetic nervous system involvement, which offers opportunities for a wider study and implementation of this interventional procedure in clinical practice.

Aim. To assess the parameters of left ventricular diastolic function in middle-aged women in association with unfavorable factors of pregnancy.

Material and methods. A total of 102 women aged 45-59 years with at least one completed pregnancy were examined. The patients underwent transthoracic echocardiography followed by interviewing to identify factors of unfavorable course and outcomes of pregnancy. The detection rate of factors of unfavorable pregnancy course and outcomes, differences in diastolic function parameters depending on specific factors of unfavorable course and outcomes of pregnancy, as well as the relationship of factors with diastolic dysfunction (DD) were assessed.

Results. The most pronounced changes in diastolic function quan­titative values were noted in relation to following hypertensive com­plications: septal peak mitral annular velocity (e’sept) was significantly lower in the group with hypertension (HTN) in pregnancy (7,3±1,5 vs 8,6±1,6 cm/sec, p=0,006); the ratio of peak transmitral flow velocity to mean mitral annular velocity (E/e’ mean) was significantly higher in the group with HTN in pregnancy — 9,1±2,4 vs 7,2±1,7 (p=0,006). Associations were found between DD and HTN (odds ratio (OR) =3,10 (95% confidence interval (CI): 1,19-8,01, p=0,02)), proteinuria (OR =4,69 (95% CI: 1,15-17,39, p=0,04)), smoking during pregnancy (OR =3,91 (95% CI: 1,16-12,89, p=0,03)).

Conclusion. The most pronounced changes in diastolic function parameters were noted in the group of women with hypertensive complications during pregnancy. The results of the study suggest an association between a number of factors of unfavorable pregnancy course and outcomes (hypertension, proteinuria, smoking) and DD.

Aim. To study the years of potential life lost (YPLL) of the population of the Zabaykalsky Krai due to cardiovascular disease (CVD) in the context of municipal structures for the development and justification of managerial measures.

Material and methods. To calculate the standardized YPLL from CVD for the region as a whole and for municipalities separately, we used depersonalized data from form № S-51 "Information on the deceased by sex, age and cause of death", information on the average annual sex and age composition of the population from form 4RN of the Zabaykalsky Krai Statistics Service for the period of 2018-2022. Relatively homogeneous groups of municipalities by the level of standardized YPLL were identified using k-means cluster analysis. To test the significance of differences between clusters, variance analysis was performed.

Results. When analyzing the YPLL, in the period of 2018-2022, the region's population annually lost from 30300 to 33989 person-years due to cardiovascular mortality. The total YPLL due to CVD increased by 0,2% over time. Throughout the analyzed period, the YPLL among men remained higher than among women, indicating excess mortality of the male working-age population. Cluster analysis based on YPLL coefficients standardized by age divided all region districts into 3 following clusters: with high, medium and low values . According to variance analysis, a significant difference was obtained between the studied clusters (p<0,05).

Conclusion. The conducted study allowed us to identify the YPLL due to premature cardiovascular death in the Zabaykalsky Krai. Population cohorts and districts with high and increasing YPLL values were identified. The data obtained require management decisions in medical organizations aimed at improving preventive measures to promote a healthy lifestyle among the population.

A unified algorithm for appointment (examination; consultation) of patients under follow-up care by a general practitioner has been developed.

In order to create the algorithm; we analyzed and systematized data on managing and conducting events within the appointment (examination; consultation) of outpatients by a general practitioner; contained in regulatory legal acts of the Russian Federation; clinical guidelines; scientific and methodological literature. Analytical and comparative methods; as well as the method of content analysis were used. The accumulation; adjustment; and systematization of the obtained results were carried out in Microsoft Office Excel 2016 spreadsheets.

The algorithm for a dispensary appointment (examination; consultation) by a general practitioner consists of 9 following modules: patient intake; physical examination; assessing the achievement of health targets; assessing the risk of adverse events; assessing the results of consultations with specialists; establishing or clarifying the diagnosis of a disease (condition); prescribing preventive; diagnostic; therapeutic; and rehabilitation measures for medical reasons; informing the patient about the appointment (examination; consultation); preparing medical documentation.

The developed algorithm contains systematized information on the activities within appointment (examination; consultation) of patients under follow-up care by a general practitioner; which will allow for the full implementation of prevention and timely detection of complications or exacerbations of diseases (conditions); treatment adjustment; reduction in the number of urgent hospitalizations; implementation of medical rehabilitation; therapeutic and preventive and health resort treatment.

The relationship between cardiovascular and liver diseases is a significant clinical problem; since diseases of one system can aggravate the other. One of the key markers for cardiovascular risk assessment in patients with liver diseases is D-dimer. This is a fibrin degradation product; the level of which increases with the coagulation system activation. It is important to note the role of ademetionine (Heptral®) in supporting liver function; reducing inflammation and oxidative stress; which can reduce the development and progression of atherosclerosis and cardiovascular complications in patients with liver disease. Determination of D-dimer is important in risk stratification and assessment of clinical outcomes in patients with liver and cardiovascular comorbidity; including those treated with ademetionine.

Aim. To perform a meta-analysis of Russian clinical trials and study the associations of cardiac contractility modulation in patients with heart failure with reduced left ventricular ejection fraction (LVEF).

Material and methods. In the meta-analysis; the following outcome measures were selected: Minnesota Living With Heart Failure Questionnaire (MLWHFQ); 6-minute walk test (6MWT); improvement in heart failure functional class; echocardiography data: LVEF; LV end-systolic and end-diastolic volumes; as well as survival rates at 12 and 24 months.

Results. The results included in the meta-analysis showed a significant improvement in the 6MWT distance (n=216) (mean difference -38;19; 95% confidence interval (CI): -65;46 to -10;91 m; p=0;006); MLWHFQ results (mean difference 7;28; 95% CI: 2;87-11;69; p=0;001); LVEF (mean difference -4;02; 95% CI: from -5;83 to 2;20; p<0;0001) and LV volume parameters (LV end-diastolic volume: mean difference 19;99; 95% CI: 7;56-32;42; p=0;002; LV end-systolic volume: mean difference 22;68; 95% CI: 12;85-32.51; p<0;001) after 24 months in the cardiac contractility modulation group compared to the control group. Survival was assessed after 12 and 24 months of follow-up — the differences were insignificant.

Conclusion. The results of the data from 3 Russian clinical non-randomized studies included in the meta-analysis suggest that cardiac contractility modulation is associated with a significant improvement in quality of life; 6MWT distance; and reverse LV myocardial remodeling. 

Penitent foramen ovale (PFO) is a structural heart abnormality with a frequency in the general population of ~27;3%; which consists of interatrial communication and related syndromes. It is often clinically asymptomatic and can be a diagnostic finding or characterized by thromboembolic events at the onset; most often ischemic stroke; transient ischemic attack; as a result of paradoxical embolism. Today; there is no doubt about the importance of shunting through the PFO in the pathogenesis of paradoxical embolism. However; there is still no unified approach to risk stratification of thromboembolic events in PFO. In addition; there are still discrepancies in determining the optimal treatment strategy for PFO in adults. A personalized approach to each patient with PFO depends on age; hemodynamic significance; shunting direction; clinical performance; and risk of cardioembolic events.

Introduction. Papillary fibroelastoma is the second most common benign cardiac tumor after myxoma. Unlike myxoma; which is mainly located in the fossa ovalis area and is a hamartoma by origin; fibroelastoma originates from endocardial cells and is therefore located on the heart valves; mainly on the aortic one (44%). It is found on the tricuspid valve in 15% of cases. Fibroelastoma may be asymptomatic; but in some cases; it leads to embolism in the form of myocardial infarction or stroke if located on the aortic valve; or pulmonary embolism if located on the tricuspid valve.

Brief description. A case of a rare tricuspid fibroelastoma in a 67-year-old woman is presented. The patient sought help due to frequent blood pressure increase against the background of the therapy she was taking. She was examined in accordance with the current clinical guidelines on hypertension in adults. Echocardiography revealed mass in the right atrium. Intraoperative assessment revealed the mass of 1;6´1;5´1;3 cm with a villous surface and a loose; jellylike consistency; which is attached to the anterior tricuspid leaflet by a pedicle. Histological analysis identified papillary fibroelastoma.

Conclusion. Differential diagnostics of papillary fibroelastoma is extensive and includes benign (myxoma; fibroma); malignant (lymphoma; sarcoma) and metastatic heart tumors. Valvular vegetations; Lambl's excrescences; cysts; thrombus; fenestration and artifacts should be also ruled out. Cardiac ultrasound does not make it possible to determine the mass origin. Only histological analysis revealed that it was papillary fibroelastoma. The clinical example emphasizes the importance of examining each patient in accordance with related clinical guidelines. This allows for timely detection and prevention of severe embolic complications; usually characteristic of fibroelastoma.