Aim. To assess the relationship between epicardial fat thickness (EFT) and metabolic-associated fatty liver disease (MAFLD), including hepatic steatosis (HS) and steatohepatitis, in myocardial infarction (MI), as well as to analyze the changes of transaminase levels in patients with a combination of ST-elevation MI (STEMI) and MAFLD to accurately identify liver disease.

Material and methods. A total of 163 patients with ST-elevation myocardial infarction (STEMI) (n=144) and non-ST-elevation myocardial infarction (NSTEMI) (n=19) with metabolic syndrome (MetS) were admitted for primary coronary angiography and percutaneous intervention (PCI). Eighty-two patients had concomitant MAFLD (55 with steatosis and 27 with steatosis). Liver elastometry, EFT measurement, cardiac troponin I levels, alanine and aspartate aminotransferase (ALT and AST) levels, and cytokeratin-18 fragment concentrations were measured.

Results. MAFLD in patients with MI compared to patients without liver pathology is associated with higher EFT (p<0,01). According to two-way analysis of variance, a stable increase in blood AST and ALT levels was established for the combination of MI and MAFLD (p<0,05, generalized η² effect size ≥0,11 for both aminotransferases). In STEMI combined with steatohepatitis, compared to HS and STEMI without MAFLD (control), a significantly higher EFT (p<0,01), AST (p<0,05) and ALT (p<0,001) levels were noted.

Conclusion. MAFLD in patients with MI is associated with an increase in EFT. For the combination of STEMI-steatohepatitis, compared to STEMI-HS and STEMI without MAFLD, a higher EFT was observed. This may indicate not only the role of EFT in acute coronary pathology but also the relationship of this indicator with MAFLD severity. In uncomplicated STEMI, analysis and interpretation of transaminase activity in assessing MAFLD are recommended no earlier than 10 days.

Aim. To evaluate the association between abdominal fat distribution and metabolic score of insulin resistance (IR) — Mets-IR, depending on the presence of metabolic syndrome (MS) in patients with stable coronary artery disease (CAD).

Material and methods. Sixty-one patients with chronic CAD. The significance of coronary atherosclerosis was determined using the Gensini Score. MS was defined according to the International Diabetes Federation criteria (2005). Abdominal magnetic resonance imaging (MRI) was performed at the L4-L5 level to determine the volume of abdominal fat depots. Blood glucose and insulin levels, lipid profile parameters, and adipokines were determined. Insulin resistance was assessed by calculating the homeostatic model assessment of IR (HOMA-IR) and Mets-I R.

Results. The MS group had significantly higher body mass indices and waist circumference, and between-group differences were found in glucose, serum leptin, and Mets-IR levels. In the MS group, abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) showed a strong correlation with Mets-I R. Patients with severe IR were characterized by increased VAT and SAT volumes; no difference in the VAT/SAT ratio was found. Body mass index, waist circumference, serum glucose, triglyceride, and high-sensitivity C-reactive protein levels were significantly higher, while high-density lipoprotein cholesterol levels were lower with greater IR severity.

Conclusion. The relationship between IR and abdominal adipose tissue volume varies depending on the severity of IR and differs depending on the presence of metabolic syndrome. Among individuals with chronic coronary artery disease (CAD), abdominal visceral obesity is associated with metabolic syndrome. The use of Mets-IR has demonstrated its validity in assessing IR in patients with CAD and metabolic syndrome, as well as a strong association with magnetic resonance imaging (MRI) parameters of abdominal fat depot volume.

Aim. To compare the immediate and long-term outcomes of percutaneous coronary intervention (PCI) with and without instantaneous wave-free ratio (iFR) monitoring in patients with diffuse and multilevel coronary artery disease (CAD).

Material and methods. The study prospectively enrolled 100 patients who underwent PCI for stable CAD with diffuse and/or multilevel involvement of target coronary artery. Comparison group was retrospectively matched using a propensity score matching. The study group had iFR-guided PCI (n=100), while the comparison group — standard PCI without iFR monitoring (n=100). Long-term outcomes were assessed in 198 (99,0%) patients.

Results. The study group had a lower number of implanted stents (1,2±0,4 vs 1,6±0,5; p<0,001) and a lower length of stented segments (45,4±14,1 vs 58,7±15,9 mm; p<0,001). The use of iFR monitoring reduced the number of stenoses treated with PCI by 32%. Diffuse involvement was associated with a 6-fold increase in the odds of failing to achieve an iFR ≥0,9 compared to local changes (odds ratio (OR) 6,11; 95% CI 1,44-25,92). Both groups had comparable 12-month risk of achieving the composite endpoint (hazard ratio (HR) 0,51; 95% CI 0,17-1,59; p=0,2460).

Conclusion. In patients with diffuse and multilevel coronary artery disease (CAD), iFR-guided PCI allows for a reduction in the number and length of implanted stents by eliminating the need for stenting functionally insignificant stenoses, with comparable 12-month survival to standard PCI.

Aim. To determine clinical, anatomical, and intraoperative predictors of sustained blood pressure (BP) reduction in patients with ipsilateral internal carotid artery stenosis after carotid artery stenting (CAS).

Material and methods. This single-center prospective study included 178 patients who underwent CAS between 2018 and 2022. All patients underwent clinical BP measurements and ambulatory 24-hour BP monitoring (ABPM) before the [procedure and after 12 months. A sustained hypotensive response was defined as a reduction in average 24-hour systolic/diastolic BP ≥10/5 mm Hg, as measured by ABPM. Anatomical (stenosis degree, plaque morphology, circle of Willis structure, etc.), anthropometric and clinical parameters (age, sex, comorbidities, etc.), as well as intraoperative factors (hypotension, bradycardia, dilation, etc.) were studied.

Results. At baseline, hypertension was detected in 98,6% of patients, while target BP values were achieved in only 28,4%. A significant decrease in office BP was observed as early as 24 hours after CAS (systolic BP 157®114 mm Hg, diastolic BP 87®64 mm Hg; p<0,001). According to ABPM data, after 1-year follow-up, an average decrease in 24-hour BP of 12/9 mm Hg was recorded (p<0,001). A persistent BP reduction ≥10/5 mm Hg was observed in 46,6% of patients. In a multivariate analysis, independent predictors of persistent BP reduction were a incomplete circle of Willis (odds ratio (OR) 3,71; p=0,007), a stenosis >80% (OR 1,06; p=0,033), and intraoperative hypotension (OR 2,42; p=0,022). The number of antihypertensive medications taken by patients did not change statistically, but in 12 cases, the possibility of dosage reduction was noted. The circadian BP profile improved after the procedure (an increase in the proportion of "dipper" patients).

Conclusion. A persistent BP reduction after CAS was observed in almost half of patients with ipsilateral internal carotid artery stenosis. The severity of the hypotensive response is determined by cerebral circulation anatomy (disconnected structure of the circle of Willis), stenosis degree, and intraoperative reactions of the carotid sinus. These factors can be used to predict the hemodynamic response and optimize patient management after CAS.

Aim. To study hemodynamic characteristics and exercise tolerance during mechanotherapy in patients after ischemic stroke (IS).

Material and methods. The study included 80 patients after IS. Mean age was 61,0±10,5 years, while the duration of ischemic stroke — 13,1±8,5 months. Rehabilitation routing score was 4. Fifty patients have sinus rhythm, while 10 — paroxysmal atrial fibrillation (AF), and 20 — permanent AF. According to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, there were 21 patients with atherothrombotic stroke, 30 patients with cardioembolic stroke, 29 patients with stroke of unknown etiology. The following examinations were performed: echocardiography with assessment of left ventricular (LV) global longitudinal strain (GLS), blood test with assessment of N-terminal probrain natriuretic peptide (NT-proBNP). Mechanotherapy was performed daily on a Reck MOTOmed muvi simulator (Germany), with hemodynamic assessment during training on days 1 and 12.

Results. Patients with AF, compared with patients in sinus rhythm, were significantly older (65,7±7,2 vs, 58,0±11,2 years; p=0,002) and had higher NTproBNP levels (192,1 [30,3; 282,2] vs, 15,7 [0; 16,2] pg/ml; p<0,001). In patients with sinus rhythm, compared with patients with permanent AF, the LV ejection fraction was higher — 59,4±4,8 vs 52,7±6,6% (p<0,001), the left atrial volume index was lower — 20,2±7,9 vs 45,0±15,6 ml/min (p<0,001), the LV GLS in absolute values was higher — -16,4±2,0 vs -11,7±2,5% (p<0,001). On the 1^st day of mechanotherapy, patients with sinus rhythm demonstrate a greater exercise distance and a higher value of maximum oxygen consumption compared with patients with permanent AF. By the 12^th day of rehabilitation, a significant increase in exercise distance was observed in both groups as follows: in sinus rhythm, 1,9±0,9 km vs 2,4±0,9 km (p<0,001), and in persistent AF, 1,3±0,5 km vs 1,8±0,9 km (p=0,005). No clinically significant hemodynamic disturbances were observed during mechanotherapy in any patient, regardless of AF.

Conclusion. During mechanotherapy, patients with AF demonstrated significantly lower exercise tolerance compared to patients with sinus rhythm. Persistent AF partially limited the effectiveness of mechanotherapy: by the 12^th day of training, patients achieved an increase in distance, but no increase in power was achieved. Hemodynamic parameters during exercise did not limit training in either patients with sinus rhythm or AF. Mechanotherapy as part of an individualized rehabilitation program after IS did not provoke arrhythmia attacks in patients with paroxysmal AF.

Aim. To investigate the relationship between phase left atrial (LA) strain components using the speckle tracking echocardiography (STE), traditional parameters of left ventricular diastolic function, and age in male volunteers without cardiovascular disease.

Material and methods. Data from 331 male volunteers was analyzed. The study included 167 volunteers (mean age 40,7±7,9 years) without cardiovascular disease or obesity. Group I (n=86) included individuals aged ≤40 years; group II (n=81) >40 years. STE was used to assess left atrial reservoir strain (LASr).

Results. According to the correlation analysis, in the general group, relationships were found between age and LASr (r=-0,243; p=0,002), age and left atrial conduit strain (LAScd) (r=-0,455; p<0,001), age and left atrial contractile strain (r=0,293; p<0,001), and age and left ventricular filling pressure (E/e’) (r=0,310; p<0,001). According to logistic regression, the complex of LAScd (odds ratio (OR) 0,917; 95% confidence interval (CI): 0,863-0,974; p=0,005), early diastolic velocity of the septal part of the mitral annulus (OR 0,747; 95% CI: 0,6200,900; p=0,002) and peak transmitral flow velocity A (OR 1,043; 95% CI: 1,011-1,076; p=0,008) was independently associated with age >40 years. In the ROC analysis, the sensitivity and specificity of the model were 76,5 and 70,9%, respectively (area under the ROC curve (AUC)=0,783; p<0,001).

Conclusion. In male volunteers without cardiovascular disease, an association between traditional and modern measures of diastolic function and age was found. The median normal LASr values for ages 18-60 years was 37,1%, for ages ≤40 years — 38,5%, and for ages >40 years — 36,2%.

Carotid angioplasty with stenting (CAS) is an alternative to surgery in patients with high surgical risk after carotid endarectomy. According to the large randomized controlled trial Carotid Revascularization Endart-erectomy versus Stenting (CREST), there are no significant differences in the rates of stroke, myocardial infarction, or death in the long-term follow-up between the CAS and carotid endarectomy groups. However,a significant number of complications in the CAS group are associated with the periprocedural period. The safety of CAS directly depends on the technical success of the procedure and minimizing the risk of cerebral embolism. Despite the use of embolic protection in 100% of cases, stroke prevention remains a pressing issue. A clinical case demonstrates the impact of intraoperative intravascular ultrasound (IVUS) on interventional tactics and complication prevention in CAS, and an algorithm for managing intraprocedural plaque protrusion is proposed.

This case confirms that IVUS is not simply a diagnostic tool, but a strategic tool that enables individualized treatment at all CAS stages. Routine use of IVUS for plaque morphology assessment, intraoperative monitoring, and complication management can significantly improve procedural safety. A management algorithm for patients with plaque protrusion is proposed.

In the era of national screening programs and the widespread availability of vascular ultrasound and multislice computed tomography, a giant abdominal aortic aneurysm with a diameter greater than 10 cm is a rare clinical finding. Delayed surgical treatment of a giant abdominal aneurysm leads to its rupture, with a mortality rate of <90%. Furthermore, performing both open and endovascular reconstructions presents a complex technical challenge for the treatment of this patient population. This article presents a case of successful aneurysmectomy in a patient with a giant ruptured juxtarenal abdominal aortic aneurysm. This case is considered unique due to the rarity of this pathology and the successful surgical outcome. This case highlights the importance of timely diagnosis, surgical intervention, and a multidisciplinary approach to achieving a favorable outcome in patients with a ruptured giant abdominal aortic aneurysm.

Obesity is a widespread chronic disease of the 21^st century, characterized by excess accumulation of adipose tissue and weight gain. These patients have a significantly increased risk of cardiovascular disease and vulnerability to respiratory infections. Cardiorespiratory complications remain the leading causes of death. The combination of bilateral pneumonia (BP) and heart failure (HF), developing in the context of obesity, significantly worsens the prognosis.

Brief description. This case presents describes a 60-year-old patient with obesity, bilateral pneumonia, HF, and hypertension. The main complaints were shortness of breath on exertion, cough with nummular sputum, and palpitations. The history included myocardial infarction. Body mass index was 36,8 kg/m², oxygen saturation (SpO₂) — 86-89%. In addition, there were high respiratory rate, moderate cyanosis, reduced breath sounds, dry and wet rales. Blood pressure was 140/80 mm Hg, heart rate — 100 beats/min. Computed tomography revealed infiltrative and reticular changes in both lungs. Echocardiography revealed a decrease in the left ventricular ejection fraction to 20% and dilation. Elevated brain natriuretic peptide levels were noted. The diagnosis of bilateral pneumonia was established based on clinical and paraclinical data. Treatment was administered according to clinical guidelines. After 15 weeks, computed tomography showed following improvements: improved left ventricular (LV) contractility, decreased LV size. However, there was a decrease in glomerular filtration rate.

Conclusion. This case reflects the atypical onset of bilateral pneumonia in a patient with obesity and HF: the disease manifested primarily with physical and imaging signs in the absence of laboratory markers of inflammation. This emphasizes the need for advanced diagnostics and individualized therapy, as the presence of pneumonia increases the risk of renal and cardiorespiratory complications.

The study aim was to provide an overview of current data on the mechanism of action, clinical efficacy, and safety of bempedoic acid (BA) as a lipid-lowering drug.

The methodological approaches included a literature search of PubMed, Web of Science, and Scopus for studies published before December 19, 2025. The review included randomized controlled trials (RCTs) evaluating the efficacy and safety of BA compared to placebo in patients with hypercholesterolemia, including the Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen (CLEAR) series of studies. Data from metaanalyses and other clinical trials were also considered.

The obtained results demonstrate that BA is the first oral adenosine triphosphate citrate lyase inhibitor, which plays an important role in the treatment of hypercholesterolemia. Due to tissue-specific activation mechanism, BA can be used in patients with statin intolerance. RCT data have demonstrated that when added to maximum-tolerated doses of statins, BA provides an additional reduction in low-density lipoprotein cholesterol (LDL-C) by 15-23%. In monotherapy, in patients with statin intolerance, LDL-C reduction reaches 23-27%. The combination of BA and ezetimibe demonstrated a reduction in LDL-C by 38-45%, and with high doses of statins, BA, and ezetimibe, a reduction of 68%. BA therapy also helps reduce high-sensitivity C-reactive protein levels by 19-32%. Longterm BA use is associated with a 13% reduction in the risk of cardiovascular events compared to placebo, with a favorable safety profile. A subanalysis of the CLEAR studies showed that BA does not increase the incidence of type 2 diabetes.

Thus, BA is an effective and safe lipid-lowering agent that reduces the risk of major cardiovascular events and can be used both as monotherapy and in combination with other lipid-lowering agents.

The emerging problem of cardiovascular toxicity associated with antitumor therapy raises the question of timely diagnosis of its early manifestations. To address this issue, a literature review was conducted on an integrated approach to diagnosing early manifestations of cardiovascular toxicity induced by anthracycline antibiotics, including genetic marker testing, coronary computed tomography angiography (CCTA), and cardiac magnetic resonance imaging.

These guidelines describe the management of outpatient monitoring of patients with stable coronary artery disease by a general practitioner and include modern approaches to diagnosis — clinical and paraclinical methods — as well as treatment and prevention of complications.

These guidelines will enable physicians to make informed clinical decisions within outpatient monitoring for patients with stable coronary artery disease based on the related algorithm presented (examinations, consultations).

The guidelines are intended for general practitioners, family doctors, as well as for mid-level health providers working with the above-mentioned doctors, for paramedics performing the doctor functions regarding organizing and conducting outpatient follow-up. These guidelines can be used by healthcare executives, heads of primary care facilities, and their departments.