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Purpose. Analysis of the incidence of COVID-19 in patients from the register «Management of chronic patients with multiple diseases» with a previously established CHF diagnosis, depending on the presence or absence of a symptom of bendopnea. Materials and methods. Retrospective analysis of electronic outpatient records of 121 patients with CHF with and without bendopnea symptom, with an assessment of the incidence of COVID-19. For statistical processing of the data obtained, we used the R language and the RStudio software environment. Results. The average age of the patients was 74.38±9.83 years. Bendopnea symptom occurred in 60,3% (n = 73) of the studied patients. The incidence of COVID-19 was 14% (n = 17), of which 88% were patients with the symptom of bendopnea (p-value = 0.023, Х2 = 5.17). The chance of COVID-19 in patients with bendopnea was higher than in patients without symptom of bendopnea (OR 5.8 (1.2; 26.7), p = 0.013). Conclusion. The presence of a symptom of bendopnea in patients with CHF increases the risk of COVID-19. A statistically significant relationship was established between the presence of a symptom of bendopnea, the level of left ventricular ejection fraction and the incidence of COVID-19. For citation: Dragunov DO, Sokolova AV, Hasanova AD, et al. Bendopnea as a risk factor for the incidence of COVID-19 in patients with CHF. City Healthсare. 2021; 2(2): 26-34. doi: 10.47619/2713-2617.zm.2021.v2i2;26-34

This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.

In opinion the Expert council provides management tactics for patients with hypertriglyceridemia (HTG). It is demonstrated that HTG is a common condition in overweight patients and is an important component of residual risk. HTG creates additional conditions for the progression of atherosclerosis, so the level of triglycerides (TG) is recommended to be measured in patients with a high, very high and extremely high risk level. An indication for the appointment of drugs that reduce the concentration of TG is its level of more than 2,3 mmol/L. Statins are the agents of choice to reduce the risk of cardiovascular disease in high-risk patients with hypercholesterolemia and HTG. Fenofibrate is used to correct HTG, and in case of intolerance to it or when the target level of TG is not reached, omega-3 ethers of polyunsaturated fatty acids in a dose of 2-4 g/day are recommended. In patients with HTG with a TG level >5,6 mmol/L, fenofibrate is the agent of choice.

Tactics for the management of patients with hypertriglyceridemia (HTG) is provided in the conclusion of the Advisory Board. It is demonstrated that HTG is quite prevalent in patients with excessive body weight and is an important component of residual risk. HTG creates additional conditions for the progression of atherosclerosis, and thus it is recommended to test triglyceride in patients with high, very high and extremely high cardiovascular risk. The indication for the pharmacological treatment to reduce the triglycerides concentration is their level more than 2.3 mmol/l. Statins are drugs of choice aimed to decrease the cardiovascular risk in patients with hypercholesterinemia and HTG. Fenofibrate is used to correct HTG; in case of its intolerance or if the triglyceride target level is not reached, ethyl esters of omega-3 polyunsaturated fatty acid can be used in the dosage of 2-4 g daily. In patients with triglyceride level higher than 5.6 mmol/l, fenofibrate is the main option of treatment.

Aim: to study changes in the volumes of muscle, fat, and connective tissue in postmortem issue samples (autoptates) from diaphragm, right ventricle, lower limb (gastrocnemius muscle), as well as morphological changes of the diaphragm muscular structure in patients with different functional classes of heart failure (HF), and to compare them with some intravital parameters of external respiration (with maximal inspiratory pressure and its amplitude simultaneously measured by ultrasound method in particular). Materials and methods. Autoptates of the diaphragm muscle, right ventricle, lower limb (n=39) from 20 men and 19 women (with in vivo diagnosis CHF NYHA functional class (FC) I-IV, hypertension, ischemic heart disease) were examined within 24 hours after the fatal outcome. Light optical microscopy was used to assess the percentages of muscle, connective, adipose tissue, numbers of fibroblasts, and collagen fibers. Spirometric measurements, measurement of respiratory muscles strength, and examination of the diaphragm contractile function were performed by echolocation 56.7±11.9 days before death. Results. In patients of all NYHA FCs most pronounced changes of volume of muscle tissue were observed in the right ventricle and diaphragm, while less pronounced – in the gastrocnemius muscle. The increase in the volume of adipose tissue in patients with I-III FC CHF was most pronounced in the right ventricle and diaphragm, and less pronounced – in the gastrocnemius muscle. The greatest increase in the adipose tissue volume was recorded in the diaphragm of patients with IV FC. Changes of connective tissue volume did not follow linear dependence. The largest “leap-like” increase in the volume of connective tissue occurred in the diaphragm of patients with III FC, what significantly outstripped this process in peripheral muscles and right ventricular myocardium. There was stable relationship between structure of tissue of the diaphragm, maximal inspiratory thickness of diaphragmatic muscle, and maximal inspiratory pressure. This relation (correlation) was positive for pairs muscle tissue volume – muscle thickness and muscle tissue volume – inspiratory pressure, and negative for pairs connective tissue volume – muscle thickness, connective tissue volume - inspiratory pressure, adipose tissue volume - inspiratory pressure (r>0.85, pConclusion. Morphofunctional changes in the diaphragm are caused by progressive decrease in the content of muscle tissue, increases of volumes of adipose and connective tissues. These changes correlate with the CHF FC, maximal inspiratory thickness of diaphragmatic muscle, and maximal inspiratory pressure. Severity of these morphological changes is maximal in patients with FC III CHF.

Aim. To assess the characteristics of patients and short-term outcomes of the disease in patients hospitalized for cerebral stroke (CS) based on the REGION-Moscow register. Material and methods . From 2012 to 2017, 900 patients were included in the REGION-Moscow register, who were consecutively admitted to one of the clinics in Moscow, and in whom CS or transient ischemic attack (TIA) were diagnosed during hospitalization. Results. The average age of the entire cohort of patients was 71±15 years. Women were 59,4%, men — 40,6%. The average age of women was 7 years more than the average age of men. Cardiovascular risk factors or a combination of them were detected in most patients. About 75% of CS were ischemic, 10% — hemorrhagic, 2% — mixed type, 13% were transient ischemic attack. Hospital mortality on average over the 5 years were 24,0%. There was a sharp increase in hospital mortality in 2014, which coincided with the organization of the vascular center, in subsequent years there was a progressive decrease in hospital mortality. Conclusion. The development of CS in most patients was predictable and determined mainly by the presence of cardiovascular risk factors or a combination of them. Organization of the vascular center led to a gradual decrease in hospital mortality. Boytsov S. A.5 on behalf of the working group. REGION-Moscow register working group: Akimova A. V., Arutyunov G. P., Belova E. N., Blagodatskikh S. V., Boytsov S. A., Vernohaeva A. N., Viskov R. V., Voronina V. P., Gladilkina M. P., Deev A. D., Dmitrieva N. A., Drapkina O. M. Zagrebelny A. V., Kvitivadze G. K, Klyashtorny V. G., Kokareva I. V. , Kudryashov E. V., Kutishenko N. P., Lerman O. V., Lukyanov M. M., Martsevich S. Yu., Matveyeva A. D., Matskevich L. A., Mitichkin A. E., Nikitina G. I., Nikoshnova E. S. Ovsepyan M. A., Okshina E. Yu., Palamarchuk V. N., Parsadanyan N. E., Porezanova M. V., Sementsov D. P, Stakhovskaya L. V., Stepina E. V., Stolboushkina E. A., Halaeva M. A., Chernyshova M. I., Shamalov N. A.

Aim To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients’ privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).ResultsThe analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic non-communicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that a large percentage of patients with these conditions have poor longer-term compliance with their treatments. The population of Russia is affected by poor compliance in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease.Hypertriglyceridemia is suspected of contributing to residual cardiovascular risk in patients whose low-density lipoprotein cholesterol (LDL-C) is well controlled. A preparation of highly purified omega-3 polyunsaturated fatty acids (EPA/DHA=1.2/1-90%, marketed as OMACOR), is indicated for the control of high triglyceride levels and also for secondary prevention of myocardial infarction (MI).DIAPAsON is a prospective observational program designed to evaluate the impact of digital technologies on patient compliance and adherence in a large sample of patients whose treatment scheme includes EPA/DHA=1.2/1-90%. A bespoke electronic data capture system has been developed for this purpose that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other objectives of the program include raising patients’ awareness about their condition via educational materials available in patient personal accounts in the electronic system.This report outlines the rationale and methodology of DIAPAsOn and the primary demographics of the study population.

The potential impact on cardiovascular morbidity and mortality have become one of the most important issues of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 may be associated with more frequent development of acute cardiovascular complications, while patients with established cardiovascular diseases are characterized by a higher risk of severe infection and adverse in-hospital outcomes. Due to the spread scale of the pandemic, understanding the long-term cardiovascular consequences of COVID-19 is of no less importance. Inability to extrapolate available international data to the Russian population has led to the initiation of a national multicenter study (registry) of patients recovered from COVID-19 and with concomitant involvement of the cardiovascular system or with baseline severe cardiovascular diseases. The article presents its rationale, design and implications of the results for clinical practice.

Objective — To analyze the effect of pneumonia on mortality among patients with circulatory decompensation. Material and methods — The study was based on the ORACLE-RF registry containing information obtained from 20 cities in Russia. Patients were monitored for one year. The research included men and women with symptoms of chronic heart failure during circulatory decompensation period. The patients' average age was 67±13 years. Final analysis included 2404 patients. Results — Hospital mortality was at 9%. By the 30th day of observation, overall mortality rate stood at 13%. Within the year, the overall mortality rate was 43%. Pneumonia and chronic kidney disease (CKD) had the most pronounced effect on death risk – 49.5% and 47.2%. The study showed that patients who do not have pneumonia and CKD among other associated diseases were 2.5 times more likely to survive after 360 days of observation than patients who have them among other associated diseases. The chances of favorable prognosis in patients without pneumonia are 1.7 times higher than in patients with pneumonia among other diseases. Conclusion — Pneumonia probably triggered the decompensation mechanism and significantly increased mortality in these patients.

The article discusses pathogenesis and treatment of COVID-19. The authors presented state-of-the-art insight into hemostatic disorders in patients with COVID-19 and clinical recommendations on prevention of thrombosis and thromboembolism in patients infected with SARS-CoV-2. The article discussed in detail a new hypothesis proposed by Chinese physicians about a new component in the pathogenesis of COVID-19, namely, about the effect of SARS-CoV-2 virus on the hemoglobin beta-chain and the formation of a complex with porphyrin, which results in displacement of the iron ion. Thus, hemoglobin loses the capability for transporting oxygen, which aggravates hypoxia and worsens the prognosis. The article stated rules of hemotransfusion safety in the conditions of COVID-19 pandemic.

Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes.

Aim To evaluate the risk of major cardiovascular complications (CVC) in patients with chronic heart failure (CHF) with intermediate and preserved ejection fraction (EF) depending on the presence of bendopnea symptom.Material and methods The study included 104 patients with stage II CHF and left ventricular EF ≥40 %. Mean age of the patients was 72.8±10.6 years. A test for detection of bendopnea symptom was performed for all patients. Two groups were formed: group 1, 69 patients with the bendopnea symptom and group 2, 35 patients with a negative test. Follow-up duration was 24 months. The composite endpoint (CEP) was death and hospitalization for any CVC.Results Mean time to the bendopnea symptom was 17.3±6.61 s. At two years of follow-up, the CEP was observed in 36 (34.6 %) patients, including 30 (43.5 %) patients in group 1 and 6 (17.1 %) patients in group 2. 12 patients died, and 9 of them had the bendopnea symptom. 21 patients of group 1 were hospitalized for CVC. Risk of CEP was significantly 1.7 times higher for men (relative risk, RR 1.7 [1.1; 2.6]) than for women. The presence of bendopnea symptom increased the risk of CEP 1.4 times (ОР 1.4 [1.1;1.9]) for women and 2.3 times (RR 2.3 [1.4; 3.6]) for men.Conclusion Results of the study demonstrated an unfavorable effect of bendopnea symptom on risk of CEP during the two-year follow-up of CHF patients with preserved and intermediate EF.

In 2015, the experts from various medical associations of Russia elaborated the clinical guidelines “Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice”. These guidelines were drawn up to improve the use of NSAIDs, our country’s most popular agents to treat pain in acute and chronic diseases. The main purpose of this paper was to reduce the frequency of potentially dangerous class-specific adverse events (AE) that may arise from the use of NSAIDs. To do this, the authors proposed a NSAID choice algorithm based on the assessment of risk factors for AE, the individual characteristics of various representatives of this drug group, and the possibility of prevention of AE. Since then, new data on the efficacy and safety of NSAIDs have been obtained. This has necessitated the revision and addition of a number of provisions in the 2015 guidelines. It seems that the new version of the guidelines, which has been drawn up based on the analysis of a large number of clinical and epidemiological studies, their meta-analysis, by taking into account the clinical experience and opinion of the world’s leading experts, presents more fully the main aspects of the use of NSAIDs in real clinical practice. The guidelines are intended for physicians of all specialties.

Aim.To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register.Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months.Results.According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure.Conclusion.According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices.

Background Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic, noncommunicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that many patients with these conditions have poor long-term adherence to their treatments. The population of Russia is affected by poor adherence in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease. Objective The purpose of this study was to examine patient adherence to a prescription-only preparation of highly purified omega-3 polyunsaturated fatty acids (1.2 to 1 eicosapentaenoic acid to docosahexaenoic ratio, 90% purity) in a large sample of patients at risk for cardiovascular diseases using digital technology to monitor patient behavior and as an outreach facility for patient education and engagement. Methods We conducted a 6-month prospective observational study (DIAPAsOn) at >100 centers in the Russian Federation. A bespoke electronic data capture and patient engagement system were developed with a well-established Russian technology supplier that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other aspects of the program included raising patients' awareness about their condition via educational materials available in personal patient accounts in the electronic system. Results From an initial cohort of 3000 patients, a safety population of 2572 patients (age: mean 60 years) with an equal proportion of men and women has been characterized. There was widespread concomitant cardiovascular pathology and commensurate use of multiple classes of cardiovascular medication, notably lipid-modifying and antihypertensive drugs. The program was completed by 1975 patients, of whom 780 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for secondary prevention after myocardial infarction and 1195 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for hypertriglyceridemia. Data collection and analysis have been completed. Conclusions DIAPAsOn will provide insights into patient adherence with prescription-grade omega-3 polyunsaturated fatty acid therapy and perspectives on the role of mobile technology in monitoring and encouraging adherence to therapy.

AIMS Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF) and has been suggested to be associated with poor prognosis. Recently completed double-blind randomised controlled trials (RCTs) studying HF patients with ID have shown improvements in functional capacity, symptoms and quality of life when treated with i.v. ferric carboxymaltose (FCM). This individual patient data meta-analysis investigates the effect of FCM vs. placebo on recurrent hospitalisations and mortality in HF patients with ID. METHODS AND RESULTS Individual patient data were extracted from four RCTs comparing FCM with placebo in patients with systolic HF and ID. The main outcome measures were recurrent cardiovascular (CV) hospitalisations and CV mortality. Other outcomes included cause-specific hospitalisations and death. The main analyses of recurrent events were backed up by time-to-first-event analyses. In total, 839 patients, of whom 504 were randomised to FCM, were included. Compared with those taking placebo, patients on FCM had lower rates of recurrent CV hospitalisations and CV mortality [rate ratio 0.59, 95% confidence interval (CI) 0.40-0.88; P = 0.009]. Treatment with FCM also reduced recurrent HF hospitalisations and CV mortality (rate ratio 0.53, 95% CI 0.33-0.86; P = 0.011) and recurrent CV hospitalisations and all-cause mortality (rate ratio 0.60, 95% CI 0.41-0.88; P = 0.009). Time-to-first-event analyses showed similar findings, with somewhat attenuated treatment effects. The administration of i.v. FCM was not associated with an increased risk for adverse events. CONCLUSIONS Treatment with i.v. FCM was associated with a reduction in recurrent CV hospitalisations in systolic HF patients with ID.

To determine a relationship between the level of total sodium in the myocardium to its stiffness.The investigation enrolled 18 hypertensive patients who had suddenly died; their mean age was 40±10 years; mean waist circumference, 102±12.5 cm; height, 170±7.7 cm; myocardial mass, 319±53 g.The variation in the myocardial level of total sodium averaged 211.7±37.5 (min, 71.5; max, 226.17) mmol/l. The sodium level was ascertained to be affected to the greatest extent by myocardial mass (SS=3615.56; p=0.00029) and age at death (SS=1965.568; p=0.0029), whereas gender and smoking had a considerably lower impact (SS=778.584; p=0.03). A univariate regression analysis showed that there was a relationship between myocardial sodium levels and the thickness of the anterior wall of the left ventricle (β=0.94; p=0.000001; r2=0.88), that of the anterior wall of the right ventricle (β=0.82; p=0.000021; r2=0.66), and that of the interventricular septum (β=0.94; p=0.000001; r2=0.89). The wall thickness of the myocardium was established to depend on its sodium level (SS=21813.89; p=0.000001; r2=0.88): the higher sodium amount in the myocardium, the thicker its walls. The average velocity of acoustic wave propagation was 6.24±0.51 m/sec. A significant correlation was observed between sodium concentrations in the myocardium and its stiffness (β=0.72; p=0.00062; r2=0.49).The level of sodium deposited in the myocardium, which is directly related to dietary sodium intake, is significantly correlated with myocardial stiffness. It can be assumed that the elevated level of sodium deposited in the myocardium is an independent factor that changes the stiffness of the myocardium and appears to influence the development of its diastolic dysfunction.Цель исследования. Определить взаимосвязь уровня общего натрия в миокарде с его жесткостью. Материалы и методы. В исследование включены 18 человек с гипертонической болезнью, умерших внезапно, возраст которых в среднем составил 40±10 лет, средняя окружность талии - 102±12,5 см, рост - 170±7,7 см, масса миокарда - 319±53 г. Результаты. Разброс значений уровня общего натрия в миокарде составил в среднем 211,7±37,5 (min 71,5; maх 226,17) ммоль/л. Установлено, что в наибольшей степени на уровень натрия влияли: масса миокарда (SS=3615,56; p=0,00029) и возраст умершего (SS=1965,568; p=0,0029), тогда как пол и курение влияли в существенно меньшей степени (SS=778,584; p=0,03). Регрессионный однофакторный анализ показал взаимосвязь содержания уровня натрия в миокарде и толщины передней стенки левого желудочка (β=0,94; p=0,000001; r2=0,88), толщины передней стенки правого желудочка (β=0,82; p=0,000021; r2=0,66), толщины межжелудочковой перегородки (β=0,94; p=0,000001; r2=0,89). Установлено, что толщина стенок миокарда зависит от содержания натрия в нем (SS=21813,89; p=0,000001; r2=0,88): чем выше содержание натрия, тем толще его стенки. Средняя скорость распространения акустической волны составила 6,24±0,51 м/с. Получена достоверная связь между концентрацией натрия в миокарде и его жесткостью (β=0,72; p=0,00062; r2=0,49). Заключение. Уровень депонированного натрия в миокарде, имеющий прямую связь с уровнем употребления поваренной соли, имеет достоверную связь с жесткостью миокарда. Можно предполагать, что высокий уровень натрия, депонированного в миокарде, является самостоятельным фактором, изменяющим жесткость миокарда и, по-видимому, влияющим на формирование диастолической дисфункции миокарда.Цель исследования. Определить взаимосвязь уровня общего натрия в миокарде с его жесткостью. Материалы и методы. В исследование включены 18 человек с гипертонической болезнью, умерших внезапно, возраст которых в среднем составил 40±10 лет, средняя окружность талии — 102±12,5 см, рост — 170±7,7 см, масса миокарда — 319±53 г. Результаты. Разброс значений уровня общего натрия в миокарде составил в среднем 211,7±37,5 (min 71,5; maх 226,17) ммоль/л. Установлено, что в наибольшей степени на уровень натрия влияли: масса миокарда (SS=3615,56; p=0,00029) и возраст умершего (SS=1965,568; p=0,0029), тогда как пол и курение влияли в существенно меньшей степени (SS=778,584; p=0,03). Регрессионный однофакторный анализ показал взаимосвязь содержания уровня натрия в миокарде и толщины передней стенки левого желудочка (β=0,94; p=0,000001; r2=0,88), толщины передней стенки правого желудочка (β=0,82; p=0,000021; r2=0,66), толщины межжелудочковой перегородки (β=0,94; p=0,000001; r2=0,89). Установлено, что толщина стенок миокарда зависит от содержания натрия в нем (SS=21813,89; p=0,000001; r2=0,88): чем выше содержание натрия, тем толще его стенки. Средняя скорость распространения акустической волны составила 6,24±0,51 м/с. Получена достоверная связь между концентрацией натрия в миокарде и его жесткостью (β=0,72; p=0,00062; r2=0,49). Заключение. Уровень депонированного натрия в миокарде, имеющий прямую связь с уровнем употребления поваренной соли, имеет достоверную связь с жесткостью миокарда. Можно предполагать, что высокий уровень натрия, депонированного в миокарде, является самостоятельным фактором, изменяющим жесткость миокарда и, по-видимому, влияющим на формирование диастолической дисфункции миокарда.

Aim To evaluate the effect of body composition on prediction of community-acquired pneumonia caused by Str. pneumoniae in patients with decompensated CHF. Materials and methods The study included 216 patients. The pneumonia agent was identified by sputum culture. Body composition with determining lean body mass and fat mass was evaluated using a bio-impedance analysis; body mass index (BMI) was calculated. Patients with BMI 18.5-24.9 kg/m2 were included into the study. Statistical analysis of obtained data was performed using the IBM SPSS Statistics 20 software. Results The in-hospital mortality was 13.4 %; the one-year mortality was 29.6 %. Fat mass strongly, negatively correlated with a fatal outcome within a year, and the degree of lean body mass shortage moderately, positively correlated with the life span of patients. Conclusion Body composition is significantly predictive for patients with decompensated CHF and community-acquired pneumonia caused by Str. pneumoniae.

Purpose. The study of quality of life (QOL) in patients with CHF with preserved LVEF (left ventricular ejection fraction) and a symptom of bendopnea with different levels of salt intake. Materials and methods. The study included 66 patients. The main symptoms of CHF were edema in 54.5% of cases, dyspnea in 77% of cases, ascites was detected in only 2 patients, an enlarged liver in 7 patients. Abdominal obesity was detected in 53 patients. Quality of life was assessed by the SF‑36 questionnaire, the level of salt intake was assessed by the Charlton: SaltScreener questionnaire. Results. On average, the time of occurrence of the bendopnea was 22.5±9.3 seconds, the minimum was 5 seconds. The absence of the effect of abdominal obesity on the risk of bendopnea (relative risk 1.18 [0.76; 1.83]) was revealed. According to the SF‑36 questionnaire, a decrease in physical health indicators (median 31.3 points [20.7; 42.3]) and psychological health (average score 43.2±21.7) was found. In patients with bendopnea, QOL was reduced due to both physical and mental health, unlike patients without bendopnea: physical functioning (Physical Functioning – PF) 24.8±16.1 against 47±28.9 points, p=0.001 ; role‑based functioning due to physical condition (Role‑Physical Functioning – RP), 0 [0; 25] vs. 37.5 [0; 100] points, p=0.008; general health (General Health – GH) 29.9±15.8 against 50±14.2 points, p=0.0005, social functioning (Social Functioning – SF) 56 ± 38 against 78.9 ± 17.8 points ; p = 0.004. Multidimensional regression analysis revealed the relationship between the time of occurrence of the symptom bendopnea and the level of salt intake, physical and psychological activity (r2=0.25; p 0.05), while the presence of bronchial asthma or chronic kidney disease significantly reduced QOL of patients (pConclusion. The presence of the symptom bendopnea significantly reduces the quality of life of patients with CHF with preserved LVEF (left ventricular ejection fraction).

cardiovascular diseases, sudden cardiac death, risk, treatment, prevention Cardiovascular mortality in Russia is one of the highest in the world reaching 614 deaths per 100,000 annually. The main causes of death from cardiovascular diseases are the progression of congestive heart failure (about half of all cases) and sudden cardiac death (the other half). Thus, we can assume that the incidence of sudden cardiac death in 2016 was no less than 300,000. In the abbreviated version of the National Recommendations in English, the principles of decision-making algorithms in various clinical situations are used.

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

Aim. To assess the parameters reflecting sarcopenia (body composition, muscle strength, muscle function) in order to determine the effectiveness of metformin in patients with sarcopenia.Material and methods. Systematic searches of clinical trials were carried out in MEDLINE databases through PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ResearchGate from January 1990 to March 2019. For statistical processing, the R language with the RStudio software was used. The following packages were used: googlesheets4, tidyverse, meta, dmetar, metafor. The metaanalysis included 391 patients with both established for the first time and existing long-term type 2 diabetes (T2D), with prediabetes, impaired glucose tolerance (IGT), as well as patients without impaired glucose metabolism. In comparison groups (194 patients who received metformin and 197 patients who received placebo), the effect of metformin on lean body mass (LBM), fat mass, muscle strength and muscle function was assessed, which made it possible to indirectly evaluate the potential effect of metformin on sarcopenia.Results. The use of metformin in patients with different glucose metabolism (type 2 diabetes, IGT, prediabetes) did not lead to significant changes in body composition (on average, LBM increased by 0,9 kg (MD, 0,8815; CI (-0,11; 1,87), p=0,0818), fat mass decreased by 0,7% (MD, -0,6856; CI (-1,54; 0,17), p=0,1170), but muscle strength significantly increased by 0,5 kg (SMD, 0,5241, CI (0,2265; 0,8217), p=0,0006).Conclusion. Meta-analysis has confirmed that the use of metformin has an effect on muscle strength, which makes it possible to consider it for sarcopenia treatment. Unfortunately, a small number of studies have not allowed to analyze the effect of metformin on a number of characteristics: muscle strength, muscle function (walking speed, functional tests). At the moment, a much larger prospective study is needed to form a final opinion on the rationale of metformin therapy in patients with sarcopenia.

At the online meeting held on September 3, 2020, the results of the international multicenter trial EMPEROR-REDUCED were considered. Number of proposals and recommendations for the further study of cardiovascular and renal effects of empagliflozin and its practical use in heart failure patients were agreed.

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients.Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed.

The study is one of the priority points of the Russian Scientific Medical Society of Internal Medicine, initiated due to known high average level of LDL cholesterol in Russian population and necessity for its optimized control by better access to treatment. AIM To conduct comparative analysis of efficacy and safety of the rosuvastatin compound akorta and original rosuvastatin crestor. MATERIAL AND METHODS To randomized crossover study (PARITET) 60 patients were included with the diagnosis dyslipidemia. Total duration of treatment phase was 14 weeks - two times by 7 weeks, when the drugs were crossed, separated by 4 weeks washout. Main endpoints were the rate of low density lipoprotein cholesterol (LDL-C) decrease comparing to baseline, and reach of LDL-C guidelines-based target level. RESULTS After the first 7-week treatment the rate of decrease in akorta group was 49.0+/-15.6%, in crestor 52.6+/-17.4% (p=0.606). After the second period, in respective groups prescription of crestor led to LDL-C decrease by 43.4+/-17.9%, akorta - by 47.2+/-16.3% (p=0.724). After the first period of treatment the value of target levels reach did not differ significantly (akorta - 70.0%, crestor - 83.3%; p>0.05). After the second period in the group crestor-akorta the value was significantly better than in akorta-crestor group (60.0% and 83.3%; p

Experts consensus of the Russian Cardiology Society (RSC)

Arterial hypertension in adults. Clinical guidelines 2020

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

Goal: to study early signs and hypertension reaction features during cardiopulmonary exercise testing (CPET) in intellectually working men with rare episodes of stress induced blood pressure (BP) increase. Methods: 47 patients (pats) with periodic episodes of high BP due to high level of stress were included (all men, 42 ± 4.6 years old). Risk factors: smoking had 83% of pats, high cholesterol level 87%, glucose intolerance 39%, family history of high BP 14%. All pats had normal BMI and no signs of visceral fat and target organ damage, 54% used hypotensive therapy non-systemically, 98% complained for sleep disorders. CPET was done for optimal training regime appointment. Baseline BP was 134± 2,8 mm Hg. Most of the pats demonstrated low physical tolerance level (6,7±0.4 MET). All patients demonstrated hypertensive reaction during test, and that was the reason for test stop. 68% of pats demonstrated systolic BP 220 mm Hg at respiratory compensation point (RCP) and RER 1,17 ± 0.01, 32% of pats demonstrated it earlier than RCP and at RER 0.85± 0.06. All pats got recommendations with optimal physical and pulse regime for training. All the patients had 3 ± 1 moderate intensive aerobic training per week for 34 ± 10.7 min. Results: in 6 months all the patients demonstrated increase in physical tolerance (ΔVO2 5,3 ±1,3 ml/kg/min). Patients with hypertension reaction at RCP showed significantly lower baseline BP (124.6± 3.5mm Hg vs 131.2 ± 4.1 mm Hg in other patients, p Conclusion: hypertension reaction at RCP during CPET in intellectually working man with episodic stress induced increase of blood pressure can be a predictor of great benefit in life style modification, cardiac risk lowering and arterial hypertension control

Aim. To study the changes in expenses for the usage of the novel medication serelaxine in treatment of decompensated chronic heart failure. Material and methods. At the core of study — buit-up Mark model that takes into consideration two scenarios of the disease course in patients with decompensated CHF: the usage of standard treatment and standard treatment with serelaxine add-on. Probability of the shift from one condition to another for both groups is calculated based on the results of international clinical trials Pre-Relax-AHF and Relax-AHF as by the data of Russian registry ORAKUL-RF. The sources of information on the price of the resources involved were open. As the whole data was not completely comparable in the build-up of the model we made some presuppositions: time hoirizon of observation — 1 year; results of Pre- Relax-AHF and Relax-AHF extrapolated to 1 year; serelaxine was prescribed only in the first episode of CHF decompensation therapy; mean rate of deaths in decompensated CHF in all age groups was the same; dynamics of mortality inside the each time cutoff (1 month, 2-6 months, 7-12 months) was similar. Except of the direct medical expenses the followinf were also calculated: amount of undercollected GDP as a result of economically active patients death; expenses for repeated hospitalizations; expenses for emergency calls; expenses for the treatment of heart failure exacerbation; size of undercollected GDP as a result of no-show of the patient at workplace for economically active patients. Results. Expenses for hospitalization and emergency calls in serelaxine group due to lower rate of hospitalizations were almost two times lower comparing to the standard therapy group: 40,9 and 19,3 mln. rubles per 1000 patients, respectively. While using serelaxine the GDP losses due to temporary disability (the size of undercollected GDP) in the group of 1000 patients decreased by 11,5 mln. rubles, or 50%, and if to include the death related losses — by 29,3 mln. rubles (36,5%) by 1 year. Additional expenses for drug therapy of heart failure by serelaxine are compensated by the decrease of general expenses (including additional therapy by serelaxine) by 7,4-28% in patients of economically active age with decompensated CHF. Conclusion. Serelaxine as drug with the main clinical properties as the decrease of general and cardiovascular mortality, positive influence on the level of nephrologic complications and hospitalizations, shows economical superiority in the management of economically active age patients. Currently the use of serelaxine in patients with decompensated CHF might optimize the expenses of Russian healthcare budget related to the treatment of patients with this condition.

The conclusion of the Expert Council "Challenging problems of hypertension management: the effect of increased heart rate and comorbidities on the choice of antihypertensive therapy in practice of cardiologist and therapist" is presented. Topical issues of hypertensive patient’s treatment, the role of heart rate in hypertension and ways to influence it are considered. The possibility of treatment of hypertensive patients with trandolapril/verapamil SR fixed combination is analyzed separately. The data on the clinical efficacy and protective effects of trandolapril/verapamil SR fixed combination are presented.

Cardiovascular mortality in Russia is one of the highest in the world and is 1462 deaths per 100,000 per year. The main mechanisms dramatic outcomes of cardiovascular disease are death due to heart failure and sudden cardiac death (SCD). According to the calculated data 200,000-250,000 patients died suddenly in Russia per year.The problem of the SCD is one of the urgent problems of healthcare because prevalence of it is growing up and there is obvious possibility of effective preventive measures.In the present article presents definitions associated with SCD, mechanisms, primary and secondary risk factors for SCD.

Aim. To compare antianginal and antiischemic efficacy and tolerability of buccal nitroglycerine – Trinotrolong (TNL) medication and most commonly used pills of isosorbide-5-mononitrate (I5M) and isosorbide dinitrate (ID) in patients with stable angina. Material and methods. The study is multicenter, randomized, openlabel. Totally 71 pt studied, mean age 59,5±4,3 y., with not less than three angina episodes (AEp) per week at the background of usual physical activity and positive exercise stress test on tread-mill (EST). After randomization all patients were taking by the cross-method the TNL 4-8 mg/day “on demand” and I5M or ID 40 mg/day during next 6 weeks each. Efficacy of the drugs was assessed by the method of repeated EST, quantity of AEp and pill (dosages) taken of the short-acting nitroglycerine. Results. All medications studied led to a significant relevant increase of the threshold exertion duration as at the 1st day of intake (coupled TNL), as during regular intake. In contrast to TNL and I5M, regular intake of ID led to relevant decrease of the threshold exertion duration comparing to the 1st day of its intake (p=0,04), that witnessed for tolerance. At the background of all medications studied, there was relevant decrease of AEp per week and of long-acting nitrates intake, without significant differences between drugs. There were no any significant differences in the prevalence of side effects, of those – the most often headache occurred with slight decrease with the continuous intake. Conclusion. Significant stable antianginal and antiischemic efficacy of TNL is achieved by transmucous load of buccal nitroglycerine into the body, fast effect development, its prolongation, that makes possible to use TNL by the “on demand” schedule, just before the expected physical and emotional activity.

Objective: to establish whether long-term combination therapy with a tumor necrosis factor (TNF) α inhibitor and a disease-modifying antirheumatic drug (DMARD) (methotrexate – MTX) may lead to sustained rheumatoid arthritis (RA) remission and its maintenance even after discontinuation of genetically engineered biological agents (GEBA). Subjects and methods. Moscow City Clinical Hospital Four had been following up 5 patients (4 women and 1 man) receiving certolizumab pegol (CZP, Cimzia) since 2005. Their treatment was performed in the CDP 879-027/28 study until August 2011; thereafter the patients continued to receive the drug at the department until February 2011. The patients’ mean age was 49.2±8.58 years; the average duration of RA was 4.4±2.3 years. The reason for using the medicament was ineffective previous standard DMARD therapy (sulfasalazine, leflunomide; when using CZP, all the patients took MTXin a dose of 10-15 mg/week; 2 patients had it in combination with prednisolone 5-7.5 mg/day). In all the patients, the disease activity remained high (mean DAS28, 6.33±0.52). Quality of life (QL) was also assessed using overall HAQ, EQ-5 questionnaires. The mean EQ-5D and HAQ QL scores were 50±7.9 and 1.825±0.17, respectively. The patients received either CZP 400 or 200 mg, or placebo in a blind study in October to December 2005; in an open-label study they took 400 mg CZP subcutaneously once two weeks since 2006 and 200 mg of this agent subcutaneously once two weeks (the dose was reduced according to the protocol after data on the efficiency of this dosage regimen were accumulated) since February 2008. Results. By the end of CZP treatment, 3 patients achieved sustained (1-year or more) remission (DAS28

The use of b-blockers is of particular interest now. There are the pros and cons of prescribing these drugs. Thus, a considerable body of the papers that cast doubt on the role of b-blockers in elderly patients with arterial hypertension (AH) in preventing chronic heart failure and enhancing exercise endurance in patients with AH has been published since 2006–2008. However, the Russian guidelines have retained indications for the use of b-blockers that are indispensable drugs in the treatment of AH with high comorbidity. The paper analyzes the most studied b-blockers