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Delaminating intramyocardial hematoma (DIMH) is a rare and potentially life-threatening complication of acute myocardial infarction. Currently, only isolated reports of cases of myocardial dissection have been published, and until recently, the diagnosis of DIMH was carried out during autopsy or surgery. The article describes echocardiographic criteria and discusses some aspects of the therapy of this pathology. The description of clinical cases of noninvasive diagnosis of DIMH in men aged 60 and 62 years hospitalized with the clinic of decompensation of chronic heart failure is given. This complication in the presented patients was diagnosed using transthoracic echocardiography, thanks to which it was possible to identify the dissection of the myocardium, as well as to trace the dynamics of the organization of an intramyocardial hematoma into a parietal thrombus. Various approaches to patient management are demonstrated: conservative tactics allowed to successfully stabilize the course of chronic heart failure in the first patient, while the condition of the other required the transplantation of a donor heart a few months after discharge from the hospital.

A qualitative change in the risk profile after an episode of decompensated heart failure (HF) calls for an as immediate as possible therapeutic response. In the absence of uniform guidelines for the sequence and timing of administering the background therapy during the hospitalization period and the subsequent “vulnerable” period, clinicians have to rely on available expert opinions and results of conducted studies. The article focuses on an evidence base for the use of background therapy for HF during the above-mentioned periods. Special attention is paid to the conditions and principles of initiating this therapy.

Aim To determine the incidence rate and the practical significance of right ventricular dysfunction (RVD) in the development of cardiovascular complications in patients with decompensated chronic heart failure (DCHF).Material and methods This prospective, single-site observational study included 171 patients older than 18 years with NYHA functional class (FC) II-IV chronic heart failure (CHF) who were hospitalized for DCHF. Standard and extended 2D and 3D echocardiography (EchoCG) was performed for all patients on admission. Additionally, functional characteristics of the right ventricle (RV) were evaluated in the 3D mode followed by autonomic 3D processing with a EchoPac station (USA). RVD was taken as a disorder of two or more RV functional parameters according to results of 2D EchoCG, or a reduced RV free wall strain according to results of 2D speckle-tracking EchoCG, or a reduced RV ejection fraction (EF) according to results of 3D EchoCG. Statistical analysis was performed with a SPSS Statistics v. 26.0 software.Results The incidence rate of RVD in general population of patients with DCHF was 75.4 % (n=129). A higher prevalence of RVD was observed in patients with CHF with a low left ventricular (LV) EF (90.1 %). Patients with RVD had a more severe clinical status (significantly higher FC and higher Clinical Condition Scale (CCS) scores), more frequent atrial fibrillation (AF), and higher concentrations of uric acid and total bilirubin. RVD significantly correlated with male sex (odds ratio (OR), 2.05; 95 % confidence interval (CI), 1.01–4.19; р=0.046) and AF (OR, 3.52; 95 % CI, 1.71–7.26; рConclusion The determined incidence, correlations, and the predictive value of RVD in patients with DCHF indicated the appropriateness of assessing the RV function to optimize the management of patients regardless of the CHF phenotype.

Aim. Assessment of impact of the duration of preoperative antimicrobial therapy (AMT) on the sensitivity of microbiological examination and polymerase chain reaction (PCR) of blood/tissues of resected valves in operated patients with infective endocarditis (IE).Materials and methods. 52 operated patients with active IE were included prospectively (Duke criteria, 2015). All patients underwent microbiological examination of blood before admission to the cardiac surgery hospital, as well as parallel simultaneous microbiological examination and PCR of blood/tissues of excised valves, followed by Sanger sequencing. The duration of preoperative treatment was calculated from the first day of AMT according to IE diagnosis to the day of surgery.Results. The causative agent of IE was established in 84.6% (n=44) patients by means of complex etiological diagnosis. A significant decrease in the sensitivity of microbiological examination of venous blood was revealed when performed in the period before and after hospitalization to a surgical hospital (up 44.2% to 17.3%, p0.05) vs. 75.0% (p0.05) vs 72.4% (pConclusion. Long-term preoperative AMT significantly reduced the sensitivity of microbiological examination of resected valve blood/tissue in operated patients with IE, whereas PCR of resected valve blood/tissue was highly sensitive even with preoperative AMT for more than 29 days.

Aortic valve lesion is a common and may have diverse causes, from degenerative, congenital and infectious diseases to autoimmune conditions. We present a rare case of Takayasu arteritis and severe heart lesion due to the myxomatous degeneration of the aortic and mitral valves associated with development of infective endocarditis (IE) complicated by abscess, fistula, valve perforation and recurrent acute decompensated heart failure in a young female patient. A combined use of histopathological and PCR analyses of valve tissues was critically important for differential diagnosis of the valve lesions, as it made it possible to identify the true cause of the disease. The presence of Takayasu arteritis has played an indirect role by creating conditions for the development of immunosuppression and determining the disease severity and its progression.

On December 1, 2021, a meeting of the Council of experts on the treatment of hypertension, coronary heart disease, and chronic heart failure during the COVID-19 pandemic was held remotely to adjust and adapt current approaches to outpatient treatment of the above pathologies under the current epidemiological situation. The meeting was attended by leading Russian specialists from federal medical research centers of cardiology and therapy.

The issue of antithrombotic therapy in patients with infective endocarditis has been studied for over 75 years. During that time studying of pathogenesis of the disease and its embolic complications, lead to the introduction of the concept of “immunothrombosis”. That mechanism allows infective agents (mostly bacteria) to be cloaked from the immune system and to multiply freely, leading to growth of vegetation, thus resulting in higher chance of fragmentation. Small-scale experimental and clinical studies on the correction of hemostatic disorders in infective endocarditis, that were performed in 20th century, didn’t show any significant results, that could affect clinical practice. However, reinterpretation of available data on coagulative system will allow to have elements of hemostasis as an application point in treating infective endocarditis. The article will discuss latest insights on the role of hemostasis system in pathophysisology of infective endocarditis, its effects on the development of the embolic complications, perspectives for diagnostics and treatment.

Aim To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97 %) or during an outpatient visit (3 %). ID was determined according to the European Society of Cardiology Guidelines.Results 83.1 % of patients had ID; only 43.5 % of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2 %, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100 pg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95 % confidence interval: 1.002–1.011, p=0.0152).Conclusion The incidence rate of HF patients is high in the Russian Federation (83.1 %). Only 43.5 % of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.

Aim. To describe prognostic meaning of cardiac and other principal clinical manifestations of systemic AL-amyloidosis in their interrelations.Material and methods. It has been made long-time survival analysis of 147 patients with systemic AL-amyloidosis. In the special investigation group (n=58) of AL (n=55) and ATTR (n=3) amyloidotic cardiopathy patients there were evaluated prognostically important structural and functional changes in myocardium with standard and impulse-wave tissue dopplerometric echocardiography in comparison with NTproBNP serum levels.Results. Even though significantly increased nowadays surviving of AL-amylodotic patients (Me=90 months) it has been found that as at previously time orthostatic hypotension and amyloid cardiopathy are being most severe initial syndromes (median 25 months), but after 1 year from diagnosis influence of these syndromes on surviving had decreased and most low surviving was more common in patients with CKD 3-5 (median 28 months). Influence of CKD 3-5 on surviving was associated predominantly with intracardial hemodynamics deterioration. Together with decreased systolic shortening strain rate (48,5%) decreased filtration rate (47,9%) was second of main factors contributing into NTproBNP increasing in effective multiple regression model (R=0,702, F(4,21)=5,095, p=0,005). NTproBNP level in less degree depended on renal clearance.Conclusion. Heart damage is one of the most prognostically unfavorable manifestations of systemic amyloidosis due to a sharp deterioration in the elastic properties of the myocardium, in the process of further development of amyloidosis, the leading factor in progression is the deterioration of the profile of cardiorenal interactions, the marker of which is the level of NTproBNP.

Aim. To study the effects of azilsartan medoxomil/chlorthalidone (AZM/CTD) and losartan/hydrochlorothiazide (LOS/HCT) combinations for NTproBNP levels, 6-minute walk test results, hydration status along with their antihypertensive efficacy according to clinical and 24-hour blood pressure in patients with hypertension and heart failure with preserved ejection fraction (HFpEF).Material and methods. An open randomized study included 56 patients with uncontrolled or untreated hypertension and HFpEF. Patients randomized to receive the AZM/CTD 40/12.5 mg/day (group 1; n=28) or LOS/HCT 100/12.5 (group 2; n=28) within 4 weeks. Patients who did not achieve the target BP Results. After 12 weeks, 92% of patients in the first and 78% of patients in the second group reached the target clinical BP (рConclusion. In patients with hypertension and HFpEF, therapy with the AZM/CTD combination compared with LOS/HCT is accompanied by a more pronounced antihypertensive effect in terms of ambulatory and peripheral blood pressure, central blood pressure, NTproBNP levels, increased distance in 6MWT and achievement of euvolemia status.

High blood pressure is a risk factor for cardiovascular morbidity and mortality, as well as cognitive decline and loss of autonomy in the elderly and old age. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy indicate the benefit of lowering elevated blood pressure in patients over 80 years of age. Older patients with senile asthenia, loss of autonomy and other geriatric problems were excluded from RCTs, and observational studies in these groups of patients indicate an increase in morbidity and mortality with lower blood pressure and antihypertensive therapy. Obviously, in very elderly patients, a universal strategy for the treatment of arterial hypertension cannot be applied due to the significant heterogeneity of their functional status. The geriatric approach to the management of arterial hypertension in older patients involves an assessment of the functional status, the presence of senile asthenia, and the degree of autonomy for the choice of antihypertensive therapy tactics.

Aim. To study the impact of heart rate (HR) reduction with beta-blockers (BB) on left atrial (LA) function in hypertensive patients with paroxysmal or persistent mild symptomatic atrial fibrillation.Material and methods. In this open prospective trial we randomly assigned patients with hypertension, sinus rhythm, elevated heart rate (≥70 bpm), and recurrent atrial fibrillation (EHRA 2A or less) to receive BB with a target HR of less or greater than 70 bpm for at least 4 months. All the patients underwent an echocardiogram [left atrial (LA) function was assessed as emptying fraction]and applanation tonometry at baseline and after 4 months. Primary endpoint was median LA emptying fraction (LAEF) measurement at the end of the study.Results. 47 patients were randomized to group with a target HR of ≤70 bpm and 44 patients to >70 bmp. Among them 44 and 41 patients completed the study. Median follow up was 4.4 months. At the end of the study (4.5 months) median HR was 62 [60; 67] bmp in ≤70 group and 73 [72; 76] bpm in >70 group. Both groups received similar antihypertensive therapy and there were no intergroup differences in systolic and diastolic blood pressure. At the end of the study, patients in ≤70 group had significantly lower LAEF compared with >70 group (37% vs 42%; p=0.01). E’avg was lower and augmentation index was higher in ≤70 group as compared to >70. In regression analysis, after E’avg and augmentation index were included in the model, the association between LAEF and randomization group lost its significance.Conclusion. Beta blockers treatment with strict HR reduction (≤70 bpm) significantly reduced LA function as compared to lenient target HR (>70 bpm).

Aim To determine the clinical and prognostic significance of subclinical pulmonary congestion, as evaluated by stress ultrasound (stress-US) examination of the lungs, in the development of heart failure (HF) during the postinfarction period after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI).Material and methods This prospective observational study included 103 patients with no history of HF and with the first AMI and successful PCI. Standard laboratory tests, including the measurement of NT-proBNP, echocardiography, stress-US of the lungs with a 6-min walk test (6MWT), were performed for all patients. Pulmonary congestion was diagnosed with the total number of B lines ≥2 during stress: mild (2-4 B lines), moderate (5-9 B lines), and severe (≥10 В lines). Subclinical pulmonary congestion implied the absence of clinical signs of congestion in the presence of ultrasonic signs of pulmonary congestion (>2 В lines) during stress. The phenomenon of “wet” lung was identified when the total number of B lines was >2 at rest (“wet” lung at rest) and ≥2 after stress, the phenotype was identified as “very wet” lung. The endpoint was hospitalization for HF during 1.5 years.Results The study showed a high incidence of subclinical pulmonary congestion as determined by the results of stress-US test of the lungs, mild (18.4 %), moderate (37.9 %) and severe (42.7 %), and of “wet” and “very wet” lung phenotypes (65 %). The “wet/very wet” lung phenotypes correlated with the body weight index (R=0.236; p=0.016), troponin concentration upon admission and at 6–12 h (R=0.231; p=0019 and R=0.212; p=0.033, respectively), NT-proBNP concentration (R=0.276; p=0.035), Е peak (R=0.241; p=0.019), global longitudinal strain (GLS) (R=–0.208; p=0.034), and left ventricular end-diastolic dimension (R=0.351; p=0.0004). The higher probability of hospitalization for HF during 1.5 years after the discharge from the hospital correlated with a LV EF ≤48 % (OR, 4.04; 95 % CI: 1.49–10.9; р=0.006), a post-stress total number of B lines ≥10 (OR, 3.10; 95 % CI: 1.06–9.52; р=0.038), a pulmonary artery systolic pressure >27 mm Hg (OR, 3.7; 95 % CI: 1.42–9.61; р=0.007).Conclusion Stress-US of the lungs with evaluation of the total number of B lines should be performed for patients after the first AMI and PCI and with no clinical signs of congestion, for stratification of the risk for HF in the postinfarction period.

In recent years there has been significant interest in treating iron deficiency (ID) in patients with heart failure (HF) due to its high prevalence and detrimental effects in this population. As stated in the 2020 Russain HF guidelines, Intravenous ferric carboxymaltose remains the only proven therapy for ID.This document was prompted by the results from the recent AFFIRM-AHF trial which demonstrates that treatment of ID after acute HF decompensation reduces the risk of future decompensations. Experts have concluded that in HF patients with acute decompensation, a left ventricular ejection fraction of < 50% and ID, Intravenous ferric carboxymaltose reduces future HF hospitalisations. Patients with stable HF may also benefit from treatment of ID to improve quality of life and alleviate symptoms. It is, therefore, reasonable to screen for and treat ID in patients with HF.

Advances in the diagnosis and treatment of patients with infectious endocarditis are limited by the high frequency of cases with an unknown etiology and imperfection of microbiological (cultural) methods. To overcome these problems new approaches to the identification of infectious endocarditis pathogens were introduced, which allowed achieving certain positive results. However, it should be noted that despite the wide variety of diagnostic tools currently used, there is no ideal method for etiological laboratory diagnosis of infectious endocarditis. The article discusses the features and place of immunochemical, molecular biological (MALDI-TOF MS, real-time PCR, sequencing, in situ fluorescence hybridization, metagenomic methods, etc.), immunohistochemical methods, and their advantages and limitations.

Atrial fibrillation and renal dysfunction often coexist, each disorder may predispose to the other and contribute to worsening prognosis. Both atrial fibrillation and chronic kidney disease are associated with increased risk of stroke and thromboembolic complications. Oral anticoagulation for stroke prevention is therefore recommended in patients with atrial fibrillation and decreased renal function. Each direct oral anticoagulant has unique pharmacologic properties of which clinician should be aware to optimally manage patients. The doses of direct oral anticoagulants require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft-Gault equation, should be used to estimate glomerular filtration rate in patients with atrial fibrillation treated with direct oral anticoagulants. Our review tries to find arguments for benefit of direct oral anticoagulants in patients with renal dysfunction.

Chronotherapy for hypertension has been a topic of debate over the past decade. A number of studies up to 2019 suggested that prescribing drugs in the evening has advantages compared to morning, both in terms of normalization of blood pressure and its circadian rhythm, as well as in terms of the risk of adverse outcomes. Some of these studies were not designed for such an analysis, and some have significant limitations that make their interpretation difficult. The results of the HARMONY and TIME studies published in the last 2 years did not confirm any advantage of taking drugs in the evening compared to the morning, but showed its safety. Selection of antihypertensive therapy should be guided by antihypertensive efficacy, duration and stability of the effect, as well as medical adherence. Therefore, a single intake of double or triple fixed-dose combination of long-acting agents at hours convenient for the patient is optimal.

The objective of this advisory board meeting was to discuss the place of vericiguat in the treatment algorithm for heart failure with reduced ejection fraction and the necessary requirements for its successful application in clinical practice.

Despite the widespread awareness that hypertension and dyslipidemia are risk factors of prime importance for cardiovascular disease, the prevalence of these risk factors is still high, and the success of their control can hardly be considered satisfactory. The latest European guidelines for the management of hypertension strengthened the position of fixed-dose combinations, the main advantage of which is increased adherence to treatment. The purpose of this review was to discuss the background and the possibility of using fixed-dose combinations containing antihypertensive drugs and a statin in the treatment of patients with hypertension and dyslipidemia. We outlined the theoretical concepts that substantiate the possibility of using such therapy and discussed the results of randomized clinical trials investigating the efficacy of combined administration of antihypertensive and lipidlowering drugs. Illustrated by single pill combination of indapamide, perindopril and rosuvastatin, the requirements for fixed drug combinations are discussed, as well as clinical scenarios when their use is considered justified.

Cardiovascular diseases remain a leading cause for unfavorable outcomes, including death, in patients with type 2 diabetes mellitus (DM2). In the recent decade, novel drugs, including glucagon-like peptide-1 receptor agonists (GPP-1-RA) and sodium-glucose cotransporter-2 inhibitors, have convincingly demonstrated their ability to reduce risk of cardiovascular complications in patients with DM2. This review discusses one of GPP-1-RA, semaglutide, with a special focus on the evidence-based data on its use, cardioprotective properties, and algorithms of administration consistent with current clinical recommendations.

Aim To evaluate trends in beta-blocker prescribing and incidence of possible reasons for beta-blocker administration, including arterial hypertension (AH), atrial fibrillation (AF), ischemic heart disease (IHD), and myocardial infarction, in participants of clinical studies enrolling patients with chronic heart failure with preserved ejection fraction (CHF-PEF).Material and methods A systematic literature search was performed in the PubMed and EMBASE databases. The study included RCSs of pharmacological therapies for patients with CHF-PEF conducted from 1993 through 2019. Studies of beta-blocker efficacy or those including a specific population (CHF-PEF+IHD or CHF-PEF+AH, etc.) were excluded from the analysis. Baseline characteristics of patients, incidence rate of beta-blocker prescribing, and prevalence of AH, AF, IHD, and MI were recorded. Trends in prevalence of concomitant diseases and the proportion of patients using beta-blockers by the year of enrollment to the study were analyzed with the Mann-Kendall test.Results 14 RCSs of 718 selected publications completely met the inclusion and exclusion criteria. Beta-blocker prescribing significantly increased between 1993 and 2019 (tau=0.51; p=0.014) and reached 80 % in recent studies. Furthermore, prevalence of IHD, MI, AH, and AF did not significantly change among the RCS participants (p>0.05 for all). However, while for AH and AF, a tendency toward an increasing prevalence (tau=0.4; p=0.055 and tau=0.043; p=0.063, respectively) could be considered and became statistically significant for AF when the ALDO-DHF study was excluded from the analysis (tau=0.5; p=0.042), the MI prevalence tended to decrease (tau= –0.73; p=0.06).Conclusion Beta-blocker prescribing to patients upon inclusion into RCSs for CHF-PEF has significantly increased for the recent 20 years while the incidence of formal reasons for beta-blocker administration (AF, AH, MI, IHD) did not significantly change.

It has been established that cardiovascular events due to coronary heart disease are highly prevalent in the population of patients with atrial fibrillation. In this review, pathophysiologic mechanisms explaining this association are detailed along with supporting epidemiological evidence. Various methods for the prediction and prevention of coronary events in atrial fibrillation are iscussed, including modification of shared risk factors, antithrombotic therapy and selection of the optimal direct oral anticoagulant in terms of favourable influence on ischemic cardiac outcomes.

Objective. To evaluate the prevalence, predictors, prognostic value of cardiorenal interrelations in patients with acute cardiovascular disease (CVD), and to develop an algorithm for stratification these patients at risk of acute kidney injury (AKI). Materials and methods. 566 patients (pts) were examined: 278 with acute decompensated heart failure (ADHF) and 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS). The levels of electrolytes, glucose, urea, creatinine were evaluated, glomerular filtration rate (GFR) was determined according to the formula CKD-EPI. Chest x-ray, electrocardiography at admission and in dynamics, echocardiography at admission with assessment of systolic and diastolic myocardial functions were performed. Chronic kidney disease (CKD), AKI, ADHF, NSTE-ACS were diagnosed according to Russian and international Guidelines. Mann-Whitney test and multivariate logistic regression analysis were considered significant if pResults. Different variants of cardiorenal interrelations were revealed in 366 (64.7%) pts. CKD was diagnosed in 259 (45.8%), with more than half of the cases (61%) diagnosed for the first time at this hospitalization, 62 (11%) pts had signs of kidney damage of unknown duration (which did not allow to diagnose CKD). AKI occurred in 228 (40,3%) pts, more frequently in patients with ADHF vs with NSTE-ACS (43.5 and 37.2%). In all groups stage 1 of AKI was prevalent. In-hospital mortality was significantly higher in pts with AKI vs without AKI (14.9 vs 3.6%, pConclusion. Prevalence of cardiorenal interactions in patients with acute CVD (ADHF and NSTE-ACS) was 64.7%. Development of AKI was associated with poor prognosis in both groups. Renal function and blood pressure levels on admission are the main predictors of AKI.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is diagnosed in the absence of anatomically significant stenoses (

The guidelines have been developed for internists, general practitioners, emergency physicians, and paramedics. The guidelines are based on expert consensus papers, accumulated clinical and scientific experience. The methodology for organizing and conducting ultrasound-assisted examinations is described in detail. Algorithms for diagnosing the main syndromes in internal medicine practice are presented to help the practitioner. Particular attention is paid to the methodology of ultrasoundassisted examinations. These guidelines will be of interest to doctors, heads of medical facilities, as well as students of medical universities.

Several recent large studies, most of which were performed in Denmark, have revealed a link between hydrochlorothiazide use and the risk of non-melanoma skin cancer. Photosensitizing properties of hydrochlorothiazide, inherent in many antihypertensive drugs, are considered a key pathophysiological mechanism underlying this association. The results of these studies prompted an update to the recommendations of the European Medical Agency for the safety of hydrochlorothiazide. However, to date there have been no convincing evidence of causality of this association. The accumulation of data on usage of hydrochlorothiazide, the most widely used diuretic worldwide, made the discussion of this association possible despite the low prevalence of skin cancer. At the same time, the retrospective design of these studies should be considered, as well as limited sample and lack of adjustment for important confounders. Therefore, the results obtained in these studies must be interpreted with extreme caution to prevent the decrease in hypertension control due to reduced compliance with treatment, unjustified withdrawal or replacement of hydrochlorothiazide, including its fixed combinations, with other thiazide or thiazide-like diuretics, which also have photosensitizing action.

Numerous studies have demonstrated the negative prognostic value of tachycardia, both in the general population and in specific subgroups, including patients with coronary artery disease (CAD), arterial hypertension (HTN) and heart failure with preserved ejection fraction (HFpEF). In the latest edition of the European guidlines for the treatment of HTN the level of heart rate (HR) exceeding 80 beats per minute is highlighted as a separate independent predictor of adverse outcomes. However, the feasibility of pharmacological reduction of HR in patients with sinus rhythm is unclear. Unlike patients with reduced ejection fraction, in whom the positive effects of HR reduction are well established, the data on the effect of pharmacological HR reduction on the prognosis of patients with HTN, CAD and/or HFpEF are not so unambiguous. Some adverse effects of pharmacological correction of HR in such patients, which may be caused by a change in the aortic pressure waveform with its increase in late systole in the presence of left ventricular diastolic dysfunction, are discussed. The reviewed data underline the complexity of the problem of clinical and prognostic significance of increased HR and its correction in patients with HTN, stable CAD and/or HFpEF.

Aim. To study the effects of fixed-dose indapamide/perindopril combination on endothelial function and arterial stiffness in patients with uncontrolled stage 1-2 hypertension (HTN) and chronic kidney disease (CKD).Material and methods. Total of 100 patients with uncured or uncontrolled with ≥3 months antihypertensive therapy HTN and CKD G3 (67% females, mean age 59,1±12,5 years) were included in the study. Each patient took indapamide/perindop combination in accordance with 1 of 3 existing regimes (depending on doses) for 3 months. Primary aim was to assess the effects of indapamide/perindopril combination on endothelial function and parameters of arterial stiffness after 12 weeks of treatment (assessment by AngioScan diagnostic complex). Secondary aims were achievement of target blood pressure (BP) after 4 and 12 weeks of therapy and assessment of glomerular filtration rate (GFR) and the albumin-tocreatinine ratio (ACR) changes after 12 weeks.Results. Initially, there was an increase in arterial stiffness parameters in all patients, and during treatment decrease was observed: central systolic BP (SBP) from 120±10,1 to 112,9±6,3 mm Hg, median augmentation index from 10,9% to 4,6%, stiffness index from 8,1±2,4 to 7,1±0,9, vascular age decreased by 9,6% (р< 0,001 for trend). Significant improvement of endothelial function was observed regardless of diabetes presence: occlusion index increased from 1,5±0,3 to 1,7±0,5, median phase shift — from -4,6 to -2,4 ms (p< 0,01). After 4 weeks, 27% of patients reached target BP, by the end of the study — 90%. A decrease in the median ACR from 16,3 to 15,0 mg/g, GFR increase from 50,2±7,6 to 53,6±8,7 ml/min/1,73 m2 were observed (p< 0,01 for trend).Conclusion. Therapy with a fixed-dose indapamide/perindopril combination in patients with uncontrolled stage 1-2 HTN and G3 CKD leads to a significant improvement in arterial stiffness, endothelial and renal function, and achievement of target BP in 90% of patients.

Aim. To assess non-invasive parameters of left ventricular (LV) myocardial work in patients with heart failure with reduced ejection fraction (CHrEF) and iron deficiency (ID) after ferric carboxymaltose (FCM) therapy.Material and methods. There were following inclusion criteria: LV ejection fraction (EF) ≤40%; body >70 kg, receiving best medical therapy (BMT) in recommended doses in accordance with the guidelines of the European Society of Cardiology and the Russian Society of Cardiology. Median age was 67±11,7 years (men, 83%), while median LVEF and N-terminal pro-brain natriuretic peptide was 29% and 315 ng/ml, respectively. Patients were randomized by the envelope method. The first group consisted of 19 patients who received therapy with intravenous FCM 1500 mg in 2 injections with an interval of one week between injections in addition to BMT. The control group consisted of 16 patients who received BMT without FCM. All patients underwent a standard echocardiography, and non-invasive LV myocardial work was assessed immediately before inclusion in the study and after 3 months.Results. In the first group of patients receiving FCM therapy, an increase in LVEF (29,1±10,3 vs 35,4±11,1; p=0,001), mitral annular plane systolic excursion (1,2 (1;1,6 ) vs 1,5 (1,3;1,9), p=0,001), LV global longitudinal strain (-7 (-5;-8) vs -8 (-6;-11), p=0,007) and non-invasive indicators of myocardial work (global work index (826±314 vs 1041±354), p=0,0001; global constructive work (1173±388 vs 1435±405), p=0,0001; global work efficiency (85 (82;87) vs 86 (82;88), p=0,017)). There were no significant changes in the studied parameters in the BMT group.Conclusion. Patients with HFrEF and ID treated with FCM showed a significant increase in LV systolic function, including non-invasive myocardial work parameters, compared with the control group.

Introduction Identification of a causative agent in patients with infective endocarditis (IE) is crucial for diagnostic and prescribing etiotropic therapy which defines positive outcome of a disease. High rate of a culture negative IE and inaccurate results of traditional microbiological methods raise a concern. So the methods of etiological diagnostics in IE are in need of development, particularly introduction of polymerase chain reaction (PCR) method might be helpful. Aim Modernisation of the algorithm of IE etiological diagnostic by introducing PCR Materials and methods The study included 85 cases of IE [first episode of IE (n=79), recurrence/relapse (n=6)] verified by DUKE criteria 2009, 2015, hospitalized in Moscow primary hospital from 2012 to 2017. All patient had venous blood investigated both with microbiological method and with broadrange and specific PCR. Following microorganisms' DNA were assessed by PCR: Staphylococcus spp. (MRCoNS, S. aureus and others), Streptococcus spp. (S. agalactiae, S. pyogenes and others), Enterococcus spp. (E. faecium, E. faecalis and others), Enterobacteriaceae, Klebsiella spp. (K. pneumoniae and others), E. coli, Proteus spp., A. baumanii, P. aeruginosa, Fungi (C. albicans, C. glabrata, Aspergillus spp. and others). Results Median age was 55.48 years (95% confidence interval (CI) 51.16–59.8), males 67.9%. History of cardiovascular diseases was in 54 (68.35%), diabetes mellitus in 18 (22.78%), hepatitis B and/or C in 31 (39.2%), intravenous drug dependency in 27 (34.18%), chronic kidney disease in 38 (48.1%), median Charlson comorbidity index was 5.44 (95% CI 4.52–6.37). Left-side IE was in 50 (63.29%), right-side IE – in 23 (29.12%), left-right-side IE in 6 (7.59%). Secondary IE was in 53 patients (62.3%). Embolic events were diagnosed in 27 cases (34.18%), in-hospital mortality – in 22 (27.8%). Microbiological method identified etiological agent in 55 of 85 cases (61.2%), featuring Staphylococcus aureus (n=23), Staphylococcus CoNS (n=6), Escherichia coli (n=1), Acinetobacter spp. (n=2), Streptococcus spp. (n=2), Enterococcus spp. (n=8), Klebsiella pneumoniae (n=2), Gemella haemolysans (n=2), several causative agents (n=6). Additional PCR testing identified etiology in 14 of 33 (42.2%) featuring Staphylococcus spp. (n=6), Enterococcus spp. (n=3), Streptococcus spp. (n=1), Aspergillus sp. (n=1) Pasteurella multocida (n=1), Enterococcus spp. + Staphylococcus spp. (n=1), Staphylococcus spp.+ A. baumanii + E. coli (n=1). PCR method identified 6 fals-positive results of microbilogical investigation [S. epidermidis (n=2), G. haemolysans, Acinetobacter spp., E. faecalis, K. pneumoniae], that are most probably due to preanalytical sample contamination Conclusions Introduction of PCR into the algorithm of IE etiological diagnostic increased validity of laboratory findings on 23.5%. True culture negative IE was present in 19 of 85 patients. Rate of mortality and complications in IE remains high. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Peoples' Friendship University of Russia (RUDN), Moscow, Russia

Purpose To assess the incidence of over and underdiagnosis of heart failure (HF) in hospital patients with type 2 diabetes mellitus (T2DM) Methods In the single-center prospective study (registry) from 01.08.2018 to 31.01.2019 we included 1008 patients admitted to the city hospital. Key inclusion criteria: a history of T2DM, age ≥40 years. Key exclusion criteria: any other disorders of carbohydrate metabolism, age Results The presence of HF in the diagnosis at admission was in 68.8% (n=693) of patients and, accordingly, it was absent in 31.2% (n=315). By the ESC HF Guidelines HF was diagnosed in 68.1% (n=686) and, accordingly, in 31.9% (n=322) it was excluded. The analysis results by the diagnosis at admission are presented in Fig. 1. The analysis of the reasons for admission depending on the HF status is presented in Fig. 2. In 35 patients admitted with HF decompensation the presence of HF was not confirmed and the diagnosis was revised: atrial fibrillation in 11 (31,4%) patients, exacerbation of COPD – 7 (20,0%), pulmonary embolism – 6 (17,1%), pneumonia – 4 (11,4%), kidney diseases – 4 (11,4%), and asthma – 3 (8,7%). Conclusion Among hospitalized patients with T2DM, there is a similar incidence of over and underdiagnosis of HF. Patients with first diagnosed HF were more likely to be admitted for reasons unrelated to cardiovascular diseases (CVD), most often with hyperglycemia (Fig. 2). Patients with unconfirmed HF – for reasons related to CVD, while the reason for admission in a quarter of patients was HF decompensation (Fig. 2). Despite the availability of examination for HF, the problem of its diagnosis is still relevant. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Background and objective Left atrial (LA) functional decline seems to be the earliest sign of hypertension-related heart damage detectable with echocardiography for the moment. Left atrial stiffness index (LASI) is a novel index reflecting both LA function and LA–left ventricular (LV) coupling. Early detection of hypertension-mediated organ damage (HMOD) is critically important in clinical decision making in certain groups of patients, such as young persons with first time diagnosed HTN. We intended to analyze the relations of LASI with office and 24 hours blood pressure levels and HMOD characteristics in subjects with HTN aged of 18 to 45 years. Methods We included 78 young subjects (median of age 23 [21; 25] years, mean BMI 25,9±4,7 kg/m2, median 24 hours systolic blood pressure (SBP) and diastolic blood pressure (DBP) 134,0 [128,8; 143,3] and 79,5 [74,0; 88,0] mm Hg, respectively) with HTN diagnosed with 24-hours ambulatory blood pressure monitoring (ABPM) according to ESH guidelines criteria (2018). Most patients (73%) had masked HTN. We performed routine clinical evaluation, including registration of anthropometric characteristics and blood and urine tests, central pulse wave assessment with applanation tonometry and echocardiography including two-dimensional speckle tracking. LASI was calculated as E/e$'$ to left atrial longitudinal strain during reservoir phase (LASr) ratio. We performed correlation analysis and multiple linear regression analysis to investigate the relationship between LASI, LASr and variables indicating presence of HMOD. Results Correlation analysis did not reveal any significant associations of LASI and LASR with office and ambulatory BP values. Both LASI and LASr were correlated with age, body mass index (BMI), waist circumference (WC) (r=0,312, p Conclusion Early left atrial functional impairment is associated with overweight, abdominal obesity and insulin resistance in young never treated patients with HTN, while impact of elevated BP in HTN of low grades seems to be not so important. LASI in contrast with LASr is independently related to albuminuria but not with other HMOD markers Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): RFBRRUDN University program 5-100

Aim. To study the impact of coronavirus disease 2019 (COVID-19) pandemic on hospitalization rates, diagnosis, and outcomes of infective endocarditis (IE) with a subanalysis of IE course in combination with COVID-19.Material and methods. This prospective cohort study included 168 patients with definite or probable IE (DUKE 2015) hospitalized in the V.V. Vinogradov City Clinical Hospital from July 2017 to July 2022. All patients underwent a conventional examination in accordance with current clinical guidelines. We studied clinical, paraclinical and etiological parameters, as well as outcomes.Two clinical observations of the combination of IE and COVID-19 are presented.Results. When assessing the local registry of patients with IE, a trend towards an increase in hospitalizations rate of IE in 2021-2022 was shown, with a decrease during the period of long-term lockdowns in Moscow and a subsequent surge after their cancellation. Patients with IE during the COVID-19 pandemic had a more favorable clinical profile, a 2-fold increase in IE diagnosis (due to late hospitalization), frequent detection of Staphylococcus aureus MSSA (32,6%), and frequent surgical treatment (up to 87,6% with a combination of IE and COVID-19), as well as high in-hospital mortality, but without a tendency to increase (30,4%). Clinical observations of IE and COVID-19 combination are presented, which demonstrates the contribution of COVID-19 as the only risk factor for native tricuspid valve IE in a patient without predisposing causes, as well as a factor in the unfavorable prognosis for native aortic valve IE after the addition of COVID-19, which led to lethal outcome.Conclusion. The present study demonstrates the profile of patients with IE and COVID-19 depending on the epidemiological situation of COVID-19 and the association with SARS-CoV-2 infection. The data obtained make it possible to discuss the potential relationship between COVID-19 and IE. The "endocarditis team" determines the timely implementation of surgery and the absence of an increase in inhospital mortality, regardless of the epidemiological situation.

Dilatation of the left ventricle cavity and its contractility decrease with the subsequent heart failure development against the background of prolonged excessive alcohol consumption is commonly called alcoholic cardiomyopathy (ACM). The direct toxic effect of ethanol and its metabolites on the myocardium, neuroendocrine disorders, other manifestations of alcoholism and a genetic predisposition play a significant role in the development of this pathology. The purpose of this review is to study modern ideas about the mechanisms of development and course of ACM. In particular, special attention is paid to discussing the doses of alcohol necessary for the onset of symptoms and its regression. Actual data are presented in relation to a survey aimed at confirming alcohol abuse and the exclusion of alternative causes of myocardial injury, as well as treating patients and determining the prognosis.

Aim. To evaluate gender-related differences of left atrial (LA) phasic function and structural remodeling in conjunction with the parameters of left ventricular (LV) diastolic dysfunction and central aortic pressure in patients with hypertension and recurrent atrial fibrillation (AF).Material and methods. The comparative study included 30 men and 37 women with non-valvular AF, hypertension and LV hypertrophy. Conventional echocardiographic measures were extended with LA measures, including its volume in three phases, LAemptying fraction (LAEF), passive and active ejection fraction. The parameters of central aortic pressure were estimated by applanation tonometry method.Results. No difference was observed between LA and LV structural parameters in men and women. However, in women LAEF (39 [28;50] vs 50 [42;55]%; p=0.02) and E/E’(9.7 [7.8;12] vs 7.1 [5.6;8.6]; p=0.001) were worse than in men. Active LA ejection fraction was higher in women (31 [21;42] vs 24 [19;31]%; p=0.04), whereas passive one – in men (12 [10;14] vs 33 [23;38]%; pConclusion. Patients of different genders with recurrent AF and hypertension have comparable LA structuralremodeling. However, women characterized by a more pronounced decrease in LAEF and impaired LV diastolic function than men. In women as distinct from men LV filling is predominantly due to LA systole. In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and GFR, whereas in women – with E’ and AI 75.

Prevention and choice of therapeutic strategies in patient,s with type 2 diabetes (T2D) and heart failure (HF) is an urgent problem. This review presents a modern concept for HF development from early stages of T2D. Glucose-lowering and cardiac medications for the prevention and treatment of HF depending on its phenotypes were considered.

Aim.To assess the incidence of blood pressure (BP) control and various phenotypes of BP by comparing the results of office and 44-hour ambulatory brachial and central BP measurement in patients with end-stage renal disease (ESRD) on program hemodialysis (HD).Materials and methods.In 68 patients ESRD receiving renal replacement therapy we evaluated office peridialysis BP and performed 44-hour ambu latory monitoring (ABPM) of brachial and central BP during peridialysis period using a validated oscillometric device BPLabVasotens (OOO “Petr Telegin”).Resultswere considered statistically significant with pResults.The frequency of control of peripheral office BP before the HD session was 25%, after – 23.5%; control of central BP – 48.6% and 49%, respectively. According to office measurement the frequency of systolic-diastolic hypertension was 44.1%, isolated systolic hypertension – 25%, isolated diastolic hypertension – 5.9%. The values of peripheral and central office systolic BP (SBP) before and after HD were not consistent with the corresponding mean and daily SBP levels for 44 hours and for the first and second days of the interdialysis period. The frequency of true uncontrolled arterial hypertension (AH) according to peripheral ABPM was 66.5%, masked uncontrolled AH – 9%. Circadian rhythm abnormalities for 44-h peripheral BP were detected in 77%, for central – in 76%. In 97% of patients agreement between phenotypes of the daily profile of peripheral and central BP was observed. 73% of patients had a significant increase in peripheral and central SBP and pulse pressure (PP) and an increase in the proportion of non-dippers from the 1st to the 2nd day.Conclusion.Patients with ESRD on HD were characterized by poor control of BP control and predominance of unfavourable peripheral and central ambulatory BP phenotypes. A single measurement of clinical peripheral and central BP in the peridialysis period was not sufficient to assess the control of hypertension in this population. The 24-h BP profiles in the 1st and 2nd days of interdialysis period had significant differences.

Achievement of target blood pressure (BP) is one of the key strategies of primary prevention of cardiovascular complications in patients with arterial hypertension (AH). Aim . To assess and compare antihypertensive effects of azilsartan medoxomil (AZM) with chlorthalidone or indapamide-retard combination in patients with AH in real clinical setting. Material and methods . The open randomized comparative study included 50 patients with uncontrolled AH who were randomized to the starting therapy with combination of AZM with chlorthalidone (Edarbi Clo 40/12,5 mg) (group 1) or indapamide-retard 1,5 mg (group 2) for 4 weeks. After 4 weeks, up-titration of one of the drugs was done in the patients who didn’t achieve target BP level (

Systematic analysis of 3 728 publications on the relationship between microelement status and chronic heart failure (CHF) was carried out. Three main areas of research have been identified: 1) magnesium, electrolytes and CHF; 2) the transcriptional and antioxidant effects of zinc, selenium, copper; 3) iron-deficiency anemia and CHF. In this paper, we consider a complex of relationships between the magnesium insufficiency and CHF, the effect of magnesium on vascular tone, mitochondria, heart rhythm and the susceptibility of cardiomyocytes to adrenergic stimulation. Using magnesium orotate for the treatment of CHF is a feasible approach to compensate magnesium insufficiency in patients with CHF.

Type 2 diabetes mellitus (T2DM) has gone beyond the professional interests of one specialty. T2DM, cardiovascular (CV) diseases and chronic kidney disease, considered from the standpoint of a single cardio-reno-metabolic continuum, place a heavy economic burden on society. At the same time, the improvement of diagnostic methods and medical technologies led to distinct decrease in the frequency and mortality from a number of complications of T2DM, including myocardial infarction and stroke, but other states took their place. Thus, heart failure (HF) has taken the position of one of the most frequent complications with average prevalence of 24–40 % and significant predominance of HF with preserved ejection fraction (HFpEF). According to this paradigm, HFpEF is not a disease of diastolic dysfunction, but a systemic disease, the central element of which is impaired renal function. All this together has a potential value for choosing the optimal therapy. In recent years the results of specially designed studies assessing the CV-safety of antidiabetic drugs from the groups of dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like preptide-1 (GLP-1) receptor agonists and sodium – glucose co-transporter-2 (SGLT2) inhibitors have become known. These drugs, except for SGLT2 inhibitors, by their mechanism of action affecting insulin resistance and hyperglycemia, demonstrated neutral or negative result on the frequency of hospitalizations due to HF. The EMPA-REG OUTCOME study with SGLT2, which has a special insulin-independent mechanism of action, demonstrated not only the efficacy and CV-safety of the drug in the form of a decrease in CV mortality by 38 %, but also a decrease in hospitalizations for HF by 35 %. Further studies with SGLT2 inhibitors confirmed positive effect on HF, indicating a class effect of the drugs. The recently completed study DECLARE-TIMI 58 proved the advantages of using dapagliflozin for the primary and secondary prevention of HF. This review highlights the prevalence of HF in diabetes mellitus, a new concept of the pathophysiology of HF, the main groups of sugar-lowering drugs and their effect on CV outcomes, in particular on HF.

Aim. To evaluate the association of a high normal blood pressure (BP) with the risk of early hypertension-mediated organ damage (HMOD) in young adults.Material and methods. Medical screening of population aged 18-45 years (n=987) revealed that in 173 persons, office BP corresponded to a high normal level or hypertension (HTN). Echocardiography (GE Healthcare Vivid 9, using EchoPAC Software) was performed when HTN was confirmed by office BP measurement and/or according to 24-hour ambulatory BP monitoring (ABPM) (n=127). In addition, creatinine and albumin-to-creatinine ratio in spot urine were measured.Results. The median age was 23 [21; 25] years. The median systolic (SBP) and diastolic BP (DBP) was 129 [121; 137] and 75±12 mm Hg, respectively. The detection rate of LV geometry abnormalities was 3,3 times higher in the high normal BP group [95% CI, 1,06-6,28, p=0,02], and 10,7 times higher in the HTN group [95% CI, 2,32-16,49, p=0,04] compared with the optimal+normal BP group. In a multivariate analysis, the independence of associations with the LV mass index (LVMI) was confirmed only for the mean nighttime DBP, left atrial volume index, and the ratio of LV peak early diastolic velocity to the average septal and lateral peak early diastolic mitral annular velocity.Conclusion. In young people, the prevalance of HMOD is comparable in the groups with high normal BP and HTN, while significant differences were found between the group with optimal+normal BP levels and patients with HTN and high normal BP. An independent association of elevated LVMI with mean nighttime DBP was found.

Aim: to investigate clinical properties of course and outcomes of infective endocarditis (IE) depending on source of infection, to find predictors of mortality in a Moscow general hospital.Materials and methods. We included in this study 176 patients with definite and possible infective endocarditis (the Duke criteria), admitted in our hospital in 2010–2017. Patients were divided in three groups according to source of infection. All patients underwent standard clinical and laboratory assessment, echocardiography, blood culture test combined with blood PCR with sequencing. Inhospital and 1­year outcome were evaluated.Results. Among 176 patients with IE 65.3 % were men (median age 57 [35–72] years), most patients (n=149, 84.7 %) had native valve IE. Etiological factor was identified in 127 (72.2 %) cases. Gram­positive infective agents prevailed (54 %). Surgery in active phase of the disease was performed in 30 (17 %) patients. Among patients with healthcare­associated IE (n=76, 43.9 %) prevailed those older than 60 years, with high Charlson comorbidity index, with culture­negative IE, and complicated clinical course (mainly progressing heart failure). Patients with intravenous drug use associated IE (n=50, 28.4 %) had low Charlson index, association with hepatitis C viral infection, involvement of tricuspid valve with big vegetations, high frequency of embolic complications, and low inhospital mortality. Group of patients with community acquired IE (n=50, 28.4 %) more often had uncommon causative microorganisms, and had better long­term outcome. In­hospital mortality was 30.1 % (n=53) mostly due to sepsis with multi­organ failure, and heart failure. Risk factors of inhospital death were history of cardiovascular diseases, old age, kidney damage, methicillin­resistant Staphylococcus aureus (MRSA) infection, uncontrolled infection, and embolic events. Risk factors of 1­year mortality were history of stroke, and heart failure as IE complication. Independent predictors of in­hospital death were MRSA infection (odds ratio [OR] 50.32, 95 % confidence interval [CI] 1.66–213.92; p=0.002), persistent infection (OR 18.6, 95 %CI 5.37–64.40; p=0.001), duration of fever >7 days after initiation of antibacterial therapy (OR 13.41, 95 %CI 3.51–51.24; p=0.001); and of death during first year – history of cerebral infarction (OR 4.39, 95 %CI 1.32–14.70; p=0.016)), and heart failure as IE complication (OR 8.1, 95 %CI 1.97–67.09; p=0.016). Among patients subjected to surgery there were no fatal outcomes during 1 year after hospital discharge, while among conservatively treated patients were 21 (14.4 %) deaths (pConclusion. Main clinical features of IE course in patients urgently admitted to a general hospital was dominance of healthcare­associated IE among patients, who were older than 60 years with severe comorbidities. These patients had more complications and worse outcome. Modeling of prognosis identified uncontrolled infection as key factor of unfavorable outcome. Surgery significantly reduced long­term mortality.

Aim.To assess the effectiveness and safety of therapy with fixed combination of amlodipine/indapamide (Arifam) in outpatients with arterial hypertension (AH) over 55 years old.Material and methods.We included 2217 patients in the observation — 692 (31%) men and 1521 (69%) women. Changes in the course of 3-month therapy of systolic and diastolic blood pressure (BP), the frequency of achievement of target BP levels (Results.With the use of Arifam fixed combination 89,81% of patients achieved target BP level by the 3rd month of treatment, 73,77% of patients achieved positive response in 2 weeks, 94,88% of patients — after 1 month. According to the selfcontrol data, the target BP level (Conclusion.The ARBALET program has demonstrated high efficacy and tolerance of using Arifam fixed combination in outpatients over 55 years old with hypertension.

Background This study evaluated the effectiveness of treatment with an indapamide/amlodipine single-pill combination (SPC) in outpatients with uncontrolled isolated systolic hypertension (ISH) aged over 55 years in real-life clinical practice. Methods This was a post-hoc analysis of the subgroup of patients with ISH from ARBALET, a 3-month, multicenter, observational, open-label study conducted in Russia among patients with grade I or II hypertension who were either uncontrolled on previous antihypertensive treatment or treatment-naïve. The effectiveness of indapamide/amlodipine SPC was assessed by the change in office systolic blood pressure (SBP) and the rate of target SBP ( Results The ARBALET study recruited 2217 patients, of whom 626 had ISH and were included in this post-hoc analysis (mean age 66.1 ± 7.8 years; 165 men [26.4%] and 461 women [73.6%]). Target SBP Conclusion This post-hoc analysis of the observational ARBALET study showed that indapamide/amlodipine SPC was associated with significant reductions in BP and high rates of target BP achievement in a broad age range of patients with ISH treated in routine clinical practice. Study registration number ISRCTN40812831.

Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and interrelated diseases, the combination of which is associated with a poor prognosis. The efficacy and safety of direct oral anticoagulants (DOACs) used to prevent thromboembolic complications of AF may depend on renal function due to the specific pharmacokinetics of these drugs. This review considers current data on the role of kidneys in the pathogenesis of ischemic and bleeding events, methods of renal function assessment and related classification issues, as well as comparison of warfarin and DOAC therapy, in patients with AF and renal dysfunction of different stages based on the results of randomized controlled trials and actual clinical practice. DOAC use in the context of dynamic deterioration of renal function, supranormal renal function, and their effect on renal outcomes is discussed. International guidelines on anticoagulant therapy in AF and renal dysfunction were analyzed.

Aim. To assess the prognostic value of the integral assessment using various modern methods for diagnosing congestion in patients hospitalized with acute decompensated heart failure (ADHF).Material and methods. This single-center prospective study included 165 patients with ADHF. All patients underwent a standard clinical and paraclinical examination, including assessing NT-proBNP levels, lung ultrasound B-lines, liver transient elastography, bioelectrical impedance vector analysis (BIVA) at admission and discharge. To assess clinical congestion, the Heart Failure Association consensus document scale was used. Long-term clinical outcomes were assessed by telephone survey 1, 3, 6, 12 months after discharge. As an end point, the allcause mortality and readmissions were estimated.Results. In patients hospitalized with ADHF, at discharge, differences were found in the incidence of residual congestion according to certain paraclinical methods — from 22 to 38%, subclinical — from 14,5 to 27%. When using the integral assessment of stagnation, the incidence of residual and subclinical congestion was 53,6% and 35%, respectively. Patients with residual congestion had more severe symptoms of congestion, compared with those with subclinical congestion. Patients in whom congestion was detected by 4 methods, in contrast to those by 1, 2, and 3 methods, had worse clinical and paraclinical parameters. There was a significant increase in the risk of all-cause mortality and readmission in the presence of congestion, identified by 3 (hazard ratio, 9,4 (2,2-40,6); pConclusion. For patients hospitalized with ADHF, integral assessment of residual and subclinical congestion at should be performed at discharge. The introduction of an integral assessment of congestion into routine practice will allow to identify a group of patients with more unfavorable prognostic characteristics in relation to the risk of death and readmissions, as well as to intensify drug therapy and followup at the outpatient stage.

Insulin resistance with normoglycemia could lead to subclinical inflammation, left atrium enlargement and ventricular systolic and diastolic dysfunction. The aim of our study was to analyzed associations between markers of insulin resistance and parameters of left atrium function in young hypertensive patients. Methods 965 young people were screened, among which 64 (6.6%) had high normal blood pressure and 57 (5.9%) had arterial hypertension. 121 patients with uncomplicated arterial hypertension grade 1–2 were included to the study (81% male, mean age 25.6 (7.3) years, 22 (18%) had obesity, 51 (42%) were smokers). All patients undergone clinical and laboratory evaluation, 24-h blood pressure monitoring, echocardiography. LA function were evaluated by 2D-speckle tracking echocardiography with left atrial reservoir strain (LASr), left atrial booster strain (LASb), left atrial conduit strain (LACs). Insulin level, serum glucose, was measured by using overnight fasting blood sampling between 7 am and 9 am. Insulin resistance was evaluated by HOMA-IR. Results Mean office systolic BP was 132 [122; 138]; diastolic BP – 70 [63; 76]. LAVI was 23 [19; 27] ml/m2. Mean insulin was 8.1 [5.4; 12.3] mIU/l, HOMA-IR – 1.9 [1.2; 2.8]. Correlations between LASr and body mass, waist circumference, insulin level, uric acid, HOMA-IR, E/e', LASb and insulin, HOMA-IR, uric acid, LASc and body mass, waist circumference, insulin level were revealed (p Conclusion Left atrium reservoir function is load dependent and influenced by LV function. For subclinical left atrium remodeling assessment booster function should be analized along with reservoir function. In young hypertensive patients insulin level were independently associated with left atrial dysfunction. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Project 5-100