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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.

Aims — identification the correlates between parameters of tissue Doppler imaging, EF thickness by MRI and biochemical markers of fibrosis and inflammation in patients with nonvalvular AF. Retrospectively to evaluate clinical and instrumental parameters influencing the development of thromboembolic events. Methods. Data analysis was performed on 151 patients with different type of AF. A retrospective analysis included 112 patients. 15 (13%) had a history of LAA thrombosis and/or thromboembolic events (stroke, TIA). The prospective analysis included 39 patients. We identified groups with idiopathic AF (N = 21), AF with arterial hypertension (N = 18). And also a group with normal or slightly enlarged (

Aim To analyze survival of patients with COVID-19 based on echocardiographic (EchoCG) criteria for evaluation of the right ventricular (RV) systolic function.Material and methods Data of patients were retrospectively evaluated at the Center for Medical Care of Patients with Coronavirus Infection. Among 142 primarily evaluated patients with documented COVID-19, 110 patients (men/women, 63/47; mean age, 62.3 ± 15.3 years) met inclusion/exclusion criteria. More than 30 EchoCG parameters were analyzed, and baseline data (comorbidities, oxygen saturation, laboratory data, complications, outcomes, etc.) were evaluated. ROC-analysis was used for evaluating the diagnostic significance of different EchoCG parameters for prediction of a specific outcome and its probability. Dependence of the overall survival of patients on different EchoCG parameters was analyzed with the Cox proportional hazards model. For assessing the predictive value of EchoCG parameters for patient stratification by risk of an adverse outcome, a predictive model was developed using the CHAID method.Results The in-hospital death rate of patients included into the study was 15.5 %, and the death rate for this period of in-hospital observation was 12 %. Based on the single-factor analysis of EchoCG parameters, a multifactor model was developed using the method of Cox regression. The model included two predictors for an unfavorable outcome, estimated pulmonary artery systolic pressure (EPASP) and maximal indexed right atrial volume (RAi), and a preventive factor, right ventricular global longitudinal strain (LS RV). Base risks for fatal outcome were determined with an account of the follow-up time. According to the obtained values, an increase in EPASP by 1 mm Hg was associated with increases in the risk of fatal outcome by 8.6 % and in the RA(i) volume by 1 ml/5.8 %. LS RV demonstrated an inverse correlation; a 1% increase in LS RV was associated with a 13.4% decrease in the risk for an unfavorable outcome. According to the ROC analysis, the most significant determinants of the outcome were the tricuspid annular plane systolic excursion (TAPSE) (AUC, 0.84 ± 0.06; cut-off, 18 mm) and EPASP (AUC, 0.86 ± 0.05; cut-off, 42 mm Hg). Evaluating the effects of different EchoCG predictors, that characterized the condition of the right heart, provided a classification tree. Six final decisions were determined in the model, two of which were assigned to the category of reduced risk for fatal outcome and four were assigned to the category of increased risk. Sensitivity of the classification tree model was 94.1 % and specificity was 89.2 %. Overall diagnostic significance was 90.0±2.9 %.Conclusion The presented models for statistical treatment of EchoCG parameters reflect the requirement for a comprehensive analysis of EchoCG parameters based on a combination of standard methods for EchoCG evaluation and current technologies of noninvasive visualization. According to the study results, the new EchoCG marker, LS RV, allows identifying the signs of right ventricular dysfunction (particularly in combination with pulmonary hemodynamic indexes), may enhance the early risk stratification in patients with COVID-19, and help making clinical decisions for patients with different acute cardiorespiratory diseases.

Objective To assess efficacy and safety of methylprednisolone pulse therapy in patients with COVID-19 Materials and Methods A retrospective analysis of 57 patients with moderate and severe novel coronavirus infection (COVID-19) receiving methylprednisolone pulse therapy (500 mg/day IV for 2-3 consecutive days) was performed Pre- and post-therapy examination of the patients included clinical (severity and duration of fever, gas exchange parameters), imaging (computed tomography) and laboratory tests (including C-reactive protein, procalcitonin, D-dimer) Results Methylprednisolone pulse therapy resulted in improved gas exchange (the mean duration of SpO2 recovery was 3 9 ± 0 25 days), body temperature normalization (the mean time to defervescence was 2 1 ± 0 2 days), significant decrease in inflammatory marker levels (CRP, D-dimer) No patients required an enhancement of respiratory support (transfer to ICU) Methylprednisolone pulse therapy was well-tolerated and did not cause bacterial complications Conclusions Methylprednisolone pulse therapy in patients with COVID-19 was shown to decrease activity of systemic inflammatory response, severity of coagulation disorders and contribute to recovery of gas exchange lung function Given the high efficacy and low cost of methylprednisolone pulse therapy, it could be one of the promising approaches to the management of patients with moderate and severe COVID-19 Further studies are needed to determine prognostic criteria of progression and optimal time for initiation of corticosteroid therapy Цель Изучить эффективность и безопасность пульс-терапии метилпреднизолоном у пациентов с COVID-19 Материалы и методы Проведен ретроспективный анализ 57 пациентов со среднетяжелым и тяжелым течением новой коронавирусной инфекции COVID-19, которые получали пульс-терапию метилпреднизолоном по 500 мг/сут в/в в течение 2-3 дней Проводилось комплексное обследование пациентов до и после пульс-терапии, которое включало клинические (оценка выраженности и длительности лихорадки, анализ показателей газообмена), инструментальные (компьютерная томография) и лабораторные методы, в том числе определение С-реактивного белка, прокальцитонина, D-димера Результаты Применение пульс-терапии метилпреднизолоном приводило к улучшению газообмена (средние сроки восстановления SpO2 составили 3,9 ± 0,25 суток), нормализации температуры тела (в среднем в течение 2,1 ± 0,2 суток), существенному снижению уровня маркеров воспаления - С-реактивного белка, D-димера Усиление респираторной поддержки (перевод в ОРИТ) не потребовалось ни в одном случае Пульс-терапия глюкокортикостероидами характеризовалась хорошей переносимостью и не приводила к развитию бактериальных осложнений Выводы Пульс-терапия метилпреднизолоном у пациентов с COVID-19 позволяет снизить активность системного воспалительного ответа, приводит к уменьшению степени выраженности коагуляционных нарушений и способствует восстановлению оксигенирующей функции легких Учитывая высокую эффективность и низкую стоимость пульс-терапии метилпреднизолоном, данный метод является одним из наиболее перспективных при ведении больных с тяжелым и среднетяжелым течением COVID-19 Необходимы дальнейшие исследования для установления прогностических критериев высокого риска прогрессирования для определения оптимального времени для добавления терапии глюкокортикостероидами

Background: The main methods of treating patients with stable coronary artery disease (CAD) are myocardial revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI). These are two fundamentally different in technique and volume of surgical interventions; PCI is associated with rapid rehabilitation of the patient, and only CABG demonstrated effective in survival benefit. Aims: Comparison of the long-term results of myocardial revascularization with CABG and PCI in patients with stable CAD. Methods: The results of a prospective one-center cohort study of 369 patients with stable CAD are presented, the average age is 60.1 5.4 years. Patients were randomized into 2 groups by the Heart Team: CABG (n = 196) and PCI (n = 173). In each group, subgroups were identified depending on the severity of the coronary lesion, and the CABG group was also separately studied in according to CABG technique ― beating-heart (off-pump) and with cardiopulmonary bypass (on-pump). The average follow-up was 54.3 7 months. The main outcomes of the study were major adverse cardiac and cerebral events (MACCE): death from all causes, cardiac mortality, nonfatal myocardial infarction (MI), nonfatal stroke and repeated coronary revascularization. Results: Over the 5-year follow-up period, no differences were found between the CABG and PCI groups with a low complexity of coronary artery lesions (SYNTAX Score 14.2 4.8) in terms of survival, cardiac mortality, nonfatal MI and stroke, and the need for repeated myocardial revascularization. Patients with stenosis of the left main coronary artery (LMCA) and/or multivascular CA disease (SYNTAX Score 25.8 5.0) in the long-term follow-up after CABG and PCI did not differ in MACCE, but the CABG group demonstrated a significant advantage in repeated myocardial revascularization. No significant differences were found in any study endpoint in patients after CABG on-pump versus off-pump. Conclusions: Our study demonstrates the advantage of CABG in patients with stable CAD with stenosis of the LMCA and/or multivascular CA disease, and which CABG technique should depends on the comorbidity of the patient, the experience of the surgeon and the surgical center.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Among patients with AF the subgroup posessing AF without traditional risk factors is differentiated. Such patients are commonly referred as having lone AF and comprise 1020% of all cases. A number of studies have demonstrated that the background of AF, and in particular lone AF, have a substantial genetic component. Aims: To evaluate the influence of gene polymorphism to the development of atrial fibrillation in patients without concomitant valvular pathology and coronary artery disease. Materials and methods: The study included 174 patients with atrial fibrillation and 124 controls without any cardiovascular pathology. All patients were divided into two subgroups: with lone AF (n=94) and with concomitant arterial hypertension (n=80). All patients underwent a complex of clinical, instrumental (ECG, echocardiography, computed tomography of the pulmonary veins) and laboratory tests (thyroid hormones, inflammatory markers, fibrosis), as well as genetic analysis (determination of single nucleotide polymorphisms described as AF risk factors in genes AGXT2, PDE4D, SLN, SCN5A, PITX2, PRRX1, ZFHX3, TBX5, CAV1 и HCN4). Results: For the rare polymorphisms rs12291814 (SLN) and rs137854601 (SCN5A) wasnt found anyone carrier of the minor allele (C and A, respectively). In the both patient subgroups the minor allele T of rs2200733 in PITX2 (OR=3.18, p0.0001), minor allele G of rs3903239 in PRRX1, and minor alleles A of 2 polymorphisms rs2106261 and rs7193343 in ZFHX3 gene were revealed as risk factor of AF (OR=2.96, p0.0001, OR=2.02, p=0.0045, OR=1.64, p=0.04, respectively). We also revealed significant difference between AF and control groups for rs3807989 in CAV1: homozygotic state of minor allele A has a protective effect on the development of arrhythmias (OR=0.39). Conclusions: We revealed the association between the polymorphisms in genes regulating transcription and the development of atrial fibrillation. These polymorphisms have already described but their frequencies have never investigated in Russian population. But the polymorphisms influence to gene functions stays unclear, although attempts to investigate relationship between genotype and gene expression have been made. When the relationship will be discovered it can help us to modify our approach in treatment to patients with atrial fibrillation.

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

Aim To evaluate possible social and economic benefits of correcting preoperative iron deficiency /iron deficiency anemia as a comorbidity in a model population in the process of transition from the routine practice to the optimized preparation of patients to elective surgery (as exemplified by several circulatory diseases: I20 – I25, class IX ICD 10).Material and methods By building imitation models depending on the patient blood management (PBM) practice, changes in years of life lost/saved adjusted for disability were evaluated, including in monetary terms, in relation to the annual number of operations performed for ischemic heart disease (IHD) (I20 – I25) in the age group of 17 years and older, as well as a potential effect of PBM on the applied health economics.Results With implementation of the PBM systemic measures in cardiac surgery, the potentially prevented annual social and economic damage will amount to more than 38 thousand years of life saved and more than 20.2 billion rubles in monetary terms. Furthermore, it will be possible to exclude 9435 hemotransfusion from the cardiosurgical practice, which will annually save more than 2.3 thousand liters of blood with a total cost of 77.7 million rubles in favor of clinical situations that have no alternative.Conclusion The implementation of PBM in cardiac surgery, the discipline with the highest levels of preoperative iron deficiency/anemia and the use of blood components, will not only improve the clinical outcomes and cost-effectiveness of surgical interventions, but will also prevent social and economic damage to the country.

The differences in mortality rates between Moscow and St. Petersburg require study. Aim . Ranking and comparison of cardiovascular mortality in Moscow and St. Petersburg in 2015 and 2018. Material and methods . Data on the population and mortality rates was assessed according to the Brief nomenclature of causes of death of Federal State Statistic Service. Eleven out of 35 nomenclature lines related to cardiovascular disease (CVD) are represented by 4-digit ICD codes, the rest are represented by groups with 3- and/or 4-digit codes. Standardized mortality rates (SMRs) were calculated based on the European standard. Comparison of SMR differences between Moscow and St. Petersburg in 2015 and 2018 was carried out using the nonparametric Wilcoxon test. Results . The proportion of CVD in all-cause SMR in both cities is about 50%. There were no significant differences in SMR (2018-2015) between Moscow and St. Petersburg for 35 CVDs. The first 3 ranking places in the CVD pattern both in Moscow and St. Petersburg were occupied by CAD, different types of chronic CAD, and stroke. In 2015, their proportion was 58,3% and 48,9% and in 2018, 52,7% and 58,7%. Other causes varied significantly in relation to SMR and ranks in different years, which is probably due to different approaches to determining the code of death cause. The SMR and myocardial infarction contribution to cardiovascular mortality decreased. Conclusion. Differences in cardiovascular mortality between Moscow and St. Petersburg remain. To understand the mortality causes and to develop effective programs to reduce it, it is necessary to eliminate the identified defects.

Aim To study the cognitive function (CF) state in patients with chronic ischemic heart disease (IHD) depending on the method of coronary bypass (CB), with extracorporeal circulation (EC) or on beating heart.Material and methods Postoperative cognitive dysfunction (POCD) is a frequent complication of CB, and its development may depend on the method of surgery, with EC or on beating heart. This single-center, prospective, nonrandomized study included 196 patients with chronic IHD aged 61.0±5.1 years. Patients were divided into two groups based on the CB method: an EC group (n=11) and a beating heart surgery group (n=85). Mean follow-up period was 26±2.1 mos. The state of CF was evaluated before and after CB (at the hospital stage, at 3, 6, 12, and 24 mos.).Results The mean duration of CF recovery was 3 mos. only in the group of CB without EC (p7.5 % (p=0.001) and 6.5–7.5 % (p=0.03), smoking (p=0.04), atherosclerotic damage of the internal carotid artery (p5 (p=0.03). The CB surgery either with EC (p=0.04) or on beating heart (p=0.04) was associated with the development of CD.Conclusion The results of the study allow identifying patients with chronic IHD and POCD-predisposing factors to recommend them beathing heart CB surgery.

Background. Epicardial adipose tissue (EAT) has certain paracrine functions, which could be associated with proinflammatory and fibrotic changes in myocardium even in patients without structural heart disease but with atrial fibrillation (AF). Purpose: to evaluate interrelationship between clinical data, parameters of tissue Doppler imaging (TDI), EAT thickness estimated by magnetic resonance imaging (MRI), and biochemical markers of fibrosis and inflammation in patients with nonvalvular AF without concomitant ischemic heart disease (IHD). Materials and Methods. We included in this study 39 AF patients without valvular pathology or IHD with normal or moderately increased left atrial (LA) dimension (mean age 50.8±13.9 years, 49% men). The following groups were distinguished for analysis: with idiopathic AF (iAFgroup, n=21); with AF and arterial hypertension (AF+AH group, n=18); with normal ( 4.5cm) LA dimensions (n=10). Besides standard ECG and echocardiography (ECHO), all patients underwent TDI and cardiac MRI with late gadolinium enhancement (LGE). Periventricular EAT thickness and LA fibrosis were calculated by MRI. Examination also included measurement of levels of matrix metalloproteinases (MMP-2, MMP-9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), transforming growth factor β 1 (TGF-β 1 ), and soluble intercellular adhesion molecule (sICAM). Results. Most close correlations were found between EAT thickness and levels of the following biomarkers were found to closest: MMP-9 (τ=0.65; Tcr=0,16), TIMP-1 (τ=0,71; Tcr=0,18) in iAF group; and TGF-β 1 (τ=0.22; Tcr=0.19) in the whole group. The LA fibrosis (%) was associated with TIMP-1 with strongest correlation in iAF group (τ=0.72; Tcr 0.21). Myocardial mass was significantly associated with TGF-β 1 in the group with LA 4.5cm (τ=0.81, Tcr 0.24). E/e’ by TDI correlated with levels of MMP-9 and TIMP-1 (τ=0.65, Tcr=0.16, and τ=0.56, Tcr=0.21, respectively), and with TGF-β 1 being closest in the group with LA 1 in patients with AF without structural heart disease. Elevation of MMP-9 and TIMP-1 levels are associated with LV diastolic dysfunction in these patients, what can reflect initial signs of atrial cardiomyopathy even in patients with nonvalvular “nonischemic” AF with normal or slightly enlarged LA.

Background: High residual platelet reactivity (HRPR) during dual antiplatelet therapy (DAPT) may impact clinical outcomes following percutaneous coronary interventions (PCI). However, whether any biomarkers assessed before PCI at DAPT loading may predict delayed maintenance HRPR is not clear. Objective: The aim of this study was to determine whether conventional clinical or laboratory indices at loading before stenting may predict HRPR at 6 months of maintenance DAPT. Methods: The study was designed on a single-center prospective cohort, and included 94 pre-PCI patients. All patients underwent elective PCI with drug-eluting stent implantation, and received DAPT with aspirin and clopidogrel. Platelet reactivity was assessed with 5 μmol/L of adenosine diphosphate-induced light transmission aggregometry before PCI, but after 24 h of DAPT loading, and repeated at 6 months. Baseline clinical characteristics, CYP2C19 polymorphism, C-reactive protein, soluble P-selectin, CD40L, interleukin-6, PAI-1 levels, and von Willebrand factor activity were analyzed. Results: The incidence (light transmission aggregometry p = 0.02), total cholesterol (p = 0.01), low-density lipoproteins (p = 0.004), CYP2C19*2 allele carriage (p = 0.006), soluble P-selectin (p = 0.009), and von Willebrand factor (p = 0.04) were linked to future HRPR. However, multivariate regression analysis suggested that only BMI and P-selectin were independent predictors of HRPR. Conclusions: Platelet reactivity before elective stenting is associated with numerous biomarkers; however, only BMI and soluble P-selectin were independent predictors of future HRPR during maintenance-phase DAPT. This may be important for future tailored antiplatelet strategies in patients with metabolic syndrome and diabetics.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Aim. To compare long term results of different methods of myocardial revascularization in patients with stable ischemic heart disease. Material and methods . In the study, 352 patients included, with stable ischemic heart disease: mean age 57,6±7,7 y.o. underwent coronary bypass operation (CBG) — group 1 (n=183) and percutaneous coronary interventions (PCI) — group 2 (n=169) with drug eluting stents implantation (1st generation — Taxus, Cypher), with high treatment adherence — medication treatment in postsurgery period. Each group was selected to 2 subgroups: 1 subgroup with 1-2 vessel disease, 2 subgroup with main left coronary artery stem disease and/or severe multivessel disease. Primary endpoints: all-cause mortality, cardiac mortality, non-fatal myocardial infarction, non-fatal stroke. Secondary endpoint: repeated revascularization or appearance of indications to it. Mean time of follow up after CBG was 37,9±6 months. Results . In long term period there were no differences in survival between groups CBG and PCI neither in 1-2-vessel lesion (95,5% vs. 96,8%), nor with stem stenosis or multivessel disease — 95,6% vs 94,1%. Also, there were differences in survival rate depending on the grade of patient comorbidity, regardless revascularization method. There were no differences in groups 1 and 2 in cardiac mortality, nonfatal events. Emerging of indications for repeated myocardial revasculariztion was significantly higher in subgroups with multivessel disease: free from revascularizations, respectively, 97,1% vs 88,0%, in CBG and PCI (p=0,34). Conclusion . Long term survival after PCI with drug eluting stents of 1st generation in comparison to CBG, does not show significant differences in patients with different severity of coronary arteries lesion and high adherence to treatment. However there is dependence on comorbidity evel. Repeated revascularization of myocardium is needed more oftenly after endovascular interventions in stem lesion and/or multivessel disease.

Ischemic heart disease (IHD) and acute coronary syndrome are the main cause of sudden cardiac death (SCD). Incidence of SCD in patients after myocardial infarction (MI) is 4-6-fold higher than in general population. The review focuses on electrophysiological changes during acute myocardial ischemia and mechanisms of myocardial electromechanical remodeling in remote period after MI. Current data on arrhythmia substrates and triggers are presented. Nowadays, the main guide for implantable cardioverter-defibrillator (ICD) use for primary prevention of SCD is reduced left ventricular ejection fraction. The significance of this parameter has been repeatedly demonstrated in large randomized studies. However, the use of a single indicator cannot solve the problem. In this review we present analysis of modern additional predictors of fatal arrhythmias which are available in clinical practice, as well as the perspective for further research of this highly important scientific, clinical, and social problem.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

The absence of consensus regarding the reference values of right ventricular free wall longitudinal strain (RVFWLS) and its predictive value prompted us to conduct a systematic review and meta-analysis of publications on the predictive role of this parameter in patients with pulmonary hypertension (PH).Aim. To study the independent predictive value of RVFWLS in PH patients using 2D/3D speckle tracking echocardiography.Material and methods. Firstly, 317 publications (PubMed) and 857 Google Scholar results were selected. Of the initially identified search results, 12 articles were analyzed. The papers were cohort designed.Results. The total number of patients with PH was 1281. The mean age of patients was 54,7±6,8 years. Four studies compared the RVFWLS with a control group (n=251). The mean RVFWLS were -17,0±2,4% and -24,7±2,2% in the experimental and control groups, respectively. A meta-analysis of the difference between the mean RVFWLS values in experimental and control group patients showed its total increase in PH subjects of 8,06% (95% CI: 5,18-10,94%; pThe total number of deaths was 268 (all-cause — 180, composite endpoint — 88). According to the meta-analysis, with an increase of 1% in RVFWLS, there is an increase in mean all-cause mortality risk by 14% (pConclusion. These results highlight the high independent predictive value of RVFWLS as a predictor of adverse outcomes or events associated with a right ventricular dysfunction progression in PH patients.

Background. Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need. Aim. To triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting. Material and methods. This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented ischemic heart disease (IHD) who underwent PCI with drug-eluting stent implantation. All patients received dual antiplatelet therapy with acetyl salicylic acid and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting, as well as CYP2C19 genotyping after patient’s discharge and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and in-stent restenosis. Results. Twenty-three patients experienced MACE. According to univariate regression analysis we found following MACE predictors after PCI: diabetes mellitus (p=0.049), P2Y12 Reaction Units (PRU) according to VerifyNow® (p=0.01), number of stented arteries more than 2 (p=0.01), number of implanted stents more than 2 (p=0.01), baseline levels of plasminogen activator inhibitor-1 (PAI-1) (p=0.03) and von Willebrand activity (vWF) (p=0.01). Using multivariate analysis we demonstrated that concomitant diabetes mellitus, PRU ≥202, PAI-1 level ≥75.95 ng/ml, von Willebrand factor activity ≥155.15% are independent predictors of adverse cardiac events after PCI in stable IHD patients. Other clinical characteristics and laboratory indices, including CYP2C19*2 carriage, showed no significant impact on outcomes after elective PCI. Conclusions. Background diabetes mellitus, high on-treatment platelet reactivity (according to VerifyNow®), PAI-1 and vWF presenting activity may be useful for MACE prediction over 28 months of follow-up after PCI with drug-eluting stent implantation.

Aim. To determine the predictive role of estimated pulmonary artery systolic pressure (ePASP) in COVID-19 patients.Material and methods. A retrospective study of inpatients with documented COVID-19 infection was carried out. Maximal follow-up period was 63 days. The study included 108 patients (men, 62; women, 46; mean age, 62,9±15,5 years). At admission, mean NEWS score was 6,0, blood oxygen saturation — 92%. Echocardiography was performed according to standard protocol using Vivid E9 ultrasound system (GE Healthcare). Quantitative measurements were performed according to the current ASE and EACVI guidelines. Statistical analysis was performed using the IBM SPSS Statistics v.26 software (developed by IBM Corporation).Results.Using the CHAID technique, a classification tree was developed and the strongest predictor of an unfavorable outcome was determined (ePASP). Threshold ePASP values, associated with an increased mortality risk were established (42 mm Hg and 50 mm Hg). Three groups of patients were selected based on the main predictor (50 mm Hg). The increased mortality risk was noted in groups 2 and 3 compared to group 1 of patients and amounted to 31,8% and 70% versus 3,9%, respectively. There was also a correlation between the severity of CT lung parenchymal lesions according to computed tomography and the study groups of patients (36% [30-49%] — group 1, 50% [36-76%] — group 2, and 84% [56-92%] — group 3, p=0,001). In groups 2 and 3, the following complications were significantly more frequent: acute respiratory distress syndrome, acute heart failure, multiple organ system failure, venous thrombosis, disseminated intravascular coagulation. In group 3, acute renal failure and systemic inflammatory response syndrome developed significantly more often than in group 1.Conclusion.A comprehensive echocardiography has proven its availability and safety in assessing the condition of COVID-19 patients, allowing to obtain relevant information on pulmonary hemodynamics. Transthoracic echocardiography reduced the risk of complications from invasive diagnostic methods and allowed to abandon the use of the Swan-Ganz pulmonary artery catheter in the studied group of patients. As a result, a relationship was noted between the increase of ePASP and the severity of clinical performance and lung tissue damage according to computed tomography, changes in laboratory blood tests, the severity of the comorbid profile, an increase in respiratory support need.

The new coronavirus infection, despite severe respiratory complications, is accompanied by serious cardiovascular manifestations A large proportion of patients have primary cardiovascular disease, which with COVID-19 increases the risk of heart complications Objective To analyze available data on cardiovascular disease and complications in patients with COVID-19 Results Patients with severe inflammatory response syndrome and «cytokine storm», often accompanied by myocardial damage, are in the highest risk group In the absence of proven pathogenetic therapy, supporting the treatment and identification of patients with high risk of heart complications is essential Conclusion The article describes the basic mechanisms of coronavirus SARS-CoV-2 exposure, the main clinical manifestations and possible mechanisms of heart complications in patients with COVID-19 Новая коронавирусная инфекция, несмотря на тяжелые респираторные осложнения, сопровождается серьезными сердечно-сосудистыми проявлениями Значительная часть пациентов первично имеют сердечно-сосудистые заболевания, что при COVID-19 увеличивает риск развития сердечных осложнений Цель исследования Провести анализ имеющихся данных по проблеме кардиоваскулярных заболеваний и осложнений у пациентов с COVID-19 Результаты В группе наиболее высокого риска - пациенты с тяжелым синдромом воспалительного ответа и «цитокиновым штормом», часто сопровождающимися повреждением миокарда Ввиду отсутствия доказанной патогенетической терапии, поддерживающее лечение и выявление пациентов с высоким риском сердечных осложнений крайне важно Заключение В статье рассмотрены базовые механизмы воздействия коронавируса SARS-CoV-2, основные клинические проявления и возможные механизмы сердечных осложнений у пациентов с COVID-19

Objective: to determine impact of different laboratory and genetic factors on high on-treatment platelet reactivity (HOPR) during dual antiplatelet therapy (DAPT). Methods. We included in this study 94 patients with stable ischemic heart disease (mean age 59±9.67 years). All patients underwent elective PCI with implantation of drug eluting stents at the background of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. Platelet reactivity was assessed using light transmission aggregometry with 5 μmol/L ADP (LTA 5ADP) and VerifyNow assay before PCI. All patients underwent genotyping to detect CYP2C19 polymorphism. In 74 patients at baseline examination we determined levels of high-sensitivity C-reactive protein (hsCPR), soluble platelet-selectin (sP-selectin), soluble CD40-ligand (sCD40L), interleukin-6 (IL-6), plasminogen activator inhibitor (PAI-1) and activity of von Willebrand factor. Results. Incidence of HOPR according to LTA-5ADP was 16% and VerifyNow - 24.5%. Univariate regression analysis showed that the following factors were significantly associated with HPR determined by LTA-5ADP: body mass index (BMI) (p=0.02), levels of total cholesterol (CH) (p=0.0l), low density lipoprotein CH (p=0.004), and sP-selectin (p=0.009), activity of von Willebrand factor (p=0.04). Carriage of CYP2C19*2 allele was also associated with HOPR (p=0.006). According to multivariate regression analysis body mass index and level of sP-selectin were independent predictors of HOPR during DAPT. Conclusions. HOPR determined by LTA was significantly associated with high BMI, levels of total and LDL CH, carriage of CYP2C19*2 allele, levels of hsCRP and sP-selectin. Independent factors significantly related to HORP were BMI and sP-selectin level.

Objective: Assessment of the role of statin therapy in the prevention of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients without prior atrial fibrillation. Methods: A retrospective analysis of 206 patients, aged 57.2 ± 7.9 years (mean ± SD), who underwent isolated CABG is carried out. All patients are divided into two groups. The first group (nSt-patients) includes the patients who did not receive statin therapy prior to CABG (n = 82). The second group (St-patients) includes the patients who received statin therapy prior to CABG (n = 124). Both groups received the statin therapy from the first day after CABG. The risk of occurrence of POAF is evaluated using the Cox-regression model. Results: The rate of POAF was 25.6% in nSt-patients and 6.5% in St-patients (P = 0.020). On the 4th day after CABG, white blood cells (WBC) count was 11.0 (9.0, 13.0) × 109/mL (medians with inter-quartile ranges) in nSt-patients and 9.0 (7.6, 10.2) × 109/mL in St-patients (P

Aim. To evaluate the influence of gene СYP2C9 activeness via losartan test on the warfarin dosage management in earlier and long-term post-operational periods. Material and methods. Totally 33 patients included with artificial heart valves. All patients underwent assessment of genes carriage by polymorphic marker СYP2C9 by PCR after preparing of DNA from whole blood. The activeness of СYP2C9 was assessed with losartan concentration and its metabolite (E-3174) in urine after single intake of losartan 50 mg. Results. The level of losartan and its active metabolite (E-3174) in urine was a prognostic marker determining therapeutic dose of warfarin in cardiac surgery patients in long-term post-operation period. Conclusion. The СYP2C9 assessment by losartan concentration and E-3174 in“losartan test” might help to determine warfarin treatment dosage in delayed postoperational period that might improve the efficiency and safety of pharmacotherapy in valve prosthesis patients.

Objective: To evaluate efficacy of one-step and two-step surgery approach in patients with arrhythmias combined with Ebstein’s anomaly. Methods: Fifty-three patients with Ebstein’s anomaly combined with tachyarrhythmias (58.5% men, 41.5% women, mean age 21.6G10.7 years) were operated on. In group A (32 patients), one-step surgical correction (simultaneous intraoperative elimination of arrhythmias and congenital heart defect repair) was performed, whereas in group B (21 patients), two-step surgery was performed with initial elimination of arrhythmogenic substrate by transcatheter radiofrequency ablation (first step) and following surgical repair of congenital heart defect (second step). Results: In group A, total hospital mortality was 3.1% (1 patient) due to initial severe condition of this patient. One-step surgery was effective in 93.5% of cases. Mortality was not observed in group B. Efficacy of transcatheter radiofrequency ablation was 76.2%. Conclusions: one-stage and two-stage surgery of arrhythmias and Ebstein’s anomaly are highly effective. First step of surgery of combined pathology reduces cardiopulmonary bypass time, complications and mortality while performing the second step of congenital heart defect surgery. However, simultaneous approach (one-step surgery) is better in terms of arrhythmia elimination. Q 2005 Published by Elsevier B.V.

From May, 1982 to April, 1991 25 patients were examined and 23 had open heart surgery for tachycardia with nodoventricular fibers (NVF) participation. All patients suffered tachycardia for more than 5 years. Most patients had syncope. The patients had: true NVF tachycardia (11), atrioventricular node reentry tachycardia (5), orthodromic atrioventricular tachycardia (AVT) (5), and atrial flutter (1) all with passive propagation through NVF, pseudonodoventricular tachycardia (AVT with slow accessory pathways) two patients. In 18 out of the 23 who had surgery there were no signs of preexcitation or tachycardia events in the follow-up period.

Psoriatic and atherosclerotic plagues were examined using the real-time polymerase chain reaction. Expression of the FOSL1 gene proved to substantially increase in both psoriatic lesions of the skin and atherosclerotic lesions of vessels as compared with nonlesion samples.

The abrupt cessation of effective cardiac function that is generally due to heart rhythm disorders can cause sudden and unexpected death at any age and is referred to as a syndrome called sudden cardiac death (SCD). Annually, about 400,000 cases of SCD occur in the United States alone. Less than 5% of the resuscitation techniques are effective. The prevalence of SCD in a population rises with age according to the prevalence of coronary artery disease, which is the most common cause of sudden cardiac arrest. However, there is a peak in SCD incidence for the age below 5 years, which is equal to 17 cases per 100,000 of the population. This peak is due to congenital monogenic arrhythmic canalopathies. Despite their relative rarity, these cases are obviously the most tragic. The immediate causes, or mechanisms, of SCD are comprehensive. Generally, it is arrhythmic death due to ventricular tachyarrythmias - sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Bradyarrhythmias and pulseless electrical activity account for no more than 40% of all registered cardiac arrests, and they are more often the outcome of the abovementioned arrhythmias. Our current understanding of the mechanisms responsible for SCD has emerged from decades of basic science investigation into the normal electrophysiology of the heart, the molecular physiology of cardiac ion channels, the fundamental cellular and tissue events associated with cardiac arrhythmias, and the molecular genetics of monogenic disorders of the heart rhythm (for example, the long QT syndrome). This review presents an overview of the molecular and genetic basis of SCD in the long QT syndrome, Brugada syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia and idiopathic ventricular fibrillation, and arrhythmogenic right ventricular dysplasia, and sudden cardiac death prevention strategies by modern techniques (including implantable cardioverter-defibrillator).