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Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

The Russian Society of Cardiology (RKO)With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians

Russian Society of Cardiology (RSC)With the participation of the Eurasian Association of Therapists, the Russian Scientific Medical Society of Therapists (RNMOT), the Russian Society of Pathologists, the Russian Society of Radiologists and Radiologists (RSR)Approved by the Scientific and Practical Council of the Russian Ministry of Health (30.09.2022)

Aim. To determine the prevalence and show the features of the development of newly diagnosed heart failure (HF) in patients with dyspnea after a coronavirus disease 2019 (COVID-19).Material and methods. This clinical prospective observational study was conducted during 2020-2022. The study consecutively included 368 outpatients with shortness of breath, who applied to the clinic. Depending on the presence of prior COVID-19, the patients were divided into 2 groups: the first group consisted of 205 patients with shortness of breath after COVID-19, the second group — 163 patients without prior COVID-19. All patients underwent a clinical examination within 3 days after presentation with an assessment of outpatient records and other medical documents for the differential diagnosis of dyspnea. The severity of dyspnea was determined using the Modified Medical Research Council Dyspnoea Scale (mMRC). The diagnosis of HF was verified in accordance with the 2020 Russian Society of Cardiology guidelines and in some cases reclassified in accordance with the 2021European Society of Cardiology guidelines. For further analysis, 2 subgroups of patients with HF were identified depending on the presence and absence of prior COVID-19. The subgroup analysis excluded patients with acute heart failure, acute illness, and conditions requiring hospitalization and/or intensive care.Results. Among 368 patients who presented to the clinic with dyspnea during 2020-2022, 205 patients (55,7%) had COVID-19. The average period of treatment after COVID-19 was 3,5 [1,5; 22,4] months. Patients after COVID-19 applied earlier after the onset of dyspnea, which is associated with higher mMRC score. The prevalence of HF among patients with shortness of breath after COVID-19 was significantly higher than in patients without this pathology in history, and amounted to 19,0% vs 9,8% (p=0,021). Prior COVID-19 increased the relative risk (RR) of HF in patients with shortness of breath by 1,7 times. RR for HF in systolic blood pressure >140 mm Hg increased by 1,9 times, while in diastolic blood pressure >90 mm Hg — by 1,9 times, with the development of a hypertensive crisis — by 28%, with a heart rate >80 bpm at rest — by 1,4 times, with the development of type 2 diabetes — by 31%, in the presence of pulmonary fibrosis — by 2,3 times. Patients with shortness of breath after COVID-19 had more severe HF, both according to clinical tests and according to the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), mainly with the preserved ejection fraction (EF) with a higher prevalence of left atrial (LA) enlargement in combination with a decrease in right ventricular (RV) systolic function and its dilatation. In patients after COVID-19 in the presence of chronic kidney disease, the RR for HF increased by 4,5 times; in the presence of C-reactive protein >4 mg/l — by 1,6 times.Conclusion. Every fifth patient with shortness of breath 3,5 months after COVID-19 had more severe HF, both according to clinical tests and according to blood NT- proBNP concentration, mainly with preserved EF with a higher prevalence of LA increase in combination with a decrease in RV systolic function and its dilatation. The risk of HF is interrelated with the female sex and multiple comorbidities.

Aim. To determine the incidence, risk factors and course of acute decompensated heart failure (ADHF) in patients with prediabetes.Material and methods. Within 24 months, 426 patients hospitalized to cardiology department of a multidisciplinary hospital with ADHF were consecutively included in the study. In addition, 136 patients who met the inclusion criteria and did not have exclusion criteria were divided into 2 groups depending on prediabetes presence. The first group consisted of 51 (37,5%) patients with prediabetes, the second — 85 (62,5%) patients without this pathology. ADHF was verified based on a rapid increase in symptoms and signs of hypoperfusion. Prediabetes was defined according to World Health Organization criteria. The risk level for type 2 diabetes was determined using the FINDRISC online calculator. In the first 48 hours of hospitalization, echocardiography was performed. The serum concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cystatin C was determined using enzyme immunoassay.Results. The incidence of prediabetes among patients with ADHF was 37,5%. In 9,8%, prediabetes was verified prior to hospitalization. Patients with prediabetes and ADHF were younger and were more likely to have obesity with a body mass index (BMI) of more than 30 kg/m2, non-alcoholic fatty liver disease, and higher waist circumference. In patients with ADHF and prediabetes, congestion symptoms were more pronounced, their higher frequency was recorded, as well as the frequency of wet-warm phenotype. Spironolactone dose was higher during hospitalization in the group of patients with ADHF and prediabetes. In the same group, the duration of hospitalization was longer. Prevalence of ADHF with preserved and mildly reduced ejection fraction (EF), severity of LV diastolic dysfunction (DD), LV mass index in patients with BMI >30 g/m2, left atrial volume index, pulmonary artery systolic pressure were significantly higher in the group of patients with ADHF and prediabetes. At a high risk of type 2 diabetes, the concentrations of NT-proBNP, triglyceride/glucose index, cystatin C, LV diastolic dysfunction severity were significantly higher, and the glomerular filtration rate was lower.Conclusion. The development of ADHF in patients with prediabetes is interrelated with multiple risk factors and comorbidities, characterized by more pronounced congestion, longer hospitalization, predominantly preserved and mildly reduced EF in combination with severe LVDD, LV hypertrophy, and activation of nonspecific inflammation.

Aim. To compare the effect of insulin therapy and oral hypoglycemic agents (OHAs) on the risk of heart failure (HF) in patients with type 2 diabetes (T2D) using different databases.Material and methods. The systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis included studies that compared the risk of HF in T2D patients, depending on the OHA therapy in the presence of a group of patients receiving insulin therapy. The inclusion criteria were a duration of treatment of at least two years with at least 1000 included patients. The analysis did not include studies that compared the types and regimens of insulin therapy without a control group (antidiabetic drugs), which included patients with acute complications of type 2 diabetes and unstable conditions associated with comorbidities, in which no clinical outcomes were reported. Search was conducted in August 2022 using several databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) at the Cochrane Library, Elibrary) using the following keywords: heart failure development, 2 type diabetes mellitus, insulin.Results. Of the 1085 publications found in the search, 5 retrospective observational cohort clinical trials, including a total of 179777 patients with a mean duration of treatment of 67,2 months, met all criteria and were included in the analysis. Statistical analysis of the relative risk (RR) of HF in T2D patients receiving insulin therapy revealed a RR increase in all studies with a total RR using fixed effects model of 2,598 (95% confidence interval (CI), 2,346-2,878; p

Aim: To assess the probability of masked arterial hypertension (MAH) in patients with low and moderate cardiovascular risk depending on polymorphisms in selected genes.Materials and methods: Ninety two (92) patients (mean age, 41.93±8.92 years) with low and moderate cardiovascular risk without any documented cardiovascular disorders were assessed clinically and had 24-hour ECG monitoring performed, as well as genotyping on the following markers: AGT Thr174Met rs4762, GNB3 C825T rs5443, MTHFR C677T rs1801133, MTRR Ile22Met rs1801394, ApoE Cys130Arg rs 429358, and PPARα G/C rs4253778. Depending on the presence of MAH, the patients were divided into two groups: with newly diagnosed arterial hypertension corresponding to the MAH criteria (n=58, 63%) and with normal office-based and ambulatory blood pressure and normal blood pressure according to the results of 24-hour ECG monitoring (n=34, 37%).Results: Two groups were not different by their age, cardiovascular risk factors, concomitant diseases and clinical characteristics. There were more men than women in the MAH group (р=0.028). In MAH patients, the most prevalent was Ile22Met rs1801394 A/G polymorphism of the MTRR gene (the odds ratio (OR) and relative risk (RR) for MAH were 4.23 [95% сonfidence interval (CI) 1.56–11.72] and 2.17 [1.25–4.12], respectively). The Cys130Arg rs 429358 Т/С genotype polymorphism of the АроЕ gene was also significant. The probability of MAH in the patients with АроЕ Т/С genotype was more than 3-fold higher: OR 3.67 [95% CI 1.34–10.28], RR 2.15 [95% CI 1.17–4.36]. The correlation analysis showed a moderate association between MAH and MTRR and АроЕ gene polymorphisms (Q=0.62 and Q=0.57, respectively).Conclusion: In patients with low and moderate cardiovascular risk, the probability of MAH depends not only from their gender, but also from their genetic background. The candidate genes for MAH in such patients are Ile22Met rs1801394 A/G polymorphism of the MTRR gene and Cys130Arg rs 429358 Т/С polymorphism of the АроЕ gene.

Aim. To assess the risk of heart failure (HF) depending on the state of renal filtration function in patients with uncomplicated hypertension (HTN) without kidney dysfunction.Material and methods. This cross-sectional screening clinical trial consecutively included 176 outpatients with uncomplicated HTN and without chronic kidney disease (CKD). To assess the HF risk, the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. To assess the renal filtration function, the blood serum concentration of creatinine and cystatin C was determined, followed by glomerular filtration rate (GFR) estimation using the CKDEPI equation with both parameters. Echocardiography was performed to assess the cardiac structural and functional state.Results. Correlation analysis revealed a moderate direct relationship between NT-proBNP and blood cystatin C concentration (r=0,370; p74 ml/min/1,73 m2. The presence of impaired glucose tolerance, left ventricular diastolic dysfunction (LV DD), LV hypertrophy and left atrial enlargement leads to an additional increase in HF risk in patients with uncomplicated HNT without CKD.Conclusion. The ROC analysis showed that cystatin C and cystatin C-based GFR (CKD-EPIcys) can be used as markers of HF risk in patients with uncomplicated HTN without CKD. With an increase in cystatin C ≥1016 ng/ml, the relative risk of HF is 2,99, while with a decrease in GFR (CKD-EPIcys) ≤74 ml/min/1,73 m2 — 1,26. The presence of impaired glucose tolerance, LV DD, LV hypertrophy and left atrial enlargement in patients with uncomplicated HTN without CKD with a cystatin C increase ≥1016 ng/ml and a decrease in GFR (CKD-EPIcys) ≤74 ml/min/1,73 m2 and below further increases the risk of developing CHF.

Aim. To determine the risk factors and diagnostic value of urinary N-terminal probrain natriuretic peptide (NT-proBNP) for verification of heart failure in human immunodeficiency virus (HIV)-infected patientsMaterial and methods. This cross-sectional screening clinical trial included 115 HIV-infected patients who were hospitalized during 24 months. The patients were divided into 2 groups, depending on the data suggestive of HF and the blood and urinary NT-proBNP concentration. So, group 1 included 69 HIV-infected patients with HF symptoms and increased blood and urinary NTproBNP, while group 2 — 46 HIV-infected patients not meeting HF criteria. NTproBNP concentration was determined on Immulite 1000 Immunoassay System (DPC, USA) in blood plasma and frozen urine using Vector Best reagents (Russia).Results. Correlation analysis revealed a significant direct moderate correlation between blood and urinary NT-proBNP in the entire cohort of studied patients (r=0,367; p

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia.

Aim. To determine the peculiarities of heart failure (HF) development in human immunodeficiency virus (HIV)-infected patients, depending on the blood concentration of C-reactive protein (CRP).Material and methods. This cross-sectional screening clinical trial included 100 patients hospitalized with HIV infection and a history of HF for 28 months. The patients were divided into 2 groups depending on blood CRP concentration. The cut-off point was CRP of 15 mg/l. The first group included 37 HIV-infected patients with HF and blood CRP 450 pg/ml, and hence the risk of acute decompensated HF in the presence of a CRP concentration of 1-9,8 mg/l in HIV-infected patients with HF was 44,73 (95% CI=8,62;311,10), while relative risk (RR) — 18,73 (95% CI=4,94;112,94). In the presence of in hospital inflammatory diseases and CRP ≥15 mg/l in HIV-infected patients and prior HF, the RR of acute decompensated HF is reduced by 88% (RR=0,12, 95% CI=0,03-0,33).Conclusion. CRP values from 1 to 9,8 mg/l in HIV-infected patients with HF are predictors of its severity, characterized by a higher incidence of HF with reduced ejection fraction, diastolic dysfunction and left ventricular hypertrophy without significant differences with patients who have CRP >9,8 mg/l. CRP concentration >9,8 mg/l in HIV-infected patients and prior HF indicates the development of an inflammatory process, and not a worsening of the HF course.

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

Disclaimer РThe EAC/RNAS Guidelines represent the views of the EAC and RNAS, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and RNAS is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/RNAS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/RNAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/RNAS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/RNAS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

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

Russian Society of Cardiology (RSC)With the participation: Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation Task Force: Gabrusenko S.A. (Chairman), Gudkova A.Ya.* (Chairman), Koziolova N.A. (Chairman), Alexandrova S.A., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Zaklyazminskaya E.V., Irtyuga O.B., Kaplunova V.Yu., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Saidova M.A., Sanakoev M.K., Stukalova O.V.

The review presents the rationale for studying cardiovascular disease in HIV-infected patients, as well as the importance of specific therapy. The embrace of this problem is due the widespread use of antiretroviral therapy in the world over the past 20 years has led to an increase in the life expectancy of HIV patients, while cardiovascular diseases have become a mortality and disability leader. The review presents the most frequently reported cardiovascular pathology and cardiac complications in HIV patients that occur both against the background of virus-mediated action and as a result of antiretroviral therapy. Some pathogenetic mechanisms of HIV influence on cardiomyocytes and the extracellular matrix have been demonstrated, resulting in early heart failure and pulmonary hypertension. Information is given on the role of statins in the management of HIV patients with the clinically significant atherosclerosis.

Aim. To assess cardiovascular remodeling in patients with diabetic cardiomyopathy (DCM) and compare it with healthy individuals.Material and methods. Among outpatients with newly diagnosed type 2 diabetes (T2D), according to inclusion and exclusion criteria, a group of participants with diabetic cardiomyopathy (DCM) with left ventricular diastolic dysfunction (LV DD) was made before treatment. The second group consisted of healthy individuals of the corresponding age. The structural and functional state of the heart was studied using echocardiography and determination of the N-terminal prohormone of the brain natriuretic peptide (Nt-proBNP) in the blood; of the arteries — using volume sphygmoplethysmography. Markers of fibrosis were determined in the blood: tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and C-terminal telopeptide 1 (CTP-1).Results. The DMC prevalence in patients with newly diagnosed T2D was 18,7%. LV DD was associated not only with T2D, but also with obesity (r=0,48; p=0,029), blood pressure even in the normal range ((r=0,42; p=0,031 for systolic blood pressure; (r=0,39; p=0,042) for diastolic blood pressure). The Nt-proBNP levels in the normal range and TIMP-1 were higher in the DCM group compared with the group of healthy individuals (p

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The study included men and women over 18 years of age with an established class II-IV HF and at least one hospitalization due to acute decompensated HF within 12-month follow-up.Results. The final analysis included 888 patients (men, 52,9%; women, 47,1%; mean age, 69 [61; 78] years). The preserved ejection fraction (EF) was detected in 47,86% of patients, mid-range — in 40,54%, reduced — in 11,6%. Only in 16% of patients, there was improved by 1 or more HF. Hypertension and coronary artery disease were predominant in etiology pattern of HF. Preserved EF was more often detected in women over 60 years of age, with HTN and obesity, as well as with HF with mid-range and reduced EF in men in the same age group. There was sufficient follow-up rate, but the extent examinations do not correspond to the recommended one. The prescription rate of renin-angiotensin-aldosterone system (RAAS) inhibitors corresponds to the recommended one, but there is a high frequency of prescribing angiotensin II receptor blockers (ARBs). The prescription rate of β-blockers and loop diuretics (mainly torasemide) increased in comparison with previous studies, while thiazide diuretics — decreased. In patients with reduced EF, the prescription rate of sacubitril/valsartan was only 14,7%, β-blockers — 83,3%, mineralocorticoid receptor antagonists (MCRA) — 72,5%. In patients with midrange EF, there was a sharp decrease in prescription rate of RAAS inhibitors, β-blockers, MCRA.Conclusion. The practical follow-up of patients with HF differs significantly from clinical guidelines. Due to inadequate pharmacotherapy, as well as insufficient noncompliance with the recommended extent of investigations, 1-year HF therapy does not lead to a pronounced improvement in the patients' class.

Aim. To assess the risk factors and diagnostic significance of the N-terminal probrain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure (ADHF) and diabetic kidney disease (DKD).Material and methods. A total of 125 patients with ADHF and type 2 diabetes (T2D) were examined. They were divided into 2 groups depending on the presence/ absence of chronic kidney disease (CKD). The first group consisted of 43 (34,4%) patients with DKD, the second — 82 (65,6%) without CKD. The inclusion criterion was the presence of ADHF and T2D. There were following exclusion criteria: cardiogenic shock, pulmonary edema, acute thromboembolic events, type 1 diabetes, prediabetes, acute coronary syndrome, stroke, prior transient ischemic attack (100 mm Hg, the odds ratio (OR) and the relative risk (RR) of ADHF in patients with DKD increases by 5,1 and 4,5 times, 2,5 and 1,8 times, respectively. In the presence of grade III-V premature ventricular contractions, OR and RR of ADHF in patients with DKD were 2,6 and 1,9, respectively. OR and RR of ADHD in patients with DKD and prior stroke or transient ischemic attack were 3,8 and 3,2, respectively. Verification of anemia at a hemoglobin level of 5 mmol/l, the OR of ADHF in patients with DKD increases by 3,7 times, the OR — by 2,3 times. The NT-proBNP >1289 pg/ml is diagnostic for verifying ADHF in DKD patients with the sensitivity of 64,3% and specificity of 93,3%.Conclusion. Every third patient with ADHF and T2D is diagnosed with DKD. A certain range of risk factors for the development of ADHF in patients with DKD has been identified. As the glomerular filtration rate (GFR) decreases, the NT-proBNP level increases. With a decrease in GFR of 60 ml/min/1,73 m2 in patients with T2D, the diagnostic value of NT-proBNP >1289 pg/ml should be considered to verify ADF.

Aim. To determine additional diagnostic criteria for atrial cardiomyopathy in patients with type 2 diabetes (T2D) and paroxysmal/persistent atrial fibrillation (AF).Material and methods. This cross-sectional screening clinical study included 80 patients with AF and T2D, who were divided into 2 groups depending on the left (LAVI) or right atrial volume index (RAVI) according to echocardiography: the first group included 49 patients with increased LAVI, while the second — 31 patients without changes in LAVI and RAVI. Inclusion criteria were presence of paroxysmal or persistent AF, T2D, age up to 65 years. There were following exclusion criteria: current smoking and less than 1 year old, the presence of cardiovascular and pulmonary diseases, heart failure, implanted artificial pacemaker, prior radiofrequency ablation; valvular heart disease and prosthetics; acute myocarditis, infective endocarditis, hypertrophic, dilated, and restrictive cardiomyopathies, storage diseases, severe liver diseases; thyroid disorders; cancer; acute inflammatory and infectious diseases; alcohol abuse, dementia and mental illness.Results. The groups did not differ significantly in terms of sex, age, cardiovascular risk factors, risk of stroke and bleeding when using anticoagulants, clinical and laboratory parameters, and the structure of drug therapy. The following parameters significant differ between the groups: LAVI (according to study design), mid-regional pro-atrial natriuretic peptide (MR-proANP), glomerular filtration rate (GFR) calculated by creatinine, tissue inhibitor of matrix metalloproteinases 1 (TIMP-1). For MR-proANP, GFR, TIMP-1, ROC curves were created in order to determine its clinical significance and operational characteristics of parameters. GFR, as a diagnostic criterion, showed unsatisfactory clinical significance when constructing the ROC curve: AUC (area under the curve) was 0,38. The MR-proANP of 62,3-85 pmol/L and TIMP-1 of 156 ng/ml and higher allows verification of atrial cardiomyopathy in patients with T2D and AF at AUC of 0,83 (95% confidence interval (CI), 0,73; 0,92) and 0,90 (95% CI, 0,83; 0,98), respectively.Conclusion. The blood MR-proANP concentration of 62,3-85 pmol/L is diagnostic for atrial cardiomyopathy in patients with T2D and AF with the sensitivity and specificity of 96,8% and 75,5%, respectively, while TIMP-1 values of 156 ng/ml and above had the sensitivity and specificity of 90,3% and 87,8%, respectively.

Aim. To study the relationship of N-terminal pro-brain natriuretic peptide (NT-proBNP) with clinical symptoms, structural and functional cardiac abnormalities in human immunodeficiency virus (HIV)-positive patients with heart failure (HF), as well as to identify risk factors for severe HF.Material and methods. During the year, 150 HIV-positive patients with typical symptoms and signs of stable HF were examined in the hospital. Among them, HF, confirmed by structural and functional cardiac changes and NT-proBNP increase above 125 pg/ml, was identified in 83 (55,3%) patients. These patients were divided into 3 groups depending on the blood concentration of NT-proBNP: group 1 (n=54) — patients with NT-proBNP of 125-700 pg/ml; group 2 (n=12) — patients with NT-proBNP of 701-1500 pg/ml; group 3 (n=17) — patients with NT-proBNP >1500 pg/ml.Results. As NT-proBNP increased in HIV-positive patients with HF, the left ventricular (LV) ejection fraction (EF) significantly decreased (p=0,005). Also, the increase in the severity of HF symptoms (p1500 pg/ml were identified. With CKD and inflammatory diseases during hospitalization, the relative risk of severe HF in patients with HIV infection is increased by more than 6 times, while with thromboembolic events — 5,3 times, infective endocarditis — 4,4 times, pneumonia during hospitalization and severe thrombocytopenia — more than 3,5 times, chronic obstructive pulmonary disease — 2,1 times, chronic hepatitis B and/or C — 1,7 times. As HIV infection progresses (CD4

Aim. To determine additional diagnostic criteria for class I atrial cardiomyopathy (ACM) in patients with lone atrial fibrillation (AF).Material and methods. This cross sectional non-randomized clinical study included 170 stable patients 125 ng/ml) in patients with sinus rhythm. In all patients, the concentration of NT-proBNP, a soluble stimulating growth factor 2 (sST2), as well as creatinine and cystatin C with calculation of the glomerular filtration rate, tissue inhibitor of matrix metalloproteinases-1 (TIMP1), and neutrophil gelatinase associated lipocalin (NGAL) was determined. Non-invasive angiography was performed.Results. According to ROC analysis, NT-proBNP, TIMP-1, NGAL as markers of class I ACM in patients with lone AF, showed unsatisfactory clinical significance. In patients with ACM and AF, regardless of the presence/ absence of HF, direct moderate relationship between sST2 and LAVI (r=0,470, p=0,012) and direct strong correlation between sST2 and NT-proBNP (r=0,726, p=0,004). Using ROC curve, for all available sST2 values, its diagnostic significance was obtained in the range from 5 to 16 ng/ml (AUC=0,98).Conclusion. The blood concentration of sST2 in the range from 5 to 16 ng/ml can be considered as an additional diagnostic criterion for class I ACM in patients with lone AF with a sensitivity of 98% and a specificity of 80%.

Aim. To determine the risk of heart failure (HF) in patients with hypertension (HTN) depending on the structure of subclinical target organ damage (TOD).Material and methods. The study included 234 patients with HTN without signs of HF. The mean age was 45,96±8,54 years. The patients underwent echocardiography with an assessment of myocardial mass index, ejection fraction, left ventricular diastolic function. Volumetric sphygmoplethysmography with determination of cardio-ankle vascular index (CAVI1) and carotid-femoral pulse wave velocity (PWVcf). Cystatin C blood concentration with the calculation of the glomerular filtration rate (GFR) was performed. NT-proBNP blood levels was also determined. Patients were divided into 4 groups depending on the presence and structure of subclinical TOD. The first group consisted of 74 (31,6%) patients without documented subclinical TOD; the second group — 99 (42,3%) patients with one subclinical TOD; the third group — 42 (18,0%) patients with two TOD; the fourth group -19 (8,1%) patients with three TOD.Results. Patients in the groups differed significantly in blood NT-proBNP concentration (p125 pg/ml, were significantly associated with the TOD structure compared to the group without confirmed TOD (p=0,035, p=0,21, p=0,044, respectively). Correlation analysis revealed direct relationships between the NT-proBNP level and TOD amount (r=0,56; p

Aim. To analyze clinical characteristics of patients with nonvalvular atrial fibrillation (AF) in the Russian population, enrolled in the GLORIA-AF registry phase 2, depending on the antithrombotic therapy received, and to assess the potential for patient retention with dabigatran during a 2-year follow-up.Material and methods. In the Russian Federation, 408 patients were included in the second phase of GLORIA-AF which is a global prospective observational registry of newly diagnosed patients with AF. The patient characteristics are presented depending on received antithrombotic therapy (dabigatran, factor Xa inhibitors, vitamin K antagonist, antiplatelet agents, or no antithrombotic therapy), with a dabigatran dosing regimen of either 110 mg or 150 mg twice daily. Duration of patient retention on dabigatran therapy was also analyzed during a 2-year follow-up.Results. Of the 405 patients with recently diagnosed nonvalvular AF, 358 (88%) received oral anticoagulants (OAC), and 47 (12%) patients received antiplatelet drugs or received no antithrombotic therapy. Most patients were treated with dabigatran (n=275, 68%), and 75 (19%) patients received vitamin K antagonist. Clinical and demographic characteristics of patients receiving dabigatran were comparable with those in the general group of the Russian patients. The mean age was 63,5 years. The most common comorbidities in Russian patients receiving dabigatran were hypertension (93%), congestive heart failure (57%), coronary artery disease (35%). It is noteworthy that 12% and 10% of patients had a previous myocardial infarction and stroke, respectively. The mean CHA2DS2-VASc score for stroke risk for these patients was 3,2; 88% of patients had a high stroke risk (score of >2). Of the 275 patients with AF who received dabigatran therapy, 164 (60%) patients received dabigatran at the dose of 150 mg twice daily, and 111 (40%) patients received 110 mg twice daily. Dabigatran doses of 110 mg twice daily were more frequently prescribed for female patients aged 65 years or older and patients with a previous coronary events and impaired renal function, who had a higher CHA2DS2-VASc score for stroke risk. There was a higher proportion of AF patients with marked symptoms in the dabigatran 150 mg twice daily group. A median duration of treatment with dabigatran with the initial dosing regimen was 24 months. The estimated dabigatran therapy retention rate was 0,87, 0,81 and 0,73 after 6, 12 and 24 months of follow-up, respectively.Conclusion. In the Russian Federation, patients with newly diagnosed AF who have an increased risk of stroke are more likely to receive OAC therapy, such as direct thrombin inhibitor (dabigatran), compared to the global cohort of the GLORIA AF Registry Program. Patients in the Russian cohort receiving dabigatran differ from the global cohort of patients by greater comorbidity. At the same time, patients receiving reduced doses of dabigatran, both in the Russian Federation and in the global Registry, are characterized by a greater proportion of patients aged >75 years, a higher incidence of previous myocardial infarction, coronary artery disease, heart failure, impaired renal function, higher CHA2DS2-VASc score for stroke risk. The potential dabigatran therapy retention rate after 24 months in the Russian Federation and in the global cohort was high and amounted to about 70%.

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

Aim. To identify risk factors for acute decompensated heart failure (ADHF) in patients with type 2 diabetes (T2D).Material and methods. In the cardiology department, 129 patients with ADHF were registered within 8 months, 59 (45,7%) of them had T2D. The study included 117 ADHF patients who were divided into two groups depending on the presence of T2D: group 1 (n=49; 41,9%) — patients with T2D, group 2 (n=67; 55,9%) without T2D. The ADHF was verified by rapid progress of hypoperfusion and congestion, which required emergency hospitalization and inotropic and/or intravenous diuretic therapy. In the first 48 hours of hospitalization, echocardiography was performed, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and creatinine were determined; the glomerular filtration rate was estimated.Results. The incidence of T2D among patients with ADHF was 45,7%. There were following risk factors for ADHF in T2D patients: diabetic ketoacidosis (p=0,002), hypertensive crisis (p=0,017), history of acute coronary syndrome (p=0,048), atrial fibrillation (p=0,030), chronic kidney disease (p=0,003), pneumonia (p=0,035), progression of anemia (p=0,049), low prevalence of beta-blockers use (p=0,001), use of inappropriate antidiabetic drugs for HF patients (sulfonylureas, insulin). ADHF, assessed by NT-proBNP level, was significantly more severe in T2D patients (p=0,001) with pronounced congestion symptoms (p=0,001), which led to an increase in the need for diuretic therapy (p=0,002). Cardiac remodeling in T2D patients with ADHF is characterized mainly by the preserved left ventricular ejection fraction (LVEF), severe LV diastolic dysfunction (LVDD) and LV hypertrophy (LVH).Conclusion. The development of ADHF in T2D patients is associated with various risk factors and is characterized by severe congestion symptoms, high need for diuretic therapy, mainly preserved LVEF in combination with severe LVDD and LVH.

Aim. To determine the heart failure (HF) risk in patients with hypertension (HTN) and high adherence to treatment, depending on the blood concentration of the N-terminal pro-brain natriuretic peptide (NT-proBNP) and gene polymorphism.Material and methods. The study included 232 patients with HTN without a verified diagnosis of HF. The mean age was 46,13±8,21 years. Patients were evaluated for genotypes by following markers: AGT Thr174Met rs4762, GNB3 C825T rs5443, MTHFR C677T rs1801133, MTRR Ile22Met rs1801394, ApoE Cys130Arg rs 429358, PPARα G/C rs425377. We also assessed ejection fraction, diastolic function and left ventricular mass index by echocardiography and determined NT-proBNP blood levels. Patients were divided into two groups depending on the NT-proBNP concentration. The group 1 consisted of 64 (27,6%) patients with NT-proBNP >125 pg/ml, the group 2 — 168 (72,4%) patients with NT-proBNP 125 pg/ml, the most significant was the C/T genotype of MTHFR C677T polymorphism (rs1801133), 95% confidence interval (CI) for the odds ratio (OR) and relative risk (RR) of HF was 4,82 and 3,29, respectively (95% CI for OR=2,24-10,60; for OR=1,80-6,39). The A/G and G/G genotypes of the MTRR Ile22Met polymorphism (rs1801394) were statistically significant. The probability of HF with the A/G genotype of the MTRR gene increased by more than 2 times (OR=2,32, 95% CI=1,15-4,64), and the OR of its development was 1,77 (95% CI=1,11-2,69). The probability of HF with the G/G genotype increased more than 3 times (OR=3,65, 95% CI=1,37-9,76), and the OR of its development was 2,20 (95% CI=1,25-3,27). Correlation analysis revealed a direct relationship between the NTproBNP levels and polymorphism of the MTHFR (r=0,47; p125 pg/ml depends on genetic determinism. Candidate genes for the HF in HTN patients with high adherence to treatment are the genotypes C/T of MTHFR C677T polymorphism (rs1801133), and A/G and G/G of MTRR Ile22Met polymorphism (rs1801394).

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

Arterial hypertension in adults. Clinical guidelines 2020

Aim. To assess the diagnostic value of soluble ST2 (sST2) for early detection of heart failure with a preserved ejection fraction (HFpEF) in patients with persistent atrial fibrillation (AF).Material and methods. A total of 165 patients hospitalized with AF paroxysm were examined. The inclusion criteria were the persistent AF and LVEF >50% according to echocardiography. A cohort of 60 patients with persistent AF and preserved LVEF was formed. Patients were divided into 2 equal groups of 30 people depending on the HF presence, assessed on the basis of LV diastolic dysfunction with or without left atrial enlargement >34 ml/m2 or left ventricular mass index >110 g/m2 in men and 95 g/m2 in women, as well as an increase in the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) >125 pg/ml. LVEF was calculated using the Simpson method; assessment of LV diastolic function was carried out with determination of transmitral flow velocity characteristics and visualization of mitral annulus motion. The NT-proBNP concentration was determined in blood serum using the Biomedica Group reagent (Austria), sST2 — using Presage ST2 (Critical Diagnostics, USA) by enzyme-linked immunosorbent assay on an Immulite 1000 analyzer (DPC, USA).Results. In patients with HFpEF and persistent AF, the correlation analysis showed a direct strong relationship between NT-proBNP and sST2 (r=0,726; p

Aim. To analyze possible association of the risk of adverse outcomes development in patients post acute coronary episode (ACS), with the polymorphism of gene TNF. Material and methods. To the study, patients included, that were under observation in 2 registry studies ORACLE I and II (Exacerbation of coronary heart disease: logic-probability ways of course prediction and treatment optimization). In overall, 2012 ACS patients assessed. Mean age 64,7±12,69 y.o. There were 1205 males (59,8%) and 807 females (40,2%). 741 patients (36,8%) included with ST elevation ACS, 1271 (63,2%) — with non-ST elevation ACS. Follow-up started at the 10th day from clinical stabilization. Clinical outcomes were gathered based on phone calls with the patients and their relatives, as during the outpatient office visits. Assessment of polymorphisms of gene TNF done with PCR.Results. In the assessed group, the frequency of alleles and gene TNF genotypes were measured: 18 patients carried genotype АА (0,9%), 561 patients — AG (279%), 1433 — GG (71,2%). In those with the allele А gene TNF, more commonly the episodes of SCD were noted (9,8% comparing to 6,6% of GG carriers, p

Aim. Evaluation of structural and functional condition of the left ventricle (LV) and kidneys in permanent atrial fibrillation patients (AF) with ischemic chronic heart failure (CHF) according to mean 24 hour heart rate and heart rate variability.Material and methods. Sixty patients, age 35-60 y. o., with permanent AF of ischemic origin. All patients underwent echocardiography for the dysfunction verification: systolic function was assessed by ejection fraction of the left ventricle by Simpson, diastolic function was assessed via the velocity of transmitral currents and visualization of tissues of the mitral valve; Holter ECG monitoring was done, as volumetric sphygmopletysmography of peripheral arteries, assessment of kidney function by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) by creatinine and cystatin C, evaluation of the status of collagen production by the tissue inhibitor of matrix metalloproteases type 1 (TIMP-1), measurement of NT-proBNP. In the first part of the study, patients were selected to 3 groups: by GFR 60 mL/min/1,73 m2. In the second — by cystatin C levels below or higher than the referent.Results. There is negative moderate correlation of the heart rate >110 bpm and SDNN (r=-0,64, p=0,040) and 70 bpm (r=0,44, p=0,022); negative moderate correlation of GFR by CKD-EPIcys and mean daily heart rate >110 bpm (r=-0,55, p=0,030). Correlational analysis also showed that in permanent AF and ischemic CHF the mean 24 hour heart rate correlates strongly with E/e’ (r=0,53, р=0,011) and with NT-proBNP (r=0,57, р=0,002). Also the negative strong correlation found for SDNN with mean 24 hour heart rate (r=-0,59, p=0,001), with NT-proBNP (r=-0,65, p=0,002), with EF LV (r=-0,50, p=0,019), with the relation E/e’ (r=-0,61, p110 bpm. With the increase of mean 24 hour heart rate there was increase of CHF severity, progression of LV diastolic dysfunction and renal dysfunction. Low HRV in a range of mean daily heart rate >110 bpm was associated with adverse cardiac remodeling presenting with LVH, and of kidney remodeling. One of possible mechanisms of the target organs with HRV decline, by our data, might be transformation of collagenolysis towards collagenogenesis in intracellular matrix, according to the dynamics of TIMP-1.

Aim. Evaluation of trimetazidine influence on the parameters of filtration and tubulo-interstinal function of kidneys in angina patients of II-III functional class (FC) and stable chronic heart failure (CHF) of II-III FC with chronic kidney disease (CKD) stage 3.Material and methods. Totally, 288 stable angina (II-III FC) patients included, among them a cohort selected of 162 (56,3%) CHF II-III FC. In 62 (38,3%) CKD of stage 3 was diagnosed. All CHF and stage 3 CKD patients were randomized to equal 2 groups depending on the kind of treatment. First group patients, together with standard CHF and coronary heart disease (CHD) management, were taking trimetazidine (Preductal МR®, Servier, France) 35 mg in the morning, and the second group patients did not receive trimetazidine. Treatment duration lasted 6 months. For renal function assessment, glomerular filtration rate (GFR) was implemented (CKD-EPIcre), calculated via serum creatinine and cystatin C in the blood (CKD-EPIcys), albumincreatinine ratio in single urine portion (UACR), molecules of tubules damage (KIM-1) in urea, tissue inhibitor of matrix proteases type 1 in the blood (ТIMP-1).Results. Introduction of trimetazidine to the standard therapy of CHD with CHF and CKD stage 3 makes it to not only improve clinical course of the disease, but increases exercise tolerance and demonstrates regression of disorder of kidney function by the dynamics of cystatin C (p=0,005), GFR increase, calculated by cystatin С (p=0,012), decrease of UACR (p=0,002), KIM-1 (p

Aim. To investigate on the specifics of chronic heart failure (CHF) course and functional remodeling of target organs in coronary heart disease (CHD) patients with chronic renal disease (CRD).Material and methods. According to the criteria, 162 patients included, with CHD and CHF II-III functional class (FC), selected to 2 equal groups: group 1 — CRD patients, group 2 — with no renal dysfunction. For comparison, the parameters were evaluated that represent the specifics of CHF pathogenesis, structural and functional condition of the left heart chambers, of arteries and kidneys.Results. The presence of CRD was related to more serious diastolic dysfunction in CHD with CHF patients (p

In the article, approaches presented to antithrombotic therapy (AT) in patients with non-valvular atrial fibrillation (AF) and coronary heart disease (CHD), in acute coronary syndrome (ACS), as in stable forms, incl. those underwent percutaneous coronary intervention. Regimens selection and duration of AT depend on the type of CHD, bleeding risks, anatomy of implanted stents in coronary arteries. As AT, in recent guidelines, for patients with AF and CHD any oral anticoagulant is recommended: vitamin K antagonists, direct thrombin inhibitor dabigatran, selective Xa factor inhibitors rivaroxaban, apixaban. Largest evidence among the novel oral anticoagulants is available for dabigatran. Choice from double or triple AT regimens for CHD patients with AF is under discussion. Among antiplatelet drugs for combination with anticoagulant, clopidogrel is preferred, as safer comparing to aspirin. Possibility to use combination therapy with anticoagulants, of ticagrelor and prasugrel is restricted. It is also pointed on the necessity of proton pump inhibitors usage during double or triple AT for patients with non-valvular fibrillation and CHD.

The article provides an overview of the data on the influence of food, herbs, alcohol and smoking on the efficacy and safety of drug treatments. It is shown, that strictly implausible is to take drug treatments and fitomedicines at the same time, those influencing metabolism in opposite ways. Alcohol consumption, depending on duration and intensity, also influences the effectiveness of drugs. The compounds of tobacco smoke significantly decrease the effectiveness of many medications, activating cytochrome systems. While choosing the medications, it is important to prefer those drugs having minimum interactions with food as with drugs.

Aim. To assess the changes in blood pressure (BP) circadian profile and variability in patients with chronic heart failure (CHF) of ischemic etiology and arterial hypertension (HT) due to the complex therapy including ivabradine. Material and methods. Patients (n=90) with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM) was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively) as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively) and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016). More significant reduction in average daily and night systolic and diastolic BP (p=0.001), as well as daily and night BP variability (p=0.001) was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP) was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm.

The article focuses on the results of data review obtained from accessible local and international sources concerning drug interaction and selection of drugs taking these data into account. The data provided on statins, angiotensine II receptors antagonists, acetylsalicylic acid and renin-angiotensine-aldosterone system. The key result of the review is conclusion that physicians in their practical work must be aware of possible drug interaction and pay attention to this part of drug sheet or on electronic sources, the links provided in the article.

As does the clinical practice show, physician often deals with a problem of intolerability of oral anticoagulants, both vitamin K antagonists and new oral anticoagulants, either with a refuse taking these drugs at all. Hence there is an issue raises on the selection of antithrombotic therapy in atrial fibrillation (AF), and primarily, with ischemic heart disease, diabetes, stroke in anamnesis. There is a broad discussion in literature of the purpose for prescription of aspirin monotherapy to such patients with the aim of myocardial infarction and ischemic stroke prevention. In the article we present a case of female patient with nonvalvular AF having ischemic stroke and acute coronary syndrome at the background of serious comorbidities, the errors in the management are shown on the selection of antithrombotic therapy and directions provided for secondary prevention of thromboembolic complications, recurrent ischemic events according to International and Russian Guidelines.

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

Aim. To assess the therapeutic potential of ivabradine, as a part of complex treatment regime, for the correction of the target organ pathology in patients with chronic heart failure (CHF) of ischemic aetiology. Material and methods. In total, 90 patients with Functional Class II–III CHF and stable angina were examined. All participants were divided into three groups, by the type of 6-month antiischemic therapy: Group 1 received perindopril and ivabradine; Group 2 was administered perindopril, bisoprolol, and ivabradine; and Group 3 received perindopril and bisoprolol. At baseline and after 6 months of the treatment, the following renal and arterial parameters were assessed: glomerular filtration rate (GFR; MDRD formula); pulse wave velocity (PWV measured for elastic-type vessels on the right and left side: R-PVW and L-PVW); cardiac-ankle-vascular index (CAVI1); carotid-femoral PWV (PWVcf); aortic PWV (PWV) and carotid PWV (C-PWV); and radial and carotid augmentation index (R-AI and C-AI). In addition, blood levels of the following biomarkers were measured: N-terminal pro B-type natriuretic peptide (NT-proBNP); and key markers of renal and arterial extracellular collagen matrix: tissue inhibitor of matrix metalloproteinase 1 (TIMP-1) and C-terminal telopeptide of collagen 1 (CTP-1). Results. After 6 months of a complex ivabradine-including therapy, a significant positive dynamics was observed for the levels of GFR, TIMP-1 and CTP-1 (extracellural collagen matrix markers), and NT-proBNP (a myocardial stress marker). The improvement in arterial wall structure and function was manifested in both reduced stiffness (decreased CAVI1 and PWVcf) and increased elasticity and distensibility (decreased PWV and C-PWV). The improvement in arterial elasticity and distensibility was significantly greater in patients receiving the three-medication therapy. Conclusion. The findings on the ivabradine therapy, as a part of complex treatment regime in patients with ischemic CHF, demonstrated nephro- and vasoprotective effects of ivabradine.

Aim. In patients with chronic heart failure (CHF) of ischemic aetiology, to assess the dynamics of heart rate variability (HRV) and ventricular ectopic activity during the complex, ivabradine-including therapy. Material and methods. In total, 90 patients with CHF and stable angina pectoris were examined. All participants were randomised into three equally sized groups: Group 1, receiving perindopril and ivabradine, as a part of the complex treatment; Group 2, receiving perindopril, bisoprolol, and ivabradine; and Group 3, receiving perindopril and bisoprolol. The therapy duration was 6 months. At baseline and in the end of the treatment phase, the following parameters were assessed: HRV measures (mean 24-hour hear rate (HR), SDNN, triangular index (HRVti), and mean weighted variation of rhythmogram (MWVR)); mean 24-hour QT, QTc, QTc dispersion (QTcd), and ventricular extrasystolia (VE). Results. The treatment was associated with a significantly greater reduction of mean 24-hour HR in Groups 1 and 2 vs. Group 3 (p

Aim. To analyse the markers of sudden cardiac death (SCD) in patients with stable angina and arterial hypertension (AH), in regard to the progression of left ventricular hypertrophy (LVH). Material and methods. In total, 90 patients with Functional Class II–III stable angina, AH, and LVH were examined. The following parameters were assessed: left ventricular myocardial mass index (LVMMI), left ventricular ejection fraction (LVEF), heart rate variability (HRV) parameters (SDNN, HRVi, CBBP); mean 24-hour HR levels, QT and QTc intervals, QT dispersion (QTds), ectopic ventricular activity; mean 24-hour blood pressure (BP) levels; levels of serum markers of myocardial collagenolysis and N-terminal pro-brain natriuretic peptide (NT-proBNP). Results. In all participants, LVEF was preserved, without significant difference between the tertiles. The increase in LVMMI was linked to a significant increase in the total number of ventricular extrasystoles (VE) over 24 hours (p< 0,011) VE per patient; reduced HRV, based on the SDNN dynamics (p=0,004); increased mean 24-hour pulse BP (p=0,003); elevated levels of tissue inhibitors of matrix metalloproteinase-1 (p=0,017) and NT-proBNP; and decreased levels of procollagen type I C-terminal telopeptide (p=0,011). Conclusion. In patients with stable angina, AH, and preserved LVEF, the LVH progression is associated with an increased number of SCD markers: increased ventricular ectopic activity, reduced HRV, increased mean 24-hour BP, and elevated levels of NT-proBNP and serum markers of myocardial fibrosis, which confirms the increase in the risk of SCD in parallel to the increase in the LVMMI.

Achieving target levels of low-density lipoprotein cholesterol (LDL-CH) with lipid-lowering therapy is the main component of the complex cardiovascular risk reduction, according to the Russian and international clinical guidelines. High-density lipoprotein cholesterol and triglycerides are regarded as secondary targets for lipidlowering therapy. High-dose statin monotherapy and combined therapy could achieve target LDL-CH levels only in 30—50 %. The available evidence demonstrates that to achieve target LDL-CH levels more effectively, statin should be combined with other lipid-lowering drugs, or fixed-dose combined lipid-lowering therapy should be prescribed. In particular, the maximal LDL-CH reduction is achieved when statin is combined with ezetimibe, or when the fixed-dose combination (simvastatin 20 mg and ezetimibe 10 mg) is used. Specific aspects of combined lipid-lowering therapy in various clinical situations are discussed, in accordance with current clinical guidelines. To improve lipid-lowering therapy compliance, patients should be involved into assessing their cardiovascular risk and discussing potential ways of risk reduction.

Aim. To investigate the features of antihypertensive therapy (AHT), as a method of left ventricular hypertrophy (LVH) prevention, in patients with essential arterial hypertension (EAH), absence of target organ damage (TOD), and high treatment compliance. Material and methods. This prospective cohort study included 428 patients with EAH and no TOD (mean followup 8,8±2,6 years). Results. In patients with EAH, and high treatment compliance, LVH incidence was 36,9 %. AHT was more aggressive in patients with LV remodelling, and was characterised by higher rates of combined treatment or b-adrenoblocker treatment. Conclusion. In EAH patients with high treatment compliance, LVH incidence was lower than in general population. More aggressive AHT among patients with LVH could be explained by potential therapy resistance in this clinical group.