Aim. The goals of this research are to define the frequency of the coronary arteries visualization possibilities depending on various factors at routine echocardiography and estimate to the relation of coronary flow ultrasound parameters to prognosis of the adverse outcomes in the subsequent year.

Material and methods. The study comprises 581 consecutive patients. All patients performed echocardiography following standard method with an additional tab called «Coronary» which was set to visualize coronary arteries. Also all patients underwent a standard examination and debriefing of anamnesis. Observation of patients was the next year after echocardiography. The end points in the study – death from any cause, myocardial infarction (MI), death/ MI, myocardial revascularization operations - stenting and aortocoronary bypass (CABG). The analysis of clinical outcomes was carried out using the study of medical history and outpatient cards, interviewing patients at the time of admission, as well as the method of telephone survey of patients or their next of kin. ROC analysis as well as subgroup survival analysis using the Kaplan-Meier method was performed.

Results. The possibility to visualize the segments of coronary arteries and to estimate the coronary flow was in 91% of cases, or 526 patients. Women predominated among the patients (59.7% versus 40.3%). During follow-up, 73 patients recorded endpoints: 23 people died, 4 patients suffered non-fatal MI. 24 patients underwent CABG, 22 patients – myocardial revascularization. Depending on the quartile distribution by body mass index and age, a significant difference in visualization was not identified. Mortality was observed significantly more frequent when the flow velocity in the left coronary artery/proximal left artery descending/circumflex artery was higher than 64 cm/s. Flow velocity in left coronary artery /proximal left artery descending 64 cm/s was the cut-off value predicting MI with 100% sensitivity, 73,4% specificity (p<0.0001). Conclusion. Coronary flow velocity parameters provide long-term prognostic value that can be used to identify individuals with high risk of developing adverse cardiovascular events. Key words: coronary flow velocity, echocardiography, coronary artery, adverse events>˂0.0001).

Conclusion. Coronary flow velocity parameters provide long-term prognostic value that can be used to identify individuals with high risk of developing adverse cardiovascular events. 

Aim. To compare different scores in assessment of risk of left atrial or its appendage thrombosis (LAAT) in patients with non-valvular atrial fibrillation (AF) or atrial flutter (AFL) undergoing transesophageal echocardiography before catheter ablation (CA) or cardioversion (CV).

Material and methods. In retrospective, single-center, case-control study medical records of 1994 patients with non-valvular AF or AF from the period 2014-2019, who underwent transesophageal echocardiography before CA or elective CV, were analyzed. LAAT was detected in 33 of them. For the control group, 167 patients without LAAT were randomly selected from this database. CHADS₂, CHA₂DS₂-VASc, R₂CHADS₂, R-CHA₂DS₂-VASc, R₂CHA₂DS₂-VASc, CHA₂DS₂-VASc-RAF, mCHA₂DS₂-VASc, CHA₂DS₂-VASc-AFR, ATRIA scores were evaluated and compared as potential predictors of LAAT.

Results. Mean age of studied patients (n=200) was 60.3±10.9, 55% of them were males. Most of patients had non-valvular AF (87,5%) and were assessed before CA (84,0%). All risk scores were associated with LAAT and CHA₂DS₂-VASc-RAF score was most informative [AUC 0.84; 95% confidence interval (CI) 0.76-0.91]. According to multivariate analysis in a logistic regression model among studied risk scores CHA2DS2-VASc-RAF score was the single independent predictor of LAAT [odds ratio (OR) 1.37; 95% CI 1.21-1.55; p=0.004). OR of LAAT among patients with CHA₂DS₂-VASc-RAF >3 was 12.8 (95% CI 3.75-43.9; p<0.0001) with sensitivity, specificity, positive and negative predicting values 90.6%, 57.1%, 30.2% and 96.7% respectively Conclusion. In the studied group of patients with non-valvular AF or AFL, without severe structural heart disease and severe concomitant diseases CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were associated with LAAT. CHA2DS2-VASc-RAF score was the most informative. >˂0.0001) with sensitivity, specificity, positive and negative predicting values 90.6%, 57.1%, 30.2% and 96.7% respectively.

Conclusion. In the studied group of patients with non-valvular AF or AFL, without severe structural heart disease and severe concomitant diseases CHADS₂, CHA₂DS₂-VASc, R₂CHADS₂, R-CHA₂DS₂-VASc, R₂CHA₂DS₂-VASc, CHA₂DS₂-VASc-RAF, mCHA₂DS₂-VASc, CHA₂DS₂-VASc-AFR, ATRIA scores were associated with LAAT. CHA₂DS₂-VASc-RAF score was the most informative.

Aim. Evaluation of the safety, clinical and hemodynamic effects of empagliflozin in patients with acute decompensated heart failure (ADHF) from the first day of hospitalization in the absence of signs of hemodynamic instability.

Material and methods. A prospective, comparative, randomized study included 46 patients admitted to the hospital in connection with ADHF in the absence of signs of hemodynamic instability. Inclusion in the study and randomization to receive empagliflozin was carried out in the first 24 hours from the moment of admission to the hospital. The main group (n=23) from the first day of hospitalization and the entire subsequent follow-up period took empagliflozin at a daily dose of 10 and 25 mg (for patients with type 2 diabetes mellitus) in addition to basic therapy, the control group (n=23) received standard therapy without gliflozines. The observation period was 3 months and included 3 control points: 1st day of hospitalization, 7th-12th day, 3rd month of observation. Clinical, anamnestic and instrumental data were evaluated at all control points.

Results. In the hospital period, by the 7th-12th day, only in the main group there was an improvement in all clinical indicators (p<0.01), an increase in the rate of diuresis (p><0.01), a decrease in the daily dose of the parenteral diuretic furosemide from 54 mg to 26 mg (p><0.01). A decrease in systolic blood pressure (SBP) occurred in both groups (p><0.01), but it was more pronounced in the comparison group [from 141 (110; 160) to 110 (90; 120) mm Hg) compared to the main group [from 140 (120; 160) to 120 (110; 130) mm Hg]. According to echocardiography data in the main group, there was a decrease in the indexed volume of the right atrium, the end-systolic volume of the left ventricle (LV ESV) and systolic pressure in the pulmonary artery, an increase in the LV ejection fraction (LV EF) (p><0.05). In the comparison group, only an increase in LV ESV was noted (p=0.04). The index of the indexed volume of the left atrium did not show significant dynamics in the main group (p=0.79), but showed a significant decrease>˂0.01), a decrease in the daily dose of the parenteral diuretic furosemide from 54 mg to 26 mg (p<0.01). A decrease in systolic blood pressure (SBP) occurred in both groups (p>˂0.01), but it was more pronounced in the comparison group [from 141 (110; 160) to 110 (90; 120) mm Hg) compared to the main group [from 140 (120; 160) to 120 (110; 130) mm Hg]. According to echocardiography data in the main group, there was a decrease in the indexed volume of the right atrium, the end-systolic volume of the left ventricle (LV ESV) and systolic pressure in the pulmonary artery, an increase in the LV ejection fraction (LV EF) (p˂0.05). In the comparison group, only an increase in LV ESV was noted (p=0.04). The index of the indexed volume of the left atrium did not show significant dynamics in the main group (p=0.79), but showed a significant decrease in the 2nd and 3rd control points compared to the control group (p=0.01 and p=0.02). Complications, against the background of taking empagliflozin, were not noted: there were no episodes of hypotension (SBP˂90 mm Hg), hypoglycemia, acute kidney injury.

Conclusion. The results obtained indicate the safety of empagliflozin in patients with ADHF, regardless of the status of carbohydrate metabolism and LV EF, as well as taking into account the clinical (more intense positive dynamics of clinical symptoms of ADHF) and hemodynamic (smooth decrease in SBP, increased diuretic effect) effects of empagliflozin, this drug should be considered as an effective and safe supplement to the main therapy from the first day of hospitalization in patients with stable hemodynamic parameters. 

Aim. To study the association of the level of endothelial dysfunction marker sVCAM-1 with the severe course of COVID-19.

Material and methods. The study included 100 patients with COVID-19, who were divided into 3 groups depending on the degree of lung damage based on the results of computed tomography (CT): group CT 1 – 29 patients, group CT 2 – 61 patients and the group CT 3 – 10 patients. In addition to the standard examination performed for coronavirus infection, all patients underwent carotid Doppler ultrasound, analysis of arterial stiffness indices (CAVI, ABI) using the VaSera device, and evaluation of the plasma sVCAM-1 concentration by ELISA.

Results. The plasma sVCAM-1 concentration was significantly higher in the groups of patients with moderately severe (CT 2) and severe (CT 3) lung lesions than in patients with mild lesions (CT 1). In the general group of patients significant correlations were found between the plasma sVCAM-1 concentration and the level of oxygen saturation (r=-0.39, p=0.032), hospital length of stay (r=0.24, p=0.026), values of C-reactive protein (r=0.25, p=0.042), ferritin (r=0.38, p=0.021), LDH (r=0.52, p=0.015) , as well as the percentage of pulmonary involvement according to CT data at admission (r=0.41, p=0.019) and on the day of discharge (r=0.35, p=0.022). According to multivariate regression analysis, sVCAM-1 does not depend upon gender, age, body mass index (BMI), the presence of type 2 diabetes mellitus (T2DM) and hypertension, and is a marker associated with cytokine storm progression, intermediate negative dynamics according to CT data, and need for respiratory support. The presence of type 2 diabetes, as well as elevated sVCAM-1 concentrations, is associated with an increased risk of high-dose glucocorticosteroid therapy. The threshold levels of this marker were calculated for each of the above events. We revealed a correlation between the sVCAM-1 concentration and the carotid intimal medial thickness in the general group of patients (r=0.25, p=0.036).

Conclusion. An increase in the plasma sVCAM-1 concentration reflects the progression of endothelial dysfunction, one of the key factors in the pathogenesis of COVID-19. The latter necessitates the need for endothelium protective therapy for these patients. The evaluation of sVCAM-1 in blood plasma is a promising diagnostic technique aimed at predicting the risk of a severe course of COVID-19 and its long-term health hazards. 

Aim. To study the frequency of prescriptions of various types of lipid-lowering therapy and their effectiveness in outpatient clinical practice based on the results of a questionnaire of primary care physicians.

Material and methods. The study was performed in 2022 in 75 constituent entities of the Russian Federation with the participation of 1117 doctors working in outpatient clinics. Most of the doctors had work experience of 10-20 years or more. Doctors of polyclinics (therapists and cardiologists, etc.) before the start of the study received instructions, questionnaires for filling out, developed by the National Atherosclerosis Society. The frequency of prescriptions by primary care physicians of various types of lipid-lowering therapy and their effectiveness in terms of the frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) was studied based on the results of a questionnaire.

Results. Monotherapy with statins was prescribed in 55.2% of cases, free combination of rosuvastatin with ezetimibe – in 17.2%, single pill combination of rosuvastatin with ezetimibe – in 23.2%, combination therapy with PCSK9 inhibitors – in 4.1% of cases. Target levels of LDL-C ˂ 1.8 mmol/l and ˂ 1.4 mmol/l were achieved with statin monotherapy in 42.6% and 28.2% of cases, respectively, free combination of rosuvastatin with ezetimibe – in 61.7% and 39 .5%, a fixed combination of rosuvastatin with ezetimibe – in 67.8% and 48.5%, combination therapy with PCSK9 inhibitors – in 96.8% and 92.8% of cases.

Conclusion. The single pill combination of rosuvastatin with ezetimibe is more effective in achieving target levels of LDL-C compared with statin monotherapy and therapy with free combination of statin with ezetimibe. Despite the fact that the target values of LDL-C when prescribing a combination with PCSK9 inhibitors were achieved in 96.8% and 92.8% of cases, they were used quite rarely at the outpatient stage of treatment in the Russian Federation.

Aim. To study the efficacy of class IC arrhythmic drugs (AAD) and catheter ablation (CA) for paroxysmal form of atrial fibrillation (AF) in patients with without structural heart disease.

Material and methods. The study included 122 patients (44 men, 78 women, mean age 63 [55;68] years) with symptomatic AF paroxysms. Patients was divided into the lappaconitine hydrobromide group (LH group; n=26), the propafenone group (P group; n=25) – 25 patients, the diethylaminopropionylethoxycarbonylaminophenothiazine hydrochloride (DH group; n=23), the CA groups: radiofrequency ablation (RFA group; n=24) and cryoballoon ablation (CRYO group; n=24) groups each included 24 patients. The primary endpoint was the AF recurrence within 6 and 12 months from the onset of antiarrhythmic drug therapyand in RFA and CRYO groups – within 6 and 12 months after the end of the blinding period. Additionally, in AAD groups a composite endpoint was assessed: the frequency of recurrence of AF within 6 months and the frequency of side effects requiring drug withdrawal.

Results. Within the 6 months AF recurrence was observed in 13 (50%) patients of the LH group, 11 (44%) patients of the P group, and 13 (56.5%) patients of the DH group (p=0.687). Side effects requiring drug withdrawal were observed in the LH group in 2 patients (7.7%), in the P group in 3 patients (12%) and in the DH group in 3 patients (13%) (p=0.801). The difference in frequency of reaching the composite endpoint was not significant (p = 0.581) and the incidence was 57.7%, 56%, 69.5%, respectively in groups LH, P and DH. The efficacy of CA was higher than class IC AADs: 77% vs 39% (that including the withdrawals of AADs due to side effects) (p˂0.001). At the same time, there was no significant difference in the effectiveness of RFA and CRYO: AF recurrences within 6 months after the end of the blinding period were registered in the RFA group in 29% of cases, in the CRYO group – in 16.7% of cases (p=0.247). The overall effectiveness of CA after 12 months was 69%, which was significantly higher than the effectiveness of AADs that was 38% (p˂0.001).

Conclusion. Starting the AAD therapy with IC class in patients with paroxysmal AF in the absence of structural pathology, despite acceptable safety, one should take into account that, regardless of the initially prescribed drug, less than half of patients can achieve prevention of AF recurrence within 1 year. CA for AF can be considered as a first line therapy or can be recommended if one of IC class AADs is ineffective. 

Aim. To study the efficacy and safety of antithrombotic therapy in patients with paroxysmal atrial fibrillation (AF) after catheter treatment during 36 months of follow-up.

Material and methods. The retrospective observational study included 592 patients (283 men) who underwent catheter treatment of AF, aged 26 to 86 years (median age was 61.0 [55; 67]) with paroxysmal AF, treated in cardiac arrhythmias department of the Institute of Cardiology of Tomsk National Research Medical Center from 01.01.2017 to 31.12.2019. All patients were retrospectively divided into 2 groups: the first group consisted of patients with effective AF ablation, the second - with ineffective AF ablation. During follow-up after 12, 24 and 36 months, patients' complaints, documented arrhythmia recurrences, adherence to the prescribed treatment, and adverse clinical events were taken into account.

Results. In patients with paroxysmal AF, the effectiveness of catheter treatment was 73.1% after 12 months of follow-up, 69.3% – after 24 months, 71.6% – after 36 months. The analysis of our data showed that during the follow-up period of 36 months, the incidence of ischemic stroke against the background of anticoagulant therapy and effective catheter treatment of paroxysmal AF was significantly lower than in patients with unsuccessful ablation (0.3% (n=1) and 3.7% (n=4), respectively), even despite the fact that not all patients from the first group received prescribed medication.

Conclusion. The use of anticoagulant therapy in patients with paroxysmal AF after interventional treatment is safe, since the invasive strategy in combination with anticoagulant therapy does not increase the risk of major and minor bleeding, and in the case of effective intervention allows statistically significantly reduce the risk of ischemic stroke and almost completely eliminate the likelihood of other thromboemolic complications. 

Aim. To assess the quality of life of patients with stable coronary heart disease (CHD) initially and 12 months after drug and non-drug secondary prophylaxis according to clinical guidelines.

Material and methods. 73 patients (57 men, 16 women) with confirmed stable coronary artery disease were included in the study, of which 44 patients described a clinic for angina pectoris of functional class I-IV. The study included 2 patient visits: an initial treatment visit (V0) and a repeat visit after 12 months (V2). At both visits, blood pressure (BP), low-density lipoprotein cholesterol (LDL-c), quality of life (QL) were assessed using SAQ (Seattle Angina Questionnaire), drug therapy. Compliance with 5 basic principles of prevention was also assessed, which included: (1) healthy lifestyle (healthy lifestyle) (rejection of bad habits (smoking), moderate physical activity, lowcholesterol and low-carb diet); (2) normalization of body weight; (3) optimal drug therapy (the frequency of taking medications was evaluated using the original questionnaire); (4) achievement of target values of LDL-c in the entire group; (5) blood pressure in hypertensive patients. During V0, if necessary, drug therapy was adjusted in accordance with clinical recommendations. During V2, 57 patients (47 men and 10 women) were examined. The response was 80.8%.

Results. After 12 months of follow-up, a statistically significant improvement in exercise tolerance (p=0.003), angina stability index (p=0.045) and the frequency of stress angina attacks (p=0.003) was noted when assessing the median of QL indicators. After 12 months of follow-up, 59% of patients used optimal drug therapy, including 4 drugs according to clinical guidelines. A healthy lifestyle (regular physical activity and smoking cessation) was achieved in 20.4% after 12 months of follow-up, the target level of LDL-c ˂ 1.8 mmol/L was achieved in 44.5% of patients, and the target blood pressure was achieved in 74,6%. The achievement of all 5 principles of secondary prevention of coronary heart disease according to the results of the work carried out by the visit after 12 months of follow-up was revealed only in 7% of patients (4 patients), and the implementation of 4 principles of prevention was noted in a quarter of patients from the group (24.5%, n=14).

Conclusions. With drug and non-drug secondary prevention of coronary heart disease in patients with stable CHD after a year of follow-up, a statistically significant increase in QL indicators was noted due to increased exercise tolerance and a decrease in the frequency of angina attacks. Nevertheless, the basic principles of prevention were fully implemented only in 7% of patients. 

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

A 64-year-old female with a family history of hereditary hemorrhagic telangiectasia (HHT) was hospitalized due to complaints of dyspnea during light physical exertion and leg edema. HHT was diagnosed at 20 y.o., recurrent nasal bleeding started at age 52, bleedings severity was aggravated by not completely compensated hypertension. At the age of 60, after a massive hemorrhage, she noted the onset of dyspnea, edema, ascites. Diuretics and iron preparations improved her well-being, but from that period onward her heart failure worsened after each massive blood loss. The last major bleeding was before the present hospitalization (Hgb 67 g/l), after which heart failure symptoms significantly deteriorated. Echocardiography showed preserved left ventricular ejection fraction, but revealed high pulmonary hypertension (systolic pulmonary artery pressure 69 mmHg). Chest computed tomography (CT) with contrast showed no evidence of pulmonary embolism, but interstitial lung lesions were detected. Pulse therapy with glucocorticosteroids did not result in positive dynamics at the control CT scan, which allowed to reject a separate interstitial lung disease. As a result of cardiotropic and diuretic therapy, as well as correction of anemia, the patient's condition improved. Macitentan was administered, but the patient refused from it because one of possible side effects was anemia. A year later the patient diedfrom acute progression of pulmonary hypertension. According to the literature, pulmonary hypertension in HHT can have a significant impact on the prognosis and requires timely diagnosis and treatment. Interstitial lung lesions are a manifestation of the underlying disease and does not require special treatment.

In a significant number of patients with symptoms of angina pectoris or myocardial infarction with ischemic changes in the myocardium, according to the results of instrumental research methods, there is no hemodynamically significant stenosis of the coronary arteries. In these cases, vasospastic angina or microvascular dysfunction is considered the cause of coronary heart disease. Coronary microvascular dysfunction is caused by several pathological mechanisms that cause structural and functional disorders in the microvascular bed of the heart. Clinical groups of coronary microvascular dysfunction include angina pectoris and myocardial ischemia without obstructive coronary artery disease (primary coronary microvascular dysfunction), in combination with coronary atherosclerosis, with myocardial damage and iatrogenic nature. Diagnostics of microvascular disorders is carried out on the basis of the results of non-invasive and invasive methods, which make it possible to clarify the nature of the changes and choose an effective nondrug and drug treatment. The prognosis for coronary microvascular dysfunction is poor, due to the development of cardiovascular complications and death, a high risk of disability, and a decrease in the quality of life of patients. 

Atrial fibrillation (AF) is associated with dramatic increasing of stroke risk. Development of this serious complication is accompanied by high mortality and disability. Nowadays we know many different scores that predict stroke risk,butthe most popular is CHA₂DS₂-VASc risk score. At the same time, this score does not have high predictive accuracyand that is why a lot of modifications with inclusion/deletion of different indicators were introduced.

The aim of this review was to estimate the different modifications of CHADS₂ и CHA₂DS₂-VASc scores in predicting stroke risk in patients with AF. In this review R₂CHADS₂, CHA₂DS₂-VASc-R, CHA₂DS₂-VA, mCHA₂DS₂-VASc and CHA₂DS₂-VAK scores are evaluated with the use of C-statistics and net reclassification index compared to the original CHA₂DS₂-VASc score. The search of studies was performed according to PubMed database (https://pubmed.ncbi.nlm.nih.gov/) from 2011 until 2021 years. In this review were included studies written in English with free full text. Literature reviews, books, abstracts books, studies performed on less than 900 patients and studies without C-statistics data available were excluded from this review. Despite of the numerous attempts to improve the quality of CHA₂DS₂-VASc score, existing modifications nowadays could not become more popular in clinical practice. At the same time, developing of the new score systems, that will have better predictive values in stroke prognosis than CHA2DS2-VASc score, is still an actual problem in modern cardiology. 

Cardiovascular and oncological diseases are the leading causes of adult death in the world. Despite proven efficacy, anticancer drugs can cause severe cardiovascular complications. Recently, data have appeared on the possible vasotoxic effects of chemotherapy drugs, which can manifest themselves as the progression of arterial hypertension and atherosclerosis, the development of myocardial ischemia and acute coronary syndrome, the formation of venous and arterial thrombosis. The key mechanism for the development of vasotoxicity is endothelial dysfunction, and anticancer drugs can also affect the processes of thrombosis. The review presents the results of 12 selected observational retro- and prospective studies involving cancer patients receiving presumably vasotoxic therapy. Data on the frequency of occurrence and possibilities for the prevention of vasotoxicity are presented. 

To date, hypolipidemic drugs of the statin group are among the most popular therapeutic agents used for the prevention and treatment of the most common worldwide atherosclerotic cardiovascular diseases (CVD). Therefore, considerable attention of researchers is focused on statins to study the additional effects of these drugs, which is accompanied by the discovery of new mechanisms of action and properties that should be taken into account to optimize the tactics of managing patients with CVD. In addition to the key lipid-lowering effect of statins associated with the inhibition of the ratelimiting enzyme (3-hydroxy-3-methylglutaryl-coenzyme A reductase), researchers report a variety of other properties of these drugs. Important circumstances contributing to the disclosure of new effects of statins are: improvement of research methods, and first of all, their sensitivity and specificity; the discovery of new molecules and molecular pathways that may be affected by statins. In general, the currently established numerous non-lipid effects of statin drugs can be divided into two groups: favorable and side effects, which must be taken into account when managing patients with CVD and comorbid diseases. Thanks to recent studies using modern clinical diagnostic cardiomarkers (highly sensitive cardiac troponins (CT)), molecular genetic and morphological methods, potential cardiotoxic properties of statin group drugs have been identified. Of particular concern are the data on a statininduced increase in the concentration of highly sensitive CT, which are a key and generally recognized criterion for myocardial damage. In this article we discuss possible mechanisms of increasing the concentration of CT and cardiotoxic effects when using statins.