Aim    To compare the long-term effectiveness of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in patients with atrial fibrillation (AF).
Material and methods    This retrospective single-site study included 597 patients with AF who had undergone CBA (n=241) or RFA (n=356) between 2016 and 2024. The study participants included 355 men (59.5%) and 242 women (40.5%) aged 58.4±10.8 years. The follow-up period was 13.0 [10.0; 27.5] months. The primary endpoint was late recurrence of AF (≥90 days after catheter ablation (CA)) confirmed by electrocardiography (ECG) or ECG Holter monitoring. To minimize confounding, the groups were compared by the propensity score matching (PSM, 234 pairs). The absence of AF recurrence was analyzed using Kaplan-Meier survival curves and group comparison with the log-rank test. Predictors for an increased risk of AF recurrence were identified by the univariate and multivariate Cox regression analysis. 
Results    With the use of PSM, late AF recurrence was found in 41 (17.5%) patients after CBA and in 85 (36.3%) after RFA (p<0.001). Thus, at 48 months after CA, AF recurrence was absent in 70% of patients in the CBA group and 53% patients in the RFA group; the difference between the groups was statistically significant (log-rank p=0.005). In the multivariate Cox analysis, independent predictors of AF recurrence were body mass index (BMI) (odds ratio (OR) 1.11; 95% confidence interval (CI) 1.05-1.18; p<0.001) and early AF recurrence within 90 days (OR 4.43; 95% CI 2.72-7.21; p<0.001). 
Conclusion    According to the study univariate analysis, CBA showed an advantage over RFA in terms of the efficacy in the long-term period. Body mass index and early AF recurrence were independent predictors of late AF recurrence after CA. 

Aim    Search for subclinical manifestations of cardiotoxicity in cancer patients at high and very high risk of cardiotoxicity and evaluation of the effectiveness of drug primary prevention during the antitumor treatment. 
Material and methods    The study included 150 cancer patients with a high and very high Mayo Clinic (USA) Cardiotoxicity Risk Score. The main group consisted of 84 patients at high and very high risk of cardiotoxicity who were prescribed cardioprotective therapy, including a fixed combination of the angiotensin-converting enzyme inhibitor (ACEI) perindopril and the beta-blocker bisoprolol with trimetazidine. The comparison group consisted of 66 patients who refused cardioprotective drugs or had intolerance to them. All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM) and multibiomarker analysis, including measurements of troponin I (TnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), soluble tumor suppressor type 2 (sST2), and two-dimensional echocardiography (EchoCG) with assessment of left ventricular global longitudinal systolic strain (LV GLS) before chemotherapy and 1, 3, 6, 9, and 12 months after the start of cardiotoxic antitumor therapy. 
Results    In patients of the comparison group already at 6 months, the left atrial volume index (LAVI) was significantly increased, and the left ventricular end-diastolic volume index (LVEDVi) showed a tendency towards an increase reaching a significant difference by 9 months of observation. In the main group, these parameters did not significantly change during the study. At the last stage of observation, there were statistically significant differences in LAVI and LVEDVi between the compared groups. The dynamics of LV GLS in the compared groups showed multidirectional changes. In the main group, this parameter remained virtually unchanged while in the comparison group, it decreased by ≥15% in 13 patients and reached a statistically significant difference. Clinically pronounced cardiotoxicity and a decrease in the left ventricular ejection fraction (LVEF) developed in 7 of these patients. During the antitumor treatment, the concentrations of the biomarkers remained within the reference values, with the exception of TnI. The greatest differences between the groups were noted in the analysis of mortality. Thus, by the final visit, 13.1% of patients had died in the main group while in the comparison group, mortality was almost two times higher and reached 22.7%. 
Conclusion    The study demonstrated clinical effectiveness of the cardioprotective therapy in cancer patients at high and very high risk of cardiotoxicity. The patients who did not receive the primary drug prevention of cardiovascular toxicity had a statistically significant impairment of the LV systolic function, an increased number of developed complications, and a higher mortality. 

Aim    To analyze the efficacy and cost-effectiveness of various options of antithrombotic therapy in patients with type 2 diabetes mellitus (T2DM) after acute coronary syndrome (ACS), based on the results of a one-year follow-up.
Material and methods    The article presents features of various antithrombotic therapies in patients with T2DM after ACS from the standpoint of efficacy and cost-effectiveness in real clinical practice based on the materials of the ORACLE II open prospective observational study (2014-2017). The data of 368 patients were divided into three groups based on the selected antithrombotic therapy. Due to the identified significant differences in the clinical characteristics among these groups, the propensity score matching was used to reach a balance between the groups by key differing indicators: gender, age, hemoglobin concentration upon admission, and the frequency of percutaneous coronary intervention during the index hospitalization. 
Results    Based on adjusted data, it was noted that the patients taking ticagrelor had fewer adverse cardiovascular outcomes during the observation period after the index event: 9 (17.6%) vs. 21 (41.2%) and 14 (27.5%) in patients taking clopidogrel or during de-escalation of the antithrombotic therapy, respectively (p=0.031). The pharmacoeconomic analysis assessed the cost-effectiveness of each type of antithrombotic therapy. The costs of drugs during the follow-up period were higher in patients taking ticagrelor: 2,723,703.45 vs. 445,880.76 in those taking clopidogrel. Nevertheless, in the conditions of real clinical practice in the Russian Federation, an economic advantage of the ticagrelor treatment during long-term follow-up was a subsequent decrease in the number of hospitalizations and, consequently, a reduction in direct medical costs of the care covered by the compulsory medical insurance. The total costs of subsequent hospitalizations due to adverse cardiovascular events for one year of follow-up were 755,773.47 for patients taking ticagrelor and 2,209,545.53 for those taking clopidogrel. Thus, the total costs per person for one year of follow-up after the index event were 14,819.09 in the ticagrelor group and 43,324.42 in the clopidogrel group. 
Conclusion    In the conditions of real clinical practice in the Russian Federation, ticagrelor is currently a more effective antiplatelet drug than clopidogrel both in terms of preventing further adverse cardiovascular events and economic feasibility in patients with acute coronary syndrome and type 2 diabetes mellitus. 

Aim        To identify non-pharmacological factors associated with ineffective blood pressure (BP) control among individuals with arterial hypertension (AH) in a Siberian urban population sample.

Material and methods          A considerable proportion of individuals with AH does not achieve BP goals. BP control is influenced by a number of non-drug determinants, including non-modifiable and multiple modifiable factors. In a population sample (men/women, 55-84 years old, n=3,898, 2015-2018, HAPIEE project, Novosibirsk), a category of individuals with AH receiving antihypertensive therapy (AHT) (n=2,449) was selected and two groups with adequate and inadequate BP control (ABPC and IABPC, respectively) were identified. We evaluated associations of IABPC and a series of potentially related factors, including gender, age, AH duration, type 2 diabetes mellitus, cardiovascular diseases (CVD), anthropometric and biochemical parameters, behavioral (smoking, alcohol consumption, physical activity (PA)) and socioeconomic factors (education, marital status, economic activity, material deprivation).

Results    In a sample of 55-84-year-old individuals with AH taking AHT, ABPC was 30.7%. In the multivariate logistic model, IABPC was directly associated with male gender (odds ratio (OR) 1.72; 95% confidence interval (CI) 1.28-2.31), AH duration longer than 10 years (OR 2.55; 95% CI 2.07-3.14), alcohol consumption 1-3 times a month (OR 1.36; 95% CI 1.02-1.81) and 1-4 times a week (OR 1.91; 95% CI 1.26-2.89) and was inversely associated with moderate PA (OR 0.78; 95% CI 0.62-0.98). In men, IABPC was additionally inversely associated with history of CVD (OR 0.62; 95% CI 0.42-0.92). In women, IABPC was additionally associated with economically inactive status (OR 1.39; 95% CI 1.03-1.86) and inversely associated with smoking (OR 0.51; 95% CI 0.29-0.87).

Conclusion            In a Siberian population sample of 55-84-year-olds, one third of individuals with AH receiving AHT adequately controlled their BP. Inadequate BP control was directly associated with male gender, long history of AH, frequent alcohol consumption, and economically inactive status (in women), and was inversely associated with moderate PA, CVD (in men), and smoking (in women). Attention to non-pharmacological determinants may help optimize BP control.

Aim     To determine the prevalence and predictors for the development of newly diagnosed chronic heart failure (CHF) in patients with shortness of breath in long-term post-COVID syndrome.

Material and methods            This screening cross-sectional clinical study was performed from April 2020 through April 2024, in two stages in an outpatient setting. At the first stage, 878 patients with shortness of breath were screened three or more months after COVID-19, and the presence of at least three diagnostic criteria for CHF, that were not in their history, was verified. At the second stage, a group of 192 patients with two or more diagnostic criteria for CHF who met the inclusion criteria and had no exclusion criteria was selected. The patients selected for the second stage were divided into two groups based on the blood concentration of the N-terminal pro-brain natriuretic peptide (NT-proBNP): the first group included 108 patients with a NT-proBNP value of ≤125 pg/ml, and the second group of 84 patients with a NT-proBNP value of >125 pg/ml.

Results Newly diagnosed CHF was found in 84 (9.57%) patients with dyspnea, who sought medical care for long-term post-COVID syndrome with three or more diagnostic criteria (symptoms/signs, structural and functional changes in the heart according to echocardiography, increased NT-proBNP concentration), mainly with preserved left ventricular ejection fraction (LVEF) (97.9%). With an increase in the left ventricular myocardial mass index (LVMI) >110 g/m², the odds ratio (OR) of developing newly diagnosed CHF increased by 2.201 times and the relative risk (RR) increased by 1.801 times; with the development of pneumonia associated with COVID-19, the OR increased by 45.5% and the RR by 70.8%; with the development of pneumonia requiring hospitalization in patients with COVID-19, the OR increased by 34.7% and RR by 54.7%; with an increase in the erythrocyte sedimentation rate >11 mm/h, the OR increased by 41.7% and the RR by 74.1%; with a decrease in the blood concentration of potassium <4.43 mmol/l, the OR increased by 4.529 times and the RR by 3.189 times; with an increase in ferritin >178 μg/ml in combination with an iron transferrin saturation ratio <20%, the OR increased by 38.8% and the RR by 45.1%; with an increase in the blood concentration of caspase-6 to >28.2 pg/ml, the OR increased by 28.8% and the RR by 35.4%.

Conclusion      Among 878 outpatients who sought treatment at the polyclinic for shortness of breath in long-term post-COVID syndrome, the prevalence of newly diagnosed CHF verified by three or more diagnostic criteria was 9.57%, mainly with preserved LVEF. The development of CHF in these patients was related with more severe forms of previous COVID-19 complicated by pneumonia and requiring hospitalization, an increase in LVMI to >110 g/m², activation of low-grade nonspecific inflammation, metabolic disorders due to a decrease in potassium even within the normal range, latent iron deficiency, and an increase in the PANoptosis processes.

Aim        To compare the results of primary percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients who recently recovered from COVID-19 with those not previously infected with SARS-CoV-2; to establish prognostic criteria for PCI complications, including stent thrombosis and restenosis (ST and SR) and progression of ischemic heart disease, and to determine ways to prevent them.

Material and methods         In 2021, middle-aged patients admitted to the Baku Central Clinical Hospital with a diagnosis of acute coronary syndrome who underwent urgent myocardial revascularization using percutaneous balloon angioplasty of the occluded coronary artery (CA) with implantation of a second-generation intracoronary drug-eluting stent were divided into two observation groups: the main group of 123 patients who had COVID-19 in the previous 6 months, and the control group of 112 patients who were not previously infected with SARS-CoV-2. The immediate results of PCI were assessed according to the TIMI scale; complications were assessed both clinically, by the incidence of severe complications (major adverse cardiovascular events, MACE), and angiographically, by the incidence of early and late ST and SR, and de novo stenosis that developed during the two-year observation period. The results of PCI were compared with the concentration of inflammatory biomarkers (high-sensitivity C-reactive protein, hs-CRP) and thrombosis (D-dimer) in order to assess their possible prognostic potential for negative outcomes of PCI after COVID-19.

Results    After COVID-19, the incidence of ST and SR, repeat myocardial revascularization, MACE, and de novo stenosis over the two-year follow-up period was higher than in patients with NSTE-ACS previously not infected with SARS-CoV-2. The D-dimer and hs-CRP levels showed a prognostic potential for negative outcomes of coronary stenting after COVID-19. Thus, early STs were associated with hypercoagulation (D-dimer ≥1500 ng/ml) in both groups, while in patients who had recently recovered from COVID-19, they were associated with the absence of a decrease in D-dimer by >50% in the 1st month of standard antithrombotic therapy, the “slow reflow” phenomenon, and “mild” hypercoagulation in combination with low-grade systemic inflammation (CRP 5-9 mg/l). Early SR were associated with mid-grade systemic inflammation (CRP ≥10 mg/l) or a two-fold “jump” in CRP concentration in the first two weeks after PCI while late SRs were associated with long-term (more than 6 months) low-grade systemic inflammation with a median hs-CRP level of 6.6 mg/l. In patients with comorbid obesity and carbohydrate metabolism disorders in the presence of low-grade systemic inflammation after COVID-19, the 6-month risk of developing complications after PCI increased by 66.4% compared to those who were not infected with SARS-CoV-2 (73.4 and 44.1%, respectively; odds ratio (OR) 1.66; 95% confidence interval (CI) 1.45-1.90; p=0.041). In this category of patients, standard pharmacotherapy was not effective enough to prevent the development of such severe cardiovascular complications as myocardial infarction, stroke, and the need for repeated revascularization, the risk of which was 2.1, 2.3 and 2.0 times, respectively, higher in the main group than in the control group.

Conclusion            COVID-19 can worsen the results of PCI in patients with NSTE-ACS. The identified prognostic predictors of ST and SR allow identification of a category of individuals at high risk of complications after PCI and warrant revising the therapeutic strategy for their prevention.

Objective This research investigated the application of real-time, three-dimensional speckle tracking imaging (RT-3D-STI) to evaluate left atrial (LA) function in individuals suffering from hypertensive heart disease (HHD) and heart failure with preserved ejection fraction (HFpEF).

Material and methods This retrospective study included 100 patients with HHD and HFpEF hospitalized from August 2023
to June 2024 (HFpEF group). 100 healthy individuals undergoing physical examinations comprised the control group. Patient data were collected, and echocardiography was performed to measure LA diameter (LAD), left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular outflow tract diameter (LVOTd), early diastolic maximum velocity of mitral valve inflow (MVE), late diastolic maximum velocity of mitral valve inflow (MVA), early diastolic and late diastolic velocities of mitral annulus measured by tissue Doppler ultrasound (e’ and a’), tricuspid annular plane systolic excursion (TAPSE), and left ventricular ejection fraction (LVEF). The LA images were analyzed using GE software, and the following parameters were measured: L emptying fraction (LAEF), LA emptying volume (LAEV), LA
volume at the onset of contraction (LAVpreA), minimum LA volume (LAVmin), maximum LA volume (LAVmax), LA strain during the reservoir phase (LASr), LA strain during the contraction phase (LASct), and LA strain during the conduit phase (LAScd). ROC curves were adopted to evaluate the diagnostic value of LA parameters for HFpEF, and a Pearson correlation analysis examined the relationship between these parameters and N-terminal pro-B-type natriuretic peptide (NT-proBNP).

Results Compared with the control group, the blood pressure in the HFpEF group was significantly higher (p<0.05). In the HFpEF group, NT-proBNP concentrations were significantly greater than those observed in the control group (p<0.05). No statistically significant variances were detected in LVEF, LVEDD, LVOTd, TAPSE, MVE, MVA, ratio of E wave velocity to A wave velocity (E / A), a’, LAEV, LAVmin, or LAVpreA between the two groups (p>0.05). Compared to the control group, the HFpEF group had dramatically higher LAD, IVST, and LVPWT (p<0.05). The HFpEF group also had lower e’, LAEF, LASr, LAScd, and LASct, while E / e’, maximum LA volume index (LAV Imax), and LAVmax were higher (p<0.05). LASr was negatively associated with NT-proBNP (r=–0.255, p=0.016), whereas no significant correlation was found among LAScd, LASct, and NT-proBNP (P>0.05).

Conclusion LA strain parameters can serve as a non-invasive method for quantitatively assessing LA dysfunction in patients with HFpEF.

Background Hyperuricemia (HUA) frequently coexists with coronary artery disease (CAD) and is linked to adverse cardiovascular outcomes. The long-term impact of urate-lowering therapy (ULT) on clinical outcomes, including all-cause mortality and major adverse cardiovascular events (MACEs), in CAD patients after percutaneous coronary intervention (PCI) has not been determined. That was the aim of this study.

Material and methods In this retrospective cohort study, we included 649 patients with HUA who underwent PCI between July 2014 and May 2020. Patients who received standardized ULT for at least one month post-PCI were assigned to the treatment group, while those untreated or nonadherent were assigned to the non-treatment group. Outcomes were assessed using Kaplan–Meier survival curves, multivariate Cox regression models, and propensity score matching. Preoperative and postoperative cardiac function, including left ventricular ejection fraction and right ventricular systolic pressure (RVSP), was evaluated.

Results Over a median follow-up of 6.32 years, the incidence of all-cause mortality was 30.41 per 1,000 personyears, and MACEs occurred at a rate of 45.90 per 1,000 person-years. ULT was associated with a significant reduction in all-cause mortality (hazard ratio [HR]: 0.915; 95 % confidence interval [CI]: 0.645–0.998) and MACEs (HR: 0.887; 95 % CI: 0.661–0.990). Subgroup and sensitivity analyses confirmed these benefits, regardless of baseline uric acid (UA) concentrations or early UA normalization.
Notably, ULT was most effective in reducing cardiovascular mortality and myocardial infarction, with no significant effect on stroke or heart failure. Cardiac function in the treatment group improved post- PCI, with significant improvements in diastolic function and RVSP. In a sensitivity analysis using propensity score matching, the protective effect of ULT on both all-cause mortality and MACEs remained robust, reinforcing the conclusions of the primary analyses.

Conclusion Early initiation of ULT in patients with HUA after PCI is associated with improved long-term survival, reduced MACEs, and better cardiac function. These findings underscore the clinical value of ULT.

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, the prevalence of which increases with age. Slowing down senescence is one of the urgent challenges of modern science. Therefore, it is important to identify individuals with markers of premature cellular senescence for further development of pharmacological agents capable of slowing it. Assuming that in AF, signs of cellular senescence emerge earlier than in individuals without AF we performed search, analysis and systematization of studies of the relationship between markers of cellular senescence, including the leukocyte telomere length (LTL) and the plasma concentration of galectin-3 in patients with AF. In most of the reviewed studies, the concentration of galectin-3 was significantly higher in patients with AF than in practically healthy individuals, while the LTL did not differ significantly between these groups. Accordingly, the signs of cellular senescence appeared earlier in patients with AF than in practically healthy individuals. Further clinical studies of cellular senescence markers in patients with AF are promising and call for large multicenter studies with a uniform design and methodology.

Fulminant myocarditis is characterized by an extremely severe course and remains a life-threatening disease. Only isolated cases of diffuse myocardial calcification in myocarditis have been reported. For this reason, the process of natural evolution of myocardial structural changes and their impact on the cardiovascular system have not yet been sufficiently studied. A clinical case of a 37-year-old patient with morphologically proven fulminant lymphocytic myocarditis and extensive myocardial calcification was selected for the analysis. This article analyzes the course of the disease, an algorithm for diagnosis and selection of a treatment method, and provides a review of previously published studies.

A middle-aged female presenting with progressive heart failure was admitted to the emergency department. She had a history of mitral and aortic valve replacement and a reoperation involving the Konno procedure. Echocardiography suggested a possible paraprosthetic leakage, which was confirmed during surgery. Additionally, severe infection, evidenced by an abscess near the great arteries, was discovered intraoperatively, despite the absence of fever or any prior signs of infection. This case underscores the importance of accurate diagnosis and thorough intraoperative exploration in identifying the underlying causes of the current condition and complications of previous cardiac surgeries. These are crucial for planning and performing a safe and effective reoperation.