Aim    Chronic heart failure with preserved left ventricular ejection fraction (CHFpEF) is characterized by high prevalence, clinical heterogeneity, and insufficient understanding of its mechanisms compared to other CHF types. One approach to improving the patient group stratification is the identification of subphenotypes based on clinical and functional data and biomarker assessment. The aim of this study was to identify the clinical, laboratory, and instrumental characteristics of patients with CHFpEF and ischemic heart disease based on left ventricular ejection fraction (LVEF).
Material and methods     This study included 145 patients with CHFpEF who were scheduled for coronary artery bypass grafting. Inclusion criteria were NYHA class ≥2 symptomatic heart failure, preserved LVEF ≥50%, and a HFA-PEFF algorithm total score ≥3, which helps diagnose CHFpEF. Patients were divided into a group with LVEF 50-60% (group 1; n=53) and a group with LVEF >60% (group 2; n=92). Before surgery, echocardiography, standard laboratory tests, and measurements of plasma biomarkers (N-terminal pre-brain natriuretic peptide (NT-proBNP), vascular endothelial growth factor (VEGF), heart fatty acid binding protein (H-FABP), interleukin receptor ST2, vascular endothelial cell adhesion molecule (VCAM), plasminogen activator inhibitor type 1 (PAI-1), neuropilin-1 (NRP-1) were performed in all patients.
Conclusion    CHFpEF subphenotypes have different clinical and laboratory characteristics. Higher neuropilin-1 concentrations were associated with lower LVEF in CHFpEF. 

Aim    To evaluate the safety and efficacy of sodium-glucose cotransporter-2 inhibitor (SGLT-2i) inhibitor therapy in kidney transplant recipients (KTRs) with and without post-transplant diabetes mellitus (PTDM).
Material and methods     KTRs (n=2146, with PTDM n=303, or 14%) who had undergone transplantation more than one year ago, with stable graft function (estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2), after excluding patients with combined kidney and pancreas transplantation (n=57), type 1 diabetes mellitus (DM) (n=124), and type 2 DM diagnosed before kidney allotransplantation (KAT) (n=74), were prescribed SGLT-2i (empagliflozin 25 mg/day or dapagliflozin 10 mg/day; n=107), the rest of the KTRs (n=1784) did not receive SGLT-2i. After pseudo-randomization, two groups were formed and included in an open, single-center prospective study: an experimental group with SGLT-2i (n=78; with PTDM n=45) and a control group, without SGLT-2i (n=78; n=45 with PTDM). The groups were comparable in the PTDM duration and the period from KAT to inclusion in the study, as well as in clinical characteristics, including gender, age, history of acute myocardial infarction (AMI) before KAT, levels of glycated hemoglobin (HbA1c), systolic blood pressure (SBP) and diastolic blood pressure (DBP), GFR, microalbuminuria (MAU), blood uric acid concentration, blood lipid profile (total cholesterol (TC), low-density lipoproteins (LDL)), basal blood concentration (C0) of calcineurin inhibitors (CNI), and therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), statins, and metformin (p >0.05).
Results     The relative risk (RR) of all-cause death in the experimental group was reduced by 60% compared with the control group (RR 0.40; 95% confidence interval (CI) 0.17-0.98 vs. RR 2.44; 95% CI 1.01-5.86; p=0.04). The RR of adverse coronary outcomes in the experimental group was reduced by 75% compared with the control group (RR 0.25; 95% CI 0.06-0.89 vs. 4.0; 95% CI 1.11-14.42; p=0.03). The RR of adverse renal outcomes in the experimental group was reduced by 72% compared with the control group (RR 0.28; 95% CI 0.09-0.85 vs. 3.50; 95% CI 1.16-10.49; p=0.02). In addition, in the experimental group, compared to the control group, the GFR decline was slower (-1.29±0.763 ml/min/1.73 m2/year vs. -3.33±0.767 ml/min/1.73 m2/year; p=0.047). Also, a pronounced advantage in the dynamic decline in GFR was observed throughout the entire study period (-3.10±1.73 ml/min/1.73 m2 vs. -7.87±1.87 ml/min/1.73 m2; p=0.040).
Conclusion SGLT2i effectively reduce cardiovascular and renal mortality, the risk of adverse renal and coronary outcomes, and slow the progression of chronic kidney disease in KTRs, regardless of the presence of PTDM. A large-scale study evaluating the efficacy of SGLT2i in KTRs is warranted to formulate appropriate clinical recommendations.

Aim        To develop and validate a simple and clinically convenient multiparametric model combining clinical, instrumental and laboratory predictors to prognose the risk of developing cardiovascular toxicity (CVT) in patients receiving antitumor therapy with subsequent personalized stratification of prevention and treatment.

Material and methods          This multicenter prospective study included 252 patients (mean age 64.8±10.4 years; 64.5% women) with large tumors and lymphoproliferative diseases who received various antitumor treatments. Demographic data, risk factors, echocardiography results, left ventricular ejection fraction, left ventricular global longitudinal strain (GLS), laboratory data (high-sensitivity troponin I/T, terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, lipid profile) were collected. The endpoint of the study was the development of CVT within 12 months according to the criteria of the European Society of Cardiology (2022).

Results    Following multivariate analysis using the Cox model, the most sensitive independent predictors of cardiotoxicity were selected: age >60 years, GLS <-18%, troponin elevation >99th percentile, and NT-proBNP concentration >300 pg/ml. A prognostic model was developed based on the identified parameters. Model validation demonstrated its high validity.

Conclusion            Integration of multicomponent data into a single compact prognostic model ensures high accuracy of assessing the risk for the development of CVT and can become a simple tool for personalized monitoring and prevention in cancer patients.

Aim    To study the relationship between adipocyte size and reactive oxygen species (ROS) production in epicardial/subcutaneous adipose tissue (EAT/SAT) with metabolic and inflammatory markers in patients with ischemic heart disease (IHD) undergoing coronary artery bypass grafting (CABG).

Material and methods    The study included 46 patients (32 men, 14 women) aged 45-72 years with IHD and coronary atherosclerosis, who had indications for CABG. Adipocytes from EAT and SAT obtained intraoperatively served as the material. The average size of adipocytes in EAT and SAT and the degree of their hypertrophy were determined; the level of ROS in adipocytes was assessed in 38 patients. The state of blood lipid transport function, glucose/insulin metabolism, the content of adipokines, and inflammatory biomarkers were studied, and surrogate indices of insulin resistance (IR) were calculated.
Results    The average size of EAT adipocytes, in contrast to SAT adipocytes, correlated with serum concentrations of tumor necrosis factor-α (TNF-α) (rs=0.43), basal C-peptide (rs=0.40), triglycerides (TG) (rs=0.36), adiponectin (rs=0.34), interleukin-1β (IL-1β) (rs=0.29) and the TyG index (rs=0.32). ROS production by EAT adipocytes correlated with the concentrations of resistin (rs=0.39), TG (rs=0.35), adiponectin (rs=–0.34), and the TyG index (rs=0.35). The following independent determinants of increased ROS production by EAT adipocytes were identified: blood concentrations of TG, TNF-α, and resistin. A threshold TG level of 1.44 mM was determined, which was associated with ROS production by EAT adipocytes above the first tertile. Increased blood TG concentrations ≥1.44 mM were associated with increased EAT adipocyte hypertrophy, ROS production, a more atherogenic dyslipoproteinemic profile, higher IL-1β levels, IR indices, and lower adiponectin concentration.
Conclusion    For the first time it was shown that in patients with coronary atherosclerosis, elevated TG levels and the TyG index are independently associated with abnormal morphometry of EAT adipocytes and their dysfunction is manifested by increased ROS production. Combined blood levels of TG, resistin, and TNF-α serve as independent determinants of ROS production by EAT adipocytes. Blood TG concentrations ≥1.44 mM are associated with activation of oxidative stress in EAT adipocytes, exacerbation of IR, adipokine imbalance, and low-grade inflammation. These findings support the need to identify optimal TG concentrations in patients with IHD and coronary atherosclerosis.

Aim        To study a possibility of using serum concentrations of cystatin C (CYS) in early diagnosis and prediction of acute kidney injury (AKI) and associated in-hospital mortality and 30-day risk of death in pulmonary embolism (PE).

Materials and methods        This study included 98 patients with suspected PE, of whom 63 had a confirmed diagnosis and formed the study group; the rest were excluded. CYS was measured on admission. The difference (CYSdiff) between the measured CYS and the estimated CYS corresponding to the glomerular filtration rate (GFR) of 75 ml/min/1.73 m² was calculated using the reversed 2012 CKD-EPI Cystatin C formula. The estimated GFR was calculated as the difference between the CYS-based GFR (2012 CKD-EPI Cystatin C) and the creatinine-based GFR (2009 CKD-EPI). The 30-day mortality risk was assessed according to the ESC/ERS Guidelines for the diagnosis and treatment of acute PE in effect at the time of hospitalization.

Results    AKI was diagnosed in 13 (21%) of 63 patients with PE aged 67±12 years, of whom 36 (57%) were men. In 7 (54%) cases, AKI was associated with chronic kidney disease (CKD), and in 6 (46%) cases, AKI developed for the first time. The measurement of the CYS concentration ensured early diagnosis and prediction of AKI with AUC=0.70 (95% confidence interval (CI) 0.57-0.81; p=0.009), optimal cutoff point (OP) >2.55 μg/ml (sensitivity 70%, specificity 62%), and AKI associated with CKD with AUC=0.78 (95% CI 0.65-0.88; p=0.001), OP >2.55 μg/ml (sensitivity 86%, specificity 62%). Similar predictive value for AKI was determined for CYSdiff: AUC = 0.70 (95% CI 0.57-0.81; p=0.009), OP >1.62 μg/ml with a sensitivity of 69% and specificity of 68%. Five patients (9%) died in hospital. The death rate was higher in AKI (χ2 = 5.8; p=0.018). CYS and CYSdiff levels did not predict in-hospital mortality (p >0.05 for both). The predictive value of eGFRdiff was unsatisfactory for either AKI or mortality (p >0.05 for both). It was found that CYS (AUC=0.76; 95% CI 0.63-0.85; p<0.001; OP>2.17 μg/ml) with a sensitivity of 70%, specificity of 70%, and CYSdiff (AUC=0.77; 95% CI 0.64–0.86; p<0.001; OP>1.22 μg/ml) with a sensitivity of 70%, and specificity of 70%, but not eGFRdiff were associated with a high 30-day risk of death (p=0.804).

Conclusion            The study results confirm the effectiveness of CYS assessment in the early diagnosis and prediction of AKI, including cases associated with CKD. Prediction accuracy can be improved using CYSdiff. CYS levels do not predict in-hospital mortality but are associated with a high 30-day risk of death in patients with PE.

Aim        To develop an optimal method for automated segmentation of atherosclerotic plaque structural components in optical coherence tomography (OCT) images using an ensemble of deep learning neural network models based on a comparison of nine artificial neural network architectures.

Material and methods          This study utilized a multidisciplinary OCT dataset obtained from examinations of 103 patients. Each OCT session was annotated as a set of two-dimensional binary masks corresponding to the pixel boundaries of four key morphological features of plaques: vascular lumen, fibrous cap, lipid core, and microvessels. Nine deep learning models, including U-Net, DeepLabV3, and others, were used to segment the anatomical structures. Model hyperparameters were tuned using Bayesian optimization, and the performance was assessed using the Dice Similarity Coefficient (DSC) metric.

Results    The models demonstrated high segmentation accuracy for the vascular lumen (DSC: 0.987) and moderate accuracy for the fibrous cap (DSC: 0.736) and lipid core (DSC: 0.751). Microvessel segmentation proved more challenging, with a final DSC accuracy of 61%. A weighted ensemble of models, accounting for the uneven representation of different morphological structures and model confidence, achieved an average DSC of 88.2%, which significantly improved the overall accuracy compared to individual models. This accuracy value exceeds those of all individual models, including the highest DSC values of 0.784 (for microvessels) and 0.751 (for lipid core), indicating a consistent improvement in the segmentation accuracy by integrating the models.

Conclusion            The study confirms the effectiveness of the proposed strategy for segmentation of atherosclerotic plaques in OCT images. This strategy is based on using specialized models for various morphological features and a weighted ensemble adapted to the uneven representation of different morphological structures and morphological complexity. This approach provided a high segmentation accuracy despite the pronounced inequality in the representation of classes. The study results can contribute to the development of decision support methods in cardiology aimed at improving diagnostic accuracy and treatment of cardiovascular diseases.

Aim        To identify morpho-functional predictors for the development of residual myocardial ischemia after revascularization in patients with ischemic cardiomyopathy and left ventricular ejection fraction (LVEF) <35%.

Material and methods          This prospective, non-randomized, single-center cohort study included 192 patients with a history of myocardial infarction, multivessel coronary disease, and LVEF <35%. Based on the evaluation of myocardial viability by delayed-enhancement magnetic resonance imaging (MRI) (criteria: transmurality index <0.5 and fibrosis volume <50% in arterial bed), 164 patients underwent myocardial revascularization, including percutaneous coronary intervention (PCI, n=92) or coronary artery bypass grafting (CABG, n=72). After 3-6 months, adenosine stress MRI was performed in all patients to assess the effectiveness of revascularization.

Results    Functionally adequate revascularization was achieved in 93.9% of patients, without significant differences between the CABG and PCI groups (91.7 and 95.7%, respectively; p=0.305). Residual ischemia was detected exclusively in patients with incomplete anatomical revascularization. Multivariate analysis identified independent predictors of functionally inadequate revascularization: fibrosis volume >40% in the affected artery bed (odds ratio (OR) = 4.8; 95% confidence interval (CI) 2.1-10.9; p<0.001) and incomplete anatomical revascularization (OR = 6.2; 95% CI 2.7-14.1; p<0.001).

Conclusion            The development of residual ischemia after revascularization in patients with low LVEF is determined by the severity of myocardial structural remodeling (fibrosis volume) and the anatomical completeness of revascularization, but is independent of the choice of revascularization method (PCI or CABG). A comprehensive preoperative evaluation, including visualization of the viable myocardium, is an important step in optimizing the management of these patients.

Background  Diabetic patients face a higher risk of adverse cardiac events following myocardial infarction (MI).
Medication adherence plays a key role in secondary prevention, but its specific impact on the prognosis
of diabetic patients with MI has not been comprehensively evaluated.

Material and methods This retrospective cohort study analyzed medical records of 428 diabetic patients with acute MI over
a 24‑mo review period. Patient adherence to antiplatelet drugs, statins, β-blockers, and angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACEI / ARBs) was retrospectively assessed through medical records and patient interviews, categorized using the 8‑item Morisky Medication Adherence Scale (MMAS-8). Primary endpoints included all-cause mortality, cardiovascular mortality, recurrent MI, and unplanned rehospitalization. Clinical indicators, including left ventricular ejection
fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP), glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL–C), blood pressure, and creatinine clearance rate (CrCl), were extracted and analyzed from electronic medical records. Cox proportional hazards models were used to analyze the association between medication adherence and clinical outcomes.

Results Retrospective analysis showed that, compared to patients with low adherence, patients with high adherence (MMAS-8 score ≥6) had a 42 % reduction in all-cause mortality, a 38 % reduction in cardiovascular mortality, and a 35 % reduction in the risk of recurrent MI. Multivariate analysis showed that medication adherence was an independent predictor of adverse cardiovascular events. For clinical indicators, the high-adherence group performed significantly better in LVEF, NT-proBNP concentration, HbA1c control, LDL–C target achievement, blood pressure control, and CrCl stability

Conclusion  Retrospective data analysis indicates that medication adherence is significantly associated with cardiac outcomes in diabetic patients after MI. Improving medication adherence should reduce the occurrence of adverse cardiovascular events and improve key clinical indicators.

Background  Preeclampsia (PE) is a severe pregnancy complication characterized by hypertension and organ damage. Recent evidence suggests that cardiac injury and platelet dysfunction may contribute to the progression of PE. This study aimed to evaluate the clinical value of combined detection of cardiac injury markers and platelet parameters in the diagnosis, risk stratification, and prognosis of PE in pregnant women.

Material and methods This retrospective study included 120 pregnant women with PE (PE group) and 120 healthy pregnant women (control group) hospitalized from January 2020 to December 2022. Serum cardiac injury markers (cardiac troponin I [cTnI], creatine kinase-MB [CK-MB], and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and platelet parameters (platelet count [PLT], mean platelet volume [MPV], platelet distribution width [PDW], and plateletcrit [PCT]) were measured. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of individual markers and their combinations.

Results  Compared with the control group, PE patients had significantly elevated cTnI, CK-MB, NT-proBNP, MPV, and PDW, and decreased PLT and PCT (all p<0.01). The diagnostic performance of a combined detection model (AUC=0.907, 95 % CI: 0.867–0.947) was superior to any single marker. In PE patients, elevated cardiac injury markers were positively correlated with PE disease severity, blood pressure, and proteinuria. Patients with both abnormal cardiac markers and platelet parameters had significantly higher rates of maternal and neonatal adverse outcomes (p<0.001) and were more likely to require early delivery and intensive care.

Conclusions  Combined detection of cardiac injury markers and platelet parameters provides better diagnostic accuracy for PE and can serve as a valuable tool for risk stratification and prognosis prediction. This approach may facilitate early intervention and individualized management strategies for pregnant women with PE.

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice treated with both pharmacological and surgical methods. Since the use of antiarrhythmic drugs does not always effectively control the heart rhythm and imposes a risk of developing proarrhythmias and conduction disturbances, radiofrequency ablation of the pulmonary vein ostia has become a recognized treatment for patients with symptomatic AF. Recurrences after catheter ablation (CA) in patients with persistent and long-standing persistent AF are significantly more common than in paroxysmal AF. In clinical practice, it is important to accurately predict the long-term outcomes of CA in patients with persistent AF to determine further treatment tactics. There is evidence that restoration of sinus rhythm before surgical treatment reduces the risk of recurrence in patients with persistent AF; however, these associations have not been adequately studied.

In patients with persistent, especially long-standing persistent AF, the degree of arrhythmogenic atrial remodeling can vary widely. Predicting the effectiveness of CA and adjusting the extent of the procedure requires a detailed characterization of the arrhythmogenic substrate in the left atrium (LA), which can be achieved through detailed mapping of areas with fibrotic changes and low-amplitude activity. Therefore, the aim of this review is to summarize the reports about the impact of prior electrical cardioversion before CA in patients with AF on the long-term outcomes of the catheter-based treatment and a possibility of achieving structural and functional reverse LA remodeling. This review may be useful for practicing interventional arrhythmologists and cardiologists engaged in the surgical and medical treatment of patients with persistent AF.

Patients with arterial hypertension (AH) and post-traumatic stress disorder (PTSD) are currently a little-known category of patients among practicing physicians. The incidence of the combination of AH and PTSD in the general population and among cardiac patients is clearly underestimated, and their mutual influence, features of the development and course, and the choice of drug treatment are insufficiently covered in the Russian medical literature. This article presents a review focusing on the clinical characteristics of the development and course of AH in patients with PTSD and approaches to the management of such patients based on an analysis of the eLibrary.ru and PubMed databases. The following keywords were used in the literature search: arterial hypertension, post-traumatic stress disorder, cardiovascular disease, pathogenesis, treatment. A total of 200 full-text literature sources were found, 60 of the most relevant sources were used to compile the review.