Background. Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF).

Objective: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients.

Materials and methods. Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively.

Results. Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003).

Conclusion. During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.

Objective: to assess the clinical status, comorbidities, complications, in-hospital mortality and its structure in dependence of age and type of acute coronary syndrome (ACS) in case of early invasive strategy of ACS management.

Materials and methods: we included in this retrospective study data of all patients (n=1353) with ACS subjected to emergency and urgent myocardial revascularization in High Medical Technologies Center (Kaliningrad, Russia) in 2014-2016. Age of 984 patients was <75 (group 1) and of 369 >75 years (group 2).

Results. Mean age was 60±8.6 and 80.1±4.2 years, in groups 1 and 2, respectively. Anamnesis of group 2 patients was substantially burdened by myocardial infarction and stroke, they significantly more often had reduced left ventricular ejection fraction (EF), congestive heart failure, valve disorders, and atrial fibrillation. Patients of group 2 more frequently had severe manifestations of acute heart failure (AHF) and cardiogenic shock. Portions of patients with Killip class III were 5.9 and 11.4%, IV -2.1% and 9.1% in 1 and 2, respectively. Group 2 patients compared with those of group 1 had higher GRACE score and higher bleeding risk. In-hospital all-cause mortality was 3.1 and 10%, ST elevation myocardial infarction mortality - 2.6 and 9.5% in groups 1 and 2, respectively. Non-ST elevation myocardial infarction + unstable angina mortality (0.5%) did not differ between groups. Mortality from AHF (2 and 6.5%) and percutaneous coronary intervention complications (stent thrombosis and no-reflow) (0.5 and 2.4%) was significantly higher in group 2. AHF mortality was similar in patients with preserved and mid-range EF of both groups, but among those with reduced EF it was significantly higher in group 2 compared with group 1 (7.3 vs. 18.6%, respectively). There were no significant differences between groups in rates of gastro-intestinal and major bleedings.

Conclusions. Clinical course of ACS was more severe in patients aged >75 years compared with patients aged <75 years. Early invasive strategy was effective irrespective of patient’s age and ACS type. Rate of fatal outcomes due to complications of stenting and AHF were higher among very elderly patients. AHF more often caused death in very elderly patients with reduced EF. The rest of the structure of complications and mortality was similar in patients of different ages.

Purpose: to assess the clinical course of ischemic mitral regurgitation (IMR) in patients with myocardial infarction of different localizations and reveal its mechanisms and predictors.

Materials and methods. We enrolled in this study patients with first inferoposterior myocardial infarction (IPMI) (n=77), and anteroseptal MI (ASMI) (n=79) revascularized within 12 hours after symptoms onset, as well as age, sex and weight matched healthy control subjects (n=50). Parameters of mitral structures and mitral annulus areas (MAA), left ventricular (LV) volumes (LVV) and sphericity index (SI), global (G) and segmental (S) longitudinal LV strain (GLS, SLS), papillary muscles (PM) LS (PMLS) and PM systolic dyssynchrony (PMSD) were measured by echocardiography on the 7^th and 180^th days of follow up.

Results. On the 7^th day of follow up IMR was diagnosed more frequently in IPMI vs. ASMI (42 vs. 28%, р<0.001). In both groups patients with TIMI 0 flow before angioplasty had highest, while those with TIMI 3 flow - lowest incidence of IMR. Presence of IMR depended on collateral flow availability in vascular bed of infarct related artery. Wall motion abnormalities (WMA) of infarcted segments, MAA, posteromedial PM posterior displacement (PPMPD), SLS, PMLS, PMSD correlated with IMR in patients with IPMI on the 7^th day of follow up. VLV, GLS and MAA correlated with IMR in patients with ASMI on the 7^th day follow up. Patients with IPMI without IMR in 7th day did not develop IMR for 180 days of follow up while IMR developed in 19.3% of patients with ASMI without IMR at initial examination. Among patients with IPMI and ASMI 37.5% and 45.5%, respectively, of those with IMR at initial examination had no IMR after 180 days of follow up. Patients with IPMI more frequently had eccentric IMR than patients with ASMI (78 and 24%, respectively, p<0.002). At examination after 6 months WMA, MAA, PMSD, PPMPD, SLS, PMLS, PMSD correlated with IMR in patients with IPMI, while VLV, AMA, PM apical displacement (PMAD), GLS and PMSD correlated with IMR in patients with ASMI. AMA, PMAD and PMSD were predictors of IMR in patients with MI of both localizations. In addition, in patients with ASMI VLV and SI were also predictors of IMR.

Purpose: to assess cardiac electrophysiological parameters in patients with paroxysmal atrial fibrillation (AF), lone or with concomitant arterial hypertension (AH), and their prognostic significance relative to treatment effectiveness.

Materials and methods. We included in this study 184 patients with paroxysmal AF (84 with concomitant AH and 100 with presumed lone AF). Cardiac electrophysiological study was performed in accordance with standardized protocol that included assessment of sinus node recovery time, sinoatrial, intraatrial and interatrial conduction time, and effective refractory periods (ERP) of right and left atria and atrioventricular node. Patients with inducible supraventricular reentrant arrhythmias that could potentially trigger AF underwent catheter radiofrequency ablation of those arrhythmias. Other patients received either antiarrhythmic drug therapy (AAD; n=79) or catheter cryo-ablation (CBA; n=81). Treatment was considered ineffective in case of any symptomatic or asymptomatic AF episode documented by ECG or Holter ECG within 12 months of follow-up.

Results. Patients with lone AF compared with those with AH had shorter ERP of the right atrium (219±21 ms vs. 253±44 ms, respectively, p<0.05) and more prominent dispersion of ERP of right and left atria (median 40 ms, interquartile range 10-50 ms vs. median 20 ms, interquartile range 10-22.5 ms, respectively, p<0.05). There was no statistically significant difference in other electrophysiology parameters between the groups. Sustained supraventricular reentrant arrhythmias were induced in 9% (9 of 100) patients with presumed lone AF and in 1.2% (1 of 84) patients with AH (p<0.05). All these arrhythmias were successfully ablated, and patients had no AF recurrence during 12-month follow-up. Among other patient treatment (CBA n=81, AAD n=79) was effective in 64% of those with lone AFib and in 34% - with AH (p<0.05). In multivariate multiple regression analysis, none of electrophysiological parameters could be assumed as a factor associated with the efficacy of CBA or AAD. Conclusion. Patients with lone AF had more prominent atrial electrophysiological inhomogeneity compared with patients with concomitant AH. Cardiac electrophysiological parameters had no influence on effectiveness of antiarrhythmic treatment.

Purpose: to study dynamics of indicators of oxidative stress and their role in development of cardiotoxicity in patients with lympho-proliferative diseases at the background of polychemotherapy.

Materials and methods. We included into this study 30 patients with newly detected Non-Hodgkin lymphomas. The control group comprised 15 healthy volunteers. For registration of dynamics of formation of oxygen active forms (OAF), we used highly sensitive chemiluminescence assay. The state of initial stage of lipoperoxidation OAF and radicals of organic compounds) was assessed by dynamics of the leukocyte chemiluminescence. The state of final stage of lipoperoxidation (formation of nonmetabolizing lipid hydroperoxides and other compounds) was assessed by the level of malonic dialdehyde. We also determined indicator of leukocyte chemiluminescence intensity (both basal and zymosan-stimulated). For assessment of the cardiovascular system functional state before and after chemotherapy we used electrocardiography (ECG), echocardiography (EchoCG) and 24-hour ECG monitoring.

Results. The data obtained were indicative of increased generation of free radicals by leukocytes during polychemotherapy. After chemotherapy course we detected various types of cardiotoxicity. We noted substantial elevation of frequency of supraventricular and ventricular extrasystoles. There was direct correlation between rate of appearance of supraventricular extrasystoles and level of chemiluminescence of leukocytes (r=0.7; p=0.03). According to data of EchoCG although the left ventricular ejection fraction remained within the normal range during chemotherapy, there was a persistent tendency to its decrease (р<0.001).

Conclusion. In this study we for the first time in patients with Non-Hodgkin lymphomas detected an elevation of level of free radical reactions and lipid peroxidation with simultaneous lowering of antiperoxidative activity of blood plasma and their relation to development of cardiotoxic effects. The results obtained indicate to necessity of search for novel early markers of oxidative stress activation, myocardial injury and disfunction able to help to substantially decrease risk of development of cardiovascular complications during and after chemotherapy.

Background: Psychosocial risk factors (RFs) play a major role in the development and progression of cardiovascular diseases (CVDs).

Aim. The COMET study aimed to obtain current data on psychosocial RFs in outpatients with arterial hypertension (AH) and/or coronary heart disease (CHD) seen in primary care facilities in 30 cities of Russia.

Methods. In 2016-2017, a multicenter cross-sectional study was carried out involving 325 physicians from community primary care facilities who enrolled 2,775 patients with AH and/or CHD ≥ 55 years of age. However, only 73 CHD patients (2.6%) were not hypertensive, therefore, these patients were excluded from the analyses. As a result, current paper is based on the comparison of AH patients (n=1687) vs. participants with both CHD and AH (AH+CHD; n=1015). We collected patients’ socio-demographic data, clinical features, traditional and psychosocial RFs, such as anxiety and depression, stress level, type D personality, and treatment adherence.

Results. The study population (women, 72%; mean age ± SD, 66.7 ± 7.9 years) had a significant prevalence of psychosocial RF. 43.8% of AH patients and 45.5 % of participants with AH+CHD rated their income as low or very low, a low educational level was reported in 21.6% and 26.0%, respectively (both p=n/s). Social isolation was uncommon, but it occurred more frequently in AH+CHD patients (8.3% vs. 5.2%, p<0.01). Nevertheless, 40.2% of AH patients and 39.4% of AH+CHD were not married, and 26.0% and 24.6% were living alone, respectively. Elevated stress level was prevalent in more than 60% of patients (67.9% in AH patients vs. 67.7% in AH+CHD patents, p=n/s), and 63.3% and 64.8% of patients, respectively, reported stressful life events in the preceding year (p=n/s). Type D personality was more common in AH+CHD patients (41.2% vs. 35.8%; p<0.01). Clinically significant anxiety symptoms were prevalent in 24.7% ofAH patients and in 27.4% ofAH+CHD patients (p=n/s), and clinically significant depressive symptoms were identified in 13.9% and 20.9%, respectively (p<0.001).

Conclusion. We obtained current data on psychosocial RFs prevalence in outpatients with the most common CVDs in primary care setting. At the moment, their prevalence remains significant.

This review article contains presentation of modern diagnostic criteria and prognostic scales for cardiogenic shock in patients with myocardial infarction as well as analysis of current clinical guidelines. Main results of clinical trials underlying recommendations of these guidelines are discussed. The article focuses on controversial and unfounded recommendations and issues requiring further research.

Number of patients with arterial hypertension and stroke steadily grows. “Target” levels of arterial pressure are not established in patients after stroke. In this review, we present results of clinical trials and data of meta-analyses on this problem. Problems related to target levels of arterial pressure after stroke are also covered in a framework of present Russian (2010), European (2018) and American (2017) recommendations on diagnosis and treatment of arterial hypertension.

Lipid metabolism disorders are the most significant risk factor of development of cardiovascular diseases (CVD). In the process of diagnosing ischemic heart disease and other cardiovascular pathologies, levels of total cholesterol, low- and high- density lipoprotein cholesterol, triglycerides are determined. However, in recent years, close attention has been paid to the intersection of the metabolic pathways of the biosynthesis of cholesterol and sphingolipids. Sphingolipids - a group of lipids, which include a molecule of aliphatic alcohol sphingosine. This group includes sphingomyelins, cerebrosides, gangliosides and ceramides, sphingosines and sphingosine-1-phosphate (S-1-P). Ceramides and sphingosines have pro-apoptotic properties, and S-1-P protects cells from apoptosis. Particular attention as inducer CVD attracts ceramide. It has been established that aggregated lipoproteins isolated from atherosclerotic zones are enriched with ceramides. The level of ceramide and sphingosine increases with ischemia/reperfusion of the heart, in the infarction zone and in the blood, and also in hypertensive disease. S-1-P has a pronounced cardioprotective properties. Its content sharply decreases with ischemia and myocardial infarction. S-1-P performs a special function in the structure of high-density lipoproteins (HDL), being one of the main lipid components of these lipoproteins, which determines their multiple functions. Recently, work has been underway to create drugs that can correct the metabolism of S-1-P. The most successful drugs are those that use the S-1-P receptor as a target, since all of its actions are carried out through receptors. Increasing ceramide and sphingosine and reducing blood plasma level of S-1-P can be an important factor in the development of atherosclerosis. It is proposed to use the determination of the level of sphingolipids in blood plasma for early diagnosis of cardiac ischemia and in arterial hypertension. Chromatography-mass spectrometry has been suggested as the main method for testing these lipids.

Chronic heart failure is the cause of hospitalization of every fifth cardiological patient. Number of patients with heart failure symptoms that have preserved or intermediate left ventricle ejection fraction increases, i.e. grows portion of diastolic heart failure grows. Gray scale myocardial strain techniques provide an opportunity to detect myocardial dysfunction on early stages when absence of clinically significant symptoms are absent and conventional echocardiography is not informative. The goal of this study is to review parameters of myocardial strain and its clinical applicability in patients with chronic heart failure.