Aim    To analyze the number of cases of acute coronary syndrome (ACS) [ST segment elevation myocardial infarction (STEMI), non-ST elevation acute coronary syndrome (nSTEACS)] and results of myocardial revascularization for ACS as a part of the monitoring performed by the Ministry of Health Care of Russia*. This analysis allows, on one hand, providing control of morbidity and mortality of patients with socially significant pathologies and, on the other hand, monitoring the effectivity of treatments to identify and correct their shortcomings. Time-related changes in results of myocardial revascularization performed for ACS patients in the Russian Federation in 2020 were analyzed and compared with the values of 2016-2019 based on data of the Russian Ministry of Health Care monitoring.
Material and methods    Yearly absolute, relative, and calculated indices of revascularization for ACS were analyzed and compared based on data of the Russian Ministry of Health Care monitoring in 2016-2020.
Results    In the Russian Federation in 2020, the lowest number of hospitalizations for ACS (403, 931) was recorded with an unprecedented ratio of 1 / 1.8 for STEMI/nSTEACS, respectively. In Russia in 2020, the proportion of primary percutaneous coronary interventions (pPCI) for STEMI continued growing; it reached 44% and peaked to the maximum for 2016–2020. At the same time, the thrombolytic therapy (TLT) remained essential in the structure of reperfusion strategies during those years (24.0–27.3 % of all STEMI cases). Total death rate of admitted patients with STEMI in Russia was stable at the level of 13.1–14.6 %. In 2020, there were no significant differences in quality indexes of the treatment for STEMI from the previous period (2016–2019). A yearly relative increase in the number of PCIs for STEACS (from 16 % in 2016 to 30 % in 2020 and from 30% to 46% for high-risk nSTEACS) was observed. In 2020, a significant increase in death rate was observed for nSTEACS as a whole (to 4.1 %) and for individual subgroups (high-risk nSTEACS, to 4.5 %; after PCI for nSTEACS, to 1.8 %; and after PCI for high-risk nSTEACS, to 2.8 %) whereas mean death rate values in these subgroups in 2016-2019 were 2.75 %, 3.45 %, 1.5 %, and 2.3 %, respectively.
Conclusion    The analysis of revascularization indexes in ACS patients based on the Ministry of Health Care of Russia monitoring performed in 2016–2020 showed a number of positive trends, including an increase in the total number of revascularization procedures; a decrease in the time from the disease onset to the endovascular treatment; an increase in the availability of stenting for severe ACS; and general stabilization of the mortality. On the other hand, the Russian Federation is considerably behind European countries in several qualitative and quantitative parameters of health care in ACS, such as pPCI availability, symptom-to-balloon time, total mortality of all hospitalized STEMI patients, and revascularization for nSTEACS. Despite the gradual improvement of relative quantitative indexes of myocardial revascularization for ACS, negative changes in the absolute number of myocardial revascularizations for various forms of ACS and a notable increase in the death rate in nSTEACS were observed in 2020, including patients after PCI. There is no doubt that the negative results of myocardial revascularization in Russia in 2020 were due to the effect of the COVID-19 pandemic.

* monitoring of measures to reduce the mortality from ischemic heart disease (letters of the Ministry of Health Care of the Russian Federation of 13.03.2015 # 17–6 /10 / 1–177 and of 24.07.2015 # 17–9 / 10 / 2–4128), which includes monthly collection of data on the Federal Research Institute for Health Organization and Informatics portal, the Automated System for Monitoring of Medical Statistics, at http://asmms.mednet.ru.

Aim      To evaluate the structural and functional condition of the vasculature using fingertip photoplethysmography and computerized videocapillaroscopy in patients with hypertrophic cardiomyopathy (HCMP).

Material and methods  The study included patients with HCMP (n=48; 28 (57 %) men; age, 54.3±13.6 years) and healthy volunteers (control group, n=33, 15 (45 %) men; age, 58.2±8.8 years). Standard laboratory and instrumental examination (blood count and biochemistry, electrocardiography, echocardiography, Holter electrocardiogram monitoring) were performed for all HCMP patients. The condition of vascular wall at various levels of the vasculature was evaluated by fingertip photoplethysmography (apparatus Angioscan-01) and computerized nail-fold videocapillaroscopy (apparatus Capillaroscan-01). The photoplethysmography study analyzed structural parameters, including the arterial wall stiffness index (aSI) of large blood vessels and the resistance index (RI) of small muscular arteries. Endothelial dysfunction was evaluated by the occlusion index (OI) and phase shift (PS). The capillaroscopy study assessed structural parameters, including the resting capillary density (rCD) and the capillary density following venous occlusion (voCD), and functional parameters, including the percentage of perfused capillaries (PPC), the percentage of restored capillaries (PRC), and the capillary density after the reactive hyperemia test (rhCD).

Results The study showed increases in aSI (8.8 [6.8; 12.2] and RI (32.5 [17.4; 47.9] in the HCMP group. The OI was significantly lower in the HCMP group (1.3 [1.1; 1.5]) than in the control group (1.8 [1.5; 2.7], р<0.001). Also, PS values were significantly decreased in the HCMP group (4.4 [2.3; 8.6]) compared to the control group (8.4 [5.1; 12.1]. p=0.018). Disorders of structural and functional capillary indexes were observed in HCMP patients compared to the control group; rCD and voCD were decreased in the HCMP group (60 [52.6; 68] and 88 [75; 90], respectively) compared to the control group (75.8 [60; 87] and 90 [73; 101]), however, no intergroup difference reached a statistical significance. The rhCD, PPC, and PRC values were decreased in the HCMP group (66.3 [55; 72], 86.7 [70.9; 104.2] and 1.7 [–6.95; 20.3], respectively) compared to the control group (86 [68.6; 100], 103 [96; 114] and 18.4 [8.1; 27.4], respectively); PPC and PRC values were significantly different (р<0.005 and p<0.004, respectively).

Conclusion      In patients with HCMP, fingertip photoplethysmography and computerized videocapillaroscopy showed increased wall stiffness in both large blood vessels and microvasculature, pronounced endothelial dysfunction, and decreases in capillary density and percentage of restored capillaries following respective tests.

Aim    To determine existence of a relationship between any clinical, echocardiographic and coronarographic factors and increased spatial QRS-T (sQRS-T) angle and frontal QRS-T (fQRS-T) angle in patients with anterior myocardial infarction.
Material and methods    This study included 137 patients aged 62 [53; 72] years with anterior acute myocardial infarction managed at the A.L. Myasnikov Institute of Clinical Cardiology. fQRS-T was calculated as the module of difference between the frontal plane QRS complex axis and the T wave axis. sQRS-T was calculated as a spatial angle between QRS and T integral vectors from a synthesized vectorcardiogram.
Results    fQRS-T values for a group (median [25th; 75th percentile]) were 81 [37; 120]°; sQRS-T values were 114 [80; 141]°. The correlation coefficient between fQRS-T and sQRS-T values was 0.41 (p<0.001). fQRS-T weakly but statistically significantly correlated with patients’ age (r=0.28; p=0.001), left ventricular ejection fraction (LV EF, r= –0.22; p=0.01), and glomerular filtration rate (r=–0.32; p=0.0002). sQRS-T weakly but statistically significantly correlated with left ventricular end-diastolic dimension (r=0.24; p=0.0048), LV EF (r=–0.28; p=0.0009), and the number of affected segments according to echocardiography data (r=0.27; p=0.002). fQRS-T values were significantly higher in the presence of concurrent arterial hypertension. sQRS-T values were significantly higher in the presence of a history of chronic heart failure. Both fQRS-T and sQRS-T values increased with increasing number of affected blood vessels and Killip class of acute heart failure.
Conclusion    In patients after anterior acute myocardial infarction, increases in fQRS-T and sQRS-T are associated with more severe damage of the vasculature, decreased LV EF, and, thus, more severe clinical course of disease.

Aim      To analyze echocardiographic parameters that reflect left ventricular (LV) myocardial contractility, using a novel method for evaluation of myocardial performance in patients with chronic heart failure (CHF) and atrial fibrillation (AF) during heart contractility modulation (HCM).

Material and methods  Standard echocardiographic parameters and indexes of myocardial strain and work were analyzed for 66 patients (52 men and 14 women; median age, 60 [54; 66] years). 36 patients had paroxysmal AF and 30 patients had permanent AF. All patients had CHF with a duration of 17 [4; 60] months; duration of AF was 12 [6; 36] months. At baseline, the left ventricular ejection fraction (LV EF) was 33 [27; 37] %.

Results After one year of HCM, LV EF significantly increased from 33 [27; 37] to 38 [33; 44] % (р=0.001). Also, there were improvements in the myocardial global longitudinal strain (from –6.00 [ – 8; – 4] to –8 [ – 10; – 6] %; р=0.001) and parameters of myocardial work, including the global work efficiency (from 74 [65; 79] to 80 [73; 87] mm Hg%; р=0.001), global constructive work (from 699 [516; 940] to 882 [714; 1242] mm Hg%; р=0.001), and global myocardial work index (from 460 [339; 723] to 668 [497; 943] mm Hg%; р=0.001). A segmentary analysis of LV work parameters showed positive changes in the myocardial constructive work in the area of the interventricular septal apical segment (at baseline, 844 [614; 1224]; after HCM, 1027 [800; 1520] mm Hg%; р=0.05) and the medium segment of the LV anteroseptal wall (at baseline, 593 [312; 1000]; after HCM, 877 [494; 1145] mm Hg%; р=0.05).

Conclusion      This method for analysis of the myocardial work provides a more detailed examination of LV structural and functional remodeling and mechanisms for its effects on the LV contractile function in patients with CHF. This method is promising and merits further study in various clinical situations.

Aim    To study the relationship between the type of circulation, severity and localization of atherosclerotic damage of coronary arteries, results of laboratory and instrumental tests, and historical data in patients with multivascular coronary lesions and atrial fibrillation (AF) that developed after coronary bypass surgery.
Material and methods    This was a novel, retrospective study of data of patients after elective coronary bypass surgery at the Cardiac Surgery Department #1 of the N.V. Sklifosofsky Research Institute of Emergency Care from December, 2018 through December, 2020. The study included 100 patients. The main group consisted of 20 patients whose early postoperative period (first 7 days after surgery) was complicated with postoperative atrial fibrillation (POAF) (mean age, 65.15±9.7 years). The comparison group included 80 patients without the POAF complication during the early postoperative period (mean age, 62.0±9.16 years). Prior to the coronary bypass surgery, all patients underwent clinical, laboratory, and instrumental examination. Based on data of selective coronary angiography, localization, severity of coronary atherosclerotic damage (according to angiographic classification), number of affected arteries, and the type of circulation were taken into account.
Results    Intergroup differences in the incidence and localization of myocardial infarctions in history, severity of arterial hypertension in history, class of chronic heart failure (according to the New York Heart Association, NYHA, classification), and heart rate were absent. 100 % of patients had left atrial (LA) dilatation not correlated with the development of AF in the early postoperative period. According to data of coronary angiography, there was no statistically significant association between the type of circulation and the development of POAF. The right type of myocardial blood supply prevailed in patients of both groups. There was no correlation between the severity and localization of coronary atherosclerotic lesions and the development of AF in the early postoperative period.
Conclusion    The development of AF following coronary bypass surgery was not associated with features of coronary atherosclerotic lesions, which may indicate active development of inter- and intra-systemic anastomoses in patients with long-term history of chronic coronary atherosclerosis.

Aim      To analyze frequency and profile of the lipid-lowering therapy (LLT) in patients with dyslipidemia (DLP) and cardiometabolic diseases (CMD) in a population sample aged 55-84 years at the current time (2015–2017).

Material and methods  Despite guidelines on DLP treatment and the availability of effective and safe lipid-lowering drugs, control of DPL in primary and secondary prevention of cardiovascular diseases (CVD) is insufficient. Knowledge of the level of pharmaceutical correction of DLP in the Russian population is limited; it requires an LLT assessment in various regions and in a wide age range, and a regular monitoring taking into account changing approaches to the correction of DLP. A random population of men and women aged 55–84 years (n=3 896) was evaluated in Novosibirsk in 2015–2017 (project HAPIEE). A joint DLP category was established as low-density lipoprotein cholesterol (LDL-C) ≥3.0 mmol/l, or total cholesterol (TC) ≥5.0 mmol/l, or triglycerides (TG) ≥1.7 mmol/l, or LLT. The combined group of DLP and CMD included ischemic heart disease (IHD), type 2 diabetes mellitus (DM2), and DLP. Regular LLD treatment for the recent 12 months, excluding the dosage of medicines, was assessed using the Anatomic Therapeutic Chemical (ATC) classification. The conditional control of serum lipids was taken as the achievement of LDL-C <3.0 mmol/l, TC <5.0 mmol/l, and TG <1.7 mmol/l.

Results In the study sample, the total prevalence of DLP and CMD was 88 % (82.8 % for men and 91.3 % for women, p<0.001). 48.3% of patients in the IHD group, 35.0% in the DM2 group, 29.4% in the DLP group, and 32.8% in the CMD group took LLT. Control of serum lipids was achieved in 18.3% (37.9 % of patients on LLT) of patients with IHD; 9 % (25.6 % of patients on LLT) of patients with DM2; 7.3 % (24.8 % of patients on LLT) of patients with DLP; and 9.0 % (27.6 % of patients on LLTсреди) in the DLP and CMD group. Women with DM2 and DLP more frequently achieved lipid control than men (p<0.001). 98.7 % of study participants took statins as LLT.

Conclusion      In the sample of urban population aged 55–84 years in 2015–2017, 90 % of patients had DLP or CMD, and at least ¾ of them required blood lipid control. The lipid control was achieved in every fifth IHD patient and in approximately 40% of those who took LLT. For DM2 or DLP patients, the lipid control was achieved in every tenth patient and in approximately 25% of those receiving LLT. Frequency of lipid control in IHD patients was comparable for men and women; in DM2 and DLP, men less frequently achieved the lipid control than women. About 70% of patients in the combined DLP and CMD group and more than 50% of IHD patients did not take LLT, which considerably contributed to the insufficient lipid control in primary and secondary prevention of atherosclerotic CVDs in this population.

Aim      To analyze the dynamics of mortality from arterial hypertension (AH) between 2013 and 2019.

Material and methods  Arterial hypertension (AH) is one of the most common diseases. At the same time, there are no unified international criteria for establishing the primary cause of death from AH. Data were studied for the period between the end of the program for modernization of health care and the start of the Federal Project “Program for combatting cardiovascular diseases”. Data for 2013-2019 by AH-related codes were provided by the Federal Service of State Statistics on request via the C15 form, “Mortality by gender and one-year age groups”. A standardized mortality ratio, its mean value, standard deviation, and a coefficient of variation were determined for each “cause”. The standardized mortality ratio was calculated using the European standard.

Results In Russia during the studied period, the standardized mortality ratio for the death from AH yearly decreased (1.7 times for 6 years; the standardized mortality ratio decreased 1.15 times). However, only in 7 regions, the standardized mortality ratio yearly decreased while in the other regions of the Russian Federation, the standardized mortality ratio changed wavily. In 17 regions of the Russian Federation, the standardized mortality ratio increased in 2019 compared to 2013, including the 31.7 time increase in the Republic of North Ossetia-Alania. In the Penza Region and the Republic of Kalmykia in 2018, there were no cases of death related with AH. The highest value of the standardized mortality ratio was observed in the Chukotka Autonomous District in 2019 (85.13 per 100,000 population) and the lowest value was observed in the Penza Region (0.14 per 100,000 population). The ratio of maximal to minimal values of the standardized mortality ratio was 622. The coefficient of variation for regional standardized mortality ratios increased by 42.3 % (from 86.8 to 123.5 %).

Conclusion      Although the standardized mortality ratio for death from AH, in general, decreased in the Russian Federation, Russian regions showed variable dynamics and a high variability of the standardized mortality ratio. The study results together with results of international studies showed that differences in standardized mortality ratios for death from AH are largely due to different approaches to determining the primary cause of death. An international consensus on the terminology and criteria for determining the primary cause of death is required.

Aim    Widespread utilization of technology has led to the construction of a growing number of facilities with coronary angiography units and percutaneous coronary intervention (PCI) capability. Some of these centers do not have cardiovascular surgery (CVS) on site. Studies regarding the efficacy and safety of PCIs performed at these hospitals have been conducted. However, to date, high-risk procedures in this context have not been evaluated. The present study compares the outcomes of PCI procedures performed on high- and low-risk lesions groups in a center without CVS back-up.
Material and methods    A total of 999 patients treated with PCI with diagnoses other than ST elevation myocardial infarction were included in this study. Patients with SYNTAX scores 22 or higher, bifurcation lesions, chronic total occlusions, left main coronary artery lesions and saphenous graft lesions were classified as a high-risk group. In contrast, patients with SYNTAX scores lower than 22 were included in the low-risk group. Coronary lesions were classified as Type-A, B, and C. The 30‑day major adverse cardiac events (MACE) and 1‑year target vessel revascularization (TVR) rates were compared.
Results    There was no significant difference between the groups in terms of the rates of MACE (2 (0.9 %) vs 5 (0.6 %); p=0.64) and TVR (9 (4.2 %) vs 25 (3.2 %); p=0.52). Analysis regarding the lesion type also revealed no significant difference between the MACE and TVR rates (p=0.56 and p=0.43, respectively).
Conclusions    The findings in this study demonstrated that, similar to low-risk procedures, complex and high-risk coronary interventions can safely and effectively be conducted in hospitals without a CVS unit.

The recommended tactics for prevention of thromboembolic complications of atrial fibrillation (AF) is the oral anticoagulant (OAC) treatment. The drugs of choice for preventing stroke for most patients with AF, excluding some valvular defects, are direct OACs (DOACS). Regardless of the drug class, all anticoagulants, even at appropriate doses, increase the risk of bleeding. However, the development of minor bleedings is not an absolute indication for DOAC withdrawal. This review presents a tactics for management of patients with minor bleeding associated with the DOAC treatment.

Frequency of hospitalizations for decompensated heart failure (HF) and associated costs are steadily increasing worldwide. An episode of HF is a risk marker, reflects a change in the course of disease, a high probability of adverse events, and requirement for using all options to improve the prognosis. This article discusses barriers and ways to overcome them in managing HF patients with low ejection fraction. An evidence-based, disease-modifying therapy exists for this HF phenotype. Administration of the therapy along with additional, novel drugs that improve outcomes, and organization of medical care are essential during the “vulnerable period” after discharge from the hospital.

The immune system is essential for maintaining the homeostasis. At present, there is convincing evidence for participation of the immune system in the pathogenesis of cardiovascular pathology, including the final step of cardiovascular continuum, heart failure. Objective difficulties in understanding subtle processes of loss of the normal cardiac structure and function are based on the diversity of pathogenetic factors of development and progression of chronic heart failure (CHF) and the involvement of most organs and body systems. Russian and international scientists actively study issues of immune homeostasis, including the efficacy of current immune therapy. At the same time, available reports are largely uncompiled and reflect isolated parts of the immunopathogenesis of cardiovascular diseases. This review focuses on comprehensive elucidation of major patterns of immune processes in the CHF pathogenesis to form an integral view of the problem under study.

This review shows historical steps in the development of topical diagnostics for ventricular arrhythmias, the current status of this issue, and the relevance of developing topical, noninvasive electrophysiological cardiac mapping.