Aim      To determine the factors that influence the long-term prognosis in patients after myocardial infarction (MI) as a part of the prospective REGistry of pATients after myocArdial infarction (REGATA).

Material and methods  In 2012–2013, 481 post-myocardial infarction patients were included into the REGATA registry; 247 (51.4 %) were men, median age 72 [62; 78] years. The median duration of prospective follow-up after the inclusion into the registry was 6.1 [4.0–6.6] years. Data were obtained for 474 (98.5 %) patients. Statistical analysis was performed with the Microsoft Excel 2010, StatsoftStatistica10.0 software and partially manually by formulas. Methods of descriptive statistics were used. For quantitative variables with normal distribution, mean values and standard deviations were calculated; intergroup differences were evaluated with Student’s t-test. Differences between groups of survived and deceased patients were evaluated with a nonparametric method using the Pearson’s chi-squared test with a Yates's correction, and the Fisher’s exact test. When the frequency of absent data for the studied variable exceeded 20 %, this variable was not included into the analysis. The 6-year survival was analyzed by the Kaplan-Meier method. Fatal outcomes were analyzed with the Cox proportional hazards regression model. Differences were considered significant at p<0.05.

Results During the follow-up period, there were 200 (41.6 %) cases of all-cause death and 123 (25.6 %) cases of cardiovascular death; 39 (8.1 %) of patients had acute cerebrovascular disease (ACVD) and 36 (7.5 %) had recurrent myocardial infarction. The median time from the inclusion into the registry to death was 3.4 [1.6; 5.1] years. A higher risk of all-cause death was significantly associated with factors of age (one-year relative risk, RR, 1.03; 95 % confidence interval, CI, 1.02–1.05; р<0.001), III-IV functional class angina (RR, 1.76; 95 % CI, 1.22–2.53; p=0.003), history of ACVD (RR, 2.12; 95 % CI, 1.50–2.98; p<0.001), atrial fibrillation (AF) (RR, 1.52; 95 % CI, 1.10–2.12; р=0.01), diabetes mellitus (DM) (RR, 1.53; 95 % CI, 1.11–2.10; p=0.009), chronic obstructive pulmonary disease (COPD) (RR, 1.77; 95 % CI, 1.20–2.62; p=0.004), and reduced hemoglobin (RR, 2.09; 95 % CI, 1.31–3.33; p=0.002). A lower risk of death was associated with administration of antiplatelets (RR, 0.57; 95 % CI, 0.37–0.89; p=0.01), angiotensin-converting enzyme (ACE) inhibitors /angiotensin II receptor blockers (ARB) (RR, 0.51; 95 % CI, 0.33–0.78; p=0.002), and statins (RR, 0.48; 95 % CI, 0.34–0.67; p<0.001). A higher risk of nonfatal stroke during the follow-up was significantly associated with age (one-year RR, 1.05; 95 % CI, 1.01–1.09; р=0.02), history of ACVD (RR, 2.74; 95 % CI, 1.33–5.63; p=0.006), and DM (RR, 2.43; 95 % CI, 1.17–5.06; p=0.02), and a higher risk of nonfatal stroke was significantly associated with a history of ACVD (RR, 1.70; 95 % CI, 1.44–2.01; p<0.001), DM (RR, 2.33; 95 % CI, 1.13–4.84; p=0.02), and COPD (RR, 2.47; 95 % CI, 1.02–6.00; p=0.06).

Conclusion      In the outpatient REGATA registry that included patients with MI at any previous time, the death rate for 6 years of follow-up was 41.6 %. In 61.5 % of cases, death was caused by cardiovascular diseases. In clinical practice in long-term, a higher risk of unfavorable outcome was associated with old age, III-IV functional class angina, a history of ACVD, AF, DM, and COPD while a lower risk was associated with the administration of antiplatelets, ACE inhibitors/ARB, and statins.

Aim: assessment of risk factors, cardiovascular status and intracardiac hemodynamics in patients with multiple myeloma before the start of specific antitumor therapy.

Materials and methods: The study included 2 equal groups of patients: the first group – 25 patients with a newly diagnosed diagnosis of multiple myeloma (MM), the comparison group – 25 patients with proven cardiovascular diseases (CVD) (hypertension (HD) and coronary heart disease (CHD)). All patients included in the study underwent standard laboratory diagnostics, instrumental research methods (ECG, Echo-KG, 24-hour Holter monitoring); proven CVD risk factors were also evaluated.

Results: When comparing the two groups, it was reliably shown that the state of CVD in patients with MM is comparable to that in patients with proven CVD. In patients from the main group, were revealed significant positive correlations of average strength between indicators of systemic inflammation, the lipid spectrum and intracardiac hemodynamics: between the levels of CRP and triglycerides (r=0,415, p<0,05); between the values of CRP and LDL (r=0,345, p=0,09); CRP and LA volume (r=0,434, p<0,05); CRP and final diastolic volume (r=0,30, p<0,05). At the beginning, a high risk of developing CV- events in patients with MM may be due to cardiac remodeling associated with the activity of systemic inflammation.

Conclusion: in view the use of potentially cardiovasculartoxicity drugs for the treatment of multiple myeloma, the assessment of the CV status and consultation with a cardiologist/cardiologist with the selection of the necessary therapy should be obligatory step before starting specific treatment.

Aim      To compare in-hospital outcomes (severe cardiovascular complications, CVC) in patients with IIB stage chronic lower limb ischemia (CLLI) in combination with ischemic heart disease (IHD) in the following groups: stepwise percutaneous coronary intervention (PCI) and stenting and angioplasty of lower limb arteries (LLA) (group 1) and combination treatment, including PCI and open surgery on LLA (group 2).

Material and methods  Since 2019, the A.V. Vishnevsky National Medical Research Center of Surgery has performed a retrospective study that includes patients with stage IIB CLLI in combination with IHD. Patients were divided into 2 groups: group 1 (n=46), stepwise X-ray endovascular treatment (PCI and stenting and angioplasty of LLA); group 2 (n=46), stepwise combination treatment (PCI and open surgery on LLA). The endpoint included severe CVCs (death, acute myocardial infarction, acute cerebrovascular disease) and severe complications in the LLA area (stent thrombosis, repeated intervention on LLA, amputation).

Results In 198 surgeries, none of 92 patients had severe CVC, and no fatal outcomes were observed. In group 2, there was one (2.1 %) severe complication on LLA during the early postoperative period, for which a successful additional intervention was performed.

Conclusion      Individualized approach to care of each patient with LLA pathology in combination with IHD helps avoiding severe CVCs at the hospital stage. It was shown that X-ray endovascular and combination treatments are safe and effective in the absence of fatal outcomes and acute disorders of coronary circulation at the hospital stage.

Aim    Energy drinks (ED) contain high levels of caffeine and taurine and are associated with several cardiovascular effects. We investigated acute effects of consuming low caffeine and taurine content ED on left ventricular (LV) and right ventricular (RV) function assessed by conventional and two-dimensional speckle tracking echocardiography.
Material and methods    In this crossover study, 34 healthy adults, age 19–48 yrs, drank an ED containing 53.25 milligrams of caffeine, 284 mg of taurine, or an equal volume of control drink (CD) on two separate sessions, 7–10 days apart. Standard echocardiographic and speckle tracking imaging were performed before and 60 min after consumption of the study beverages.
Results    Compared to CD, ED caused a significant increase in tricuspid annular plane systolic excursion (p=0.04) and RV systolic wave velocity (p=0.01) with no effect on global longitudinal strain when compared to CD. LV systolic function was not altered, but mitral early diastolic velocity by tissue Doppler imaging was significantly higher (p=0.031), and early diastolic strain rate, as measured by speckle tracking echocardiography, was significantly lower (p=0.022).
Conclusion    Reduced caffeine and taurine content ED does not affect LV systolic function, but increases RV longitudinal contractility and improves LV early diastolic filling.

The article presents a clinical case of a 78-year-old female patient with a clinical picture of vasospastic angina during the capecitabin treatment. The issues under discussion include difficulties of diagnosing vasospastic angina, a potential danger and incidence of coronary vasospastic reactions during chemotherapy with drugs of this group, and current approaches to prevention and correction of fluoropyrimidine cardiotoxicity. The presented clinical case confirms that vasospasm is a manifestation of capecitabin cardiotoxicity. This case also illustrates the importance of interaction and co-ordination of the work of oncologists and cardiologists at all stages of care of oncological patients. 

This article presents a case of diagnosis and treatment of a rare form of left ventricular (LV) hypertrophic cardiomyopathy (HCMP), asymmetric topical HCMP without obstruction of the LV outflow tract, and raises the issue of diagnosis and treatment of rare forms of this disease. In the Federal Center for Cardiovascular Surgery in 2019–2020, 5 cases of asymmetric hypertrophic apical cardiomyopathy were observed and documented with echocardiography (EchoCG), cardiac magnetic resonance imaging (MRI), and Holter ECG monitoring. A 60-year-old female patient underwent a comprehensive evaluation, including physical examination, EchoCG, MRI, Holter ECG monitoring, and coronary angiography. Apical HCMP was detected. The clinical picture was explainable from the perspective of functional and structural alterations in the LV myocardium, where full obstruction of the cardiac apex develops during systole. The small LV cavity is unable to provide effective hemodynamics. Changed small coronary arteries also contribute to this disorder, which, in results, affects myocardial oxygen supply. The administered therapy included antiplatelets, beta-blockers, angiotensin II receptor blockers, diuretics, and ranolazine. The effect of therapy was assessed as positive. Risk of sudden death, according to European Guidelines, 2014 was 0.86 %.

The article presents a rare clinical case of a 45-year-old patient with generalized myasthenia with damages to the muscular apparatus of the extremities and the heart. A special feature of the case was myocardial damage evident as alterative-productive interstitial myocarditis with a peculiar immune phenotype of cell infiltrate, Cd3+, Cd4+, Cd8–, Cd68+. Furthermore, Cd68-expressing cells were presented by large macrophages with cytoplasmic granulation, which surrounded damaged cardiomyocytes. Around sites of cardiomyocyte alteration there were manifestations of neoangiogenesis with signs of Cd34 protein expression in thin-wall, capillary type blood vessels. These morphological and immunohistochemical changes in the myocardium supplement the concept of myasthenia morphogenesis.