Aim. To study the cytokine profile of macrophages in valve tissues in operated patients with infective endocarditis (IE), its correlation with inflammatory markers for optimization of the assessment of IE activity.

   Material and methods. There were prospectively included 25 adult patients with active IE (2015Duke criteria) and 24 patients with non-IE valvular heart disease admitted for cardiac surgery (2021-2022). Laboratory and instrumental examination was conducted, including pathogen verification, as well by means of Real-Time PCR in blood/tissues of resected valves, echocardiography, and neutrophil-to-lymphocyte ratio evaluation. Valvular tissues were analyzed for macrophage phenotypic characteristics using immunohistochemistry (IHC) and for pro- and anti-inflammatory cytokine gene expression via real-time PCR.

   Results. IE patients had a high proportion of secondary IE due to degenerative heart defects (n = 10, 40.0 %) and left-sided localization of IE (n = 16, 64.0 %). IHC revealed a predominance of intact pro-inflammatory CD 86+ macrophages phenotype in patients without IE compared with patients with IE [0.054 (0.029-0.073) vs. 0.008 (0.0071-0.0096), p < 0.05]. There was no significant difference in the anti-inflammatory CD 206+ macrophages phenotype. In the group of operated patients with IE, Real-Time PCR revealed significant expression of IL-1β genes (Ме [IQR] 0.0037 [0.0005-0.0155] vs. 0.0002 [0.0001-0.0026], p < 0.05) and IL-6 (Ме [IQR] 0.0034 [0.0007-0.0167] vs. 0.0005 [0.0004-0.0038], p < 0.05) compared with patients without IE. There were no significant differences in anti-inflammatory cytokines. The level of cytokine gene expression by tissue macrophages, depending on the presence of embolic events, etiological affiliation to S. aureus, as well as hospital mortality and the combined endpoint (death from all causes or recurrence of IE in 6 months after surgery) did not differ between IE patients with or without events. IL-1β had the most favorable characteristics for assessing the activity of IE (IL-1β AUC 0.816 (p = 0.02)).

   Conclusion. Increased macrophages destruction with excessive release of pro-inflammatory cytokines in the valve tissue determines the uncontrolled course of IE and the need for cardiac surgery. IL-1β has a high diagnostic value for determining the inflammation activity in operated patients with IE.

   Aim. To find out physicians’ knowledge and perceptions about the possibilities of using therapy affecting the prognosis in patients with chronic heart failure with reduced ejection fraction (CHFrEF).

   Material and methods. Data of an anonymous survey of 207 physicians (155 cardiologists, 44 internists, 8 other specialists) who past advanced course of professional training in the spring of 2023. Questionnaire contained questions reflecting physicians’ awareness about treatment for improving the prognosis of patients with CHFrEF.

   Results. The quadruple therapy: sacubitril- valsartan (ARNI)/angiotensin- converting enzyme inhibitor /angiotensin II receptor blocker + beta-blocker (BB) + mineralocorticoid receptor antagonist (MRA) + sodium- glucose cotransporter type 2 inhibitor (SGLT2i) was named as an optimal treatment for CHFrEF by 63.3 % of doctors (71.6 % of cardiologists and 36.4 % of internists). 80 % of respondents (89 % of cardiologists and 50 % of internists) correctly pointed out the indications for ARNI, 75.4 % (83.9 % of cardiologists and 45.4 % of internists) — for therapy with BB, 71.0 % (80 % of cardiologists and 36.3 % of internists) — for prescribing AMR, and 76.8 % (86.4 % of cardiologists and 43.1 % of internists) — for using SGLT2i. 81.7 % of respondents (89.7 % of cardiologists and 52.3 % of internists) correctly named the target dose of BB, 45.9 % (51 % of cardiologists and 31.8 % of internists) indicated the neuromodulatory dose of AMR, and 74.3 % (83.9 % of cardiologists and 52.3 % of internists) correctly noted the recommended dapagliflozin dose (p < 0,01 for all comparisons between groups of cardiologists and internists). Among the drugs that are most often used in everyday practice to improve the prognosis of symptomatic patients with CHFrEF, respondents named BB (66.2 %), MRA (58.5 %), angiotensin- converting enzyme inhibitor/angiotensin II receptor blocker (57 %), ARNI (37.7 %), and SGLT2i (45.4 %). Cardiologists use ARNI (p < 0,01), SGLT2i (p < 0,01), and MRA (p < 0,05) more often than internists.

   Conclusion. Insufficient knowledge of physicians, especially internists, of the key provisions of clinical guidelines for CHFrEF pharmacotherapy can be considered as one of the reasons for suboptimal treatment.

   Aim. To determine the main socio- demographic, psychological, hemodynamic and meteorological predictors of seasonal blood pressure (BP) increase in the cold season in patients with stable arterial hypertension (AH) in Moscow.

   Material and methods. The study was conducted at the National Medical Research Center for Therapy and Preventive Medicine from 1997 to 2009. It involved patients with hypertension without severe concomitant diseases requiring regular therapy. At the first and second visits, psychological status (PS) and quality of life (QL) were assessed, daily blood pressure monitoring (ABPM) was performed. All procedures were performed after washout period (3-5 days). Visits were carried out in different months of the same year, and the difference in daily ambient temperatures between the first and second visits was 5 °C or more. PS was assessed using the Mini- Mult test (Russian short version of MMPI questionnaire, Minnesota Multiphasic Personality Inventory), QL — using the "General Well- Being Questionnaire" (GWBQ). The severity of the seasonal blood pressure increase (ΔBP) with a in ambient temperature decrease and indicators was calculated as the difference between
the BP levels that were recorded in the colder and warmer seasons. A multivariate regression analysis was performed to assess the relationships between the ΔBP severity and initial hemodynamic data, socio- demographic indicators, and psychological characteristics of AH patients.

   Results. Data from 137 patients with stable AH (77 (56 %) women, 60 (40 %) men) were analyzed. The average age was 55.7 ± 0.8 years, the AH duration was 11.9 ± 0.8 years, the height — 167.3 ± 0.7 cm, weight — 81.1 ± 1.2 kg, mass index body (BMI) — 28.9 ± 0.4 kg/m². The initial blood pressure during ABPM were: 1) average daytime systolic BP (SBPd) 144.7 ± 1.4 mm Hg, nighttime (SBPn) — 126.0 ± 1.3 mm Hg; 2) average daytime diastolic BP (DBPd) — 91.6 ± 0.8 mm Hg, nighttime (DBPn) — 75.1 ± 0.8 mm Hg. After regression analysis, the following seasonal BP increase predictors in the cold season were found: 1) for SBPd — DBPd — 5 scale scores of the QL questionnaire; 3) for DBPn — diastolic white coat effect (WCEd). Several seasonal BP decrease predictors were found: 1) for DBPd — systolic WCE (WCEs) and body mass index (BMI).

   Conclusion. The main hemodynamic predictors of the BP seasonal changes were WCE level. The psychological component of QL was a DBPd seasonal increase predictor, and BMI was a DBPd seasonal decrease predictor in the cold season.

   Aim. To characterize anaemia in chronic heart failure (CHF) with preserved left ventricular ejection fraction (CHFpEF) and evaluate the effectiveness of an iron supplement with a hepcidin- independent absorption mechanism.

   Material and methods. An uncontrolled study included 30 patients with CHFpEF NYHA class I-III and anaemia. Patients received "standard therapy" for CHF in combination with sucrosomial iron (60 mg/day orally) for three months. Treatment response was assessed via clinical blood test, iron metabolism parameters, inflammatory markers, and functional tests at baseline and three months post-treatment.

   Results. Anaemia in CHFpEF corresponds to anaemia of chronic disease with elevated hepcidin content, 219 (149-553) ng/mL occurs with impaired absorption and metabolism of iron and the development of iron deficiency. Hemoglobin levelincreased from 115 (98-117) g/L to 120 (103-133) g/L, p = 0.01, red blood cell count increased from 3.6 (3.5-4.1) × 1012/L to 4 (3.7-5.3) × 1012/L, p = 0.05, and serum ferritin increased from 106 (40-181) μg/L to 117 (83-166) μg/L, p = 0.04. N-terminal natriuretic propeptide (NT-proBNP) level decreased from 374 (330-443) ng/mL to 236 (128-349) ng/mL, p = 0.004. After treatment, exercise tolerance exercise tolerance improved: 6-minute walk test distance increased from 343.1 ± 100 m to 397±73 m (p = 0.01). Quality of life (QoL) level increased and was determined by the clinical status assessment scale (CAS), p = 0.01 and by the Minnesota Health Failure Questionnaire (MHFLQ), p = 0.002.

   Conclusion. Adding oral hepcidin- independent iron to standard HFpEF therapy in patients with CHFpEF and anaemia significantly increased hemoglobin and serum ferritin levels, exercise tolerance, and QoL scores while reducing NT-proBNP levels and NYHA functional class after three months.

   Aim. To assess the contribution of extremely elevated Lipoprotein(a) [Lp(a)] level to cardiovascular risk stratification using the SCORE-2 scale and the likelihood of familial hypercholesterolemia (FH) diagnosis.

   Material and methods. A retrospective cohort study included 45 patients (25 men) with hyperlipoproteinemia(a) from the federal registry "RENESSANS." Participants were over 40 years old and had Lp(a) levels ≥180 mg/dL. The diagnosis of heterozygous FH was confirmed using the Dutch Lipid Clinic Network (DLCN) criteria. Low-density lipoprotein cholesterol (LDL-C) levels were adjusted using Friedewald formula modified by Dahlen. Cardiovascular risk (SCORE-2) was calculated considering LDL-C levels before and after adjustment.

   Results. Among the 45 patients, the LDL-C level calculated using Friedewald formula was 5.1 [3.17; 7.19] mmol/L. After adjustment with Dahlen’s modification, the LDL-C level decreased to 3.03 [1.54; 4.96] mmol/L, representing a significant reduction (by 2.07 mmol/L or 40.6 %, p < 0.001). Adjusted LDL-C levels affected the FH diagnosis in 8 (26 %) out of 31 patients. Incorporating Lp(a) into the SCORE-2 risk assessment significantly increased cardiovascular risk estimates. The median SCORE-2 value initially was 14 % [7; 20], which increased to 27.2 % [13.6; 54.5] after adjustment, representing a 94 % increase (p < 0.005).

   Conclusion. Including Lp(a) in routine cardiovascular risk assessment and FH diagnosis is an important addition for more accurate risk stratification and appropriate pharmacological management. In patients with extreme hyperlipoproteinemia(a), LDL-C levels may be overestimated compared to true values, potentially affecting the accuracy of FH diagnosis and treatment strategies. Future multicenter studies should include larger and more diverse populations to validate these findings.

   Aim. To evaluate the frequency and characteristics of self-medication in patients with cardiovascular diseases within the Chuvashia Inappropriate Prescribing Study (CHIP) Registry.

   Material and methods. The CHIP study is a cross- sectional study, which consistently included patients over the age of 50 who applied to a cardiologist at the outpatient clinic of the Republican Cardiological Dispensary. Exclusion criteria: presence of mental illnesses, oncological diseases detected less than 5 years ago, acute cardiovascular disorders within 6 months prior to treatment. The patient recruitment period is from 12/14/2023 to 08/07/2024. The physician conducted an examination, assessed drug therapy, adherence to it, and adjusted therapy in accordance with the clinical recommendations in force at the time of the study. The patients completed original adherence assessment questionnaires (the National Society for Evidence-based Pharmacotherapy Adherence Scale) and the pharmacotherapy features. This paper describes the research protocol and analyzes the data related to self-medication.

   Results. The study included 300 patients (120 men and 180 women), 120 (40 %) of them had self-medication. 140 types of medicines were included in the number of medicines taken by patients on their own. Since some of the patients took more than 1 drug, 164 cases of self-medication were identified. The following types of self-medication were identified: self-administration of an unspecified drug (38.4 %), self-administration of a contraindicated drug (0.6 %), self-administration of an indicated drug but not prescribed by a doctor (2.4%), duplication of drugs belonging to the same class (3.6 %), replacement of the prescribed drug with an analog (5.5 %), justified self-medication (use of both over-the-counter and prescription drugs; 23.2 %), independent symptomatic use of over-the-counter drugs, which is not justified (26.3 %). When evaluating the results of self-medication, 7 (4.3 %) cases were identified when it led to the creation of a potentially dangerous combination of drugs. When duplicating drugs in 2 (1.2 %) cases, their combination was irrational. The replacement of the drug in 4 (2.4 %) cases was nonequivalent. There were no statistically significant differences between patients in the groups with and without self-medication, except for the presence of a history of acute cerebrovascular accident: among these patients, there were significantly fewer of those who took medications on their own.

   Conclusion. In the CHIP registry, 40% of patients observed by a physician for cardiovascular diseases independently took drugs (both over-the-counter and prescription) together with or instead of the therapy prescribed by their physicians. Self-administration of an unspecified drug was the most common type of self-medication in CHIP register patients (38.4 %). In 4 % of cases, potentially dangerous drug combinations were the consequence of self-medication.

   International experience in implementing specialized programs into clinical practice — programs that assist healthcare professionals in applying evidence-based treatment outlined in clinical guidelines (CG) — confirms the effectiveness of this approach. It demonstrates significant, sustained improvement in healthcare quality, improved treatment outcomes, and reduced adverse events. An integral part of such programs are special tools (indices, checklists, scales) that enable evaluation of treatment quality, including pharmacotherapy (PhT), and monitoring adherence to CG. Since 2018, in the Russian Federation, CG have been legally recognized as regulatory documents governing the provision of medical care. Since January 2025, a phased transition to mandatory compliance with CG provision across all levels of healthcare has been completed. Given that PhT is the most common type of medical intervention, there is an increasing need to develop and implement quality indicators for PhT. These indicators would assess alignment of prescribed treatments with CGs and must be integrated into clinical practice. The article discusses international and domestic PhT quality control tools that have been developed and tested to date. The use of these indices as independent tools for quality control systems or as part of comprehensive electronic programs for medical decision- making and self-examination of prescriptions by attending physicians seems to be a very promising area in the field of healthcare and requires further study, development, and implementation into practice.

   The no-reflow phenomenon remains a significant challenge in the management of myocardial infarction, despite advances in reperfusion therapy, including widespread use of primary percutaneous coronary intervention (PCI). This condition, characterized by inadequate microcirculation following the restoration of coronary blood flow, significantly worsens clinical outcomes by increasing the risk of heart failure and mortality. The advent of advanced diagnostic modalities, such as magnetic resonance imaging (MRI) and dynamic myocardial scintigraphy, has enabled more precise assessment of microcirculatory disturbances, offering a better understanding of the mechanisms underlying no-reflow and facilitating targeted prevention strategies. Preventive measures include prolonged stent ballooning, antithrombotic agents (e. g., IIb/IIIa inhibitors and intracoronary thrombolysis), and the use of nicorandil. Nicorandil, with its vasodilatory and cytoprotective properties, has shown promising results in improving angiographic and surrogate markers of reperfusion. However, treating established no-reflow remains a formidable challenge, as current interventions primarily improve surrogate markers (e.g., TIMI flow and ST-segment resolution) without significantly affecting long-term clinical outcomes. The most effective treatments for refractory no-reflow include nicorandil and epinephrine, with the latter demonstrating robust coronary vasodilation and improved coronary blood flow, as well as a reduction in microvascular obstruction volume. Future research directions involve the exploration of monoclonal antibodies capable of selectively blocking key inflammatory pathways and the use of hyperoxemic reperfusion. Nonetheless, additional clinical trials are required to confirm the efficacy and safety of these approaches. Thus, the search for optimal therapeutic solutions for managing no-reflow remains a critical priority, demanding further investigation to improve outcomes for myocardial infarction patients.

   The article is dedicated to the perioperative management of patients with non-valvular atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) and undergoing elective surgical interventions or invasive procedures. It discusses key factors influencing the strategy for discontinuing and resuming anticoagulant therapy, including the classification of surgical procedures by bleeding risk, type of anesthesia, creatinine clearance, and the pharmacokinetic properties of specific DOACs. A standardized algorithm is presented to determine the optimal timing for discontinuation and resumption of anticoagulants. The detailed analysis of possible clinical scenarios, such as endoscopic cholecystectomy, tooth extraction, radical prostatectomy, and knee arthroplasty is described. Practical recommendations for perioperative management are offered for each case, considering individual patient characteristics, the risk of thromboembolic and hemorrhagic complications, and the need for venous thromboembolism (VTE) prophylaxis. Special attention is given to challenges in real-world clinical practice, such as a lack of coordination between specialists, differences in the interpretation of guidelines, and the absence of standardized in-hospital protocols. The importance of a multidisciplinary approach is emphasized to ensure balanced decision-making. It highlighted the necessity of an individualized approach when deciding on the discontinuation and resumption of anticoagulant therapy, as well as the importance of standardized protocols to enhance patient safety in AF management. It is recommended to consider the pharmacokinetic properties of the drugs, patient- specific factors, and the planned procedure, along with potential risks. The use of clear algorithms and active multidisciplinary collaboration among clinicians can help minimize both thromboembolic and hemorrhagic complications in the perioperative period.

   A clinical case of Q-myocardial infarction (MI) of the lower wall of the left ventricle in a 71-year-old patient with a history of MI in the presence of chronic occlusions of the right and circumflex coronary arteries (CA), extended narrowing of the intermediate branch in the upper and middle segments from 50 % to 80 % and stenosis of the anterior interventricular artery in the upper the 99% segment is described. Upon admission to the hospital, the patient’s ECG revealed a completely right bundle branch block and ST-segment elevation of up to 0.5 mm in lead III against the background of sinus rhythm. The diagnosis of myocardial infarction was confirmed by a diagnostically significant high-sensitivity troponin I level. The refusal of attempts to stent chronic occlusions of the right and circumflex CA and stenting of the proximal anterior interventricular artery led to relief of pain, stabilization of the patient’s condition and subsequent discharge from the hospital. Echocardiography at discharge revealed akinesia and mild bulging of the upper half of the left ventricular (LV) inferior wall, severe hypokinesia of the upper and middle thirds of the LV posterior wall, and hypokinesia of the upper third of the LV inferoseptal wall. The LV ejection fraction (Simpson’s method) was 44-45 %. The clinical case presented in the article demonstrates the importance of the correct management tactics for patients with distant MI, when the correct choice of infarct- related CA and its stenting led to a favorable outcome in an elderly patient with severe multivessel CA lesion and developed recurrent Q-lower distant MI.

   Myocardial injury in COronaVIrus Disease 2019 (COVID-19) mainly occurs in young and middle-aged men and is associated with severe course, unfavorable prognosis and high hospital mortality, especially in combination with elevated troponin and brain natriuretic peptide (BNP) levels. Cardiovascular manifestations may occur in the acute period of the disease or later, have short-term (cardiogenic shock, tachyarrhythmias, acute heart failure) and long-term consequences (transformation into dilated cardiomyopathy, chronic heart failure), ultimately contributing to adverse outcomes. We present a clinical case of a young male admitted to the intensive care unit with the acute left ventricular failure (pulmonary edema). The examination revealed elevated myocardial injury markers, dilation of all heart chambers, and reduced left ventricular ejection fraction (LVEF) to 30%, indicating myocardial dysfunction. Increased pro-inflammatory markers confirmed its inflammatory origin. A significantly elevated N-terminal pro- BNP (NT-proBNP) level and clinical signs of pulmonary edema indicated acute left ventricular failure (Killip III). The background disease: severe COVID-19 complicated by inflammatory cardiomyopathy, acute heart failure Killip III. Due to timely initiated pathogenetic therapy, the patient’s condition was stabilized and a fatal outcome was avoided despite the poor prognosis. Three-month post-discharge follow-up revealed positive trends, including thrombus resolution in the cardiac cavity, disappearance of inflammation signs, and a slight increase in LVEF, suggesting gradual regression of myocardial injury.