Aim: to evaluate the diagnostic and prognostic role of the MELD-XI index in hospitalized patients with CHF.

Material and methods: The prospective study included 182 patients (92 men and 90 women), age 72.3±12.1 years, hospitalized at Clinical Hospital No. 4 of the First Moscow State Medical University with the CHF class II-IV. All patients signed the informed consent and underwent a standard examination with determination of NTproBNP and calculation of the MELD-XI index = 5.11 (ln [total bilirubin, mg/dl]) + 11.76 (ln [creatinine, mg/dl]) + 9.44. The primary endpoint was death from all causes within 36±3 months.

Results: Based on the median MELD-XI index, 2 groups of patients were identified - high MELD-XI index>11.4 points (n=85 (47%)) and low - MELD-XI<11.4 points (n=97 (53 %)). Patients in the groups were comparable in age, comorbid diseases, and main classes of drug therapy received. Patients with a high MELD-XI index were characterized by a more severe course of stage IIB-III CHF and low LVEF (42.5[37; 50]% vs 52 [40; 60], p=0.0005).

All-causes death over 3 years of follow-up was 39.6%. In patients who reached the end point, regardless of their initial LVEF, MELD-XI index values ​​were significantly higher (12.2 [9.7; 15.2] points) compared to survivors (10,6 [8,2;12,8] points (p<0.001)). According to ROC analysis, the threshold value of the MELD-XI index for high risk of death was 11.4 points (sensitivity 62.73%, specificity 59.15% (AUC 0.634; p=0.03)). Regression analysis showed that MELD-XI index values ​​>11.4 points increase the risk of death by 2.3 times (OR: 2.345, 95% CI: 1.274-4.315, p = 0.006) and are independent significant predictors of poor prognosis, along with LVEF <40%, NT-proBNP and sST2 levels and community-acquired pneumonia. Each subsequent 1-point increase in MELD-XI score increases the odds of death by 1.157 times (OR: 1.157, 95% CI: 1.0616-1.261, p<0.01)

Conclusion: The MELD-XI score is a simple and reliable method for diagnosing multiple organ dysfunction in patients with CHF. MELD-XI index>11.4 points is a predictor of poor long-term prognosis in hospitalized patients with CHF.

Aim. To evaluate the contribution of arterial hypertension (AH), high lowdensity lipoprotein cholesterol (LDL-C) level and their combination to the development of (myocardial infarction) MI and stroke.

Material and methods. The analysis is based on data from 1 and 2 observations of ESSE-RF study (Epidemiology of cardiovascular diseases in various regions of the Russian Federation)". A multi-s tage cluster random sample was used, formed according to the territorial principle on the basis of medical and preventive institutions (health facilities). Socio-demographic data (gender, age, education, wealth), smoking status and medical history were determined. Blood pressure (BP) was measured twice, on the right arm, in a sitting position with an automatic blood pressure monitor. Blood samples and its derivatives (serum and plasma) were stored at a temperature of -70ºC. LDL-C value was also included into analysis (LDl- C ≥3 mmol/l). Prospective monitoring of new cases was carried out in the initial sample without patients with coronary artery disease, MI, and stroke. The median follow-up time is 7.5 years. The sample size was 19 794. 356 non-fatal cases were identified, including 222 cases of MI and 174 cases of stroke.

Results. The average age was 44.7 years, in men — 43.2, and in women — 45.3. The prevalence of isolated forms of hypertension, high LDL-C level and its combination were 12.7%, 30.3% and 32%, respectively. It was revealed that the age was the lowest in healthy and those with an increased LDL-C, whereas those with hypertension and combined conditions were older. The risk of nonfatal cases of MI and stroke in the Cox models, was adjusted for gender, age and region. There was a significantly higher risk of new cases of nonfatal CVD in individuals with isolated hypertension compared with those with isolated LDL-C.

Conclusion. The frequency of isolated AH and isolated LDL-C were 13% and 30%, respectively. The combined condition was detected in 30%. The presence of AH, isolated LDL-C and their combinations in the sample doubled the risk of new CVD events.

Aim. To study the long-term effects of complex therapy with the addition of enhanced external counterpulsation (EECP) in patients with stable coronary artery disease (CAD) complicated by chronic heart failure (CHF).

Material and methods. In the open randomized trial EXCEL (NCT05913778), 118 Patients with the verified ischemic CHF NYHA class II-III with reduced or intermediate left ventricular ejection fraction were included. They were randomized into group 1 (n=59) — optimal medical therapy (OMT) and EECP (35 hours, 2 courses per year), group 2 (n=59) — OMT and EECP (35 hours, 1 course per year). The primary endpoint was the proportion of patients with a 6-minute walk test (6MWT) increase of at least 20% from baseline. The secondary composite endpoint included adverse cardiovascular clinical outcomes (myocardial infarction, revascularization, stroke, death), new cases of atrial fibrillation, diabetes mellitus, decreased renal function, and hospitalizations for CHF.

Results. The average CHF NYHA class decreased in group 1 from 2.41±0.49 initially to 1.95±0.47 after 24 months (p<0.001), and in group 2 from 2.37±0.49 to 2.19±0.43, respectively (p=0.021; p<0.001 for intergroup differences). The proportion of patients with an increase in distance walked during 6MWT >20% (primary endpoint) in groups 1 and 2 after 24 months was 98.3% (n=58) and 79.7% (n= 46) respectively (p<0.001). Cumulative event-free survival in group 1 was significantly higher than that in group 2 (88.1% versus 66.1%; Chi² = 7.792, p = 0.005). In group 1, compared with group 2, the chances of combined endpoint development were 4.2 times lower (odds ratio 0.263, 95% confidence interval 0.101-0.683; p=0.006), and failure to achieve the primary endpoint (increased distance walked in 6MCT >20%) — 16.4 times lower (odds ratio 0.061, 95% confidence interval 0.008-0.484; p=0.009).

Conclusion. Over the 24-month study period, the effect of EECP in patients with coronary artery disease complicated by CHF demonstrated a stable improvement in exercise tolerance, as well as a decrease in the incidence of adverse clinical outcomes, significantly more pronounced in the group with a large number of EECP procedures

Aim. To compare the clinical effectiveness of two patient management programs for 12 months after myocardial infarction (MI) (standard outpatient monitoring and office- based management with additional active remote medical supervision).

Material and methods. 150 patients with non-fatal MI aged 35 to 70 years were included. At discharge, patients were randomized into groups with different followup programs for 12 months after MI (standard outpatient follow-up (n=75) or its combination with active remote patient monitoring (n=75)). One year after MI, the following parameters were was assessed: vital status, frequency of emergency cardiovascular hospitalizations due to coronary insufficiency, actual adherence to therapy and regular outpatient follow-up, achieving target parameters of cardiovascular health, and dynamics of behavioral risk factors.

Results. In the group of patients with MI who spent 12 months in a combined program, compared with patients with standard monitoring, 4.8 times fewer combined ischemic events were registered (p<0.001); the proportion of emergency hospitalizations for cardiovascular reasons was 4.7 times lower (p<0.001). It was shown that patients observed in a combined program throughout the year were 1.7 times more likely to make regular visits to the clinic (p<0.001). Over a year, patients with active remote monitoring were more likely to achieve behavioral changes: the proportion of patients reporting an increase in weekly physical activity (p=0.013) and a decrease in the number of periods of monthly stress or their complete absence from work and/or home was 1.6 times higher (p=0.020), who were 1.8 times more likely to indicate a decrease in the frequency of monthly alcohol consumption and a decrease in the number of servings (p=0.001), as well as changes in dietary patterns. Patients who underwent additional remote patient monitoring were 1.2 times more likely to indicate a decrease in daily consumption of table salt (p = 0.011), 1.3 times more likely to note the addition of dietary meat to the diet (p=0.003), 1.1 times more likely to more often — fresh and cooked vegetables (>300 g per week) (p=0.032), 1.4 times more often — fresh fruits and berries (>300 g per week) (p=0.003), 1.2 times more often reported about reducing the consumption of complex carbohydrates to > ¼ of the plate per day (p=0.036).

Conclusion. An original program of combined standard outpatient monitoring of patients and their active remote monitoring for 12 months after MI demonstrated advantages in secondary prevention of cardiovascular events and modification of cardiovascular risk factors.

Aim. To study possible causes of dyspnea in patients with stable coronary artery disease (CAD).

Material and methods. 101 patients with stable CAD and paroxysmal dyspnea who underwent inpatient treatment in the cardiology department were included in the observational study. The following parameters were analyzed: presence and severity of dyspnea, angina pectoris, chronic heart failure (CHF), anxiety and/or depression, results of physical examination, electrocardiography,laboratory tests (levels of high sensitive cardiac troponin, natriuretic peptide and thyroid-s timulating hormone in the blood), a 6 minute walk test, multispiral computed tomography or chest X-ray, Holter monitorechocardiography, stress echocardiography with a treadmill load, spirometry with a bronchodilation test, as well as coronary angiography, which was performed in the detection of myocardial ischemia were.

Results. Transient myocardial ischemia as a cause of dyspnea was diagnosed in 36 patients (35.6%). At the same time, chest pain during stress echocardiography was noted only in 5% of cases. In addition to myocardial ischemia, the following possible causes of dyspnea were found: CHF with preserved left ventricular ejection fraction (EF) in 76 patients (75.2%), obesity — in 34 (33.7%), anxiety — in 33 (32.7%), valvular pathology — in 28 (27.7%), pulmonary ventilation disorders — in 21 (20.8%), depression — in 20 (19.9%), cardiac rhythm and conduction disorders — in 9 (8,9%), thyroid dysfunction — in 7 (6.9%), CHF with mildly reduced EF — in 7 (6.9%), CHF with reduced EF — in 2 (2.0%), anaemia — in 2 (2.0%). The potential cause of dyspnea was not established in 2 patients (2.0%). One cause of dyspnea was diagnosed in 8.9%, a combination of two causes — in 38.6%, three — in 25.7%, four — in 15.8%, five — in 6.9%, six causes — in 1% of participants. Dyspnea commonly was associated with transient myocardial ischemia combined with CHF with preserved EF (17%), as well as CHF with preserved EF and valvular pathology (13.9%).

Conclusion. The obtained results confirm the variety of possible causes of dyspnea in patients with stable CAD, as well as the fact that transient myocardial ischemia is not the most common cause of dyspnea in this category of patients and in many cases is combined with other disorders accompanied by similar symptoms.

Aim. To study the effect of dietary supplements containing omega-3 polyunsaturated fatty acids (Omega-3 PUFAs) on the parameters of ambulatory blood pressure monitoring (ABPM), 24-hour electrocardiogram (HM-ECG), and lipid profile in postmenopausal women.

Material and methods. The study involved 95 postmenopausal women with a mean age of 55.9±6.0 years, without cardiovascular complications, type 2 diabetes mellitus and atrial fibrillation/flutter. The patients were divided into the main group (n=49; dietary supplement with Omega-3 PUFAs 1 g 2 times/day — content of Omega-3 PUFAs at least 30%) and the placebo group (n=46; taking capsules with vegetable oil). 17 (34.7%) patients from the main group and 18 (39.1%) patients from the placebo group took constant antihypertensive therapy, 7 (14.3%) of patients from the main group and 7 (15.2%) patients from the placebo group took constant lipid- lowering therapy. The patients did not undergo any adjustment of antihypertensive and lipid-l owering therapy during observation. The patients underwent 24-hour blood pressure and electrocardiogram monitoring, and a lipid profile evaluation at the initial visit and after 3 months.

Results. It was statistically registered a significant decrease in average daily diastolic BP according to ABPM data by 1.8 mmHg. Art. (p=0.03), as well as the average daily heart rate according to HM-ECG data by 1.9 beats per minute (p=0.04) in the main group after 3 months. LDL levels tended to decrease (p=0.07) in the mail group. There were no statistically significant changes in the average daily systolic blood pressure according to ABPM, the number of supraventricular and ventricular heart rhythm disturbances, or the lipid profile (TC, LDL, triglycerides, HDL) in both groups.

Conclusion. The dietary supplements containing Omega-3 PUFAs in postmenopausal women significantly reduces the level of daily diastolic blood pressure and daily heart rate without significant effect on lipid profile.

Aim. To describe and analyze a series of cases of absolute non-adherence to treatment (ANA), as well as to study the relationship of the phenomenon of refusal of treatment with long-term adverse outcomes in patients with acute cerebrovascular accident (ACVA), according to the LIS-2 registry (Lyubertsy Mortality Study 2).

Material and methods. The study analyzed the results of two stages of prospective follow-up of patients with acute cerebrovascular accident included in the  LIS-2 registry (n=960). After 2.8 [2.1; 3.5] years, an examination, a survey, and an assessment of treatment adherence according to the original questionnaire were conducted in 370 patients. After 6.9 [6.1;7.7] years, the outcomes of these patients were evaluated. The survival analysis included death from all causes, nonfatal myocardial infarctions and repeated ACVA, and emergency hospitalization for cardiovascular diseases also. These are the components of the primary combined endpoint.

Results. According to the results of the questionnaire, 23 (6,2%) patients replied that they did not take prescribed medications, i.e. they were absolutely not adherent to treatment. Absolutely non-adherent patients smoked more often (p=0.004), were less comorbid, and had statistically significant difference in hypertension and coronary heart disease (CHD) (p<0.001 and p=0.03, respectively). The most common reason for ANA was unwillingness to take medications for a long time (n=12, 52,2%), the second most common reason was fear of drugs side effects and harm to health during long-term treatment (n=5, 21.7%). The components of the primary combined endpoint were registered in 10 (43.5%) absolutely non-adherent patients and in 104 (30.0%) people of the rest of the group. There was a discrepancy in the Kaplan-M ayer survival curves for the groups of absolutely non-adherent and all other patients, which did not reach statistical significance (p=0.12), as well as an increased risk of adverse long-term outcomes (hazard ratio, HR) in patients who completely refused treatment: HR=1.68, 95% confidence interval (CI) 0.87-3.21, p=0.12 (univariate Cox analysis). According to the results of multivariate Cox regression analysis, the predictors significantly associated with an increase in the risk of endpoints were ANA (HR=2.66, 95% CI 1.06;6.68, p=0.037); presence of coronary heart disease (HR=2.18, 95% CI 1.13;4.24, p=0.021); increase in age for each year (HR=1.08, 95%CI 1.04;1.12, p<0.0001).

Conclusion. The phenomenon of complete treatment refusal or ANA was noted in 6% of cases in patients with ACVA. Its leading cause was the reluctance of patients to take medications for a long time. In patients with ACVA it has been shown that the presence of CHD and complete refusal of recommended treatment increases the risk of adverse long-term outcomes by more than two times.

The results of studies investigating the clinical effects of cardiac rehabilitation (CR) in patients after acute myocardial infarction (MI) and cardiovascular surgery are discussed. It is known that CR programs vary in duration and dose (number of training sessions) across different countries. Systematic analysis of studies evaluating the clinical effectiveness of the program depending on its duration is relevant. The results of studies aimed at determining the minimum number of training sessions that can lead to a reliable increase in physical performance are also described. The analysis of studies on patients’ adherence to rehabilitation programs and its impact on the final clinical effects of CR is presented. It is shown that the most noticeable result is observed when patients participate in 80% or more of the required training sessions. Patients’ high adherence to physical training (PT) depends on many reasons. In this review we describe groups of patients with low adherence to PT. One of the important conditions for maintaining adherence to CR is a high-quality approach in management of such patients, giving a clearly noticeable favorable clinical effect. At the present stage, there is a need for individualization of CR strategy and transition to new forms of CR (home rehabilitation, tele-rehabilitation, etc.). When applying different "new models" of CR, it is important to maintain their high clinical efficacy.

Aim. To analyze demographic, anamnestic and clinical parameters in subjects with coronary artery disease (CAD) or peripheral artery disease (PAD) included in the XATOA study from Russian centers and to compare them with the total population of the international registry.

Material and methods. XATOA study is an international, multicenter, prospective registry, where characteristics of patients receiving dual pathway inhibition therapy with rivaroxaban 2,5 mg twice a day and low-dose acetylsalicylic acid (ASA) daily were analyzed. The secondary endpoint of the study was to assess clinical outcomes and bleeding rates in real world setting.

This analysis was based on the comparison of indicators presented in tables of descriptive statistics from the XATOA study database for subjects from Russia and the general study database respectively. The methodology of this sub-analysis is descriptive only and does not imply any statistical difference assessment.

Results. The Russian population included 795 subjects: 232 (29.2%) subjects with CAD; 293 (36.9%) subjects with PAD and 270 (34.0%) subjects with both. The average follow-up period was 14.4 months. The most common antithrombotic treatment regimen for patients with CAD or PAD prior enrollment in the registry was ASA monotherapy (81.3%); ACE inhibitors/ARBs were prescribed in 61.8%, lipid-l owering therapy in 68.9%. After the enrollment and prescription of rivaroxaban 2.5 mg BID + ASA, the incidence of myocardial infarction, stroke or cardio-v ascular death in subjects in the Russian Federation remained at 1.9%, and the incidence of major adverse limb events (MALE) at 0.8%, which corresponds to the results obtained in the COMPASS randomized controlled trial. Major bleeding was reported in 1 subject (<0.1%). Adherence to the therapy among subjects in the Russian Federation amounted to 89.8%.

Conclusion. Despite the increased incidence of concomitant diseases and insufficient use of routine cardiovascular therapy in subjects with CAD or PAD in the Russian Federation, the ischemic complications rate remains at a relatively low level while using antithrombotic treatment with rivaroxaban 2.5 mg twice a day + ASA 100 mg a day.

Non-syndromic mitral valve prolapse (MVP) is a common disease. In most cases, its benign course is noted, however, a connection between MVP and ventricular arrhythmias is reported, as well as sudden cardiac death. Clinical signs (chest pain, syncope/lipotymia, mid-systolic click), results of instrumental studies (electrocardiographic, echocardiographic, magnetic resonance imaging) allow us to identify known ("old") risk factors and new phenomena encountered in rhythm and conduction disturbances during MVP. Signs of "arrhythmic" MVP, often detected in young women, include prolapse of thickened both mitral valve leaflets, T wave inversion in the inferior basal leads on the electrocardiogram, annulus fibrosus disjunction, fibrosis of the papillary muscles and myocardium in the inferior basal wall of the left ventricle, determined by magnetic resonance imaging. resonance tomography and myocardial biopsies. In 2022, the European Heart Rhythm Association Expert Consensus presented risk stratification and treatment principles for patients with arrhythmic MVP, identifying low, intermediate and high-risk groups, and in 2024, the first meta-analysis of studies was performed to identify prognostic risk factors of arrhythmic MVP. The most significant predictors of arrhythmias included late gadolinium enhancement on magnetic resonance imaging, T-wave inversion on the electrocardiogram, prolapse of both mitral valve leaflets, and mitral annulus disjunction. When choosing treatment for patients with arrhythmic MVP, clinical characteristics are taken into account and a personalized approach is used to prevent sudden cardiac death and severe ventricular arrhythmias. As a rule, to prevent sudden cardiac death in patients with arrhythmic MVP, four treatment options are considered: medications (beta-blockers or non-dihydropyridine slow calcium channel blockers, a combination of a beta-blocker and flecainide, or amiodarone), radiofrequency ablation, surgical treatment of the mitral valve, implantable cardioverter — defibrillator (for primary or secondary prevention of sudden cardiac death).

The rationale for surgical, electrophysiological, and/or therapeutic treatments depends on the specific rhythm disorder.

In recent years, it has been shown that sodium-g lucose co-transporter type 2 inhibitors (SGLT2), drugs for type 2 diabetes mellitus treatment, significantly improve metabolic parameters and have protective effect on the kidneys and heart not only in patients with type 2 diabetes mellitus. New research indicates that the progression of chronic heart failure (CHF) and chronic kidney disease (CKD) involves metabolic reprogramming, which consists of a deterioration in energy metabolism in the heart as a result of a mismatch between glucose uptake and its oxidation, leading to the accumulation of glucose-6-phosphate (G6P), glycogen and activation of the pentose phosphate pathway. This nutrient excess activates the mammalian target of rapamycin (mTOR), thereby promoting pathological myocardial remodeling, and at the same time suppresses the nutrient deficiency sensors SIRT1, AMPK and PGC-1α, which is accompanied by mitochondrial dysfunction, increased oxidative stress and decreased fatty acid oxidation. Similar processes occur in the proximal convoluted tubules of the kidneys in CKD, leading to renal dysfunction, albuminuria, and interstitial fibrosis. SGLT2 inhibitors inhibit the reabsorption of sodium and glucose in the proximal tubule, which leads to increased urinary glucose excretion and moderate osmotic diuresis and natriuresis. Nutrient deficiency resulting from glucose excretion promotes the activation of AMPK, which is involved in the regulation of mitochondrial biogenesis by stimulating PGC-1α, stimulates catabolic metabolism and activates autophagy by inhibiting mTORC1, which is accompanied by antiinflammatory effects, reduced oxidative stress and apoptosis and increased autophagy. These processes are accompanied by a decrease in blood pressure and a decrease in the load on the myocardium, with a simultaneous decrease in the tone of the sympathetic nervous system. Taking SGLT2 inhibitors is accompanied by normalization of tubuloglomerular feedback and a decrease in hyperfiltration, which has a beneficial effect on glomerular hemodynamics, as well as stimulation of erythropoiesis as a result of simulating systemic hypoxia. The described processes may serve as the basis for the cardioprotective and nephroprotective effects of SGLT2 inhibitors.

The immune checkpoint inhibitors (ICTs) emergence has opened up new perspectives in cancer immunotherapy. Nevertheless, serious, including life-threatening conditions caused by ICT cardiotoxic effects pose a number of obstacles to clinical specialists. The lack of knowledge about pathophysiology of cardiovascular adverse events in the treatment of ICT tumors is one of the reasons why oncological specialists seek help from cardiologists. Some works consider the mechanisms of individual complications development, but the number of works that would systematize and summarize descriptions of all the most significant ICT inhibitor therapy complications is small. In this regard, a literature review on the use of ICT inhibitors was conducted with a search in PubMed, Embase, Web of Science, e-L ibrary, Google Scholar. The purpose was to analyze the accumulated data on the mechanisms of ICT therapy complications development; Preference was given to systematic reviews, randomized clinical trials, which would be supplemented by separate cohort studies and descriptions of some experiments. Thus, it was determined that the ICT inhibitors cardiotoxicity can affect any part of the cardiovascular system, causing changes in both inflammatory and non-inflammatory etiology. Understanding their mechanisms increases the ability of specialists to form an effective treatment strategy while minimizing the risk of complications. Although a lot of theoretical, experimental and clinical empirical data on the side effects of this class of anticancer drugs have been accumulated in oncological practice, the ICT inhibitors cardiotoxicity is a problem requiring further research.