Pulmonary arterial hypertension (PAH) associated with connective tissue diseases is a lifethreatening condition in which elevated pressure in the pulmonary vasculature leads to a marked increase in right heart afterload, causing severe right ventricular failure and premature death. PAH is most frequently associated with systemic sclerosis and systemic lupus erythematosus. Polymyositis is a rare autoimmune disease resulting from aberrant activation of cytotoxic Tlymphocytes and macrophages against autologous muscle tissue, leading to inflammatory myopathy. In polymyositis, the inflammatory process may involve the vascular bed (small pulmonary artery vasculitis), which can lead to PAH. PAH in polymyositis is an extremely rare entity. This article presents a clinical observation of a patient with idiopathic polymyositis who developed a fatal complication — PAH — over several years. Key diagnostic aspects, clinical course features, and characteristic signs of the disease are demonstrated. The need for a multidisciplinary approach in managing patients with this condition is emphasised, and the importance of accumulating data on pulmonary hypertension in polymyositis is highlighted
Aim. To study quantitative and morphological parameters of myocardial injury using cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement in patients with acute myocardial infarction and to identify factors associated with scar zone size.Material and methods. The single-centre observational study included 202 patients (91% men) with ST-segment elevation (86%) and non-ST-segment elevation (14%) MI, aged 57 (50; 61) years. Primary percutaneous coronary intervention was performed in 136 patients (67%), and pharmacoinvasive revascularisation was performed in 66 patients (33%). On days 7–10, examination was performed, including echocardiography (Echo) and magnetic resonance imaging (MRI) of the heart with contrast. Based on cardiac MRI results patients were divided into three groups: Group 1 — 43 patients with LV scar burden of <5% or its absence: Group 2 — 83 patients with LV scar burden of 5-20%; Group 3 — 76 patients with LV scar burden of >20%. One-factor logistic regression analysis was used to identify variables that help diagnose different scar sizes.Results. Patients in Group 3 were more likely to have type 2 diabetes mellitus compared to Group 2. Non-ST-segment elevation MI was more common in Group 1 compared to Groups 2 and 3 (p1-2,3 <0.05); pathological Q waves were diagnosed in Group 3 12.4 and 1.6 times more often than in Groups 1 and 2, respectively (p1-2,3;2-3 <0.001). It was also noted that Group 1 received thrombolytic therapy more quickly than Group 3 (p=0.032). Echo data revealed a predominance of indexed left ventricular (LV) volume parameters and the LV myocardial mass index in Group 3 compared to Groups 1 and 2, while the ejection fraction (EF) was minimal in Group 3 (p1,2-3 <0.05). MRI results revealed additional differences in the end-systolic volume index and LVEF between Groups 1 and 2. According to cardiac MRI results, the ratio of peri-infarction heterogeneous zone mass to the scar mass in Group 1 was 123.3 (81.3; 182.1) %, in Group 2 — 77.2 (57.8; 112.8) %, in Group 3 — 42.9 (29.4; 56.4) % (p1-2,3;2-3 <0.05). In Group 1, reperfusion injury was detected in only one patient (2.3%), in Group 2 — in 34.9% of cases, and in Group 3 — in 78.9% (p1-2,3;2-3<0.05). According to the regression analysis results, the following general significant indicators were found for the absence of a scar zone or SM/LVMM <5% and SM/LVMM >20%: high-sensitivity troponin I, N-terminal pro-brain natriuretic peptide; according to EchoCG data — end-systolic volume index, EF, LV myocardial mass index; according to MRI data — indexed volume indicators, EF, indexes of local contractility and global contrast.Conclusion. A small scar burden had no adverse effect on cardiac morphological or functional parameters in patients with acute myocardial infarction who had no detectable scar or only a minimal scar burden (scar mass/left ventricular myocardial mass <5%) on late gadolinium enhancement cardiac MRI. Type 2 diabetes mellitus and pathological Q waves on electrocardiography, elevated blood levels of high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide, as well as reduced left ventricular ejection fraction and increased left ventricular volumes assessed by echocardiography and cardiac magnetic resonance imaging, were associated with a greater scar burden (scar mass/left ventricular myocardial mass >20%).
Aim. To identify genetic variants associated with the risk of developing anthracycline-induced cardiovascular toxicity during antitumor therapy in patients with follicular lymphoma.Material and methods. The prospective study included 83 patients diagnosed with non-Hodgkin B-cell follicular lymphoma who received chemotherapy. Based on the results of follow-up standard and speckle-tracking echocardiography, the patients were divided into 2 groups: Group 1 — median age 59.0 (51.5; 69.0) years old, of which 44.1% were men (n=15), Group 2 — median age 55.0 (47.0; 66.5) years old, of which 55.1% were men (n=27)). Clinical, demographic, and laboratory assessments were performed, including high-throughput sequencing.Results. Minor alleles of rs2072708, rs2072710, rs2075939 NCF4, rs1443638, rs2306422, rs72547284, rs11661275 CELF4, CYBA, and FHOD3; rs246232 ABCC1; rs3749442 ABCC5 are associated with an increased risk of anthracycline-induced cardiovascular toxicity. Minor alleles of rs2233260, rs3833910, rs7232329, rs8096379, rs200571909, rs625223, rs2566514 MYL2, MYOM1, NEB and NOS3; rs1128503, rs2032582, rs2214102, rs2235013, rs2235033, rs4728699 ABCB1; rs212088, rs35604 ABCC1; rs1056892 and rs2835286 CBR3; rs1549758 NOS3, rs3731750 TTN is associated with a reducedlikelihood of complications.Conclusion. This study identified several novel genetic variants associated with the risk of cardiovascular toxicity, highlighting the potential for developing personalised approaches to anticancer therapy.
Aim. To characterise the clinical-laboratory profile of adults with type 1 diabetes (T1D) hospitalised for diabetic ketoacidosis (DKA) and to assess echocardiographic parameters according to DKA severity and the presence of acute myocardial injury.Material and methods. The single-center cross-sectional study included 160 patients aged 18 years and older with T1DM presenting with DKA. Based on DKA severity, patients were classified into mild (n=31), moderate (n=94), and severe (n=35) groups; additionally, patients were stratified by the presence or absence of AMI into AMI «positive» (n=90) and AMI «negative» (n=70) groups. Within the first 24 hours of hospitalisation, clinical evaluation, assessment of SOFA, APACHE II, and Glasgow Coma Scale scores, laboratory tests (glucose, HbA1c, high-sensitivity troponin I, N-terminal pro-brain natriuretic peptide, creatinine, urea, C-reactive protein, acid-base status parameters, lactate), as well as standard and speckle-tracking echocardiography were performed.Results. In 72.0% of patients, DKA developed in previously diagnosed type 1 diabetes with poor treatment adherence, whereas in 28.0% it occurred at disease onset. Severe DKA was associated with longer diabetes duration (p=0.015), hemodynamic instability, higher APACHE II scores, lower Glasgow Coma Scale scores, and myocardial injury in all patients of this subgroup (p<0.001). Compared with injury-negative patients, the injury-positive group had longer diabetes duration (p=0.038), lower blood pressure, higher heart rate, more severe acidosis, and higher troponin I, NT-proBNP, creatinine, urea, glucose, and lactate levels (all p<0.001). Echocardiography showed higher left ventricular ejection fraction (p<0.001), larger indexed left atrial volume (p=0.007), less negative global longitudinal strain and right ventricular strain (both p<0.001), and lower global work efficiency (p<0.001), TAPSE (p=0.048), and peak atrial contraction strain (p=0.005). In the multivariable model, admission glucose (OR 1.08; 95% CI 1.00-1.16; p=0.04) and anion gap (OR 1.31; 95% CI 1.16-1.48; p<0.001) remained independently associated with myocardial injury.Conclusion. DKA severity in adult patients with T1DM is accompanied by worsening metabolic and hemodynamic disturbances and an increased incidence of AMI. The presence of AMI is associated with alterations in myocardial deformation parameters and right heart function, despiteb preserved or increased left ventricular ejection fraction.
Aim. Тo evaluate the bioequivalence of Valsartan + Indapamide 160 mg + 1.5 mg modified release tablets developed by Gedeon Richter Polska Sp. z o. o. (Poland) compared to the reference products Diovan® (Siegfried Barbera S.L. (formerly Novartis Farmaceutica S.A.), Spain) coadministered with Arifon® Retard (Servier RUS LLC, Russia).Material and methods. Three randomised, single-centre, open-label, crossover studies with two sequences were conducted in a population of healthy adult volunteers of both sexes aged 18–45 years who met the inclusion criteria and had no exclusion criteria. Study A included four periods assessing single-dose administration under fasting conditions (n=56), Study B included two periods assessing single-dose administration under fed conditions (n=52), and Study C included two periods assessing multiple-dose administration under fasting conditions (n=52). The washout period was at least 14 days between all periods. Plasma concentrations were determined using validated analytical methods of high-performance liquid chromatography and tandem mass spectrometry. However, as valsartan was not modified release its exposure was not measured in all studies. Pharmacokinetic parameters including AUC0-inf, Cmax and AUC0-t in study A and B, and AUC0-τ, Cmax,ss and Cτ,ss in study C were determined using non-compartmental analysis. Bioequivalence was concluded if the 90% confidence intervals for the test/reference ratios of given parameters fell within the 80.00-125.00% range, except for Study A valsartan Cmax parameter, where the range was widened to 78.05-128.13%.Results. In Study A, the GMRs for AUC0-t and Cmax were 105.97% and 108.15% for indapamide and 104.07% and 104.15% for valsartan, respectively.In Study B, GMRs for the specified parameters for indapamide were 101.03% and 96.47%. In Study C, the GMR values for AUC0-τ and Cmax,ss were 109.69% and 111.75% for indapamide. All 90% confidence intervals were within the predefined bioequivalence limits. The drug was well tolerated. Only mild and well-known treatment-emergent adverse events were reported, without any treatment discontinuation. Conclusions. The fixed dose combination of valsartan and indapamide 160 mg + 1.5 mg, modified released tablets manufactured by Gedeon Richter Polska Sp. z o. o. is bioequivalent to Diovan® co-administered with Arifon® Retard, and is safe and well tolerated. The results support the use of this fixed dose combination as an effective alternative to the concurrent administration of the reference products for the treatment of hypertension
Aim. To identify risk factors of in-hospital mortality in patients with hyponatremia in a cardiology hospital setting.Material and methods. This single-center retrospective study included 119 patients (mean age 71.2±12.7 years) admitted to a cardiology center from June 2024 to March 2025, who had at least one recorded instance of hypotonic hyponatremia (sodium level <135 mmol/L). Patients with acute coronary syndrome and myocardial infarction were excluded. Statistical analysis was performed using logistic regression and ROC analysis.Results. The prevalence of hyponatremia was 4.1%. In-hospital mortality reached 16.0% (19 deaths). Hypervolemic hyponatremia, typical for patients with chronic heart failure, was the most common type (48.7%). According to multivariable regression analysis, factors associated with in-hospital mortality were minimum sodium level (OR 0.843; 95% СI 0.749-0.950; p=0.005), glomerular filtration rate (OR 0.957; 95% СI 0.921-0.991; p=0.021), and left ventricular ejection fraction (OR 0.949; 95% СI 0.907-0.994; p=0.027). The constructed predictive model demonstrated good discriminative ability: AUC=0.851 with sensitivity of 78.6%, specificity of 76.7%, and overall accuracy of 77.0%.Conclusion. Minimum serum sodium level is a risk factor of in-hospital death, particularly in patients with reduced glomerular filtration rate and left ventricular ejection fraction.
Aim. To evaluate the association between lipoprotein(a) [Lp(a)] levels and the presence and severity of coronary artery calcium (CAC) in patients without clinically established atherosclerotic cardiovascular disease (ASCVD).Material and methods. The study included1,777 outpatients without clinical manifestations of ASCVD who underwent routine preventive examination in the MEDSI clinic network (Moscow and Moscow region) between 2021 and 2025. Eligible patients had both noncontrast computed tomography with quantitative CAC scoring and laboratory measurement of Lp(a). Patients were classified according to CAC values: 0, >0, >100, >300 Agatston units. Lp(a) was evaluated as a continuous variable and according to clinically relevant thresholds >30, >50 and >70 mg/dL.Results. The median age of participants was 47 [41; 55] years, and 43.2% were women. Coronary calcification (CAC >0) was detected in 30.6% of patients. Compared with individuals without calcification, patients with CAC >0 were older (54 vs 45 years; p <0.001), more frequently had arterial hypertension (58.9% vs 39.1%; p <0.001) and diabetes mellitus (7.7% vs 2.4%; p <0.001). Median Lp(a) levels were significantly higher in patients with CAC >0 — 25 [8; 87] mg/dL versus 15 [6; 59] mg/dL in those with CAC=0 (p <0.001). In multivariable logistic regression, Lp(a) remained significantly associated with the presence of CAC >0 (adjusted odds ratio [AOR] 1.007 per 1 mg/dL; 95% confidence interval [CI] 1.004-1.009; p <0.001). The association persisted when using clinical thresholds: for Lp(a) >30 mg/dL AOR was 1.81, for >50 mg/dL — 1.89, and for >70 mg/dL — 2.06 (all p <0.001). Higher Lp(a) values were more prevalent among patients with calcification: in those with CAC >0, the proportions of Lp(a) >30, >50 and >70 mg/dL were 47.8%, 38.4% and 29.8%, respectively. Severe calcification (CAC >300) was found in 2.4% of individuals without ASCVD.Conclusion. Elevated Lp(a) levels are independently associated with subclinical atherosclerosis defined by CAC, even after adjustment for traditional risk factors. Combined assessment of Lp(a) and CAC helps identify patients at “hidden” very high cardiovascular risk and design strategies for early preventive and therapeutic interventions.
Aim. To develop and validate a Composite Index of Dispensary Follow-up Effectiveness (CIDFE) for the adult population based on compulsory health insurance (СHI) data for the comparative assessment of 85 constituent entities of the Russian Federation and prioritisation of management interventions.Material and methods. A population-based observational study was conducted (unit of observation: constituent entity of the Russian Federation, n = 85, period 2023–2024). The index comprises 7 sub-indices grouped into two domains based on Donabedian’s model: “Process” (60%: DF coverage, enrolment activity, intensity, and completeness of follow-up) and “Outcome” (40%: hospitalisation rate, emergency medical service call rate, mortality among DF patients). Normalisation was performed using the min-max method (0–100 points); aggregation used a weighted sum in accordance with OECD methodology. Robustness was assessed by Monte Carlo simulation (10,000 iterations, ±20% weight perturbation); criterion validity was evaluated by correlation with Rosstat 2024 mortality data. Regions were stratified into 4 quadrants based on median CIDFE and mortality values.Results. The mean CIDFE for 2024 was 65.65±9.77 points (Me=67.55; range 31.60-84.33; coefficient of variation 14.9%). Class I (≥75 points) was assigned to 10.6% of regions, Class II (55-75) to 75.3%, and Classes III-IV to 14.1%. Robustness was confirmed by a high intraclass correlation coefficient (ICC=0.994; p <0.001); temporal stability by the correlation between CIDFE 2023 and 2024 (r=0.671; p <0.001). Quadrant analysis revealed that mortality in Quadrant A (high CIDFE + low mortality; n = 25) was 4.4‰ lower than in Quadrant D (low CIDFE + high mortality; n=19): 11.1±2.6‰ versus 15.4±1.1‰ (U=0; p <0.001; Cohen’s d=2.06). For a typical region with a population of approximately 1.5 million, this difference corresponds to roughly 660 preventable deaths per year.Conclusion. The CIDFE is the first Russian composite instrument for monitoring the quality of dispensary follow-up at the regional level, based on routine СHI data. The index demonstrates high robustness and stability, ensuring its suitability for annual monitoring. Quadrant analysis enables the identification of regions requiring priority systemic interventions and the selection of benchmark entities for disseminating best DF practices.
Aim. To compare the efficacy and safety of furosemide dose titration during the first 24 hours of treatment for decompensated heart failure (HF) with fluid retention, based on either urine volume or spot urinary sodium concentration.Material and methods. This prospective, randomised, open-label, single-center study included 110 patients with decompensated HF, signs of fluid retention, and regular furosemide use. The initial intravenous furosemide dose was twice the outpatient dose. In the first group (n=55), efficacy was assessed by 6-hour urine output: if ≥100 mL/h, the same dose was repeated after 12 hours; if response was insufficient, the dose was doubled every 6 hours until the target urine volume was achieved. In the second group (n=55), the 2-hour spot urinary sodium concentration was used: if ≥50 mmol/L, the same dose was repeated after 12 hours; if <50 mmol/L, the dose was doubled every 6 hours until target natriuresis was reached. After 24 hours, if urine output was <3.5 L with persistent congestion, the last furosemide dose was repeated as a bolus twice daily with the addition of acetazolamide 500 mg/day for 3 days. If the response remained insufficient after 48 hours, hydrochlorothiazide 25 mg/day was added without changing the furosemide dose. For urine output between 3.5 and 5 L, the furosemide dose was unchanged; for output >5 L with signs of congestion, the dose was halved. Once congestion resolved, patients were switched to oral furosemide.Results. Mean patient age was 74±9.2 years; male proportion was 52.7%. The median intravenous furosemide dose in the first 24 hours was 160 mg in the urine sodiumguided group versus 80 mg in the urine volumeguided group (p<0.001). At 72 hours, the urine sodiumguided group showed greater congestion relief (median fluid overload score 4 vs. 6, p<0.001), lower body weight (median 83 vs. 88 kg, p=0.024), and less dyspnea (VAS 4 vs. 7; Likert 2 vs. 3; p<0.001 for both). Hospital stay was shorter by 2 days in the sodiumguided group (9±1.6 vs. 11±2.6 days, p<0.001), and persistent congestion at discharge was less frequent (7.3% vs. 20%, p<0.001). The composite of allcause death or HF rehospitalization at 3 months was lower in the urine sodiumguided group (21.8% vs. 36.4%, p=0.02). No significant betweengroup differences were observed in inhospital complication rates.Conclusion. In patients hospitalised with decompensated HF, furosemide dose titration during the first 24 hours based on urinary sodium concentration (compared to the urine volumebased approach) was associated with the use of higher doses, leading to greater weight loss, better congestion relief, an
The aim of this review is to systematize current data on the mechanisms of action of pasteurized Akkermansia muciniphila in obesity and metabolic syndrome and to evaluate its clinical potential. Obesity and metabolic syndrome are leading risk factors for cardiovascular disease. In recent years, compelling evidence has accumulated on the important role of intestinal microbiota dysbiosis in the pathogenesis of these conditions, opening up prospects for the development of new therapeutic strategies aimed at its correction. Pasteurized A. muciniphila is of interest as a potentially promising postbiotic capable of preserving the effects of live bacteria while simultaneously enhancing its safety profile. Pasteurized A. muciniphila has been shown to exert a multicomponent effect, including reduction of intestinal barrier permeability, metabolic endotoxemia, and chronic low-grade inflammation, modulation of intestinal glucose transport, interaction with the gut-brain axis, and regulation of energy metabolism. Currently, efficacy data remain limited and are based primarily on preclinical studies. A. muciniphila has been shown to reduce body weight and fat mass, improve glycemic control, increase insulin sensitivity, and reduce inflammatory and fibrotic changes in the liver and adipose tissue. However, there remains a need to standardize postbiotic formulations, including pasteurization and dosing regimens, and to conduct large, long-term randomized trials to determine clinical efficacy and safety.
Aim. Тo evaluate the impact of intensive statin therapy on subclinical left (LV) and right ventricular (RV) function using advanced speckle-tracking echocardiography (STE) in patients without coronary artery disease receiving statin for primary prevention.Material and methods. This single-center prospective study enrolled patients who were planned to initiate high-intensity statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) for primary prevention. A total of 38 patients (mean age 51.5±7.6 years; 36.8% male) with low-density lipoprotein cholesterol (LDL-C) levels ≥160 mg/dl and no history of coronary artery disease, heart failure, or hypertension were included. Conventional echocardiography and two-dimensional STE were performed at baseline (before therapy initiation) and at a 6-month follow-up. LV global longitudinal strain (LV-GLS) and RV global longitudinal strain (RV-GLS) were calculated to detect subtle myocardial changes.Results. After six months of intensive therapy, a significant reduction in LDL-C (200.5±39.8 to 97.5±29.3 mg/dl; p<0.001) and triglycerides (p=0.001) was observed. Despite significant increases in creatine kinase (p=0.014) and liver enzymes (asparagine aminotransferase: p=0.049, alanine aminotransferase: p=0.036) within the normal-to-borderline range, no clinical myopathy occurred. Echocardiographic analysis showed no significant differences in LV-GLS (-19.2±2.3% vs. -19.4±1.7%; p=0.569) or RV-GLS (-19.2±4.2% vs. -19.5±4.4%; p=0.553) between baseline and follow-up. Similarly, diastolic function parameters (e’, E/e’ ratio) and ejection fraction remained stable throughout the study period.Conclusion. Six months of high-dose statin therapy did not significantly alter biventricular strain parameters in patients without preexisting coronary artery disease. These findings suggest that intensive short-term statin use is not associated with adverse effects on myocardial mechanical function. The stability of strain values, despite lipid reduction and mild enzyme elevations, supports the myocardial safety profile of intensive statin therapy in a primary prevention population.
Aim. To determine the 99th percentile value of hs-cTnI in a sample of apparently healthy individuals from the Russian population, considering sex and age, based on standardized IFCC criteria.Material and methods. Data from the ESSE-RF1 and ESSE-RF2 studies (n=14,035, age 25-64 years) were used. After excluding participants with cardiovascular and chronic diseases, diabetes mellitus, renal dysfunction, and those taking antihypertensive or lipid-lowering medications, 4,356 individuals (1,588 men and 2,768 women) were included in the analysis. Hs-cTnI levels were measured using the Architect i2000sr analyzer (Abbott). Statistical analysis was performed using nonparametric methods; the 99th percentile was estimated using the Harrell-Davis method with bootstrap.Results. Hs-cTnI concentrations were above the limit of detection in 67.9% of participants. The median hs-cTnI level in the overall sample was 1.5 ng/L [Q1-Q3: 0.9-2.5], with significantly higher levels in men (1.9 [1.2-3.0] ng/L) compared to women (1.3 [0.7-2.2] ng/L) (p<0.001). The 99th percentile values (upper reference limits) were: overall — 16.5 ng/L (95% CI 14.7-19.4); men — 17.1 ng/L (14.6–20.9); women — 16.2 ng/L (13.7-21.5). No significant age dependence of the 99th percentile was observed (p>0.05). Compared to the manufacturer’s reference limits, the obtained values for men were significantly lower (17.1 vs. 34.2 ng/L), while for women they were slightly higher (16.2 vs. 15.6 ng/L).Conclusion. The 99th percentile values of hs-cTnI in the healthy Russian population differ from the reference levels proposed by the manufacturer, demonstrate sex-specific differences, but do not depend on age. These findings emphasize the necessity of sex-specific stratification of hs-cTnI in the diagnosis of myocardial injury and infarction.
This clinical case report describes the development of intoxication symptoms (nausea, muscle cramps, generalised weakness) and instability of blood pressure associated with long-term uncontrolled intake of high-dose vitamin D (up to 35,000 IU per week) in a 68-year-old female patient with comorbid conditions: secondary arterial hypertension, primary hyperparathyroidism, and chronic kidney disease stage C3a. Laboratory analysis revealed a typical triad of abnormalities: hypercalcemia (total calcium up to 2.82 mmol/L), elevated parathyroid hormone level (115.4 pg/mL), and a high serum 25(OH)D concentration (70.6 ng/mL). Key evidence of the iatrogenic nature of the symptoms was the complete resolution of complaints and normalisation of blood pressure on the previous antihypertensive therapy following discontinuation of vitamin D intake, as well as recurrence of symptoms upon resumption of vitamin D supplements, even at a lower dose (14,000 IU/day). A notable feature of this case is the development of toxic effects at a serum 25(OH)D level only slightly above the normal range, which underscores the importance of identifying adverse effects when prescribing therapy to patients with comorbidities. This observation highlights the necessity for thorough laboratory monitoring (calcium, parathyroid hormone, 25(OH)D, renal function parameters) prior to and during vitamin D supplementation, particularly in patients with hyperparathyroidism and chronic kidney disease.
Aim. To conduct a comparative analysis of individual cardiovascular risk (CVR) assessment using three versions of the SCORE scale and to evaluate the associations of risk with regional living conditions.Material and methods. Individual data from the cross-sectional phase of the ESSE-RF study in 2012-2014, 2017-2018, and 2020-2022 were used for the analysis. The analytical sample included 15,298 women and 10,861 men aged 40-64 years without a history of stroke, coronary heart disease, myocardial infarction, or diabetes, and without missing data. Individual CVR was assessed using the SCORE, SCORE2, and SCORE2-RF scales. The annual Economic, Demographic, Industrial, and Social Indexes of the National Medical Research Center for Therapy and Preventive Medicine were used as regional characteristics. Linear regression was used for quantitative outcomes, and logistic regression for binary outcomes. Logistic regression associations are expressed as odds ratios (ORs) and 95% confidence intervals.Results. According to the SCORE scale, the proportion of individuals with high/very high cardiovascular risk (CVR) is 2.2% among women and 28.8% among men; according to SCORE2, the proportions are 25.7% and 54.7%; and according to SCORE2-RF, the proportions are 6.8% and 12.9%, respectively. Improvements in demographics (only for women) and social conditions in a region are associated with a reduced likelihood of high/very high CVR. Thus, an increase in the quintile of the Demographic Index is associated in women with a decrease in the likelihood of high/very high CVR: according to SCORE OR=0.81 (0.73-0.90), according to SCORE2 OR=0.94 (0.90-0.97), according to SCORE2-RF OR=0.88 (0.83-0.94). An increase in the quintile of the Social Index in women is associated with a decrease in the likelihood of high / very high CVR: according to SCORE OR=0.85 (0.77-0.94), according to SCORE2 OR=0.95 (0.92-0.99), according to SCORE2-RF OR=0.93 (0.88-0.98). In men, an increasing Social Index quintile is associated with a decreased likelihood of high/very high cardiovascular risk: according to SCORE, OR =0.91 (0.87-0.96), according to SCORE2-RF, OR=0.92 (0.87-0.96).Conclusion. The study results suggest that the calibrated version of the SCORE2-RF scale is the most acceptable for practical use in preventive cardiology. Regional demographic and social conditions are associated with the profile of cardiovascular risk factors and can potentially be considered as population health factors. For Russia, a geographically diverse country, taking into account regional characteristics of the population allows for differentiation of prevention, as well as its focus and assessment of effectiveness.
In clinical practice, arterial hypertension often shows inadequate blood pressure control despite standard antihypertensive therapy. Genetically determined variability in pharmacokinetics and pharmacodynamics may contribute to interindividual differences in treatment efficacy and tolerability, yet it is rarely incorporated into routine prescribing. We report a clinical case of a 54-year-old female patient of Kyrgyz ethnic origin with uncontrolled blood pressure on combination therapy and an adverse reaction (peripheral edema) during amlodipine treatment. Pharmacogenetic testing revealed CYP2C9 *1/*3 (potentially reduced formation of the active losartan metabolite), CYP3A5 *3/*3 (a possible association with an increased risk of amlodipine-related adverse reactions), and CYP2D6 *10/*10 (a potential risk of dosedependent adverse reactions with certain beta-blockers). Therapy adjustment based on the obtained profile (switching from losartan to perindopril in combination with indapamide) was associated with achievement of target blood pressure levels without initiation of triple therapy. Pharmacogenetic information may be considered an additional tool to support antihypertensive therapy selection in selected patients.
Aim. To compare the performance of the CHA2DS2-VASc and the simplified CHA2DS2-VA scores in predicting 1-year thromboembolic events among patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs).Material and methods. In this single-centre observational cohort study, we followed 212 consecutive patients (median age 76 years, 53.5% female) with non-valvular AF receiving NOAC therapy for 12 months. Baseline clinical characteristics and thromboembolic risk scores were recorded. The primary outcome was thromboembolic events, defined as a composite of ischemic stroke, transient ischemic attack, or systemic embolism. Discriminative performance of the CHA2DS2-VASc and CHA2DS2- VA scores was assessed using receiver operating characteristic analysis and compared with the DeLong test. Cox proportional hazards regression was used to identify predictors of thromboembolic events.Results. During follow-up, 33 patients (15.6%) experienced thromboembolic events. The median CHA2DS2-VASc score was 5 (IQR 4-6) and the median CHA2DS2- VA score was 4 (IQR 3-5). Event rates increased progressively across higher strata of both scores. The area under the receiver operating characteristic curve was 0.640 for CHA2DS2-VASc and 0.637 for CHA2DS2-VA, with no significant difference between the two scores (p=0.966). Using a cut-off value of ≥4, CHA2DS2-VASc yielded a sensitivity of 93.9% and specificity of 24.6%, while CHA2DS2-VA yielded a sensitivity of 90.9% and specificity of 30.2%. In multivariable analysis including individual score components, impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m²) was the only independent predictor of thromboembolic events (hazard ratio 2.36, 95% confidence interval 1.11-5.02; p=0.026).Conclusion. In anticoagulated patients with AF, the CHA2DS2-VASc and CHA2DS2-VA scores demonstrated modest and comparable discrimination for 1-year thromboembolic events. A higher score threshold (≥4) identified patients with increased residual risk, while impaired renal function was the only independent predictor of events.
Current data describing the features of arginine vasopressin (AVP) system activation in healthy individuals and in patients with chronic heart failure (CHF) are presented. This article presents current data on the cardiovascular effects of interactions between AVP system mediators and specific receptors. Based on an analysis of current literature, the osmotic and non-osmotic pathways of AVP system activation are described in detail, both under physiological conditions and in CHF. The authors are the first in Russian-language literature to use the term “osmotic incompetence” in a broader context, extending beyond the syndrome of inappropriate antidiuretic hormone secretion to describe the mechanism of AVP system activation despite increased plasma osmolality. It is emphasized that despite the potential attractiveness of this mediator of the AVP system as a diagnostic and prognostic marker in various acute conditions and decompensation of chronic diseases, to date, a very small number of studies have been conducted, both in our country and worldwide, devoted to its role in the pathogenesis of various diseases, including CHF. Along with a detailed description of the mechanisms of AVP system imbalance, the authors provide clinical scenarios of osmotic incompetence in patients with various diseases. Particular attention is given to the role of copeptin as a surrogate marker for assessing the activity of the arginine vasopressin system. The authors aimed to highlight the complexity of the relationships between osmosis-dependent and osmosis-independent pathways of AVP activation in CHF, emphasizing the prospects for studying the AVP system, understanding the functioning of which in CHF conditions should lead to the development of targeted therapeutic strategies that can alleviate symptoms, improve treatment results, clinical outcomes and improve the quality of life of patients with heart failure.
Aim. To evaluate the efficacy and safety of a single intravenous fixed dose of cavutilide 350 μg compared to propranolol in patients with paroxysms of atrial fibrillation (AF) and atrial flutter (AFl)Material and methods. 70 patients with paroxysmal AF/AFl (36 women and 34 men, mean age 64.8±10.6 years) were divided into two groups. In the first group (n=35) a single intravenous injection of cavutilide 350 μg was administered to restore sinus rhythm (SR). In the second group (n=35) rate-control therapy with propranolol (10-20 mg per os every 3-4 hours) was performed. The main endpoints were SR restoration within 60-min and 24h, time to arrhythmia termination, and absence of AFib/AFl relapses. Safety was assessed by monitoring for major adverse cardiovascular events and proarrhythmia.Results. Within the first 60-min period SR was restored in 77.1% of patients in cavutilide group and in none of the patients in propranolol group (0; p<0.001). SR was restored in 100% of patients with AFl (n=7) within 1 hour after cavutilide administration. After 24h SR was restored in 88.6% of patients in group of cavutilide versus 45.7% of patients in propranolol group (p<0.001). Median time to SR restoration was 8,0 [5,0; 13,0] minutes in cavutilide group versus 375,0 [232,0; 915,0] minutes in propranolol group (p<0.001). A decrease in heart rate of more than 10 beats/min was observed in 3 out of 4 patients (75%) who did not restore SR after administration of cavutilide, and in 28 out of 35 patients in propranolol group (75% vs 80%; p=0.41). There were 2 cases of asymptomatic decrease in heart rate <50 beats/min. and 3 cases of transient prolongation of QT >500 ms after cavutilide administration. In all 3 cases QT interval decreased to normal values within 1 hour. No AF/AFl recurrencies, proarrhythmia and major adverse cardiovascular events occurred in both groups.Conclusion. A single fixed dose of cavutilid 350 μg is safe and highly effective for restoration of SR in paroxysmal AF/AFl, outperforming propranolol in likelihood of SR recovery, time to relief, and relapse prevention. Notably SR recovery after administration of cavutilide in 100% of patients with AFl, who are characterized by extremely low efficacy of other antiarrhythmic drugs. The high efficiency and rapid achievements of results, without significant adverse events, indicate the potential prospects for the use of a fixed dose of cavutilide 350 mg in outpatient settings.
Takotsubo syndrome (TS) management is a complex task that requires a comprehensive and differentiated approach, taking into account various clinical scenarios and potential complications. This review analyses current strategies for TS management, covering the treatment of uncomplicated cases, management of lifethreatening complications, and assessment of longterm prognosis. In uncomplicated cases, the primary treatment goal is to stabilise the patient’s condition and relieve symptoms. Firstline medications typically include betablockers and angiotensinconverting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). While the role of betablockers remains a subject of debate within the scientific community, ACEIs/ARBs have shown promising results in improving longterm prognosis and reducing the likelihood of recurrences. Management of patients with complicated forms of TS, particularly cardiogenic shock and intraventricular thrombosis, requires more aggressive therapeutic interventions. In cases of cardiogenic shock, it is crucial to differentiate whether left ventricular outflow tract obstruction is present, as this determines the choice of optimal inotropic support. The detection of intracardiac thrombus is an indication for anticoagulant therapy, with a recommended duration of at least three months or until full recovery of myocardial contractility. Although the overall prognosis for TS is generally favourable, with a high probability of left ventricular dysfunction regression, the risk of disease recurrence persists. To optimise longterm patient management, it is advisable to conduct not only regular monitoring of left ventricular function but also assessment of the patient’s psychoemotional state. However, the lack of conclusive evidence regarding the effectiveness of longterm pharmacological therapy in preventing disease recurrence underscores the need for further largescale studies.
Aim. To develop an online calculator of individual NT-proBNP thresholds to diagnose heart failure with preserved ejection fraction (HFpEF) and to pilot it in clinical practice.Material and methods. At the first stage, an online calculator that computes a personalised NT-proBNP threshold based on age, sex, body mass index (BMI), estimated glomerular filtration rate (CKD-EPI), and the presence of atrial fibrillation was developed. A total of 128 patients (50% women; median age, 71 years) with HFpEF hospitalised at University Clinical Hospital No. 1, Sechenov University, between January and August 2024 were enrolled to validate the calculator. Diagnoses based on guideline-recommended NT-proBNP cutoffs were compared with diagnoses incorporating individualised thresholds from the calculator. Agreement between methods was assessed using Cohen’s kappa, and differences in diagnosis rates were evaluated with McNemar’s test.Results. When comparing diagnoses based on standard NT-proBNP thresholds with those using individualised values, the diagnosis changed in 38 cases (29.7%): HFpEF was established in 30 patients and excluded in 8. Cohen’s kappa was 0.35. The difference between approaches was statistically significant (p=0.0005). The greatest diagnostic discrepancies were observed in patients younger than 60 years and in those with BMI 30-34 kg/m² and ≥40 kg/m²; statistically significant differences in diagnosis frequency were found only for patients with BMI 30-34 kg/m² (k=0.38, p <0.001). The minimum and maximum calculated NT-proBNP thresholds were 45 pg/mL and 506 pg/mL, respectively, delineating a “gray zone” in which the calculator may be particularly useful for refining diagnosis.Conclusion. NT-proBNP remains a key biomarker in HFpEF diagnosis; however, patient sex, age, and comorbidities affect its circulating levels. We therefore propose using our online calculator to derive individualized NT-proBNP thresholds for HFpEF diagnosis to reduce diagnostic errors, initiate treatment in a timely manner, and avoid unnecessary medication.
