BACKGROUND:The relationship between myocardial injury after cardiac surgery (MICS), ischemia on electrocardiogram (ECG), and mortality is uncertain. In this study we aimed to determine whether potential ischemic ECG changes after cardiac surgery are associated with 30-day mortality. METHODS:In a cohort of adults who underwent cardiac surgery, experts interpreted ECGs preoperatively; on postoperative days 0, 1, 2, and 3; and on the last day before discharge (59,539 total ECGs reviewed) for new potential ischemic ECG changes. RESULTS:Among 12,594 patients, 9097 (72.2%) had potential ischemic ECG changes; 259 (2.1%) died within 30 days after surgery. Among patients with troponin elevation meeting MICS criteria, in models adjusting for EuroSCORE II, the hazard ratio (HR) for 30-day mortality was 0.57 (95% confidence interval [CI] 0.35-0.94, P = 0.03) for new Q waves, 2.17 (95% CI 1.14-4.13, P = 0.02) for ST depression ≥ 2 mm, and 0.58 (95% CI 0.39-0.87, P = 0.007) for T-wave inversion 1-1.9 mm. ST elevation was not significantly associated with 30-day mortality. The only ECG change for which coronary artery bypass grafting (CABG) was an effect modifier was new left bundle branch block (LBBB), with an HR of 2.78 (95% CI 1.69-4.60, P = 0.0001) with CABG and an HR of 1.10 (95% CI 0.54-2.21, P = 0.27) without CABG (P value for interaction = 0.03). CONCLUSIONS:After cardiac surgery, potential ischemic ECG changes are common and have divergent associations with mortality. ST depression was associated with a higher risk of death, whereas new Q waves and T-wave inversions were associated with a lower risk of death. A new LBBB was associated with a higher risk of death only among patients who underwent CABG. Potential ischemic ECG changes are common after cardiac surgery and lack specificity for the diagnosis of myocardial infarction.

Cardiology, like other branches of medicine, is increasingly faced with the need not only to optimize patient treatment, reduce financial costs, but also to improve long-term outcomes. The volume of information required for such tasks is significant, and a doctor’s time is severely limited. Additional software capable of processing large amounts of data in a short period can assist doctors. Clinical decision support system (CDSS) is a type of software that, based on numerous clinical characteristics, provides doctors with information on the most likely diagnosis, patient risk profile, most suitable therapy, and more. Nowadays, CDSS finding more and more applications in cardiology and cardiovascular medicine. The experience of its clinical use has also been accumulated in the Russian Federation. The problem of the correct choice of anticoagulant therapy remains relevant in clinical practice. In addition, despite the proven benefit of prescribing anticoagulants in patients with atrial fibrillation (AF) at a high risk, the frequency of "underprescription" of oral anticoagulants (OACs) remains relatively high. The introduction of a strategy for a personalized approach to the selection of anticoagulants, based on individual patient characteristics, can significantly improve adherence to clinical guidelines and, as a result, reduce the risk of thromboembolic complications. This article discusses the positive and negative aspects of using CDSS in the management of patients with AF, highlighting the main limitations when using them in conditions close to real clinical practice.

Background and Aims: Aim was to assess LDL-C control in patients with history of myocardial infarction (MI) using analytics of Clinical decision support system (CDSS) MedicBK based on Electronic Health Records (EHRs). Methods: MedicBK CDSS accumulated EHRs data from one of the regions of Russia for 2022, EHRs of 25496 patients were received. 6880 patients had a history of MI, 1297 patients underwent MI within one year (median age 63 [31-98] years, 435 women (33.5%)) and 709 patients underwent MI from one to two years ago (median age 64 [29-92] years, 245 women (34.6%)). The prevalence of comorbidities did not differ between the groups, except moderate eGFR decrease (4.5% and 7.3% in patients with MI from one to two years ago, p = 0.001). Results: EHRs of 266 patients with MI within one year included information about LDL-C (20.5%). 34 patients had LDL-C less than 1.4 mmol/L (12.8% of patients with known LDL-C, 2.6% of patients with MI within one year). EHRs of 154 patients with MI from one to two years ago included information about LDL-C (21.7%). 27 patients had LDL-C less than 1.4 mmol/L (17.5% of patients with known LDL-C and 3.8% of patients with MI from one to two years ago). The mean level of LDL-C in patients underwent MI within one year was 2.5 mmol/L, in patients underwent MI from one to two years ago was 2.26 mmol/L (p = 0.018). Conclusions: СDSS analytics should be used for LDL-C control assessment after MI. Further detailing of such kind of analytics is needed.

The optimal approach for prevention of cardiovascular events and reduction of bleeding in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) is still controversial. The aim of our study is to asses our single-center experience with concomitant left atrial appendage occlusion (LAAO) and percutaneous coronary intervention (PCI). 50 patients with ACS without ST elevation and history of AF were randomized after successful PCI to LAAO or conventional medical therapy. The primary endpoints were safety and length of hospitalization. The follow-up period was 30 days. The mean procedural times were 113 ± 23 min PCI + LAAO implantation and 39 ± 19 min of PCI only (p < 0.001), while mean fluoroscopy times were 18 ± 8 min and 12 ± 8 min (p < 0.001), respectively. No procedure-related complications were observed. There was no difference observed for length of hospitalization between two groups. LAAO in patients with ACS and AF undergoing PCI appears safe.

Background and Aims: The rapid development of digital technology in Healthcare systems led to the big data era of analytics. Electronic Health Records (EHRs) have a lot of data, but it is difficult to analyze all of them. Our aim is to provide real-world data on LDL-C management in two regions of Russia using Clinical decision support system (CDSS) MedicBK analytics based on EHRs. Methods: MedicBK CDSS is a software that is able to detect patient parameters and specific disease characteristics from EHRs. In addition to suggesting therapeutic strategies on the basis of clinical guidelines and high-quality randomized clinical trials data it collects big data from EHRs available for analysis. MedicBK CDSS accumulated EHR data from Lipetsk and Voronezh regions (Russia) for 2021-2022. EHRs of patients with arterial hypertension, coronary artery disease, dyslipidemia, atrial fibrillation and heart failure were received. Results: EHR of 41775 patients were analyzed (24684 in Lipetsk, 17091 in Voronezh). Very high and high cardiovascular risk were defined in 27776 (66.5%) and 3340 (8%) patients, respectively. Obesity was found in 19868 (47.6%) of the patients. Information about LDL-C level was found in EHRs of 3894 (9.3%) patients in the whole and in EHRs of 2697 very high risk patients (9.7% of very high risk patients). Only 1861 of very high risk patients had LDL-C level less than 1.4 mmol/L that is 6.7% of all very high risk patients and 69% of very high risk patients with known LDL-C levels. Conclusions: СDSS analytics should be used for target lipid goals achievement and treatment corrections.

Aim To evaluate prescription of lipid-lowering and antithrombotic therapy in clinical practice and to compare differences in recommendations using the clinical decision support service (CDSS). Material and methods Electronic medical records (EMR) of 300 patients from the Chazov National Medical Research Center of Cardiology, as well as from medical organizations controlled by the Department of Health of the Lipetsk Region and the Ministry of Health of the Voronezh Region, were analyzed for the period of August - December 2022, during the pilot implementation of CDSS. Retrospective information about the prescription of lipid-lowering and antithrombotic therapy from the EMR was compared with the CDSS guidelines under the expert supervision based on digitized clinical and laboratory profiles of patients. The study primary endpoint was a change in the initially prescribed lipid-lowering and / or antithrombotic therapy as per CDSS guidelines. Results Overall 292 patients were included in the final analysis; 46 (15.7 %) were from the primary prevention group and 246 (84.3 %) from the secondary prevention group. In group 1, the lipid-lowering therapy recommended by the CDSS differed by 50 % (p<0.001) from the baseline therapy recorded in the EMR. In the secondary prevention group, 78.9 % (p<0.001) differences were found in the lipid-lowering therapy recommended in the CDSS guidelines compared to the prescriptions in the EMR. In 76.8 % (p<0.001) of patients, antithrombotic therapy was significantly different from the baseline therapy in the EMR. Conclusion The use of CDSS may improve the practice of choosing lipid-lowering and antithrombotic therapy for prevention of cardiovascular complications.

Objective: To evaluate the model of atrial fibrillation (AF) in mini-pigs with endocardial approach implantation of CRT-P using bi-electrodes pacing through RV/LV connectors.Methods: All surgical interventions were minimally invasive and conducted under general anaesthesia. CRT-P was implanted endocardially, using X-ray. First electrode was fixed in the right atrial appendage. The second one — in the interatrial septum or the right atrial free wall. Both of them were connected with CRT-P through RV/LV. Bi-electrode atrial stimulation was realized during a week with a basic heart rate of 150 bpm and a delay between electrodes of 80 ms (mean 450 bpm), which corresponds to the heart rate (HR) of AF. Electrophysiological study was performed during the experiment to analyze the cardiac conduction system. AF inducibility was evaluated before and after stimulation.Results: A series of experiments demonstrated that there were no complications following the device and electrodes implantation. There was a non-sustained paroxysm of AF before permanent pacing in one of three pigs. After pacing we noted a tendency to increase the baseline HR (average frequency from 94 ± 4 to 98 ± 6 bpm). Non-sustained paroxysm of AF was induced in all cases. The sustained AF with 92 min burden was induced in one pig.Conclusion: Endocardial bi-electrode atrial pacing in mini-pigs has proven to be safe. This AF model improves AF inducibility and can be considered as an alternative to epicardial stimulation for experiments employing AF models. Received 4 December 2022. Revised 17 January 2023. Accepted 18 January 2023. Funding: The study was supported by Russian Science Foundation (project No. 22-25-00672). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: V.V. Beloborodov, D.V. Losik, E.V. FisherData collection and analysis: E.V. Fisher, V.V. Beloborodov, D.V. Losik, A.G. FilippenkoDrafting the article: D.V. Losik, E.V. Fisher, V.I. Murtazin, V.V. BeloborodovCritical revision of the article: A.B. Romanov, D.V. Losik, V.V. Shabanov, I.L. MikheenkoFinal approval of the version to be published: D.V. Losik, V.V. Beloborodov, E.V. Fisher, V.I. Murtazin, A.G. Filippenko, I.L. Mikheenko, V.V. Shabanov, A.B. Romanov

Цель. Изучить метод индуцируемости модели фибрилляции предсердий у мини-свиней минисибс при помощи эндокардиальной имплантации электродов в правое предсердие и постоянной стимуляции с двух электродов при помощи ресинхронизирующего бивентрикулярного устройства. Методы. Разработку модели осуществляли на свиньях породы минисибс весом 76,7 ± 3,5 кг в условиях экспериментальной рентгеноперационной. Все оперативные вмешательства были малоинвазивными и выполнялись в условиях общей анестезии. Один электрод фиксировали в область ушка правого предсердия; второй — в область межпредсердной перегородки или свободную стенку правого предсердия. Оба электрода коммутировали с ресинхронизирующим бивентрикулярным устройством в разъемы для правожелудочкового и левожелудочкового электродов. С помощью двух электродов осуществляли стимуляцию предсердий с базовой частотой сердечных сокращений 150 уд/мин и задержкой между стимулами двух электродов 80 мс в течение недели. В ходе эксперимента проводили электрофизиологическое исследование при помощи имплантированного устройства и оценивали индуцируемость фибрилляции предсердий до и после эксперимента. Результаты. Серия экспериментальных работ продемонстрировала отсутствие осложнений при имплантации электродов и устройства. Исходно базовая средняя частота сердечных сокращений составила 94 уд/мин, эффективный рефрактерный период правого предсердия в среднем составил 307 мс. У одной из трех мини-свиней индуцировали неустойчивый пароксизм фибрилляции предсердий до постоянной стимуляции. После постоянной стимуляции предсердий в течение недели со средней частотой сердечных сокращений 450 уд/мин отметили увеличение базовой частоты сердечных сокращений (средняя — от 94 до 98 уд/мин), у всех субъектов эксперимента индуцировали неустойчивые пароксизмы фибрилляции предсердий, в одном случае — устойчивый пароксизм продолжительностью 92 мин. Заключение. Эндокардиальная стимуляция предсердий у мини-свиней минисибс безопасна. Модель фибрилляции при помощи стимуляции предсердий с двух электродов со средней частотой сердечных сокращений 450 уд/мин увеличивает индуцируемость и может быть рассмотрена как альтернатива эпикардиальной стимуляции для экспериментальных работ с применением моделей фибрилляции предсердий. Поступила в редакцию 4 декабря 2022 г. Исправлена 17 января 2023 г. Принята к печати 18 января 2023 г. Финансирование Исследование выполнено при финансовой поддержке гранта Российского научного фонда, проект № 22-25-00672. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн: В.В. Белобородов, Д.В. Лосик, Е.В. Фишер Сбор и анализ данных: Е.В. Фишер, В.В. Белобородов, Д.В. Лосик, А.Г. Филиппенко Написание статьи: Д.В. Лосик, Е.В. Фишер, В.И. Муртазин, В.В. Белобородов Исправление статьи: А.Б. Романов, Д.В. Лосик, В.В. Шабанов, И.Л. Михеенко Утверждение окончательного варианта статьи: все авторы

urpose.Epicardial adipose tissue (EAT) is thought to play an important role in the development and progression of cardiovascular diseases.However, the diagnostic and prognostic role of EAT measurement in patients with atrial fibrillation (AF) and heart failure (HF) coexistence is still unclear.The aim of the present study was to investigate the volume and distribution of EAT and their correlation with level of B-type natriuretic peptide (BNP) as wellestablished HF biomarker.Material and methods.69 patients with symptomatic HF and AF underwent cardiac computed tomography (CT) before catheter ablation (CA).The BNP levels, total and peri-atrial EAT volumes were evaluated.The study cohort was divided into two groups according to the BNP level: BNP≥105 pg/ml, n = 37 («AF with HF») and BNP<105 pg/ml, n=32 («AF without HF»).Results.The median peri-atrial EAT volume was higher in the «AF with HF» group compared with «AF without HF» group (52.1 [40;59] ml vs 45.6 [35;56] ml, respectively).Twenty-one (57%) out of 37 patients with BNP ≥105 pg/ml had HF with preserved ejection fraction (HFpEF).In this cohort, total and peri-atrial EAT was associated with BNP ≥105 pg/ml (coefficient 0.33 [95% CI, 0.08 to 0.57], p = 0.011 and 0.16 [95% CI, 0.09 to 0.22], p < 0.001).Conclusions.Cardiac CT for EAT assessment may be useful as an additional diagnostic tool of HFpEF in patients with AF.In patients with AF and HFpEF the EAT volume is associated with an increase of BNP level.

Background and Aims : Widespread obstacle to take entire advantages of LDL-C-lowering-drug therapy (LLT) is suboptimal lipid management. Clinical decision support systems (CDSS) are promising tools to augment clinicians in their decision-making processes and improve healthcare delivery. Aim was to develop emerging CDSS to resolve the issue of insufficient LLT effectiveness.Methods: MedicBK CDSS was developed as software that is able to detect patient parameters and specific disease characteristics from electronic health records (EHRs) and suggest therapeutic strategies on the basis of the latest clinical guidelines and high-quality randomized clinical trials data related to certain cases.Results: MedicBK CDSS detects from EHRs patient parameters. Some indicators are calculated at this stage, such as eGFR and SCORE. MedicBK CDSS defines the patient risk category using a set of obtained parameters. Then the system determines corresponding treatment goals for LDL-C and non-HDL-C or ApoB in some particular cases. MedicBK CDSS defines indications for lifestyle intervention and drug intervention. The system suggests an optimal drug therapy according to clinical guidelines taking into consideration exhaustive patient characteristics and previously conducted therapy. MedicBK CDSS performs indirect efficacy and safety comparison between treatment strategies through network meta-analysis by R-statistic program. Additionally the system evaluates adherence of ongoing therapy to clinical guidelines.Conclusions: MedicBK CDSS is a promising novel tool for improving healthcare delivery by exhaustive analysis of patient parameters, promoting adherence to clinical guidelines and precise usage of clinical trials data. MedicBK CDSS apparently is capable to make a significant contribution to proper lipid management. Background and Aims : Widespread obstacle to take entire advantages of LDL-C-lowering-drug therapy (LLT) is suboptimal lipid management. Clinical decision support systems (CDSS) are promising tools to augment clinicians in their decision-making processes and improve healthcare delivery. Aim was to develop emerging CDSS to resolve the issue of insufficient LLT effectiveness. Methods: MedicBK CDSS was developed as software that is able to detect patient parameters and specific disease characteristics from electronic health records (EHRs) and suggest therapeutic strategies on the basis of the latest clinical guidelines and high-quality randomized clinical trials data related to certain cases. Results: MedicBK CDSS detects from EHRs patient parameters. Some indicators are calculated at this stage, such as eGFR and SCORE. MedicBK CDSS defines the patient risk category using a set of obtained parameters. Then the system determines corresponding treatment goals for LDL-C and non-HDL-C or ApoB in some particular cases. MedicBK CDSS defines indications for lifestyle intervention and drug intervention. The system suggests an optimal drug therapy according to clinical guidelines taking into consideration exhaustive patient characteristics and previously conducted therapy. MedicBK CDSS performs indirect efficacy and safety comparison between treatment strategies through network meta-analysis by R-statistic program. Additionally the system evaluates adherence of ongoing therapy to clinical guidelines. Conclusions: MedicBK CDSS is a promising novel tool for improving healthcare delivery by exhaustive analysis of patient parameters, promoting adherence to clinical guidelines and precise usage of clinical trials data. MedicBK CDSS apparently is capable to make a significant contribution to proper lipid management.

Aim. To assess the level of various cardiac biomarkers and the volume of epicardial adipose tissue (EAT) in patients with heart failure (HF) depending on the type of atrial fibrillation (AF).Material and methods. This prospective observational study included 69 patients with symptomatic AF, as well as with manifestations of New York Heart Association (NYHA) class II-III HF. All patients were examined before catheter ablation for AF. The following investigations were performed: echocardiography, computed tomography, myocardial perfusion scintigraphy, immunochemical analysis of cardiac biomarkers (brain natriuretic peptide (BNP), high-sensitivity troponin I (hs-TnI)), as well as biochemical analysis of high-sensitivity C reactive protein (hsCRP). Patients were divided into 2 groups, depending on the AF type, into paroxysmal and non-paroxysmal (persistent and long-standing persistent).Results. The analysis included 69 patients with various AF types and symptomatic HF. There were significantly more patients with HF confirmed by an elevated BNP level in the group with non-paroxysmal type (27 (71%) vs 5 (16%), p<0,00001). Comparison analysis showed that in group 2 the mean BNP level was significantly higher than in group 1 (135,5 pg/ml [75,2;303,2] vs 40 pg/ml [20,7;56,9], respectively, p<0,00001). The hs-TnI level was higher in group 2 (2,5 [1,7;5,1] vs 1,9 [0,8;3,9], respectively, p=0,19), but there was no significant difference between the groups. The level of hsCRP did not differ in both groups. In group 1, the EAT volume was 139 [117,5;171] vs 169 [130;209,5] in group 2 (p=0,03).Conclusion. The type of AF plays a role in the interpretation of cardiac specific enzymes, and BNP levels and EAT volume are higher in patients with the non-paroxysmal form.

Objectives: Erythropoietin (EPO) improved cardiac regeneration in experimental models of ischemic heart disease. A pilot trial found subcutaneously administered EPO to improve surrogate markers of left ventricular (LV) function in ischemic cardiomyopathy. This clinical study tests the feasibility and safety of the intramyocardial delivery route of a long-acting EPO-analogue (C.E.R.A.) in patients with ischemic cardiomyopathy. Methods: The ALSTER C.E.R.A. trial was a Phase II, open label, 1:1 randomized, single-center study testing intramyocardial injections of long-acting EPO analogue C.E.R.A. (C.E.R.A. NOGA: once 180 µg) using the NOGA XP system versus the subcutaneous application (C.E.R.A. SC: 30µg s.c./month for 6 months) in 59 symptomatic chronic heart failure (HF) patients with impaired LV function (ejection fraction (EF) £ 45%). Results: Follow-up up to three years with both clinical and imaging endpoints found intramyocardial delivery of C.E.R.A. to be feasible, safe and to possibly attenuate LV remodeling. Patients in the C.E.R.A. NOGA group showed stable parameter for LV end-diastolic diameter and volume (LVEDD and LVEDV), while C.E.R.A. SC patients had significant dilation of the LV (C.E.R.A. NOGA vs. SC, mean ± standard error of the mean: DLVEDD 0.02±0.1mm, p=0.8 vs. 0.3±0.09mm, p=0.0026; DLVEDV 10±15.9ml, p=0.5 vs. 34.8±11.3ml, p=0.0081; ∆EF 2.4±1.2%, p=0.045 vs. -1.6±1.1, p=0.1 respectively). NYHA class significantly improved and the hospitalization rate was numerically reduced in the C.E.R.A. NOGA group, while three-year mortality was identical. Conclusions: Intramyocardial injection of C.E.R.A. is feasible, safe and possibly attenuates LV remodeling in ischemic HF patients with LV dysfunction compared to the systemic application.

The role of epicardial adipose tissue (EAT) in the pathogenesis and prognosis of cardiovascular diseases has been actively discussed. This review provides information regarding the main mechanisms by which EAT influences the pathophysiology of rhythm disturbances, such as atrial fibrillation and ventricular arrhythmias, as well as their relationship with chronic heart failure. The pathogenesis of cardiac arrhythmias is exceedingly complex. As such, the mechanism by which EAT influences arrhythmias and heart failure can vary according to the anatomy and type of arrhythmia, one of which involves the autonomic nervous system (ANS). Some studies have shown a good treatment effects by targeting EAT in atrial fibrillation, whereas others have found that EAT volume can be used to predict the efficacy of radiofrequency ablation, a method for treating atrial fibrillation and ventricular arrhythmias. However, no standards have yet been established for the use of EAT visualisation. Fundamental, translational and clinical research are needed to study the role of EAT and ANS in the pathogenesis of cardiovascular diseases.Received 15 March 2021. Revised 25 April 2021. Accepted 26 April 2021.Funding: The work is supported by a grant of the Russian Science Foundation (project No. 17-75-20118).Conflict of interest: The authors declare no conflicts of interests.Contribution of the authorsConception and study design: D.V. Losik, N.A. Nikitin, S.M. Minin, A.B. Romanov, A.M. ChernyavskiyDrafting the article: D.V. Losik, I.L. Mikheenko, E.V. Fisher, N.A. NikitinCritical revision of the article: D.V. Losik, I.L. Mikheenko, E.V. Fisher, N.A. NikitinFinal approval of the version to be published: D.V. Losik, N.A. Nikitin, S.M. Minin, E.V. Fisher, I.L. Mikheenko, A.M. Chernyavskiy, A.B. Romanov

Aim. To evaluate the relationship between the clinical decision support system use (CDSS) and adherence to clinical guidelines.Materials and methods. Medical records of 300 patients with atrial fibrillation and hypertension from the electronic medical database of the Almazov National Medical Research Center were analyzed. Demographic and clinical data, as well as information on anticoagulant, antiarrhythmic and antihypertensive prescriptions were analyzed. The primary endpoint was adherence of prescribed treatment to current clinical guidelines for each of the three therapies. Firstly, a group of independent clinical experts assessed primary endpoint for retrospective prescriptions. Secondly, new prescriptions were simulated by another group of clinical experts using CDSS and blinded to previous therapy. Primary endpoint at the second step was analysed by independent experts. We compared adherence to relevant clinical guidelines with and without use of CDSS. Additionally, we analyzed predictors of failing to meet the current recommendations in the retrospective records.Results. Out of 300 patients, only 291 (97%) had all characteristics and were included in the analysis. In 26 patients (18%), all three treatment strategies were in accordance with current clinical guidelines. Anticoagulant therapy was adherent to the guidelines in 92% of cases. Experts who used CDSS were 15% (95% confidence interval [CI], 10-21%) more likely to prescribe novel oral anticoagulants and 14% (95% CI, 10-19%) less likely to prescribe warfarin compared to baseline. Antiarrhythmic therapy was adherent to the guidelines in 69% of cases. When the CDSS platform was applied, experts were 14% (95% CI 4-19%) more likely to prefer antiarrhythmic drug (AAD) monotherapy and 32% (95% CI 26-37%) more often prescribed radiofrequency ablation (RFA) of left atrium. At baseline, antihypertensive therapy combinations were adherent clinical guidelines in 28% of cases. The use of the CDSS platform by experts was significantly associated with an increase in the frequency of prescribing dual and triple antihypertensive therapy.Conclusion. CDSS use is associated with improved adherence to current clinical guidelines. Prospective randomized trials are needed to evaluate the CDSS effectiveness in the prevention of cardiovascular events.

Abstract Background The guideline treatments based on a relatively broad set of enrollment criteria inhibits the personalized evidence-based approach. Personalized evidence-based medicine (EBM) involves the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment. Objective We report the 1-year follow-up data of the Atrial Fibrillation Registry, focusing on the relationship between personalized EBM and guideline-adherent anticoagulation therapy use and the occurrence of major clinical adverse events. Methods 2683 patients at high risk for stroke and 1-year follow-up were enrolled in study. The primary endpoint was the percentage of guideline-based and personalized EBM recommendations acted on by clinicians. Secondary endpoints include the following: outcomes for all-cause mortality, thromboembolism (TE), bleeding, and the composite endpoints. Results From 2683 patients, 1971 (73.5%) EMR were guideline adherent and only 824 (30.7%) of them were personalized EBM anticoagulation therapy adherent, whilst 712 (26.5%) were non-guideline adherent and 1147 (42.8%) were guideline adherent but non-personalized EBM adherent. The composite endpoint of cardiovascular death, any TE or bleeding was significantly lower in personalized EBM adherent patients during 1-year follow-up (P=0.02). The endpoint of all cause death and any TE is increased by >20% by guideline adherent but non-personalized EBM adherent treatment [hazard ratio (HR) 1.254 (95% CI 0.931; 1.689)] and >80% non-guideline adherent and non-personalized EBM adherent treatment [HR 1.892 (95% CI 1.359; 2.635)]. For the composite endpoint of cardiovascular death, any TE or bleeding, guideline adherent but non-personalized EBM adherent treatment increased risk by >40% [HR 1.454 (95% CI 1.037; 2.040)], and non-guideline adherent and non-personalized EBM adherent treatment by >110% [HR 2.113 (95% CI 1.453; 3.074)]. Conclusion Personalized EBM anticoagulation management is associated with significantly better outcomes, including those related to the composite endpoint of cardiovascular death, any TE or bleeding in high-risk patients. Funding Acknowledgement Type of funding sources: None.

Abstract Background New clinical decision support system (CDSS) MedicBK use algorithms for presents treatment suggestions in frame of guideline-based therapy and personalized evidence-based medicine (EBM) therapy. Objective We hypothesized that clinicians with access to CDSS (MedicBK) would provide more personalized EBM anticoagulation treatment and improve outcomes. Methods 2683 patients at high risk for stroke and 1-year follow-up were enrolled in study and analyzed by CDSS and core laboratory. The primary endpoint was the quantify the performance of the CDSS (MedicBK) algorithm. Secondary endpoints include the following: outcomes for all-cause mortality, thromboembolism (TE), bleeding, and the composite endpoints. Results From 2683 patients, 1971 patients were core laboratory-classified as guideline adherent and 824 of them were personalized evidence-based therapy adherent. All 1971 (100%) patients were also detected as guideline adherent by CDSS, whereas only 748 (90.8%) were classified as personalized EBM adherent. The sensitivity for identifying patients with guideline and personalized EBM therapy adherence is therefore 100% and 90.8%. 712 and 1935 patients classified as guideline and personalized EBM therapy non-adherent by the core laboratory. All of them CDSS confirmed the absence of adherence, resulting in a specificity of 100%. The PPV and NPV of detecting with or without adherence to guideline, respectively, are 100% (1971 of 1971 pts) and 100% (712 of 712 pts). The PPV and NPV of detecting personalized EBM therapy adherence or non-adherence, respectively, are 100% (748 of 748 pts) and 96.1% (1859 of 1935 pts). The composite endpoint of cardiovascular death, any thromboembolism (TE) or bleeding was significantly lower in personalized EBM adherent patients during 1-year follow-up (P=0.02) and increased risk by >40% [HR 1.454 (95% CI 1.037; 2.040)], and non-guideline adherent and non-personalized EBM adherent treatment by >110% [HR 2.113 (95% CI 1.453; 3.074)]. Conclusion MedicBK appears to be promising to improve adherence to guideline and personalized EBM therapy in general practice. Personalized EBM anticoagulation management is associated with significantly better outcomes. Funding Acknowledgement Type of funding sources: None.

he association between the presence of atrial fibrillation (AF) and an increased epicardial adipose tissue (EAT) volume has been established, linking a certain amount of probable and possible pathophysiologic mechanisms that could contribute to promoting arrhythmogenesis.In the present study, we aimed to assess the reliability of EAT volume measurements on cardiac CT with adjusted thresholds for fat detection and analyze the association of EAT distribution and volume with the clinical presentation in AF patients in comparison with healthy individuals.Materials and methods.45 consecutive AF patients (mean age 55.2 ± 10.3 years, mean AF duration 49.0 ± 38.4 months) with different AF patterns scheduled for an initial ablation for AF and 15 healthy individuals (mean age 36.2 ± 12.6 years) without a history or symptoms of cardiovascular diseases were included.The total, as well as periatrial EAT volumes, were obtained on cardiac CT datasets with adjusted thresholds for fat detection.Results.The mean difference (95% CI) of total EAT between healthy individuals and AF patients were 103 ml (74, 132 ml; p<0.01) and 33.6 ml (24.8, 42.4 ml; p<0.01) for periatrial EAT.Patients with persistent AF had slightly more total EAT volume but did not significantly differ from patients with paroxysmal AF or long-standing persistent AF.Conclusion.Сardiac CT allows to reliably quantify the volume of EAT.Patients with AF have significantly large EAT volumes compared to individuals without a history of cardiovascular diseases.There is no significant difference in EAT volumes and distribution between patients with different patterns of AF.

Обзор посвящен проблемам патогенеза нарушений ритма сердца. Роль эпикардиальной жировой ткани в развитии различных сердечно-сосудистых заболеваний активно обсуждается. В статье рассмотрены основные механизмы влияния эпикардиальной жировой ткани на патогенез таких нарушений ритма сердца, как фибрилляция предсердий, желудочковые нарушения ритма, а также их взаимосвязь с хронической сердечной недостаточностью. Обозначены перспективы и нерешенные вопросы данной области знаний. Цель обзора — показать роль эпикардиальной жировой ткани и автономной нервной системы в патогенезе нарушений ритма сердца в зависимости от анатомического расположения и нозологии. Поступила в редакцию 15 марта 2021 г. Исправлена 25 апреля 2021 г. Принята к печати 26 апреля 2021 г. Финансирование Исследование выполнено при финансовой поддержке гранта Российского научного фонда (проект № 17-75-20118). Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: Д.В. Лосик, Н.А. Никитин, С.М. Минин, А.Б. Романов, А.М. Чернявский Написание статьи: Д.В. Лосик, И.Л. Михеенко, Е.В. Фишер, Н.А. Никитин Исправление статьи: Д.В. Лосик, И.Л. Михеенко, Е.В. Фишер, Н.А. Никитин Утверждение окончательного варианта статьи: все авторы

The guideline treatments based on a relatively broad set of enrollment criteria inhibits the personalized evidence-based approach. Personalized evidence-based medicine (EBM) involves the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment.