Background/Objectives: The study aimed to examine the association between the total SPPB score and serum leptin levels in patients with coronary artery disease (CAD) undergoing elective percutaneous coronary intervention (PCI). Methods: A cross-sectional study included 204 prospectively enrolled patients with CAD who were admitted for elective PCI. The mean age was 67.45 ± 8.63 years; 63.2% of patients were male. The Short Physical Performance Battery (SPPB) was used to screen for prefrailty and frailty (10–12 points: no frailty; 8–9 points: prefrailty; ≤7 points: frailty). The levels of leptin, a biomarker of fat remodeling, were measured by a highly sensitive and highly specific enzyme immunoassay using a Diagnostics Biochem Canada Inc. Leptin ELISA Kit (London, ON, Canada). Results: The prevalence of frailty and prefrailty in patients with stable CAD was 20.1% and 40.2%, respectively. A comparative analysis revealed that frailty was significantly more likely in older women with CAD before elective PCI. The total serum leptin level was 13.00 [8.00–50.00] ng/mL. Frail patients with CAD had higher leptin levels than patients without frailty (25.40 [7.00–60.00] ng/mL vs. 12.00 [5.15–19.70] ng/mL, p = 0.037). The leptin level in patients with prefrailty was 16.70 [13.00–49.10] ng/mL. Moreover, there was a moderate inverse correlation between the total SPPB score and serum leptin levels before PCI (p = 0.006). A regression analysis found that the total SPPB score in patients with stable CAD was associated with high serum leptin levels (p < 0.001) and older age (p = 0.017). Conclusions: Our study found that frail patients with CAD undergoing PCI had higher serum leptin levels than patients without frailty.

Aim. To assess the prevalence of dynapenia, presarcopenia and their relationship with structural and functional parameters of the heart in patients with coronary atherosclerosis.Material and methods. The study included 136 people with stable types of coronary artery disease (CAD). Hand grip test was performed to measure muscle strength. In women, a decrease in grip strength of <16 kg was a sign of decreased muscle strength, while in men — <27 kg (according to the guidelines of the Writing Group for the European Working Group on Sarcopenia in Older People 2 of 2019). All patients underwent computed tomography with skeletal muscle index (SMI, cm2/m2) estimation. The threshold values of SMI, a decrease in which was regarded as a decrease in muscle volume, were 52,4 cm2/m2 for men and 38,5 cm2/m2 for women. If patients had an isolated decrease in SMI according to computed tomography, the condition was classified as presarcopenia. With a decrease in muscle strength according to the hand grip test, the condition was classified as dynapenia. All patients underwent echocardiography using a standard technique.Results. The analysis revealed that individuals with presarcopenia were exclusively male and were taller (175 (168; 179) cm) than those with normal muscle mass (166 (159; 172,5) cm (p=0,001)), but the body mass index in presarcopenia was lower (27,3 (24,4; 30,3) kg/m2 and 29,5 (25,8; 33,1) kg/m2) in individuals without this pathology (p=0,02). When comparing echocardiographic parameters, a lower left ventricular (LV) ejection fraction was found among patients with presarcopenia. The LV end-diastolic volume (EDV), LV end-systolic volume (ESV), LV end-diastolic dimension (EDD), and LV end-systolic dimension (ESD) were greater in the group of patients with presarcopenia compared to other patients (p<0,05). Patients with presarcopenia were more likely to have prior myocardial infarction — 24 patients (68,6%) versus 41 (46,6%) in the group without presarcopenia (p=0,02). Patients with dynapenia differed in the following parameters: they were older (68 (65,6; 71,4) years versus 65 years (63; 67,9) in rest of the sample), mostly women (74,2%) and shorter (164 (159,6; 165,4) cm) compared to individuals without dynapenia (170 (168; 172) cm (p<0,05)). Patients with dynapenia were more likely to have prior type 2 diabetes and chronic kidney disease (p<0,05).Conclusion. Patients with presarcopenia and CAD more often have prior myocardial infarction and larger LV size and volume. Patients with dynapenia and coronary atherosclerosis are more often female, have shorter stature, and more often had chronic kidney disease and diabetes.

Background: The aim of this study was to analyze the prevalence of prefrailty and frailty syndrome (FS) in patients with coronary artery disease (CAD), and the clinical and biological characteristics of frail patients undergoing elective percutaneous coronary intervention (PCI). Material and Methods: The study included 78 patients with CAD who were admitted to the clinic to undergo PCI. To detect prefrailty and FS in patients, we used a short physical performance test battery (10–12 points—no FS, 8–9 points—prefrailty, 7 or fewer points—FS). We used the RayBio® Human ELISA Kit (Norcross, GA, USA), a highly sensitive and highly specific enzyme-linked immunosorbent assay, to determine the concentration of biological markers of inflammation (IL-6, IL-10, IL-13, IL-15, TNF-α) and bone, muscle, and fat remodeling (leptin, calcitonin, osteoprotegerin, osteocalcin, myostatin) in the serum of patients with coronary artery disease before planned PCI. Results: Taking into account the test battery score, the prevalence of FS in patients with CAD before elective PCI was 24.4%, the prevalence of prefrailty was 33.3%. According to the results of the study, older women with type 2 diabetes in their history were significantly more likely to be frail. Studying a wide range of biological markers of inflammation and musculoskeletal and fat remodeling, we noted lower levels of calcitonin (2.60 [1.50; 5.85] pg/mL, p = 0.018) and osteoprotegerin (0.80 [0.60; 1.20] ng/mL, p = 0.025) in the serum of frail patients with CAD. Later we confirmed the results by correlation analysis. Moreover, we found an association between FS and higher serum leptin levels in patients with CAD before elective PCI. Conclusion: The results of the study confirm the high prevalence of prefrailty (33.3%) and FS (24.4%) in patients with CAD. Older women with type 2 diabetes in their history were significantly more likely to be frail. At the same time, the presence of FS is associated with lower levels of calcitonin and osteoprotegerin, and higher levels of leptin in the serum of frail patients before elective PCI.

Background: Thanks to the tactics of early myocardial revascularization and active secondary prevention, there is a tendency to increase the average age of patients with atherosclerotic coronary lesions. At the same time, muscle tissue deficiency in patients with multivessel disease can affect both the choice of surgical tactics, considering possible complications, and the possibilities of pre- and rehabilitation. Objectives: To determine the clinical portrait of a patient with stable coronary artery disease (CHD) and concomitant impaired muscle status using data from computed tomography of the chest. Methods: The study included 387 people with coronary artery disease with indications for open myocardial revascularization (men n=283, women n=104), average age 65±0.58 years. Of these, 29.1% (n=113) were obese, 25.3% (n=98) had type 2 diabetes, and 36.6% (n=142) were smokers. 57.1% of patients (n=221) had a history of myocardial infarction. Angina pectoris was diagnosed in 86.3% of patients (n=334), of which 22.9% had FC I (n= 89), FC II – 52.7% (n= 204), FC III – 10.6 % (n= 41). The overwhelming number of patients had a history of arterial hypertension syndrome - 83.5% (n=323). Before surgery, all patients were diagnosed with sarcopenia in accordance with the criteria of the European Working Group on Sarcopenia in the Elderly (EWGSOP2) and a quantitative assessment of skeletal muscles was performed on a computed tomography (Somatom Sensation 64, Siemens, Germany) using data from a routine chest scan. On the resulting scans, the muscle area at the level of the Th8-9 intervertebral disc was determined. Using the obtained value of skeletal muscle area, the muscle body index (BMI) was calculated as the ratio of the area of muscle tissue to the square of the height index. Threshold values below which the percentage of muscle mass from the body composition of the test person is less than the average values of representatives of the adult population of the same sex by two standard deviations or more and corresponds to sarcopenia were taken as 33.85 cm2/m2 for men and 24.85 cm2/m2 for women. The severity of coronary lesions was assessed based on selective coronary angiography (INNOVA 3100, GE, USA). Additional assessment of the coronary arteries using the SYNTAX scale was carried out to objectify the severity of the lesion, considering the location and morphological indicators of arterial stenosis. A comparative analysis of clinical and anamnestic characteristics of groups of patients with sarcopenia and with normal muscle status was performed. Results: Sarcopenia was detected in 39.3% (n=152) of patients with stable coronary artery disease. In the sarcopenia group and the group with normal muscle status, there was a predominance of males - in 86.2% and 64.7% (p = 0.01), the presence of hypercholesterolemia - in 51.3% and 31.1% (p = 0).02), type 2 diabetes mellitus – in 21.1% and 28.1% (p=0.06), multi-vessel coronary artery disease – in 25.6% and 17.8% of cases (p=0.018) respectively. In sarcopenia, a 4-fold longer history of diabetes mellitus was noted (p=0.01) and a 2.3-fold longer duration of coronary artery disease (p=0.03). The incidence of obesity with sarcopenia is 3.4 times less (p=0.003). Correlation analysis showed a relationship between muscle status and age (r=-0.674; p=0.002), duration of history of coronary artery disease (r=-0.582; p=0.001) and diabetes (r=-0.748; p<0.001). When assessing the coronary bed, there were no statistically significant differences between the studied groups, either in the number of SYNTAX Scores (p = 0.35) or in the prevalence of risk levels determined by the SYNTAX Score. However, hemodynamically significant coronary lesions involving three coronary arteries were verified in 25.6% of patients with sarcopenia, whereas in the group with normal muscle mass, three-vessel lesions were detected in 17.8% of patients (p = 0.018). Conclusion: The clinical and anamnestic image of a patient with stable coronary artery disease and sarcopenia is characterized by an association of reduced muscle mass with male gender, age, hypercholesterolemia, multivessel coronary disease, a long history of diabetes mellitus and angina pectoris. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

Objective. To assess the density of the calcified substrate of atherosclerotic plaques of the carotid arteries using data from the computed tomography of patients with multifocal atherosclerosis. Material and methods. In 251 patients with verified atherosclerosis of the coronary and carotid arteries, with a high prevalence of angina pectoris, a history of myocardial infarction and modifiable cardiovascular risk factors, multislice computed tomography (MSCT) of the carotid arteries was performed to assess the calcium index and determine the equivalent density of calcium deposits (EDCD). A morphological sub-study of the material from the removed atherosclerotic plaques was carried out using scanning electron microscopy (SEM) in 12 patients. Results. According to the MSCT data, we identified 5 main types of calcium deposit location in the thickness of the atherosclerotic plaque. We noted that totally calcified plaques were associated with carotid artery stenosis by more than 30 %. According to the SEM data, we identified 2 leading patterns: diffuse and compact types of microcalcification. There was a statistically significant association of a low level of EDCD with a diffuse type of calcification both in vivo (p=0.010) and ex vivo (p=0.008). Patients, having carotid artery EDCD less than 0.21 mg/mm3, reported a significantly higher incidence of type 2 diabetes mellitus (p=0.0001) and a history of stroke (p=0.021). When comparing the MSCT data on the calcium deposit density and their localization in the atherosclerotic plaque, we noted a statistically significant predominance of low EDCD with superficial calcification of the plaque (p=0.002). Conclusion. The use of a calculated indicator of the equivalent density of calcium deposits of the atherosclerotic substrate allows us to non-invasively obtain new data on the structure of plaques. The observed association of the superficial distribution of calcification with low calcification density according to the MSCT data may indicate potential plaque instability.

The growing number of studies on cerebral venous circulation disorders associated with extrinsic stenosis of the internal jugular veins, as well as attempts to surgically influence the restoration of blood flow, are an indicator of the importance of this problem. Studies show that extracranial outflow disorders are associated with a wide range of neurological clinical manifestations and may contribute to the development of congestive intracranial hypertension. Anatomical variants of the development of the extracranial venous system, constitutional insufficiency and stenosis often play similar roles in the development of disorders of the cerebral venous outflow, but differ parametrically. There are no standard diagnostic criteria for differential diagnosis, normal and pathological parameters are contradictory, and the diagnosis largely depends on the combined use of imaging techniques. The history of attempts to study disorders of the cerebral venous circulation is quite long, associated with the technical innovations in every period of time. The most non-invasive, accessible and safe tools for diagnosing non-thrombotic lesions and anomalies of the internal jugular veins are currently recognized as ultrasound scanning and MR venography in tandem. Researchers note both local hemodynamic disturbances at the level of stenosis and changes in the overall picture of the venous vascular network of the neck with certain patterns of its remodeling. The pathological significance of the compensatory expansion of nonjugular outflow tracts (vertebral, paraspinal collateral, spinal epidural veins, etc.) is still a controversial issue. MRI and ultrasound combined show a high degree of agreement between the results, which should stimulate further research into the pathophysiology and differentiation of various causes and severity of non-thrombotic lesions of the jugular veins.

The article is devoted to the analysis of the current status of nuclear cardiology in the Russian Federation. The data on the number of facilities performing radionuclide investigations for the diagnosis and monitoring of the treatment of cardiovascular diseases, their staffing and equipment are given. The statistics of the conducted nuclear cardiology tests for 2018-2020 are given, as well as their methods, features and diagnostic significance are described.

Highlights. Using ECHO and MSCT data, a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement was performed. A significant increase in the fluid flow, wall and viscous shear stresses in the area of regurgitation is shown. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosisAim. To make a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement based on retrospective clinical data.Methods. The study included echocardiography and multi-slice computed tomography data as input data for modeling one pulsation of a fluid similar in properties to blood. Reconstruction of the paraprosthetic fistula and the ascending aorta was performed in the Mimics medium (Materialise, Belgium). The obtained 3D models were processed in the Salome software (OPEN CASCADE SAS, France), after which they were exported to HELYX-OS (ENGYS, Great Britain) to build a finite element mesh. The flows were modeled using the OpenFOAM software package version 6 (The OpenFOAM Foundation Ltd, UK).Results. The simulation result, expressed quantitatively and qualitatively in the form of diagrams of the measured parameters – fluid flow velocities, wall and viscous shear stresses, shows a significant increase in indicators in the area of paraprosthetic regurgitation. Thus, the velocity in the affected area was 1.9–4.2 m/s, which is 3.8 higher than the average value in the entire computational area. The wall shear stress value was up to 61 Pa in the critical area, which may indicate an increased risk of thrombus formation due to the initiation of the clotting cascade through the von Willebrand factor. The value of viscous shear stress, the main component of the destruction of red blood cells in laminar flow, amounted to 20–26 Pa, which, in general, is not enough for mechanical hemolysis.Conclusion. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosis.

A rare clinical case of thrombosis of varicose superior ophthalmic vein in combination with a unilateral venous anomaly of the subcortical region of the brain with successful antithrombotic therapy is presented. Varicose veins of the superior ophthalmic vein are rare (2% of all orbital formations) and are a risk factor for thrombosis. Material and methods. A 41-year-old patient with verified thrombosis of unilateral orbital venous varicose veins was observed for 9 months. Initially, MSCT of the brain and MSCT angiography were performed, then dynamic monitoring was carried out by performing MRI of the brain and MR venography, and finally an ultrasound examination of the orbit was performed. Description of a clinical case. The clinical presentation consisted of a slight non-pulsatile unilateral exophthalmos, mild ptosis, periorbital soft tissue edema, subconjunctival hemorrhage, paraorbital hematoma, and venous dysfunction in the fundus. MSCT and MSCT angiography revealed a thrombus inside the sac of orbital venous varicose veins. The disease was probably secondary in nature, given that it was combined with venous angioma of the subcortical region on the same side. During 9 months of observation, to monitor the effectiveness of therapy, MRI was performed three times before and after contrast enhancement, which showed a gradual decrease in exophthalmos, the size of the thrombus and the varicocele sac, which was accompanied by a gradual improvement in the clinical picture until subjective recovery. Conclusion. MRI was as good an imaging modality as MSCT, and, in our opinion, more preferable due to the absence of radiation exposure and the need for iodine contrast agent.

Highlights. Patients with coronary artery disease and age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) who underwent elective on-pump coronary artery bypass grafting are at higher risk of developing cardiovascular complications, non-infectious complications, and death.Musculoskeletal disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) in combination with traditional predictors (age, diabetes mellitus, prior myocardial infarction and stroke, cancer) are risk factors for unfavorable prognosis of postoperative period of coronary artery bypass grafting. Aim. To assess risk factors for unfavorable prognosis in patients with coronary artery disease (CAD) undergoing elective on-pump coronary artery bypass grafting, taking into account age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia).Methods. This single-center study included 387 CAD patients admitted for elective coronary artery bypass grafting. Taking into account the diagnosed age-related disorders, four groups of patients were formed. The first group consisted of 52 (13.4%) patients with sarcopenia, the second group was comprised of 28 (7.2%) patients with osteopenia (osteopenia/osteoporosis), the third group included 25 (6.5%) patients with osteosarcopenia, and the fourth group consisted of 282 (72.9%) participants with coronary artery disease and without musculoskeletal disorders (MSD). Risk factors for a composite endpoint (myocardial infarction, stroke, paroxysmal atrial fibrillation, cardiac rhythm disturbances) and death, and noninfectious complications (resternotomy for bleeding, pneumothorax aspiration and thoracentesis) were assessed.Results. The composite endpoint occurred more frequently in patients with osteopenia (group I – 9.6%, group II – 32.1%, group III – 12%, group IV – 12.8%; p = 0.029), and non-infectious complications occurred more frequently in patients with sarcopenia and osteosarcopenia (group I – 17.3%, group II – 7.1%, group III – 12%, group IV – 5.3%; p = 0.002). MSD were associated with the risk of composite endpoint (odds ratio (OR) 1.73, p = 0.035), and osteopenia increased it three-fold (OR 3.01, p = 0.046). Moreover, MSD were associated with higher risk of non-infectious complications (OR 1.71, p = 0.026), especially in patients with sarcopenia (OR 2.02, p = 0.034). The assessment of risk factors for unfavorable prognosis highlighted the presence of osteopenic syndrome (100 CU), prior stroke (88 CU) and myocardial infarction (85 CU). The risk of non-infectious complications was associated with prior ischemic events (ranking level for myocardial infarction – 100 CU, stroke – 75 CU), and MSD (89 CU) and its types (osteosarcopenia – 77 CU, osteopenia – 69 CU, sarcopenia – 52 CU).Conclusion. Age-related disorders in combination with MSD increase the risk of a composite endpoint and non-infectious complications by one to three times.

Aim. To determine the clinical profile of a patient with stable coronary artery disease (CAD) and impaired muscle status. Material and methods . The study included 387 patients with stable CAD who had indications for open myocardial revascularization. Quantification of muscle tissue was carried out using computed tomography. Comparative analysis of clinical and anamnestic characteristics of groups of patients with sarcopenia (n=152) and those with normal muscle status (n=235) was performed. Results . Signs of sarcopenia were found in 39,3% of patients with stable CAD. In the group of sarcopenia and the group with normal muscle status, there was a predominance of males — 86,2 and 64,7% (p=0,01), the presence of hypercholesterolemia — 51,3 and 31,1% (p=0,02), type 2 diabetes — 21,1 and 28,1% (p=0,06), multivessel CAD — 25,6 and 17,8% of cases (p=0,018), respectively. In sarcopenia, a 4 times longer history of diabetes was noted (p=0,01) and a 2,3 times longer duration of CAD (p=0,03). The prevalence of obesity in sarcopenia was 3,4 times less (p=0,003). Correlation analysis showed the relationship of muscle status with age (r=-0,674; p=0,002), duration of CAD history (r=-0,582; p=0,001) and diabetes (r=-0,748; p<0,001). Conclusion. The clinical and anamnestic profile of a patient with stable CAD and sarcopenia is characterized by an association of decreased muscle mass with male sex, hypercholesterolemia, multivessel coronary CAD, a long-term history of type 2 diabetes and angina.

Aim. To assess the relationship of various clinical and biological markers of bone metabolism with the progression of coronary artery calcification (CAC) in patients with stable coronary artery disease (CAD) within 5 years after coronary artery bypass grafting (CABG).Material and methods. This single-center prospective observational study included 111 men with CAD who were hospitalized for elective CABG. In the preoperative period, all patients underwent duplex ultrasound of extracranial arteries (ECA) and multislice computed tomography (MSCT) to assess CAC severity using the Agatston score, as well as densitometry with determination of bone mineral density in the femoral neck, lumbar spine and T-score for them, In all participants, the following bone metabolism biomarkers were studied: calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone. Five years after CABG, ECA duplex ultrasound, MSCT coronary angiography and bone metabolism tests were repeated. Depending on CAC progression (>100 Agatston units (AU)), patients were divided into two groups to identify significant biomarkers and clinical risk factors associated with CAC progression.Results. For 5 years after CABG, contact with 16 (14,4%) patients was not possible; however, their vital status was assessed (they were alive). Death was recorded in 4 (3,6%) cases (3 — due to myocardial infarction, 1 — due to stroke). In 18 (19,7%) cases, non-fatal endpoints were revealed: angina recurrence after CABG — 16 patients, myocardial infarction — 1 patient, emergency stenting for unstable angina — 1 patient. There were no differences in the incidence of events between the groups with and without CAC progression. According to MSCT 5 years after CABG (n=91 (81,9%)), CAC progression was detected in 60 (65,9%) patients. Multivariate analysis allowed to create a model for predicting the risk of CAC progression, which included following parameters: cathepsin K <16,75 pmol/L (p=0,003) and bone mineral density <0,95 g/cm3 according to femoral neck densitometry before CABG (p=0,016); OPG <3,58 pg/ml (p=0,016) in the postoperative period 5 years after CABG.Conclusion. Within 5 years after CABG, 65,9% of male patients with stable coronary artery disease have CAC progression, the main predictors of which are low preoperative cathepsin K level (<16,75 pmol/L) and low bone mineral density (<0,95 g/cm3) according to femoral neck densitometry, as well as a low OPG level (<3,58 pg/ml) 5 years after CABG.

Background and Aims : Purpose: to evaluate the relationship between adipocytokine gene expression in the AT of the heart of patients with CVD and morphometric parameters of AT.Methods: This study included 150 patients with CAD. The area of abdominal, visceral AT, thickness PVAT and EAT was determined using MSCT, MRI. The SAT area was calculated mathematically. Adipocytes were isolated from subcutaneous (SAT), epicardial (EAT), and perivascular (PVAT) AT, and were cultured for 24 h. The expression of adiponectin (ADIPOQ), adiponectin receptor 1, 2 (ADIPOR1, ADIPOR2), leptin (LEP), leptin receptor (LEPR) and interleukin-6 (IL6) genes was determined using PCR.Results: The thickness of the EAT LV, PVAT of the LCA trunk, the proximal third of the anterior descending artery, the proximal third of the circumflex artery, and the area of the VAT, more associated with coronary atherosclerosis. for them have been set for these parameters. EAT was characterized by the lowest level of ADIPOQ and ADIPOR1,2 expression, high level of lep expression, LEPR and IL6. The ADIPOQ expression in the EAT and PVAT, ADIPOR1,2 in the EAT, LEP in the EAT, LEPR in the EAT, IL6 in the EAT and PVAT were most associated with an increase in the size of local fat depots.Conclusions: Increased production of leptin and IL-6 and reduced production of adiponectin in EAT and PVAT, are associated with atherosclerosis, an increase in the size of AT in the heart region and are a prognostically unfavorable sign in patients with CAD. Background and Aims : Purpose: to evaluate the relationship between adipocytokine gene expression in the AT of the heart of patients with CVD and morphometric parameters of AT. Methods: This study included 150 patients with CAD. The area of abdominal, visceral AT, thickness PVAT and EAT was determined using MSCT, MRI. The SAT area was calculated mathematically. Adipocytes were isolated from subcutaneous (SAT), epicardial (EAT), and perivascular (PVAT) AT, and were cultured for 24 h. The expression of adiponectin (ADIPOQ), adiponectin receptor 1, 2 (ADIPOR1, ADIPOR2), leptin (LEP), leptin receptor (LEPR) and interleukin-6 (IL6) genes was determined using PCR. Results: The thickness of the EAT LV, PVAT of the LCA trunk, the proximal third of the anterior descending artery, the proximal third of the circumflex artery, and the area of the VAT, more associated with coronary atherosclerosis. for them have been set for these parameters. EAT was characterized by the lowest level of ADIPOQ and ADIPOR1,2 expression, high level of lep expression, LEPR and IL6. The ADIPOQ expression in the EAT and PVAT, ADIPOR1,2 in the EAT, LEP in the EAT, LEPR in the EAT, IL6 in the EAT and PVAT were most associated with an increase in the size of local fat depots. Conclusions: Increased production of leptin and IL-6 and reduced production of adiponectin in EAT and PVAT, are associated with atherosclerosis, an increase in the size of AT in the heart region and are a prognostically unfavorable sign in patients with CAD.

Th e aim of the research. To analyse the structure of complications in patients with coronary artery disease and different musculoskeletal disorders (MSD) undergoing elective coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Material and methods. From 2019 to 2020, a single-centre cohort study was conducted on 387 stable coronary artery disease patients aged over 50 before elective CABG. The following MSD were assessed: sarcopenia, osteopenia, and osteosarcopenia. Patients were divided into four groups according to the MSD type: group I included 52 (13.4 %) patients with sarcopenia, group II included 28 (7.2 %) patients with osteopenia, group III was composed of 25 (6.5 %) patients with osteosarcopenia, and group IV included 282 (72.9 %) patients without MSD. Patients underwent CABG using cardiopulmonary bypass. Cardiovascular, infectious and non-infectious complications, death, a composite endpoint including cardiovascular complications and death, as well as the total number of complications were analysed. Results. Infectious complications were revealed in 23 (5.9 %) patients. Th e highest frequency of infectious complications was noted in patients with osteosarcopenia while the lowest frequency was found in patients without MSD (24 % vs 5.8 % in group I, 7.1 % in group II, 4.3 % in group IV). The highest number of surgical complications was noted in patients with sarcopenia and osteosarcopenia (17.3 % in group I, 7.1 % in group II, 12 % in group III, 5.3 % in group IV; p = 0.002). The composite endpoint was significantly more prevalent in patients with osteopenia (32.1 vs. 9.6 % in group I, 12 % in group III, and 12.8 % in group IV). Th ere were no statistically signifi cant diff erences in the total number of complications between the groups of patients with MSD. Th e complications were 2-fold more likely to occur in patients with osteopenia and osteosarcopenia compared to patients without MSD. Moreover, MSD increased the risk of the composite endpoint by 1.7 times (odds ratio (OR) 1.73, 95 % confi dence interval (CI) 1.04-2.89; p = 0.035); osteopenia increased the risk of the combined endpoint by 3 times (OR 3.01, 95 % CI 1.02-8.9; p = 0.046). Surgical complications were associated with baseline MSD (OR 1.71, 95 % CI 1.06-2.76; p = 0.026); sarcopenia increased the risk of surgical complications by 2 times (OR 2.02, 95 % CI 1.05-3.88; p = 0.034). Conclusion. The frequency of complications in patients with MSD was 1.79-fold higher compared with patients without MSD. Cardiovascular and infectious complications as well as complications associated with surgical treatment were more common in patients with MSD. MSD can be used as a risk factor for the development of in-hospital complications because the presence of these disorders increases the risk of cardiovascular complications, non-infectious complications and death by 1.7 times. Moreover, osteopenia was associated with a threefold increase in the composite endpoint risk, while sarcopenia doubled the risk of non-infectious complications.

Highlights. Taking into account the connection between the increase in the volume of myocardial adipose tissue and vessels with massive calcification of the coronary arteries in coronary heart disease, morphometry of epicardial and perivascular adipose tissue during routine tomographic examinations can be considered as a non-invasive technique for determining a surrogate marker of severe coronary lesion.Aim. To evaluate the relationship of coronary artery calcification (CA) and morphometric parameters of local fat depots in patients with coronary heart disease (CHD).Methods. 125 patients with stable coronary artery disease aged 59±8.9 years were examined. Visualization of local fat depots, abdominal fat depots, and coronary calcification (CC) was performed using multislice computed tomography with subsequent post-processing of images on the Siemens Leonardo workstation (Germany). Non-contrast magnetic resonance imaging of the heart was used to determine the EAT thickness.Results. Coronary calcification was detected in 95.2% of the examined patients with coronary artery disease (n = 119). There were higher indices of the EAT thickness of the right and left ventricles in case of massive CC, the thickness of the pericardial adipose tissue at the level of the trunk of the left coronary, anterior descending, circumflex arteries, and increased morphometry indices of the abdominal fat depot in comparison with the patients who had moderate and medium CC.Conclusion. An increase in the volume of adipose tissue of the myocardium and vessels in CAD is associated with massive calcification, which is reflected in the pathogenetic “adipovascular” continuum, characterized by the stimulation of adipogenesis against the background of atherocalcinosis of the coronary arteries. Morphometry of epicardial and perivascular adipose tissue during routine tomographic studies is a non-invasive technique for determining a surrogate marker of severe coronary lesions.

Aim. Determination of the clinical and prognostic value of the equivalent density of calcium deposits (EDCD) of coronary arteries in patients with stable coronary heart disease (CHD) and concomitant osteopenic syndrome (OS) after coronary artery bypass grafting (CABG), based on five-year follow-up. Materials and methods. A prospective study included 393 patients with stable CHD hospitalized for CABG. All patients underwent multispiral computed tomography of coronary arteries to assess the degree of calcification and EDCD, and Х-ray absorptiometry. During the five-year observation we studied mortality and adverse cardiovascular events. The average duration of the observation period was 58.91.8 months. Results. Data were obtained on the correlation of EDCD with the presence of OS (r=0.19; p0.001), a decrease in the T-criterion of the thigh (r=-0.21; p0.001) and lumbar vertebrae (r=-0.19; p0.001). With a decrease in the EDCD of coronary arteries below the level of 0.19 mg/mm3, an increased mortality risk is noted (odds ratio 2.84, 95% confidence interval 1.545.25). Linear regression analysis revealed that predictors of adverse outcomes over the course of a follow-up were the presence of carotid artery stenosis 30%, low left ventricular contractility, elevated triglyceride levels, and low EDCD. Conclusion. According to the results of the study the negative prognostic significance of the low EDCD of coronary arteries in relation to mortality, myocardial infarction, and revascularization in patients after CABG, regardless of the presence of concomitant OS.

Highlights. Non-invasive method for the assessment of the mobility and deformation of the wire element of the bioprosthesis in the cardiac cycle based on the developed mathematical algorithm is presented. Numerical analysis of the behavior of the wire element of the “TiAra” bioprosthesis is shown for the first time. The developed method can be used for other medical devices as well.Aim. To develop a method for non-invasive assessment of the mobility and deformation of the wire element of the aortic heart valve bioprosthesis in the cardiac cycle based on mathematical processing of visual medical data.Methods. Multidetector computed tomography data of patient P. (male, 66 years old), who received the “TiAra” aortic bioprosthesis (NeoCor CJSC, Kemerovo), were used for the study. Using the built-in tools in the Mimics Medical Image Processing Software (Materialize, Belgium), based on the radio density, 5 stages of movement of the wire element of the bioprosthesis were reconstructed in the form of 3D-models. The differences between the models, characterizing deformation in the cardiac cycle, were quantitatively assessed using a proprietary Matlab algorithm (The MathWorks, USA), calculating the distance between similar points. Moreover, obtained data on displacements was used in the numerical study of the stress-strain state of a 3D-model of the wire element by the finite element method in the Abaqus/CAE software (Dassault Systèmes SE, France).Results. The proposed method for assessing the mobility of the wire element made it possible to quantitatively evaluate the biomechanics of the “TiAra” stentless bioprosthesis based on multidetector computed tomography, a non-invasive clinical tool. The movements that the bioprosthesis undergoes during the cardiac cycle (the maximum value is 2.04 mm in the radial direction) are comparable to the movement of the aortic root of a healthy patient. The results of the numerical modeling of the stress state of the wire element did not indicate high amplitudes (peak value – 564 MPa) that would be capable of causing critical damage to the wire. It allows us to confirm the clinical safety of the bioprosthesis in real conditions like asymmetric and uneven loads. Moreover, deformations observed in the bioprosthesis are similar in the amplitude to the displacements of the aortic root described in the literature, which highlights the main feature of the bioprosthesis – ensuring the physiological biomechanics throughout the cardiac cycle.Conclusion. The presented method of qualitative computer assessment of the movement of the wire element of heart valve prosthesis using the “TiAra” bioprosthesis as an example demonstrates its validity as a tool for studying prosthesis functioning.

Aim. To assess the changes in cardiology diagnostics scope in the Russian Federation during the coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), including questions about changes in the workflow of diagnostic laboratories and the scope of cardiac diagnostics from March 2019 (pre-pandemic) to April 2020 (first wave of the pandemic) and April 2021 (recovery stage), 15 Russian medical centers from 5 cities took part.Results. The decrease in the diagnostics scope by April 2020 by 59,3% compared to March 2019, by April 2021, stopped and was replaced by growth (+7,1%, the recovery rate, 112,1%). The greatest increase was in routine examinations, such as echocardiography (+11,6%), stress echocardiography (+18,7%), stress single photon emission computed tomography (+9,7%), and to a lesser extent resting computed tomography angiography (+7,0%) and magnetic resonance imaging (+6,6%). The performance of stress electrocardiography, stress magnetic resonance imaging and positron emission tomography for the diagnosis of endocarditis in April 2021 compared to March 2019 decreased by 10,3%, 63,2% and 62,5%, respectively.Conclusion. Due to the resumption of patient admissions for cardiac examinations during the ongoing COVID-19 pandemic, with the anti-epidemic measures taken and certain changes in the workflow, there has been a recovery in the diagnostics scope in most of the included centers.

Background and Aims : Aim: to study the relationship between the adipocytokine profile of epicardial AT (EAT) and perivascular AT (PVAT) with the severity of coronary artery calcification (CC) in patients with coronary artery disease (CAD).Methods: The study included 125 patients with CAD, whose mean age was 59.12 (53.35; 66.41) years. Coronary artery (CA) calcification degree was assessed by multislice spiral computed tomography (MSCT) method (Siemens AG Medical Solution, Germany). During coronary artery bypass grafting, biopsies of subcutaneous adipose tissue (SAT), EAT and PVAT were obtained in all patients. Adipocytes were isolated under sterile conditions. The expression of ADIPOQ, LEP, IL6 was determined using PCR with detection of products in real time and the level of adipocytokine secretion in the culture medium using test systems "R&D Systems" (Canada) by enzyme-linked immunosorbent assay.Results: The highest level of expression of the ADIPOQ in all types of fat stores was observed in patients with moderate/medium CС compared to those with massive CС; the maximum expression of ADIPOQ was observed in the culture of PVAT adipocytes. Expression of the LEP and IL6 in massive CC was higher, with the maximum values in the culture of EAT adipocytes relative to SAT and PVAT adipocytes. Decreases in the levels of ADIPOQ and its secretion, increases in the levels of LEP and IL6 and their secretion in adipocytes of the EAT and PVAT were associated with the development of СС in patients with CAD.Conclusions: High expression and secretion of leptin and IL6 and low adiponectin are associated with massive coronary calcification. Background and Aims : Aim: to study the relationship between the adipocytokine profile of epicardial AT (EAT) and perivascular AT (PVAT) with the severity of coronary artery calcification (CC) in patients with coronary artery disease (CAD). Methods: The study included 125 patients with CAD, whose mean age was 59.12 (53.35; 66.41) years. Coronary artery (CA) calcification degree was assessed by multislice spiral computed tomography (MSCT) method (Siemens AG Medical Solution, Germany). During coronary artery bypass grafting, biopsies of subcutaneous adipose tissue (SAT), EAT and PVAT were obtained in all patients. Adipocytes were isolated under sterile conditions. The expression of ADIPOQ, LEP, IL6 was determined using PCR with detection of products in real time and the level of adipocytokine secretion in the culture medium using test systems "R&D Systems" (Canada) by enzyme-linked immunosorbent assay. Results: The highest level of expression of the ADIPOQ in all types of fat stores was observed in patients with moderate/medium CС compared to those with massive CС; the maximum expression of ADIPOQ was observed in the culture of PVAT adipocytes. Expression of the LEP and IL6 in massive CC was higher, with the maximum values in the culture of EAT adipocytes relative to SAT and PVAT adipocytes. Decreases in the levels of ADIPOQ and its secretion, increases in the levels of LEP and IL6 and their secretion in adipocytes of the EAT and PVAT were associated with the development of СС in patients with CAD. Conclusions: High expression and secretion of leptin and IL6 and low adiponectin are associated with massive coronary calcification.

The aim of this paper is to evaluate the effect of pulmonary vein (PV) morphometric characteristics and spatial orientation on the results of cryoballoon ablation (CBA). Methods: A randomized, prospective, single-center controlled study was conducted, enrolling 230 patients with drug-refractory atrial fibrillation (AF). We compared procedural and long-term outcomes in patients who underwent their first procedure of pulmonary vein isolation (PVI) for AF with either radiofrequency ablation (RFA) (n = 108) or CBA (n = 122) and assessed their interaction with the different pattern of PV anatomy, morphometric characteristics, and spatial orientation. The primary efficacy endpoint was any documented atrial arrhythmia recurrence (AF, atrial flutter, or atrial tachycardia) lasting over 30 s during a 12-month follow-up after a 90-day blanking period and discontinuation of antiarrhythmic drugs. The procedure’s endpoint was the achievement of PVI. Before the intervention, all patients underwent computed tomography (CT) to assess the PV anatomical variant, maximum and minimum diameters of the PV’s ostia, their cross-sectional area, orifice ovality index, and PV tilt angles. Results: The mean follow-up period was 14 months (12; 24). Long-term efficacy in the cryoablation group was 78.8% and in the RFA group—83.3% (OR = 0.74; 95% CI 0.41–1.3; p = 0.31). The RFA results did not depend on PV anatomy. The «difficult» occlusion of the right inferior PV (RIPV) occurred in 12 patients and was associated with a more horizontal PV position in the frontal plane; the mean tilt angle was −15.2 ± 6.2° versus −26.5 ± 6.3° in the absence of technical difficulties (p = 0.0001). In 11 cases (9%), during ablation of the right superior PV (RSPV), phrenic nerve injury (PNI) occurred and was associated with the maximum and minimum RSPV diameter, 20.0–20.4 mm (OR = 13.2; 95% CI: 4.7–41.9, p < 0.05) and 17.5–20 mm (OR = 12.5; 95% CI 3.4–51, p < 0.05), respectively. Patients with arrhythmia recurrence were characterized by significantly larger diameters and ovality of the left superior PV (LSPV). The spatial orientation of the PV does not affect the long-term results of cryoablation. Conclusion: Preprocedural evaluation of PV morphology and orientation using cardiac CT might help choose the optimal technology for the individual patient.