Aim. To analyze the relationship of low blood potassium concentration before surgery with the risk of postoperative atrial fibrillation (POAF).Material and methods. Data were collected and analyzed from patients admitted to the intensive care unit after cardiac surgery between January 2023 and June 2023. During the study period, 691 patients were operated on. Of these, 96 (13,9%) patients developed POAF, which made up group A (mean age 68,3±10,0). Control group B of patients with sinus rhythm was formed using a random generator and consisted of 96 patients with a mean age of 63,5±8,3.Results. The median time to onset of arrhythmia was 39,0 (29,2-51,0) hours. The blood potassium concentration one hour before surgery was significantly reduced in patients who developed arrhythmia compared with the control group (p<0,001) and averaged 3,4±0,4 mmol/L. To determine the sensitivity and specificity of the association of hypokalemia with POAF, we used a confirmatory statistical method, namely constructing ROC curves (AUC 0,640 (95% confidence interval: 0,562-0,718; p<0,001)).Conclusion. This study demonstrated the association of low preoperative blood potassium concentrations with the risk of POAF. Electrolyte concentrations alone cannot fully explain the risk of arrhythmia. However, optimizing electrolyte balance and, in particular, maintaining potassium concentrations >4,5 mmol/L may prevent the atrial fibrillation in some patients.

Introduction. Constrictive pericarditis is a long-term consequence of any pathological process developing in the pericardium due to fibrinous thickening and calcification of its layers, which prevents normal cardiac diastolic filling. One of its forms is transient constrictive pericarditis, which resolves after anti-inflammatory therapy. Brief description. A 19-year-old man with Bruton disease was admitted to the clinic with complaints of severe weakness, shortness of breath at rest, cough, chest pain, hyperthermia to 38 0 C, decreased blood pressure to 80/60 mm Hg, and abdominal distension. During the initial echocardiography, the results did not raise serious suspicions. However, given the rather specific interventricular septum motion, pericardial constriction was suspected. Discussion. During the additional examination, echocardiography made it possible to verify constrictive pericarditis, which was subsequently confirmed by heart catheterization. Due to significant immunoglobulin level deviations, a decision was made to resume immunoglobulin replacement therapy, followed by a clinical status reassessment. The article presents a clinical description of a patient with constrictive pericarditis, which was a manifestation of Bruton disease. During follow-up, resolution of constriction was noted with resumption of immunoglobulin replacement therapy.

The prognosis after heart transplantation continues to improve. Therefore, the prevention of chronic post-transplant sequelae, such as chronic kidney disease, allograft vasculopathy, and malignancies is becoming increasingly important. Everolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is increasingly used for immunosuppression after heart transplantation. However, everolimus may cause a characteristic complex of adverse effects, including dyslipidemia. Currently there are no guidelines for the long-term screening and treatment of dyslipidemia in heart transplant recipients treated with everolimus. This article presents a clinical case of hypercholesterolemia that developed after the start of the everolimus treatment in a heart recipient. The patient was a 39-year-old man who underwent orthotopic heart transplantation for ischemic cardiomyopathy in 2012 (at the age of 27). In 2019, the patient’s immunosuppressive therapy was converted from mycophenolate mofetil to everolimus due to the development of cardiac allograft vasculopathy. The change in the immunosuppressive therapy was associated with increases in total cholesterol and low-density lipoprotein cholesterol, which were not reversed with a combined lipid-lowering therapy (maximum doses of rosuvastatin, ezetimibe, fenofibrate). A decrease in lipid levels was achieved with a blocker of hepatic proprotein convertase subtilisin/kexin type 9 synthesis at the level of microribonucleic acid (inclisiran). This case demonstrates the difficulties in correcting dyslipidemia in patients with cardiac allograft, since the treatment with the immunosuppressant everolimus worsens existing dyslipidemia. However, the combination lipid-lowering therapy, that affects various elements of the pathogenesis (specifically, the combined inhibition of hydroxymethylglutaryl-CoA reductase with a statin, cholesterol absorption from the small intestine with ezetimibe, and PCSK9 messenger RNA with inclisiran), provides an effective control of blood lipids and minimizing the adverse effects of immunosuppressive therapy, such as cardiac allograft vasculopathy.

Introduction. The growing prevalence of transcatheter aortic valve implantation (TAVI) over the past few years has revealed a unique set of events and complications that require rapid identification and treatment to improve outcomes, often involving a multidisciplinary team.Brief description. We present the case of a 79-year-old woman with severe aortic stenosis who underwent a TAVI procedure that was complicated postoperatively by hectic fever without an identified source of infection. After excluding all possible causes of fever, a diagnosis of post-implantation syndrome was made, and glucocorticosteroid therapy led to the patient's recovery.Discussion. A systemic inflammatory response may occur after endovascular aortic aneurysm repair in some patients. This inflammatory response is called postimplantation syndrome and includes fatigue or other flu-like symptoms, fever, and laboratory signs of inflammation. Our case describes the difficulties in differential diagnosis of post-implantation syndrome as a possible complication of TAVI, and also demonstrates the importance of a multidisciplinary approach to such patients.

Newly diagnosed postoperative atrial fibrillation (NDPAF) is one of the most common complications after cardiovascular surgery, provoking early and late complications, such as cardiovascular, thromboembolic complications, cerebral circulation disorders, prolonged hospital stay and repeated hospitalizations to the intensive care unit and hospital. Objective. To identify biochemical and clinical predictors of NDPAF in patients who underwent open-heart surgery for any indication. Materials and methods. The study included patients operated in the cardiac surgery department No.2 of the Research Institute – Prof. S.V. Ochapovsky Territorial Clinical Hospital One (Krasnodar) in the period from January 1, 2020 to January 1, 2021. During the analyzed period of time, open heart surgery was performed in 1503 patients, of whom 158 (10.5%) had NDPAF. Results. Hematological/biochemical parameters include low levels of hemoglobin (<12.5 g/dl), hematocrit (<35%), erythrocytes (<4,2•1012/L), and high levels of lymphocytes (>3,0•109/L), bilirubin (20.5 mmol/L), creatinine (115 mmol/L), urea (8.3 mmol/L), aspartate aminotransferase (>35 U/L), alanine aminotransferase (>55 U/L), C-reactive protein (>5 mg/L) were associated with an increased frequency of NDPAF in single-factor analysis (p<0.05 for all comparisons). Conclusion. Hematological indicators can predict the risk of atrial fibrillation before surgery. The study of risk factors for NDPAF will allow to effectively influence them, thereby preventing the possibility of arrhythmia and improving the prognosis for postoperative complications and survival.

Russian Society of Cardiology (RSC)With the participation of: the National Society for the Study of Atherosclerosis (NOA), the Atherothrombosis National Society, the Russian Association of Cardiovascular Surgeons, the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Society of Radiologists and Radiologists (RSRR), the Russian Association of Ultrasound Diagnostics Specialists in Medicine (RASUDM), the Russian Scientific Society for X-ray Endovascular Diagnosis and Treatment

The Russian Society of Cardiology (RKO)With the participation of: Russian Scientific Medical Society of Internal Medicine (RSMSIM)Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation (12.09.2024)

Solid organ transplantation is considered the most effective treatment for endstage heart, lung, pancreatic, liver, and kidney diseases. The increasing number of transplants performed, and long-term survival of recipients have contributed to an increase in the diagnostic rate of non-transplant-related diseases.Heart transplant patients are at increased risk of complications when undergoing elective or emergency surgery. We report a case of hip replacement in a young man after orthotopic heart transplantation.

Objective: to evaluate the course and outcomes of ACS in patients with type 2 diabetes taking SGLT-2 inhibitors. Materials and methods: the study included patients admitted to the Research Institute – Regional Clinical Hospital No. 1 n.a. Prof. S.V. Ochapovsky” Krasnodar from 01.11.2023 to 01.02.2024. Results: a retrospective analysis of medical documentation revealed that the number of patients with ACS while taking NGLT-2 inhibitors was significantly lower compared to those taking other glucose-lowering therapy. Patients taking iNGLT-2 had a significantly lower body mass index. Significant differences concern markers of liver dysfunction and microalbuminuria, which were significantly lower in the group receiving NGLT-2. In addition, these patients were less likely to experience hospital complications such as acute kidney injury, cardiac arrhythmias, ischemic stroke, left ventricular thrombus formation, and death. Conclusions: the results of local experience with the use of iNGLT-2 in hospitalized patients with type 2 diabetes and ACS are presented, confirming the metabolic and cardiorenal benefits of this class of drugs in real clinical practice. In addition, the study results clearly demonstrate a more stable course of ACS and a lower risk of in-hospital complications and mortality. However, these parameters did not achieve statistically significant results due to the small sample.

Introduction: a significant group of patients undergoing cardiac surgery develop postoperative atrial fibrillation. 40 % after coronary artery bypass grafting alone, 49 % after coronary artery bypass surgery plus aortic valve replacement, and 64 % after coronary artery bypass surgery plus mitral valve replacement. Determine the frequency of postoperative complications in the development of atrial fibrillation. The study included patients operated on at the Cardiac Surgery Department of the State Budgetary Healthcare Institution of Research Institute-KKB No. 1 of Krasnodar in the period from January 1, 2020 to January 1, 2021. During the analysed period of time, open-heart surgery was performed in 1503 patients, 158 of whom had newly diagnosed postoperative atrial fibrillation (10.5 %). Patients with postoperative atrial fibrillation were more likely to have ischaemic stroke, haemorrhagic complications, ventricular arrhythmias (ventricular fibrillation or flutter), and clinically significant atrioventricular block II and / or III degree, in addition, they had higher mortality in the early postoperative period (with index hospitalization), while acute myocardial infarction occurred with the same frequency in the compared groups. Thus, the relationship between postoperative atrial fibrillation and unfavourable early outcomes is significant, and therefore timely verification of arrhythmia and effective treatment of arrhythmia become relevant. Postoperative atrial fibrillationis a frequent complication of cardiac surgery, which worsens the short-term prognosis, and therefore it is necessary to identify patients at high risk of developing AFP. The appointment of anticoagulant therapy in patients with AFP remains a controversial issue and requires further study in a larger group of patients. It is important to note that AF after cardiac surgery increases the risk of intrahospital mortality, which requires an active search for predictors of this arrhythmia and the development of effective preventive strategies.

Training a highly qualified internist in residency is a multifaceted task facing the teaching staff of the Kuban State Medical University.The aim of the study was to analyze the long-term experience of training internal medicine physicians (from 2019 to 2022) at the Kuban State Medical University.Conclusion. A developed methodological system for personalized preparation of internists, the integration of theoretical and practical training, the individual work of students with ongoing progress monitoring of each resident, the mentor system, as well as the active use of modern technical equipment, novel methodological techniques, digital and simulation technologies, introduced organizational measures and material incentives for students have made it possible to achieve 100% employment of General Medicine residency graduates of the Kuban State Medical University in recent years.

Aim. To describe demographic and clinical laboratory characteristics, concomitant diseases and drug therapy of outpatients with heart failure (HF) in the Russian Federation. Material and methods. An interim analysis of a prospective observational multicenter registry study of patients with chronic heart failure in the Russian Federation ("PRIORITET-CHF") was performed. The study included outpatients with HF followed by a general practitioner or cardiologist. Results. Data from 6255 patients were analyzed (31,3% of the study sample; median age, 65 years; men, 65%). HF with reduced ejection fraction (HFrEF) was diagnosed in 42,4%, HF with preserved EF — in 31,9%. In addition, 57,4% of patients were characterized by NYHA class II HF. The most common causes of HF were hypertension, coronary artery disease, and atrial fibrillation or flutter. Of the concomitant diseases, doctors most often reported chronic kidney disease (CKD) (43,2%), obesity (37,8%) and diabetes (26,7%) in HF. Conclusion. In the Russian Federation, among outpatients with HF, there was domination of men, HFrEF phenotype, NYHA class II. The relatively young mean age and frequent associations of HF with cardiovascular risk factors and diseases underscore the importance of timely prevention initiatives. The identified high proportion of patients with CKD requires special attention and separate analysis. Despite the relatively high prescription rate of certain classes of diseasemodifying therapy for HF, the prescription of optimal quadruple therapy and electrophysiological treatments for HFrEF is insufficient.

Many prognostic tools have been developed over the past decades, however, the identification of biomarkers that can predict the risk of acute coronary disease and its associated complications, especially heart failure, remains a promising direction, the study of which will provide understanding of the pathophysiology of this disease and identify new targets for therapy. One such potential biomarker is soluble suppression of tumorigenicity 2, which is able not only to predict left ventricular remodeling and poor clinical outcome among patients with acute coronary syndrome, but also to complement other well-established cardiac biomarkers such as natriuretic peptides and cardiac troponins. At the same time, if a number of separate but often converging pathways are involved in the pathogenesis of acute coronary disease, then multimarker approaches with various combinations of new cardiac biomarkers and their continuous assessment are likely to improve the prediction of cardiac risk and long-term outcomes.

Aim. To evaluate the early and long-term outcomes of heart transplantation (HT) at the Research Institute of the S. V. Ochapovsky Regional Clinical Hospital № 1.Material and methods. On the basis of the Research Institute of the S. V. Ochapovsky Regional Clinical Hospital № 1 from March 2010 to March 2023, 230 HTs were carried out. Among the patients, men predominated 86% (n=198), women — 14% (n=32). The mean age was 48,3±11,7 years. The reason for HT in 42,6% (n=98) was ischemic cardiomyopathy (ICM), in 40% (n=92) — dilated cardiomyopathy (DCM), while 17,4% were operated on for another cardiac pathology (n=40). All recipients underwent immunological examination, endomyocardial biopsy (EMB), 2D-speckle-tracking echocardiography (2D-STE), transthoracic echocardiography (TTE), coronary angiography (CAG), as well as a number of studies for early diagnosis of possible cancer complications.Results. Acute rejection during the first three years was detected in 77 recipients (42,5%), of which cellular rejection (grade ≥2, 3) and humoral rejection was verified in 49 and 28 recipients, respectively. During the entire follow-up period, de novo anti-human leukocyte antigen (HLA) antibodies were detected in 34 recipients in the posttransplantation period, of which 50% (n=17) and 35% (n=12) were diagnosed with humoral and cellular rejection, respectively. Of the 34 patients with anti-HLA antibodies, 11 (32%) died. All of them died due to a humoral rejection. The survival rate of patients with antibodies was lower (59%) than in patients without antibodies (66%), p=0,023. The annual survival rate of all patients after transplantation in our center was 83,1% (during the first year after transplantation, 30 and 9 patients died due to an acute rejection and infectious complications, respectively).Conclusion. Since the introduction and modification of immunosuppressive therapy regimens, tremendous progress has occurred, and the incidence of acute cellular rejection has decreased. However, the risk of humoral rejection and long-term complications remains one of the main reasons for graft failure.

Aim. To assess the possibility of familial hypercholesterolemia (FH) detection among patients with early coronary artery disease (CAD) in practice in comparison with data from different populations. Patients with early manifestations of CAD are a promising group for identifying a proband with FH and subsequent cascade screening. The question remains open about the sufficiency of clinical criteria for diagnosing this disease. Material and methods. We examined 651 patients with CAD manifestations aged £55 years in men and £60 years in women. FH was diagnosed according to the Dutch Lipid Clinic Network (DLCN) criteria, and cardiovascular risk was assessed using the Montreal-FH-SCOR E. In 35 phenotype-positive patients with FH, as well as 5 with lowdensity lipoprotein cholesterol levels ³5,5 mmol/l and 23 with age of manifestation of coronary artery disease £35 years, the coding sequence of the genes for apolipoprotein B ( APOB ), low-density lipoprotein receptor ( LDLR ), low-density lipoprotein receptor adapter protein 1 ( LDLRAP1 ), proprotein convertase subtilisin/kexin type 9 ( PCSK9 ). Results. Definite FH was in 8 (1,2%), probable in 27 (4.2%), possible in 339 (52,1%) patients, while 277 (42,5%) patients had DLCN score of <3 points; 31 (88,6%), of 35 phenotype-positive patients had a high Montreal-FH-SCORE risk. Six carriers of pathogenic variants were identified, 2 of which were among phenotype-negative patients. A meta-analysis of 16 studies with 13065 patients (2012-2023) showed that the incidence of FH is 5,22 (4,848-5,619)% (fixed model) and 5,93 (4,528-7,515)% (random model). Conclusion. The use of existing diagnostic scales does not provide guaranteed detection of FH among patients with early CAD. It is likely that DLCN modification by additional gradation of the criterion for the age of CAD manifestation will help increase its diagnostic value.

Heart failure (HF) is a global health problem. Despite advances in the development of effective treatments for patients with heart failure, morbidity and mortality from remain high, and the prognosis is poor. However, there is potential to improve outcomes in HF patients with current disease-modifying therapy. Planning needs and resources, assessing the effectiveness of care for HF patients in clinical practice requires high-quality epidemiological data. Previously performed Russian observational studies of HF were characterized by relatively small sample sizes, inclusion of patients in only one or a few regions, strict selection criteria, single-stage design, or short follow-up. The rationale and design of the all-Russian prospective observational multicenter registry study "PRIORITET-CHF", which included 20000 patients with HF throughout the Russian Federation, is presented. The main aims of the study are to (1) describe baseline clinical and demographic characteristics in outpatients with HF in the Russian Federation and (2) characterize routine therapy and evaluate the compliance of treatment for HF with reduced ejection fraction with current clinical guidelines.

A case report is devoted to the successful management of a 33-year-old patient with subacute infective endocarditis of the tricuspid valve and pacemaker, as well as chronic thromboembolic pulmonary hypertension. There were following therapy stages: 1) pharmacotherapy — antimicrobial agents, treatment of heart failure, pulmonary hypertension; 2) an interventional approach — tricuspid valve replacement with chamber sanitation, pacemaker explantation, endocardial lead removal from the right heart, implantation of a pacemaker with an epicardial lead system and 3) delayed balloon pulmonary angioplasty.

Цель. Целью исследования явилась оценка эффективности и приверженности гиполипидемической терапии, частоты развития сердечно-сосудистых осложнений у пациентов с гомо- и гетерозиготной семейной гиперхолестеринемией (СГХС) в течение пятилетнего периода наблюдения в регистре РЕНЕССАНС (Регистр пациентов с СГХС и пациентов очень высокого сЕрдечно-Сосудистого риска с недоСтАточной эффективНоСтью, проводимой гиполипидемической терапии). Материал и методы. РЕНЕССАНС является открытым, национальным, наблюдательным исследованием и включает больных с СГХС. Учитывали наличие факторов риска атеросклероза, анамнез сердечно-сосудистых заболеваний, гиполипидемическую терапию. В каждом центре выполняли определение концентрации: общего холестерина, триглицеридов, холестерина липопротеидов высокой плотности в сыворотке крови. Содержание холестерина липопротеидов низкой плотности (ХС ЛНП) рассчитывали по формуле Фридвальда. В некоторых центрах проводили измерение уровня липопротеида(а). При оценке частоты конечной точки, включавшей фатальные и нефатальные сердечно-сосудистые осложнения (ССО), проводили анализ Каплана-Майера. Результаты. В регистр включено 17 больных с гомозиготной СГХС (средний возраст 22±13 лет, 65% женского пола, 29% дети) и 2288 пациентов с гетерозиготной СГХС (48±16 лет, 57% женского пола, 6% дети). В группе гомозиготной СГХС за период наблюдения 74±13 месяцев ССО зарегистрированы у 5 (29%) пациентов, многокомпонентную гиполипидемическую терапию получали 94% и ни один больной не достиг целевого уровня ХС ЛНП. В группе гетерозиготной СГХС динамическое наблюдение проведено у 1067 (47%) пациентов в течение 32±27 месяцев, конечная точка зарегистрирована у 10% больных. Мужской пол (относительный риск 1,7; 95% доверительный интервал 1,2-2,6 p<0,01), гипертония (3,8; 2,3–6,2; p<0,001), ишемическая болезнь сердца (9,3; 5,6–15,3; p<0,001), отягощенный анамнез по сердечно-сосудистым заболеваниям (ССЗ) (2,6; 1,5–4,5; p<0,001) и концентрация липопротеида(а)≥30 мг/дл (2,2; 1,0–4,7; p<0,05) явились предикторами развития ССО. Частота назначения трехкомпонентной гиполипидемической терапии с ингибиторами PCSK9 возросла с 2 до 9%, а достижение целевого уровня ХС ЛНП − с 2 до 14% (р <0,001 для обоих). Заключение. Пятилетнее наблюдение за участниками регистра РЕНЕССАНС демонстрирует увеличение использования многокомпонентных схем лечения. Мужской пол, гипертония, ишемическая болезнь сердца, отягощенный анамнез по ССЗ и концентрация липопротеида(а) ≥30 мг/дл остаются ведущими факторами, ассоциированными с увеличением риска развития ССО.

Nonvalvular atrial fibrillation (AF) is the most common cause of arterial thromboembolism, especially of ischemic stroke. Other than stroke AF-associated embolic events are usually underestimated but at least similarly important. We present a rare case of simultaneous multiple embolism in a 70 years old women with permanent AF.

The Russian Society of Cardiology (RKO) With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians