Cardiovascular diseases are a serious problem for medicine, society and economy all over the world. Currently, there is an active search for new biological markers and therapeutic targets in order to develop effective approaches to risk stratification and secondary prevention of cardiovascular pathology. The range of scientific interests of researchers recently includes the study of disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) in atherosclerosis and related diseases. ADAMTS regulate the structure and function of extracellular matrix components. In our scientific review, we analyze current experimental and clinical studies devoted to the study of ADAMTS-4 as a new diagnostic and prognostic marker in atherosclerosis. The studies conducted to date indicate the important role of this biological marker in the pathogenesis and diagnosis of atherosclerosis. Future large-scale preclinical and clinical studies are expected to show that ADAMTS-4 may be a valuable addition to laboratory diagnostic methods. Regulation of ADAMTS-4 levels and expression may be an effective strategy for the treatment of patients with atherosclerosis.

Invasive aspergillosis is a disease that occurs mostly in people with a compromised immune system. The most important pathogen is Aspergillus fumigatus (it accounts for about 90% of the patients). The risk group includes patients who have primary and secondary immunodeficiencies, people receiving immunosuppressive therapy, cancer patients, etc. However, the incidence of this disease among COVID-19 ( COronaVIrus Disease 2019) patients have been reported recently. The aim of our work is to present a patient with invasive aspergillosis after COVID-19 who was not in a standard risk group and did not receive immunosuppressive therapy. Conclusion. Patients who had COVID-19 are under a risk of developing invasive pulmonary aspergillosis. Therefore, it is important to exclude this disease in a patient with prolonged pneumonia that does not respond to standard therapy.

Cardiovascular diseases (CVD) are a global medical, social and economic problem. Currently, the search and study of new biological markers that can provide early diagnosis of CVD, serve as a laboratory tool for evaluating the effectiveness of treatment or be used as prognostic markers and criteria for risk stratification continues. The interest of scientists is focused on the study of the type 1 lectin-like receptor for oxidized low-density lipoproteins (LOX-1) as a diagnostic and prognostic marker in CVD. The presented literature review highlights the potential significance of the LOX-1 study as a diagnostic and prognostic laboratory tool in CVD. It is expected that future clinical and experimental studies will confirm the possibility of using LOX-1 as an additional non-invasive tool for diagnosis and prognosis assessment in patients with CVD. Modulation of LOX-1 levels and expression using pharmacological drugs may prove to be a promising direction for the treatment of CVD.

Chronic heart failure (CHF) is a global medical, social and economic problem. Currently, the search and study of new biomarkers that can provide early diagnosis of CHF, serve as a laboratory tool for assessing the effectiveness of treatment, or be used as prognostic markers and risk stratification criteria are ongoing. Scientists' interest is focused, in particular, on studying the role of fibroblast growth factor 21 (FGF21) in CHF. There is increasing evidence highlighting the value of FGF21 as a new marker for the diagnosis and assessment of prognosis in patients with CHF. The role of FGF21 in CHF is very interesting due to its cardioprotective aspects. Final confirmation of the diagnostic, prognostic and therapeutic roles of FGF21 will come from future studies.

Chronic heart failure (CHF) is a global medical, social, and economic problem. It is a syndrome caused by imbalanced neurohumoral regulation of the cardiovascular system, which is accompanied by impaired systolic and/or diastolic function of the heart. Currently, the search and study of new biological markers that can help in the early diagnosis of CHF, serve as a laboratory tool for assessing treatment effectiveness, or be used as prognostic markers and risk stratification criteria are ongoing. Researchers focused on studying the role of Klotho protein, fibroblast growth factor 23 (FGF23), and sclerostin in patients with CHF. Klotho expression decreases as the body ages, and impaired production has been reported in various aging-related diseases. The FGF23 / Klotho axis plays a key regulatory role in cardiovascular pathology. Laboratory, clinical, and genetic studies have suggested that sclerostin is associated with heart disease, although available data are not entirely consistent. Clinical work conducted on the study of the Klotho protein, FGF-23, and sclerostin indicates the potentially important diagnostic and prognostic significance of their analysis in patients with CHF. Thus, more studies of the issues related to serial testing of these biological markers, including in the aspect of the multibiomarker model, are needed.

Biological markers have been thoroughly incorporated into clinical practice as a convenient and simple method for diagnosing and monitoring the condition of patients. The analysis of biomarkers has found its niche in oncology; however, their application in cardiovascular diseases is still in its infancy. Studies on apelin indicate the potential diagnostic and prognostic significance of the assessment of this marker in patients with cardiovascular diseases. The beneficial effect of apelin on the heart and blood vessels allows us to consider this marker as a therapeutic target. The combination of apelin with other biological markers, particularly brain natriuretic peptide and its precursor, may increase the predictive value of apelin.

Echinococcosis or hidatid disease is a parasitic illness which is caused by the most common pathogens Echinococcus granulosus, E. multilocularis and E. oligarthrus. When the agent gets into the organism, it penetrates the organ and forms a cyst. Cysts are located more often (75%) in the liver where they exist without any clinical manifestation. They can be located in other internal organs: lungs, the heart and others. The localization of cysts in several organs simultaneously is a very rare case. The article aims to demonstrate a patient who had a combined echinococcosis of the lungs, heart and liver.

Leukemoid reaction (LR) associated with solid tumors has been documented for many decades. LR is often associated with an unfavorable prognosis and aggressive course of the disease. However, the differential diagnosis of LR is of significant difficulty when a patient has several potential etiological factors, each of them individually may cause LR or, on the contrary, lead to a systemic reaction of the body within a single pathogenetic chain. We present a clinical observation of an elderly patient admitted to the intensive care unit due to the first-time encountered weakness in the right extremities. Clinical and instrumental examination revealed an acute cerebral ischemia with leukocytosis increase up to 60.000 cells/μL with leukocyte formula left shift and subsequent patient decompensation with lethal outcome, despite the intensive treatment. Autopsy revealed a low-differentiated adenocarcinoma of the pancreatic tail with multiple metastatic lesions in regional lymph nodes and liver, as well as a competing disease — acute infective endocarditis of the aortic valve, which was the cause of sepsis development with septicemia type and thromboembolism both in the great circulation circle with the presence of ischemic cerebral infarction, spleen infarcts, and in the small circle with the development of thromboembolism in the right segmental branches of the pulmonary artery. Given the advanced stage of pancreatic cancer and lack of direct evidence of sepsis at primary diagnosis, paraneoplastic nature of LR is more likely, but infective endocarditis and concomitant pathology also may have contributed to the development of LR.

BACKGROUND: Non-compact left ventricular myocardium is a rare heterogeneous pathology, which in the two-layer structure of the myocardium. There is no generally accepted definition of this form of pathology for both echocardiography and cardiac magnetic resonance imaging. Non-compact left ventricular myocardium can occur at any age and is often asymptomatic. Treatment of non-compact left ventricular myocardium is nonspecific and symptomatic. DESCRIPTION: This study describes a clinical case of a young patient who was diagnosed with non-compact left ventricular myocardium. The disease debuted in the form of cardiac arrhythmia. Holter monitoring showed frequent ventricular extrasystole and atrioventricular block of the first and second degrees. Moreover, echocardiography revealed a decrease in global contractile function of the left ventricle. The diagnosis was made after magnetic resonance imaging of the heart, which revealed the presence of non-compact myocardium of the anterior, lateral, and inferior walls of the left ventricle in the apical and middle segments. Sustained rhythm disturbances were not induced in electrophysiological research by rapid and programmed stimulation. The patient was prescribed antiarrhythmic therapy, followed by echocardiography Holter monitoring. In the future, the patient needs regular monitoring by a cardiologist. CONCLUSION: Non-compact left ventricular myocardium should be diagnosed at an early stage, so that life expectancy can be increased owing to timely treatment of heart failure and the use of oral anticoagulants, antiarrhythmic drugs, cardiac resynchronization therapy, cardioverter-defibrillator implantation, and heart transplantation when other treatment options are ineffective.

This article describes a rare case of necrotic xanthogranuloma in a 46-year-old patient who presented with the development of periorbital xanthelasms, progressive bilateral sensorineural hearing loss and bilateral vestibulopathy, followed by multiple myeloma and amyloidosis. For several years, the patient underwent standard rehabilitation for chronic sensorineural hearing loss and was fitted with a hearing aid. During hospitalisation for exacerbation of chronic bronchitis, monoclonal gammopathy was identified, and later, after careful examination and repeated biopsies, necrotic xanthogranuloma, multiple myeloma and AL-amyloidosis were confirmed. Targeted immunochemotherapy resulted in improvement of hearing and significant recovery of the vestibuloocular reflex bilaterally.

Cardiac involvement is the most important factor determining prognosis in patients with systemic amyloidosis. This retrospective observational study of 98 patients with amyloidosis was undertaken to assess the amyloid types that are most likely to affect the heart, describe histopathological and clinical features of cardiac amyloidosis, and estimate the number of cases not diagnosed clinically prior to death. All cases were divided into two groups based on the method of examination. The first group included 46 patients with cardiac amyloidosis revealed via endomyocardial biopsies (EMBs), and the second group included 52 amyloidosis patients who did not undergo EMBs, in whom cardiac involvement was identified only at autopsy. The EMBs demonstrated that AL amyloidosis was detected in 21 (46%) specimens, ATTR amyloid in 24 cases (52%), and AA amyloid in 1 case (2%). The autopsy reports defined 15 (46%) cases of AL amyloidosis, 21 (40%) of ATTR and 16 (31%) of AA amyloidosis. It should be noted that a clinical diagnosis of ATTR amyloidosis was made only in 9.5% of patients from the autopsy group, suggesting that ATTR may be an underdiagnosed cause of heart failure in elderly patients. The most intense amyloid deposits were determined in biopsy and autopsy specimens of patients with AL kappa amyloidosis, underlying a poorer prognosis.

Mucopolysaccharidoses (MPS) are a group of lysosomal storage diseases. Cardiovascular pathology occurs in all types of MPS, represented by valvular defects, myocardial hypertrophy, and coronary artery disease. Cardiovascular abnormalities in parents of carriers with MPS are poorly understood, which was the purpose of our work. In 2022 year 21 parents (81% female) of children with MPS were examined.The median (25th and 75th percentiles) of age was 36 (33; 37) years. All MPS carriers-parents underwent a standard clinical and laboratory examination, ECG, echocardiography, 24-hour Holter ECG monitoring. There were no confirmed myocardial and brain infarctions, diabetes mellitus in the examined carriers. Arterial hypertension was diagnosed in 14.3% of carriers. A decrease in LV ejection fraction <40% was found in 4.8%, up to 40-50% in 9.5% of carriers. LV wall thickness ≥1.5 cm was detected in 66.7% of carriers, asymmetric LVH in 85.7%. Thickening of the mitral valve leaflets (MV) was detected in 76.2% of carriers. Hydropericardium was detected in 23.8% of carriers. Atrial fibrillation was registered in 4.8%, atrial flutter - in 4.8%, paroxysmal supraventricular tachycardia - in 33.3%, sinus bradycardia - in 14.3%; conduction disorders - in 71.4% of carriers. A short PR interval was detected on the ECG 9.5% of carriers. A prolonged QT interval was registered in 14.3% of carriers, transient ST-segment depression in 47.6%, ST-segment elevation in 14.3% of carriers. Our results suggest the possibility of clinical manifestations of cardiac involvement in MPS carriers. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No external funding was received ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics сommittee of the Pirogov Russian National Research Medical University gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Study data can be provided via author's email upon request

Hemochromatosis is a life-threatening condition if left untreated, that is caused by excess iron in the body. It can be primary (hereditary) hemochromatosis, resulting from genes mutations, and secondary (acquired) as a result of excessive intake of iron from food or drugs, liver diseases or repeated blood transfusions. Deposition of excess iron in parenchymal tissues leads to cellular dysfunction and clinical manifestations of the disease. The liver, pancreas, joints, skin, pituitary gland and heart are most often affected. Cardiac hemochromatosis is an important and potentially preventable cause of heart failure. Initially, diastolic dysfunction and arrhythmias develop, at later stages a picture of dilated cardiomyopathy can appear. Signs of heart damage in hemochromatosis can be detected using complex 2D and Doppler echocardiography, cardiac MRI with T2* relaxation time measurement and other diagnostic methods. Genetic testing is the gold standard for diagnosing hemochromatosis and should be performed after secondary causes of iron overload have been excluded. The basis of therapy is therapeutic phlebotomy and iron chelation. Median survival is less than a year in untreated patients with severe heart failure caused by hemochromatosis. However, with early and aggressive treatment, survival approaches that of patients with heart failure of other etiologies.

Aim: to assess and describe gender- and age-specific characteristics of patients with chronic heart failure (CHF). Patients and Methods: in this retrospective study with a prospective component the authors analyzed medical records of 197 patients with CHF, including: CHF stage and functional class, co-morbidities, and echocardiography (Echo) findings. Twenty four (21, 28) months after discharging patients from the hospital, telephone follow-up calls were made to the patients and/or their relatives, and medical documentation of the medical information system was reviewed to assess the vital status of patients or the causes of lethal outcomes. For evaluating the obtained results, patients were divided into groups by gender and age. The middle-aged group comprised of males (45 to 59 years) and females (45 to 54 years) — 18 (9.1%) patients. The group of elderly persons included males (60 to 74 years) and females (55 to 74 years) — 69 (35.1%) patients. The senile group consisted of persons aged 75 years and over — 110 (55.8%) patients. Results: the median and interquartile range of patient age were 74.7 (68, 82) years. In the groups of middle-aged and elderly persons there were more men than women (р=0.001), while women prevailed in the senile group (р<0.001). The diagnosis of HF with reduced ejection fraction (HFrEF) was established more frequently in males than in females, and the difference was statistically significant (p=0.006). There were no statistically significant differences between male and female patients as regards the prevalence of HF with moderately reduced LVEF (HFmrEF). HF with preserved LVEF (HFpEF) was diagnosed more frequently in females than in males, and the difference was statistically significant (p=0.007). Using pair-wise comparison of LVEF in women of different age groups, it was shown that HFmrEF was more prevalent in middle-aged than in elderly (р=0.024) or senile (р=0.011) patients. The prevalence of HFpEF was higher in senile than in middle-aged women (р=0.012). No statistically significant differences in LVEF were found between the male patients of different age groups. There were no significant differences between males and females of middle-aged and elderly groups as regards the prevalence of co-morbidities. However, among senile persons co- morbidities were found more frequently in women than in men, and the difference was statistically significant (p<0.001). Conclusion: more than half of the patients with CHF were senile persons. Most patients with CHF in the elderly group were males, and in the senile group — females. It is necessary to consider gender and age-specific characteristics in the management of CHF patients, risk stratification and in the selection of adequate therapy. KEYWORDS: chronic heart failure, comorbidity, concomitant diseases, age ranges, gender characteristics. FOR CITATION: Reznik E.V., Ushakova N.A., Ershov N.S. et al. Gender- and age-specific characteristics of patients with chronic heart failure in real clinical practice. Russian Medical Inquiry. 2023;7(1):13–21 (in Russ.). DOI: 10.32364/2587-6821-2023-7-1-13-21.

The COVID-19 pandemic has become a global crisis of unprecedented level for all mankind. The whole process of studying the disease (etiopathogenesis, diagnosis, treatment, prevention, prognosis) was not easy, because COVID-19 is a relatively new nosology that the world has never encountered. Cardiovascular complications in COVID-19 play an important role in the prognosis of morbidity and mortality. As the COVID-19 pandemic spreads, more and more patients with cardiac arrhythmias, arterial hypertension and other cardiovascular complications appear. This may be due to the impact of the SARS-CoV-2 virus on the respiratory, cardiovascular and other systems, as well as the development of inflammation. During the COVID-19 pandemic, there were more patients with arrhythmias. According to some data, the risk of arrhythmias in COVID-19 in hospitalized patients varies from 7.57% to 17.97%. The main causes of arrhythmia in the context of COVID-19 are hypoxia (acute respiratory distress syndrome, pulmonary embolism, the effect of SARS-CoV-2 on chemoreceptors), myocarditis (direct and indirect effects of SARS-CoV-2 on the myocardium), electrolyte imbalance, autonomic dysfunction, cardiotoxic drugs used in COVID-19. There can often be several reasons, and it is quite difficult to figure out which one has become the main one for each patient. This review focuses on the potential mechanisms for the development of cardiac arrhythmias in patients with COVID-19. Cardiologists, therapists and family medicine physicians should be aware of cardiovascular complications in the management of patients with COVID-19, and the prophylactic medical examination of the population.

In recent years, the attention of scientists has been actively focused on studying the role of endocan as a biological marker of endothelial dysfunction in cardiovascular diseases. Until recent years, endocan has been studied in acute kidney injury, chronic kidney disease, and renal replacement therapy. Endocan, formerly known as endothelial cell-specific molecule-1, is a soluble dermatan sulfate proteoglycan expressed and secreted into the circulation from endothelial cells. Currently available studies demonstrate the diagnostic and prognostic value of endocan evaluation in cardiovascular pathology. It is expected that further scientific and clinical studies will demonstrate the possibilities of using endocan as an additional laboratory tool for diagnosing and assessing the prognosis in patients with a cardiac profile. Drug regulation of endocan concentration and expression may be a promising target for the treatment of cardiac and vascular pathology.

Infiltrative cardiomyopathies are a group of diseases characterized by the deposition of abnormal substances in heart tissues, which leads to thickening of the walls or dilation of chambers with a secondary decrease in wall thickness and the development of diastolic, less often systolic, ventricular dysfunction. Most often, these are progressive diseases that, in the absence of adequate therapy, have an unfavorable prognosis. Clinical manifestations of infiltrative cardiac diseases are variable, which often leads to diagnostic difficulties and errors. In most cases, specific laboratory and morphological tests are required to confirm or clarify the diagnosis. Early diagnosis is critical to initiating therapy and improving patient prognosis. This article provides characteristic signs and symptoms, the so-called "red flags", making it possible to suspect infiltrative cardiomyopathies, diagnose them at an early stage and start life-saving therapy.

Microscopic colitis is an inflammatory bowel disease of unknown etiology that presents as chronic watery diarrhea with no endoscopic evidence of the bowel involvement but with the microscopic changes. Diagnosis of microscopic colitis is based on the histological examination of the intestinal biopsy and requires a highly qualified gastroenterologist, endoscopist and histologist. The article presents a clinical case of microscopic colitis in a 42-year-old patient, reflects the main stages of diagnosis and treatment of the patient.