Cardiovascular diseases (CVD) represent a leading cause of mortality in most industrialized countries. Community-acquired pneumonia significantly worsens the clinical course of CVD and increases the risk of cardiovascular death. Streptococcus pneumoniae (pneumococcus) is one of the most common etiological pathogens of community-acquired bacterial pneumonia. It may cause direct myocardial injury through hematogenous dissemination, as well as exert indirect deleterious effects on the cardiovascular system via the induced inflammatory response and the action of bacterial toxins, the most important of which is pneumolysin. Myocardial and vascular wall injury, along with platelet activation, may substantially contribute to the decompensation of heart failure, as well as to the development of myocardial infarction, stroke, and cardiac arrhythmias in patients with pneumonia. Most cardiovascular complications (CVC) occur during the early acute phase of pneumonia; however, some may also develop in the delayed period, creating conditions for the long-term persistence of an increased risk of cardiovascular death for several years after the infection. The risk of CVC in patients with pneumonia may be reduced by the use of aspirin and statins, as well as effective antibiotic therapy; however, these approaches do not completely eliminate the risk. Vaccination against pneumococcal infection is the most effective method for the prevention of CVC associated with S. pneumoniae. Currently, several types of pneumococcal vaccines are available, with conjugate vaccines being the most advanced, providing sustained immunity against the most prevalent pneumococcal serotypes after a single administration. Vaccination against S. pneumoniae is recommended across a wide spectrum of CVD, including pulmonary hypertension, chronic heart failure, myocarditis, and dilated cardiomyopathy. Broad implementation of pneumococcal vaccination in patients at high cardiovascular risk may significantly reduce both the incidence of cardiovascular complications and overall mortality in this population.

Unstable angina (UA) is a type of acute coronary syndrome (ACS) without ischemic myocardial damage. The main criterion for the diagnosis of UA in ACS is the absence of changes in the concentration of cardiac troponin in the patient's blood. When the volume of myocardial damage is small, it may be difficult to detect myocardial infarction in a patient using low -sensitivity tests for determining of cardiac troponin in the blood. This issue may lead to overdiagnosis of UA in patients with non-STE ACS. Optimal drug therapy and revascularization of the coronary arteries significantly reduce the risk of death and the development of myocardial infarction both in the hospital and in the long-term period in patients with UA. Outpatient follow-up and provision of free of charge medications to patients may reduce long-term mortality after an episode of UA.

Background. Systems for self-determination of international normalized ratio (INR) may increase adherence to regular monitoring of hemostasis parameters in patients taking vitamin K antagonists. However, evidence of the effectiveness of self-determination of INR in real-world clinical practice in Russia is limited. Aim. To compare the effectiveness of remote monitoring of INR using the CoaguChek® INRange coagulometer in patients who have undergone mechanical heart valve implantation with traditional INR control by measuring it in the outpatient department laboratory. Materials and methods. A prospective study enrolled 101 patients receiving warfarin after a mitral or aortic mechanical heart valve prosthesis implantation. In Group 1 (n=51), conventional laboratory INR control was used; in Group 2 (n=50), patients monitored INR by themselves using a CoaguChek® INRange coagulometer. The follow-up duration was 1 year. Results. Patients in Groups 1 and 2 did not differ in INR: 2.62 [2.45; 2.85] vs 2.6 [2.5; 2.8], respectively (data are presented as the median [1st to 3rd quartile]), and the time of INR in the therapeutic range: 66.7% [50; 78.6] vs 67.7% [53.2; 80.6]. The intervals between INR determinations in Group 1 were significantly longer: 30.5 [29.5; 31] days vs 20 [13; 25] days. Conclusion. The CoaguChek® INRange system enables remote patient monitoring during continuous warfarin therapy and achievement of the target INR with a time in the therapeutic range comparable to that for patients with INR measurements in outpatient laboratories.

Background: The extent of myocardial damage largely determines both in-hospital and long-term mortality in patients with acute coronary syndrome. According to the literature, the in-hospital and long-term mortality rates in patients with unstable angina (UA) are lower than those in the patients with myocardial infarction (MI). Aim: To evaluate the in-hospital and long-term mortality rates and their predictors in patients undergoing in-patient treatment for acute coronary syndrome (MI and UA) in the regional cardiovascular center with the service territory of 1 million persons. Materials and methods: This retrospective registry study enrolled 1130 patients (715 [63.3%] men, 415 [36.7%] women) who were treated for UA and MI in the regional cardiovascular center in 2019. Based on the discharge diagnosis, the patients were divided into two groups: patients with MI (n = 766) and those with an UA episode (n = 364). The in-hospital and delayed mortality rates, as well as their predictors, were analyzed in both groups. The mean duration of the follow-up was 17.8 3.6 months. Results: The in-hospital mortality in patients with confirmed MI was 11.1% (85 patients) versus 0.27% (1 patient) in the UA patients (p 0.001). The independent predictors of in-hospital mortality in MI patients were a decreased left ventricular ejection fraction (LV EF) (odds ratio (OR) 0.9021, 95% confidence interval (CI) 0.82090.9914, p = 0.0324), chronic kidney disease C3a and above (OR 9.3205, 95% CI 2.670632.5283, p = 0.0005), and the extension of coronary involvement at coronary angiography (OR 1.3526, 95% CI 1.06670.0127, p = 0.0127). The long-term mortality in MI patients was 10.4% (72 patients) with no significant difference from that in UA patients (9.9%, 36 patients, p = 0.76). The independent predictors of long-term mortality after MI were older age (OR 1.12, 95% CI 1.011.22, p = 0.0052), chronic kidney disease C3a and above (OR 2.3375, 95% CI 1.13924.7963, p = 0.0206), decreased EF (OR 0.8895, 95% CI 0.730.99, p = 0.0364), atrial fibrillation on admission (OR 3.1462, 95% CI 1.35107.3268, p = 0.0079), and diabetes mellitus (OR 2.3163, 95% CI 1.25524.2744, p = 0.0072). In the UA patients, the predictors of the long-term mortality were a decrease in LV EF (OR 0.9139, 95% CI 0.86830.9619, p = 0.0006) and in blood hemoglobin level (OR 0.9729, 95% CI 0.95440.9917, p = 0.0050). Conclusion: The in-hospital mortality in UA patients is lower than that in MI patients, with comparable long-term mortality. This indicates the need of active follow-up of the patients with past UA, irrespective of the endovascular assessment and intervention.

Dispensary observation of patients with coronary artery disease can significantly reduce the likelihood of cardiovascular complications onset. Active outpatient monitoring allows to correct the main risk factors for cardiovascular complications, to estimate the risk of unfavorable cardiovascular events onset and to identificate patients who will get benefit of coronary revascularization. The introduction of a comprehensive assessment of cardiovascular risk and the development of remote monitoring technologies will improve the long-term results of outpatient follow-up of patients with coronary artery disease at high cardiovascular risk.

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

BACKGROUND: Adherence to drug therapy in patients with coronary artery disease is quite low nowadays, both in patients with myocardial infarction and in patients with chronic forms of coronary artery disease. AIMS: of our work was to assess adherence to drug therapy (aspirin and statins) and control of risk factors for coronary artery disease in patients undergoing coronary stenting 12 months after endovascular treatment. MATERIALS AND METHODS: The study included 279 patients, of whom 3 groups were formed. Patients of group 1 (n=96) personally visited the National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, adherence to the prescribed therapy and its effectiveness were assessed during the examination by a cardiologist, and if necessary, it was corrected. Patients of group 2 (n=95) contacted the study coordinator remotely. Patients of group 3 (n=88) were monitored by a general practitioner and visited a cardiologist at the National Medical Research Center of Cardiology according to the decision of the general practitioner. RESULTS: At baseline, adherence to therapy in all groups was low and did not differ significantly between groups. 12 months after stenting, groups 1 and 2 showed a significant increase in the number of highly adherent individuals (from 17 to 33 and from 13 to 42, respectively, p 0.05), as well as a significant decrease in the number of individuals with low adherence to treatment (from 63 to 42 and from 67 to 36, respectively, p 0.05). The adherence to antiplatelet drugs was higher than to statins: 57.9% of people reduced the dose or stopped taking statins. After the follow-up time, there was a significant decrease in systolic blood pressure in groups 1 and 2 and a significant decrease in diastolic blood pressure in group 2. In group 2, a significant decrease in the number of smokers was noted: from 46.3 to 31.6% of the total number of patients in the group (p 0.05). CONCLUSION: Active monitoring of patients by a cardiologist both during the visit and remotely contributes to an increase in adherence to drug therapy and improves control of risk factors for coronary artery disease.

Aims: The authors examined the phenotype of circulating monocytes in patients with coronary atherosclerosis depending on age. Methods: A total of 121 patients were categorized into three groups according to the severity of coronary atherosclerosis assessed by angiography and into two groups depending on age above/below the median 60.0 (range: 56.0-66.0). Classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16+ monocytes were analyzed via direct immunofluorescence and flow cytometry. Results and conclusions: In patients >60 years of age, the severity of atherosclerosis was associated with the decreased number of classical monocytes in the blood. In patients under 60 years of age, this relationship was not observed. The authors hypothesize that the contribution of different subtypes of blood monocytes to the development of atherosclerosis may vary with age.

Background and Aims : In-stent restenosis (ISR) after coronary angioplasty and stent implantation is associated with recurrent angina symptoms, higher risk for acute coronary syndrome, and increased mortality. Current ISR risk prediction models (PRESTO-1, PRESTO-2, and EVENT) suffer from insufficient predictive power. We aimed to investigate patient outcome prediction with classification predictive modeling in Machine Learning.Methods: In retrospective study 203 available cases of ISR and 1009 control cases were included. Twenty seven demographic, clinical, biochemical and angiographic characteristics from each patient were obtained. Such machine-learning classifiers as logistic regression, random forest and XGBoost were used. The initial dataset was randomized into training (n=1057) and test (n=155) datasets. The prediction was performed by classifying samples into low or high digital risk score (DRS) groups. The prediction of outcome in the test dataset performed by machine-learning classifiers was further compared with the human expert classification.Results: The incidence of ISR in the test dataset was 11%. Among the used machine-learning algorithms, the XGBoost classifier demonstrated the best predictive capacity in the unbalanced dataset. The DRS classification resulted in an odds ratio of 14.57 (95% CI 2.69–84.30, p=0.01) for prediction of ISR. The accuracy (C-index) of the DRS grouping was 0.89 (95% CI 0.84–0.94), as compared to 0.75 (95% CI 0.68–0.82) for human expert prediction in the same cohort.Conclusions: Development of machine-learning algorithms will allow to reveal patients at higher risk of ISR for the further closer monitoring ISR or consideration of alternate therapies. A prospective validation is required before this biomarker can be implemented in clinical workflows. Background and Aims : In-stent restenosis (ISR) after coronary angioplasty and stent implantation is associated with recurrent angina symptoms, higher risk for acute coronary syndrome, and increased mortality. Current ISR risk prediction models (PRESTO-1, PRESTO-2, and EVENT) suffer from insufficient predictive power. We aimed to investigate patient outcome prediction with classification predictive modeling in Machine Learning. Methods: In retrospective study 203 available cases of ISR and 1009 control cases were included. Twenty seven demographic, clinical, biochemical and angiographic characteristics from each patient were obtained. Such machine-learning classifiers as logistic regression, random forest and XGBoost were used. The initial dataset was randomized into training (n=1057) and test (n=155) datasets. The prediction was performed by classifying samples into low or high digital risk score (DRS) groups. The prediction of outcome in the test dataset performed by machine-learning classifiers was further compared with the human expert classification. Results: The incidence of ISR in the test dataset was 11%. Among the used machine-learning algorithms, the XGBoost classifier demonstrated the best predictive capacity in the unbalanced dataset. The DRS classification resulted in an odds ratio of 14.57 (95% CI 2.69–84.30, p=0.01) for prediction of ISR. The accuracy (C-index) of the DRS grouping was 0.89 (95% CI 0.84–0.94), as compared to 0.75 (95% CI 0.68–0.82) for human expert prediction in the same cohort. Conclusions: Development of machine-learning algorithms will allow to reveal patients at higher risk of ISR for the further closer monitoring ISR or consideration of alternate therapies. A prospective validation is required before this biomarker can be implemented in clinical workflows.

Aim . To study predictors of radial artery occlusion (RAO) and ways to prevent it after interventions using radial access. Material and methods . The study consisted of prospective and retrospective parts. The total number of included patients was 2284. Patients undergoing interventions by radial access in various medical organizations were retrospectively considered. The prospective study included 1284 patients who were subject to interventional treatment. Patients were randomized into two groups as follows: in group 1, hemostasis was performed within 4 hours, in group 2 — >6 hours. All patients underwent a bedside Barbeau test with a pulse oximeter and an ultrasound of access arteries to determine the radial artery patency/occlusion. Results . The RAO rate in the retrospective part was 21,8%, while in the prospective one — 10,1% with long-term hemostasis and 1,4% with short-term hemostasis (p<0,001). Predictors of RAO were type 2 diabetes (odds ratio (OR), 1,9, 95% confidence interval (CI), 1,1-3,4, p=0,03) and an increase in hemostasis duration by 1 hour (OR, 1,2, 95% CI, 1,1-1,3, p<0,001). When analyzing the retrospective part, the predictors of RAO were body mass index (OR, 1,06, 95% CI, 1,02-1,09, p=0,002), female sex (OR, 0,6, 95% CI, 0,4-0,9, p=0,02), smoking (OR, 1,38, 95% CI, 1-1,91, p=0,047). The administration of statins in different dosages, as well as antihypertensive and anti-ischemic agents, did not have a significant effect on the RAO rate. Conclusion . The main predictors of RAO were type 2 diabetes, an increase in hemostasis duration, female sex, smoking, and the artery-to-introducer diameter ratio. Taking statins, anti-ischemic and antihypertensive agents does not have a protective effect on RAO rate.

Aim . To compare the prevalence of coronary atherosclerosis in patients after coronary stenting (CS) receiving outpatient and remote cardiology follow-up during a one-year study. Material and methods . We enrolled 279 patients aged 61,5±9,5 years with class ≥II stable angina or silent ischemia after CS. Three groups were formed: group 1 (n=96) — outpatient visits before CS, 1, 3, 6 and 12 months after CS. Group 2 (n=95) — remote monitoring: patients were followed up by a primary care physician with the involvement of a cardiologist via remote communication (e-mail, telephone, Skype) 1, 3, 6 and 12 months after CS. Group 3 (n=88) were followed up by a primary care physician and contacted with the study coordinator before and 12 months after CS. After 12 months, all patients underwent stress-induced myocardial ischemia testing. In case of a positive or uncertain test result, coronary angiography (CA) was performed. Results . Stress-induced myocardial ischemia 12 months after CS was verified in 58 patients (21%): 19 patients (19,8%) — group 1; 9 patients (9,5%) — group 2; 30 patients (34,1%) — group 3 (p<0,05). Repeat CA was performed in 96 patients (34,4% of the total number of patients). Restenosis was detected in 8 (2,9%) patients, coronary atherosclerosis progression — in 38 (13,6%), combination of restenosis and atherosclerosis progression — in 4 (1,4%) patients. Coronary atherosclerosis progression was significantly more frequent in group 3: 10,4%, 9,5% and 21,6% in groups 1, 2 and 3, respectively (p<0,05). The incidence of stent restenosis was comparable: 2,1%, 3,2% and 3,5% in groups 1, 2, and 3, respectively. Conclusion . Coronary atherosclerosis progression was the main reason for repeated revascularizations 12 months after the CS. Outpatient and remote cardiology follow-up is associated with a lower incidence of coronary atherosclerosis progression and repeated CA during 12-month follow-up after CS.

В настоящее время ишемическая болезнь сердца (ИБС) является наиболее частой причиной смерти в развитых странах, причем смертность от хронических ее форм значительно преобладает над смертностью от инфаркта миокарда (ИМ). С изменением тактических подходов к лечению ИМ значительно снизилась госпитальная летальность, однако смертность в отсроченном периоде остается высокой, достигая, по некоторым данным, 25,1%. В настоящем обзоре проанализированы данные об отдаленном прогнозе после ИМ по данным как российских, так и зарубежных исследований, а также суммированы факторы, влияющие на годичную летальность после индексного события.

На настоящий момент приверженность к медикаментозной терапии у лиц с сердечно-сосудистыми заболеваниями, в частности, после перенесенного инфаркта миокарда (ИМ) является невысокой. Низкая приверженность к лечению ассоциирована с неблагоприятным клиническим прогнозом, включая смерть, повторные госпитализации, острый коронарный синдром (ОКС), острое нарушение мозгового кровообращения (ОНМК), внеплановую коронарную реваскуляризацию. В данном обзоре рассмотрена факторы, ассоциированные с высокий и, напротив, низкой приверженностью к лечению, описаны меры по преодолению проблемы низкой приверженности к лечению после индексного события.

Background and Aims: Blood monocytes form a heterogeneous populations differently contributing to the inflammatory process in atherosclerosis. We compared the number of classical, intermediate and non-classical monocytes in blood of patients with the severity of coronary atherosclerosis.

Background and Aims: Chronic inflammation plays a key role in atherosclerosis progression. Blood monocytes form a heterogeneous populations differently contributing to the inflammatory process in atherosclerosis. High level of lipoprotein(a) [Lp(a)] is a proven ASCVD risk factor. We compared the number of classical, intermediate and non-classical monocytes in blood of patients with coronary atherosclerosis and different Lp(a) levels.

Every year formed by more than 200 thousand patients who have coronary stenting and need regularly observation. A large number of patients live in remote areas and do not have the opportunity to be under the regular control of cardiologist.

Background Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group (p < 0.001). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group (p < 0.001). Conclusion Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

Background and Aims: The low adherence to cardiovascular treatment is a well known problem. We aimed to investigate the LDL and hsCRP blood level dynamics in patients after coronary stenting (CS) receiving remote monitoring or care with outpatient visits.

Background and Aims: Coronary stenting is evidence-based treatment approach of stable angina. The objective was to determine the rate of restenosis and atherosclerosis progression that led to the repeat coronary angiography.