Background/Objectives: This study aims to evaluate the association between frailty syndrome and depressive symptoms within a cohort of patients with ischemic heart disease (IHD). Methods: This single-center cross-sectional study included 169 patients with IHD admitted for elective percutaneous coronary intervention. The median age was 68.00 [63.00–73.00] years; 59.7% of the patients were male. Frailty screening was performed using the European PRISMA-7 questionnaire, where a score of 3 or higher indicated a high probability of frailty. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The total GDS-15 score was interpreted as follows: 0–5 points indicated no depressive symptoms, 6–10 points indicated mild depression, and 11–15 points indicated severe depression. Results: The prevalence of frailty in the study cohort, based on the PRISMA-7 questionnaire, was 52.7%. The Geriatric Depression Scale (GDS-15) indicated a high probability of depressive symptoms in 19.5% of patients with IHD. The prevalence of depressive symptoms was significantly higher in frail than in non-frail patients. Furthermore, depressive disorders were 2.913 times more frequent among elderly frail patients with IHD compared to non-frail patients (95% CI: 1.262–6.725; p = 0.010). Correlation analysis confirmed a direct positive relationship between PRISMA-7 scores and GDS-15 scores (ρ = 0.392; p < 0.001). Conclusions: A significant association was identified between frailty and depressive symptoms in patients with IHD.

Objective: This study aimed to assess the relationship between excess epicardial fat and the patterns of perioperative myocardial remodeling in patients undergoing surgical correction of mitral valve (MV) disease. Methods: A total of 148 patients with acquired non-infectious MV disease scheduled for surgical correction under cardiopulmonary bypass were screened in this prospective observational non-randomized study. Preoperative computed tomography (CT) of the heart was performed to assess epicardial adipose tissue (EAT) volume. Transthoracic echocardiography (Echo), including evaluation of left ventricular (LV) global longitudinal strain (GLS), right ventricular (RV) free-wall longitudinal strain, and RV systolic function (3D Echo), was conducted preoperatively, as well as postoperatively during one year after surgery. Analysis of postoperative myocardial remodeling and complications within one year after surgery was performed. Patients were divided into groups before surgical correction of MV based on the (1) EAT volume, associated with atrial fibrillation (AF) presence (EAT volume less than or > 115.1 cm3 by CT), and (2) EAT volume, associated with the presence of at least three metabolic factors (EAT volume less than or ≥100.6 cm3). Results: Prior to MV correction, Echo showed that patients with EAT volume > 115.1 cm3 exhibited larger left and right atrial (LA/RA) volumes and more pronounced RV systolic dysfunction. An EAT volume of >115.1 cm3 was associated with a 4.6-fold increase in the odds of detecting a preoperative TAPSE value < 1.7 cm (OR: 4.6 [95% CI: 1.2543; 16.7481]; p = 0.02). In the early postoperative period, patients with EAT volume > 115.1 cm3 exhibited larger RA dimensions and higher RV end-systolic volumes, as well as impaired RV-pulmonary artery coupling. At the one-year follow-up, patients with EAT volume > 115.1 cm3 exhibited larger indexed atrial volumes and basal RV dimensions. By the one-year follow-up, the group with EAT volume ≤ 115.1 cm3 was characterized by dynamic improvements, including a 10.7% increase in LV GLS (p = 0.02), a 33.6% reduction in the indexed LA volume (p = 0.004), a 28% reduction in the LV mass index (p = 0.003), and a 10.3% reduction in the LV end-diastolic dimension (p = 0.01). Furthermore, this group exhibited a 15% increase in LV stroke volume (p = 0.009), a 17.6% increase in TAPSE (p = 0.02), and a 6.5% increase in RV ejection fraction (p = 0.04) (3D Echo), none of which were observed in the group with EAT volume > 115.1 cm3. Patients with EAT volume ≥100.6 cm3 had more pronounced impairment of LV GLS before and one month after surgery compared with those with EAT < 100.6 cm3 (p = 0.046; p = 0.045). One month after surgery, worsening of RV GLS was observed specifically in the group with EAT ≥ 100.6 cm3 (p = 0.031). By the one-year follow-up, significant improvement in RV systolic function was observed only in the group with EAT volume < 100.6 cm3. Conclusions: The presence of excess epicardial fat (verified by cardiac CT) in cardiac surgery patients with acquired MV disease is associated with less favorable preoperative remodeling of both the left and right cardiac chambers and impaired reverse myocardial remodeling within one year post-surgery. Further studies in larger, independent cohorts are needed to confirm the prognostic and clinical relevance of the EAT cut-off in patients with mitral valve disease.

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.

The study investigated the changes in theta activity and localization of its sources by standardized low resolution brain electromagnetic tomography (sLORETA) in patients who have underwent two variants of multitasking cognitive training (CT) in the early postoperative period of coronary artery bypass grafting (CABG). Two groups were formed in a pseudo-random way, which differed according to the type of motor problem used: CT I (n = 27)—a postural balance task and CT II (n = 27)—a simple visual-motor reaction. Cognitive tasks were the same for both groups (counting backwards, verbal fluency, and unusual uses for common objects). Daily sessions of CT were held from the 3rd to 4th day after CABG, with a duration of 5 min on the 1st day of training and up to 20 min on the 6th to 7th day of training. The current density of theta-rhythm sources was lower before CABG than after surgery in the CT II group only. The most significant differences are in Brodmann area 31, the parietal occipital lobes, and precuneus, which may indicate damage associated with cardiac surgery. This effect was not observed in the CT I group. The results of our study demonstrated the informativeness of sLORETA indicators to determine an effective cognitive recovery option after CABG. The reduction of the severity of damaging effects of CABG during training using cognitive tasks and postural balance tasks was shown. Further research is needed to determine the optimal mode and duration of cognitive training to maximize the functional reserves of such patients.

Aim. To study the long-term prognostic value of the novel START vascular stiffness index in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG).Material and methods. The study included 256 patients with CAD who underwent CABG at the Kemerovo Research Institute for Complex Issues of Cardiovascular Diseases. Before surgery, vascular stiffness was assessed using the haSTART cardio-ankle index. The mean follow-up period was 9,7±0,9 years. Two following study groups were formed: Group I — haSTART < the median (Me) index of 8,4 (haSTART 0,05).Conclusion. Evaluation of the haSTART stiffness index before CABG surgery may have prognostic value in the long-term follow-up period in patients with CAD.

AIMS:The relationship between body mass index (BMI) and clinical outcomes in patients with cardiovascular disease, including acute heart failure (AHF) and acute myocardial infarction (AMI), remains debated. This study investigates the association between BMI and clinical outcomes within the PARADISE-MI cohort, while also evaluating the impact of angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitor (ACE-I) treatment on this relationship. METHODS AND RESULTS:The analysis included 5589 patients from the PARADISE-MI study with available baseline BMI data. The cohort comprised patients with AMI and pulmonary congestion and/or left ventricular ejection fraction ≤40%. Patients were categorized into six World Health Organization BMI subgroups. The primary outcome of interest was the composite endpoint of cardiovascular death, heart failure (HF)-associated hospitalization, and outpatient symptomatic HF episodes. The mean baseline BMI of the cohort was 28.1 ± 5.0 kg/m2. The lowest rate of the primary composite endpoint (6.2/100 patient-years) was observed in overweight patients (BMI 25-29.9 kg/m2), while the highest rates were found in the lowest and highest BMI subgroups (8.4/100 patient-years for BMI <18.5 kg/m2 and 9.7/100 patient-years for BMI >40 kg/m2). There was no significant interaction between BMI and the treatment effect of ARNI versus ACE-I on the primary composite outcome (p = 0.73). Additionally, no significant differences in the incidence of adverse events or serious adverse events were noted across the BMI subgroups. CONCLUSIONS:In AMI with AHF patients, the relationship between BMI and the primary composite outcome is non-linear, with the lowest event rates observed in overweight individuals. Outcomes and safety profiles for ARNI and ACE-I treatments were similar across BMI subgroups.

Introduction. Currently, the effectiveness of cardiac rehabilitation of patients with comorbid CHF using physical training when prescribing optimal drug therapy, including SGLT2 drugs, has not been studied.Aims. To study the effect of controlled physical training on the quality of life and prognosis of patients with CHF comorbid with type 2 diabetes mellitus against the background of rational pharmacotherapy.Materials and methods. The study included 74 patients with CHF against the background of type 2 diabetes mellitus, receiving optimal drug therapy, with mandatory intake of SGLT2 drugs. Two groups were formed using the simple randomization method: “Physical training” (n = 35) – basic drug therapy supplemented by a program of controlled physical training and “Standard drug therapy” (n = 37) – only basic drug therapy. Patients in the standard drug therapy group were recommended regular aerobic physical activity of moderate intensity for 30–60 minutes at least 5 days a week.Results. In the Physical Training group, after 12 months, an increase in the distance according to the results of the 6-minute walk test by 39.6% (on average 407.2 meters) was registered, in the Standard Drug Therapy group, physical tolerance increased by 12.2% (324.5 meters) (p = 0.002). According MLHFQ questionnaire in patients with CHF, the results were obtained that characterize the high social adaptation of patients during physical training in comparison with standard pathogenetic drug therapy. Thus, the MLHFQ indicator in the Physical Training group changed by an average of 25.2 points, and in the Standard Drug Therapy group – by 5.7 points, amounting to 37.3 ± 5.9 in the Physical Training group, and 58.2 ± 2.1 in the Standard Drug Therapy group (p = 0.001).Conclusions. Physical training in patients with CHF associated with type 2 diabetes mellitus against the background of optimal drug therapy leads to an increase in the distance according to the results of the 6-minute walk test and contributes to an improvement in the quality of life.

AIM:Comparative analysis of clinical, anamnestic, and laboratory and instrumental data of patients with chronic heart failure (CHF) and iron deficiency (ID) diagnosed according to the AHA/ESC/RSC criteria, and CHF patients diagnosed with ID based on decreased transferrin saturation (TSAT) ≤19.8% or serum iron (Fe) ≤13 μmol/l. MATERIAL AND METHODS:An additional analysis of the ID-CHF-RF study was performed. The analyzed population included 498 patients (198 women) with CHF. In addition to the ID criteria provided by the protocol (AHA/ESC/RSC criteria: ferritin &lt;100 μg/l or ferritin from 100 to 299 μg/l and TSAT&lt;20%), concentrations of ID biomarkers were assessed, which showed high sensitivity and specificity for the diagnosis of ID compared to the morphological picture of the bone marrow (TSAT&lt;19.8% or Fe ≤13 μmol/l). Subgroups of patients with ID determined only by the AHA/ESC/RSC criteria, only by the TSAT≤19.8% and Fe ≤13 μmol/l criteria, and by both were analyzed. RESULTS:ID diagnosed by the AHA/ESC/RSC criteria was found in 83.1% of patients. The TSAT ≤19.8% and Fe ≤13 μmol/l criteria revealed ID in 74.5% of patients. In 341 patients (76.8%), ID was diagnosed using both criteria. Patients with ID diagnosed by the TSAT≤19.8% and Fe≤13 μmol/l criteria, compared with patients with ID diagnosed by the AHA/ESC/RKO criteria, had a 50% lower Fe (9.8 μmol/l vs. 19.4 μmol/l) and a higher incidence of anemia (43.3% vs. 23.3%) and diabetes mellitus (DM) (36.7% and 24.7%). Also, these patients had higher values of body mass index (BMI) and NT-proBNP concentration (2317 [1305;9092] vs. 1691 [709;3856] pg/ml), and lower LV EF values (41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%), respectively. The most severe course of CHF and the greatest changes in laboratory tests associated with ID and anemia were observed in patients with ID determined by two criteria. Patients in this group were older, with a higher BMI, more frequent presence of atrial fibrillation, and higher NT-proBNP (4182 [1854;9341] pg/ml). CONCLUSION:Patients with isolated low ferritin are characterized by less severe clinical and functional impairment compared to patients with low TSAT or Fe. At the same time, patients with ferritin higher than 300 μg/l and low TSAT and/or Fe were characterized by very severe CHF and a low functional status, although this may not be related with ID. Thus, the use of the ferritin-based criteria of ID may lead to overdiagnosis of ID in some patients and, at the same time, miss some of the most "severe" patients who likely require the ID correction. Patients with ID who show a decrease in all three parameters are likely to benefit most from Fe supplementation. It is advisable to perform additional studies on the effect of Fe supplements on the course and prognosis of the disease in this cohort of patients.

Aim: To perform a quantitative analysis of the effectiveness of three concepts of heart valve prosthesis support frames from the perspective of their safety under the most critical loads, conducted through numerical modeling.Materials and Methods. The study utilized three computer-generated concepts of stent-like support frames, created based on the analysis of similar balloon-expandable prostheses. The modeling was conducted using Abaqus/CAE software and included the analysis of two key loads characteristic for this element: compression and implantation phases. A linear description of cobalt-chromium was used as the material model. The feasibility of the concepts was quantitatively assessed using von Mises stress and its qualitative distribution on the surface of the models as stress contours.Results. The analysis revealed that two of the three proposed models experienced stresses exceeding the strength limit (933 MPa) – 999.6 and 954.0 MPa during the compression phase and reaching 1022.4 and 1044.7 MPa, respectively, during the implantation phase. Concept 3 had significantly lower stresses during loading; however, in the working state, the indicators approached the threshold, reaching 924.2 MPa.Conclusion. Numerical modeling identified the inefficacy of concepts 1 and 2 and directions for optimizing concept 3 – reducing amplitudes to form a “strength reserve” for stress. The analysis emphasized the importance of numerical modeling in the early assessment and optimization of medical devices.

Relevance. Healthcare-associated infections are a serious complication worldwide, with improper hand cleaning thought to be the main cause. Compliance with handwashing requirements is achieved in only 38% of cases. A risk management technology is the implementation of a standard operating procedure in practice, and an effective tool for analyzing non-compliance with its standards is an audit system that allows you to respond in a timely manner to existing deviations. The introduction of a system of audits of the epidemiological safety of medical technologies seems to be one of the directions of the risk-based approach to the prevention of infectious complications. Aim. To evaluate the effectiveness of hand sanitizing technology audits as a tool to reduce the risk of infections. Materials and methods. Over a three-year period, an audit of handwashing was carried out in four departments of the cardiac surgery center, during which 9924 checklists were analyzed. The audit itself took place according to the methodological recommendations we had previously developed. The audit results were processed in Microsoft Excel to form a database. Risk grading was carried out for each checklist using the risk matrix and the Percentile function in increments of 0.25 Results. During the audit, 5 items related to hand treatment technology were assessed: equipment of the workplace for hand treatment, hand treatment technology, the presence of antiseptic in areas of mandatory hand treatment, epidemiological safety during manipulation and patient care, organization of the hand treatment system. Initially, the risk in all positions was assessed as high, the implementation of corrective measures reduced the risk of infections associated with the provision of medical care to low values, and the incidence of infections in the cardiac surgery hospital decreased from 3.42 to 1.25 per 1000 patient days. Conclusion. The introduction of an audit system for hand sanitizing technology is an effective measure to reduce the risk of infection.

The aim of the study is to identify social and economic factors associated with the development of coronary and cerebral ischemic events in urban residents based on the results of a three-year follow-up. Material and methods. The prospective non-interventional observational study included 431 patients. Data on the coronary and cerebral ischemic events in history, and social, economic and demographic data were collected at the baseline. Follow-up appointments were scheduled 3 years later to assess new cases of coronary and cerebral ischemic events. Taking into account the presence or absence of the adverse events in history at the baseline and follow-up visit, four groups of patients were formed. There were 350 (81.2 %) people without a coronary history (group 1), and 81 (18.8 %) with it (group 2). Respondents without a coronary history were divided into a subgroup with the absence of new ischemic (coronary and cerebral) events at the repeat stage, numbering 246 (57.1 %) people (1a), as well as a subgroup with their development – 104 (24.1 %) (1b). Similarly, respondents with a coronary history were divided into a subgroup with the absence of adverse events at the second stage, which included 35 (8.1 %) people (2a), as well as a subgroup with their occurrence – 46 (10.7 %) (2b). Results. At the baseline, only 18.8 % out of 431 patients had coronary events in history. At the follow-up visit, 150 (34.8 %) patients presented with new coronary or cerebral ischemic events: 10.7 % of those cases were fatal, 1.9 % – new cases of myocardial infarction, 3.5 % – cases of stroke, 13.5 % – new cases of angina pectoris, and 5.3 % – other diseases associated with coronary artery disease. One third out of 350 patients without coronary events in history and half of patients with coronary events in history presented with newly developed adverse events. Young respondents (35–49 years old) with no coronary history were 3 times more likely to have coronary and cerebral ischemic events over 3 years than people of the same age, but with previous diseases of the cardiovascular system. During the 3-year followup period, the risk of coronary and cerebral ischemic events in patients with coronary events in history was associated unemployment odds ratio (OR) 2.74 (95 % confidence interval (CI) 1.33; 5.66, p = 0.006), widowhood OR 2.98 (95 % CI 1.32; 6.74, p = 0.008), living in a rural area OR 2.30 (95 % CI 1.16; 4.55, p = 0.017) and female gender OR 2.63 (95 % CI 1.28; 5.43, p = 0.008). Conclusions. The risk of coronary and cerebral ischemic events during the 3-year follow-up period in the population of urban residents is associated with social and economic determinants such as female gender, unemployment, living in a rural area, and widowhood in the presence of a coronary history. 35–49-year-old men without a coronary history should also be considered as a group of special attention for the prevention of adverse events.

Aim. To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.Material and methods. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).Results. A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.Conclusion. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the “aggressiveness” of therapy.

Aim . To identify the epidemiological features of HAIs in all patients admitted for surgery from 2018 to 2022. in a cardiac surgery hospital for the implementation of a risk-based prevention strategy. Materials and Methods . A descriptive retrospective epidemiological study of the HAI epidemic process was performed from 2018 to 2022. in patients of a large cardiac surgery hospital (n = 6179). Stratified indicators were calculated. To display unknown relationships and make a forecast, Fourier spectral analysis was performed, followed by the use of artificial intelligence technology - neural networks. The STATISTICA Automated Neural Networks (SANN) tool was used, as well as the StatTech v. 3.0.5. Results . The average rate of HAIs incidence over a 5-year period was 4.22 per 1000 patient days. We revealed decreasing trend of HAIs. Incidence of HCAI cardiopulmonary bypass surgery (CBS) was 3 times higher than without CBS (4.68 and 1.51 per 1000 patient-days, respectively). Fourier analysis revealed 10, 20, 30 cyclicity due to the dominant Klebsiella pneumoniae without the same time-series for other pathogens. The technology of neural network modeling did not reveal neural networks suitable for describing the forecast. Klebsiella pneumoniae showed properties typical of the hospital population and caused 35.49% of all cases of HAIs, had multidrug resistance to antibiotics in 74.45% of cases, with more than half of the strains having extended resistance, and 10.21% were pan-resistant. Acinetobacter baumanii also showed high epidemic activity, causing almost a fifth of all cases of HAIs, although its antimicrobial resistance characteristics were less pronounced than those of Klebsiella pneumoniae . Conclusion . The epidemiological characteristics of the epidemic process of HCAI is one of the mandatory components of risk identification. The identified features of the dynamics of the epidemic process of HCAI in a cardiac surgery hospital, risk groups and time, the structure and characteristics of the microbiota should be taken into account in the HCAI risk management system.

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. Orthotopic heart transplantation (OHT) is the gold standard treatment for individuals with end- stage heart failure (HF), providing the best survival and quality of life. In Russia, the number of OHT procedures and transplantation of other organs have significantly increased in recent years. At the same time, there is lower perioperative mortality and higher survival in the post-OHT long-period. Objective: to analyze OHT outcomes in Kuzbass over a 10-year period. Material and methods. From January 2013 to December 2023, 72 OHTs (36.7% of those included on the heart transplant waiting list (HTWL) over a 10-year period) were performed at the Research Institute for Complex Issues of Cardiovascular Diseases. Recipient median age was 56 [50.5; 61.0] years, which included 61 men and 11 women. Among the etiologic causes of end-stage HF, ischemic cardiomyopathy was predominant in 65.3% (n = 47) of recipients, whereas dilated cardiomyopathy was present in 25% (n = 18) of recipients. Other cardiomyopathies accounted for 9.7% (n = 7). Results. Atotal of 196 patients with end-stage HF were included in the HTWL over a 10-year period; 74 (37.8%) of these did not live to get a transplant. The waitlist time was 173 days (5.77 months) - which is slightly longer than the average waiting time of 3.9 months for OHT according to data from European registries. Waitlist mortality was 19.6%. The 10-year average in-hospital mortality rates among patients after OHT were 16.7% and 1-year mortality was 15.3%. These rates are consistent with worldwide trends for this high-tech medical care. Cumulative survival at the end of 2023 was 51.4% (36 patients after OHT). Median length of stay in the hospital was 28 days, with 14 days spent in the intensive care unit. Donor heart anoxia time was 112 [85.25; 170.5] minutes, and cardiopulmonary bypass time was 145 [124; 169.5] minutes. Ten patients (13.9%) required extracorporeal membrane oxygenation, while 8.3% of cases required extracorporeal homeostasis correction. Conclusion. The 10 years of successful experience at the Research Institute for Complex Issues of Cardiovascular Diseases validates the need to develop the OHT program in Kuzbass as a gold standard for treating end-stage HF.

Aim To evaluate the efficacy and safety of azilsartan medoxomil for preoperative preparation and improving the long-term prognosis of elective percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD), arterial hypertension (AH), and type 2 diabetes mellitus (DM). Material and methods The study sample included patients with type 2 DM referred for elective PCI who had poor blood pressure (BP) control according to 24-hour BP monitoring (24-BPM) (mean daily systolic BP >= 130 mmHg, mean daily diastolic BP >= 80 mmHg). The data were collected from 2018 through 2020. A total of 75 patients was included and distributed by simple randomization into two groups: group 1 (main, n=37) received azilsartan medoxomil as an antihypertensive drug at a dose of 40 mg / day (previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARB) were discontinued); group 2 (control, n=38) continued on their previous antihypertensive therapy. The follow-up period was 6 months. During each of 5 consecutive follow-up visits, the patient was examined, 24-BPM was recorded, and urinary markers of renal dysfunction (glomerular filtration rate, GFR; neutrophil gelatinase-associated lipocalin, NGAL; urine albumin-creatinine ratio, UACR; kidney injury molecule, KIM-1; and interleukin-18, IL-18) were measured. Results During the azilsartan treatment, GFR decreased by 7.4 %, while in the control group, it decreased by 18.9 % (p<0.001). For 6 months of follow-up, no changes in the NGAL concentration were found in the main group, while the NGAL concentration in the control group increased by 12.9 %. With azilsartan, there was a decrease in the urinary concentration of IL-18 (16.9 %), while in patients of the control group, IL-18 increased (7.14 %). Proteinuria progressed in both groups, which was expectable given the presence of DM; however, in patients receiving azilsartan, the UACR value increased by 37.5 %, while in patients of the control group, it increased by 96.15 %. These differences were statistically significant. No statistically significant differences were found in the concentrations of cystatin C and KIM-1. Conclusion This study demonstrated two important facts: the possibility for diagnosing contrast-induced acute kidney injury (CI-AKI) using new, more sensitive markers of kidney damage, which is important for assessing the effectiveness of prevention, and the possibility of using ARBs, in particular azilsartan, for the prevention of CI-AKI in patients with IHD in combination with AH and DM.

Aim. To determine differences in laboratory coagulation parameters using routine and integral monitoring methods in patients depending on anticoagulant therapy >12 months after pulmonary embolism (PE) with a high recurrence risk. Material and methods. The study included 72 patients who, according to indications, received long-term anticoagulant therapy >12 months due to a high risk of recurrent thromboembolism. During the follow-up period (15-20 months from the first pulmonary embolism episode), the plasma coagulation parameters were studied using a conventional panel and D-dimer assessment, as well as a thrombin generation test and thrombodynamics. Patients adherent to prolonged anticoagulation were included in group 1. During the collection period, 8 patients independently stopped taking anticoagulants, despite the high risk of recurrent pulmonary embolism (group 2). Results. There were no significant differences in coagulation parameters and D-dimer levels between the studied groups of patients. In the group of patients continuing to take anticoagulants, there was an increase in clot growth delay parameters in comparison with patients of group 2 according to the thrombodynamics results (p=0,046) and the thrombin generation test in platelet-poor plasma in comparison with reference values (p=0,001). Conclusion. Long-term anticoagulant therapy effectively prevents recurrent venous thromboembolism. In patients after primary pulmonary embolism who refuse anticoagulation, the clot growth delay values are shortened, which indicates an increased risk of recurrent venous thromboembolism. The most stable plasma coagulation parameters are observed in patients taking direct oral anticoagulants.

Despite the presence of various signs of cardiac amyloidosis ("red flags"), the introduction into routine practice of new non-invasive diagnostic methods (Speckle Tracking technology using echocardiography, myocardial scintigraphy with technetium pyrophosphate, genetic testing, screening for free light chains of immunoglobulins to exclude AL-amyloidosis), which have high specificity and sensitivity, transthyretinic (ATTR) cardiomyopathy is still a difficult to diagnose disease, especially in the early stages when treatment is most effective. The article presents a clinical case of ATTR-amyloidosis with predominant heart damage, manifested by severe diastolic heart failure resistant to treatment. The timing, from the moment of the first episode of decompensation of heart failure to death, is 4 months, which confirms the rapid progression of severe biventricular dysfunction of the heart. Despite the presence of cardiac and extracardial "red flags" of ATTR-amyloidosis in the patient, the diagnosis was established at autopsy. The paper analyzes possible errors of early diagnosis at the outpatient and inpatient stages of patient management.

Using information technologies at all stages of patient care is necessary at the current state of medical development. It is particularly important to implement innovative information technologies in the management of patients with cardiovascular diseases in the outpatient setting, in secondary prevention and rehabilitation that continues throughout life. Various wearable devices for hemodynamic monitoring, electrocardiographic and physical activity assessment, that help the patient`s condition during rehabilitation, have been widely used in clinical practice all over the world. However, considering the outpatient setting, a cardiologist or rehabilitologist should to be able to monitor the data obtained using a single source, and to communicate with the patient in order to adjust treatment. Applications for mobile devices providing feedback can be a convenient tool in this regard. To date, many applications have been developed for smartphones, including those that synchronize with wearable devices, to record patient parameters, including the level of physical activity. Most of them are limited by self-control. Both in Russia and in other countries, a number of problems and limitations associated with the use of these technologies are related to the patient, the imperfection of the health care system, and problems with the devices themselves. The present article is devoted to an overview of existing remote rehabilitation technologies focusing on the applications for mobile devices. The authors present a short summary on domestic and international development in information technologies, identify the problems and future development of this area in health care.

Aim      To evaluate the role of iron deficiency (ID) identified by various criteria, anemia, and the combination of ID and anemia in determining the severity of the clinical course of chronic heart failure (CHF) in a retrospective analysis of data from 498 patients who participated in the ID-CHF-RF Russian multicenter program.Material and methods  ID was diagnosed by the following three criteria established by the European Society of Cardiology (ESC) and the Russian Society of Cardiology (RSC): 1) ferritin concentration &lt;100 μg/l or ferritin concentration 100-299 μg/l in combination with a decreased transferrin saturation (TS) &lt;20%; 2) ID criteria that showed a high sensitivity and specificity when compared with bone marrow morphology (BMM): TS ≤19.8% or serum iron (SI) ≤13 μmol/l; and 3) a composite index including a ferritin concentration &lt;100 μg/l in combination with TS &lt;20% and SI ≤13 μmol/l. The presence of anemia was defined as a hemoglobin concentration of less than 12.0 g/dl in women and less than 13.0 g/dl in men according to the criteria of the World Health Organization.Results Concomitant anemia was detected in 40.3% of patients with CHF; in 85.1% of cases, anemia was combined with the SI concentration below normal. CHF patients with concomitant anemia were significantly older and had low levels of not only red blood cells and hemoglobin but also all parameters of iron metabolism, i.e., SI, ferritin concentration, and TS. The mean deviation of the red blood cell size, that characterizes the degree of anisocytosis, was significantly increased in patients with anemia, especially with a low SI. These patients had a higher CHF functional class, elevated levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) and walked a shorter distance in the 6-minute walk test, which reflects significantly more severe manifestations of CHF with concomitant anemia, particularly in combination with a low SI. The incidence of ID was 83.1% (including 23.3% in combination with anemia) according to the ESC/RSC criteria; 74.5% (including 43.3% with anemia) according to the BMM criteria; and 51.6% (including 51.7% with anemia) according to the composite index, which seems to be stricter compared to the first two criteria. Regardless of the assessment method (by total weighted average data), in ID combined with anemia, not only the hemoglobin concentration was significantly reduced but all three analyzed parameters of iron metabolism were also significantly reduced (SI 9.0 μmol/l vs. 10.4 μmol/l; ferritin 41 μg/l vs. 59 μg/l; TS 8.5% vs. 12.9%) compared to ID without anemia, respectively. The CHF severity and the NT-proBNP concentration were also maximum for the combination of ID and anemia, in contrast to ID without anemia, regardless of the ID criterion used. A more accurate comparison of the methods for determining ID in CHF in the context of their prognostic value will be obtained by analyzing the data of a two-year follow-up of patients in this study, which will be the subject of the next article.Conclusion      This analysis suggests that the presence of concomitant ID without anemia or anemia without ID moderately affects the severity of clinical manifestations of CHF and may be rather markers than factors determining the course of the disease, and in this case, does not require special correction with iron medications. And only ID anemia (a combination of ID with anemia) in patients with CHF can be considered a condition requiring special correction (for example, with intravenous medication) in addition to optimal therapy for CHF. This conclusion does not change depending on the used criteria for ID and requires verification in new RCTs.