The aim of this study is to assess the life quality of patients with stable coronary artery disease after angioplasty and stenting of coronary arteries at the post-hospital stage. Materials and methods. Methods of the sociological analysis (questionnaire surveys) and methods of mathematical statistics (descriptive statistics, time series method, factor and variance analyses) were used at different stages of the prospective observational study. The research materials were as follows:1458 electronic patient records with a stable coronary heart disease (SCHD) after angioplasty and stenting of coronary arteries (ASCA); 620 questionnaires filled in by patients before the surgery, 1, 6, 12 months after discharge. The statistical analysis was performed using the IBM SPSS Statistics software. Results. The results of a comprehensive survey make it possible for us to assert that during the studied period, stable good healths of cardiac surgery patients with ASCA were maintained. Within the framework of the EQ-5D-5L questionnaire, it was revealed that more than 50% of patients have no physiological problems. The results of the SAQ analysis demonstrate that 58% of the patients feel better, and more than 34% of the patients do not have shortness of breath 1 year after the surgery. A statistically significant improvement in their healths was established according to a visual analogue scale relatively to the annual observation mark (62.82 ± 20.95), which corresponds to the high results assessment of the medical technology use. At the same time, 53% of the patients notify that the treatment results meet their own expectations. Conclusion. The proposed calculation of the integrated index of patients’ treatment efficiency demonstrated by the patients with stable coronary heart disease after angioplasty and stenting of the coronary arteries is based on the results of the factor analysis. This calculation can be used to assess the efficiency of pharmacotherapy in the framework of a value-oriented approach to the treatment of a number of other pathologies.

The potential impact on cardiovascular morbidity and mortality have become one of the most important issues of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 may be associated with more frequent development of acute cardiovascular complications, while patients with established cardiovascular diseases are characterized by a higher risk of severe infection and adverse in-hospital outcomes. Due to the spread scale of the pandemic, understanding the long-term cardiovascular consequences of COVID-19 is of no less importance. Inability to extrapolate available international data to the Russian population has led to the initiation of a national multicenter study (registry) of patients recovered from COVID-19 and with concomitant involvement of the cardiovascular system or with baseline severe cardiovascular diseases. The article presents its rationale, design and implications of the results for clinical practice.

Aim . To evaluate the relationship between the clinical decision support system use (CDSS) and adherence to clinical guidelines. Materials and methods . Medical records of 300 patients with atrial fibrillation and hypertension from the electronic medical database of the Almazov National Medical Research Center were analyzed. Demographic and clinical data, as well as information on anticoagulant, antiarrhythmic and antihypertensive prescriptions were analyzed. The primary endpoint was adherence of prescribed treatment to current clinical guidelines for each of the three therapies. Firstly, a group of independent clinical experts assessed primary endpoint for retrospective prescriptions. Secondly, new prescriptions were simulated by another group of clinical experts using CDSS and blinded to previous therapy. Primary endpoint at the second step was analysed by independent experts. We compared adherence to relevant clinical guidelines with and without use of CDSS. Additionally, we analyzed predictors of failing to meet the current recommendations in the retrospective records. Results . Out of 300 patients, only 291 (97%) had all characteristics and were included in the analysis. In 26 patients (18%), all three treatment strategies were in accordance with current clinical guidelines. Anticoagulant therapy was adherent to the guidelines in 92% of cases. Experts who used CDSS were 15% (95% confidence interval [CI], 10-21%) more likely to prescribe novel oral anticoagulants and 14% (95% CI, 10-19%) less likely to prescribe warfarin compared to baseline. Antiarrhythmic therapy was adherent to the guidelines in 69% of cases. When the CDSS platform was applied, experts were 14% (95% CI 4-19%) more likely to prefer antiarrhythmic drug (AAD) monotherapy and 32% (95% CI 26-37%) more often prescribed radiofrequency ablation (RFA) of left atrium. At baseline, antihypertensive therapy combinations were adherent clinical guidelines in 28% of cases. The use of the CDSS platform by experts was significantly associated with an increase in the frequency of prescribing dual and triple antihypertensive therapy. Conclusion . CDSS use is associated with improved adherence to current clinical guidelines. Prospective randomized trials are needed to evaluate the CDSS effectiveness in the prevention of cardiovascular events.

Current guidelines for the management of patients with dyslipidemia are well known and easily accessible. Despite this, according to research data based on actual clinical practice, selection of optimal tactics for managing patients with dyslipidemia often causes difficulties and leads to a failure to achieve the target levels. Tools such as clinical decision support system (CDSS) can help clinicians follow current clinical guidelines, taking into account the diversity of phenotypic profiles and side effects. This review highlights the effectiveness of CDSS implementation in medical practice as a means for making decisions in managing patients with dyslipidemia, as well as presents the algorithm for CDSS for lipid metabolism disorders created by specialists of the Almazov National Medical Research Center and the University of Milan.

Aim . To determine the association of prehypertension (PHTN) with cardiometabolic and hormonal factors in a population sample of St. Petersburg residents. Material and methods . As part of the ESSE-RF epidemiological study, a random sample of 1600 residents of St. Petersburg at the age of 25-64 was examined. All participants signed informed consent and completed the questionnaires. Anthropometry, fasting venous blood sampling, blood pressure (BP) measurements were performed. BP was measured by the OMRON BP monitor (Japan) twice on the right hand in a sitting position. Mean BP was calculated. Respondents, depending on the BP level and availability of antihypertensive therapy, were divided into 3 groups: optimal BP ( 173,0 pmol/L (2,99 [1,22; 7,36], p=0,017), HOMA-IR >2,9 (2,12 [1,42; 3,19], p 173,0 pmol/L (2,14 [1,30; 3,54], p=0,003), HOMA-IR >2,9 (1,83 [1,39; 2,42 ], p536 nmol/L (1,59 [1,25; 2,05], p125 pg/ml (2,05 [1,32; 3,20], p=0,002). Conclusion . In a random sample of St. Petersburg residents, the presence of hyperinsulinemia increases the risk of PHTN and insulin resistance by 3 and 2 times, respectively.

Телемедицинское наблюдение является ценным дополнением в лечении артериальной гипертензии (АГ). Несмотря на очевидные краткосрочные клинические преимущества, отдаленная перспектива и экономическая эффективность подобных вмешательств изучены недостаточно. Цель. Дать прогноз клинических исходов в долгосрочной перспективе с параллельным определением экономической эффективности телемониторирования артериального давления (АД) и телемедицинского дистанционного консультирования (ТМДК) у пациентов с АГ. Материалы и методы. На основании 3-месячного наблюдения 240 пациентов (160 в группе ТМДК и 80 в группе контроля) с неосложненной АГ построена марковская модель для предсказательного моделирования и экстраполяции результатов на 10 лет с годичным циклом для гипотетической когорты пациентов ( n =1000). Пациенты находились в начальном состоянии АГ и могли переходить в иные ее осложнения. В конце каждого цикла вероятности перехода между состояниями транслированы в число пациентов, находящихся в каждом из них. Оценивали показатель сохраненных лет жизни (LYG) с поправкой на ее качество (QALY). Затраты оценивались с позиции системы здравоохранения. Результаты. В результате моделирования число умерших пациентов – 91 в группе контроля и 67 в группе ТМДК. Показатели LYG составили в группе контроля 9,6 года, в группе ТМДК – 9,71 года. QALY составил 7,82 года в группе контроля против 8,31 года в группе ТМДК. Суммарные затраты на лечение АГ и возможных осложнений на конец исследуемого горизонта планирования составили 145 237 700 руб. в группе контроля и 102 508 000 руб. в группе ТМДК, а стоимость 1 QALY в последнем случае составила 27 5178,98 руб. (134 837,70 руб./0,49). Заключение. Согласно результатам моделирования, можно говорить о долгосрочной клинико-экономической эффективности внедрения ТМДК в стандартную практику лечения пациентов с АГ.

The combined effect of dyslipidemia and high blood pressure largely contributes to the development and progression of cardiovascular diseases, and therefore the control of these risk factors should be a priority strategy both within primary and secondary prevention. A concept of a polypill, which provides effective control of both blood pressure and lipid profile, is a promising strategy. It allows of controlling several factors of the cardiovascular continuum, and contributes to a higher patient adherence to treatment. Therefore, the wider implementation of a polypill strategy will improve patients’ prognosis and quality of life.

В данной статье проведено сравнение капилляроскопических изменений ногтевого ложа у пациентов с системной склеродермией, у пациентов с ревматологическими заболеваниями (ревматоидным артритом, полимиозитом, остеоартритом), а также с идиопатической легочной гипертензией. У всех пациентов с диагнозом системной склеродермии по данным капилляроскопии ногтевого ложа обнаружена характерная комбинация капиллярных нарушений — расширение всех трех сегментов капиллярной петли, «потеря» капилляров и разрушение ногтевого капиллярного ложа, характерная для синдрома Рейно. У пациентов в группах сравнения капилляроскопическая картина была представлена единичными патологическими изменениями капилляров, не складывающимися в патогномоничные склеродермические паттерны, за исключением группы с дермато/полимиозитом, где у 2 пациентов диагностирован достоверный синдром Рейно. Наблюдались также достоверные различия в плотности капиллярной сети у больных системной склеродермией по сравнению с больными других групп.

Цель исследования. Оценка клинической эффективности телемедицинского наблюдения и дистанционного консультирования (ТМДК) среди пациентов с неконтролируемой артериальной гипертензией (АГ) на основании методов математического анализа. Материалы и методы. В исследование включено 240 пациентов, рандомизированных в формате 2:1 в группу ТМДК (n=160, медиана возраста 47 лет) и группу стандартного наблюдения (n=80, медиана возраста 49 лет). Использовалось простое и безопасное программное обеспечение с мобильной (для пациентов) и стационарной (для врачей) платформами, обеспечивающее внесение, хранение и анализ данных самоконтроля артериального давления (АД) и удаленные консультации «врач - пациент». Предусмотрено 3-месячное наблюдение с обязательным начальным и завершающим очными визитами с оценкой офисного систолического АД (оСАД). Математическую оценку показателей эффективности проводили с помощью методов атрибутивной статистики. Основываясь на частоте достижения целевого показателя оСАД, рассчитывали показатели абсолютной эффективности (АЭ) для обеих групп, атрибутивной эффективности (АтЭ), относительной эффективности (ОЭ), популяционной атрибутивной эффективности (ПАЭ) для ТМДК, а также стандартные ошибки для каждого вида эффективности и 95% доверительные интервалы (ДИ). Результаты. Спустя 3 мес наблюдения показатели оСАД оказались значимо ниже в группе ТМДК, чем в группе контроля (-16,8±2,9 мм рт. ст. против -7,9±3,9 мм рт. ст.; р<0,001). При этом 120 пациентов в группе ТМДК и 16 пациентов в группе контроля достигли целевого уровня (АЭ 75±6,7% против 20±8,8%). АтЭ составила 55,0±11,3%, ОЭ - 3,75 (95% ДИ 1,94-5,56), ПАЭ соответствовала 36,7% (95% ДИ 24,1-49,2). Индекс потенциальной пользы ТМДК составил 1,8. Заключение. Внедрение ТМДК в процесс лечения пациентов выраженно влияет на достижение целевых показателей АД и значительно увеличивает вероятность контролируемости заболевания.

Background. Diet and nutrition can favorably modulate arterial function during vascular aging, and therefore the search for their relationship is important. Objective. To study the relationship between eating behavior and markers of early vascular aging in patients with prehypertension and arterial hypertension. Design and methods . The respondents from the population sample of the epidemiological observational study ESSE-RF were questioned. 477 questionnaires were selected for further analysis of the respondents’ eating habits and the prevalence of early vascular aging among them. Inclusion criteria were age over 40 years to assess the risk of developing cardiovascular complications using the SCORE and ASCORE scales; lack of criteria for high and very high risk on the SCORE scale. A standard questionnaire was used, developed on the basis of adapted and validated international methods, with 12 modules. In the answers of the respondents, the amount and frequency of consumption of table salt, sugar, animal fats, meat and processed meat products, vegetables and fruits, poultry and fish were analyzed. The estimated vascular age of all respondents was assessed using the ASCORE scale. Results. In total, the responses on eating behavior were analyzed in 295 women and 182 men aged 40 to 65 years; the estimated vascular age (ASCORE) was 55.5 ± 9.6 years. For respondents with healthy vascular aging, compared to respondents with premature vascular aging, significantly less salt (57.2% versus 70.6%), sausages (44.1% versus 27%) and higher consumption of poultry meat are typical (44.1% versus 13.9%), dairy products (73.6% versus 41.4%) and fresh vegetables / fruits (88.2% versus 58%). The group of people with healthy vascular aging showed a higher level of daily consumption of sweets (55.9% versus 30.5%). Conclusion. Based on the results of a questionnaire survey of the population sample, it can be assumed that there is a connection between the peculiarities of the food pattern and vascular aging. Express assessment of eating behavior and calculation of vascular age can be used in outpatient practice for preventive counseling.

At the online meeting held on September 3, 2020, the results of the international multicenter trial EMPEROR-REDUCED were considered. Number of proposals and recommendations for the further study of cardiovascular and renal effects of empagliflozin and its practical use in heart failure patients were agreed.

Objective. The aim of the present study was to compare conventional and novel, potentially earlier biomarkers of kidney injury in patients with different severity and duration of arterial hypertension (HTN) and healthy controls. Design and methods. Urine levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule‑1 (KIM‑1), liver fatty-acid binding protein (L‑FABP), albuminuria and serum levels of cystatin C and creatinine were measured in 92 hypertensive patients (46 male, mean age 50,7 ± 12,2 years) and 34 healthy control subjects (16 male, mean age 49,9 ± 11,4 years). Hypertensive patients were divided into four age- and sex-matched groups according to HTN severity: 1st grade (n = 24), 2nd grade (n = 26), 3rd grade (n = 17) and resistant hypertension (n = 25). Glomerular filtration rate (GFR) was estimated by the level of serum creatinine and cystatin C by MDRD and CKD-EPI formulas. Instrumental examination included measuring office blood pressure (BP), 24‑hour ambulatory BP monitoring (ABPM, SpaceLabs 90207), applanation tonometry (SphygmoCor, Artcor Medical) with the calculation of central aortic pressure. Results. As compared to healthy control subjects, hypertensive patients were characterized by higher creatinine and albuminuria levels, and lower GFR, however, creatinine levels remained within the normal range despite the increase in the severity of HTN. Levels of albuminuria increased only in patients with severe HTN. Also as compared to healthy controls, HTN patients had significantly higher levels of cystatin C, which already was found in patients with 1st and 2nd stages of HTN, which occurs more often than an increase of creatinine and albuminuria levels. Patients with HTN had significantly lower sCys-estimated GFR and creatinine-sCys-estimated GFR. In HTN patients these biomarkers were associated with office systolic BP (SBP), central aortic systolic and diastolic (CAP) and mean 24‑hour BP level. There were no differencesin NGAL, KIM‑1 levels between the groups, however, KIM‑1 levels were associated with office SBP, mean daily 24‑hour of diastolic BP (DBP) and systolic and diastolic CAP in patients with severe HTN. At the same time, as compared with healthy controls, patients with initial HTN were characterized by higher levels of urine L‑FABP and its concentration increased in patients with severe HTN. In addition, L‑FABP levels were associated with office SBP and DBP, mean 24‑hour BP and systolic and diastolic CAP. Conclusions. The simultaneous assessment of creatinine and cystatin C levels, and the calculation of GFR using the formula CKD-EPI seems to be more accurate method for CKD stage classification in general and, in particular, in hypertensive patients; in hypertensive patients L‑FABP appears to be earlier biomarker of kidney injury, reflecting the progression of tubulointerstitial injury.

Systemic hypertension (HTN) is the most prevalent non-communicable disease and the leading cause for major cardiovascular events, renal failure and cognitive decline. The World Health Organization showed that HTN is a key area of concern for healthcare and identified this condition as one of the primary targets for intervention to reduce global morbidity and mortality. The hard-hitting AHA/ACC Guidelines on management of High blood pressure in adults published in 2017 shocked medical community and enforced reconsidering overall significance HTN once again due to the large pool of newly diagnosed individuals and higher healthcare costs. Ensuing debates around Task Force committee opinions were fomenting at every scientific session related to cardiac diseases throughout first half-year 2018 and beyond the lecture halls as well. Thus all attendees at the 28th European Congress on Hypertension and Cardiovascular Protection held in Barcelona, Spain in June were captivated with the European expert’s presented preview of the new 2018 ESH/ESC joint clinical Guidelines on diagnosis and management of HTN. This short review highlights the bullet points presented before fulltext publication. The chapters on diagnosis, risk stratification, blood pressure treatment target ranges had undergone minor but crucial corrections. Key changes include medical treatment of uncomplicated HTN and drug therapy in special groups with major comorbidities, management of resistant HTN, device-based HTN therapy and adherence interventions.

Распространенность сахарного диабета типа 2 (СД 2) в последнее время прогрессивно возрастает, как и других заболеваний, ассоциированных с ожирением. При этом наблюдается низкая выявляемость новых случаев СД. Настоящее исследование посвящено оценке распространенности СД 2 в российской популяции и среди больных артериальной гипертонией (АГ). Цель. Оценить распространенность СД 2, в том числе недиагностированного, в общей популяции и в популяции больных АГ на основании данных, полученных в ходе исследования ЭССЕ-РФ (Эпидемиология Сердечно-Сосудистых заболеваний в рЕгионах Российской Федерации). Материалы и методы. Объектом исследования явилась случайная популяционная выборка мужского и женского взрослого населения в возрасте 25-64 лет 10 городов России (n=16 936). Результаты. Распространенность СД в популяции составила 5,2%, впервые выявленный (недиагностированный) СД зарегистрирован у 3,5% респондентов. Среди лиц с АГ распространенность СД была выше и составила 8,6%. Еще 5,2% обследованных имели уровень глюкозы натощак выше 7 ммоль/л без упоминания о СД в анамнезе. Таким образом, распространенность СД в общем в популяции составила 8,6%, а среди больных АГ - 13,8%.

In the review, the data presented, on sleep disordered respiration in chronic heart failure patients with emphazis on sleep apnea syndrome (SAS). The aspects of prevalence are discussed, as of pathogenesis, diagnostics and specifics of SAS management in decreased or normal ejection fraction. The original results presented, on the disordered breathing assessment in patients with severe systolic dysfunction. The necessity underscored for personalized diagnostic and management approach to obstructive sleep apnea syndrome which is not just a risk factor for heart failure, but is a comorbidity at various stages of cardiovascular continuum.