Aim. To study cardiac remodeling, blood concentrations of fibrosis biomarkers depending on nocturnal hypoxemia (NH) in patients with atrial fibrillation (AF) and obstructive sleep apnea (OSA).Material and methods. This case-control cross-sectional comparative study included 334 subjects as follows: 122 patients with AF(+)/OSA(+), 117 patients with AF(-)/OSA(+), 95 patients with AF(+)/OSA(-). The subjects underwent respiratory monitoring during sleep and transthoracic echocardiography. The blood concentrations of profibrogenic biomarkers were determined.Results. The mean blood saturation level is lower, and the proportion of sleep time with saturation less than 90% is higher in patients with a combination of AF and OSA compared to patients without arrhythmia. The left atrial diameter, volumes and volume indices of both atria, pulmonary artery size, and pulmonary artery pressure in patients with AF combined with NH are greater than in patients with AF without NH. The blood levels of galectin-3 and growth differentiation factor-15 (GDF-15) are higher in patients with AF combined with NH than in patients with AF without NH and then in patients with NH without AF. In patients with AF in combination with OSA, an increased probability of NH is associated with a high blood concentration of GDF-15 (odds ratio =1,21, 95% confidence interval 1,001-1,34, p=0,002). NH increased the AF probability by 2,6 times (odds ratio =2,57, 95% confidence interval 1,47-4,46, p<0,001).Conclusion. AF in patients with OSA in combination with NH is characterized by more significant cardiac remodeling (greater left and right atrial dilation), higher pulmonary hypertension and higher blood levels of profibrogenic factors (galectin-3 and GDF-15) than in patients without NH.

Aim. To evaluate the effect of blood concentrations of biomarkers of inflammation and fibrosis, obesity parameters, and parameters characterizing cardiac remodeling on the risk of recurrent atrial fibrillation (AF) within 6 months after elective electrical cardioversion (ECV) in patients with metabolic syndrome (MS). Materials and methods. The study included patients with AF and MS (n=60) and with AF without MS (n=41), who underwent elective ECV. Prospective observation was carried out for 6 months. Results. Arrhythmia recurrence within 6 months after ECV in patients with AF in combination with MS is higher than without MS (34/60 and 9/41, p = 0.003). Among echocardiographic parameters, left atrial volume and volume index, and epicardial adipose tissue thickness (EAT) are associated with arrhythmia resumption in patients with MS and AF. Blood concentrations of galectin-3 (17.4 (12.8-19.6) and 13.3 (5.1-14.9), p=0.0001), connective tissue growth factor (CTGF) (163, 1 (134.1-232.2) and 156.7 (104.7 - 189.1), p=0.002), growth differentiation factor 15 (GDF-15) (2343.9 (1206.1-3254.2 ) and 986.1 (812.5-1775.5), p=0.0001) and interleukin-6 (IL-6) (3.8 (2.3-7.3) and 2.3 (1, 3-3.4), p=0001) in patients with MS with recurrent arrhythmia is higher than without arrhythmia. According to the ROC analysis of EAT, the concentration of galectin-3 and IL-6 in the blood was most predictive of relapse of AF in MS; threshold values of the predictors were established: EAT more than 6.1 mm, IL-6 more than 2.8 pg/ml, galectin-3 more than 15.9 ng/ml. Conclusion. In patients with AF combined with MS, the frequency of maintaining sinus rhythm after effective ECV for 6 months is lower than in patients without MS. Epicardial adipose tissue thickness, high concentrations of galectin-3 and IL-6 are associated with relapse of AF in patients with MS.

The literature review is devoted to one of the most common secondary forms of arterial hypertension – renovascular hypertension of atherosclerotic genesis. The review examines the prevalence of this problem, pathogenetic mechanisms, risk factors and clinical manifestations. Special attention should be paid to the problem of combining renovascular arterial hypertension with renal dysfunction and with manifestations of heart failure, which is most typical for bilateral hemodynamically significant stenoses or significant stenosis of a single functioning kidney, and allows us to formulate an idea of atherosclerotic renovascular disease. The review contains modern ideas about the diagnosis of this disease and the tactics of managing patients with this pathology. Special attention should be paid to indications for revascularization and ways to restore blood flow through the renal arteries. The review discusses in detail the problems of patient management after interventional treatment and the prognosis of patients with atherosclerotic renovascular disease.

Sleep-disordered breathing and nighttime bradyarrhythmias associated with this syndrome are often encountered in clinical practice. With high-grade atrioventricular blocks, such patients are usually implanted with a permanent pacemaker, but this treatment method is not indicated for patients with reversible conduction disorders. A clinical case of the successful use of CPAP therapy in a patient with second degree atrioventricular block at night associated with obstructive sleep apnea syndrome is presented. Approaches to the diagnosis and treatment of patients with bradyarrhythmias are discussed.

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

An important role in the development and evolution of hypertension in females is applied to sex hormones. Estrogen deficiency and hyperandrogenism, characteristic of periand postmenopause, are links in the pathogenesis of hypertension in this period of a woman's life and are accompanied by an increase in sympathetic nervous system activity, renin-angiotensin-aldosterone system activation, salt sensitivity, abdominal obesity and metabolic syndrome, left ventricle hypertrophy, left atrial dilatation with a high risk of atrial fibrillation, stroke and heart failure development. The paper discusses antihypertensive therapy during periand postmenopause, effectiveness and tolerability of different drug classes. Special attention is paid to the mechanism of action of selective I1-imidazoline receptor agonist moxonidine, which in women during this period both effectively reduces high blood pressure and has a beneficial metabolic effect, what is documents in studies of monotherapy, combined antihypertensive therapy with major classes and in combination with menopausal hormone therapy. The paper presents the joint expert opinion concerning above mentioned issues.

Objective – to study the incidence and risk factors of atrial fibrillation (AF) in patients with obstructive sleep apnea syndrome (OSA), verified according to screening respiratory monitoring during sleep, performed during hospitalization in a therapeutic hospital. Design and methods. The study performed a retrospective analysis of 291 case histories of patients hospitalized in a therapeutic clinic in 2021-2022. All patients underwent overnight respiratory monitoring as part of the initial screening examination for sleep-disordered breathing. Results. Obstructive sleep apnea syndrome was identified in 216 patients, mild severity – in 27,8%, moderate severity – in 20,3%, severe severity – in 26,1% of patients. The incidence of atrial fibrillation in patients with diagnosed OSA was 28,7% and was significantly higher in patients with severe apnea compared to patients with mild apnea (p=0,043). According to the results of the analysis of the reasons underlying the development of AF in patients with verified apnea, arterial hypertension was identified in 96,8% of patients, chronic heart failure in 72,6%, coronary heart disease in 51,6%, thyrotoxicosis in 6,5%, sick sinus syndrome in 4,8% of patients, 19,4% of patients without structural heart damage. In severe apnea, the permanent form of AF was more common (p=0,008), and in mild OSA, paroxysmal AF was more common (p=0,024). It was found that the volumes of the left and right atria in patients with AF and severe OSA are greater than in patients with mild apnea. Conclusion. AF in OSA often occurs in patients without organic heart disease. The most common risk factors for AF in patients with OSA were arterial hypertension, found in 96,8% of subjects, as well as obesity (in 74,2%). The incidence of AF in patients with severe apnea is higher than in patients with mild apnea. The permanent form of AF is detected more often, and atrial volumes are larger in patients with severe OSA compared to patients with mild sleep-disordered breathing.

The issues of diagnosis and treatment of hypertension (HTN), as well as the prevention of its complications, are an urgent problem in cardiology. On June 21, 2023, the Journal of Hypertension published guidelines on HTN from the European Society of Hypertension (ESH), which were first presented to the public at the annual European Hypertension Meetings on June 24, 2023 in Milan. This publication describes the highlights and key updates of the guidelines and outlines its clinical significance. Russian experts also discussed current problems of pathogenesis, diagnosis and treatment of HTN.

Introduction. Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are common in the population and share common risk factors. The prevalence of OSA in AF is established, but the incidence of AF in patients with OSA is not studied.Purpose. To study the incidence of atrial fibrillation and atrial remodeling in patients with varying severity of obstructive sleep apnea syndrome.Materials and methods. Retrospective analysis of 216 medical records of patients hospitalized in a therapeutic hospital in whom screening respiratory monitoring revealed OSA.Results. Atrial fibrillation was diagnosed in 62/216 patients (28,7 %) with OSA. AF was more often observed in patients with severe OSA – in 27/76 (35,5 %) compared to those examined with a mild degree – 16/78 (20,5 %) (p=0,043). Permanent AF was more common in severe OSA compared to mild OSA (48,2 % and 10,5 %; p<0,01). The left atrial volume index (LAVI) in patients with paroxysmal AF in combination with severe OSA is greater than in patients with AF and mild and moderate OSA (58,4±11,3; 40,8±8,1 and 41,9±7,7; p<0,01). The right atrium volume index (RAVI) in patients with paroxysmal AF in combination with severe OSA is greater than in patients with AF and mild and moderate OSA (42,8±11,0; 30,2±2,2 and 32,7±8,4; p<0,05).Conclusion. Atrial fibrillation in patients with obstructive sleep apnea syndrome is more common than in the general population, and the combination of paroxysmal atrial fibrillation with severe sleep disordered breathing characterized by more pronounced atrial remodeling than when arrhythmia is combined with mild to moderate sleep apnea.

This review presents epidemiological data on the effect of sex hormones and reproductive status on the level of blood pressure (BP) and the incidence of es­sential hypertension (EHT) in women. The role of estrogen deprivation and hyper­androgenism in the development of EHT in peri- and postmenopause is discussed. The main mechanisms of EHT in periand postmenopausal women: sympathetic and renin-angiotensin-aldosterone system hyperactivity, salt-sensitivity, high prevalence of abdominal obesity, metabolic syndrome, left ventricular hypertrophy, left atrial dilatation and high risk of atrial fibrillation, stroke and heart failure with preserved left ventricle ejection fraction. Data on the efficacy and tolerability of the main classes of antihypertensive drugs in women is presented. We discussed the mechanisms of selective I1-imidazoline receptor agonists and the results of cohort studies of moxonidine monotherapy and its combination with other antihypertensive drugs and hormonal menopausal therapy in peri- and post­menopausal women. Moxonidine reduces high blood pressure in peri- and postmenopausal women and has a beneficial effect on metabolic syndrome components, but is also effective in patients with hypertensive crises, especially with sympathetic hyperactivity.

The objective was to study the clinical features of symptomatic hypertrophic cardiomyopathy (HCM) depending on the age of onset and the presence of cardiometabolic risk factors. Methods and materials. From 2014 to 2020, 250 patients were examined, 100 patients with symptomatic HCM aged 18 to 86 years were included in the study. Results. The incidence of arterial hypertension (AH), obesity, and angina syndrome was significantly higher in patients with HCM aged 45 years and older. The patients with HCM and associated obesity had greater left ventricular end-diastolic dimension and left antero-posterior size regardless of the age of onset of clinical manifestations. The young patients with HCM and associated obesity had more often AH. Patients with HCM with the disease onset ≥ 45 years of age and associated obesity had greater left ventricular posterior wall thickness, left ventricular end-diastolic dimension index. In this group of patients, pulmonary hypertension was more often diagnosed. Conclusion. Obesity and other cardiometabolic risk factors are predictors of the progressive course of HCM, which points the need for their prevention and timely correction.

The objective was to study the clinical features of symptomatic hypertrophic cardiomyopathy (HCM) depending on the form (familial / non-familial), the age of onset and the presence of arterial hypertension (AH).Methods and materials. During 6 years, we examined 250 HCM patients, 100 patients with symptomatic HCM aged from 18 to 86 years were included in the study. Results. Patients with the clinical manifestations onset at a young age more often had a familial form of the disease, an autosomal dominant type of inheritance, an asymmetric HCM with reverse curve interventricular septal morphology. On the contrary, patients with the clinical manifestations onset at the age of ≥45 years had non-familial form of the disease and asymmetric HCM with basal interventricular septal hypertrophy. The young HCM patients with associated AH more often were obese, had CHF of III–IV functional class (NYHA), larger anteroposterior left atrial diameter than patients without AH and more often needed interventricular septal reduction. HCM patients and associated AH with the disease onset at the age of ≥45 years significantly more often had angina syndrome. Absolute indications for interventricular septal reduction in HCM patients with the disease onset ≥45 years of age were determined only for HCM patients and associated AH. At the same time, 50 % of HCM+AH patients both at a young age and in the older group, had obesity. Conclusions. The interventricular septal morphology differs significantly depending on the age of clinical manifestations onset. Co-existing AH and obesity are predictors of the progressive HCM course and an increase in the proportion of patients with absolute indications for interventricular septal reductions regardless of the age of clinical manifestations onset.

Aim. To identify the most significant factors contributing to the development of abdominal obesity (AO) in young and middle-aged residents of St. Petersburg. Design. A single-stage study conducted according to the “case — control” type. Materials and methods. We examined 966 employees of various institutions of the city of St. Petersburg who underwent a dispensary examination in 2008–2009. Of these, 503 patients (366 women and 137 men) with AO were included in the study, whose diagnosis was established according to anthropometric studies (measurements of waist circumference, WC). The comparison group consisted of 50 people (38 women and 12 men) without AO, comparable in age and gender with patients with AO. Results. 82.7% of people aged 30 to 39 years were obese, 91.3% of patients aged 40–49 years and 97.9% of participants aged 50–55 years, the prevalence of obesity increased with age (p < 0.01). Patients with AO were significantly more likely than participants in the comparison group to eat easily digestible carbohydrates (268 (53.3%) and 12 (24%), respectively, p < 0.001) and fats (248 (49.3%) and 11 (22%), respectively, p < 0.001). Among patients with AO, those who ate 1–2 times a day or, conversely, 6 or more times a day had body weight (p < 0.001) and body mass index (BMI) (p < 0.01) significantly higher than those examined who ate 4 times a day. When comparing BMI and WC in AO patients with different birth weights, it was found that AO patients whose birth weight was more than 4 kg had higher BMI and WC values. 482 (95.8 %) patients with abdominal obesity (AO) had low physical activity — less than 210 minutes weekly; 21 (4.2 %) patients with AO — at least 210 minutes weekly (р < 0.001). Almost all the examined patients without AO had higher education 49 (98%), while among patients with AO — only 297 (59%), p < 0.001. The analysis of the income level structure revealed that the income level of individuals with AO is slightly lower than in the group without AO. Conclusion. The prevalence of AO among residents of St. Petersburg aged 30–55 years is 52.1%. We have created a model based on the calculation of the logistic regression equation to assess the risk of AO development. The most significant parameters influencing its formation are highlighted: the level of education, age, type of nutrition, number of meals per day, birth weight, gender, income level, physical activity. Keywords: abdominal obesity, risk factors for the development of abdominal obesity, body mass index, waist circumference.

Aim. To determine the role of biomarkers in predicting atrial fibrillation (AF) recurrence within 12 months after radiofrequency ablation (RFA) in patients with metabolic syndrome (MS).Material and methods. The study included 245 patients with AF aged 35 to 65 years: patients without MS components (n=32), with 1-2 MS components (n=62) and patients with 3 or more MS components (n=153). All patients underwent a comprehensive clinical and anamnestic, anthropometric, laboratory and echocardiographic examinations. The prospective follow-up for 12 months included 135 patients with AF who underwent RFA.Results. It was found that the presence of 3 or more MS components increased the risk of AF recurrence by 4,1 times within 12 months after RFA (relative risk (RR) =4,1, 95% CI 2,19-7,65, p<0,0001). According to binomial logistic regression, epicardial fat thickness (EFT) (OR =3,71, 95% CI 2,12-6,73, p=0,00001), the severity of left atrial fibrosis (OR =1,48, 95% CI 1,03-1,78, p=0,0006), concentrations of galectin-3 (OR =1,31, 95% CI 1,12-1,51, p=0,0001) and GDF-15 (OR =1,11, 95% CI 1,02-1,18, p=0,0002) in patients with AF and MS increase the risk of AF recurrence after RFA. For galectin-3, GDF-15, and EFT, using ROC analysis, the following threshold values were established, the excess of which had the greatest effect on the risk of AF recurrence after RFA in patients with MS: galectin-3 >11,0 ng/ml (RR =3,43, 95% CI 1,79-6,58, p=0,0001), GDF-15 >1380,7 pg/ml (RR =2,84, 95% CI 1,81-4,46, p<0,0001) and EFT >6,4 mm (RR =4,50, 95% CI 2,32-8,71, p<0,0001). In patients with excess of all three biomarker thresholds, the total risk of AF recurrence in patients with MS within 12 months after RFA increases by 3,2 times (RR =3,16, 95% CI 1,97-5,11, p<0,00001).Conclusion. The risk of AF recurrence within 12 months after RFA in patients with three or more MS components is higher than in patients with 1-2 MS components. An increase in the blood concentration of profibrogenic biomarkers galectin-3, GDF-15 and an increase in the thickness of epicardial adipose tissue is associated with an increased risk of AF recurrence in patients with MS, and these biomarkers are likely to play a significant role in predicting recurrent episodes of AF after RFA.

The review discusses the relevance of the problem of obstructive sleep apnea syndrome in real clinical practice, features of diagnostics and a personalized approach to therapy considering various comorbid conditions, a review of the results of major clinical studies and recommendations. Literature search and selection of clinical studies was carried out for the period from 2000 to 2020 on the websites of the European and Russian Societies of Cardiology, as well as databases PubMed, eLibrary, Google Scholar.

The objective of our study was to determine the reasons for not prescribing anticoagulant therapy (ACT) in the therapeutic department of university clinic for patients with atrial fibrillation (AF) and a high risk of stroke and to discuss the optimal management of these patients.Methods and materials. A retrospective analysis of 1307 case histories of AF patients admitted to a university therapeutic clinic from 2014 to 2018 presented. The reasons for not prescribing ACT to patients with AF and high risk of stroke and optimal ACT discussed.Results. ACT was not prescribed to 109 (9.7 %) hospitalized patients out of 1128 patients with AF without prosthetic valves and mitral stenosis who had a high risk of stroke ((4.5±1.1) points on the CHA2DS2VASc scale). The risk of bleeding – (1.6±0.1) (HAS-BLED). The age of patients was (73.8±10.4) years. From 2014 to 2018, the frequency of unjustified non-prescribing ACT decreased by 3.7 times – from 47/205 (22.9 %) in 2014 to 11/178 (6.2 %) in 2018 (p=0.001). In general, over 5 years of observations, subjective reasons for not prescribing ACT were: lack of stroke risk assessment (78.0 %), senile age of patients and the presence of dementia (42.2 %), the first paroxysm of AF (22.9 %) during myocardial infarction and heart surgery, planned surgical treatment, effective radiofrequency ablation and patient refusal. Objective (usually transient) reasons for not prescribing ACT were: severe and moderate anemia (24.8 %), recent bleeding (11.9 %), gastrointestinal diseases predisposing to bleedings (9.2 %), oncology (12.8 %), end-stage chronic kidney disease (2.8 %), thrombocytopenia (2.8 %). Often various reasons for not prescribing ACT were combined.Conclusion. In patients with AF and a high risk of stroke, the incidence of not prescribing ACT decreased by 3.7 times from 2014 to 2018. In 2014, the most common reasons for not prescribing ACT were the lack of stroke risk assessment and the senile age of patients, and in 2017–2018 senile age, the first paroxysm of AF, effective radiofrequency ablation, anemia, recent bleeding, and gastrointestinal diseases predisposing to bleedings.

Metabolic syndrome is a problem of our time due to its high prevalence (from 20 to 50% in the adult population). The aim of the work was to outline the main stages in the study of the totality of hemodynamic and metabolic disorders that was later designated “metabolic syndrome”, in Russia. The article focuses on the development of the ideas of D.D.Pletnev and G.F.Lang from the beginning of the 20th century to the present at the Department of Faculty Therapy in Petrograd Medical Institute for Women, which was later named the First Leningrad Medical Institute and is now named Federal State Budgetary Educational Institution of Higher Education Academician I.P.Pavlov First St. Petersburg State Medical University under the Ministry of Healthcare of Russian Federation. The article discusses current trends in the study of the metabolic syndrome, including data from epidemiological studies on the prevalence of the metabolic syndrome and its individual components in Russia.Results. The paper presents the results of molecular genetic and instrumental methods for examining patients with abdominal obesity, metabolic syndrome, including those with complications such as atrial fibrillation, coronary heart disease, chronic heart failure with preserved left ventricular fraction. The review presents data on the molecular and other features of subcutaneous and visceral (epicardial) adipose tissue.Conclusion. The paper outlines priority areas for studying the metabolic syndrome in the future, which will be important for preventing the development and progression of this pathological condition.

The objective was to determine the concentrations of biomarkers of fibrosis and inflammation in the blood, parameters characterizing heart remodeling in patients with atrial fibrillation (AF) in combination with type 2 diabetes mellitus (T2DM).Methods and materials. The study included 231 examined patients aged 35 to 65 years: patients with DM (n=99), of which 49 patients with AF, and the comparison group consisted of patients with AF without T2DM (n=54) and healthy examined patients (n=78).Results. It was found that the concentration of profibrogenic biomarkers circulating in the blood of patients with AF and T2DM is higher than in patients with AF without T2DM: galectin-3 (13.4 (9.1–16.9) and 6.8 (4.6–12.8) ng/ml, p<0.001), TGF-beta1 (3032.5 (2468.5–4283.5) and 2339.7 (1813.3–3368.8) pg/ml, p=0.01), GDF-15 (2359.3 (1234.3–3465.1) and 1256.7 (889.9–2083.7) pg/ml, p><0.001), PINP (3625.4 (2462.1–4463.7) and 2451.3 (1842.0–2941.0) pg/ml, p><0.001) and PIIINP (92.8 (68.6–122.4) and 67.6 (47.9–93.3) ng/ml, p><0.001). Concentrations of proinflammatory cytokines CRP (3.5 (2.2–4.4) and 2.7 (1.4–7.1) mg/l, p=0.01) and CT-1 (1032.1 (667.6–1495.3) and 549.1 (411.9–960.1) pg/ml, p><0.001) in patients with AF and T2DM is higher than in patients with T2DM without AF. The levels of TNF-alpha, IL-6 in patients with AF and T2DM are comparable to the concentrations of these biomarkers of inflammation in patients with T2DM without AF. According to the results of echocardiography, it was revealed that the thickness of the epicardial adipose tissue in patients with AF and T2DM is greater than in patients with AF without T2DM and greater than in patients with T2DM without AF (7.1±0.4, 4.5±0.3 and 5.1±0.3, respectively, p><0.001). A strong positive correlation between GDF-15 and HbA1c was established according to the correlation analysis (r=0.617, p><0.0001) and regression analysis (β=0.586, p><0.0001). According to binomial logistic regression, it was found that T2DM in the examined cohort increased the risk of AF by 2.2 times (OR=2.2, 95 %CI 1.41–3.31, p=0.00004). Conclusion. The obtained new data on the increase in the concentration of profibrogenic factors in patients with AF in combination with T2DM indicate an important role of the formation of myocardial fibrosis in the development of this arrhythmia in these patients. Keywords: biomarkers, fibrosis, inflammation, atrial fibrillation, diabetes mellitus>˂0.001), TGF-beta1 (3032.5 (2468.5–4283.5) and 2339.7 (1813.3–3368.8) pg/ml, p=0.01), GDF-15 (2359.3 (1234.3–3465.1) and 1256.7 (889.9–2083.7) pg/ml, p˂0.001), PINP (3625.4 (2462.1–4463.7) and 2451.3 (1842.0–2941.0) pg/ml, p˂0.001) and PIIINP (92.8 (68.6–122.4) and 67.6 (47.9–93.3) ng/ml, p˂0.001). Concentrations of proinflammatory cytokines CRP (3.5 (2.2–4.4) and 2.7 (1.4–7.1) mg/l, p=0.01) and CT-1 (1032.1 (667.6–1495.3) and 549.1 (411.9–960.1) pg/ml, p˂0.001) in patients with AF and T2DM is higher than in patients with T2DM without AF. The levels of TNF-alpha, IL-6 in patients with AF and T2DM are comparable to the concentrations of these biomarkers of inflammation in patients with T2DM without AF. According to the results of echocardiography, it was revealed that the thickness of the epicardial adipose tissue in patients with AF and T2DM is greater than in patients with AF without T2DM and greater than in patients with T2DM without AF (7.1±0.4, 4.5±0.3 and 5.1±0.3, respectively, p˂0.001). A strong positive correlation between GDF-15 and HbA1c was established according to the correlation analysis (r=0.617, p˂0.0001) and regression analysis (β=0.586, p˂0.0001). According to binomial logistic regression, it was found that T2DM in the examined cohort increased the risk of AF by 2.2 times (OR=2.2, 95 %CI 1.41–3.31, p=0.00004).Conclusion. The obtained new data on the increase in the concentration of profibrogenic factors in patients with AF in combination with T2DM indicate an important role of the formation of myocardial fibrosis in the development of this arrhythmia in these patients.

Cardiovascular diseases are widespread and are the leading death cause in most countries, despite the creation and improvement of strategies to reduce cardiovascular risk. A significant role in the development and evolution of cardiovascular diseases belongs to sympathetic nervous system hyperactivity, and therefore the methods of effecting it are relevant for the prevention and treatment of cardiovascular pathology. The article discusses modern approaches to interventional and conservative regulation of the autonomic nervous system and neuromodulation in the prevention and treatment of hypertension, heart failure, tachyarrhythmias, as well as reflects a conjoint expert judgment on these issues.

Objective . To determine the blood concentrations of biomarkers of fibrosis and inflammation in patients with metabolic syndrome (MS), atrial fibrillation (AF) and obstructive sleep apnea (OSA) and to establish their role in the formation of left atrial myocardial fibrosis. Design and methods . A cross-sectional case-control study included 286 patients aged 35 to 65 years: 78 patients with MS(+)/AF(+)/OSA(+), 79 patients with MS(+) / AF(+)/OSA(-), 73 patients with MS(+)/AF(-)/OSA(+) and 56 patients with MS(+)/AF(-)/OSA(-). Patients with AF and MS (n = 71) were assessed for the severity of left atrial myocardial fibrosis with electroanatomical mapping. Results . It was found that the concentration of profibrogenic biomarkers circulating in the blood of patients with MS(+)/AF(+)/OSA(+) is higher than in patients with MS(+)/AF(-)/OSA(+): galectin-3 (13,4 (8,5-17,6) and 8,4 (5,1-11,6) pg/ml, p < 0,0001), growth differentiation factor-15 (GDF-15) (1648,3 (775,32568,1) and 856,0 (622,5-1956,4) pg/ml, p < 0,0001), N-terminal peptide of type III procollagen (PIIINP) (95,6 (78,6-120,4) and 50,6 (38,9-68,3) ng/ml, p < 0,0001), N-terminal peptide of type I procollagen (PINP) (3459,4 (2167,1-4112,1) and 2355,3 (1925,0-3382,1) pg/ml, p < 0,0001). In the examined cohort of patients with OSA, positive correlations were found between galectin-3 and cardiotrophin-1 (r = 0,410, p = 0,00002), galectin-3 and GDF-15 (r = 0,430, p = 0,0003), galectin-3 and PIIINP (r = 0,451, p = 0,0001). Correlation analysis showed a strong positive relationship between the apnea/hypopnea index (AHI) and blood concentrations of GDF-15 (r = 0,661, p < 0,00001), galectin-3 (r = 0,519, p < 0,00001), interleukin 6 (r = 0,310, p = 0,0001) and C-reactive protein (CRP) (r = 0,361, p = 0,002). Negative correlations of the average level of SpO2 with CRP (r = -0,354, p = 0,001), galectin-3 (r = -0,451, p < 0,00001), GDF-15 (r = -0,637, p < 0,00001) were found. In patients with AF and OSA, fibrosis was more severe than in patients with AF without OSA (28,6 (23,6-36,6) and 13,5 (9,9-23,6) %, p = 0,0002). AHI positively correlated with the severity of fibrosis (r = 0,708, p < 0,00001). The patients with AF and OSA showed the strongest positive relationship between the severity of fibrosis and PINP (r = 0,572, p < 0,0001; в = 0,511, p < 0,0001) and galectin-3 (r = 0,449, p = 0,0009; в = 0,807, p < 0,0001). Conclusions . An increase in the concentration of fibrosis biomarkers in the blood is associated with an increase in the severity of left atrial myocardial fibrosis and probably has a pathogenetic role in increasing the risk of AF in patients with MS and OSA.