Aim. Cryoballoon ablation (CBA) is one of the methods for catheter pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF). Left atrial additional lesion (LAAL) to PVI were proposed to eliminate extrapulmonary AF triggers. Nonetheless whether the additional lesions improve CBA effectiveness is not clear. Methods. Primary CBA procedures performed for paroxysmal AF during 2017-2021 were analyzed. The study group (Algorithm group, n=82) was recruited prospectively in 2019-2021. As the first step CBA PVI were performed in all pts. In those who were on sinus rhythm (SR) after the PVI, AF induction attempts with burst atrial pacing were performed. Pts with induced AF and those who stayed on AF after PVI underwent LAAL at the left ganglionated plexus area. In case of stable SR (non-inducible AF) the procedure finished. If AF was inducible or did not terminate during CBA, the second LAAL set were performed - LA posterior wall lesions. If AF was still inducible or did not terminate, the SR was restored by electrical cardioversion. The control group (Control group, n=94) was formed retrospectively from patients with routinely performed only CBA PVI with achievement of isolation criteria in 2017-2019. If AF continued, sinus rhythm was restored by cardioversion. There were no attempts of induction AF during the procedure. Results. The Algorithm and Control groups were comparable in terms of clinical, demographic and electrophysiological characteristics. At 12 months postoperatively, the effectiveness was higher in the Algorithm group than in the Control group (78.0% vs. 62.8%, p = 0.044). No adverse effects were found. Conclusion. Thus, the stepwise approach with LAAL increases the effectiveness of CBA in the long-term period and does not affect the risk of complications.

Thrombin is a key regulator of the homeostasis system. Also, it actively participates in progression of various systemic diseases, including atherosclerosis. There is a large amount of experimental and clinical data on the involvement of thrombin in the pathogenesis of ischemic heart disease (IHD). Thus, studying thrombin activity regulation is promising. Also, the question whether it is possible to use biomarkers of thrombin activity as predictors of cardiovascular complications in IHD patients is relevant. The present review focuses on major mechanisms of thrombin functioning, its role in development and progression of atherosclerosis, and available tests for evaluation of thrombin functional activity. Major clinical studies are discussed that evaluated the efficacy of thrombin inhibitors and protease-activated receptor antagonists.

Цель. Выявление электрокардиографических (ЭКГ) признаков стенотического поражения ствола левой коронарной артерии (СЛКА) при нагрузочном тестировании пациентов с хронической ишемической болезнью сердца (ИБС) с множественным поражением коронарных артерий.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

Цель. Оценка взаимосвязи тяжести течения COVID-19 у пациентов без исходной сердечно-сосудистой патологии с различными эхокардиографическими параметрами дисфункции миокарда обоих желудочков.

Objective: to assess results from the Stroke Network created on the basis of the Infarction Network in the metropolis Moscow for endovascular treatment in patients with occlusion of the large cerebral artery (the internal carotid artery, the M1 and M2 segments of the middle cerebral artery, and the main artery).Patients and methods. A total of 742 thromboextractions were performed in patients with ischemic stroke in Moscow Stroke Network hospitals in 2019. The final analysis included 729 patients aged 25 to 97 years (mean age, 71 years); of them there were 370 (50.8%) men and 359 (49.2%) women. The selection criteria for endovascular treatment for ischemic stroke were consistent with those set out in the 2015 American Heart Association/American Stroke Association (AHA/ASA) guidelines, which included a pre-stroke modified Rankin Scale (MRS) score of 0–1; ≥18 years of age; a National Institutes of Health Stroke Scale (NIHSS) score of ≥6; and an Alberta Stroke Programme Early CT score (ASPECTS) ≥6. The angiographic results were assessed using the Thrombolysis in Cerebral Infarction (TICI) scale. The clinical outcomes were measured with the NIHSS and the MRS.Results and discussion. Successful recanalization (TICI 2b/3) was achieved in 547 (75%) patients. The predominant technique for thromboextraction was thromboaspiration that was used in 376 (51.6%) patients. Combined procedures (the co-use of an aspiration catheter and a stent retriever) were the second most commonly used – in 231 (31.7%) patients. By the end of the 20th day, good functional recovery (MSR 0–2 scores) was observed in 213 (29.2%) patients. The 20-day mortality rate was 31.8%.Conclusion. The successfully functioning Infarction Network in Moscow was used to create the Stroke Network for treatment in patients with ischemic stroke and large cerebral artery occlusion, the clinical results of which are comparable to large European registry studies.

Несмотря на то, что 13–15% пациентов поступают в стационар позднее 48 ч от начала симптомов острого инфаркта миокарда с подъемом сегмента ST (ОИМпST), оптимальная тактика лечения в этих случаях до сих пор неясна.

Aim. Coronary artery calcification is a characteristic of coronary atherosclerosis, which is often detected by chest computed tomography (CT). The aim of this study is to assess the efficiency of low-dose chest CT in calcium score (CS) determining and to compare it with conventional method and results of CT and selective coronary angiography.Material and methods. A total of 251 patients underwent a low-dose chest CT and a CS determining. Coincidence between the two methods was evaluated by the absolute CS values and by stratification of patients into five risk categories (“zero” CS values were excluded from the analysis). Eighty patients underwent CT or selective coronary angiography and the results were divided into two groups according to the degree of coronary stenosis — ˂50% and ≥50%. The CS values determined by chest CT are compared with the results of coronary angiography. Results. In 79 patients (31%), the CS was 0 and they were excluded from further analysis. The absolute CS values comparability between the two scanning methods in other 172 patients was very high (r=0,978, p<0,05). The coincidence in stratification of patients by risk groups was also high (contingency coefficient k=0,846). The CS specificity compared with coronary angiography was 97,5%, but with a low sensitivity of 43,6%, if the CS value is set to 400, above which coronary stenosis will considered significant. In comparing CS values with results of CT, the relationship of high CS values with coronary stenosis, were statistically proved: in 17 patients from 18 with CS >400 significant coronary stenosis was detected, in comparison with 22 patients from 52 patients with a CS more than 400 (p<0,05). Conclusion. The research showed that low-dose chest CT can be used to determine CS. Studied values correlate with the results of coronary angiography.

Aim. To assess the processes of clot formation in relation to endogenic fibrinolysis in patients with various types of acute coronary syndrome (ACS).Material and methods. To the study, 89 persons (40 males) included: 59 with ACS, 30 — control group. Among the ACS patients, 28 were ST-elevation (STEMI), 31 with non-ST-elevation ACS (NSTEACS). All participants were assessed for clotting formation parameters and thrombus lysis with rotational elastometry on ROTEM equipment (Germany) and “Hemacore” Thrombodynamics (Russia), before coronary arteriography.Results. Clot density and its size in 10 minutes were significantly higher in ACS comparing to control patients (2867 units vs 25084 units, p<0,001; 41,8 mm vs 36,4 mm, p<0,05, respectively). The time from onset of thrombus lysis was lower in ACS (79,4 min vs 69,3 min, p<0,05). The percent of lysis by the end of process registration was lower in ACS (20,1% vs 23,1%, p<0,05). Amplitude of clot formation in 20 minutes from the onset of clotting, as the maximum density of clot were significantly higher in NSTEACS comparing to STEMI (56,2 mm vs 49,7 mm, p=0,018; 59 mm vs 53,2 mm, p=0,011; respectively). Thrombus lysis was slower in NSTEACS patients comparing to STEMI (62,26 min vs 45,5 min, p=0,02).Conclusion. With the measurement in vitro, the process of clotting and thrombus lysis is more active in ACS patients comparing to controls, that point on a baseline activated hemostasis. Within the ACS group, higher the existing clot in vessel lumen, more active the shift of the balance to anticoagulation and fibrinolysis.

Coronary artery embolism (CAE) takes an important place among non-atherosclerotic causes of acute myocardial infarction (AMI). The features of embolic AMI are difficulties in diagnostics and absence of evidence-based guidelines for the management of CAE. Purpose of this review - to present synthesis of available data on embolic AMI. We also report here three cases demonstrating new approaches to treatment of CAE.

Atherosclerosis underlies the development of many cardiovascular diseases that continue to hold a leading place among the causes of death in developed countries. The role of activated immune cells in atherosclerosis progression has been convincingly demonstrated, but the mechanism of their action remains poorly investigated. Since atherosclerosis is associated with chronic inflammatory response, involvement of viral and bacterial infections in atherogenesis has been examined. A special place among the infectious agents is held by human herpesviruses as the most common persistent viruses in human population coupled to chronic inflammation during atherosclerosis. We found that activation of cytomegalovirus (CMV, human herpesvirus 5) infection is associated with the emergence of acute coronary syndrome, which is in a good agreement with the data on productive CMV infection published elsewhere. In this review, we discuss the data obtained by us and other researchers regarding the role of cytomegalovirus infection and related potential mechanisms resulting in the expansion of atherosclerotic plaques during ischemic heart disease and stroke, including virus transfer to immune and endothelial cells via extracellular vesicles. In particular, the data presented in the review demonstrate that virus spreading in the vascular wall triggers immune system activation in atherosclerotic plaques and causes endothelial dysfunction. Moreover, productive CMV infection in patients with acute myocardial infarction correlates with the extent of endothelial dysfunction. The mechanisms described by us and other researchers may explain the role of CMV infection in atherosclerosis and development of ischemic heart disease.

Данная статья знакомит читателя с обновленными рекомендациями европейского общества кардиологов по острому инфаркту миокарда с подъемом сегмента ST. Обсуждаются изменения в рекомендациях, касающиеся реваскуляризации миокарда и медикаментозной терапии. Статья будет полезна практикующим кардиологам, терапевтам и врачам интервенционных методов диагностики и лечения.