Aim. To investigate the association of testosterone levels (TES) and oxidative stress activity with 10-year survival in men with cardiac resynchronization therapy (CRT).Methods. 86 men with CRT (59.0±9.8 years; 66.3% ischemic cardiomyopathy) were divided into 4 groups: Gr.1 (n=19) TESmedian level; Gr.3 (n=23) TES> medians + MPO < median level; Gr.4 (n=26) TES > median level + MPO > median level. Echocardiography parameters, incidence of ventricular extrasystole, TES in plasma, estradiol, progesterone, dehydroepiandrosterone sulfate, norepinephrine, MPO, NT-proBNP, matrix metalloproteinase, tissue inhibitor of metalloproteinase were assessed. Prognostic level of NT-proBNP was assessed by ROC analysis; 10-year survival was measured by Kaplan-Meier method, factors associated with it were evaluated using Cox regression.Results. The majority of patients were NYHA II and NYHA III for Gr. 3 and Gr.4 respectively (р3-4=0,010). At baseline: there was no difference in echocardiography parameters, levels of NT-proBNP, MPO, steroids, matrix metalloproteinase between groups; tissue inhibitor of metalloproteinase was higher in Gr.2 and Gr.4; the highest norepinephrine levels was in Gr.4. Follow-up: reverse cardiac remodeling was associated with NT-proBNP decreasing and was registered in Gr.4 and Gr. 3. The level of MPO was decreased in Gr.3, Gr.4., and was the highest in Gr.4. The level of estradiol was increased in Gr.1; There were no difference in hormone levels in Gr.2. TES, dehydroepiandrosterone sulfate was increased, but progesterone was decreased in Gr.3 and in Gr.4. The norepinephrine`s levels were increased in all groups. The number of ventricular extrastimuli was increased in Gr.4. Predictive level of NT-proBNP was 756.0 pg/ml (AUC=0.685; p=0.003; sensitivity: 64%, specificity: 68%). The 10-year survival rate was 15.4%; 33.5%; 76.3%; 24.4% for Gr. 1-4 respectively (Log Rank test: Gr.1-2=0.378; Gr.1-3<0.001; Gr.1-4=0.070; Gr.2-3=0.009; Gr.2-4=0.772; Gr.3-4=0.010). The survivance was higher in patients with the best CRT response time (p=0.004), the level of NT-proBNP>756.0 pg/ml (p=0.001) in Gr.1, Gr.2; the best CRT response time (p=0.001), left ventricular ejection fraction (p=0.046), MPO>median (p=0.041), amiodarone administration (0.008) in Gr. 3, Gr. 4.Conclusion. CRT modulates steroidogenesis. Increase of TES and dehydroepiandrosterone sulfate with lower oxidative stress activity is associated with greater reverse cardiac remodeling and better 10-year survival rate. The higher level of TES and simultaneously MPO more than 32.5 pg/ml were related to less reverse cardiac remodeling, higher rate of amiodarone administration by 5.2 times, increasment of ventricular arrhythmias rate and higher relative risk of death by 4.2 times. Relationship between 10-year survival rate and period of best CRT response indicates less physiological nature of forceful modulating effects of CRT.

Aim. To study the diagnostic value of the left atrial stiffness index (LASI) of heart failure with preserved ejection fraction (HFpEF) depending assessed by transthoracic echocardiography (TTE) in the diagnosis on diastolic stress test (DST) results.Material and methods. DST was performed in cases of insufficient criteria for increased left ventricular filling pressure assessed by TTE. One hundred patients were examined (52,0% men, 66,1±5,4 years). Patients with a ratio of early transmitral flow velocity to early diastolic mitral annulus velocity (E/e') ratio >15 in DST were included in group I (n=45), patients with E/e' <15 — group II (n=55). The speckle tracking echocardiography was used to assess left atrial reservoir strain (LASr).Results. Significant differences were identified between the groups in sex (40,0% of men in group I and 61,8% in group II, respectively; p=0,044), body mass index (32,9 [29,5;36,0] and 29,6 [27,3;31,8] kg/m2; p=0,001), hypertension stage (2,9±0,3 and 2,5±0,8, p=0,037), the presence of coronary artery disease (88,9 and 67,3%; p=0,016), NYHA heart failure class (2,0±0,4 and 1,5±0,7; p=0,003). TTE re­vealed significant differences in the left atrium volume index (31,9 [28,5;36,0] and 27,8 [24,1;34,6] ml/m2; p=0,039), E/e' ratio (10,9 [9,7;12,5] and 9,3 [7,4;10,8]; p<0,001), LASr (23,5 [19,3;28,3] and 28,9 [25,6;32,2]%, p<0,001) and LASI (0,46 [0,38;0,56] and 0,30 [0,25;0,39]; p<0,001). According to ROC analysis, the largest area under the curve (AUC), optimal sensitivity and specificity in HFpEF diagnosis were observed in LASI (AUC=0,829, p<0,001; 77,8 and 74,5%, respectively). Lower classification quality was shown by the H2FPEF score (AUC=0,701, p=0,001; 66,7 and 69,1%), while the HFA-PEFF score was not significant in the pretest detection of HFpEF (AUC=0,608, p=0,065; 53,3 and 61,8%).Conclusion. LASI with a cut-off point >0,38 has the greatest ability to detect HFpEF among the possible pretest diagnostic methods.

HighlightsAdherence to CPAP therapy in patients with severe obstructive sleep apnea and cardiovascular diseases can be predicted using a model that includes the desaturation index and anxiety. Aim. To evaluate the results of CPAP therapy (Continuous Positive Airway Pressure) in cardiac patients with severe obstructive sleep apnea (OSA) and to identify factors predicting adherence to CPAP therapy using prospective follow-up data.Methods. The study included 52 patients with severe OSA (82.7% men, 55.6 ± 8.8 years) examined in 2019–2022, the data was collected from the registry of cardiac patients with OSA (n = 138). Arterial hypertension was diagnosed in 96.1% of patients, coronary artery disease (CAD) was diagnosed in 42.3% of patients, chronic heart failure was diagnosed in 86.5% of patients. Clinical and laboratory parameters, data from OSA screening scales, overnight pulse oximetry, diagnostic scales of anxiety, depression, quality of life and cognitive function were assessed before the start of CPAP therapy and 12.3 ± 7.0 months after its start. 8 patients adequately used CPAP therapy (group with CPAP) and 44 patients either refused to use it or used it inadequately (group without CPAP).Results. When comparing the groups at baseline, there were no differences in age, gender, body mass index and clinical characteristics. Predictors of adherence to CPAP therapy were a higher desaturation index (odds ratio (OR) 1.264, 95% confidence interval (CI) 1.017–1.569, p = 0.034) and manifestations of anxiety (OR 1.056, 95% CI 1.01–1.115, p = 0.049). The sensitivity of the model was 85.7%, specificity was 78%, and area under the ROC curve was 0.843 (95% CI 0.712–0.974, p = 0.004). There were no new cases of CAD in the group with CPAP, in the group without CPAP, 5 new cases of CAD developed during follow-up.Conclusion. Adherence to CPAP therapy in patients with severe OSA and cardiovascular disease can be predicted with high sensitivity and specificity using the model that includes the desaturation index and anxiety. Supposedly, CPAP therapy is relevant for secondary prevention of coronary artery disease.

Background. Despite the high prevalence of iron deficiency (ID) in heart failure with preserved ejection fraction (HFpEF), relationship between iron status indicators with the presence of the disease and parameters of diastolic function and myocardial strain have been insufficiently studied.Aim: To evaluate association of iron status indicators with the disease and parameters of diastolic function and myocardial strain in HFpEF patients.Material and Methods. According to diastolic stress test (DST) 67 patients with EF > 50% (65.8 ± 5.5 years) were divided into 2 groups: Gr.1 with HFpEF (n = 41), Gr.2 without HFpEF (n = 26). Parameters of diastolic function, left atrial reservoir strain (LASr), global longitudinal strain (GLS), diastolic reserve as per DST, serum iron (Fe), ferritin, iron transferrin saturation coefficient (ITSC) , hemoglobin (Hb), N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), creatinine, estimated glomerular filtration rate (eGFR) were assessed. Spearman method was used to study the relationships between iron status indicators and parameters of diastolic function, LASr, GLS; the cut-off point for ITSC was found by ROC analysis; factors associated with HFpEF were assessed via regression analysis.Results. In group 1, FCII (NYHA) was revealed more frequent with trends to greater prevalence in women, obesity, higher values of peak E, NT-proBNP, CRP > 3.0 mg/ml, lower values of E/e΄, LASr, Hb, ITSC. As per DST, differences between groups in all variables related elevation left ventricular filling pressure were registered; supreme load and heart rate were lowest in Gr1. Anemia was detected in 6 (9%) patients: 5 (12.2%) vs 1 (3.8%), respectively, p = 0.238; Iron deficiency in 27(40.3%): 18 (43.9%) vs 9 (34.6%), p = 0.157. Correlations were defined between Fe and ITSC with supreme load with DST and diastolic function parameters, but not with LASr and GLS. New cut-off point for ITSC = 29.2% (AUC = 0.699, p = 0.009; sensitivity = 71%, specificity = 69%) associated with HFpEF risk (OR 5.029 95% CI 1.575–16.055; p = 0.006) was revealed.Conclusion: Regardless of HFpEF, ID prevailed in patients aged over 60 years old, which determined the necessity of its screening study for the purpose of timely correction. Association between ITSC reduction less than 29.2% and the disease presence was found: risk of having HFpEF concurrently increased by five times. Interactions were registered between Fe and ITSC with supreme load and diastolic function parameters, but not with LASr and GLS. Higher incidence of CRP > 3.0 mg/ml with HFpEF confirmed pro-inflammatory status of the disease.

Введение. Фибрилляция предсердий (ФП) – прогностически неблагоприятная аритмия, ассоциирующаяся с пятикратным увеличением риска тромбоэмболических осложнений, источником которых является тромб ушка левого предсердия (УЛП). Цель исследования: изучить роль полиморфизма генов тромбофилии у пациентов с неклапанной ФП и тромбозом УЛП. Материалы и методы. В проспективное исследование включены 86 пациентов с неклапанной ФП (53 мужчины и 33 женщины, средний возраст 58,35 ± 9,34 лет): 60 пациентов с тромбозом УЛП (основная группа), 26 пациентов – без тромбоза УЛП (контрольная группа). Всем пациентам выполнялись лабораторные методы исследования с определением параметров коагуляционного и тромбоцитарного звеньев гемостаза и молекулярно-генетическое тестирование: FII 20210 G > A, FV 1691 G > A, FVII 10976 G > A, F13 G > T, FGB 455 G > A, ITGA2 807 C > T, ITGB3 1565 Т > С, PAI‑1–675 5G > 4G. Результаты. У пациентов с наличием тромбоза УЛП в сравнении с контрольной группой отмечена более частая встречаемость генов тромбоцитарного звена гемостаза – полиморфизма 807 T гена ITGA2 (51,7% и 23,1%; р = 0,014) и 1565 С гена ITGB3 (23,3% и 3,8%; р = 0,032). Не выявлено значимых различий по показателям агрегометрии между группами в зависимости от наличия мутантных аллелей ITGA2 и ITGB3. Сочетание мутантных аллелей обоих генов интегринов является прогностически неблагоприятной комбинацией для развития тромбоза и ассоциируется с увеличенным индексом объема левого предсердия (47,5 ± 13,3 мл/м2) в отличие от изолированного присутствия мутаций одного из интегринов — ITGA2 или ITGB3 (37,3 ± 9,5 мл/м2), либо полного отсутствия данных мутаций (36,1 ± 10,7 мл/м2). Заключение. У пациентов с ФП и тромбозом УЛП значимо чаще встречается неблагоприятная комбинация носительства мутантных аллелей генов ITGA2 и ITGВ3, ассоциирующаяся с выраженностью структурного ремоделирования левого предсердия и не связанная с агрегационной активностью тромбоцитов. troduction. Atrial fibrillation (AF) is cardiac arrhythmia with an unfavorable prognosis. AF is associated with a 5-fold increase in the risk of thromboembolic complications due to a thrombus in the left atrial appendage (LAA). Aim: to study the role of thrombophilia gene polymorphisms in patients with non-valvular AF and LAA thrombosis. Materials and Methods. The prospective study included 86 patients with non-valvular AF (53 men and 33 women with a mean age of 58.35 ± 9.34 years). Among them, 60 patients had LAA thrombosis (main group), while the remaining 26 patients had no such thrombosis (control group). All patients underwent laboratory testing to evaluate coagulation and platelet hemostasis parameters, as well as molecular genetic testing: FII 20210 G > A, FV 1691 G > A, FVII 10976 G > A, F13 G > T, FGB 455 G > A, ITGA2 807 C > T, ITGB3 1565 T > C, PAI‑1–675 5G > 4G. Results. Platelet hemostasis genes were observed more frequently in patients with LAA thrombosis compared with the control group. Specifically, 807T polymorphism of the ITGA2 gene (51.7% and 23.1%; p = 0.014) and 1565 C of the ITGB3 gene (23.3% and 3.8%; p = 0.032) were noted. There were no significant differences in aggregometry between the groups depending on the presence of mutant alleles of ITGA2 and ITGB3. The combination of mutant alleles of both integrin genes is prognostically unfavorable for thrombosis development and is associated with an increased left atrial volume index (47.5 ± 13.3 mL/m2) in contrast to the presence of mutations in only one of the integrins – ITGA2 or ITGB3 (37.3 ± 9.5 mL/m2), or the absence of these mutations (36.1 ± 10.7 mL/m2). Conclusion. In patients with AF and LAA thrombosis, a statistically significant increase in frequency was found in carriers of mutant alleles of the ITGA2 and ITGВ3 genes. This unfavorable combination was associated with the severity of left atrium structural remodeling but not associated with platelet aggregation activity.

BACKGROUND: In patients who successfully survived the 1st year after myocardial infarction, the risk of death remains elevated. AIM: To determine laboratory and instrumental parameters of myocardial remodeling associated with a lethal outcome in the long-term follow-up period in patients 1 year after myocardial infarction. MATERIAL AND METHODS: The study included 184 patients 12 months after myocardial infarction: the first group — living patients at the 5-year follow-up point (n=160), the second group — deceased patients at the 5-year follow-up point (n=24). A comparative analysis of inflammation and myocardial dysfunction biomarkers, as well as echocardiographic parameters reflecting the types of left ventricular remodeling, linear dimensions of the cavities and wall thickness of the heart, chamber volumes, and ventricular systolic function was retrospectively performed. After assessing the distribution of quantitative data, the Student's t-test or Mann–Whitney U-test and the χ2 criterion for categorical data were used. The model was built on the basis of logistic regression. The ROC curve, the Hosmer–Lemeshow test, and the bootstrap method were used to assess the model itself and its reliability. RESULTS: Patients in the second group were older (p=0.007), and more often had myocardial infarction with ST-segment elevation during hospitalization (p 0.001). Twelve months after myocardial infarction, a multidirectional pattern of changes in the level of N-terminal brain natriuretic propeptide was revealed: a decrease was registered in the first group, while an increase was registered in the second group. In the dynamics of the second group, the index of end-diastolic volume (p=0.014) and the size of left ventricular asynergy were higher (p=0.043), and the ejection fraction was lower (p=0.015) than in the first group. The model for predicting 4-year mortality in patients who survived myocardial infarction during the 1st year included such parameters as the index of the left ventricular end-diastolic volume, the content of the N-terminal fragment of the natriuretic peptide and the presence of concentric hypertrophy of the left ventricle. CONCLUSION: In patients who survived 1 year after myocardial infarction, the long-term risk of death is associated with a set of parameters reflecting left ventricular remodeling and the development of heart failure.

Introduction. There is still no understanding of whether the clinical characteristics of COVID-19 (including the recovery period) in health care professionals may differ from the general population. It is logical to assume that a higher viral load of SARS-CoV-2 in health care professionals may lead to worse clinical outcomes, especially in the presence of comorbid cardiovascular pathology. The study aims to scientifically substantiate and develop criteria for assessing the long-term cardinal consequences of COVID-19 in health care workers who are at high biological risk in the performance of their work duties, as well as to evaluate the effectiveness of their treatment. Materials and methods. Of the 350 patients included in the "Prospective Registry of persons with pneumonia associated with COVID-19, 45 of the 67 medical workers suffered from arterial hypertension (AH). The control group consisted of 90 patients with arterial hypertension, comparable to group 1 in age, gender, body mass index, work experience and severity of hypertension. The researchers assessed clinical, laboratory and instrumental parameters in the groups during the hospital period for pneumonia caused by COVID-19 and 3 months after discharge. Symptoms of anxiety, depression (GAD7, PHQ 9 scales), stress (perceived stress scale-10) and quality of life (according to the SF-36 questionnaire) were assessed. Results. In the hospital period, with comparable severity of pneumonia in the groups, duration of hospitalization, stay in intensive care units and intensive care units, genetically engineered biological drugs were more often used in the group of medical workers. 3 months after discharge, the body mass index in both groups corresponded to grade 1 obesity. There were no intergroup differences in the frequency of prescribing groups of drugs. The average values of total cholesterol, low-density lipid cholesterol, very low-density lipid cholesterol, glycated hemoglobin and highly sensitive C-reactive protein were higher than normal in both groups. The left ventricular ejection fraction (LVEF) in both groups corresponded to the norm, however, the group of medical workers was distinguished by higher indicators of systolic and diastolic LV function. A decrease in global longitudinal deformation of the left ventricle was registered in 20.0% of medical workers and in 23.9% of patients in the control group (p=0.798). Symptoms of anxiety on the GAD7 scale were significantly more common in the group of medical workers. Limitation. This study was limited by the duration of follow-up (3 months after COVID-19 pneumonia) and the sample size. Conclusion. Thus, the main criteria for assessing the cardinal consequences of COVID-19 (post-COVID-19 syndrome) health care workers include: high prevalence of arterial hypertension (67.2% of the total number of health care workers); elevated levels of total cholesterol, low-density lipid cholesterol, very low-density lipid cholesterol; presence of subclinical disorders of LV function (high frequency of reduction of LV global longitudinal strain — up to 20.0% of the total number of observations); excess glycated hemoglobin levels; increased levels of highly sensitive C-reactive protein and high average values of the ratio of neutrophils to lymphocytes (NLR) associated with an increase in the number of lymphocytes and a decrease in the number of neutrophils in the long term after COVID-19 pneumonia. In the group of health care workers, there was significantly more frequent detection of anxiety symptoms on the GAD7 scale, which, in our opinion, contributes to an increase in the severity of the course of the cardiac consequences of COVID-19. Ethics. The study was carried out in compliance with medical research protocol from the Committee on Biomedical Ethics of the Tyumen Cardiology Research Center (protocol No. 159 of July 23, 2020).

:The hypothesis of the study was the assumption that the serum levels of soluble ST2 (sST2) and growth differentiation factor (GDF-15) can be predictors of atrial fibrillation (AF) recurrence in long-term period after primary radiofrequency catheter ablation (RFA). Of the 165 patients included in the prospective follow-up, the final analysis included 131 patients whose follow-up duration reached 18 months after the end of the blanking period (3 months after RFA). The median age of patients was 59.0 (50.0; 64.0) years, and 80 (61

Aim: To test the previously developed predictive model on a test set, including patients with non-valvular atrial fibrillation (AF). Material and Methods. A predictive model was previously developed on a training set of 638 patients with non-valvular AF. The test set included 175 randomly selected patients with non-valvular AF hospitalized at the Tyumen Cardiology Research Center for radiofrequency ablation (RFA) or electrical cardioversion in 2018-2021. The quality of the predictive model was assessed using ROC analysis. Results. Arterial hypertension, coronary heart disease, congestive chronic heart failure, and persistent AF were more common in patients of both sets with left atrial appendage (LAA) thrombosis. Patients of the training and test sets with LAA thrombus had more pronounced structural changes in the heart cavities and similar changes in the geometry of the heart: normal left ventricle (LV) geometry was less common and eccentric LV hypertrophy was more common. According to the results of a previous retrospective analysis of the data, independent predictors of LAA thrombosis were persistent type of AF, left atrium size, and eccentric LV hypertrophy. Based on the data gathered, a predictive model LAA thrombosis was developed as an equation that includes 3 variables. The cut-off point for calculating the probability of LAA thrombosis is 0.07. Applying this model on a test set showed the good quality of the model: the area under the curve obtained using ROC analysis was 0.750 ( p < 0.001). At the same time, the sensitivity and specificity of this model for the detection of LAA thrombosis were 72.3% and 71%, respectively. Conclusion. The evaluation of the quality of the LAA thrombosis predictive model developed on the training set confirmed its good quality on a similar test set of patients with non-valvular AF hospitalized for RFA or electrical cardioversion.

Aim. To develop a method for predicting the area of low-voltage area (LVA) in the left atrium (LA), associated with the minimum and maximum expected effectiveness of primary radiofrequency ablation (RFA) in patients with non-valvular atrial fibrillation (AF) using non-invasive predictors. Methods. A longitudinal single-center study included 150 symptomatic non-valvular AF pts aged 20-72 years (median 59.0 [51.0; 64.0]), including 63 women (42%) hospitalized for primary RFA; 119 pts (79.3%) had paroxysmal and 31 (20.7%) - persistent AF. All pts initially underwent general clinical examination, transesophageal and advanced transthoracic echocardiography, estimation of NT-proBNP (pg/ml) and growth differentiation factor 15 (GDF-15, pg/ml) in the blood. Electroanatomical mapping was performed in sinus rhythm before RFA. The area of LVA (<0.5 mV) was calculated as percentage of total LA area. Left ventricular (LV) ejection fraction (LVEF) was >50% in all pts. Results. LVA area varied from 0 to 95.3%, median was 13.7% [5.1; 30.9]. Depending on LVA area, pts were divided into 3 groups: 36 pts (<5%) in gr. 1; 74 pts (5-30%) in gr. 2; 40 pts (>30%) in gr. 3. Increase of LVA area was associated with age, presence, and severity of congestive heart failure (CHF), persistent AF, CHA 2 DS 2 -VASc score ≥3 points, increase of LA volume, LV hypertrophy and increase of NT-proBNP and GDF-15 levels. In univariate analysis, LVA area <5% was associated with NT-proBNP level <125 pg/ml, absence of obesity and CHF, lower LA volume index (<28 ml/ m 2 ). Independent predictors of LVA <5% were: NT-proBNP <125 pg/ml, absence of obesity and LA volume index ≤28 ml/ m 2 . The model was of good quality, C-statistics was 0.775 (p<0.001). In univariate analysis, LVA area >30 % was associated with age >60 years, NT-proBNP >125 pg/ml, GDF-15 >840 pg/ml, persistent AF, presence of LV hypertrophy, LVEF ≤60%, LA volume index ≥ 32 ml/m 2 . Independent predictors of LVA >30% were: LA volume index ≥32 ml/m 2 , GDF-15 >840 pg/ml, and LVEF ≤60%. The model was of good quality, C-statistics was 0.752 (p<0.001). Conclusion. Evaluation of noninvasive parameters, including clinical characteristics, echocardiographic parameters, and blood levels of NT-proBNP and GDF-15, allows prediction of electroanatomical substrate in left atrium in pts with non-valvular AF referred to primary RFA.

Aim To identify predictors of decreased left ventricular global longitudinal strain (LV GLS) using the method of speckle-tracking in gray scale one year after COVID-19-associated pneumonia in patients without ischemic heart disease (IHD), previous pulmonary embolism (PE), peripheral thrombosis, and atrial fibrillation (AF). Material and methods The study included 156 patients from the Prospective Registry of People After COVID-19-Associated Pneumonia, with optimal visualization quality according to echocardiography (EchoCG), without IHD, AF, history of pulmonary embolism (PE), and peripheral thrombosis. The patients underwent clinical examination in the hospital during the acute period and at 3 and 12 months after discharge from the hospital. To identify earlier predictors of LV GLS impairment, clinical, laboratory, and instrumental data obtained in the hospital and at 3 months of discharge were compared based on the presence of LV GLS impairment one year after discharge (43 patients with reduced LV GLS and 113 patients with normal LV GLS). An LV GLS value ≥18% was considered reduced. Results At 3 months after discharge from the hospital, LV GLS impairment was detected in 34 (21.8%) of 156 patients, and 12 months later, in 43 (27.6%; p=0.211) of 156 patients. In contrast to the group with normal LV GLS, the majority of the group with reduced LV GLS were men (74.4% vs. 37.2%; p=0.001). In this group, body mass index (BMI) was significantly higher (29.9±4.3 kg/m2 vs. 28.1±4.5 kg/m2; p=0.011), and biological (11.6% vs. 2.7%; p=0.024) and hormonal therapy was administered more frequently (38.1% vs. 22.3%; p=0.049). The final predictive model for LV GLS impairment included male gender (odds ratio (OR), 5.65; 95% confidence interval (CI), 1.22-14.37; p <0.001), BMI (OR, 1.11; 95% CI, 1.01-1.23; p=0.040), left ventricular end-systolic volume index (LVESVI) (OR, 1.10; 95% CI, 1.01-1.22; p=0.046) and right ventricular outflow tract (RVOT) acceleration time (OR, 0.98; 95% CI, 0.95-0.99; p=0.027). Conclusion One year after COVID-19-associated pneumonia, a decrease in LV GLS was observed in 27.6% of patients without IHD, AF, history of PE, and peripheral thrombosis and was associated with male gender, increased BMI and LVESVI, and shortened RVOT acceleration time as measured 3 months after discharge from the hospital. The decrease in LV GLS one year after discharge was not associated with the severity of the disease, length of stay in the hospital, or biological and hormonal therapy.

Background. Studying the impact of complicated course of new coronavirus infection on the cardiovascular system in the long term after patient discharge from hospital is of high significance. Purpose. To compare the clinical and echocardiographic parameters of persons with history of verified COVID-19 pneumonia one year after discharge from hospital depending on the value of left ventricular (LV) global longitudinal strain (GLS). Material and Methods. A total of 116 patients (50.4% men) aged 49.0 ± 14.4 years (from 19 to 84 years) with history of verified COVID-19 pneumonia were examined one year ± three weeks after discharge. The parameters of left ventricular global and segmental longitudinal strain were studied in 80 patients with optimal quality of echocardiographic visualization. Patients were divided into groups depending on the LV GLS value: group 1 included 35 patients with normal LV GLS (<–20%); group 2 comprised 45 patients with impaired LV GLS (≥–20%). The groups did not differ in age ( p = 0.145), severity of lung injury during hospitalization ( p = 0.691), duration of hospitalization ( p = 0.626), and frequency of stay in the intensive care unit ( p = 0.420). Results. Abnormal values of LV GLS one year after discharge were found in 57.5% of patients with optimal visualization quality while the LV ejection fraction (EF) was normal in all patients. The majority of patients in group 2 were men (71.1% vs 28.6%, p < 0.001). A combination of coronary artery disease (CAD) and hypertension (AH) was more often diagnosed in this group (22% vs 6%, p = 0.040). The values of LV EF did not differ between the groups. The values of LV GLS were significantly worse in patients of group 2 (–17.6 ± 1.9% vs –21.8 ± 1.2%, p < 0.001). Moreover, the parameters of diastolic function including the left atrial emptying volume index (1.3 ± 0.3 mL/m2 vs 1.4 ± 0.3 mL/m2, р = 0.052) and velocity of the lateral part of the mitral valve fibrous ring e’ (10.8 ± 4 .4 cm/s vs 12.8 ± 4.0 cm/s, p = 0.045) were also lower in this group. Conclusions. The LV GLS was impaired in 57.5% patients with normal LV EF one year after COVID-19 pneumonia. In the group with impaired LV GLS, men predominated; coronary artery disease was more often detected in combination with AH; and parameters of LV diastolic function were worse compared with the corresponding parameters in the group of patients with normal LV GLS.

Introduction. Studies show that coronary atherosclerosis and coronary artery disease in the Arctic and Subarctic regions have their own characteristics and need to be further studied. Aim. To conduct a comparative prospective analysis of clinical, laboratory, echocardiographic and coronary angiography data in middle-aged residents of the Arctic regions compared with residents of the south of Tyumen region. Material and methods. From the Coronary Angiography Registry we selected 229 patients of mean age 45-59 years who underwent coronary angiography more than once between 2000 and 2021. The average interval between the 1st and 2nd survey points was 9.0±3.4 years. Patients who underwent coronary angiography to verify the diagnosis, patients with stable coronary artery disease and old myocardial infarction were included. Individuals with acute coronary syndrome were not included. Patients were divided into 2 groups: 85 residents of Tyumen and the south of Tyumen region and 144 residents of the Yamal-Nenets Autonomous Okrug. Differences between groups and dynamics of the studied parameters were assessed using the application package IBM SPSS Statistics 21. Results and discussion. The groups were comparable in demographic characteristics. Initially, cardiovascular status was more severe in Yamal-Nenets Autonomous Okrug group of patients: more severe (II and III) functional classes of exertional angina and a history of myocardial infarction, hemodynamically significant coronary lesions, including coronary artery occlusion, were more common. In Yamal-Nenets Autonomous Okrug group, the level of high-density lipoprotein cholesterol was initially lower. During the follow-up period, obesity and echo-signs of post-infarction changes were detected in patients of Yamal-Nenets Autonomous Okrug more often, higher asynergy index and triglyceride levels were recorded. Intergroup differences in the incidence of myocardial infarction and occlusive lesions and high-density lipoprotein cholesterol levels persisted. Conclusion. During 9-year follow-up, middle-aged patients who underwent elective coronary angiography and lived in the Arctic zone had more severe baseline indicators of cardiovascular status, as well as their more significant negative dynamics compared to patients lived in the south of Tyumen region.

Цель. Изучить динамику сердечно-сосудистой патологии, параметров продольной деформации и диастолической функции левого желудочка (LV GLS) через 3 и 12 мес после пневмонии COVID-19.

Purpose: To study the prevalence of cardiovascular diseases and the correlations of left ventricle global longitudinal strain (LV GLS) in patients 3 months after proven COVID-19 pneumonia. Material and methods. 369 patients with proven COVID-19 pneumonia underwent a comprehensive clinical examination and echocardiography (EchoCG) after 3 months ± 3 weeks after their discharge from the hospital. Mean age of the patients was 54 [46; 61]; 50.9% of them were women. LV GLS was studied in 284 (77%) of patients with optimal visualization quality during echocardiography. LV GLS was considered reduced in the limit of > –18%. Study Registration: ClinicalTrials.gov ID: NCT04501822. Results. 3 months after discharge, obesity was noted in 46.5% of patients, cardiovascular diseases were diagnosed in 73.4%, including de novo in 8.4%. Arterial hypertension occurred in 71.5% of patients, coronary artery disease — in 22.5%. The average left ventricle (LV) ejection fraction was 67.8 ± 5.0%, the average LV GLS was –19.5 ± 2.3%. LV GLS was reduced in 24.4% of the patients. LV GLS showed no correlation with the patient age, NYHA functional class and LV ejection fraction. Reduced LV GLS was independently associated with male sex (OR 1.399; 95% CI 1.239–1.580; p < 0.001), obesity (OR 1.268; 95% CI 1.132–1.421; p < 0.0001), diabetes mellitus (OR 1.204; 95 % CI 1.017–1.425; p = 0.031) and hypertension (OR 1.120; 95% CI 1.002–1.252; p = 0.046). LV GLS showed moderate positive correlations with echocardiographic parameters of right ventricle (RV): the length (r = 0.346), diastolic (r = 0.333) and systolic area (r = 0.326), width at the basal (r = 0.358) and midlevel (r = 0.321), as well as with the dimension of the proximal RV outfl ow tract (r = 0.302, all p < 0.001). LV GLS showed a weak correlation with the severity of lung lesions during hospitalization (r = 0.184; p = 0.002). Conclusions. 3 months after COVID-19 pneumonia, cardiovascular diseases were diagnosed in 73.4%. Reduced LV GLS was observed in 24.4% of survivors and was associated with male sex, obesity, diabetes mellitus, arterial hypertension and linear and planimetric RV dimensions.

Aim. To study the changes of biventricular contractile function depending on the types of left ventricular involvement according to the speckle tracking echocardiography (STE).Material and methods. Of the 380 patients from the Prospective Registry of People Survived COVID-19 Pneumonia, the study included 85 patients, which can be followed-up — 3 months (visit 1) and 12 months (visit 2) after COVID-19 pneumonia (men — 68,2%; mean age — 50,6±10,9 years).At visit 2, patients with diffuse left ventricle (LV) involvement according to STE (visual involvement of ≥4 segments of the same LV level) comprised group I (n=27), patients with regional LV involvement (≥3 segments corresponding to anterior, circumflex or right coronary arteries) — group II (n=39), patients without visual LV involvement — group III (n=19).Results. The groups were comparable in main clinical, functional and echocardiographic (conventional) parameters 3 and 12 months after COVID-19 pneumonia, with the exception of sex and body mass index. STE in group I showed a significant decrease in global longitudinal strain (GLS) (-18,0±2,0% at visit 1 and -16,9±1,4% at visit 2, p=0,025) and LS of all LV levels; in group II — an increase in right ventricular free wall strain (RV FWS) (-22,8±3,2% and -24,0±2,6%, respectively, p=0,006); in group III — an increase in GLS (-19,3±2,3% and -21,2±1,9%, p=0,005), LS of basal and medium LV levels, RV FWS (-23,3±2,9% and -25,0±3,0%, p=0,033). In group I, a significant increase in affected LV segments was revealed (7,0 [5,0;9,0] and 9,0 [7,0;10,0], p=0,010), while in group III there was a decrease in their number (5,0 [3,0;6,0] and 10,0 [1,0;2,0], p<0,001). According to logistic regression, LV basal LS at visit 1 (odds ratio 0,420; 95% confidence interval 0,273-0,644; p<0,001) had an independent association with diffuse LV involvement at visit 2. When it decreases, <15,8% sensitivity and the specificity of this model in predicting diffuse LV involvement was 74,1% and 74,1%, respectively (AUC=0,807; p<0,001).Conclusion. Patients with diffuse LV involvement according to STE are characterized by suppression of global biventricular contractile function during 1-year follow-up.

Introduction.Climatic conditions of the Far North are a factor in the early development and progression of coronary artery disease. Aim. To study the clinical-anamnestic and laboratory-instrumental characteristics of patients with coronary artery disease living in the Far North and the temperate climate zone. Material and methods. An observational analytical study of 302 patients with coronary artery disease admitted to the hospital for coronary angiography was performed. Group 1 (n=168) included patients living in the Yamalo-Nenets Autonomous Okrug, group 2 (n=134) included patients living in the temperate climate zone. The clinical status of patients, drug therapy, laboratory data, and coronary angiography results were assessed. Student’s t-test, Mann-Whitney U-test, χ2 test or Fisher’s exact test were used when comparing indicators between the groups.. Results and discussion. In group 1, despite the younger age of patients, a history of myocardial infarction and chronic heart failure with a low left ventricular ejection fraction were more often recorded, which may be due to the so-called “polar tension syndrome”, which triggers pathological mechanisms of remodeling of the cardiovascular system. In elderly patients in group 2, hypertensive crises were more often recorded, and systolic blood pressure was higher and did not reach the target values. There were no differences in the nature of the lesion of the coronary bed. In both groups, a high incidence of hyperlipidemia was established and elevated levels of homocysteine, matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1, which are markers of atherosclerotic plaque instability and rapid progression of atherosclerosis, were registered. There were no differences in adherence to statin therapy, but the average dose of atorvastatin in group 2 was 2 times lower than in group 1. Group 1 patients were more adherent to taking antiplatelet agents, mainly due to middle-aged patients. Conclusion. In patients with coronary artery disease living in the Far North, despite their younger age, myocardial infarction and severe heart failure were more often found. All patients had a high incidence of hyperlipidemia and elevated levels of immune inflammation biomarkers. Regional differences in prescribed therapy and in the formation of patients’ adherence to treatment were revealed.

Background and Aims : To study dynamics of biomarkers of inflammatory response and to estimate their association with parameters of ventricular systolic function in arterial hypertension (AH) and coronary artery disease (CAD) patients with and without metabolic disorders (MD) such as obesity and impaired carbohydrate metabolism of those who underwent COVID-19-associated pneumonia.Methods: The study included 264 patients (56.97±8.48 years). Gr.1 (n=116) involved AH and CAD patients without MD, gr.2 (n=148) AH and CAD patients with MD. Age, volume of lung damage were comparable. Baseline parameters of complete blood count, biochemistry were assessed on the day of hospitalization. In-depth analysis of biomarkers and echocardiography with speckle tracking were performed 3 months after.Results: Initially in both groups, statistically significant exaggeration of the normal range of maximum CRP; NLR; PLR; ESR were registered. Dynamics of CRP, NLR, PLR, ESR reached normative values in both groups after 3 months, however, hs-CRP was 4.75±2.09 and 7.06±3.13 mg/l with exaggeration of value in gr.2 (p<0.001). Global myocardial strain parameters were significantly more apparent in gr.2. In both groups, parameters of the strain were positively correlated with parameters of RBC, HGB, HCT, creatinine, APTT. Additionally, relationship with LYM was revealed in gr.1, positive relationship with CRP, TG, GFR, and negative with HDL-C was found in gr.1.Conclusions: In group of patient with AH, CAD and MD after COVID-19, more significant alteration was detected in global myocardial strain associated with changed parameters of hematological and inflammatory biomarkers, correction of which can lead to optimization of contractile ventricular function. Background and Aims : To study dynamics of biomarkers of inflammatory response and to estimate their association with parameters of ventricular systolic function in arterial hypertension (AH) and coronary artery disease (CAD) patients with and without metabolic disorders (MD) such as obesity and impaired carbohydrate metabolism of those who underwent COVID-19-associated pneumonia. Methods: The study included 264 patients (56.97±8.48 years). Gr.1 (n=116) involved AH and CAD patients without MD, gr.2 (n=148) AH and CAD patients with MD. Age, volume of lung damage were comparable. Baseline parameters of complete blood count, biochemistry were assessed on the day of hospitalization. In-depth analysis of biomarkers and echocardiography with speckle tracking were performed 3 months after. Results: Initially in both groups, statistically significant exaggeration of the normal range of maximum CRP; NLR; PLR; ESR were registered. Dynamics of CRP, NLR, PLR, ESR reached normative values in both groups after 3 months, however, hs-CRP was 4.75±2.09 and 7.06±3.13 mg/l with exaggeration of value in gr.2 (p<0.001). Global myocardial strain parameters were significantly more apparent in gr.2. In both groups, parameters of the strain were positively correlated with parameters of RBC, HGB, HCT, creatinine, APTT. Additionally, relationship with LYM was revealed in gr.1, positive relationship with CRP, TG, GFR, and negative with HDL-C was found in gr.1. Conclusions: In group of patient with AH, CAD and MD after COVID-19, more significant alteration was detected in global myocardial strain associated with changed parameters of hematological and inflammatory biomarkers, correction of which can lead to optimization of contractile ventricular function.

Aim. To study the role of fibroblast growth factor 23 (FGF-23) as a predictor of left atrial appendage (LAA) thrombosis in patients (pts) with non-valvular atrial fibrillation (AF) and different risk levels of thromboembolic complications (TEC) according to the CHA 2 DS 2 -VASc score. Methods. The study included 250 pts with non-valvular AF hospitalized for radiofrequency ablation, divided into 2 groups: group (gr.) 1 - with 0-1 points (n=79) and gr.2 - with ≥2 points on the CHA2DS2-VASc scale (n=171). According to the results of transesophageal echocardiography, pts of each group were divided into subgroups depending on the presence of LAA thrombosis, which was found in 19 pts of gr.1 and 72 of gr.2. Patients underwent transthoracic echocardiography, determination of blood biomarkers: NT-proBNP (pg/ml), GDF-15 (pg/ml), FGF-23 (pmol/l), highly sensitive C-reactive protein (mg/l), cystatin C (mg/l). Results. Pts with LAA thrombosis in both groups had in common: a longer history of arterial hypertension, a greater proportion of coronary artery disease and persistent AF, lower GFR, higher values of atrial volume indices, left ventricle myocardial mass, systolic pressure in the pulmonary artery, median NT-proBNP, FGF-23 and GDF-15. Logistic regression analysis performed separately in the groups revealed the same independent predictors of LAA thrombosis in both groups: LA volume index (LAVI) and the level of FGF-23 in the blood. At the same time, the threshold value of FGF-23, separating pts by the presence of LAA thrombosis, was higher in gr.1 (≥0.85 and ≥0.5 pmol/l, respectively), and the area under the AUC curve for FGF-23 in gr.1 was greater: 0.964 vs 0.865 in gr.2 (p=0.026). Conclusion. The serum level of FGF-23, along with the LAVI, is an independent predictor of LAA thrombosis in pts with AF and various risk of TEC according to CHA 2 DS 2 -VASc; the threshold level of FGF-23 for pts at low risk of TEC is significantly higher than for high risk pts, and allows more accurate prediction of the presence of LAA thrombosis.

The study of the characteristics and dynamics of laboratory biomarkers in patients with cardiovascular diseases (CVD) undergoing COVID-19-associated pneumonia may be of great clinical importance. The study included 116 patients who underwent COVID-19-associated pneumonia. The patients were divided into 2 groups. The first group included 49 patients without CVD, the second group - 67 patients with CVD. A blood sample was performed in all patients at the time of hospitalization and 3 months after discharge from the hospital. The parameters of general blood count, biochemistry, hemostasis, and biomarkers of inflammation were assessed - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine and IL-6. All patients initially underwent computed tomography of the chest organs. We found that ESR, WBC (leukocytes), NLR (neutrophils/lymphocytes ratio), fibrinogen, LDH (lactate dehydrogenase), LYM/CRP ratio (lymphocytes/CRP) were parameters that significantly distinguished patients in the 1st and 2nd groups. Three months after discharge from the hospital in patients of both groups the increased indicators approached the reference values, however, some parameters such as CRP, ESR, WBC, fibrinogen remained at a higher level in group 2 compared to group 1. Correlation analysis revealed the relationship between parameters of inflammation and hemostasis in the 2nd group of patients, which confirms the presence of latent vascular inflammatory potential in this group. It was revealed that such indicators as lymphocytes, neutrophils, APTT and LDH were associated with the initial volume of lung lesion more than 50%. Increase of these parameters by 1 unit contributes to increase in the volume of lung tissue damage by 6.5%, 6.4%, 11%, and 0.6%, respectively. Thus, dynamic control of laboratory parameters has prognostic value in assessing the nature of the course of COVID-19 associated pneumonia in patients with CVD and developing an algorithm for personalized monitoring of patients in the post-COVID period with the aim of timely correction of therapy to prevent unwanted vascular complications.