Aim. To evaluate the prognostic role of the extracellular volume (ECV) assessed by cardiac magnetic resonance imaging (MRI) in relation to systolic dysfunction and unfavorable remodeling of the left ventricular (LV) at 24 weeks after myocardial infarction (MI) and revascularization. Materials and methods. The study included 154 patients with primary MI aged 56±8 years. MRI was performed at 7–10 days and after 24 weeks, including assessment of indexed volumes, LV ejection fraction (LVEF), ECV, and patterns of ischemic and reperfusion injury. The study is registered in the international clinical trials registry with the number NCT04347434 (ClinicalTrials.gov). Results. Patients were divided into two groups after 24 weeks: Group 1 (n=24) with LVEF <50%, and Group 2 (n=130) with LVEF ≥50%. At 7–10 days, scar mass in Group 1 was 58.5 (39.5; 69.8) g vs. 17.1 (9.2; 29.7) g in Group 2 (p<0.001); microvascular obstruction was present in 23 cases (95.8%) vs. 55 (42.3%) (p<0.001). After 24 weeks, intergroup differences increased (p<0.05). Global ECV and remote myocardial ECV were significantly higher in patients with LVEF <50% both at 7–10 days and after 24 weeks compared to those with LVEF ≥50% (p<0.05). Infarct zone ECV did not differ between groups. Persistent systolic dysfunction after 24 weeks was predicted by global ECV >38.3% (p<0.001) and remote myocardial ECV >33.6% (p=0.008). Predictors of an increase in end-diastolic volume index >12% after 24 weeks in the subgroup of patients with initial systolic dysfunction were global ECV >42.8% (p=0.017) and remote myocardial ECV >35.6% (p=0.012). Conclusion. Global ECV and remote myocardial ECV measured by MRI in the acute stage of MI are predictors of persistent systolic dysfunction and unfavorable LV remodeling in the medium term.

Background/Objectives: This study aimed to evaluate the prognostic role of the extracellular volume (ECV) assessed by cardiac magnetic resonance imaging (MRI) in relation to systolic dysfunction and unfavorable remodeling of the left ventricular (LV) at 24 weeks after myocardial infarction (MI) and revascularization. Methods: The study included 154 patients aged 56 ± 8 years who had been diagnosed with their first MI. Cardiac MRI was performed at 7–10 days and after 24 weeks, including assessment of indexed volumes, LV ejection fraction (LVEF), ECV, and patterns of ischemic and reperfusion injury. The study is registered in the international clinical trials registry with the number NCT04347434 (ClinicalTrials.gov). Results: Patients were divided into two groups after 24 weeks: group 1 (n = 24) with LVEF < 50% and group 2 (n = 130) with LVEF ≥ 50%. At 7–10 days, the scar mass in group 1 was 58.5 (39.5; 69.8) g vs. 17.1 (9.2; 29.7) g in group 2 (p < 0.001); microvascular obstruction was present in 23 cases (95.8%) vs. 55 (42.3%) (p < 0.001). After 24 weeks, inter-group differences increased (p < 0.05). Global ECV and remote myocardial ECV were significantly higher in patients with LVEF < 50% both at 7–10 days and after 24 weeks compared to those with LVEF ≥ 50% (p < 0.05). Infarct zone ECV did not differ between groups. Systolic dysfunction after 24 weeks was predicted by global ECV > 38.3% (p < 0.001) and remote myocardial ECV > 33.6% (p = 0.008). Predictors of an increase in end-diastolic volume index > 12% after 24 weeks in the subgroup of patients with initial systolic dysfunction were global ECV > 42.8% (p = 0.017) and remote myocardial ECV > 35.6% (p = 0.012). Conclusions: Global ECV and ECV of the remote myocardium, which exceed a certain level established by a cardiac MRI in the acute stage of MI, are among the predictors of LVEF < 50% and unfavorable LV remodeling in the medium term.

Background/Objectives: The aim of this study is to identify markers and develop a multifactorial model for characterizing extensive scar tissue after revascularization in patients with myocardial infarction (MI). Methods: A total of 123 patients with MI were examined. The patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th–10th days from the onset of the disease. At the first stage, we performed a comparative analysis and built a multifactorial model based on the examination results of 92 (75%) patients enrolled from April 2021 to October 2023. These patients formed the group used for model development, or the “modeling group”. The mass of the scar was calculated, including relative to the left ventricular (LV) myocardium mass (Mscar/LVMM, in %). Results: The first subgroup consisted of 36 (39%) patients with a large scar, denoted as “LS” (Mscar/LVMM > 20%). The second subgroup included 56 (61%) patients with a smaller scar, referred to as “SS” (Mscar/LVMM ≤ 20%). Logistic regression was used to identify independent factors affecting scar tissue size. A multifactorial model was created. This model predicts Mscar/LVMM > 20% on MRI. It uses readily available clinical parameters: high-sensitivity troponin I (HscTn I) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and LV relative wall thickness (RWT). We tested the multifactorial model on the “modeling group” (n = 31). The sensitivity was 63.6% and the specificity was 85.7%. Conclusions: These indicates the feasibility of its application in clinical practice.

Aim. To assess the safety and efficacy of a single intravenous bolus of non-immunogenic staphylokinase compared with alteplase in patients with massive pulmonary embolism and hemodynamic instability. Non-immunogenic staphylokinase is a modified recombinant staphylokinase with low immunogenicity, high thrombolytic activity and fibrin selectivity.Material and methods. This multicenter, open-label, randomized, comparative clinical trial FORPE in two parallel groups was conducted in 23 clinical centers in Russia. A total of 310 patients aged 18 years and older with hemodynamic instability and computed tomography pulmonary angiography verified massive pulmonary embolism and right ventricular dysfunction were included. The patients were randomly assigned in either non-immunogenic staphylokinase (15 mg) or alteplase (100 mg) group. Both medicines were administered intravenously. An independent biostatistician created a randomization sequence using computer-generated random numbers. Randomization was performed using the envelopes. The study was open-label, and emergency unit staff, investigators, and patients were informed about the assigned drug. The primary efficacy endpoint was 7-day all-cause death after randomization. The non-inferiority margin was set at 10% for the difference in 7-day all-cause mortality after randomization between the compared groups. Non-inferiority was tested using the Welch t-test for the primary efficacy endpoint. Secondary efficacy endpoints were analyzed in both the intention-to-treat and per-protocol populations.Results. Of 348 patients screened between December 25, 2020, and July 31, 2023, 310 (89%) were included in the study. Of the total number, 155 (50%) patients were randomized to the non-immunogenic staphylokinase group and 155 (50%) to the alteplase group. In the non-immunogenic staphylokinase group, the primary efficacy endpoint, 7-day all-cause death, was 2% in the intent-to-treat population and 2% in the per-protocol population, whereas in the alteplase group it was 3% (odds ratio (OR) 0,75, 95% confidence interval (CI) 0,11-4,49; p=1,00) and 3% (OR 0,75, 95% CI 0,11-4,52; p=1,00), respectively. The difference in the primary efficacy endpoint was 0,6% (95% CI -2,8 to -4,0) in the intent-to-treat population and 0,6% (95% CI -2,9 to -4,2) in the per-protocol population. Thus, the lower limit of the 95% CI did not cross the non-inferiority margin (p<0,001). There were no cases of hemorrhagic stroke in the non-immunogenic staphylokinase group, whereas there were three cases (2%) of hemorrhagic stroke in the alteplase group (p=0,25). Serious adverse events were experienced by 11 patients (7%) in the non-immunogenic staphylokinase group compared with 12 patients (8%) in the alteplase group (p=1,00).Conclusion. Non-immunogenic staphylokinase is at least as effective as alteplase in the treatment of patients with massive pulmonary embolism with hemodynamic instability and has a higher safety profile. Future observational studies of non-immunogenic staphylokinase are needed to continue assessing its safety and efficacy. Given the high safety and efficacy of non-immunogenic staphylokinase, its use should be studied in patients with moderate-to-high risk pulmonary embolism.

Aim. To study the effect of 48-week therapy with atorvastatin and ezetimibe on laboratory parameters, structural and functional arterial characteristics and heart failure markers in the post-infarction period.Material and methods. A total of 87 patients with acute myocardial infarction were included. In the first 24 hours, atorvastatin 80 mg/day was prescribed. During hospitalization, after 5-6, 24, 48 weeks, clinical and paraclinical examinations were performed. In the level of low-density lipoprotein cholesterol (LDL-C) >1,4 mmol/l and the decrease <50% at one of the follow-up visits, ezetimibe 10 mg/day was additionally prescribed.Results. Eighty participants (93%) completed the study. Patients were divided into following groups: group 1 (n=32) — atorvastatin monotherapy; group 2 (n=49) — ezetimibe and atorvastatin therapy. In group 1, LDL-C decreased after 48 weeks by 53% (p<0,001), while in group 2 by 63,2% (p<0,001). According to carotid ultrasound in group 2, a decrease in the intima media thickness after 24 and 48 weeks was revealed by 9,1% (p<0,001) and 10,5% (p<0,001) compared to the baseline value, while in group 1 — by 4,5% only on the 24th week (p=0,012). When analyzing endothelial function, there was an increase in flow-dependent vasodilation only in group 2 from 9,1 (5,6; 11,8)% to 14,3±6,8% after 48 weeks (p<0,001). With the addition of ezetimibe, there was a regression of the N-terminal pro-brain natriuretic peptide after 24 weeks by 69,6% (p=0,005), after 48 weeks — by 72,4% (p=0,009). In group 2, it decreased by 75,5% by the end of follow-up (p=0,010).Conclusion. The results rationale adding ezetimibe to statins in very high-risk patients due to the most pronounced lipid lowering effect, improvement of the structural and functional properties of the common carotid arteries, endothelial function and clinical and laboratory heart failure markers.

Myocardial infarction remains one of the most common causes of chronic heart failure. Modern innovative treatment of patients with high cardiovascular risk is the use of sodium-glucose cotransporter type 2 inhibitors - a class of antidiabetic drugs. This review is devoted to the study of dapagliflozin and empagliflozin effect on the quality of life and prognosis in patients with myocardial infarction and chronic heart failure. Special attention in the review is paid to the analysis of some pleiotropic effects of drugs in clinical studies of patients with various variants of coronary heart disease, as well as in experimental studies on animals. The systematic review was carried out in accordance with the recommendations and reporting provisions for Systematic Reviews and Meta-analyses (PRISMA). The search was conducted in PubMed electronic databases, elibrary.ru without restrictions on the date of publication of publications. The last search was carried out on August 12, 2023.

Background. Despite the global trend towards a decrease in mortality from cardiovascular pathology of atherosclerotic genesis, this group of diseases continues to occupy a leading position in the structure of disability and mortality among the population of many countries. Aim. Identification of noninvasive markers of arterial wall lesions associated with the presence of arterial hypertension (AH) and coronary heart disease (CHD) in persons younger than 55 years. Materials and methods. The study included 81 people. Three groups were distinguished from them: 1st (n=31) – a control group of practically healthy individuals, average age – 43 (40; 48) years; 2nd group (n=21) – patients with coronary heart disease without a history of cardiovascular diseases (CVD), average age – 45,5±6,1; group 3 (n=29) – patients with AH without CHD, average age – 47 (35; 50) years. The parameters of a biochemical blood test were determined, volumetric sphygmography and a sample with post-occlusive reactive hyperemia were performed. Results. In groups of patients with CHD and AH, negative changes in the lipid profile and higher glucose levels were recorded compared to healthy individuals. According to the results of volumetric sphygmography, the pulse wave velocity in arteries of predominantly elastic type (R/L-PWV) in group 1 was 10.1±1.7 m/s, in group 2 – 12.9±1.8 m/s, in group 3 – 13.1 (12; 14) m/s (р1–2=0.029; р1–30.001); cardio-ankle vascular index (CAVI) – 6.5±0.7, 7.7 (7; 8.7) and 7.8 (7.3; 8.4), respectively (р1–20.001; р1–30.001). According to the data of the test with post-occlusive reactive hyperemia, a comparably high frequency of pathological values of flow-dependent vasodilation (FDV) and reactivity index (RI) was demonstrated in patients with CHD and AH (р1–20.05; р1–30.05). A multifactorial model of noninvasive diagnosis of CHD in individuals without a history of CVD, including non-high-density lipoprotein cholesterol, R/L-PWV, and FDV, has been developed. For patients with AH, glucose, lipid metabolism, R/L-PWV, pulse wave velocity in muscle-type arteries (B-PWV), augmentation index (AI), biological age, CAVI, FDV, RI were the risk factors for the presence of the disease in the anamnesis. Conclusion. The results obtained confirm the importance of an integrated approach in the screening diagnosis of CVD.

Aim. To analyze ischemic and reperfusion injury characteristics, as well as myocardial performance, to identify predictors of reduced left ventricular (LV) ejection fraction (EF) <50% 24 weeks after ST-segment elevation myocardial infarction (STEMI) in patients who underwent revascularization.Material and methods. The study included were 65 patients (age 58 (52; 60) years), who were examined on days 7-10 and after 24 weeks. Based on cardiac magnetic resonance imaging (MRI), parameters of ischemic and reperfusion injury were determined. Speckle tracking echocardiography was used to evaluate the myocardial function.Results. All 65 patients completed the study. Based on echocardiography, patients were divided into following groups: 1 — 45 people with LVEF ≥50%, 2 — 20 patients with LVEF <50%. In patients with LVEF ≥50% 24 weeks after STEMI, there was a decrease in the ischemia injury mass by 32,3% (p=0,001) due to regression of the scar mass by 28% (p=0,008) and the peri-infarct heterogeneous zone by 33,3% (p=0,020). In group 2, the indicators did not change. At the repeat visit, there was a decrease in the number of people with microvascular obstruction in the group of LVEF ≥50% from 44 to 16% (p<0,001), while in LVEF <50% — from 65 to 40% (p=0,045). According to echocardiography, global wasted work in group 1 decreased from 77 (50,5; 105,5) to 59 (43; 92) mm Hg% (p=0,042), while in group 2, it increased from 99,5 (59; 181) to 104,5 (58,5; 156,5) mm Hg% (p=0,765). Global work efficiency and global work index prevailed in patients with LVEF ≥50% at two visits (p<0,05). The following predictors of decreased LVEF were determined 24 weeks after STEMI: ischemia injury mass, scar tissue, microvascular obstruction, global contrast index according to MRI; global work efficiency and global work index on echo cardiography.Conclusion. Contrast-enhanced cardiac MRI and speckle tracking echocardiography are complementary methods that allow quantitative morphofunctional assessment of post-infarction cardiosclerosis and predict the development of mildly reduced and reduced LVEF in the medium term.

The problem of ischemia-reperfusion injury, in particular, reperfusion arrhythmias, has remained controversial for many years. To date, there are no one frame of mind on the clinical and prognostic significance of tachyarrhythmias in the acute period of myocardial infarction. In addition, data on the incidence of reperfusion arrhythmias and related mortality are very contradictory. The review summarizes current concepts and results of studies devoted to the study of the clinical role of reperfusion arrhythmias. Their pathogenesis, structure, and impact on the long-term prognosis of patients are discussed. The need to study ischemia-reperfusion injury within the pharmacoinvasive strategy using modern thrombolytic agents is emphasized, which seems especially relevant given the Russian geographical features.

Background. To study the dynamics of blood pressure (BP), lipid profile and arterial stiffness after 12 weeks of polypill therapy, including perindopril, indapamide and rosuvastatin. Materials and methods. 40 patients with arterial hypertension (AH) and dyslipidemia who underwent COVID-19 were included. 35 persons (87.5%) completed the follow-up period. All patients had their office blood pressure measured using the Korotkov method. A biochemical blood test was performed to determine total cholesterol, highdensity lipoproteins (HDL), triglycerides (TG). The level of low-density lipoprotein cholesterol (LDL) was calculated. With the applanation tonometry, systolic (SDao), diastolic (DDao) and pulse (PDao) pressure in the aorta, carotid-femoral pulse wave velocity (PWVcf) were recorded. Results. Against the background of polypill therapy, a decrease in systolic blood pressure by 18% and diastolic blood pressure by 17% was noted for 12 weeks. The target BP (<140 and 90 mmHg) were achieved in 30 patients (85.7%) after 4 weeks of treatment, and in 34 patients (97.1%) after 12 weeks. There was also a decrease in OS by 39.6%, TG – by 27.7%, LDL cholesterol – by 51.2%. The target levels of LDL cholesterol were reached by 23 patients (65.7%). According to the data of applanation tonometry, a significant decrease in the indicators of central hemodynamics was recorded: SDao – by 17,5%, DDao – by 12,9%, PDao – by 17,6%, as well as a decrease in PWVcf by 10,1%. Conclusions. Taking polypill therapy for 12 weeks demonstrated a significant improvement in the parameters of the lipid profile, a decrease in office and central blood pressure.

Aim. To study the diagnostic value of myocardial function parameters to assess their predictive ability in relation to left ventricular (LV) global contractility in patients after myocardial infarction (MI).Material and methods. The final analysis included 97 patients with MI aged 55,9±8,6 years. We performed standard two-dimensional echocardiography and speckle tracking echocardiography with analysis of following myocardial function parameters: global work index (GlobalWI, mm Hg %); global constructive work (GlobalCW, mm Hg %); global wasted work (GlobalWW, mm Hg %); global work efficiency (GlobalWE). The probability of ejection fraction (EF) reduction was analyzed using ROC curves using three criteria. The function parameters with the maximum sum of sensitivity and specificity were selected as the cut-off point.Results. On days 7-9 after MI, depending on the EF, patients were divided into 3 groups: "REF" — patients with EF <40%); "MREF" — with EF from 40 to 49%, and "PEF" — patients with EF ³50%. By the 24th week, GlobalWI increased by 23% in the PEF group and by 33% in the MREF group. In the REF group, there was a gradual decrease in GlobalWI until the end of the study. In the PEF group, GlobalCW increased by 21% by week 24. By the end of follow-up, an increase in GlobalWW of 15% was observed in the REF group. GlobalWI, GlobalCW and GlobalWW were found to have the highest sensitivity values (60%) for reduced EF, ranging from 4049% at 24 weeks from the index event. GlobalWW had the highest specificity value (80%). With regard to a decrease in EF <40% by week 24, the GlobalWW had the highest sensitivity (50%) and specificity (70%).Conclusion. Parameters of myocardial function have diagnostic and prognostic value for assessing LV systolic function after MI. Already in the acute period, myocardial function parameters can be used to determine the risk of decreased LV global contractility.

The purpose of the study was to identify factors characterizing a decrease in LV global systolic function in patients with ST-segment elevation myocardial infarction (STEMI) after revascularization using cardiac magnetic resonance imaging (MRI)-based ischemic injury pattern and laboratory parameters sensu left ventricular global systolic function. A total of 109 STEMI patients were examined. The patients underwent contrast-enhanced cardiac MRI with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th–10th days from the onset of the disease. According to cardiac MRI analysis, the patients were divided into the following groups with regard to left ventricular ejection fraction (LVEF) values: Group 1—patients with LVEF ≥ 50%; group 2—patients with mildly reduced LVEF 40–49%; group 3—patients with low LVEF < 40%. A predominance of most parameters of the ischemic injury pattern was noted in patients with mildly reduced and low LVEF versus patient group with LVEF ≥ 50%. Some risk factors for a decrease in LVEF < 50% systolic function in STEMI patients after revascularization were revealed: male gender; time from the onset of the anginal attack to revascularization; coronary artery status; several LV parameters; ischemic injury characteristics; natriuretic peptide and troponin I levels.

Aim. To study the lipid-lowering and pleiotropic effects of statin monotherapy and combination with ezetimibe in patients in the postinfarction period, depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) for 24 weeks. Materials and methods. 114 patients with myocardial infarction were included. Treatment was started with statin monotherapy, with insufficient efficacy, ezetimibe was added. After 24 weeks, the 1st group included 38 people, the 2nd – 76 patients. On 7–10th days and 24 weeks later, the lipid profile, the N-terminal fragment of the precursor of the cerebral natriuretic peptide (NT-proBNP) were determined, speckle-tracking echocardiography, ultrasound examination of the carotid arteries (CA) with RF technology were performed. Results. At week 24, the patients were divided depending on the achievement/non-achievement of the LDL cholesterol target. The highly effective therapy group (HET) included 52 patients, the insufficiently effective therapy group (IET) consisted of 62 people. The ratio of the chances of achieving LDL cholesterol with the addition of ezetimibe to a statin was 3.4 [1.8; 6.6] (p0.001). In the HET group, by the 24th week, NT-proBNP decreased by 59.6% (p=0.045); in the IET group – by 52.2% (p=0.042). According to echocardiography data, after 24 weeks in the HET group, an increase in global constructive work GCW by 9.1% (p=0.036) and the global work index GWI by 8.2% (p=0.041) was revealed without dynamics of indicators in the comparison group. In the study of the CA, the thickness of the intima-media complex in the HET and IET groups regressed by 9.5% and 6.8% respectively (p0.05). Only in the HET group did the common CA stiffness indicators improve. Conclusion. The achievement of LDL cholesterol control on the background of combined lipid-lowering therapy in patients in the postinfarction period is characterized by the most pronounced organoprotective effect.