To assess the incidence, severity, and predictors of functional atrial mitral regurgitation (FAMR) and its impact on outcomes in patients with heart failure with preserved ejection fraction (HFpEF) depending on the presence of atrial fibrillation (AF). Data from 218 patients with HFpEF and FAMR hospitalized between 2020 and 2023 were analyzed retrospectively. The median follow-up period was 589 days. rehospitalization for heart failure (HF), cardiovascular death (CVD), and the composite endpoint (CE). Moderate FAMR was detected in 53.3% of patients with AF, and severe FAMR in 15.3%, which was significantly higher than the incidence in patients with sinus rhythm (SR) (24.5% and 8.0%, respectively, p<0.001). In the subgroup with AF, severe FAMR was associated with a 4.1-fold increased risk of rehospitalization for HF (95% confidence interval (CI): 1.7-10.2, p=0.002) and a 2.6-fold increased risk of CE (95% CI: 1.4-4.9, p=0.002). In patients with SR, no statistically significant association between FAMR and clinical outcomes was found. FAMR in AF is an independent predictor of poor prognosis in patients with HFpEF. This highlights the importance of rhythm control as a pathogenetic strategy for this patient category.
The development of new drugs for cardiovascular diseases based on endogenous peptide hormones is a field of significant interest, driving intensive experimental research. One promising direction is the synthesis of short bioactive peptides that mimic the effects of larger peptide molecules while offering superior physicochemical properties. Recent studies have shown that C-terminal fragments of the peptide apelin mitigate metabolic and functional impairments following cardiac injury. This review summarizes current literature alongside our own experimental findings regarding the effects of apelin-13, [Pyr1]apelin-13, apelin-12, and its chemically modified analogs on the heart during in vitro and in vivo pathophysiological modeling. The therapeutic spectrum of apelin-12 analogs in the damaged myocardium includes reduced cardiomyocyte death, decreased membrane damage, improved myocardial metabolic status, and the suppression of reactive oxygen species and lipid peroxidation products. These findings highlight the potential of molecular construction of apelin receptor (APJ) agonists with enhanced proteolytic resistance and shelf-life stability as a foundation for a new class of cardiovascular drugs.
Aim        To evaluate the dynamic impact of an 8-month glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy with semaglutide on anthropometric metrics, blood lipid profiles, and adipokine status in obese patients, with and without type 2 diabetes mellitus (T2DM).Material and methods    The study included 65 patients with obesity, 26 of whom had T2DM. All participants were prescribed semaglutide, with dose titration up to 1 mg once weekly over 8 months. Before and after the treatment period, the following variables were assessed: anthropometric data (body weight, body weight index, waist circumference), biochemical parameters (lipid profile, glucose, aspartate aminotransferase, alanine aminotransferase, creatinine), and adipokine concentrations (leptin, adiponectin, resistin) via immunofluorescence assay.Results  Semaglutide therapy was associated with a statistically significant reduction in body weight (p<0.001), body mass index (p<0.001), and waist circumference (p<0.001). Improvements in the lipid profile were observed over time, including decreased concentrations of low-density lipoprotein cholesterol (p=0.001), triglycerides (p<0.001), and total cholesterol (p=0.001), alongside an increase in high-density lipoprotein cholesterol (p<0.01). Therapy significantly impacted adipokine status: a statistically significant increase in anti-atherogenic adiponectin (p<0.001) and a decrease in leptin levels (p<0.001) were recorded, indicating improved adipose tissue metabolic function. However, no significant changes in resistin concentrations were found. Additionally, positive effects on liver and kidney function markers were noted, manifested by reductions in aspartate aminotransferase and alanine aminotransferase activity, as well as creatinine levels. In the subgroup of patients with T2DM, a statistically significant improvement in glycemic control was observed.Conclusion         Semaglutide therapy for 8 months in obese patients yielded a robust cardiometabolic impact, characterized by significant weight reduction, optimized lipid profiles, and improved liver and kidney function markers, alongside a favorable restructuring of adipokine status. These results support the use of GLP-1 RAs not only for glycemic and weight control but also as a multifaceted cardioprotective therapy for obese patients.
Aim    To evaluate changes in speech signal parameters during treatment in patients with chronic heart failure (CHF) and to optimize a set of speech parameters that can be used for remote monitoring of patients' condition after treatment.Material and methods    Speech signals of 55 patients with CHF during exacerbation and 38 patients of the same group during remission were analyzed using a proprietary technique. The results were compared with speech signal data of 57 apparently healthy individuals. The following acoustic and prosodic parameters were calculated for the three groups using the Praat v 6.4.35 software: mean, minimum, and maximum values of the fundamental tone frequency, its standard deviation, variation range and mean absolute slope, jitters (local, abs, rap, ppq5, ddp), shimmers (local, apq3, apq5, apq11, dda), harmonic-to-noise ratio, and the ratio of the number of voiced frames to the total number of frames.Results    The study compared three groups: patients before treatment (group 1.1), after treatment (group 1.2), and a control group of apparently healthy individuals (group 2). Analysis of speech signal parameters showed that patients before treatment had significantly different from the control values of several parameters, which reflected the frequency and amplitude instability of the voice. After the course of therapy, the Jitter (local) value was significantly decreased (p=0.012), while in group 1.2, the jitter values did not differ from the values in the control group, indicating the normalization of the frequency stability of the voice signal. The Bowley skew index also was significantly increased (p=0.041) and approached the values of the control group (p=0.068). The Shimmer (dda) and Shimmer (apq3) indexes did not show positive dynamics and maintained significant differences from the control values.Conclusion    The study showed that during treatment of patients with CHF, as their condition improved, jitter significantly decreased while the nonparametric pitch asymmetry coefficient increased and approached the control values. Other speech parameters either did not change significantly or did not approach the values in the control group. This finding can be used for remote monitoring of CHF patients after hospital discharge.
Patients with end-stage renal disease (ESRD) have a very high risk of cardiovascular disease (CVD). Addressing lipid metabolism disorders for both primary and secondary prevention of cardiovascular complications (CVC) is a critical priority for this population. However, patients with ESRD or organ transplants are frequently excluded from major randomized trials. The lack of large-scale evidence-based studies on lipid-lowering therapy and the risk of drug-drug interactions limit the use of intensive lipid-lowering treatment in this patient cohort. Furthermore, international consensus documents have not been updated to reflect the latest evidence. Consequently, target low-density lipoprotein cholesterol (LDL-C) levels are often not achieved following coronary complications, even with combination therapy (statins + ezetimibe).This article presents a clinical case of the successful use of inclisiran in a female patient with ESRD and confirmed multifocal atherosclerosis, both prior to and following a planned kidney transplant.
Aim        Evaluation of clinical, demographic, laboratory, and instrumental characteristics of patients with acute decompensated heart failure (ADHF) depending on the outcome over the hospitalization period.Material and methods    The prevalence of chronic heart failure (CHF) and ADHF remains extremely high. Hospitalization for ADHF is the most important predictor of death and readmission in the long term, and each subsequent hospitalization significantly increases the risk of death. Research of in-hospital mortality in this group of patients is limited in the Russian literature; however, numerous studies have examined mortality at 30, 60, and more days after discharge. This comprehensive retrospective study included patients aged >18 years who were hospitalized for ADHF in a multidisciplinary hospital from December 1, 2019 through December 1, 2021. Patients were divided into two groups based on their outcomes during their hospital stay. Laboratory, clinical, and instrumental characteristics were assessed with subsequent multivariate data analysis. Statistical analysis was performed using an IBM SPSS Statistics version 24.0 software.Results  During the observation period, 498 patients were included. In-hospital mortality was 8% (n=41). According to the results of binary logistic regression, the need for inotropic drugs (odds ratio (OR) 94.6; 95% confidence interval (CI): 19.8-451; p<0.001), presence of an infectious disease requiring antimicrobial therapy (OR 6.6; 95% CI 1.5-29; p=0.01), an increase in high-sensitivity troponin >99th percentile on admission (OR 6.1; 95% CI: 1.35-28.1; p=0.01), and systolic blood pressure <110 mmHg. (OR 4.2; 95% CI 1.06-16.6; p=0.01) were directly associated with the likelihood of death during the hospital stay. The resulting regression model was statistically significant (p<0.001). Based on the value of the Nigelkirk determination coefficient, the compiled model takes into account 71.1% of the factors that determine the likelihood of death during hospital stay. The sensitivity of the model was 98.6%, the specificity was 74.1%, and the diagnostic efficiency was 96.5%.Conclusion         Thirty percent of hospitalized patients with ADHF without signs of acute coronary syndrome or other focal pathology had elevated high-sensitivity troponin levels >99th percentile upon admission, which was directly associated with the in-hospital mortality. These patients represent a special group with a poor prognosis during their hospital stay, and myocardial injury markers have a high predictive value for assessing clinical outcomes in this patient population.
Objective    To evaluate the diagnostic efficacy of exercise stress echocardiography in patients with suspected coronary artery disease (CAD) without typical angina symptoms, and to explore its predictive value for intermediate-term prognosis.Material and methods    A total of 643 patients aged 45-76 yrs (mean age 58.4±9.7 yrs) with suspected CAD but without typical angina symptoms were retrospectively enrolled in this study. All patients underwent treadmill exercise stress echocardiography using the modified Bruce protocol. Left ventricular wall motion was assessed using the 17 segment scoring method, with coronary angiography or coronary computed tomography angiography (CCTA) as the reference standard for evaluating diagnostic efficacy. The median follow-up time was 36.2 mos. The primary endpoint was a major adverse cardiovascular event (MACE) including cardiac death, non-fatal myocardial infarction, elective revascularization based on objective evidence of myocardial ischemia, and hospitalization for unstable angina. ROC curve analysis was used to evaluate diagnostic efficacy, the Kaplan-Meier method for survival analysis, and a Cox proportional hazards regression model to analyze risk factors for occurrence of MACE.Results    Of the 643 patients, 253 (39.3 %) were diagnosed with severe obstructive CAD (stenosis ≥70 %), and 246 (38.3 %) had positive results of exercise stress echocardiography. The sensitivity of exercise stress echocardiography for diagnosing severe obstructive CAD was 76.3 %, specificity was 88.5 %, AUC was 0.824, and diagnostic accuracy was 83.5 %. During follow-up, there were 89 cases (13.8 %) of MACE. The 3 yr MACE-free survival rate was 72.8 % in the positive exercise stress echocardiography group and 94.2 % in the negative group (p<0.001). Multivariate Cox regression analysis showed that positive exercise stress echocardiography immediately post-stress, wall motion score index, N-terminal pro-B-type natriuretic peptide concentration, and age were independent risk factors for MACE (all p<0.01).Conclusion    Exercise stress echocardiography demonstrated good diagnostic accuracy in patients with suspected CAD but without typical angina symptoms. It had significant predictive value for intermediate-term adverse cardiovascular events. Exercise stress echocardiography can be used for risk stratification and clinical decision-making in this population.
Aim        A comprehensive assessment of retinal microcirculation in patients with stable ischemic heart disease (IHD) exhibiting obstructive and non-obstructive coronary artery (CA) lesions.Materials and methods  This observational comparative study included 35 patients with stable IHD, divided into those with CA obstructive lesions (n=25) and those with ischemia with non-obstructive coronary arteries (INOCA) (n=10). A control group consisted of 30 healthy volunteers with no cardiovascular risk factors. The groups were matched for age and body mass index. All participants underwent coronary angiography or CT coronary angiography. Tissue perfusion and the amplitude-frequency spectrum of blood flow fluctuations (endothelial component) were assessed via laser Doppler flowmetry (LDF) of the bulbar conjunctiva, and optical coherence tomography angiography (OCT-A) of the macular region was performed using the SOLIX platform (Optovue, USA).Results  Compared to the control group, patients with INOCA exhibited significantly higher vascular resistance (σ) and coefficient of variation (Kv), indicating more pronounced perfusion fluctuations. Both obstructive IHD and INOCA groups showed reduced endothelial flow amplitudes, a marker of endothelial dysfunction. OCT-A revealed that while macular vessel density remained stable, all IHD patients had increased foveal avascular zone (FAZ) area and perimeter. Specifically, the FAZ area was more significantly enlarged in obstructive IHD, whereas the FAZ perimeter was greater in INOCA (p<0.05). The left eye FAZ perimeter showed moderate diagnostic accuracy in differentiating stable IHD patients from healthy volunteers (AUC=0.632).Conclusion         LDF of the bulbar conjunctiva effectively captures systemic vascular alterations in IHD and differentiates between obstructive and non-obstructive IHD. The integration of LDF and OCT-A provides a promising multimodal approach for the early detection of microvascular impairment, including in IHD patients.
Objective        To develop and validate an early diagnostic prediction model for acute coronary syndrome (ACS) in patients with chest pain; thus providing scientific evidence for clinical decision-making.Material and methods    A retrospective cohort study design was employed, including 480 chest pain patients who presented to the emergency department from January 2020 to January 2025. The patients were randomly divided into a modeling set (336 cases) and a validation set (144 cases) at a 7:3 ratio. Data collected included demographic characteristics, clinical symptoms and signs, medical history, laboratory tests, electrocardiogram, and imaging examinations. Univariate and multivariate logistic regression analyses were used to screen independent predictors and establish the prediction model. Model performance was evaluated through receiver operating characteristic (ROC) curves, Hosmer-Lemeshow test, and Bootstrap resampling, and a simplified risk scoring system was established.Results    Multivariate logistic regression analysis showed that elevated cTnI (OR=17.231), ST-segment changes (OR=8.451), typical chest pain (OR=4.047), age ≥60 years (OR=2.441), smoking history (OR=2.103), sweating (OR=1.931), male sex (OR=1.799), and pain duration >30 min (OR=1.689) were independent predictors of ACS (all p<0.05). The area under the curve (AUC) of the model in the modeling set and vali-dation set were 0.921 (95 %CI: 0.890-0.952) and 0.908 (95 %CI: 0.857-0.959), respectively, with sensitivities of 86.4 % and 82.9 %, and specificities of 89.7 % and 87.4 %, respectively. The Hosmer-Lemeshow test indicated good model calibration (modeling set p=0.609, validation set p=0.776). The established risk scoring system (0-20 points) classified patients into four risk stratifications: low risk (0-4 points, ACS incidence 3.8 %), moderate risk (5-8 points, 23.1 %), high risk (9-12 points, 62.2 %), and very high risk (13-20 points, 91.9 %), with an optimal cutoff value of 8 points (Youden index 0.716).Conclusion    The ACS early diagnostic prediction model established in this study incorporated eight readily accessible clinical variables and demonstrated good discrimination and calibration. The risk scoring system based on this model is simple and practical. This scoring system can effectively perform risk stratification and provide a valuable clinical tool for early diagnosis and risk assessment of chest pain patients.
To evaluate the clinical, functional and prognostic outcomes, including left ventricular (LV) reverse remodeling, of combining percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) in patients with ischemic cardiomyopathy (ICM) and reduced left ventricular ejection fraction (LVEF). ICM with significantly reduced LVEF remains one of the severe forms of chronic heart failure (CHF), associated with a high risk of adverse outcomes. The choice of the optimal treatment strategy, coronary revascularization in addition to intensive medical therapy, is a subject of active discussion and requires further study, especially regarding its effect on LV reverse remodeling and long-term prognosis. This retrospective cohort study included 561 patients with ICM and LVEF <40%. The follow-up lasted from 2014 through 2024. 74% of the patients were men aged 61.4±8.7 years. Patients were divided into a revascularization group (PCI+OMT, n=281) and an OMT group (n=280). The structural and functional state of the heart was assessed using transthoracic echocardiography (ECHO) with standard protocols. The OMT group had a significantly higher EuroSCORE II surgical risk (4.0±1.9% vs. 3.0±1.5% in the PCI+OMT group; p<0.05), a greater prevalence of stage III or higher chronic kidney disease (35.7% vs. 17.8%; p<0.05), and more severe LV dilatation (LV end-diastolic volume 265±54 ml vs. 245±45 ml; p<0.05). The PCI+OMT group presented with significantly higher anatomical lesion complexity compared to the OMT group (SYNTAX Score 33.5±8.8 vs. 28.9±9.7, p<0.05). At the 24-month follow-up, the PCI+OMT group demonstrated a superior improvement in LVEF (+10.7±6.8% vs. +2.1±4.5%, p<0.001). The proportion of patients with severe mitral regurgitation (III+) was lower in the PCI+OMT group (5.3% vs. 16.1%, p<0.001), and overall mortality was 10.7% vs. 23.2% in the OMT group (p<0.001). The CHF-related hospitalization rate was also significantly lower in the PCI+OMT group than in the OMT group (17.8% vs. 33.9%; p<0.001). The combination of PCI and OMT is associated with a pronounced recovery of myocardial contractility, reverse LV remodeling, and regression of functional mitral regurgitation. The structural changes in the myocardium achieved through the integrative approach translate into a significant reduction in overall mortality and hospitalizations rates due to decompensated CHF during mid-term follow-up.
To evaluate the feasibility of stress echocardiography (stress-ECHO) with an extended protocol in the diagnosis of hemodynamically significant coronary artery disease (CAD) and in the differential diagnosis of different phenotypes of chronic coronary syndromes. This observational study enrolled 454 patients (60.79% men, mean age 61.2±9.8 years) with established (n=191; 42.07%) or suspected (n=263; 57.93%) ischemic heart disease (IHD). The stress-ECHO protocol assessed left ventricular (LV) regional wall motion abnormalities (RWMA) (A), B-lines (B), contractile reserve (LVCR) (C), coronary flow reserve (CFR) (D), heart rate (HR) reserve (E), global longitudinal strain (GLS), and diastolic function. Based on multislice computed tomography/coronary angiography with fractional flow reserve (if necessary), patients were categorized into four phenotypes: Group 0, non-obstructive hemodynamically insignificant CAD (conditional normal; n=118; 26.0%); Group 1, non-obstructive hemodynamically significant CAD (microvascular IHD; n=84; 18.5%); Group 2, obstructive hemodynamically insignificant CAD (obstructive coronary atherosclerosis; n=107; 23.6%); and Group 3, obstructive hemodynamically significant CAD (obstructive IHD; n=145; 31.9%). Significance was set at p=0.05. The groups differed significantly in maximum CAD percentage (p<0.0001 for all) and number of CA with ≥50% stenosis (p<0.05 for all). Detection of hemodynamically significant CAD was associated with chest pain, ST segment depression, RWMA, reduced HR reserve, CFR, lower LV stroke volume, diastolic dysfunction, and higher total protocol scores. In multivariate regression analysis, RWMA (chi-square 92.75; p<0.0001) and CFR (chi-square 38.95; p<0.0001; sensitivity 95.2%, specificity 73.9%, diagnostic accuracy 85.4%) were included in the model as predictors of ischemia. The ABCDE stress ECHO protocol did not allow identifying patients with ischemia caused by obstructive lesions of the main coronary arteries among those with hemodynamically significant CA disease. Differentiation of patients based on the severity of coronary artery (macro- or microvascular) damage was only possible by LV GLS ≤17.5% at the peak of the test (AUC 0.66; 95% confidence interval 0.58-0.74; p<0.001). The extended ABCDE stress-ECHO protocol in a modern cohort of individuals with chest pain reliably identifies hemodynamically significant CAD, but fails to differentiate between obstructive and non-obstructive lesions. Differentiation based on the severity of CA damage was only possible using a peak stress LV GLS.
To evaluate the effect of inclisiran therapy on the blood lipid profile 90 days post-injection and to describe the baseline structural and ultrasound characteristics of carotid and femoral plaques in high- and very high-risk patients who failed to achieve low-density lipoprotein cholesterol goals despite ongoing lipid-lowering treatment. This prospective observational single-center study included 22 patients (mean age 50.9±8.6 years, 50% men) with dyslipidemia and atherosclerotic plaques in peripheral arteries narrowing the lumen by 25-49%. Familial hypercholesterolemia was diagnosed in 59% of patients, and statin intolerance in 36%. Duplex scanning of the carotid and femoral arteries was performed. The gray-scale median (GSM) method is currently used for the quantitative assessment of carotid artery (CA) plaque echogenicity. Inclisiran was administered on day 1, day 90, and then every six months. Blood lipid profiles, including low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides, and lipoprotein (a) [Lp(a)], were assessed. At baseline, median concentrations were 3.7 [2.5; 5.4] mmol/l for LDL-C, 5.4 [4.4; 6.8] mmol/l for TC, and 22.0 [5.0; 108.0] mg/dl for Lp(a). Carotid artery evaluation showed a median of 4.0 [2.0; 4.0] plaques, total stenosis of 110% [63.8; 118.8], and a GSM of 38.6 [28.6; 52.4], with a predominance of heterogeneous plaques (59%). Femoral artery assessment revealed a median of 2.0 [2.0; 3.0] plaques, 75% [42.5; 111.3] total stenosis, and a minimum echogenicity of 41.5 [33.4; 57.4] gray-scale units, with 65% heterogeneous plaques. Ninety days post-initiation of inclisiran, LDL-C was reduced by 65% (to 1.3 [1.2; 2.9] mmol/L, p<0.01), TC by 30% (p<0.01), triglycerides by 35%, and Lp(a) by 33%. Inclisiran demonstrated high efficacy in reducing LDL-C levels in patients at high and very high risk of cardiovascular disease who failed to reach targets with standard therapy. The identified plaque characteristics indicate a high risk of atherothrombosis in this cohort. The dynamics of these structural plaque changes will be assessed after completing the one-year follow-up.
Aim        To identify predictors of increased N-terminal pro-brain natriuretic peptide (NT-proBNP) in a population of outpatients at a high risk for chronic heart failure (CHF) using methods based on the clinical decision limit (CDL), reference intervals (RI), and age- and sex-adjusted NT-proBNP ratio.Material and methods    Timely diagnosis and initiation of treatment at the early stages of CHF improve the prognosis of patients. Accordingly, a program for supporting patients at a high-risk of CHF by measuring NT-proBNP was implemented in all federal districts (FDs) of the Russian Federation. The analysis included 11,740 patients at high risk of developing CHF, who had a single NT-proBNP measurement in an outpatient setting. The inclusion criteria were age >18 years, symptoms and signs of CHF and/or abnormalities on electrocardiogram and/or the presence of diseases (arterial hypertension and/or any form of ischemic heart disease). The analysis included determining the proportion of patients with NT-proBNP test results above the CDL (NT-proBNP ≥125 pg/ml) and above the RI (97.5th percentile). For additional assessment, the age- and gender-adjusted NT-proBNP ratio was used. The risk of elevated NT-proBNP was assessed based on CDL, RI, and the NT-proBNP ratio.Results  The median age of patients was 66 [58.0; 73.0] years, 55.8% were >65 years, and 59.3% were women. In 43.5% of patients, the NT-proBNP concentration was less than 125 pg/ml. The risk of achieving CDL was 50% higher among men, associated with the patient's age, and increased by 73% in the 45-54 age group, 2.52 times in the 55-64 age group, and 6.62 times in the >65 years age group compared to the 18-44 age group. Living in a city with a population of less than one million people increased the risk of achieving CDL by 17% compared to living in a city with a population of over a million. NT-proBNP values above the RI were achieved by 22% of patients, with the risk being 69% higher among men and 24% higher among patients living in cities with a population of less than one million. Evaluation of the NT-proBNP test results using the RI criterion showed that 44.3% of patients with normal RI values had NT-proBNP values above the CDL (≥125 pg/ml). The NT-proBNP ratio was the lowest in the Ural Federal District and the highest in the Far Eastern Federal District. The risk of an increased NT-proBNP ratio ≥1 was higher among men by 67% (p<0.001), for residents of small towns by 21% (p<0.001), and for residents of the Far Eastern Federal District compared to any other region (p<0.001).Conclusion         Independent risk factors for elevated NT-proBNP when assessed by the RI and NT-proBNP ratio included male gender, residence in cities with a population of less than one million, and residence in the Far Eastern Federal District. Assessing the NT-proBNP test solely based on the CDL, without taking into account physiological changes related to gender and age, carries a risk of overdiagnosis of CHF.
Objective        This study aimed to investigate the effects of exercise snacking (ES) on body composition, carotid-femoral pulse wave velocity (cfPWV), and serum resistin in male and female obese college students.Material and methods    A total of 50 male and 50 female college students, each with a body mass index (BMI) ≥28 kg / m², were enrolled in the study. The male and female groups were each further divided into an exercise snacking group (ES group, n=25) and a moderate-intensity, continuous training group (MICT group, n=25). The ES group conducted two 5 min high-intensity interval training (HIIT) sessions and one 30 min session of aerobic exercise incorporating HIIT elements daily, while the MICT group performed 45 min of running at the maximal fat-burning intensity each day. All participants were tested for body composition, including body weight (BW), body mass index (BMI), body fat mass (BFM), trunk fat mass (TFM), skeletal muscle mass (SMM), arterial stiffness, and serum resistin concentrations before and after a 12 wk exercise program. Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (cfPWV).Results    After the exercise program, the ES and the MICT groups both had reduced BW, BMI, BFM, and TFM (p<0.01). Only in the ES group, were significant changes observed in SMM, cfPWV, and serum resistin, (p<0.01). Pearson correlation analysis revealed that for obese male students, changes in serum resistin correlated positively with cfPWV (r=0.67, p<0.01) and negatively with the increase in muscle mass (r=-0.68, p<0.01). For obese female students, changes in serum resistin tended to show a positive correlation with TFM, however, no statistically significant difference was observed (r=0.35, p=0.09). There was a positive correlation with cfPWV (r=0.44, p<0.05), and a negative correlation with the increase in muscle mass (r=-0.90, p<0.01).Conclusion    An ES protocol can serve as an effective exercise strategy to help obese college students significantly improve their body composition and cfPWV indicators of arterial stiffness.
Inflammation is an integral part of the pathophysiological processes leading to damage or regeneration of the heart and blood vessels. Interest to the "inflammatory theory" of cardiovascular disease is once again at the peak of scientific research, driven by the discovery of new laboratory and instrumental methods, as well as the emergence of new cardiotropic viruses, including SARS-CoV-2. Colchicine, the most effective and safe drug used to modulate excessive inflammation in heart disease, is included in guidelines for the treatment of perimyocarditis and ischemic heart disease with a high class of evidence. Furthermore, it has been shown that colchicine can reduce the innate and, to some extent, the acquired immune response. Thereby, colchicine can affect the arrhythmia substrate and trigger, the inflammatory component of chronic myocardial degeneration during the development of heart failure. Also, colchicine can exert specific and nonspecific positive effects on the cardiac complications of COVID-19. The use of this medication in cardiology practice is limited by insufficient awareness of its indications and side effects, while in rheumatology practice, it is limited by a lack of knowledge about colchicine's additional properties in cardiac conditions. This review summarizes medical studies available online that assess the clinical efficacy of colchicine medicines in the conditions not yet included in official guidelines for its use, such as atrial fibrillation, autoinflammatory diseases, heart failure, and cardiac complications of COVID-19. For each of these conditions, colchicine can be used with the consideration of specific indications. This article includes published in the internet medical studies, abstracts, and meta-analyses with no publication date restrictions up to July 2025. The PubMed, ScienceDirect, Google Scholar, and CENTRAL databases were used to review 520 literature sources that described the clinical efficacy of colchicine medicines and the heterogeneity of its effects across different regimens for various cardiovascular diseases.
Background    Heart failure (HF) patients with type 2 diabetes mellitus (T2DM) are at high risk of hospital readmission due to cardiovascular events. Glycemic control may play a key role in reducing this risk, but the optimal glycemic control threshold for preventing readmissions remains unclear.Material and methods     This single-center, retrospective cohort study included 160 adult patients with HF and type 2 diabetes mellitus (T2DM). Patients were classified into two groups based on HbA1c measured 3 months after discharge: poor glycemic control (HbA1c ≥ 7.0 %) and good glycemic control (HbA1c < 7.0 %). Data were collected from electronic medical records, and cardiovascular event readmissions were tracked over a one-year follow-up period. Kaplan-Meier event-free survival (EFS) analysis and Cox regression models were used to examine the relationship between the three-month HbA1c and cardiovascular event readmission. A Fine-Gray competing-risk model was additionally applied to provide a more robust estimate of the cumulative incidence of cardiovascular readmission.Results         Among the 160 patients, 56 (35 %) were readmitted due to cardiovascular events, including HF exacerbation (39.3 %), myocardial infarction (25.0 %), arrhythmias (14.3 %), and coronary artery disease (8.9 %). Their median EFS time was 121 days. The readmission rate was significantly higher in patients with poor glycemic control (HbA1c ≥7.0 %), with 58.8 % of the patients being readmitted compared to 17.4 % in the group with good glycemic control (HbA1c <7.0 %, p<0.001). Kaplan-Meier EFS analysis confirmed a significantly shorter EFS in patients with poor glycemic control. Cox regression analysis identified the three-month HbA1c value as an independent predictor of cardiovascular event readmission (HR=3.41, 95 % CI 2.15-5.29, p<0.001), which was consistent with the Fine-Gray competing-risk analysis (sub-distribution HR = 3.12, 95 % CI 1.95-4.98, p<0.001).Conclusion    Early glycemic control, particularly the three-month HbA1c value, is a strong predictor of cardiovascular event readmission in HF patients with DM. Optimizing glycemic control within the first three months post-discharge may significantly reduce readmission risk and improve clinical outcomes.
Background    Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI) in young women, with hormonal factors potentially playing a significant role.Case summary    A 32 year-old woman taking combined oral contraceptives for four months presented with acute chest pain and ST-segment elevation. Coronary angiography revealed diffuse LAD narrowing that improved after intracoronary nitroglycerin. Follow-up optical coherence tomography at 6 weeks confirmed intramural hematoma consistent with SCAD. Conservative management was pursued. At one-year follow-up, the patient had recovered with normalized left ventricular function.Conclusion    Clinicians should be highly suspicious of SCAD in young women with ACS or AMI, particularly those using oral contraceptives. Early identification with appropriate imaging can lead to favorable outcomes.
It has been proven and widely accepted that comprehensive cardiac rehabilitation that underlies secondary prevention reduces morbidity, disability, and mortality from cardiovascular diseases and their complications, improves quality of life, and minimizes economic losses to the healthcare system and the state as a whole. Unfortunately, despite the recognized benefits of cardiac rehabilitation, it remains underutilized or inadequately utilized. In addition to the common barriers to participation in rehabilitation that occur in most countries, the Russian Federation faces a number of limiting factors related to discrepancies between current regulations and clinical guidelines on cardiac rehabilitation, which critically impacts the rehabilitation of cardiac patients. To address this issue, it would be appropriate to separate cardiac rehabilitation from the "medical rehabilitation of patients with somatic diseases." This situation requires cardiologists to create a consensus document on cardiac rehabilitation, which should address organizational issues, routing, a description of cardiac rehabilitation programs with proven effectiveness, and criteria of the rehabilitation effectiveness specific to cardiac patients. Therefore, this should be a document aimed at reducing mortality, complications, disability, and increasing the life expectancy of cardiac patients, which is the primary goal of healthcare.
Aim        To evaluate the efficacy and safety of a new 3D navigation-guided technique for transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and a high risk of atrioventricular (AV) conduction disorder.Material and methods    The study presents the results of a single-center prospective randomized pilot study. Sixty patients meeting inclusion and exclusion criteria with at least one criterion of a high risk for AV conduction disorder were enrolled in the study. All included patients were randomized 1:1 into two groups. In Group 1, TAVI was performed using a 3D navigation-guided technique, while in Group 2, the classical TAVI technique was used. The primary endpoint was the composite incidence of permanent pacemaker (PP) implantation and new-onset complete left bundle branch block (LBBB) at 6 months.Results  In the early postoperative period, the 3D navigation-guided TAVI group had a lower incidence of new-onset LBBB (10.3% vs. 33.3%; p=0.03), better parameters of intraventricular conduction according to electrophysiology study (EPS) (H-V interval 79.1±13.5 ms vs. 96.0±39.9 ms; p=0.03) and electrocardiography (QRS complex duration 108.0±16.3 ms vs. 119.0±22.6 ms; p=0.04). The incidence of PP implantation during the hospital stage, A-H interval duration, and Wenckebach point in the AV junction according to EPS did not differ significantly between the groups. The incidence of the primary endpoint (PP implantation + new-onset LBBB) during the 6-month follow-up period was 43.3% in the classical technique group and 16.7% in the 3D navigation-guided TAVI group (p=0.02). There were no statistically significant differences between the groups in the incidence of procedural complications or major adverse cardiovascular and cerebrovascular outcomes.Conclusion         This study demonstrated the efficacy and safety of a new 3D navigation-guided TAVI technique in reducing the composite rate of implantation PP and LBBB at 6 months post-procedure, with comparable rates of procedural complications and major adverse cardiac and cerebrovascular events (MACCE) during long-term follow-up. Implementation of these findings into clinical practice will enable personalization and optimization of transcatheter treatment outcomes in patients with severe AS.
Aim    To develop of a protein panel to identify patients with progressive chronic heart failure with reduced left ventricular ejection fraction (HFrEF) based on proteomic analysis of blood fractions.Material and methods    The study included 81 patients with HFrEF associated with postinfarction myocardial scarring or dilated cardiomyopathy. Patients were enrolled both in a stable period (n=48) and with signs of decompensated heart failure (n=33). Proteomic chromatography-mass-spectrometric analysis of blood plasma and extracellular vesicles (EVs) was performed in all patients. The analysis identified proteins differentially represented between groups in each blood compartment. The effectiveness of using individual proteins and integrated protein panels based on these proteins to identify patients with progressive HFrEF was assessed.Results    Twelve plasma proteins and one BB fraction protein were detected, the concentration of which significantly differed between the groups with and without decompensated HFrEF. Individual protein concentrations demonstrated approximately the same quality indicators in identifying patients with decompensated HF as the classical HF marker, the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). Accordingly, we developed two integrated panels including the concentrations of NT-proBNP and several plasma or BB fraction proteins. The plasma panel included five proteins (APOE, LPA, C7, GPLD1, and TF), and the BB panel included two proteins (APOC4, FGB); the proteins are designated in accordance with their genes in the UniProt database. The plasma protein panel demonstrated the highest efficiency in identifying patients with decompensated HF, with a sensitivity of 78.8% and a specificity of 87.5%.Conclusion    The study resulted in the development of a plasma protein panel that can identify patients with progressive chronic HFrEF. This panel is more effective than previously described or currently used biomarkers. However, further research is needed to implement this protein panel into clinical practice.