Over the past decades, lipid-lowering therapy, which is essentially limited today to the prescription of statins, has become extremely popular in cardiology for the primary and secondary prevention of cardiovascular diseases of atherosclerotic nature. Prescription of statins to cardiac patients is a mandatory element of comprehensive treatment. However, one must admit that treatment with statins is characterized by many unresolved problems: the feasibility of primary prevention with statins has not been proven in particular in young people; no data regarding the true frequency of side effects were obtained especially for the long-term follow-up; the principles of control during treatment were not identified; the target levels of low-density lipoprotein cholesterol (LDL-C) that physician should strive to achieve are also questionable; and most importantly, the question of the true effectiveness of lipid-lowering therapy itself remains open since there are no clear signs of causal associations between serum cholesterol levels and cardiovascular events. The purpose of the review is to draw attention of researchers to this issue and to show that the mechanisms of atherogenesis are more complex, and that only cholesterol-lowering therapy with statins does not completely solve the problem.

Aim. To build a clinical and instrumental profile of patients with myocardial infarction (MI) complicated by the development of cardiogenic shock (CS) who underwent intra-aortic balloon pump (IABP) counterpulsation and evaluate the results of this treatment.

Material and Methods. The single-center observational registry study comprised patients with admitting diagnosis of MI complicated by CS who were admitted to Cardiology Research Institute of Tomsk NIMC from 01.01.2020 to 12.31.2021. All patients received emergency IABP at admission, and reperfusion of infarct-related artery was achieved. According to these criteria, a total of 23 patients were included in the analysis.

Results. The average age of patients was 79 years. There were comparable numbers of men and women in study group. Vast majority of patients (78.2%) had postinfarction cardiosclerosis; 86.9% of patients had hypertension; third of patients had diabetes mellitus; and almost half of patients were obese. Most of these patients (73.9%) had MI with ST segment elevation; the rest of patients had MI without ST segment elevation. 60.9% of patients had anterior wall MI, and the rest of patients had inferior wall MI. The pain-to-door time was 223 minutes on average. Thrombolysis was performed in 9 cases (39%) at the prehospital stage with an efficiency of 55%. The majority of patients (n = 22) underwent coronary stenting of infarct-related artery. The duration of IABP was 52.5 hours an average, and the mortality rate was 69.5%. All fatal outcomes occurred as a result of CS progression. There were no statistically significant differences in the main clinical and anamnestic characteristics between the groups with the administration of IABP before and after PCI, although the patients in the group of IABP before PCI were younger, had a lower level of troponin at admission, more often achieved coronary reperfusion TIMI-2-3 at PCI, and had lower mortality.

Conclusion. The frequency of IABP administration to patients with MI and CS in our department was 8%. The mortality rate among patients who underwent IABP insertion reached 69.5%, which was not lower than the corresponding rate in the general group of CS (55%). The combination of IABP installation before PCI in the presence of achieved coronary reperfusion (spontaneous or due to thrombolysis) was associated with a tendency to decrease in mortality compared with the installation of IABP after PCI.

World statistics data suggest that the surgical revascularization of the myocardium in multivessel coronary artery disease is performed in 40 to 60% of cases. However, severity of coronary artery disease is often evaluated through the analysis of clinical presentation and selective coronary angiography (ICA) data without an assessment of the functional significance of stenosis. A precise algorithm for the treatment of patients with multivessel coronary artery disease and stable coronary artery disease is still unavailable, i.e. extent of revascularization, its time, and criteria for complete withholding of surgical treatment remain unclear. Many factors affect myocardial blood supply in multivessel disease including the type of blood supply to the heart, presence of scar and collaterals, diameter of the affected artery, and presence of microvascular dysfunction. All these factors require rational and intelligent approach to establishing the optimal tactics. In this review, the authors identified discussion vector and presented their original opinion on the advisability/unreasonableness of approaches to revascularization in patients with multivessel coronary disease based on published clinical trials and current recommendations. In addition, we analyzed the existing data, identified the missing information, and proposed the prospects for possible new clinical studies in this scientific field.

Hypertrophic cardiomyopathy (HCM) is a genetically determined disease with a high prevalence and manifestation at the age of 30–40 years. Currently available most effective treatments are extended myectomy and Morrow septal myectomy. However, the frequent occurrence of postoperative complications and restrictions to the use of these methods in certain groups of patients provides rationale for the improvement of the existing treatment methods and search for new pharmacological approaches. One of the most promising areas of conservative therapy is the study of a specific small-molecule allosteric inhibitor of myosinadenosine triphosphatase (mavacamten). Clinical studies of the efficacy and safety of this drug continue to this day, and if they are successfully completed, the drug may be included in the pharmacotherapy protocol for HCM.

Aim. The study aimed at analysis of unfavorable prognostic factors and creation of a prognostic model for choosing the optimal strategy for cerebral and myocardial revascularization using carotid endarterectomy (CEE) and percutaneous coronary intervention (PCI).

Material and Methods. A total of 263 myocardial and cerebral revascularizations were performed using PCI and CEE in patients with multifocal atherosclerosis and concomitant carotid and coronary artery disease from 2011 to 2017. Depending on selected treatment strategy, the patients were divided into two groups: group 1 (n = 133) comprised patients with stepby- step interventions in different sequences (CEE and PCI); group 2 (n = 130) comprised patients who underwent hybrid interventions (CEE + PCI). A binary logistic regression was performed with step-by-step inclusion and exclusion of predictors in order to identify predictive factors in the long-term period. A multivariate analysis was also performed, and the odds ratios were determined.

Results. The analysis allowed to identify the significant effects of certain factors on death, favorable outcome (the absence of significant adverse cardiovascular events), and the availability of revascularization. The following protective factors increased the probability of favorable outcome in the general sample of patients throughout the entire follow-up period: the absence of chronic obstructive pulmonary disease (COPD), EUROSCORE II score of less than 1.5, compliance with prescribed therapy, no need for repeated planned revascularization in the long-term period, no emergency hospitalizations in the long-term followup period, PCI via the radial access, and CEE using the classical method. The statistically significant factors in the created model included surgical risk score by EUROSCORE II scale (for the total sample of patients and for the staged and hybrid strategies) and the coronary lesion severity by SYNTAX Score (for the total sample of patients and the hybrid strategy). It should be noted that the hybrid strategy was associated with a significantly greater availability of revascularization during the follow-up period compared with the step-by-step strategy.

Conclusion. An important outcome of this study was a comprehensive analysis of a wide array of factors (clinical-instrumental, anatomic-angiographic, and perioperative), which allowed to identify predictors of adverse (favorable) outcome in the long-term follow-up period in patients with combined coronary and cerebral lesions when using PCI and CEE as the revascularization strategies.

Transcatheter aortic valve replacement is an appropriate alternative to open surgery in some patients with severe aortic stenosis who have significant comorbidities and high surgical risk.

Aim. To evaluate the immediate results of transcatheter aortic valve replacement in patients with severe aortic stenosis.

Material and Methods. This is a retrospective study, which included 350 patients who underwent transcatheter aortic valve replacement from 2015 to 2021. Mortality, complications, clinical data, and echocardiographic parameters were assessed in the early postoperative period after the procedure.

Results. The patient mean age was 75.3 ± 7.2 years. The majority of patients had intermediate surgical risk: EuroScore II of 6.7 ± 5.4 and STS-PROM score of 3.3 ± 1.9. In most cases, there was severe hypertrophy of left ventricular (LV) myocardium with an average LV myocardial mass of 330.9 ± 88.4 g. The average postprocedural pressure gradient across the aortic valve was 8.9 ± 4.4 mm Hg. The most common procedural complication was complete heart block (10%). In-hospital mortality rate was 1.7%.

Conclusion. Our register demonstrated the optimal immediate clinical and echocardiographic results of transcatheter aortic valve replacement in patients with severe aortic stenosis.

Aim. To study the capabilities of risk assessment score for angiographic no-reflow phenomenon in predicting myocardial perfusion disorders according to contrast echocardiography data in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary interventions (PCI).

Material and Methods. A total of 40 STEMI patients after PCI were included in the analysis. The individual risk score for noreflow phenomenon was calculated using previously developed scale in all patients. Risk of no-reflow was assessed as high when the score was ≥ 35. All patients underwent contrast echocardiography with myocardial perfusion assessment within six hours after PCI. The clinical angiographic characteristics and in-hospital outcomes were analyzed including the lethality, myocardial infarction recurrence, and stent thrombosis rates.

Results. High risk of no-reflow phenomenon was identified in 13 (32.5%) patients. The rates of angiographic no-reflow phenomenon (46.2% versus 11.1%, p = 0.038) as well as contrast-enhanced echocardiography-based myocardial perfusion disorders (61.5% versus 18.5%, p = 0.011) were significantly higher in the high-risk patient group. According to results of ROCanalysis, no-reflow risk assessment scale for identifying patients with myocardial perfusion disorders according to contrast echocardiography had sensitivity/specificity/area under the curve (AUC) of 62%/85%/0.789 (p = 0.003).

Conclusions. Angiographic no-reflow risk assessment score allowed to identify patients with high risk of developing myocardial perfusion disorders according to contrast echocardiography.

RETRACTED ARTICLE

Objective. The aim of this study was to identify predictors of adverse events after ascending aortic replacement for the aortic aneurysms in the early postoperative period.

Material and Methods. The analysis included 151 patients with ascending aortic aneurysm who underwent non-hemiarch or hemiarch repair. The following adverse outcomes were selected: postoperative delirium, respiratory failure, bleeding, multiple organ dysfunction syndrome, and in-hospital mortality. Predictors of adverse clinical events were identified by constructing uni- and multivariate logistic regression.

Results. Significant predictors of early outcomes and mortality after ascending aortic replacement were as follows: female gender, atrial fibrillation, low glomerular filtration rate, chronic obstructive pulmonary disease, aortic root repair, multiple organ dysfunction, duration of cardiac arrest, operation time, and reoperation for bleeding.

Conclusions. The risk factors of adverse outcomes after ascending aortic replacement were decreased kidney function, atrial fibrillation, female gender, aortic root repair, and increased duration of cardiac arrest and operation time.

Objective. To assess the changes in subclinical MRI signs of brain damage in relationship with the changes in blood pressure, proinflammatory cytokines, and endothelial function one year after renal denervation (RDN) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM).

Material and Methods. The prospective interventional study (ClinicalTrials.gov identifiers NCT02667912 and NCT01499810) analyzed qualitative brain MRI imaging data from 39 patients with RHTN and T2DM. All patients underwent 24-h ambulatory blood pressure monitoring (ABPM), brain MRI scan (1.5 T), blood tests for high-sensitivity C-reactive protein (hsCRP), and brachial artery flow-mediated dilation (FMD) measurements by high-resolution ultrasound. Patients were taking an average of 4.5 (3–6) antihypertensive drugs and were instructed not to change the therapy regimen throughout the study. A total of 29 patients completed the one-year follow-up.

Results. A significant decrease in average daily systolic/diastolic blood pressure by 12 [95% CI 4.1; 19.8]/5.9 [95% CI 0.4; 11.3] mmHg (p = 0.004/0.038) according to 24-h ABPM, increase in FMD (p = 0.008), and a decrease in hsCRP level (p = 0.04) were observed one year after RHTN. Over half of patients (57%) had a decrease in 24-h systolic blood pressure by ≥ 10 mm Hg; target level of blood pressure was achieved in 38% patients. No changes in the MRI signs of brain damage (linear dimensions of liquor systems, white matter lesions [WMLs], brain damage MRI score, and intensity of MRI signal from the basal nuclei and WMLs) were observed except for a decrease in the severity of liquorodynamic disturbances. Reduction or stabilization of WML degree was observed in 24 patients (86%). No relationships were found between the dynamics of WMLs and the changes in blood pressure, FMD, and hsCRP.

Conclusion. Administration of RDN to patients with RHTN and T2DM allowed to limit the WMLs in most cases and reduce the severity of liquorodynamic disorders during one-year of follow up.

Purpose. To develop a system for assessing liver function in patients with liver cirrhosis according to magnetic resonance imaging (MRI) with gadoxetic acid.

Material and Methods. Data from studies of 74 patients who underwent abdominal MRI with intravenous gadoxetic acid (GA) enhancement were analyzed. For statistical analysis of the data, two groups were formed: group 1 (n = 22) comprised patients with unchanged liver parenchyma, normal liver function, and benign tumors; group 2 (n = 52) comprised patients with liver cirrhosis, with the presence of regenerative and/or dysplastic nodes, and hepatocellular carcinoma (HCC). The following quantitative parameters were studied to assess liver function in patients of two groups: relative enhancement (RE), contrast enhancement index (CEI), liver/skeletal muscle (SM) index, liver/spleen index, liver/kidney index, analysis of histograms (AH), and liver function imaging scale (FLIS).

Results. The criteria for a functional deficiency of liver function based on calculated data of contrast agent transport and accumulation were a decrease in FLIS total score to 4 and below, RE values below 0.85, and CEI values below 1.38 with sensitivity and specificity of 100 and 75%, the values of liver/SM and liver/kidney indices below 0.350, liver/spleen index below 0.750 with sensitivity and specificity of 100 and 81%, respectively, in patients with cirrhosis.

Conclusion. The developed system for assessing liver function using FLIS, intensity matching analysis (IMA), and AH according to MRI with GC in comparison with METAVIR allowed for liver function assessment in patients with cirrhosis with a sensitivity and specificity of 100% and 80%, respectively.

Features of longitudinal left ventricular (LV) myocardial deformation in female patients of reproductive age with undifferentiated connective tissue dysplasia (UCTD) have not been specifically studied before.

Aim. To study the features of longitudinal LV myocardial deformation using speckle tracking echocardiography in female patients of reproductive age with UCTD.

Material and Methods. A noninvasive assessment of systolic LV myocardial deformation in the longitudinal direction using echocardiography was performed in 20 young adult female patients with UCTD (the average age was 23.5 ± 2.6 years). A control group composed of 34 apparently healthy women of comparable age (the average age was 24.8 ± 2.4 years) with no signs of UCTD were examined.

Results. The indices of longitudinal systolic myocardial deformation in female patients with UCTD practically did not differ from the control group. Significant differences were found only for the median segment: excessive shortening of the interventricular septum and a decrease in deformation in the lateral wall of the left ventricle. Segments 8–10 (mid anteroseptal, mid inferolateral, and mid inferior) and all apical LV segments (13–17: apical anterior, apical septal, apical inferior, and apical lateral) were subjected to maximum deformation, p < 0.05.

Conclusions. In patients of reproductive age with UCTD, a significant decrease in global longitudinal systolic LV deformity was recorded in the basal segment of the interventricular septum and the apical segment of the anterior LV wall. Segments 8–10 (median anterior-septum, median inferior-septum, and lower) and all apical LV segments (13–17: apical anterior, apical septum, apical lower, and apical lateral) were subjected to the greatest deformation in the examined patients.

Aim. To evaluate the contribution of SOD1, CAT, PXDN1, NOS3, EDN1, VCAM, ICAM, PECAM, SELE and SELP genes to the pathogenesis of infective endocarditis in patients undergoing cardiac surgery.

Material and Methods. We studied 25 native heart valves obtained from patients with infective endocarditis and 13 native heart valves obtained from patients with other valvular pathology. The expression of SOD1, CAT, PXDN1, NOS3, EDN1, VCAM, ICAM, PECAM, SELE and SELP genes was determined by qPCR. Immunofluorescent staining was performed using specific primary antibodies to nitrotyrosine.

Results. Native heart valves obtained from infective endocarditis patients were characterized by the decreased expression of genes involved in the processes of oxidative stress and genes encoding cell adhesion molecules. Immunofluorescence staining showed that the heart valves obtained from infective endocarditis patients had lower nitrotyrosine staining compared to the control suggesting the decreased oxidative stress.

Aim. The present work aimed at studying the proatherogenic potential of doxorubicin-cyclophosphamide (AC) chemotherapy regimen while simultaneously substantiating the use of trimetazidine as a modifier of the changes induced.

Material and Methods. The fundamental, randomized, controlled, experimental in vivo study was conducted. To perform the experimental work, 80 inbred Wistar rats were randomly divided into four groups with equal numbers of animals in each group. The course dosages doxorubicin, cyclophosphamide, and trimetazidine were 15, 150, and 42 mg/kg, respectively. The experiment lasted for 14 days. Trimetazidine was chosen as a probable stabilizer of endothelial functioning.

Results. The deviations of the following parameters were evaluated in the framework of this study: total cholesterol, triglycerides, high-density lipoproteins, and low-density lipoproteins. Coronary index and atherogenic index (CA) were also analyzed as prognostic indicators. Statistically significant intergroup differences were recorded in lipid profiles (one-way ANOVA, p < 0.0001) two weeks after beginning the AC chemotherapy regimen. It is worthy of note that the AC chemotherapy regimen caused destabilization of all studied parameters of cholesterol metabolism while trimetazidine showed statistically and pathogenetically significant mild hypolipidemic effect. The study showed that the concentration of CA in group 2 was higher by 187.4 and 172.8%, and the values of coronary risk index (CRI) were higher by 115.8 and 113.9% than the corresponding parameters in groups 1 and 4, respectively. Comparative analysis of groups 3 and 2 showed that the use of TMZ was associated with decreases in CA by 55.5% and in CRI by 44.2% (Tukey’s post-hoc test, p < 0.05).

Conclusions. (1) AC chemotherapy regimen was an inducer of atherogenic hyperdyslipidemia, and (2) trimetazidine had a hypolipidemic effect.

Mitral regurgitation is one of the prevalent entities among valvular defects in the adult population. In approximately half of the patients, the etiology of this defect is directly related to obstructive coronary artery disease. As a rule, the high perioperative risk in such patients is the main reason for the refusal to perform traditional open interventions. According to the available literature, the first experience of successful simultaneous percutaneous coronary intervention and transcatheter mitral valve repair “edge-to-edge” with the MitraClip G4 device is presented in a 77-year-old patient with severe mitral regurgitation who had previously suffered myocardial infarction and paroxysmal atrial fibrillation. The advantages of such an approach to treatment are demonstrated, and the need for its further study for systemic implementation is actualized.

This case demonstrates the possibility of using balloon angioplasty in patients with non-ST segment elevation acute coronary syndrome and restenosis of previously implanted coronary stents as a measure to temporary stabilize coronary blood flow and the patient’s condition for preoperative preparation for subsequent emergency coronary bypass grafting.

Pial arteriovenous fistula (PAVF) is an extremely rare type of intracranial vascular congenital anomalies. The presented clinical case is a unique example of intrauterine diagnosis of PAVF using fetal MRI at 30 weeks of gestation, which allowed successful surgical treatment in the early neonatal period. The case demonstrates the capabilities of fetal MRI in the diagnosis of PAVF and estimation of accompanying brain changes, which are fully consistent with the results of postnatal cerebral angiography. Based on neuroimaging data, endovascular embolization of the fistula with detachable microcoils was successfully performed on the 2nd day of the child’s life. A good neurologic outcome of the surgery was stated. Taking into account the known unfavorable outcome of PAVF in the case of untimely surgical treatment, this observation demonstrates the need to use fetal MRI for prenatal differential diagnosis of vascular malformations in order to reduce the risk of possible complications and mortality in the early neonatal period.

A necessary condition for obtaining a high-quality image with optical coherence tomography (OCT) is the displacement of blood from the visualized segment of the vessel to provide a transparent medium between the vascular wall and the photo detector. Traditionally, liquid iodine-containing contrast is used for this, which can be dangerous in patients with iodine allergy or renal insufficiency. We present a clinical case of successful OCT using CO2 in a patient with anaphylactic reaction to iodine-containing contrast. OCT was performed to monitor the safety of radiofrequency renal denervation. CO2 was injected as standard into a guide catheter located in the renal artery. With the help of CO2, it was possible to effectively displace blood from the renal artery and obtain high-quality OCT images of the vascular wall microstructure.

Modern imaging techniques including various echocardiographic technologies have become firmly established in the practice of cardiac surgery. The method of intraoperative transesophageal echocardiography (TEE) is of particular significance for ensuring the safety of patients during open heart surgery. This method is necessary for performing reconstructive interventions on the valve apparatus of the heart in patients with initial myocardial dysfunction to assess the anatomical and functional state of the heart and its structures at all stages of surgical treatment. Information obtained in the operation room using TEE allows the surgeon to choose the optimal tactics of surgical intervention, evaluate the results of surgery, and predict the course of early postoperative period. The presented clinical case demonstrates the capabilities of intraoperative use of TEE during the Ozaki procedure in a patient with congenital bicuspid aortic valve.