One of the manifestations of ischemic cardiomyopathy is remodeling of left ventricular (LV), which can manifest itself both globally and as a result of an aneurysm. In the vast majority of cases, LV aneurysm location is the apex and the anterior septal region; very rarely, aneurysms are localized in the area of the posterior LV wall and are large. Due to the relative rarity of the given localization surgical treatment tactics of this pathology is not well-established and standardized. The work presents a clinical case of surgical treatment of an aneurysm of the LV posterior wall, demonstrates the stages of diagnosis, and also identifies the features of surgical intervention with the results of treatment in 6 months after surgery.

Aim: To access frailty and its impact on 10-year survival in patients with implanted devices for cardiac resynchronization therapy (CRT).

Methods: 77 patients with congestive heart failure (74% men, 26% women; mean age of 58.7 ± 10.7 years) with NYHA class II–IV were enrolled. Frailty Index was calculated using 31 parameters (the ability to perform daily activities, clinical status, laboratory markers, comorbidities). Based on the frailty index patients were identified as not frail (< 0.375; n = 41; 53%), and frail (≥ 0.375; n = 36; 47%).

Results: The mean follow-up period was 49.0 ± 34.2 months. Survival at 10-year follow-up was 87.5% for non-frail patients, compared to 47.2% for frail patients (log-rank test p < 0.001). In univariate analysis, frailty associated with 10-year mortality (OR 7.824; 95% CI 2.495 – 24.533; p < 0.001). After adjustment for age, gender, rhythm, NYHA class, left ventricular ejection fraction, left bundle branch block, and QRS width, frailty remained a significant prognostic factor associated with 10-year mortality (OR 9.528; 95% CI 2.720 – 33.368; p < 0.001). Also, according to logistic regression, the presence of frailty reduced the chance of superresponse (decrease of left-ventricular end -systolic volume ≥ 30%) to CRT (OR 0.278; 95% CI 0.100–0.770; p = 0.014).

Conclusion: Frailty is widespread in patients with heart failure and implanted devices for CRT. In these patients frailty is associated with a more than seven-fold increased risk of death during 10-year follow-up and with a lower chance of superresponse to CRT.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, had a profound impact on global health, and society and become one of the deadliest in history. Knowledge of risk factors for mortality is critically important in the formation of organizational, methodological and clinical decisions to limit disease progression and reduce the number of fatal outcomes. However, it is still unclear whether generally accepted risk factors can be equally useful in identifying risk groups in a diverse population of patients in small cities.

Aim: To evaluate the utility of demographic, clinical, and laboratory characteristics in the prediction of negative outcome of patients with COVID-19 admitted to the intensive care unit (ICU) of the multidisciplinary COVID-19 hospital in the city of Saransk.

Material and Methods. Medical records of 153 patients (including 134 recovered and 19 dead) with laboratory-confirmed SARS-CoV-2 infection treated in the intensive care unit of the S.V. Katkov Republican Clinical Hospital between March and December of 2020 were included in this retrospective, single-center, clinical trial. Demographic, clinical, and laboratory characteristics, complications and therapeutic interventions were compared between deceased and recovered patients. The primary endpoint was in-hospital all-cause mortality. Risk factors for mortality were analyzed using logistic regression.

Results. Multivariate regression analysis showed that in the population studied, included both therapeutic and surgical patients, a history of coronary artery disease, chronic non-specific lung disease, acute surgical conditions, plasma creatinine at ICU admission ≥ 106 µmol/L had a negative effect on in-hospital mortality, whereas fever at admission had a protective effect. Patients who died had lower oxygen saturation upon the admission to ICU and were more likely to receive invasive mechanical ventilation and higher doses of dexamethasone in treatment.

Conclusion. The present study identified predictors to mortality of patients with COVID-19, treated in the ICU of a Mordovia Republic hospital (Russia), which were somewhat different from those previously reported for larger cities and indicate a large contribution of concomitant diseases to the negative outcome. We did not identify a significant contribution of many proposed laboratory markers to predicting mortality. These findings may help authorities and clinicians optimize organizational, methodological, and clinical approaches to medical care of patients to reduce the risk of a negative outcome from COVID-19.

A review of domestic and foreign scientific publications from 2018 to 2023 was conducted. The search was carried out using the Pubmed biomedical research database and the Russian Science Citation Index. 1673 articles were found, using keywords. Various etiological and pathogenetic variants of gastroduodenitis (GD) are considered. One of the most common pathogens of gastroduodenal pathology is Helicobacter pylori (Hp), which, due to its virulence factors, can persist for a long time on the mucous membrane of the stomach and duodenum, thereby causing its inflammation, subsequently leading to gross damage to the mucosa and complications of gastrointestinal tract. Today, despite the prevalence of Hp, many new etiological agents are found: cytomegalovirus, Epstein - Barr viruses, Lamblia intestinalis, Blastocystis spp., Entamoeba spp. and various factors contributing to the development of this disease. For example, such as human constitution, environment, gender differences, age, genetics, drug exposure, stress, the relationship of perinatal brain lesions, endothelial dysfunction and immunity with the detection of GD has also been described. Every year the range of etiological agents expands, which leads to changes in the pathogenesis of GD.

Background. Pediatric hypertrophic cardiomyopathy (HCM) is a major cause of sudden cardiac death in children and represents a clinically and genetically heterogeneous condition distinct from adult disease. Although advances in adult HCM have informed management strategies, pediatric-specific evidence remains comparatively limited, particularly regarding imaging-based risk assessment and validation of pediatric risk prediction models.

Aim: To assess current diagnostic approaches, genetic insights, and current challenges in risk stratification in pediatric HCM.

Methods. A structured narrative review of studies published from 1997 through early 2025 was conducted using major biomedical databases and guideline references. Priority was given to pediatric cohort studies, population-based registries, contemporary clinical guidelines, and genetic investigations addressing epidemiology, etiologic classification, diagnostic evaluation, and risk prediction.

Key Content and Findings. Recent evidence confirms the predominant role of sarcomeric gene variants beyond infancy, while underscoring the importance of syndromic and metabolic etiologies in early childhood. Advances in electrocardiographic risk markers, multimodal imaging including cardiac magnetic resonance imaging assessment of myocardial fibrosis and next generation genetic testing have enhanced diagnostic precision and family screening. However, phenotypic variability, age-dependent penetrance, and limitations in external validation of pediatric risk prediction tools, including HCM Risk-Kids, continue to challenge individualized management.

Conclusion. Pediatric HCM remains a prognostically complex and biologically diverse disease. Refinement of pediatric-specific risk stratification models, improved integration of imaging and genetic data, and international collaborative research are essential to optimize early diagnosis and personalized care in affected children.

Myocardial ischemia-reperfusion injury remains a major determinant of adverse post-infarction outcomes, contributing to irreversible myocardial damage, coronary microvascular dysfunction, an exaggerated inflammatory response, and pathological cardiac remodeling. In recent years, the endocannabinoid system has emerged as an important regulator of cellular adaptation to ischemia-reperfusion injury.

Aim: To summarize current experimental data on the role of CB1 and CB2 cannabinoid receptors in the mechanisms of cardioprotection and vasculoprotection in myocardial ischemia-reperfusion injury. The review assesses the localization and expression of cannabinoid receptors in the myocardium and vascular wall, their intracellular signaling pathways, and their functional significance in ischemia-reperfusion injury. Experimental studies on the effects of CB1 and CB2 receptor activation on infarct size, inflammatory response, endothelial function, coronary microvascular dysfunction, and post-infarction cardiac remodeling are discussed. Particular attention is also given to experimental data confirming the involvement of CB1 and CB2 receptors in the cardioprotective mechanisms of ischemic preconditioning, remote ischemic preconditioning, postconditioning, and heat stress. The available data indicate that the biological effects of cannabinoid receptors depend on receptor subtype, the mode of receptor activation, and the experimental model employed. In most experimental studies, activation of CB2 receptors has been associated with pronounced anti-inflammatory, vasculoprotective, and cardioprotective effects, whereas the role of CB1 receptors appears to be more complex and is influenced by the characteristics of the experimental model of myocardial ischemia-reperfusion injury, as well as the timing and pattern of receptor activation. Overall, current data suggest that cannabinoid receptors represent promising therapeutic targets for the development of novel pharmacological strategies aimed at preventing myocardial ischemia-reperfusion injury and adverse cardiac remodeling following myocardial infarction.

This review evaluates the use of intraoperative epiaortic scanning (IES) of the ascending aorta in coronary artery bypass grafting. The diagnostic advantages of IES 3 over traditional palpation and transesophageal echocardiography are discussed, allowing for the detection of atherosclerotic plaques, including mobile and ulcerated ones. Clinical trial data are presented, demonstrating that the use of IES leads to a change in surgical tactics in 5–15% of cases (avoidance of aortic manipulation, use of contactless devices, conversion to off-pump surgery) and a reduction in the relative risk of perioperative stroke by 38–60%. The advantages of specialized systems (MediStim and similar systems) over transesophageal echocardiography, aortic computed tomography, and ultrasound through a special sterile sleeve are discussed, as well as the role of IES in the diagnosis of iatrogenic aortic injuries and in comprehensive intraoperative assessment, which allows for personalized surgical strategy and improved neurological outcomes.

The novel coronavirus infection has had a significant impact not only on the healthcare system as a whole, but also on the number of surgical myocardial revascularization procedures. COVID-19, being a severe disease with high mortality, has affected the incidence of postoperative complications in coronary artery bypass grafting (CABG). A study of research based on the analysis of the postoperative course of CABG and COVID-19 revealed the most common complications. Against the background of an increase in mortality after CABG operations, pneumonia and stroke were more often observed compared to patients who underwent CABG but did not develop COVID-19. The article presents the results of studies on the features of the course of the postoperative period against the background of COVID-19 at different times relative to surgery.

Background. Ethanol solutions are used in surgical, endoscopic, and endovascular practice, including as sclerosing and embolic agents. This determines the scientific and practical interest in studying their local embolic effect, which depends on concentration, volume, duration of contact with the vascular wall, and blood flow conditions. The minimum concentration of ethanol solution required to achieve reproducible intraluminal thrombus formation under standardized arterial exposure remains insufficiently studied.

Aim: To evaluate the effect of ethanol concentration on thrombus formation in an isolated rabbit femoral artery segment.

Material and Methods. The experiment included nine female Soviet Chinchilla rabbits weighing 3.0–3.5 kg and aged approximately 6 months. A bilateral study design allowed the assessment of 18 femoral artery segments, which were allocated into three groups of six segments according to ethanol concentration: 1%, 5%, and 10%. A 20–30-mm segment of the femoral artery was exposed and isolated using proximal and distal atraumatic vascular clamps. The calculated volume of the ethanol solution corresponded to the intraluminal volume of the isolated segment. Following direct puncture injection, ethanol was allowed to remain in contact with the vessel for 5 minutes. The clamps were not removed, and the arterial segment was excised en bloc without restoration of blood flow. Animals were euthanized under deep anesthesia by anesthetic overdose, followed by confirmation of biological death based on the absence of spontaneous respiration and cardiac activity. All procedures were performed in accordance with bioethical requirements, the European Convention for the Protection of Vertebrate Animals Used for Experimental and Other Scientific Purposes (ETS No. 123), Directive 2010/63/EU, and the 3R principles. The primary outcome was complete macroscopic luminal occlusion. Secondary outcomes included the pattern of thrombotic masses, the presence of a residual lumen, and thrombus length.

Results. Intraluminal thrombotic masses were identified in all 18 arterial segments. Complete luminal occlusion was observed in 5 of 6 segments (83.3%) exposed to 1% ethanol and in all segments exposed to 5% and 10% ethanol–6 of 6 segments (100%) in each group. The between-group differences in complete occlusion rates were not statistically significant (p>0.05). In the 1% ethanol group, mural-to-occlusive thrombotic masses predominated, and a residual lumen persisted in one segment. Exposure to 5% and 10% ethanol resulted in occlusive thrombi without a macroscopically detectable residual lumen. Thrombus length was 8–12 mm, 10–15 mm, and 12–18 mm in the 1%, 5%, and 10% ethanol groups, respectively.

Conclusion. Increasing the ethanol concentration improved the reproducibility of complete luminal occlusion and increased thrombus length in isolated femoral artery segments. A 5% ethanol concentration resulted in occlusive thrombus formation in all observations, whereas increasing the concentration to 10% did not further increase the rate of complete occlusion.

Introduction. In patients with type 2 diabetes mellitus (T2DM), myocardial ischemia often develops in the presence of non-obstructive coronary artery disease (NOCAD), indicating a leading role of coronary microvascular dysfunction (CMD). Quantitative assessment of myocardial flow reserve (MFR) using dynamic SPECT with semiconductor detectors (CZT) represents a promising yet understudied approach in this cohort.

Aim: To determine the functional characteristics of the microcirculatory bed in patients with T2DM and NOCAD using dynamic CZT-SPECT myocardial perfusion imaging. Material and methods. The study included 75 patients with NOCAD: 36 with T2DM and 39 without diabetes. All patients underwent dynamic myocardial SPECT with ⁹⁹ᵐTc-MIBI and perfusion ECG‑gated SPECT. Semi-quantitative perfusion parameters, absolute values of myocardial blood flow (MBF) at rest and during stress, and MFR were assessed.

Results. Compared with the non-diabetic group, patients with T2DM demonstrated statistically significantly higher summed perfusion defect scores (p<0.01) and higher rest MBF (p=0.004) were found, whereas stress MBF did not differ significantly. The medians of MFR and absolute increase in blood flow were lower in the T2DM group (p<0.01 and p=0.03, respectively). Multiple regression analysis confirmed T2DM as an independent predictor of elevated resting MBF.

Conclusion. For the first time, using dynamic CZT-SPECT, it was demonstrated that in patients with T2DM and NOCAD the key hemodynamic abnormality is an increase in resting MBF, which leads to a reduction in MFR and may indicate early CMD. Quantitative assessment of MBF components by dynamic CZT-SPECT expands diagnostic capabilities and may serve as a basis for cardiovascular risk stratification in this patient group.

Despite the rapid development of interventional treatment modalities and the introduction of novel antiarrhythmic drugs, amiodarone continues to occupy a unique niche in long-term relapse prevention therapy for atrial fibrillation. This is particularly relevant for patients with organic myocardial disease, chronic heart failure with reduced ejection fraction, and in regions with limited access to catheter ablation or costly alternative medications. However, the complex, multifactorial pharmacokinetics of amiodarone – high lipophilicity, enormous volume of distribution, the presence of the pharmacologically active metabolite desethylamiodarone, and an exceptionally long elimination half-life – pose significant challenges for clinicians. A narrow therapeutic window and a high risk of dose-dependent adverse effects justify the potential value of therapeutic drug monitoring (TDM). The lecture based on a critical appraisal of available evidence and real-world clinical data reviews current perspectives on the clinical significance of measuring amiodarone and desethylamiodarone concentrations. Pharmacokinetic features that determine patient management strategies are discussed in detail, along with the controversies surrounding existing clinical guidelines and the methodological limitations of published studies. Particular attention is devoted to identifying clinical scenarios in which TDM may be most informative and to outlining directions for future randomized controlled trials.