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.

Introduction. Radionuclide imaging of somatostatin receptor type 2 (SSTR-2) shows great promise as a novel marker of cardiovascular inflammation. However, it is still unclear whether local inflammation and high levels of macrophages in the infarct area that overexpress SSTR-2 are positive or negative factors for myocardial healing.

Aim. To evaluate the relationship between inflammatory biomarkers as indicators of the systemic response to ischemic injury and the local inflammatory response in the myocardium, as measured by SSTR-2-targeted imaging, during the early post- infarction period.

Material and methods. Twenty-three patients with acute primary anterior wall myocardial infarction and ST-segment elevation myocardial infarction (STEMI) were included in the study. On the first day (before PCI) and on the fifth day after AMI, venous blood was collected from all patients to determine hsCRP and IL-6 levels. Five to six days after the acute coronary event, all patients underwent SPECT/CT with ^99mTc-Tektrotyd. Seven days after the acute coronary event, they underwent myocardial perfusion scintigraphy with ^99mTc-MIBI at rest.

Results. The results of the study indicated a negative correlation between hs-CRP and IL-6 levels on days 1 and 5 with left ventricular ejection fraction (LVEF) and a positive correlation with the summed rest score (SRS). Concurrently, SUVmax exhibited no correlation with hsCRP and IL-6 levels. Concurrently, SUVmax exhibited a moderate correlation with SRS (r = 0.517, p = 0.011). In the context of univariate linear regression, SUVmax demonstrated no statistically significant impact on hs-CRP and IL-6 levels. Concurrently, the total resting perfusion defect score (SRS) exerted an influence on the alteration in the levels of inflammatory biomarkers. It is also noteworthy that no regression relationship was identified between SUVmax and SRS.

Conclusion. The findings indicated that the intensity of accumulation of somatostatin analog ^99mTc-Tectrotyd in the left ventricular myocardium during the early postinfarction period is not associated with the levels of inflammatory biomarkers. Our findings indicate the activation of cellular and biochemical pathways of the inflammatory cascade. Conversely, the study identified a potential anti-inflammatory function of somatostatin receptor type 2 hyperexpression.

Introduction. Today, one of the urgent health problems is the increasing antibiotic resistance of pathogenic microorganisms. In this regard, there is an increasing need to find new antimicrobial agents for medical use. Benzophenazine derivatives may be an example of promising antimicrobial agents. This article presents a study of the antimicrobial properties of newly synthesized compounds of the benzophenazine group.

Aim: To evaluate the antibacterial and antifungal potential of benzophenazine derivatives under experimental conditions in vitro.

Material and Methods. The antimicrobial activity of a panel of benzophenazine derivatives – unsubstituted benzophenazin-5-ol (VN-13), o-methylated benzophenazin-5-ol (VN-16-3), 4,5-difluorobenzophenazin-5-ol (VN-11), and o-methylated 4,5-difluorobenzophenazin-5-ol (VN-35-3) – was assessed by titration in sterile 96-well plates, followed by plating on solid media. The antimicrobial activity of the compounds was evaluated against pathogens of infectious diseases such as Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 29213, Streptococcus agalactiae, Pseudomonas aeruginosa, MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant Enterococcus), CRAB (carbapenem-resistant Acinetobacter baumannii), Burkholderia cenocepacia, Candida albicans. The antibacterial and antifungal potential of the compounds was assessed by the presence or absence of microbial colony growth at various concentrations of the benzophenazines (from 2000 μg/ml to 0.016 μg/ml).

Results. The study results demonstrated that all tested benzophenazine derivatives exhibited antibacterial activity against Streptococcus agalactiae and Burkholderia cenocepacia. Against other tested strains, including multidrug-resistant ones, only unsubstituted benzophenazine-5-ol (VN-13) showed activity. Pseudomonas aeruginosa and Escherichia coli ATCC 25922 were resistant to all studied compounds.

Conclusion. Benzophenazine derivatives demonstrate bactericidal or bacteriostatic activity against a number of bacteria, including polyresistant strains, as well as fungi of the genus Candida. Based on the results obtained, it is possible to assume the relevance of further research in the direction of studying the efficacy and safety of benzophenazines as promising antimicrobial agents.

Background. Amiodarone is widely used as an antiarrhythmic drug, but its effectiveness is not entirely predictable, and its side effects are not completely controllable. To determine the effective concentration of amiodarone in the blood, a method for quantitative analysis of the drug in the presence of a biological matrix is needed.

Objective. To develop a procedure for quantitative determination of amiodarone (AMI) and desethylamiodarone (DEA) in blood plasma by high-performance liquid chromatography (HPLC).

Materials and Methods. The procedure was developed using an Agilent 1260 Infinity chromatograph with diode array detector (Agilent, USA) on a Tsunami C18 Pharm column (250×4.6 mm, 5 μm) with proprietary stationary phase. Agilent Zorbax SB C8 precolumn (9.4×15 mm, 7 μm) was used to protect the column from mechanical contaminants. Validation was performed according to OFS.1.1.0012.15 “Validation of Analytical Methods” for the following parameters: selectivity, matrix effect, linearity, accuracy, precision, stability and limits of detection and quantification.

Results. The QuEChERS sample preparation was modified to achieve optimal conditions for the extraction of AMI and DEA from the biological matrix. Mobile phase A was phosphate buffer (pH 3, 7.5 mM), mobile phase B was 100% acetonitrile. The separation was performed in gradient mode. Up to 7.00 minutes – the B phase content was 55%, from 7.00 to 7.15 minutes – an increase in B phase content to 85% in order to elute the more hydrophobic components, from 7.15 to 15.00 minutes – the B phase content did not change, followed by a return to the original 50% at 15.15 min. The total analysis time was 18 minutes. Column thermostat temperature was set to 30 °C, flow rate – 1.2 mL/min; injection volume – 80 µL; selective wavelength was 241 nm. The value of retention factor for AMI was 2.25; for DEA – 1.44.

Conclusion. The authors have developed and validated the new HPLC procedure for quantitative identification of AMI and DEA in human blood plasma.

Relevance. For almost six decades, in right ventricular outflow tract reconstruction the choice of a conduit has been and remains a chelleging task for cardiac surgeons. Among the vast number of valve prostheses offered, the choice of its material is still controversial. There are various allografts, xenografts, a combination of Dacron linear prostheses with an implanted locking element made of biological tissue and mechanical materials. Synthetic prostheses with handmade valves made of expanded polytetrafluoroethylene (ePTFE) and bioresorbable tissue-engineered conduits are also being popularized. The constant search for the best conduit is associated with unsatisfactory long-term performance results. The main problem relates to the inevitable biodegradation of the material from which the prosthesis is made. Durability is the main and most important indicator of the quality of conduits.

Aim: To review conduits for right ventricular outflow tract reconstruction based on the analysis of literature data.  

Material and Methods. The research was carried out in the databases Medline (PubMed) and the Russian Science Citation Index (RSCI) using search queries, keywords and logical operators.

Results. According to a systematic literature analysis, the aspects of choosing a conduit for implantation in the pulmonary position were studied. The main complications, immediate and long-term postoperative results were highlighted.

Conclusion. Currently, there is no consensus on the choice of conduit. Quantaty of adult patients previously underwent interventions is increasing. Biodegradation has led to obstruction of the prosthesis, insufficiency of the locking element, or a combination of both situations.

Introduction. Cardiac magnetic resonance (CMR) is the gold standard for assessing myocardial remodeling after myocardial infarction. Particular attention is paid to myocardial tissue characteristics assessed using late gadolinium enhancement (LGE). Textural heterogeneity parameters of LGE are a novel quantitative metric that reflects the structural heterogeneity of left ventricular (LV) myocardial tissue changes.

Aim: To investigate the association between textural parameters, assessed by quantitative analysis of signal intensity heterogeneity on late gadolinium enhancement CMR, and the development of major adverse cardiovascular events (MACE) in patients with acute myocardial injury.

Material and methods. This retrospective study included 108 patients admitted to the emergency cardiology department with a diagnosis of primary ST-elevation or non-ST-elevation myocardial infarction (STEMI or NSTEMI). A composite primary endpoint was established, which included the following clinical outcomes: cardiovascular death, all-cause death, non-fatal myocardial infarction, and non-fatal acute stroke. Inclusion criteria were: 1) performance of contrast-enhanced CMR within 4–7 days of hospitalization; 2) CMR findings consistent with acute ischemic injury of the LV; and 3) satisfactory image quality. CMR criteria for acute ischemic injury included: a high-intensity signal on T2-weighted images (T2WI) with co-localized LGE in a segment(s) demonstrating an ischemic pattern of contrast distribution. Quantitative CMR analysis was performed using the dedicated post-processing software CVI42 (Circle Cardiovascular Imaging, Canada). Myocardial texture analysis was conducted using the 3D Slicer application, version 5.2.2 (The Slicer Community, USA). For the analysis, LGE images were used. From each slice, textural features of signal intensity (SI) heterogeneity were extracted separately for the following regions of interest (ROIs): the LV myocardial injury zone, intact myocardium, and the entire LV (comprising both injured and intact myocardium).

Results. The mean age of the patients was 59.56 ± 10.7 years, with 75% (n = 81) being male. STEMI was present in 89.3% of the entire cohort. The follow-up period was 1095 ± 23 days. Follow-up data were obtained for all 108 patients (100% of the sample). Based on the occurrence of the primary endpoint, two groups were formed: the group without cardiovascular events (“–MACE”) and the group that reached the endpoint (“+MACE”). Analysis of LV myocardial tissue characteristics assessed in the LGE phase revealed no significant differences between the study groups for almost all parameters, with the exception of the global LV SI elevation on T2-WI, which was significantly lower in the “+MACE” group. Quantitative analysis of SI heterogeneity across the entire LV using textural features revealed differences in first-order statistics, with higher values of these indices in the “+MACE” group. Patients who experienced a MACE during the follow-up period were characterized by a more asymmetric and complex signal texture, featuring abrupt variations in gray-level intensity, higher gray-level irregularity, shorter lengths of homogeneous areas and run lengths, and a predominance of small heterogeneous areas. Analysis of the intact myocardium in the LV also demonstrated higher heterogeneity and gray-level irregularity, with a high number of small heterogeneous regions.

Conclusion. Heterogeneity parameters assessed by CMR reflect the changes occurring in the LV myocardium after MI, are associated with cardiac functional indices, and may be considered prognostic factors for an adverse clinical course. Given the limitations of this study, further research is needed to investigate the relationship between LV tissue characteristics on CMR, entropy, and adverse outcomes after acute myocardial injury.

Introduction. Achieving therapeutic concentrations of direct oral anticoagulants (DOAC) and, accordingly, personalization of anticoagulant therapy in certain groups of patients are becoming increasingly important. To optimize drug monitoring in routine clinical practice, it is necessary to develop and test sensitive and selective methods that can quantitatively determine the content of DOAC in the blood, including rivaroxaban.

Aim: To modify the method for determining the concentration of rivaroxaban in the blood using high-performance liquid chromatography (HPLC), as well as testing the selected conditions for determining the concentration of the drug in the whole venous blood of patients.

Material and Methods. For the first stage of the work, the samples for the study were blood samples (n = 20) from healthy volunteers (n = 5) not taking medications. Blood was collected from a peripheral vein using a vacuum system in a volume of 6 ml. Blood collection tubes with four different fillings were used. Before preparation, the samples were divided into 6 parts and each was supplemented with a solution of rivaroxaban of different concentrations, prepared from the pure substance Rivaroxaban (India). Next, liquid extraction of rivaroxaban with acetonitrile from a sample of whole venous blood was carried out with parallel elimination of the interfering effect of proteins by precipitation with nickel chloride. The separation of the sample components was performed by reversed-phase high-performance liquid chromatography on a liquid chromatograph (1260 Infinity II LC). The analytical signal on a diode-array detector (1260 DAD WR, Agilent Technologies) was recorded at two wavelengths of 254 nm and 280 nm. For the second stage of the work, the samples for the study were whole venous blood samples from patients taking rivaroxaban (n = 54). Blood is collected in the morning, on an empty stomach, 12 hours after taking the last dose of the drug.

Results. The authors investigated and established the factors influencing the decrease in the detection limit of rivaroxaban (Bayer, Germany) in the blood when determining it by HPLC using an Agilent 1260 liquid chromatograph with a diode array detector (Agilent Technologies, Germany). To assess the degree of rivaroxaban extraction and select the working wavelength, calibration dependences of the anticoagulant in the initial acetonitrile solutions and graphs of changes in the peak areas of rivaroxaban from its content in the blood were constructed: at a wavelength of 254 nm (R2 = 0.98) and 280 nm (R2 = 0.99). The dependence function at a wavelength of 254 nm has a larger slope, which makes it possible to reduce the detection limit of the substance being determined. The silicon dioxide content in the tube does not significantly affect the analytical signal of rivaroxaban (minimum detection limits 0.25 µg/ml, minimum determination limits 0.77 µg/ ml), and does not introduce additional error into the accuracy of the method. The median concentration of rivaroxaban was 0.32 µg/ ml (0.26; 0.49) 12 hours after taking the drug.

Conclusion. The use of a modified HPLC method with a wavelength of 254 nm selected for detecting the analytical signal makes it possible to reduce the detection limit of the substance being determined and increase the range of concentrations being determined. And the use of tubes with silicon dioxide can be recommended for decreasing the influence of the matrix effect on the quantitative determination of rivaroxaban in blood and increasing the accuracy of the method.