Complex Issues of Cardiovascular Diseases
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”
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COMPLIANCE WITH QUALITY ASSESSMENT CRITERIA FOR PATIENTS WITH ATRIAL FIBRILLATION AT THE OUTPATIENT STAGE
Highlights For the first time, the fulfillment of criteria for assessing the quality of management of patients with atrial fibrillation at the outpatient stage and their contribution to the impact on the endpoints after a year of follow-up was analyzed. On average, at least 5 quality criteria are met in more than 50% of patients. The hypothesis of the predictor of CC for outcomes after one year has not been confirmed by endpoints (emergency calls p = 0.967; death from CVD p = 0.179; TIA p = 0.383; all deaths p = 0.220). The possibility of using 6 quality criteria as a diagnostic feature in the presence of paroxysmal AF with a sensitivity of 93.3 was found %; the specificity is 39.7%. Aim. To study the clinical and functional characteristics of patients with AF followed in primary healthcare, and to assess the effectiveness of DO for patients with AF after one year of outpatient follow-up based on endpoints such as the frequency of EMS calls, CVD hospitalizations, CVD death, and death from other causes, depending on adherence to QC. Methods. The study included 108 patients with non-valvular AF. All patients underwent a general clinical examination, assessment of adherence to QC, selection of a heart rate (HR) control strategy, therapy adjustment, patient education, and recommendations for further follow-up. After one year of DO, the patient was invited for a follow-up appointment with a cardiologist. Over the year, data on newly diagnosed diseases, EMS calls, hospitalizations due to CVD, frequency of TIA, deaths and their causes were collected in the information system. Results. A comprehensive characterization of patients with AF is presented, including clinical, functional, and instrumental characteristics, and the frequency of adherence to QC according to regulatory documents. Out of 13 assessed QC at the outpatient stage, 5 were met in 50% of patients, and more than 5 QC were met in 50% of patients. The hypothesis about the possibility of using QC as predictors of outcomes after 1 year of follow-up (such as EMS calls, CVD hospitalizations, CVD deaths, and others) was tested. This hypothesis was not confirmed. According to the results of the analysis of the frequency of endpoint development in the groups with and without compliance with the CC, no significant differences were found the results for endpoints were as follows: frequency of EMS calls (p = 0.967), CVD hospitalizations (p = 0.725), CVD death (p = 0.179), development of TIA (p = 0.383), all-cause mortality (p = 0.220). In the group of patients with adherence to 5 or fewer QC, hospitalizations during the subsequent year were statistically significantly more frequent (p = 0.015). Conclusion. On average, no fewer than 5 QC are met. When assessing endpoints, no statistically significant association with the number of QC is observed. Patients with AF for whom 5 or fewer QC were met on an outpatient basis are hospitalized due to CVD more often during the one-year follow-up period
CORRELATION BETWEEN SMOKING AND LIPID AND CERAMIDE METABOLISM DISORDERS AMONG COAL MINING WORKERS
Highlights Smoking and dyslipidemia are common cardiovascular risk factors among workers of the coal sector of the economy. Although non-smokers exhibit a more unfavorable profile of lipid metabolism, it has been found that smoking contributes to the development of various variants of dyslipidemia. Aim. To investigate the correlation between lipid and ceramide metabolic disorders and smoking status among coal industry workers. Methods. The study included 209 coal miners, they were examined and divided into three groups based on their smoking status: current smokers (44%), former smokers (39.9%), and non-smokers (26.8%). Dyslipidemia and ceramide profile were assessed in those analyzed groups. Results. Among the participants, 73.2% were former smokers, and 44% were current smokers. 64.6% of the participants had dyslipidemia, the predominant types of dyslipidemia were hypercholesterolemia (61.7%), high levels of apolipoprotein B (ApoB) (50.7%), and low-density lipoprotein cholesterol (LDL) (34.5%). Low levels of very-low-density lipoproteins (VLDL) and apolipoprotein A were rare, and no individuals had high levels of lipoprotein(a). Statistical differences were revealed only in the content of LDL, which was higher (p = 0.007) in the group of non-smokers (3.03 (2.43; 3.51) mmol/L) compared with former smokers (2.66 (2.11; 3.22) mmol/L). The ApoB content was statistically comparable in the groups of current smokers and non-smokers, but higher than in the group of former smokers, however, there were no significant differences in the proportion of people with elevated ApoB levels. Ceramide concentrations were not affected by smoking status. Correlation analysis showed an association between smoking and total cholesterol, triglycerides, ApoB, and some types of ceramides. Multivariate and correlation analyses confirmed the effect of smoking on dyslipidemia development. Thus, smoking causes hypertriglyceridemia in 27.81% of respondents, an increase in VLDL in 18.76% of cases, an increase in LDL and ApoB in 18.76%, a decrease in ApoA and an increase in ApoB in 14.87%, and an increase in Lp(a) and hypercholesterolemia in 13.31%. Conclusion. Smoking and dyslipidemia are common among workers of the coal industry. Hypercholesterolemia and elevated ApoB levels are the most common variants of dyslipidemia. The analysis of the ceramide profile showed no statistically significant differences. The lipid profile is worse in non-smokers, but the results of an in-depth analysis suggest that smoking affects different forms of dyslipidemia.
ANALYZING THE BUDGET IMPACT OF NEW ORAL ANTICOAGULANTS AND ENDOVASCULAR LEFT ATRIAL AURICULAR CLOSURE IN PATIENTS WITH ATRIAL FIBRILLATION
Highlights This study is the first in Russian Federation to evaluate the impact of left atrial appendage closure (LAAC) on the healthcare budget based on real clinical data. The work demonstrates the clinical and economic advantages of LAAC over conventional anticoagulant therapy in patients at high risk of complications. Aim. To evaluate the clinical and cost-effectiveness of left atrial appendage closure (LAAC) compared with novel oral anticoagulants (NOAC) on the basis of real patient data, and to perform a scenario analysis of the impact of these approaches on the healthcare budget in the Russian Federation. Methods. The study included 145 patients divided into two groups: LAAC (n = 46) and NOAC (n = 99). The mean age was 65.5 ± 8.1 years in the LAA closure group and 67 ± 7.0 years in the NOAC group. Patients with LAA closure had a higher risk of thromboembolic and haemorrhagic complications. Direct medical costs were estimated based on the cost of procedures, drugs, and complications. Budget impact analyses were performed over a 5- and 10-year horizon, taking into account a 29% increase in the use of LAAC each year. Results. LAAC provides higher survival (95.7% vs. 79.8%) and complication-free survival (74.0% vs. 60.6%) compared to NOAC. Direct treatment costs are 405,754 RUB per patient for LAAC and 10,116 RUB for NOAC. Scenario analysis showed that over 10 years, if the share of LAA closure increases, costs will increase from 900.344 RUB billion to 920.516 billion RUB. The difference between the scenarios was 2.017 billion RUB, indicating an increase in the economic burden when the technology is scaled up. Conclusion. LAA closure is a clinically effective strategy with the potential for cost-effectiveness in the long term. It can be recommended for patients at high risk of stroke, in case of limited healthcare resources. However, successful implementation of the technology requires additional training of specialists and quality control of procedures.
THE SPECIFICS OF THE INTERVENTION ON THE HEART WITH INFECTIOUS ENDOCARDITIS DURING ROSS C SURGERY IN A PATIENT
Highlights The use of Ross surgery for endocarditis is most effective in IE, and in young patients with progressive pathology this is the preferred treatment method. After removal of the autograft, an unprecedented exposure of the exit tract of the left ventricle is achieved. Even in patients with very advanced pathology, the excretory tract of the left ventricle usually remains intact, which allows the autograft to be implanted in a standard way. For individual patients with simple endocarditis, Ross surgery is an attractive option for its usual advantages. Aim. To evaluate the immediate results of the Ross procedure (using allografts and autografts) in patients with infective endocarditis. Methods. The study included 17 patients with infective endocarditis of the aortic valve who underwent the Ross procedure. The mean age of patients was 34 ± 8.5 years (range 18–55 years). Patients over 35 years underwent preoperative coronary angiography. All patients underwent transthoracic echocardiography (TTE) before and after surgery, as well as intraoperative transesophageal echocardiography. Results. Hospital mortality was 11.76% (2 cases) due to severe course of the disease with widespread valve damage and severe heart failure. Intraoperative echocardiography revealed no autograft insufficiency in any patient. No fatal outcomes were registered in the long-term period. During the follow-up period (3–56 months), one case of probable recurrent right-sided endocarditis was recorded in a patient with drug addiction. One patient underwent reoperation due to homograft stenosis. Conclusion. The Ross procedure demonstrates high efficiency in treating infective endocarditis of the aortic valve, especially in young patients with progressive pathology. The technique provides optimal visualization of the left ventricular outflow tract after autograft removal. With preserved left ventricular outflow tract, standard autograft implantation is possible even in patients with severe pathological changes. In uncomplicated IE cases, the Ross procedure can be considered as the method of choice due to its advantages.
A COMPARISON OF EARLY RESULTS OF NON-RESECTION TECHNIQUES FOR CORRECTING DEGENERATIVE MITRAL REGURGITATION
Highlights Non-resection repair techniques – transposition of secondary chordae and chordal replacement – in mitral valve prolapse showed comparable short-term results, which indicated the effectiveness of the methods. Aim. To compare the early outcomes of chordal transposition and chordal replacement techniques in patients with degenerative mitral regurgitation. Methods. The prospective study included 58 adult patients (mean age 57 (49; 64) years, 21 female) with severe degenerative type II MR (ERO 43 (30; 50) mm2) who underwent primary MV repair. 94,7% of patients were in NYHA class II or III before surgery. The patients were randomized in two groups: 1) chordal transposition (CT) group included 30 patients, 2) chordal replacement (CR group) included 28 patients. Mitral prosthetic ring implantation was performed in all cases. Transthoracic echocardiography was performed one year after surgery. Results. Successful MV repair was accomplished in all patients without conversion to valve replacement. Both groups had comparable structural and functional ultrasound heart characteristics in postoperative period. Patients in both groups did not have recurrent MR of more than 1 degree (41% with MR 1 degree). Systolic anterior motion of MV and iatrogenic mitral stenosis after valve repair were not detected. One patient in the CR group had an ischemic stroke in early postoperative period. No other secondary endpoints were reached in either group. Conclusion. Compared non-resection techniques are effective comparable methods of MV reconstruction with good early outcomes.
TELOMERE LENGTH REGULATION IN WISTAR RATS UNDER SUBCHRONIC LOW-DOSE DOXORUBICIN EXPOSURE
Highlights Doxorubicin is an anthracycline chemotherapeutic drug that stops proliferation, activates apoptosis, and has cumulative and dose–dependent cardiotoxicity. The cardiotoxicity of anthracyclines is based on damage to myocardial cells, accompanied by left ventricular dysfunction. Telomere dysfunction plays an important role in cellular aging processes that are associated with myocardial damage. Aim. To evaluate the expression of genes encoding proteins involved in the regulation of the length of telomeric DNA regions of Wistar rat cardiomyocytes under subchronic low-dose doxorubicin exposure. Methods. The study included two groups of male Wistar rats: an experimental group (10 rats, weekly injection of doxorubicin into the tail vein at a dosage of 2 mg/kg for 4 weeks) and a control group (10 rats, weekly injection of 0.9% NaCl into the tail vein for 4 weeks). The expression level of TERT and shelterin genes Trf1, Trf2, Rap1, Tin2, Tpp1 and Pot1 was determined using PCR. Results. The experimental group was characterized by increased expression of the shelterin genes Trf1, Trf2, Tpp1 and Tin2 compared to the controls. The mRNA level of Pot1 and Rap1 was lower in the experimental group compared to the controls. The TERT gene was expressed at an extremely low level. Conclusion. The study findings revealed that the lengthening of telomeric regions of DNA in Wistar rat cardiomyocytes in response to subchronic low-dose exposure to doxorubicin is due to changes in the expression profile of genes encoding proteins responsible for maintaining telomere homeostasis, and probably occurs due to the triggering of the mechanism of alternative lengthening of telomeres.
EXPRESSION OF ADIPONECTIN AND ITS RECEPTORS IN ADIPOSE TISSUE OF EPICARDIAL AND PERICORONARY LOCALIZATION OF PATIENTS WITH CARDIOVASCULAR DISEASES
Highlights Numerous studies support the role of adiponectin (AN) in the pathophysiology of the cardiovascular system (CVS). Clinical data indicate an association of low serum AN level with coronary artery disease (CAD) and an increased risk of atherosclerosis. The lack of data on the expression of high-molecular-weight adiponectin (HMW-ADPN) and its receptors in epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) highlights the need for further research to understand their role in the development of cardiovascular diseases (CVD). Aim. To evaluate the expression features of total adiponectin (ADPN), high-molecular-weight adiponectin (HMW-ADPN) and its receptors in epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) of patients with cardiovascular diseases (CVD). Methods. The study included 156 patients with stable coronary artery disease and 120 patients with degenerative non-rheumatic valvular heart disease. Patients in the study groups were matched for gender, age, and body mass index. During surgery, 3–5 g samples of subcutaneous, epicardial, and pericoronary AT (SAT, EAT, and PCAT) were obtained. Adiponectin gene expression (ADIPOQ) was determined by quantitative real-time polymerase chain reaction (qRT-PCR). Total ADPN, HMW-ADPN, and ADPN receptor concentrations were determined by enzyme immunoassay according to the manufacturers’ protocols. Statistical analysis was performed using GraphPad Prism 8 and Statistica 12.0. Results. Patients with coronary atherosclerosis had low ADIPOQ mRNA levels, low total ADPN and AdipoR1 receptor levels in EAT adipocyte cultures compared to SAT adipocytes and the acquired heart defects (AHD) group. The levels of HMW-ADPN and AdipoR2 were minimal in both EAT and PCAT adipocyte cultures, which were higher among individuals with ADP. Severe and extremely severe coronary artery disease was associated with low ADIPOQ mRNA expression and low HMW-ADPN levels in EAT and PCAT and AdipoR2 deficiency in EAT. Conclusion. Coronary atherosclerosis is characterized by the presence of HMW-ADPN and ADPN receptor deficiency not only in EAT adipocytes but also in PCAT adipocytes. A decrease in the level of HMW-ADPN secretion in adipocytes of EAT and PCAT and the expression of AdipoR2 in EAT is associated with more severe coronary artery disease.
MOLECULAR MARKERS OF ENDOTHELIAL DYSFUNCTION IN PRIMARY HUMAN CORONARY ARTERY AND INTERNAL THORACIC ARTERY ENDOTHELIAL CELLS
Highlights Endothelial cell dysfunction is accompanied by reduced expression of genes encoding endothelial phenotype markers, basement membrane proteins, and extracellular matrix components. Primary human coronary artery and internal thoracic artery endothelial cells have distinct molecular profile of endothelial phenotype markers, basement membrane components, and angiogenic proteins. In comparison with primary human coronary artery endothelial cells, profile of basement membrane and extracellular matrix components of human internal thoracic artery endothelial cells is more similar to intact endothelial cells. Aim. To compare the gene and protein expression profile in primary human coronary artery endothelial cells (HCAEC) and human internal thoracic artery endothelial cells (HITAEC) in physiological and dysfunctional states. Methods. To perform an unbiased and high-throughput analysis, we applied RNA sequencing and ultra-high performance liquid chromatography-tandem mass spectrometry. Fold change and transcripts per million were used as metrics to evaluate RNA sequencing results. Mass spectrometry data were assessed by ranking the expression of 2,986 detected molecules after measuring areas of respective chromatographic peaks. Results. Dysfunctional ECs showed decreased expression of the genes encoding endothelial phenotype markers, basement membrane components, extracellular matrix proteins, and angiogenic molecules, concurrently having higher expression of the genes encoding oxidative and endoplasmic reticulum stress proteins. In comparison to HITAEC, HCAEC had higher expression of angiogenic proteins (including B-type ephrin receptors EPHB2 and EPHB4) and both subunits of endothelial integrin αvβ3 (ITGAV and ITGB3). In turn, HITAEC had higher expression of endothelial transcription factors ERG and FLI1, angiopoietins (ANGPT2 and ANGPTL2) and their receptors (PTPRB and TEK), VEGF co-receptors (NRP1 и NRP2), and also higher expression of basement membrane and extracellular matrix components which have been overexpressed in the intact ECs (such as laminin, type IV collagen, von Willebrand factor, angiopoietin-related protein 2, biglycan, nultimerin 1, cathepsin С, and ADAMTS4). Conclusion. Dysfunctional ECs have lower expression of basement membrane and extracellular matrix components. HCAEC and HITAEC have significant differences in the molecular profile of endothelial phenotype markers, basement membrane proteins, extracellular matrix components, and angiogenic proteins.
HEALTHY LIFE EXPECTANCY IN CENTRAL ASIA: THE ATHEROGENIC ENVIRONMENT AND REGIONAL FEATURES OF CARDIOMETABOLIC PREVENTION
Highlights Within a shared urban environment in Central Asia, three distinct ethnocultural groups (Uzbeks, Russians and Koreans) display a broadly similar cardiometabolic phenotype characterized by excess body weight, insulin resistance and triglyceride-driven atherogenicity. In men with arterial hypertension and type 2 diabetes, a more pronounced residual-risk profile is observed, including higher triglycerides, non-HDL cholesterol, a higher atherogenic index of plasma and lower eGFR. The findings support the need for environment-focused preventive interventions (nutrition, physical activity, urban design) and for intensifying lipid-lowering therapy already in midlife, in order to increase healthy life expectancy in the region. Background. In Central Asian countries, rising life expectancy coexists with persistently high cardiovascular mortality. It is assumed that an atherogenic environment (energy-dense diets, low everyday physical activity, heat exposure, air pollution and chronic stress) amplifies insulin resistance and triglyceride-driven atherogenicity in middle-aged and older adults. Aim. To characterize the lipid and metabolic profile of Central Asian residents aged ≥ 50 years; to assess indices of triglyceride-mediated atherogenicity and insulin resistance and their association with sex, arterial hypertension (AH), type 2 diabetes (T2D), carotid atherosclerosis and statin use; and to demonstrate that the impact of a shared urban environment outweighs ethnic differences. Methods. We conducted a single-centre cross-sectional study in Tashkent (December 2024 – August 2025; cut-off date 4 September 2025). We enrolled 167 participants (Uzbeks n = 108, Russians n = 46, Koreans n = 13; 66% women) aged ≥ 50 years, born and living in Central Asian countries. Anthropometry, biochemical and hematological tests, and carotid duplex ultrasonography were performed. The following indices were calculated: non-HDL-C, AIP, TG/HDL-C, remnant cholesterol, HOMA-IR, QUICKI, TyG and eGFR (CKD-EPI 2021). Statistical analyses included the t-test/Mann–Whitney test, Fisher’s exact test and Spearman’s ρ; multiple testing was controlled using Benjamini–Hochberg FDR correction; α = 0.05. Results. Across all ethnic groups, women showed a more favorable lipid profile (higher HDL-C, lower Castelli I/II, AIP and TG/HDL-C), whereas men more often exhibited a combined dyslipidemia phenotype (elevated TG, non-HDL-C and AIP). Among Uzbek men, HOMA-IR 5.0 ± 3.7 and QUICKI 0.33 ± 0.03 reflected marked insulin resistance; similar patterns were observed in the Russian and Korean strata. The presence of T2D was associated with higher glucose, insulin, HOMA-IR, AIP, non-HDL-C and triglycerides, and with lower eGFR in all sex-ethnic subgroups. In patients with AH, BMI, TG, AIP and HOMA-IR were higher. Under statin therapy, total cholesterol/LDL-C/non-HDL-C were reduced, but AIP and TG/HDL-C remained elevated; fewer than 40% of treated patients achieved LDL-C targets. Correlation analysis demonstrated robust positive associations of AIP, TG/HDL-C and non-HDL-C with HOMA-IR and TyG, and inverse correlations with HDL-C. The direction of effects was preserved after stratification by sex and ethnicity. Conclusions. Within a common urban environment in Central Asia, triglyceride-driven atherogenicity on a background of insulin resistance predominates, with a less favorable phenotype in men and in those with T2D and AH, irrespective of ethnic origin. Practical priorities include expanded lipid assessment (non-HDL-C, remnant-C, AIP, TyG), intensification of lipid-lowering therapy (high-intensity statins ± ezetimibe/EPA), early detection of insulin resistance and environment-focused preventive measures (nutrition, physical activity, urban environment). Such a strategy at both clinical and community level has the potential to increase healthy life expectancy in the region.
MODERN ASPECTS OF PATHOPHYSIOLOGY AND DIAGNOSTICS OF HEART FAILURE WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION
Highlights The pathophysiology of heart failure with preserved ejection fraction differs from heart failure with low ejection fraction. There are modern scales (HFA-PEFF and H2FPEF) that show the probability of heart failure with preserved ejection fraction. The sensitivity and specificity of both scales are insufficient. New research is needed. Abstract HFpEF is a common disease. It has a poor outlook due to high death rates and complex drug treatments. The article describes a modern view of HFpEF's pathophysiology. It focuses on the causes of myocardial remodeling. It also presents new algorithms for diagnosing HFpEF. The triggers for HFpEF are activation of the neuroendocrine system, low-level inflammation, and myocardial fibrosis. The causes and mechanisms of HFpEF are complex. So, researchers must revise current diagnostic methods. New risk scales, HFA-PEFF and H2FPEF, aim to identify HFpEF patients. Researchers are still studying their effectiveness. Using both imaging and lab tests gives a complete view of heart changes. This helps detect HFpEF with greater accuracy. The low agreement between these scales shows a need for more study of HFpEF patients, given their phenotyping. This may help develop simpler diagnostic algorithms.
OPEN SURGERY FOR ATRIAL FIBRILLATION: FROM HISTORICAL ORIGINS TO CONTEMPORARY APPROACHES (A REVIEW ARTICLE)
Highlights The literature review is dedicated to elucidating the origins of atrial fibrillation research and the key mechanisms underlying its development. The review discusses the contributions of prominent figures in the field of medicine to the advancement of atrial fibrillation surgery. The manuscript not only outlines the primary procedures performed in open atrial fibrillation surgery but also elaborates on the mechanisms of action of various energy sources. Abstract Atrial fibrillation, as the most prevalent sustained cardiac arrhythmia, remains a significant challenge in cardiac surgery. Open surgical approaches, originating with the development of the Cox-Maze procedure in the 1980s, aim to eliminate ectopic foci by creating controlled ablation lines. Modern open surgery for atrial fibrillation has evolved through the integration of energy-based ablation modalities, such as radiofrequency and cryoablation, which enable the formation of transmural lesions with reduced invasiveness. The purpose of this review article is to provide an overview of the historical development of surgical interventions for atrial fibrillation.
POTENTIAL APPLICATIONS OF INTRAVASCULAR IMAGING IN PATIENTS WITH UNPROTECTED LEFT MAIN CORONARY ARTERY LESIONS
Highlights An analysis of current literature data is presented, focusing in the evidence base for the use of intravascular imaging methods in patients with unprotected left main coronary artery disease. Abstract Coronary artery disease (CAD) is the leading cause of disability and mortality globally. In the Russian Federation, the ongoing aging of the population and the accumulation of numerous comorbid diseases necessitate physicians to increasingly manage severe forms of CAD. Percutaneous coronary intervention (PCI) presents an alternative to coronary artery bypass grafting (CABG) for the treatment of left main coronary artery (LMCA) lesions in specific patients with coronary artery disease. Stenting of the LMCA under the guidance of intravascular ultrasound imaging (IVUS) and optical coherence tomography (OCT) enhances in-hospital and long-term stenting outcomes. Nevertheless, the optimal imaging method for PCI of the LMCA remains a subject of ongoing research. This article provides a comprehensive summary of the historical background and contemporary advancements in these imaging modalities.
SURGICAL RECONSTRUCTION OF LEFT VENTRICULAR ANEURYSM IN INFANTS. DESCRIPTION OF CLINICAL CASES
Highlights The article presents a positive experience of surgical treatment of iatrogenic aneurysms of the left ventricle in two young children with a long-term follow-up period of up to 2.5 years. Abstract Left ventricular aneurysms are a rare but potentially dangerous pathology in children. Unlike adults, in whom myocardial infarction is the most common cause of LV aneurysm development, in children it is more often a consequence of traumatic damage to LV myocardium. Currently, there are no generally accepted approaches and recommendations for optimal management of such patients. The approach to managing children with this pathology is individual and depends on the overall clinical picture and the presence of concomitant conditions. Surgical reconstruction of a left ventricular aneurysm is associated with high risks of postoperative complications. This article describes two clinical cases. The first patient is a 1 year and 8 months old child undergoing resection of the aneurysmal sac and reconstruction of VSD with LV wall patching. After 30 months of follow-up, the preservation of the geometry and pumping function of the systemic ventricle of the heart was noted. The second patient is a 5 months old child undergoing LV reconstruction (Jatene technique). Normalization of geometry and restoration of LV contractile function remained throughout a follow-up period of 4.5 months. The results obtained, despite the length and severity of the postoperative period, are encouraging.
DEVELOPMENT OF CONCEPTS FOR PRIMARY HEART VALVE REPLACEMENT
Highlights Average cycle stress for the developed concepts was 413.6–528.0 MPa. Hydrodynamic tests were successful – effective orifice area was 3.41 ± 0.08 and 3.52 ± 0.07 cm2. Two frame concepts were unsuitable, and the third requires geometric optimization. Aim. To develop and analyze concepts of support frames for transcatheter aortic valves based on numerical modeling methods in order to evaluate their mechanical characteristics, strength properties and hydrodynamic efficiency. Methods. The study used three-dimensional models of the support frames created using SolidWorks software (Dassault Systemes, France). The mechanical characteristics were assessed in the Abaqus/CAE environment (Dassault Systèmes, France) using the finite element method. The study included an analysis of the stress-strain state, fatigue strength, and radial forces arising during crimping and implantation of the prosthesis. The hydrodynamic characteristics were assessed using the Pulse Duplicator II stand (Vivitro Labs, Canada), which simulates the operating conditions of the prosthesis in the left ventricle of the heart. Results. Numerical modeling analysis showed that two of the three concepts studied demonstrated exceedance of the material strength limit, which makes them unsuitable for further use. One of the concepts demonstrated lower stress levels, but some areas of the design require further refinement. Radial stability tests revealed a predictable pattern of material deformation, which confirms the stability of the design under physiological conditions. Hydrodynamic tests showed compliance of the valve operation with established standards, the absence of critical turbulence zones and acceptable regurgitation levels. Conclusion. The obtained results indicate the need for further optimization of the geometry of the supporting frame of the developed device to reduce local stresses, as well as improvement of the surface finishing technology to improve the roughness index. The manufactured prototypes of the prosthesis have satisfactory hydrodynamic characteristics.
COMPARATIVE ANALYSIS OF THE IMMEDIATE OUTCOMES OF AORTIC VALVE REPLACEMENT VIA RIGHT ANTERIOR MINI-THORACOTOMY AND J-STERNOTOMY: PROPENSITY SCORE MATCHING
Highlights A single-center study of two surgical approaches using a pseudo-randomization method revealed the advantages of mini-thoracotomy while maintaining a high level of clinical safety. Aim. To conduct a comparative analysis of the immediate outcomes of aortic valve replacement (AVR) performed via right anterior mini-thoracotomy (RAMT) and J-sternotomy (JC) within a single center. Methods. From January 2024 to April 2025, a total of 47 AVR procedures were performed using minimally invasive approaches. Of these, 17 patients underwent RAMT and 30 underwent JC. The mean age in the RAMT group was 63 [45; 68] years, compared with 67 [62; 70] years in the JC group (p = 0.040). After propensity score matching, 17 matched pairs of patients with similar baseline characteristics were identified. Results. Cardiopulmonary bypass (CPB) and aortic cross-clamp times in the RAMT group were 124 [98; 146] min and 89.06 ± 23.85 min, respectively, compared with shorter durations in the JC group: 101 [90; 115] min and 73.20 ± 18.86 min (p = 0.008). In both groups, biological prostheses were more frequently used, with a predominance in the JC group (80%). The median intraoperative blood loss in the RAMT group was 300 mL, significantly lower than 500 mL in the JC group (p < 0.001). Postoperative blood loss within the first 24 hours was also lower in the RAMT group: 150 [100; 200] mL versus 302 [205; 375] mL in the JC group (p < 0.001). The smaller intra- and postoperative blood loss corresponded with a lower need for blood transfusions in the RAMT group: 11.8% versus 43.3% in the JC group (p = 0.049). No statistically significant differences were found between the groups in terms of duration of mechanical ventilation, intensive care unit stay, or inotropic support. Similarly, no differences were observed in the incidence of adverse events. Conclusion. Despite its technical complexity, RAMT is an effective and safe approach for aortic valve replacement, combining several positive effects such as reduced blood loss, decreased transfusion requirements, and faster patient recovery.
OFF-PUMP CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH CORONARY HEART DISEASE AND CONCOMITANT VALVULAR HEART DISEASE
Highlights The relevance of the study is determined by the high importance of optimizing surgical approaches to treating patients with coronary artery disease and concomitant valve lesions: comparing myocardial revascularization techniques on a beating heart (OPCABG) and under conditions of extracorporeal circulation (ONCABG) allows identifying a strategy that ensures a reduction in intraoperative risks (shortening the time of aortic clamping and extracorporeal circulation), decreasing the need for blood transfusion, and reducing the duration of surgery and hospital stay. This collectively enhances the safety of the intervention and improves treatment outcomes for this complex category of patients. Aim. To compare the results of myocardial revascularisation (MR) in the working heart (OPCABG) with MR on cardiopulmonary bypass (ONCABG) in patients with coronary heart disease (CHD) and combined mitral and aortic valve damage. Methods. The study included 132 patients with CAD and concomitant valvular heart disease who underwent one-stage revascularization and valve surgery. Patients were divided into 4 groups: ONCABG + AV (n = 36); OPCABG + AV (n = 36); ONCABG + MV (n = 31); OPCABG + MV (n = 29). Results. The OPCABG technique demonstrated several advantages over the ONCABG technique: shorter aortic cross-clamp time (AV: 106,4 ± 25,1 min vs 83,3 ± 24,7 min / MV: 115,6 ± 21,9 min vs 84,07 ± 21,3 min, p < 0.05), reduced CPB time (AV: 139,4 ± 26,8 min vs 123,5 ± 25 min / MV: 166,2 ± 32,7 min vs 133,2 ± 34,9 min, p < 0.05), and shorter total operation time (AV: 336,1 ± 66,4 min vs 306,4 ± 71 min / MV: 352,5 ± 100,7 min vs 298,1 ± 84 min, p = 0.07). There was also a lower need for blood and blood product transfusions: packed red blood cells (AV: 2,56 ± 0,84 vs 2,2 ± 0,47 / MV: 2,81 ± 0,47 vs 2,38 ± 0,56); erythrocyte concentrate (AV: 2,36 ± 0,48 vs 1,94 ± 0,53 / MV: 2,23 ± 0,49 vs 1,83 ± 0,35), respectively p < 0.05, and a trend towards a shorter length of hospital stay (AV: 16,6 ± 6,68 vs 13,7 ± 4,3 / MV: 17,5 ± 6,4 vs 13,5 ± 4,8). Conclusions. Coronary artery bypass grafting on the beating heart in patients with concomitant valvular heart disease demonstrated several important advantages: it is a safe and effective technique that can be successfully applied in clinical practice, which in turn reduces aortic cross-clamp time, cardiopulmonary bypass time, operation time, transfusion requirements, and length of hospital stay.
AN EXPERIMENT WITHOUT CONTRAST IMPLANTATION OF STENTS INTO THE CAROTID ARTERY OF SHEEP UNDER THE CONTROL OF IVUS IN AN EXPERIMENT
Highlights Contrast‑induced nephropathy is a serious complication of endovascular procedures caused by the administration of contrast media; its incidence reaches 30 %, and no effective treatments for сontrast‑induced nephropathy currently exist. The study proposes an innovative stenting technique using external and intravascular ultrasound guidance that completely eliminates the use of contrast media and fluoroscopy, thereby avoiding the risk of developing contrast‑induced nephropathy. The use of intravascular ultrasound as a substitute for conventional angiography has the potential to reduce or completely eliminate the need for fluoroscopy and contrast media during stenting; this technique has demonstrated safety and efficacy, but requires further clinical research. Aim. To develop a technique for contrast-free and fluoroscopic stenting in an experiment using intravascular ultrasound. Methods. In the experiment, six healthy sheep of the Edilbaev’s breed, under general anesthesia and under the control of percutaneous ultrasound, underwent puncture of the common carotid artery. After systemic heparinization (2 500 units), a IVUS sensor was installed to assess the reference diameter of the vessel and select the required stent size. In parallel to the sensor, the stent is placed 0.5–1.0 cm distally. After positioning, the IVUS sensor was inserted into a conductive catheter for further monitoring. The stent was implanted with a nominal pressure (9–10 atm), after which the IVUS was monitored, and when a malformation was detected, postdilation with a balloon from under the stent (14–16 atm.) was performed with a re-evaluation of the result. Coronary balloon-expandable stents were implanted in sheep, sizes 5 × 8 mm and 4.5 × 10 mm were used. Results. Suturing of the puncture site was performed using an Angio-seal device. In the postoperative period, all animals were prescribed double antiplatelet therapy. On a control ultrasound 3 months after stenting, the stents are passable. Conclusion. The problem of reducing the fluoroscopy time and the amount of contrast used remains one of the most urgent today. The use of IVUS, as a replacement for the usual angiography, can potentially lead to a decrease or even complete absence of X-ray and CA during stenting. The technique demonstrated above has shown its safety and viability. However, this methodology requires further clinical studies.
RESULTS OF PRECLINICAL STUDIES OF POLYMER PATCHES WITH PROANGIOGENIC FACTORS AND ANTI-TROMBOGENIC COATING ON A PRIMATE MODEL
Highlights Patency of polymer patches with pro-angiogenic factors and anti-thrombogenic coating in the femoral artery of baboons reached 80% at 6 months post-implantation. No intimal hyperplasia, aneurysmal dilation, inflammation, or calcification was observed. In all patent patches, neointima formed on the luminal surface, fully lined by an endothelial monolayer; pronounced bioreabsorption of the polymer wall was absent. Thus, the patches demonstrated high functionality and biocompatibility upon long-term implantation. Aim. To conduct preclinical trials of polymer patches with proangiogenic factors and an anti-thrombotic drug coating in a primate model, assessing their long-term patency and remodeling. Methods. Polymer patches were fabricated using emulsion electrospinning from a polycaprolactone-polyurethane composite with a complex of proangiogenic factors. The surface of the patches featured a hydrogel coating incorporating iloprost and heparin. The polymer patches were implanted into the femoral artery of five adult male baboons for 6 months. Ultrasound examination of the femoral artery patency with the implanted patches was performed 5 days, 1, 3, and 6 months after implantation. Explanted patches and adjacent femoral artery segments were examined using stereomicroscopy and scanning electron microscopy, as well as histological and immunofluorescence studies. Statistical data processing was performed using GraphPad Prism 8. Results. The patency rate of polymer patches at 6 months post-implantation was 80.0%. The absence of neointimal hyperplasia and aneurysmal dilation of the patch wall was confirmed. After 6 months of implantation, the polymer patches showed no significant bioresorption. In all patent patches, a neointima developed without signs of hyperplasia, which was fully covered by an endothelial monolayer along the entire length of the patch. A well-vascularized neoadventitia had formed on the outer surface of the patches. Conclusion. At 6 months post-implantation of polymer patches with proangiogenic factors and an anti-thrombotic coating into the femoral arteries of baboons, patency rate was 80.0%. The patent patches exhibited the formation of an endothelial monolayer, neointima, and neoadventitia, with no significant resorption of the polymer wall. No signs of concomitant inflammation, calcification, or aneurysm formation were detected.
PRO-INFLAMMATORY ACTIVATION OF ENDOTHELIAL CELLS AND MONOCYTES AT CALCIUM STRESS
Highlights Pathophysiological calcium stress (5 μg calcium per 1 mL) causes the release of pro-inflammatory cytokines, soluble membrane receptor forms, and pro-angiogenic factors into the cell culture medium by endothelial cells regardless of the stress source (free calcium ions, calciprotein monomers, and calciprotein particles). Exposure of monocytes to fetuin-centric calciprotein monomers and calciprotein particles (5 μg calcium per 1 mL) increased the expression of endothelial cell-ligating receptors, elevated the release of pro-inflammatory and pro-thrombotic molecules, and induced adhesion of monocytes to endothelial cells under the pulsatile flow. Intravenous administration of fetuin-centric calciprotein monomers and calciprotein particles (5 μg calcium per 1 mL) to Wistar rats induced higher pro-inflammatory response then free calcium ions, and increases the release of soluble endothelial receptor forms, pro-inflammatory molecules, pro-thrombotic molecules, bioactive matrikines, and hepatokines. Aim. To define the pathological effects of free calcium ions (Ca2+), fetuin-centric calciprotein monomers (CPM-F), and fetuin-centric calciprotein particles (CPP-F) on endothelial cells (ECs) and monocytes. Methods. Primary human coronary artery endothelial cells (HCAEC) and human internal thoracic artery endothelial cells (HITAEC) and human monocytes were incubated with Ca2+ (using CaCl2 as a donor), calciprotein monomers, and calciprotein particles to induce pathophysiological calcium stress (5 μg per 1 mL, equal to ≈ 10% increase in Ca2+) with the following analysis of the gene expression and measurement of the pro-inflammatory molecules in the cell culture medium by dot blot profiling. Adhesion of ECs to monocytes was performed after their co-culture under the 24 hours of pulsatile flow. Systemic inflammatory response was conducted by the intravenous injections of CaCl2, CPM-F, and CPP-F to Wistar rats with the subsequent measurement of pro-inflammatory molecules in the serum by dot blotting. Results. Regardless of the calcium stress mode (Ca2+, CPM-F, or CPP-F), it has led to the increased release of: 1) pro-inflammatory cytokines (IL-6, IL-8, MCP-1/CCL2, CCL5/RANTES, GM-CSF, CXCL1/GROα, MIF); 2) soluble endothelial receptor forms (CD31/PECAM-1, CD105/ENG, CD147/BSG, CD106/VCAM-1) indicating cell death or pathological shedding of these receptors; 3) pro-angiogenic factors (angiogenin, angiopoietin-2, HGF, PDGF, SDF-1α) into the cell culture medium by ECs. Exposure of monocytes to CPP-F elevated the expression of the genes encoding EC-ligating receptors (ITGB1, ITGA4, SELPG), whilst treatment with CPM-F and CPP-F increased the release of pro-inflammatory (lipocalin-2/NGAL, MMP-9, and myeloperoxidase), pro-angiogenic (angiogenic, BDNF), and pro-thrombotic (uPAR, PAI-1, thrombospondin-1) molecules by monocytes. After 24 hours of co-incubation in the pulsatile flow system, monocytes showed an increased adhesion to ECs upon the treatment with Ca2+, CPM-F, or CPP-F. Intravenous administration of CPM-F or CPP-F to Wistar rats elevated an increased release of soluble endothelial receptor forms (VCAM-1/CD106, ICAM-1/CD54), pro-inflammatory molecules (CXCL7, CCL11/eotaxin, FLT3LG), pro-thrombotic molecules (PAI-1), matrikines (fibulin-3, osteopontin, endostatin, CCN3, MMP-3), hepatokines (hepassocin, fetuin-А, RBP4, IGF-1, IGFBP-2/3/5/6), and proteins of metabolic pathways (resistin, RAGE, lipocalin-2/NGAL). Conclusion. Our results indicate the pathophysiological relevance of endothelial and monocyte activation under calcium stress in context of endothelial dysfunction.
ACUTE HEART FAILURE AND DECOMPENSATED HEART FAILURE: THE IMPORTANCE OF MULTIMORBIDITY (LITERATURE REVIEW)
Highlights Understanding the interaction between various diseases in patients with acute heart failure and acute decompensated heart failure is key to developing effective prevention and management strategies aimed at improving the quality of medical care and reducing morbidity and mortality among this group of patients. Abstract Acute decompensated heart failure (ADHF) is a serious clinical condition that is often accompanied by multimorbidity, i.e. the presence of several chronic diseases simultaneously. These comorbidities significantly complicate the diagnosis, treatment and prognosis of outcomes in patients with ADHF. The review considers the most common comorbid conditions, such as arterial hypertension, diabetes mellitus, chronic kidney disease, obesity, depression and cognitive impairment. Each of these factors individually, as well as together (synergistically), affects the course of ADHF, increasing the risk of complications and worsening the patient's quality of life. Emphasizes the importance of an integrated approach to the management of patients with ADHF and multimorbidity. Early detection and pathogenetic therapy of comorbidities can reduce the frequency of hospitalizations, improve the functional capabilities of patients and increase life expectancy. Thus, understanding the interactions between various diseases in patients with ADHF is key to developing effective prevention and treatment strategies aimed at improving the quality of medical care and reducing morbidity and mortality in this group of patients.
ENDOCARDITIS CAUSED BY HACEK GROUP MICROORGANISMS
Highlights A systematic review of modern scientific data on the etiology, epidemiology, pathogenesis, features of laboratory diagnostics and etiotropic treatment of endocarditis by HACEK was conducted. To analyze the research, we used information platforms and scholarly search services such as PubMed, Web of Science, Google Scholar, eLIBRARY.RU, and CyberLeninka. The search was carried out by keywords; after the initial analysis, 45 articles were selected. Further study of the epidemiological, clinical, immunopathological and microbiological aspects of Infective endocarditis by HACEK is necessary. Abstract Infective endocarditis caused by HACEK group microorganisms (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella corrodens, and Kingella spp.) is a rare but potentially life-threatening condition that requires timely diagnosis and adequate treatment. This review analyzes current data on the epidemiology, microbiological features, diagnosis, treatment, and prognosis of HACEK endocarditis. Regional differences in the prevalence of the disease, risk factors, and predictors of its development in various patient categories are highlighted. The clinical manifestations of HACEK endocarditis are characterized in detail. The possibilities of laboratory diagnosis of HACEK endocarditis with an emphasis on culture and molecular genetic methods are considered. Modern approaches to antibacterial therapy and surgical treatment of the disease, taking into account the increasing antibiotic resistance of pathogens, are analyzed. Data on hospital mortality of patients with HACEK endocarditis are presented. Unresolved problems and promising directions for further research of this pathology are identified.
PATHOPHYSIOLOGY OF MYOCARDIAL INFARCTION: HISTORICAL ESSAYS AND NEW HORIZONS
Highlights In the analytical review, the main pathophysiological mechanisms of myocardial infarction development are presented, including complex molecular processes that lead to ischemia and necrosis of the heart muscle. Historically, understanding of this condition has come a long way from its first descriptions to modern diagnostic and treatment methods, which have significantly improved the prognosis for patients with MI. Understanding the history and pathophysiology of myocardial infarction is key to medical practice, research, and patient education. This knowledge contributes to improved diagnosis, treatment, and prevention, which ultimately leads to improved quality of life for patients and a reduced burden of cardiovascular disease at the societal level. Abstract Understanding the historical aspects and pathophysiology of myocardial infarction is important for both medical professionals and patients. Knowledge of the mechanisms of myocardial infarction development allows physicians to more accurately assess the patient’s condition and choose optimal treatment methods, including drug therapy and interventional procedures. An analysis of scientific literature and articles published over the past decade was conducted using the resources of the PubMed and eLibrary search engines using the following keywords: atherosclerosis, history of myocardial infarction, pathophysiology of myocardial infarction, ischemic heart disease, pathogenesis of atherothrombosis, endothelium, inflammation. In the selection, preference was given to systematic reviews and meta-analyses as sources with the highest level of evidence, as well as randomized controlled trials (RCTs), large cohort studies and authoritative clinical guidelines.