Aim: To compare the early outcomes of chordal transposition and chordal replacement techniques in degenerative mitral regurgitation.

Methods: 58 adult patients (mean age 57(49;64) years, 21 female) with severe degenerative type II MR (ERO 43(30;50) mm²) underwent primary MV repair were included in the prospective study. 94,7% of patients were in NYHA class II or III before surgery. The patients were randomized in two groups: 1) chordal transposition – CT – 30 patients, 2) chordal replacement – CR – 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 had not recurrent MR more than 1 degree (39,7% with MR 1 degree). Systolic anterior motion of the MV and iatrogenic mitral stenosis after valve repair were not detected. One patient had an ischemic stroke in early postoperative period in CR group. Any secondary endpoint was not reached in either group.

Conclusion: Compared non-resection techniques are effective comparable methods of MV reconstruction with good early outcomes.

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).

Materials and 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.

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.

Materials and 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.

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.

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. Statistical analysis included assessment of quantitative and qualitative indicators, odds ratio, and ROC curve analysis.

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.