Aim. To compare the circumstances of the prehospital deaths among patients with acute myocardial infarction (AMI) in Tomsk in 1984 and 2018.

Methods. Population-level data were collected from the WHO project “Acute Myocardial Infarction Registry”. In 1984, 739 cases of AMI were recorded, in 2018 - 924 ones. 262 (35.5%) and 359 (38.9%) deaths occurred in the acute phase, respectively. Of them, 158 (60.3%) and 148 (41.2%) patients died in the prehospital setting. 66 (41.8%) and 46 (31.1%) cases of deaths were selected for further analysis.

Results. In 2018, the number of patients who did not receive timely medical care decreased from 74.2% to 52.2%, compared to 1984 (p <0.05). The number of cases when patients failed to call the ambulance due to a rapid loss of consciousness (cardiac arrest) or managed to call, but died before the ambulance arrived, was similar. The number of death among patients who received emergency medical services (EMS) increased from 25.8% to 47.9% (p <0.05).

Conclusion. Prehospital mortality from AMI in Tomsk has improved over thirty years, but not drastically. Despite the number of patients who died before the first medical contact has decreased, they still make up about half of all cases. Every 4th-5th patient fails to contact EMS. In terms of reducing prehospital mortality, measures focused on the regular clinical examination of patients with cardiovascular diseases seem to be more promising for effective secondary prevention of coronary artery disease and AMI.

Background. Monitoring of hemostasis in patients with pulmonary embolism (PE) to assess the efficacy and safety of anticoagulant therapy is one of the most emerging needs in clinical practice.

Aim. To determine the factors associated with an insufficient decrease in the rate of fibrin clot formation in patients after pulmonary embolism receiving anticoagulation therapy.

Methods. 33 patients were recruited in the study. To control plasma hemostasis, we measured coagulogram indices and performed dynamic thrombophotometry (T-2 Thrombodynamics Registrar, GemaCore, Russia).

Results. The median rate of fibrin clot formation in the general sample of patients was within the normal range. However, 13 patients (39.4%) had these values higher than 29 pm/min. Patients with an insufficient decrease in the rate of fibrin clot formation were significantly younger (p = 0.045), more often had massive PE of the main branches of the pulmonary artery (p = 0.015), and high systolic pulmonary artery pressure (p = 0.043).

Conclusion. Thrombodynamics allows identifying patients with PE and an increased thrombogenic potential under anticoagulation therapy by the end of the hospital stage. A high rate of fibrin clot formation by the end of the hospital period is observed in younger patients with thrombosis of the main branches of the pulmonary artery and high pulmonary hypertension.

Aim. To study serum levels of Klotho protein in men with arterial hypertension and to explore its association with some cardiometabolic risk factors.

Methods. 134 men with hypertension aged 50-65 years old and over 80 years old were enrolled in a study. 44 men of the corresponding age without high blood pressure were enrolled in the control group. Serum levels of Klotho protein were measured using ELISA.

Results. Both, the study and the control group, have similar serum levels of Klotho protein (464 [287; 849] and 458 [128; 1121] pg/dL, respectively; p>0.05). Significant differences in the serum levels of Klotho protein in the study groups are related to three risk factors: physical inactivity, obesity, and the presence of diabetes mellitus. A positive correlation between Klotho protein levels and regular physical activity has been found in men with arterial hypertension. Besides, negative correlations between Klotho proteins and diabetes mellitus and obesity have been stated. Multivariate analysis reports a positive association between Klotho protein and regular physical activity in men with hypertension regardless of their age, diabetes, lipid disorders, and obesity.

Conclusion. Men with arterial hypertension and without it have similar Klotho protein levels. Serum Klotho protein levels are lower in obese men who are physically inactive. Klotho protein levels are lower in men with hypertension and concomitant diabetes mellitus. Klotho protein is positively associated with regular physical activity regardless of age and some cardiometabolic risk factors in men with arterial hypertension.

Aim. To evaluate the quality of reperfusion, medical therapy, as well as the short-term outcomes in patients with acute coronary syndrome (ACS) in 2018 using the data of the national ACS registry.

Methods. Medical records of 30,594 ACS patients (62% - men, the mean age of 65±11,2 years) treated in 30 regions of the Russian Federation in 2018 were selected in the National ACS Registry and analyzed. The rate and timing of percutaneous coronary intervention (PCI) and fibrinolysis, prescription of aspirin, clopidogrel, beta-blockers, statins, and in-hospital mortality rate were assessed.

Results. Fibrinolysis was performed in 29.9% of patients with ST-segment elevation acute coronary syndrome. 54,3% of patients with ST-segment elevation ACS underwent PCI. 47.7% and 60.5% of patients were treated within 30 minutes of first medical contact to fibrinolysis and 90 minutes to primary PCI. 95.6% of patients received aspirin, 84.9% - clopidogrel, 88.8% - beta-blockers, and 93.4% - statins. The inhospital mortality was 2.9%.

Conclusion. The main clinical performance and quality measures for medical therapy in 2018 were high according to the National ACS Registry. PCI prevailed among the selected reperfusion strategies. However, the timing of both, PCI and fibrinolysis, was insufficient.

Aim. To assess the effects of combined myectomy with mitral valve repair on a three-dimensional model of the mitral valve in patients with obstructive hypertrophic cardiomyopathy.

Methods. 24 patients with obstructive hypertrophic cardiomyopathy and left ventricular outflow obstruction over 50 mm Hg at rest were recruited in a study. Eight patients underwent combined myectomy with mitral valve repair according to the Carpentier method. Seven patients underwent the Alfieri's edge-to-edge repair, and nine patients underwent secondary chordae resection using the Ferrazzi’s technique. Before combined myectomy and two weeks after it, all patients underwent standard transthoracic echocardiography and real-time 3D transesophageal imaging of the mitral valve, followed by quantitative 3D reconstruction of the mitral valve and calculation of the annulus, the leaflets, and the aorto-mitral angle.

Results. Despite the selected mitral valve repair technique, we observed a decrease in the LVOT obstruction gradient. There were no differences in the residual obstruction gradient between the selected mitral valve repair technique. Patients with obstructive hypertrophic cardiomyopathy, who underwent combined myectomy and posterior mitral leaflet plasty valve according to the Carpentier approach, reported a correlation of a decrease in the LVOT obstruction with the non-planar angle (r = -0.83; p = 0.040), sphericity index (r = 0.83; p = 0.04) and a decrease in the velocity excursion of the annulus (r = 0.94; p = 0.005). Patients who underwent the Alfieri's edge-to-edge repair demonstrated that the residual LVOT obstruction gradient depended on the annulus height (r = 0.90; p = 0.04) and the ratio of this height to the commissural diameter of the annulus ( r = 0.90; p = 0.04). After secondary chordae resection, a decrease in the LVOT obstruction gradient correlated with the sphericity index (r = 0.77; p = 0.03), the anterolateral-posteromedial annulus diameter (r = -0.72; p = 0.04), the anterior (r = -0.78; p = 0.02) and posterior (r = -0.78; p = 0.02) leaflets, the ratio of the total leaflet length to the anteroposterior diameter of the annulus (r = -0.83; p = 0.01), the area (r = -0.76; p = 0.0з) and the mitral valve tenting height (r = -0.95; p = 0.00).

Conclusion.Combined myectomy with mitral valve repair is the method of choice in the treatment of patients with obstructive hypertrophic cardiomyopathy. The comparison of three mitral valve repair techniques did not reveal any differences in the residual LVOT obstruction gradient. However, the Alfieri's edge-to-edge repair may be considered as the most physiological technique to repair dynamic LVOT obstruction.

Aim. To assess the efficacy and safety of venoarterial ECMO in the early postoperative period after congenital heart surgery in children with biventricular physiology, to evaluate the recovery of ventricular contractile function, and to determine predictors able to predict the outcome of treatment and the prognosis of the disease.

Methods. 15 medical records of pediatric patients treated in the period from 2016 to 2018 were retrospectively reviewed in a single-center study. The short-term outcomes of venoarterial ECMO in the early postoperative period were examined. Patients aged 1 month to 18 years were selected for the study. The median age of patients undergoing congenital heart surgery was 5 months (from 1 month to 4 years). 60% of them were male.

Results. ECMO was started in the postoperative period due to inability to go off-pump in 5 OR patients (33.3%), postoperative circulatory arrest in 4 patients (26.7%), and low cardiac output syndrome in 6 patients (40%). The median body weight was 5.7 kg (from 3.7 to 15.6 kg). 14 patients underwent biventricular surgery. One patient underwent palliative repair, and then was referred to the total repair. The mean cardiopulmonary bypass time was 103.6 (±62.3) minutes with the aortic cross-clamp time of 51.9 (±27.3) minutes. 12 patients (80%) were disconnected from ECMO. The overall hospital survival was 66.7% (10 patients). The mean duration of ECMO support in survivors was 118.4 (±37.5) hours.

Conclusion. The survival of patients improves with the steeper learning curve. ECMO contributes to the improved ventricular contractile function. Prolonged ECMO increases the number of specific complications associated with the procedure and affects survival. Our single-center experience in pediatric ECMO is generally consistent with the national and global trends in the use of mechanical support for intensive care.

To date, the rate of cardiac surgeries among elderly patients with significant comorbidities is gradually increasing, thereby proving the need for developing differentiated approaches to the management ofthese patients to optimize the course of the postoperative period. The healthcare systems in the Russian Federation and abroad have focused their efforts to improve the quality and duration of life for the elderly and advanced age patients. Therefore, the diagnosis and prevention of geriatric syndromes, including frailty, is taking on new significance. Recent evidence of the prognostically unfavorable potential of frailty in patients with cardiovascular diseases has emerged the need for precise approaches to the management of this group of patients. Thus, cardiac rehabilitation seems to be one of the effective measures. However, its use is currently limited due to the absence of safe and effective approaches for the elderly and advanced age patients with frailty. The review reports the key results of using cardiac rehabilitation in frail patients who have undergone cardiac surgery. Current limitations are highlighted.

Atherosclerosis is a leading cause of cardiovascular diseases. It is responsible for heart attacks and strokes due to the critical narrowing of the arteries. Atherosclerosis is an inflammatory disease that affects various arteries in the human body. The pathological process is accompanied by the focal thickening of the intima of the affected arteries. The last contributes to plaques building up as the disease progresses. The exploration of atherosclerotic mosaicism, either local or focal, is regarded as one of the most promising research areas. Many hypotheses have been suggested to explain this phenomenon. We suppose that mosaic atherosclerotic lesions are caused by genetic variations. Variations in the nuclear and mitochondrial genes of the arterial wall cells affect the development of atherosclerosis. The presence of these variations may be considered as novel markers suggesting the disease predisposition, its progression, and potential prognosis.

The review reports the main causes underlying endoplasmic reticulum stress and related intracellular phenomena. The relationship of endoplasmic reticulum stress with inflammation and lipid accumulation in cells during atherosclerosis is discussed.

The review article discusses the challenges in diagnosing frailty in the elderly population of different countries. It is one of the most critical issues in the recent clinical practice. The global proportion of the elderly population is increasing annually, thereby the prevalence of the frailty syndrome is projected to increase to an unprecedented rate. This syndrome worsens the quality of life of the population, limits physiological reserve and increases the risk of disability and fatal events. This review provides recent approaches for diagnosing frailty syndrome in the elderly population of different countries. Relevant pros and cons of each frailty assessment tools are briefly discussed. The rationale for the further clinical studies aimed at developing highly sensitive and specific method for frailty diagnosis is presented. The PubMed database was used to identify relevant studies and systematic reviews.

The review indicates the priority of implantable cardioverter-defibrillators in the prevention of sudden cardiac death. Attention is drawn to the fact that most defibrillators implanted in the world are endocardial systems. The presence of the leads in the heart chambers is associated with a number of specific complications that cannot be prevented. It reduces the function capabilities of the defibrillator and increases the risk of morbidity and mortality. Subcutaneous systems eliminate the need for implantation of the endocardial leads, being preferable for patients with a long life expectancy. The main disadvantages include the impossibility to terminate ventricular tachycardia painlessly because of lack of antitachycardiac pacing and the inability to perform cardiac pacing for bradycardia. To assess the safety and efficacy of subcutaneous defibrillators, large multicenter studies have been conducted and are still ongoing. Their findings have demonstrated that subcutaneous systems are not inferior to traditional endocardial ones according to selected criteria. Recent advances in subcutaneous defibrillators have resulted in their superiority in some functional parameters of these systems over endocardial ones. Devices have a priority for patients with a high risk of infection and vascular access difficulties. Nevertheless, due to known limitations of subcutaneous systems, there are more stringent requirements for the selection of candidates for surgery. Among the entire cohort of patients requiring implantation of any type of defibrillator, there are many candidates for a subcutaneous device, as that can be conditionally equated to a single-chamber endocardial defibrillator, which is implanted in the majority of cases. The likelihood of the need to change in the future the device to a more functional endocardial is defined as low.

Acute pancreatitis is one of the most common gastrointestinal causes for hospitalization after acute appendicitis. Despite recent advances in the treatment methods, mortality from acute pancreatitis and its complications remains high. Hypertriglyceridemia is an underestimated cause of acute pancreatitis, accounting for 10% among other etiological factors. Timely diagnosis of hypertriglyceridemia, a personalized approach, and the selection of adequate lipid-lowering therapy allow reducing the risk of developing and/or preventing recurrent acute pancreatitis. The article presents the clinical case of a patient with recurrent pancreatitis and hypertriglyceridemia. Despite high levels of triglycerides and annual hospitalizations for recurrent pancreatitis, the patient has not received optimal treatment for a long time. Therefore, lipid-modifying therapy has not been prescribed and none dietary recommendations have been suggested, including the exclusion of alcoholic beverages. Structural changes in the pancreas (the formation of pseudocysts) and the progression of pancreatogenic diabetes have developed.

This clinical case demonstrates the benefit of coronary artery bypass grafting as a method of revascularization in patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTE ACS). Organizational measures set at the Research Institute for Complex Issues of Cardiovascular Diseases (the appointment of double antiplatelet therapy in patients with NSTE ACS after coronary angiography, Abstract   the selection of treatment strategy and timing, the accessibility of coronary artery bypass grafting in 24/7 mode) allowed performing revascularization in the set timing recommended by current guidelines for myocardial revascularization. This case has shown that coronary artery bypass grafting is as effective as percutaneous coronary intervention in patients with high-risk NSTE ACS and multivessel coronary artery disease.