Aim. To develop classification criteria for stratifying congestive heart failure (CHF) patients based on the underlying disease.
Methods. 61 patients with CHF were recruited in a study. All patients were assigned to three groups according to the underlying disease: patients with coronary artery disease (CAD) (n = 29), patients with arterial hypertension (AH) (n = 19), and those present with dilated cardiomyopathy (DCM) (n = 13). Patients underwent routine clinical examination. Biochemical and inflammatory markers (IL-6, its soluble receptor sIL-6R, and sgp130) were measured in all patients. The Mann-Whitney U test, the Kruskal-Wallis H test, the Pearson χ² test, and Fischer exact test were used to analyze the selected variables. Discriminant analysis was used for generating prediction models. The quality of the models was evaluated with the ROC analysis.
Results. Statistically significant variables identified by the pairwise comparison of patients with CAD and AH, CAD and DCM, AH and DCM were included in the discriminant analysis along with clinically valid parameters. Clinical prediction models of stratifying patients to different etiological groups were based on these parameters. The optimal cut-off values were determined for each model. The area under the ROC curve (AUC) was used to evaluate the quality of the model. The AUC value for CAD and AH groups was 1, for AH and DCM - 72±0.024, and for CAD and DCM - 0.907±0.053.
Conclusion. Diagnostic prediction models were developed using the discriminant analysis. These models allow stratifying CHF patients according to the underlying disease (CAD, AH, and DCM). The ROC curves have confirmed the good classifying quality of the models.

Aim. To determine the clinical factors affecting the timely reference of patients with coronary artery disease after myocardial revascularization to Phase 3 cardiac rehabilitation.
Methods. 773 patients with coronary artery disease (CAD) who underwent myocardial revascularization were recruited in a study. Of them, 77 (9.96%) underwent coronary artery bypass grafting and 696 (90.04%) underwent PCI. Within 1 month of discharge, patients were examined by a cardiologist in the outpatient hospital and then referred to the cardiac rehabilitation team to assess their eligibility. The eligibility for exercise rehabilitation was assessed based on the results of general examination, clinical and laboratory findings. The prevalence of absolute and relative contraindications to exercise rehabilitation was measured.
Results. 10% of CAD patients after myocardial revascularization had absolute contraindications and 29.6% had relative contraindications to exercise rehabilitation. The presence of relative contraindications (exaggerated blood pressure response (>80/100 mm Hg) to exercise or a decrease in systolic blood pressure ≥20 mm Hg, ventricular extrasystole and tachycardia, paroxysmal tachyarrhythmias in response to exercise, active gastroduodenal ulcer, and less than 1 month after its exacerbation, moderate heart valvular disease (aortic stenosis), decompensated carbohydrate metabolism disorders) required the management of risk factors limiting patients on the participation in exercise rehabilitation. The routing of CAD patients after myocardial revascularization at Phase 3 cardiac rehabilitation was developed and introduced in the Clinical Cardiological Dispensary in the Omsk region.
Conclusion. Most patients with CAD after myocardial revascularization should be referred to exercise rehabilitation. These patients rarely have absolute contraindications (about 10%). Despite relative contraindications are rather high (about 30%), risk factors limiting patient participation in exercise rehabilitation are managed successfully. Optimal routing of patients contributes to their prompt recruiting to cardiac rehabilitation. Effective management of cardiovascular risk factors allows recruiting more patients in exercise rehabilitation.

Aim. To assess the relationship of abdominal obesity with left ventricular systolic function and to predict outcomes in patients with MI within 10 years.
Methods. 581 medical records of patients enrolled in the Acute coronary Syndrome Registry between 2008 and 2010 were retrospectively reviewed for the period of 10 years. The following clinical endpoints were collected: all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, stroke, hospitalization due to unstable angina and decompensated heart failure. Baseline left ventricular ejection fraction (LVEF) and the presence of abdominal obesity measured as waist-to-hip ratio were collected in all patients.
Results. Abdominal obesity was found in 392 (67.4%) patients admitted with MI. The presence of abdominal obesity did not affect main outcomes within 10 years after the indexed event. Cardiovascular mortality was the lowest among patients with abdominal obesity., an association between abdominal obesity and low cardiovascular mortality was found in patients with intermediate LVEF using the risk stratification data based on the severity of systolic dysfunction at discharge. The highest rate of recurrent hospitalization due to unstable angina was found in patients with abdominal obesity and intermediate LVEF.
Conclusion. The prevalence of abdominal obesity in MI patients was high (67%). Abdominal obesity appeared to confer protective effects on the 10-year clinical outcomes in patients with low and intermediate LVEF based on all-cause and cardiovascular mortality. The waist-to-hip ratio were significant in the generation of 10-year allcause and cardiovascular disease mortality prediction models in patients with MI.

Aim. To determine heart rate variability (HRV) in depressed patients with chronic coronary artery disease (CAD) and to assess the effects of agomelatine on HRV.
Methods. 74 patients with CAD (class 3-4 angina pectoris) were recruited in a study. Patients (n = 45) with CAD and depression were assigned to Group 1, whereas CAD patients (n = 29) without any signs of depression were assigned to Group 2. 17 patients received agomelatine (Subgroup 1) and 28 patients did not take any antidepressants (Subgroup 2). HRV was measured using SCHILLER MT-200 Holter-ECG apparatus at baseline and after 6 months.
Results. Patients with depression demonstrated a significant decrease in HRV compared to non-depressed patients (pNN50% (3.9 [2.2; 5.4] vs 5.7 [2.9; 12.6], p = 0.03), SDANN (81 [63; 97] ms vs 91 [79; 102] ms, p = 0.06), SDNNindx (46 [36; 56] ms vs 55 [48; 66] ms, p = 0.002), rMSSD (28 [21; 36] ms vs 33 [ 29; 45] ms, p = 0.02), SDNN (97 [75; 121] ms vs 110 [98; 127] ms, p = 0.02). Subgroups 1 and 2 did not differ in HRV (p>0.05). After 6 months, significant differences in the following parameters were found in those patients who received agomelatine therapy and those who did not: rMSSD (36.5 [28.5; 51] ms vs 26.5 [25; 32] ms, p = 0.02), SDANN (88 [72,5; 114,5] ms vs 67,5 [58; 83] ms, p = 0.03), SDNN strives to a significant difference - 100 [87; 133.5] ms vs 85.5 [75; 103] ms, p = 0.07.
Conclusion. HRV significantly decreased in depressed patients with CAD suggesting autonomic dysfunction and worsening their prognosis. Agomelatine therapy in patients with CAD is effective in treating heart rate variability and reducing the risk of developing life-threatening arrhythmias.
Key

Background The HEART score is an effective method of risk stratifying emergency department (ED) patients with chest pain. The rate of major adverse cardiovascular events (MACE) in patients with moderate HEART score referred from an urgent care (UC) for an expedited outpatient cardiology evaluation for 11 months was described in 133 patients in a previous study. This is a follow-up study with 18 months of data and 206 patients.

Aim. The primary outcome was to examine the rate of MACE when patients with moderate HEART score were referred for an expedited outpatient cardiology follow-up after evaluation in urgent care. The secondary outcome was to determine if there is a decrease in rate of ED transfer after this protocol was introduced.

Methods. A cross-sectional study was conducted by a multispecialty group in Las Vegas, Nevada, which included 206 patients with a HEART score of 4 to 6 (i.e.: moderate risk) who presented to one of five UC centers with chest pain or an anginal equivalent. A streamlined evaluation protocol to assess each HEART score component was adopted by all UC providers to facilitate an expedited outpatient cardiology follow-up, as an alternative to referral to the emergency department. Data was collected from February 14, 2019 through August 13, 2020. The population was followed for 6 weeks with a primary endpoint of MACE determined by electronic medical record review and direct phone contact with patients. Outcomes were confirmed in 98% of patients. Chest pain transfer data was compared between 12 months prior to implementing HEART protocol and 18 months of data analysis while using the new protocol.

Results. Over the course of 18 months, 206 patients with a moderate risk HEART score were referred to outpatient cardiology in an expedited manner. The average age was 65 with 53% female and 47% male patients. 150 patients (73% of the 206) were seen within 3 days, 114 (55%) underwent stress testing, 6 (3%) had coronary computed tomography angiogram, and 6 (3%) received an invasive coronary angiogram. Five patients were found to have MACE: one patient who had a non-ST-elevation myocardial infarction and subsequent coronary stent, two patients were found to have obstructive disease after coronary angiography with subsequent coronary artery bypass graft, one patient had an abnormal stress test and subsequent coronary stent, and one patient had critical mitral stenosis, multi-vessel coronary artery disease and underwent coronary artery bypass graft with mitral valve replacement with complications of renal failure and COVID-19 and expired. The emergency department referral rate declined by 21%.

Conclusion. Patients with a moderate risk HEART score referred from UC for an expedited outpatient cardiology evaluation had a low rate of MACE and no deaths due to delay of care. There was also a significant decrease in the rate of ED referrals.

Aim. To determine the factors contributing to the progression of peripheral artery diseases in patients receiving outpatient care within the 3-year follow-up.
Methods. 585 patients with peripheral artery disease undergoing outpatient treatment in the period from 2010 to 2016 were recruited in a study. The follow-up period was three years. Patients were divided into two groups: Group 1 patients (n = 225) with a favorable course of peripheral atherosclerosis, and Group 2 patients (n = 303) with an unfavorable course of peripheral atherosclerosis. Patients were assigned to the groups based on their medical history (a decrease in pain-free walking distance within three years, amputation) and/or data of duplex scanning of the lower extremity arteries (significant progression of stenosis >20% over three years).
Results. 87.1% of patients from Group 1 and 70.63% of patients from Group 2 visited cardiologists regularly within 3 years (p<0.0001). A total of 69.33% of patients from Group 1 and 61.39% of patients from Group 2 (p = 0.058) visited vascular surgeons within the follow-up period. Within three years, 47 (8.9%) patients achieved hard endpoints. Of them, 18 deaths, 14 myocardial infarctions, and 15 ischemic strokes. 25 patients underwent myocardial revascularization. Adherence to treatment within 3-years follow-up was significantly higher in patients with a favorable course (57.33% vs. 45.21%, p = 0.006). Multivariate logistic regression reported that adherence to treatment years (р=0.0009) and regular visits to cardiologists (p<0.001) significantly improved the 3-year prognosis in patients with peripheral artery disease.
Conclusion. 57% of patients had an adverse course of peripheral atherosclerosis within 3-years follow-up. These results show that regular outpatient examinations of patients with peripheral atherosclerosis by cardiologists allow prescribing optimal drug therapy and reducing the risk of atherosclerosis progression.

Aim. To determine indications to emergency coronary artery bypass angiography.
Methods. 7,616 medical records of patients with coronary artery disease who underwent isolated CABG in the period from 2012 to 2019 at the Federal Center for Cardiovascular Surgery were reviewed. Of them, 103 (1.35%) patients underwent emergency coronary artery bypass graft angiography in the early postoperative period to verify signs of myocardial damage. Patients were assigned to two groups based on angiographic findings and selected treatment strategy. Out of 75 patients, 57 patients from Group 1 had no severe angiographic signs of occlusive changes of the grafts and native arteries. But 18 patients reported failed graft and required conservative management. Group 2 (n = 28) included patients who had failed coronary artery bypass grafts according to angiography findings. 20 patients underwent endovascular treatment, and 8 patients underwent repeated surgery. The control group included 30 patients (0.39%) without any signs of ischemic myocardial damage. Intraoperative flow was assessed as well as postoperative electrocardiographic and echocardiographic records. Biochemical markers of myocardial damage were measured.
Results. Blood flow velocity was less than 20 ml/min, and the pulsatility index exceeded 3.0 according to the intraoperative flow assessment of coronary artery bypass grafts with impaired blood flow according to angiography findings. There was no relationship found between ischemic changes according to ECG, ECHO-CG, and angiographic findings. Significant differences were found in troponin I levels between Group 1 (patients with coronary artery graft dysfunction) and the control group (Group 3) at all time intervals (1, 6, 12, 24 and 48 hours).
Conclusion. The predictors of failed coronary artery bypass grafts in the early postoperative period allowed identifying indications to emergency angiography.

The article summarizes the current knowledge on epidemiology, pathophysiology, and management of patients with peripartum cardiomyopathy. The incidence of peripartum cardiomyopathy varies and largely depends on the geographic region. The overall mortality reaches up to 4-28%. Risk factors for developing peripartum cardiomyopathy include multiple pregnancies and multiple births, family history, smoking, diabetes mellitus, hypertension, preeclampsia, poor nutrition, older or adolescent maternal age, and long-term treatment with beta-adrenergic agonists. Genetic factors play the leading role in the pathophysiology of peripartum cardiomyopathy. It is generally confirmed by family history and the incidence variation depending on the geographical region. The pathogenetic role of vasoinhibin, an isoform of prolactin, is described. Vasoinhibin has antiangiogenic, proapoptotic, proinflammatory, and vasoconstrictor effects. The important role of an imbalance between angiogenic and antiangiogenic factors is discussed. There are no guidelines for obstetricians and gynecologists on the management of pregnant women, parturient women, and postpartum women. One of the reasons is the absence of evidence. An urgent cesarean section is indicated if the pregnant woman has acute heart failure and requires inotropic support and/or invasive therapy. However, 2018 ESC Guidelines for the Management of Cardiovascular Diseases during Pregnancy recommend vaginal delivery in these patients.

The relationship between nutrition and cardiovascular health has emerged over the past two decades. European Society of Cardiology has become a leading platform for discussion. This article encompasses the main findings of a multitude of studies presented at ESC. The assessment of population dietary patterns should include the data on the profile of food and nutrients as well as their lifestyle, socio-economic status, the quality of products, and macronutrients replacement. The study design aimed at assessing dietary patterns nutrition should be a prospective long-term study focusing on collecting the data on ethnic and socio-economic components as well as the data suggesting the adherence to a particular dietary pattern.

May-Turner syndrome is a condition where the left common iliac vein is compressed between the lumbar spine and the overlying right common iliac artery. Left iliac vein compression is common (up to 24%) in the general population, but clinical manifestations occur in a few patients. This syndrome should be considered in case of unexplained edema of the left lower extremity since routine duplex ultrasound does not possess optimal sensitivity and specificity in the study of the iliac veins and the inferior vena cava. Intravascular ultrasound is the most accurate diagnostic method. However, the advent of computed tomography angiography and magnetic resonance angiography providing high-quality images of the vasculature have become a promising alternative to invasive intravascular ultrasound. Treatment for May-Turner syndrome usually involves stenting of the left common iliac vein along with medical therapy, including antithrombotic (anticoagulant and antiplatelet) therapy combined with phlebotonics. Our review reports modern methods of diagnosis and treatment of May-Turner syndrome.

Aim. To assess ergonomic properties of a long-term ECG monitoring device from the standpoint of its usability and reliability of data recording.
Methods. Three generations of the long-term ECG monitoring device were tested. 86 volunteers (30 women) were recruited in a study. Over 100 ECG recordings were collected to estimate ergonomic properties. A set of measures to improve the ergonomic properties was recommended after each generation testing. After the upgrading, the device was entering the next stage. The overall study duration was 3 years.
Results. The assessment of ergonomic properties of the long-term ECG recording device resulted in the improvement of the device case, universal electrodes, safe data transmission channel, and a user-friendly instruction manual. The software package for data processing was improved and allowed the introduction of remote data transmission to physicians.
Conclusion. The device corresponds to all standards of ergonomics and usability. It received the Federal Health Care Supervisory Agency (Roszdravnadzor) approval.

The results of the international multicenter study EMPEROR-Reduced have been discussed on October 31, 2020, at the online expert meeting. Considering the positive cardiovascular and renal effects of empagliflozin, the experts have supported the use of empagliflozin in the clinical practice to treat patients with chronic heart failure.