Highlights

The study of severity of psychological and emotional disorders in hypertensive patients with comorbidity who suffered COVID-19, as well as their association with clinical and laboratory indicators reflecting the course of diseases, is of high interest in the current epidemiological situation. Patients with hypertension who suffered COVID-19 presented with mild dementia and geriatric depression. Significant associations between systolic blood pressure and lung damage, between diastolic blood pressure and the average score on the geriatric depression scale, and lung damage were revealed.

Abstract

Background. Modern studies have highlighted a more severe course of the new coronavirus infection (COVID-19) in elderly patients with hypertension, diabetes mellitus and cerebrovascular disease. The basis of the pathogenesis of COVID-19 is cerebrovascular ischemia, which arose as a result of coagulopathy with an increased risk of thrombotic complications, the clinical reflection of which is the development of mental and emotional disorders as a part of the post-covid syndrome.

Aim. To analyze the severity of psychological and emotional disorders in hypertensive patients with comorbidity who suffered COVID-19.

Methods. The study included 40 patients with arterial hypertension (AH) and comorbid pathology, aged 60 to 90 years. Taking into account the lung damage due to COVID-19, the patients were divided into 2 groups: the group 1 included 17 AH patients with lung damage of grade 1–2 according to computed tomography, and the group 2 included 13 AH patients with grade 3 lung damage. The control group consisted of 10 AH patients who did not suffer COVID-19. The Statistica 6.0 program was used for statistical processing of the data.

Results. According to our data, patients in the group 2 suffered a more severe clinical course of COVID-19, the number of AH patients taking angiotensin-converting enzyme inhibitors (ACE inhibitors) in the group 2 was higher (85%) compared with the group 1 (47%), (p = 0.009). In the post-covid period, AH patients in the group 2 who suffered COVID-19 and had grade 3 lung damage presented with mild dementia and geriatric depression. AH patients in the group 1 with grade 1-2 lung damage presented with mild cognitive impairment (cognitive impairment no dementia) in the post-covid period. The analysis revealed a significant correlation between the score on the geriatric depression scale and the duration of fever and oxygen support. Moreover, the results of the analysis indicate a moderately negative correlation between the score on the geriatric depression scale and the minimum oxygen saturation, hemoglobin and leukocyte levels, a moderately negative correlation between MMSE scores and myalgia, and a moderate negative relationship between the scores on the geriatric depression scale and MMSE scale.

Conclusion. The results obtained confirm the data on the development of mental health disorders in short and long-term periods after COVID-19.

Highlights

• Bilateral internal thoracic artery (BITA) grafting is one of the most effective methods of direct myocardial revascularization. However, its results are still contradictory, despite the worldwide trend to use more autogenous arterial conduits.
• This study involves more than fifteen years of data in the use of BITA in Kuzbass in coronary artery disease surgery. The findings presented in the course of the analysis confirm the need to use both internal mammary arteries more actively.

Aim. To analyze long-term results of BITA grafting in terms of more than 15 years follow-up.

Methods. The study included 232 patients who were admitted at the Cardiac Surgery Department for coronary artery bypass grafting (CABG). All patients were divided into 2 groups depending on usage of single or bilateral internal thoracic artery conduits. Both groups included an equal number of patients 116 (50%). Long-term results were assessed in terms of more than 15 years follow-up.

Results. BITA grafting is comparable with CABG in such major adverse cardiac and cerebrovascular events as repeated myocardial revascularization, stroke, and in combined endpoint such as myocardial infarction (MI), stroke, repeated myocardial revascularization, or patient’s death within 15 years. However, the BITA group is superior to the CABG group in freedom from MI, all-cause deaths, showing a higher life expectancy after surgery (p = 0.011), and improved left ventricular ejection fraction and decreased functional class of angina. Moreover, in the present research it was confirmed that the severity of atherosclerosis in the coronary arteries is lower after bypassing with autogenous arterial conduits.

Conclusion. BITA is safe procedure comparable with CABG, however, it has more advantageous long-term clinical and angiographic results.

Highlights

We have described the outcomes of aortic valve replacement using autologous pericardium without special templates. Although S. Ozaki is considered by many to be the founder of neocuspidization technique, the methods for sizing of the neocusps were proposed long before him. The method of the Japanese professor involves using special templates. This article presents a mathematical formula to calculate neocusps` size, which significantly simplifies the procedure, and makes it possible to perform it in centers that do not possess Ozaki templates.

Abstract

Aim: To describe an original technique of aortic valve replacement using autologous pericardium without templates. The calculation of the neocusps` size is based on the diameter of aortic annulus, which can be estimated both intraoperatively and preoperatively, helps to reduce the duration of surgery, CPB time and myocardial ischemia, and lower the rates of late complications.

Methods: The prospective study included 34 patients with aortic valve disease admitted to the Cardiac Surgical Department of the University Clinical Hospital No.1 of the First Moscow State Medical University named after I.M. Sechenov, Ministry of Health of Russia in the period from January 2020 to March 2023. The mean age of the patients was 51±17 years (from 19 to 78 years). Gender distribution in the total group was as follows: male 50% (n = 17), female 50% (n = 17). All patients underwent aortic valve replacement using autologous pericardium without templates (by calculating the neocusps` size). Isolated aortic valve replacement was performed in 17 patients (50%), ascending aorta replacement in 11 patients (32.3%), mitral valve intervention in 5 (14.7%), coronary artery bypass grafting in 3 (8.8%) cases. 11 patients (32.3%) had aortic valve stenosis, 4 patients (11.7%) had insufficiency, and 19 patients (55.8%) had both stenosis and insufficiency. Bicuspid aortic valve was detected in 18 patients (52.9%). All patients were divided into two groups: Komarov (aortic valve replacement only) and Komarov Plus (aortic valve replacement and treatment for concomitant cardiac pathology).

Results: There were no cases of conversion to traditional aortic valve replacement using prosthetic valves. There were 2 cases of in-hospital mortality; according to medical records, death in both cases was due to complications provoked by double pneumonia caused by SARS-CoV-2. 1 patient required reoperation 4 months after the intervention due endocarditis caused by Streptococcus viridans. In the midterm follow-up period, hemodynamic parameters such as peak gradient, mean gradient, and peak velocity were 11.96±4.70 mm Hg, 5.88±2.07 mm Hg, 168.19±30.56 mm Hg.

Conclusions: The obtained valve prosthesis is anatomically analogous to the native valve and provides reliable peak pressure reduction, no postoperative regurgitation, and increased effective orifice area. The proposed method is safe and can serve as an alternative to the Ozaki procedure, in which the neocusps are outlined using special templates.

Highlights

• ECG signs of metabolic cardiomyopathies in men aged 25–44 years, regardless of age and waist circumference, are directly associated with the serum adipsin concentration and inversely associated with the concentration of glucagon-like peptide 1 in the blood.
• ECG signs of metabolic cardiomyopathies in women aged 25–44 years are directly associated with the serum c-peptide concentration and inversely associated with the concentration of glucose-dependent insulinotropic polypeptide 1 in the blood.

Abstract

Aim. To study the relationship between electrophysiological signs of metabolic cardiomyopathy (MC) and biomolecules associated with the secretory activity of visceral adipocytes in persons aged 25–44 years residing in Novosibirsk.

Methods. The study included 1 198 subjects. A single-stage survey of a random sample of the 25–44-year-old population of Novosibirsk (49,7% men, 50,3% women) was conducted. During the examination, among other things, a resting 12-lead ECGs was recorded, and later the ECGs were classified according to Minnesota Code categories. Five ECG signs of MC were analysed: 1) ST-segment displaced above baseline (ST-segment elevation); 2) ST-segment displaced below baseline (ST-segment depression); 3) T wave changes; 4) TV1>TV6 patterns and 5) ECG signs of left ventricular hypertrophy. Serum concentrations of biomolecules associated with the secretory activity of visceral adipocytes were determined by multiplex analysis.

Results. The results of multivariate logistic regression analysis showed that the ECG signs of MC in men aged 25–44 years, regardless of age and waist circumference, are directly associated with the serum adipsin concentration (Exp B 1,039, 95% CI 1,002–1,077, p = 0.039) and inversely associated with the concentration of glucagon-like peptide 1 in the blood (Exp B 0.999, 95% CI 0.998–1,000, p = 0.042). ECG signs of MC in women aged 25–44 years are directly associated with the serum peptide concentration (Exp B 1,439, 95% CI 1,082–1,915, p = 0.012) and inversely associated with the concentration of glucose-dependent insulinotropic polypeptide in the blood (Exp B 0.986, 95% CI 0.978–0.995, p = 0.001).

Conclusion. The results obtained reflect the significant influence of these biomolecules associated with the secretory activity of visceral adipocytes on the occurrence of ECG signs of MC in young people aged 25–44 years.

Highlights

It has been shown that chronic adaptation to cold (28 days, +2 – +4°C) has a cardioprotective effect in in vivo model of myocardial ischemia/reperfusion injury in rats. Certain types of receptors and К_АТP-channels might be involved in mechanisms of this effect.

Aim. To evaluate the role of opioid, cannabinoid, bradykinin receptors and the К_АТP-channels in the infarct-limiting effect of chronic adaptation to cold.

Methods. The study involved male Wistar rats weighing 250–300 g. Rats (two in a cage) were placed in a refrigerator for 28 days. The temperature inside the chamber was +2 – +4^oC. The infarct-limiting effect of chronic adaptation to cold and its possible cancelation by receptor blockers was studied in a 45-minute coronary artery occlusion and a 120-minute reperfusion of the rat myocardium in vivo. The quantitative assessment of myocardial injury was determined by the necrotic zone to the area at risk (NZ/AAR) ratio.

Results. We have found that К_АТP-channels are involved in the mechanism of the infarct-limiting effect of chronic adaptation to cold. Opioid, cannabinoid and bradykinin receptors are not involved in this effect.

Conclusion. The obtained results have expanded our understanding of cold adaptation, as well as receptor pathways involved in the mechanism of ischemia/reperfusion injury resistance. Further studying of the signaling and receptor pathways of the infarct-limiting effect of cold adaptation will reveal molecules responsible for tolerance to ischemia/reperfusion injury. These molecules can be used to develop novel cardioprotective drugs for the treatment of acute myocardial infarction.

Highlights

Every year more than 4 million deaths are registered from cardiovascular diseases (CVD), which is 46% of all deaths. Over the past 40 years, a downward trend in mortality from CVD has been revealed. However, the COVID-19 pandemic period has changed the statistics of indicators of both total mortality and mortality from CVD.

Aim. To analyze the mortality rate (MR) features from CVD in the Kemerovo Region (KR) from 2017 to 2021, in comparison with the Russian Federation (RF) rate.

Materials and Methods. Mortality rates of the adult population of KR and RF for the period 2017–2021 were taken from the official sources. The KR/RF dynamics was approximated by a linear trend using Microsoft Excel 2010.

Results. Over the past 5 years (from 2017 to 2021) the increase in mortality from CVD was 58.2% in the KR and in the RF – 9%. In 2017 the mortality rates in the RF were higher than in the KR and they levelled off by 2018. However, in the period 2019-2021 there was a sharp increase rate in the KR, in comparison with the RF. According to Kemerovo Statistical Office, the mortality rate from CVD in the region in 2021 was 10.8% higher than in 2020. The structure of mortality from CVD in 2021 in the KR had 52.8% of death cases due to coronary heart disease and 32.6% were caused by the cerebrovascular disease. During the COVID-19 pandemic (2019–2021) the first 3 places among the causes of total mortality in the KR were occupied by CVD (46.3% – 49.4% – 49.3%, respectively), neoplasms (17.1% – 15.2% – 13.2%) and external causes of death (9% – 7.7% – 6.5%). In the structure of total mortality cases the COVID-19 share is 2% in 2020 and 6.4% in 2021, respectively, which raised them to the 4th place in 2021.

Conclusion. An increase in mortality rates in the region may indicate both the real causes of death, they can also be associated with the peculiarities the death cases coding and the impact of clinical and organizational technologies as well as the aging of the population. All the data  require further in-depth research.

Highlights

The differences in the postnatal ontogenesis of the heart in children from one to five years old born prematurely and with low, very low, and extremely low birth weight were revealed. The coexistence of different models in contractile-rotational processes of the left ventricle was demonstrated.

Abstract

Aim. To expand the traditional ideas about the left ventricle (LV) mechanics formation processes in children born with low, very low and extremely low body weight in the postnatal period during the process of growth and development.

Methods. The study was conducted in 237 children aged from one to five years old: 51 children born healthy and full-term (FT), 68 children born with low body weight (LBW) and 118 children born with very low (VLBW) and extremely low body weight (ELBW). The analysis of clinical, anamnestic data, indicators of standard echocardiography and LV mechanics was performed using discriminant analysis. To demonstrate the assessment of remoteness or proximity between clinical groups, the Mahalanobis distance was used. Visualization of the structure distribution of groups in a multidimensional feature space was carried out in the coordinates of the first two discriminant functions (canonical roots, canonical variables) of discriminant analysis. The evaluation of the discriminant functions significance was verified by Wilks statistics. Statistical analysis was performed on a personal computer using the Statistica program (version 12).

Results. The most informative criteria for F (8.462) = 100,84 are “body weight at birth” (p = 0.000000), “character of feeding up to a year” (p = 0.000000) and direction of apex rotation (p = 0.0098).

Conclusion. The use of discriminant analysis makes it possible to establish a change in the degree of the selected criteria influence on the level of differences between clinical groups, demonstrating fundamentally new aspects of a child's heart mechanics formation in the history of prematurity.

Diagnosis and management of type 2 myocardial infarction present significant challenges nowadays due to variety of its etiological factors and clinical manifestations.  The correct and definitive identification of type 2 myocardial infarction is of paramount importance, since the treatment in most cases differs significantly from that of type 1 myocardial infarction.

Cardiovascular diseases are the leading cause of morbidity and mortality among both sexes in developing countries, accounting for a third of all deaths worldwide and almost 50% of all deaths in Europe – more than 4 million annually. Death from cardiovascular diseases accounts for almost half of all cases of mortality in the Russian Federation. Type 2 MI (MI2), defined as MI, developing as a result of an acute imbalance in myocardial oxygen supply and demand without atherothrombosis, has become a very common clinical phenomenon, and it is currently detected twice as often as before. Differential diagnosis between MI1 and MI2 is often difficult. Nevertheless, the correct and definitive identification of MI2 is of paramount importance, since the treatment in most cases differs significantly from that of MI1. The existing clinical guidelines for the management of patients with ACS without STEMI do not affect the algorithm of diagnosis and treatment of MI2, since they mainly relate to MI1. With such a large number of uncertainties regarding the treatment of MI2, there is an urgent need to develop validated recommendations for the diagnosis and treatment of this type of MI.  In this article, we propose an algorithm for the diagnosis of MI2, developed on the basis of data from modern literature.

Highlights

The article presents an overview of the main studies on the treatment of patients with coronary artery disease and cancer.

Abstract

Cardiovascular and oncological diseases remain the leading causes of death globally. The combination of coronary artery disease and cancer is becoming more common in clinical practice. Despite the achievements in the treatment of both of these diseases separately, their combination is a considerable issue for specialists. This review article discusses the main issues of managing patients with cancer and coronary artery disease. Moreover, the article presents various treatment strategies, including simultaneous and step-by-step interventions, and shows the current trends of endovascular approach to the treatment of these patients.

Highlights

The review analyzes the studies devoted to the possibility of using machine learning methods to predict the occurrence of atrial fibrillation, cardiovascular risk factors, carotid atherosclerosis, and total cardiovascular risk. The combinations of machine learning methods with mobile, cloud and telemedicine technologies have significant prospects. In the near future, such technologies are expected to be used for atrial fibrillation screening and risk stratification using cardiac imaging data. Based on machine learning methods, mobile preventive technologies are being developed, particularly for nutritional behavior management.

Abstract

The article reviews the main directions of machine learning (ML) application in the primary prevention of cardiovascular diseases (CVD) and highlights examples of scientific and practical problems solved with its help. Currently, the possibility of using ML to predict cardiovascular risk, occurrence of atrial fibrillation (AF), cardiovascular risk factors, carotid atherosclerosis, etc. has been studied. The data of questionnaires, medical examination, laboratory indices, electrocardiography, cardio visualization, medications, genomics and proteomics are used in ML models. The most common classifiers are Random Forest, Support Vector, Neural Networks. As compared to traditional risk calculators many ML algorithms show improvement in prediction accuracy, but no evident leader has been defined yet. Deep ML technologies are at the very early stages of development. Mobile, cloud and telemedicine technologies open new possibilities for collection, storage and the use of medical data and can improve CVD prevention. In the near future, such technologies are expected to be used for atrial fibrillation screening as well as cardiovascular risk stratification using cardiac imaging data. Moreover, the addition of them to traditional risk factors provides the most stable risk estimates. There are examples of mobile ML technologies use to manage risk factors, particularly eating behavior. Attention is paid to such problems, as need to avoid overestimating the role of artificial intelligence in healthcare, algorithms’ bias, cybersecurity, ethical issues of medical data collection and use. Practical applicability of ML models and their impact on endpoints are currently understudied. A significant obstacle to implementation of ML technologies in healthcare is the lack of experience and regulation.

Highlights

We report a case of a patient with extreme hypertrophic cardiomyopathy and complex cardiac pathology undergoing heart transplantation. The article will be useful for cardiologists, therapists and cardiovascular surgeons.

Abstract

We present a case of a patient with extreme hypertrophic cardiomyopathy, Wolff–Parkinson–White syndrome and nonspecific chronic exudative pericardial effusion with recurrent idiopathic transudative pericardial effusion. This case involves several approaches to treatment – medication and surgery for treating a patient with combined cardiomyopathy and pericardial effusion, which served as a “bridge” for a later change inro radical treatment - orthotopic heart transplantation.

Highlights

Fibromuscular dysplasia (FMD) is an idiopathic, non-atherosclerotic muscular layer artery lesion predominantly affecting the carotid and renal arteries. This pathology is quite rare in the general population and is most often diagnosed in women. In this article, on the example of a clinical case, up-to-date information is presented regarding the features of the clinical picture, diagnostic and therapeutic algorithms in patients with FMD, which may be useful for physicians of different specialties.

Abstract

Arterial hypertension in young people is most common cause of another disease. The task of the physician who encounters such a patient is to make up a specific plan for further action.

Despite the low fibromuscular dysplasia incidence in the population, this disease is relevant for differential diagnosis in young patients with arterial hypertension. The presented clinical case clearly shows that a timely diagnosis and timely treatment can help to prevent the development of complications and improve the patient's quality of life.

Highlights

The article presents a unique clinical case of correction of hypoplastic left heart syndrome with Norwood procedure using a “KemAngioprosthesis” vascular xenograft as a Sano shunt.

Abstract

We present the first successful clinical case of using the “KemAngioprosthesis” vascular xenograft in the pulmonary position as the Sano shunt in the Norwood procedure for correction of hypoplastic left heart syndrome. A newborn baby (gestation period of 38 weeks) diagnosed with congenital heart disease, and hypoplastic left heart syndrome was admitted to the Research Institute for Complex Issues of Cardiovascular Diseases. The child survived the first stage of the modified Norwood procedure (Sano shunt) using a biological vascular prosthesis. This clinical case showed that using the “KemAngioprosthesis” vascular xenograft in Norwood procedure to modify pulmonary blood flow by creating an anastomosis between the right ventricle and bifurcation of the pulmonary artery is effective and safe in the short-term period.

Highlights

The study is devoted to the analysis of metabolic hormones and their relationship with the main risk factors for cardiovascular diseases, in particular, elevated levels of low-density lipoprotein cholesterol. The study included people under the age of 45 with active hormones.

Abstract

Aim. To assess the relationship between the levels of LDL and metabolic hormones reflecting metabolic disorders in young people.

Methods. The study included 305 people. The group 1 included 146 people with an LDL level of <2.1 mmol/L, the group 2 included 159 people with an LDL level of ≥4.2 mmol/L. Serum total cholesterol (TC), triglycerides, HDL and glucose concentrations were determined by enzymatic method using Thermo Fisher Scientific kits (Finland) on a 30i KonelabPrime clinical chemistry analyzer. The calculation of concentrations of LDL was carried out according to the Friedwald formula. The levels of amylin, C-peptide, ghrelin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1 (GLP-1), glucagon, interleukin 6, insulin, leptin, monocyte chemoattractant protein-1, pancreatic polypeptide, peptide YY, tumor necrosis factor alpha were determined by multiplex analysis using the Human Metabolic Hormone V3 (MILLIPLEX) panel on a Luminex MAGPIX flow fluorimeter.

Results. In the group of patients with LDL ≥4.2 mmol/L, fasting glucose disorders were much more prevalent, the average BMI (p = 0,0001) was higher, and arterial hypertension was twice as frequent (24.8% vs. 11.6%, p = 0.003) compared with the group 1. The levels of triglycerides, TC, and glucose were higher, whereas HDL level was lower in the group 2(p = 0,0001). In patients with LDL ≥4.2 mmol/L, the values of HOMA-IR and the occurrence of IR (83.8%) according to the HOMA-IR were higher compared with the group with LDL <2.1 mmol/L (p = 0,0001). Statistically significant differences in the levels of the studied indicators between the groups 1 and 2 were obtained for C-peptide, GLP-1, insulin and leptin. The relative chance of having LDL≥4.2 mmol/L is associated with an increase in the level of C-peptide (OR = 2.042, 95% CI 1.209–3.449, p = 0.008) and a decrease in the level of GLP-1 (OR = 0.997, 95% CI 0.996–0.999, p = 0.001).

Conclusion. An increase in LDL levels in young people is associated with disorders of lipid and carbohydrate metabolism. These data are confirmed by changes in the serum metabolic markers that characterize metabolic disorders in the human body.

Highlights

Repeated hospitalizations occupy a special place in adverse clinical events in heart failure, currently representing one of the most powerful predictors of adverse outcomes in this group of patients. Echocardiographic parameters such as longitudinal myocardial deformation, displacement in the annulus of the tricuspid valve, and left atrial volume index can serve as predictors of hospitalization for cardiovascular diseases in patients with heart failure with preserved ejection fraction and obstructive sleep apnea.

Abstract

Aim. To study the prognostic role of individual echocardiographic parameters in heart failure with preserved ejection fraction (HFpEF) in patients with arterial hypertension and obstructive sleep apnea (OSA).

Methods. The study included 59 men with hypertension and OSA (apnea/hypopnea index >15 per hour). At baseline all patients underwent a sleep study and echocardiography with an additional assessment of the global longitudinal strain (GLS). Upon inclusion in the study and after 12 months of follow-up, a 6-minute walk test was performed. After 12 months, the clinical course of the disease was retrospectively assessed. The criteria for an adverse clinical course were episodes of hospitalization for cardiovascular diseases, the development of paroxysmal atrial fibrillation or high-grade ventricular arrhythmias (III–V class according to Ryan), worsening of heart failure with a transition to a higher functional class according to NYHA.

Results. Significant differences were found in several echocardiographic parameters between the groups of patients with and without hospitalizations within 12 months of follow-up: tricuspid annular plane systolic excursion (TAPSE) (p = 0.017), GLS (p = 0.005), left atrial volume index (LAVI) (p = 0.032). According to the regression analysis results, TAPSE, GLS and left ventricular ejection fraction make a statistically significant contribution to the probability of hospitalizations among the evaluated echocardiographic predictors.

Conclusion. The results of the study allow us to consider certain echocardiographic parameters, in particular GLS, TAPSE and LAVI, as predictors of hospitalizations in patients with HFpEF and OSA.

Highlights

• Stabilization of bovine pericardial tissue by ethylene glycol diglycidyl ether does not remove the N-glycolylneuraminic acid contained in its structure, which is one of the most immunoreactive glycan xenoantigens;
• N-glycolylneuraminic acid can potentially cause early immune rejection of epoxy-treated bioprosthetic heart valves.

Aim. To assess the presence of N-glycolylneuraminic acid (Neu5Gc) in an intact bovine pericardial tissue stabilized by ethylene glycol diglycidyl ether and in the leaflets of epoxy-treated bioprosthetic heart valves (BHV) explanted due to dysfunction.

Methods. By means of immunochemistry (using anti-Neu5Gc antibodies), we studied the fragments of 5 samples of intact epoxy-treated bovine pericardium commonly used in cardiac surgery. Similarly, we examined the fragments of the leaflets of 8 epoxy-treated BHVs that lasted for different time periods (1 day to 68 months) and excised during reoperation. The native bovine pericardium and the leaflets of 3 human aortic valves (AV) removed during reoperation in patients with aortic stenosis were used as positive and negative controls, respectively.

Results. Positive reaction for Neu5Gc was observed in intact epoxy-treated xenopericardium and BHVs excised 1, 2, 20 and 42 days after implantation. The tissue of BHV that had lasted 30 months was characterized by the faint presence of Neu5Gc. In the leaflets of AV and in BHVs, explanted after 34, 63 and 68 months, Neu5Gc was not detected. 

Conclusion. Stabilization of xenobiomaterial with ethylene glycol diglycidyl ether does not remove the Neu5Gc. This saccharide remains in the biological tissue of epoxy-treated BHV for about 2.5 years after implantation. 

Highlights

Higher rates of COVID-19 morbidity and mortality compared to Russia as a whole were noted in Moscow during the COVID-19 pandemic and after it (2020-2021). We have reached the conclusion that it is necessary to develop regional prevention and rehabilitation approaches for COVID patients.

Aim. To analyze health and demographic indicators of Moscow, Russia and its constituent entities in the context of the COVID-19 pandemic to develop regional prevention, management and rehabilitation programs for COVID patients.

Methods. The study incorporated statistical, analytical, and observational methods. The data of the Federal State Statistics Service, and reports of the Central Research Institute of Healthcare of the Ministry of Health of Russia for 2012–2022 were used for the analysis.

Results. General morbidity of the population in Moscow (2021) amounted to 148 906.0 per 100 000 population. The highest rates were noted in the following classes of diseases: diseases of the respiratory system, circulatory system, diseases of the musculoskeletal and connective tissue, genitourinary system, etc. In the Russian Federation, the overall incidence rate in 2021 was 167 713.8‰₀₀, which is 11.6 % higher compared to Moscow. In 2019 (before the COVID-19 pandemic) the frequency of primary morbidity in Moscow was 65 818.1‰₀₀, in 2020 the frequency decreased to 63 204.4‰₀₀, and in 2021 it increased to 71 523.9‰₀₀, which is 8.7% higher than in 2019. Between 2019 and 2021, there was an increase in primary morbidity rates in the following classes of diseases in Moscow: mental and behavioral disorders by 12.1%, diseases of the blood, hematopoietic organs and disorders involving the immune mechanism – by 5.3%, diseases of the nervous system – by 2.1%, etc., which indicates the need for rehabilitation of patients with this pathology. In 2021 the incidence rate of COVID-19 in Moscow increased to 8 976.0‰₀₀, in the Russian Federation the incidence rate was lower – 8 085.7‰₀₀. The difference in indicators between the constituent entities of the Russian Federation is quite high and amounts to 11.8. The pandemic has exacerbated the demographic situation in Russia. Mortality rates (for 2019–2021) increased in the Russian Federation from 12.3‰ to 13.6, and in Moscow the increase was more significant – from 9.5 to 16.7‰. The results of the analysis indicate the need to improve preventive and management programs for COVID patients, even more so in Moscow. In Moscow and Russian Federation as a whole higher rate of general morbidity in children and adolescents compared to total and adult population morbidity over 10 years (2012–2021) points to the importance of prevention and management programs of this population.

Conclusion. The results of the study reaffirm the need to develop regional prevention, management and rehabilitation approaches for COVID patients.

Highlights

The article describes the main differences between the types of myocardial infarction, in particular, differences between type 1 and type 2 myocardial infarction, the complexity of diagnosis and management of patients with myocardial infarction type 2, and summarizes data on the prevalence of patients with myocardial infarction type 2. The arguments supporting the need for further researches to differentiate various phenotypes of myocardial infarction are provided.

Abstract

Despite the high interest in the study of type 2 MI, many unresolved issues concerning diagnosis, criteria for diagnosis and, especially, therapeutic tactics remain unresolved. The available data regarding type 2 MI remain limited and inconsistent, and are based on sources that include the analysis of type 1 MI. According to various predictions, the prevalence of type 2 MI will increase even more. Type 2 MI management strategy should be patient-specific and in accordance with the etiology and pathogenesis, therefore, timely diagnosis, and MI differentiation according to universally accepted definitions is a relevant scientific topic and a practical necessity.

Thus, summarizing all the above, we can say that type 2 myocardial infarction is a topic that encompasses many unresolved issues concerning diagnosis, patient management and further secondary prevention.

Highlights

Hypertensive disorders of pregnancy are associated with short- and long-term risks for the mother.

We have identified several key points in the management strategy of this pathology in the postpartum period, which should contribute to the emergence of new directions in the prognosis and treatment modalities of this disease.

Abstract

The article presents an analytical review of modern data on the treatment of hypertensive disorders of pregnancy (HDP) in the postpartum period. HDPs lead to maternal morbidity and mortality in developing and poor countries, and in regions with well-developed healthcare systems as well. HDPs can later progress into hypertension and are associated with the risk of coronary artery disease and stroke. Moreover, HDPs increase the likelihood of low-birth-weight babies and preterm births. The incidence of HDP is growing worldwide despite the implemented prevention methods: according to the Global Health Data Exchange, from 1990 to 2019 HDPs` incidence by 10.9% from 16.3 million to 18.08 million people. However, the introduction of universal approaches to prevention of complications made it possible to reduce mortality from HDP in the same period by 30.05%. The risk of hypertensive complications increases significantly in the postpartum period. Modern research confirms this – the likelihood of worsening HDP and the development of complications increases significantly in the first 24–48 hours after childbirth. About one third of cases of eclampsia occur in the postpartum period, of which almost half occur 48 hours after delivery. Stroke in women with HDP occurs in the postpartum period in half of the cases. Arterial hypertension (AH) in the postpartum period often requires an increase in doses of antihypertensive drugs, whereas after 3–6 months, many patients no longer need such therapy. During the first year after childbirth, the risk of progression of AH and the development of complications due to hypertension is increased, and remains so for many years. The feasibility of antihypertensive therapy in HDP today is beyond doubt, however, there are issues that require further study. They are related to the safety of prescribed drugs during lactation, and as a result, in many guidelines, antihypertensive therapy in the postpartum period is prescribed with reservations. Another problem is the relatively small number of RCTs directly assessing the effectiveness of antihypertensive therapy in the postpartum period.

Highlights

The article summarizes the data on the influence of growth and differentiation factor 15 on the genesis, course and outcomes of cardiovascular system pathologies. The presented analysis of experts' opinions allows to approach the answer to the question, which is topical in the scientific community: whether this factor promotes the progression of cardiovascular diseases or performs a protective function.

Abstract

Growth and differentiation factor 15 (GDF-15) is a circulating protein and is associated with a variety of pathological processes, including being a marker of endothelial dysfunction. GDF-15 expression is upregulated in cardiomyocytes after ischemia, reperfusion, pressure overload and mechanical stretch, allowing it to be used for the diagnosis of subclinical coronary atherosclerosis, arterial hypertension and heart failure. This paper presents a review of studies that have focused on the diagnostic spectrum of this marker. We also considered two perspectives on the role of GDF-15 in the pathogenesis of cardiovascular disease: as a factor contributing to pathology progression or as performing a compensatory function? The introduction of highly specific markers, in particular GDF-15, into clinical practice may help to reduce the risk of cardiovascular complications, disability and mortality.