Highlights

• Iron deficiency is one of the most common comorbidities in heart failure, associated with a negative prognosis; however, the significance of iron deficiency in patients with acute decompensated heart failure remains uncertain.
• The obtained results allowed us to expand the profile of patients with acute decompensated heart failure and evaluate the contribution of iron deficiency to the course of the disease and the long-term prognosis of patients.

Aim. To determine the prevalence of iron deficiency (ID), to assess its clinical and prognostic significance, and its impact on one-year outcomes in patients with acute decompensated heart failure, based on data from a single-center cohort study.

Methods. This prospective cohort study consecutively (from January 1, 2023 to January 1, 2024) included 812 patients admitted with acute decompensated heart failure. The observation period was from January 1, 2023 to January 1, 2025, inclusive. The median age was 72 [57; 83] years.

Results. The clinical phenotypes of patients with ADHF were predominantly represented by an ischemic origin of heart failure. All patients with ADHF had a high prevalence of hypertension and a high Charlson comorbidity index. It was found that patients with ID had significantly higher NT-proBNP values ​​than patients without ID: 2810.8 [1 783.6; 4 198.3] versus 1 981.2 [1 221.5; 3 241.7] pg/ml. Patients with ID had a higher prevalence of major underlying diseases: type 2 diabetes (n = 181, 37.0% vs n = 102, 31.5%; p < 0.05), obesity (n = 378, 77.3% vs n = 170, 52.6%, p < 0.05), CKD (n = 263, 53.9% vs n = 144, 44.5%, p < 0.05); as well as older age (76 [54; 83] vs 69 [47; 79] years). The total number of adverse events was higher in the group of patients with ID.

Conclusions. The prevalence of iron deficiency in patients with ADHF was 60%. Patients with ID were characterized by older age, a high prevalence of type 2 diabetes, obesity, and CKD, as well as a greater number of adverse events during the long-term follow-up period.

Highlights

• Multifocal atherosclerosis is characterized by the involvement of two or more vascular bed. The high prevalence of multifocal atherosclerosis is associated with a poorer prognosis. A clinical and anamnestic analysis of patients with multifocal atherosclerosis was conducted, along with a comprehensive assessment of treatment adherence. The obtained results demonstrate predominant comorbidity and low treatment adherence among patients with multifocal atherosclerosis, which calls for new approaches to the prevention of cardiovascular events in this patient cohort.

Aim. To evaluate the clinical and anamnestic characteristics and treatment adherence of patients with multifocal atherosclerosis who had experienced a cardiovascular event.

Methods. The study included 200 patients, including 54 (27%) women and 146 (73%) men aged 75 years or younger. All patients had experienced a cardiovascular event and had multifocal atherosclerosis documented by instrumental examination methods.

Results. The age of patients included in the study was 65.0 [43.0; 74.0] years. Patients included in the study were characterized by high systolic and diastolic blood pressure. Most men were overweight, with a similar increase in waist circumference in both sexes (p = 0.626). The primary clinical diagnosis in all patients was coronary artery disease. The presence of multifocal atherosclerosis in patients was confirmed by the presence of coronary atherosclerosis in 100% of patients, as well as by involvement of individual vascular beds. A very low proportion of respondents –12% were characterized as sufficiently adherent.

Conclusion. Patients with multifocal atherosclerosis are characterized by high comorbidity and low adherence to treatment, which directly affects the effectiveness of ongoing therapeutic and preventive measures.

Highlights

• Biomarkers associated with inflammation (hf-CRP, NLR, SIRI) and fibrosis (sST-2) are associated with chronic heart failure and are predictors of worsening heart failure.
• The results obtained in elderly patients confirm the expediency of measuring the level of soluble ST2 to assess the clinical course of CHF after a myocardial infarction without ST elevation.
• Unlike traditional biochemical markers of inflammation, the calculation of NLR and SIRI indices based on a general blood test requires less time, which contributes to their more active implementation in medical practice.

Background. One of the leading causes of chronic heart failure (CHF) in elderly patients is a recent myocardial infarction. There is particular interest in inflammatory biomarkers – those detectable via a complete blood count – and soluble ST2 (sST2) as a marker of myocardial fibrosis and remodeling. However, their role in the development of CHF during the post‑infarction period in elderly patients has not been sufficiently studied.

Aim. To conduct a comprehensive assessment over a six‑month prospective follow‑up period of potential relationships between inflammatory biomarkers (C‑reactive protein, NLR, MLR, SII, SIRI) and soluble ST2 (sST2). Additionally, the objective is to determine their diagnostic significance in chronic heart failure among elderly patients who have experienced a non‑ST‑segment elevation myocardial infarction (NSTEMI).

Methods. The study included 176 elderly patients who had suffered a non‑ST‑segment elevation myocardial infarction (NSTEMI) six months prior. Inclusion criteria: age: 60–74 years; NSTEMI occurred six months earlier; CHF with moderately reduced left ventricular ejection fraction at the time of hospital discharge. Examination procedures included: echocardiography; blood tests (complete blood count, biochemical analysis, levels of NT‑proBNP, C‑reactive protein, and sST2); calculation of inflammatory indices from the complete blood count: NLR (neutrophil‑to‑lymphocyte ratio); MLR (monocyte‑to‑lymphocyte ratio); SII (systemic inflammation index); SIRI (systemic inflammatory response index). The sST2 level was determined using the ELISA method (The RayBio® Human IL‑1 R4/ST2 ELISA kit, USA) according to the manufacturer’s protocol. Statistical analysis was performed using StatTech v.4.9.5 (Russia).

Results. The best prognostic indicators were demonstrated by: high‑sensitivity C‑reactive protein (hs‑CRP) (AUC = 0.848, p < 0.001); NLR index (AUC = 0.802, p < 0.001). This was followed by the SIRI index (AUC = 0.774, p < 0.001). Furthermore, a comparison of the two patient groups showed a significant association between elevated levels of sST2 and inflammatory markers and the development of CHF, depending on the left ventricular ejection fraction.

Conclusion. In elderly patients with myocardial infarction without ST elevation and initially moderately low EF (41–49%), the level of sST-2 ≥ 31.00 ng/l 6 months after the infarction was significantly higher in the absence of restoration of myocardial contractility than with normalization of the ejection fraction. NLR and SIRI indexes have the highest discrimination ability. A comprehensive assessment of sST-2, NLR/SIRI, and clinical factors allows stratification of patients to enhance personalized therapy and control.

Highlights

In the structure of threats of loss of labor resources due to loss of work functions, hypertension and ischemic heart disease were identified as the most significant in the class of circulatory system diseases.

Aim. To determine the significance of circulatory system diseases (CSD) in the structure of threats to the loss of vital and labor resources of society in the Russian Federation.

Methods. Statistical and analytical. The study utilized data from Rosstat, statistical materials from the Federal State Budgetary Institution “TsNIIOIZ” for 2019–2023, the Russian Ministry of Health, federal and industry statistical monitoring forms, and Order No. 585n of the Russian Ministry of Labor and Social Protection dated August 27, 2019, “On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination”. A developed methodology for calculating the threat of labor force loss in the Russian Federation was used.

Results. Among those who died from coronary heart disease in the working age group, the largest share was made up of deaths due to ischemic heart disease – 43.2%, cerebrovascular diseases – 18.7%, including acute cerebrovascular accident – 15.0%. These diseases are the main ones in the structure of losses of vital resources of the population of the Russian Federation. The analysis of the overall incidence of coronary heart disease in the adult working-age population of the Russian Federation in dynamics (2019–2023) showed an increase in the indicator in 2023 by 4.1%. Of particular concern is the increase in hypertensive heart disease by 19.0% and acute myocardial infarction by 8.2%, which requires strengthening measures for prevention, medical examination and rehabilitation of the working-age population. In order to determine the significance of circulatory system diseases in the threat of labor resource losses, the study, using the developed methodology, calculated the morbidity rates (general) of the adult working-age population of the Russian Federation, determining the first group of disability and leading to complete loss of working capacity. It has been established that the top two diseases are hypertensive heart disease and ischemic heart disease. These conditions largely determine the risk of loss of society's workforce.

Conclusion. The study's results identified the need to monitor morbidity among the adult working-age population in the Russian Federation and develop management solutions aimed at reducing the loss of society's vital and labor resources.

Highlights

• Mechanical aortic valve prostheses demonstrate significant long-term advantages in patients aged 50–65 years compared with bioprosthetic valves, including higher survival, a lower risk of reoperation, and a reduced incidence of prosthetic valve endocarditis.
• Both types of prostheses showed comparable outcomes with respect to postoperative complications, in-hospital mortality, and the incidence of stroke.
• These findings underscore the need for an individualized approach to prosthesis selection, taking into account patient age and concomitant risk factors.

Aim. To compare the immediate and long-term outcomes of aortic valve replacement (AVR) using mechanical and biological prostheses in patients aged 50–65 years.

Methods. This retrospective study included data from 792 patients who underwent AVR with mechanical or biological prostheses between 2009 and 2019. After pseudorandomization, 374 patients were selected and divided into two groups: Group 1 (n = 187) – mechanical prostheses, Group 2 (n = 187) – biological prostheses. Inclusion criteria: age ≥ 18 years, isolated AVR. Exclusion criteria: left ventricular ejection fraction < 35%, double or triple valve replacement, age < 50 or > 65 years. The median follow-up period was 90 months (range: 53–118 months). Immediate and long-term outcomes were evaluated, including survival, reoperation rates, stroke incidence, and prosthetic endocarditis.

Results. There were no statistically significant differences in immediate postoperative outcomes between the groups. The 1-, 3-, 5-, and 10-year survival rates in the mechanical prosthesis group were 94.9%, 93%, 89.7%, and 86.4%, respectively, which were higher than in the biological prosthesis group (93%, 88.7%, 84.2%, and 66.4%; p = 0.001). Freedom from reoperation at 1, 3, 5, and 10 years in the mechanical prosthesis group was 97.7%, 97.7%, 97.7%, and 97.7%, while in the biological prosthesis group, it was 98.3%, 96.9%, 95.4%, and 76.4% (p < 0.001). The incidence of stroke at 1, 3, 5, and 10 years in the mechanical prosthesis group was 2.7%, 5.4%, 5.4%, and 12.2%, while in the biological prosthesis group, it was 2.1%, 5.8%, 6.7%, and 9.4% (p = 0.486). Freedom from prosthetic endocarditis at 1, 3, 5, and 10 years in the mechanical prosthesis group was 100%, 100%, 100%, and 100%, while in the biological prosthesis group, it was 99.4%, 97.3%, 97.3%, and 94.5% (p = 0.003).

Conclusion. Mechanical AV prostheses demonstrate significant long-term advantages in patients aged 50–65 years compared to biological prostheses. They are associated with higher survival rates, lower risks of reoperation, and reduced incidence of prosthetic endocarditis. However, both types of prostheses showed comparable results in terms of postoperative complications, in-hospital mortality, and stroke incidence. These findings highlight the importance of an individualized approach to prosthesis selection, taking into account patient age and associated risk factors.

Highlights

• Preoperative risk factors that affect the fatal outcome of coronary artery bypass grafting performed at the Voronezh Cardiac Surgery Center were identified.
• The IV functional class of angina pectoris, the EuroSCORE II value, the ejection fraction, the fact of unstable angina pectoris in the previous month, and pulmonary hypertension had an impact on the lethal outcome of surgery at a significance level < 0.001.
• The level of statistical significance < 0.05 was influenced by multifocal atherosclerosis, the fact and duration of myocardial infarction, and the functional class of chronic heart failure.

Aim. Analysis of the influence of preoperative risk factors on the fatal outcome of coronary artery bypass grafting.

Methods. The materials for the study were medical documentation data obtained from 1,584 patients who underwent coronary artery bypass grafting in 2021–2024. The analysis was carried out on the basis of 24 preoperative signs and the fact of death in the early postoperative period. Spearman's correlation analysis was used in the statistical processing of the material, and the normality of the distribution of feature values was assessed using the Kolmogorov–Smirnov and CHI² tests.

Results. The IV functional class of angina pectoris, the EuroSCORE II value, the ejection fraction, the fact of unstable angina pectoris in the previous month, and pulmonary hypertension had an impact on the lethal outcome of surgery at a significance level < 0.001. At the level of statistical significance < 0.05, multifocal atherosclerosis, the fact and duration of myocardial infarction, and the functional class of chronic heart failure had an impact on death.

Conclusion. The research work provides information about the patient's risk factors that have the greatest and least impact on the development of death during surgery and in the early postoperative period. Since the correlation analysis did not reveal the prevailing interrelationships of individual signs, a regression analysis should be performed to further predict the fatal outcome.

Highlights

Heart valve surgery is the most effective treatment modality for acquired heart diseases (AHD), which, despite the advancements in diagnosis and treatment, still pose a serious global health challenge.

Aim. To assess the changes in the volume and availability of surgeries for acquired heart diseases in the Russian Federation (in the period 2004–2023), and compare the results with global trends in the development of open and interventional surgery.

Methods. The analysis involved the data published in the annual reports of Russian clinics reflecting the state of the cardiovascular diseases and cardiovascular surgery in the Russian Federation (in the period 2004–2023). Statistical processing of the data was carried out using Microsoft Office Excel. Excel&apos;s quartile function was used to group data into periods.

Results. Over a 20-year period, the Russian Federation saw a more than twofold increase in the total number of heart valve surgeries (from 6,542 to 13,514). The availability of surgeries for AHD doubled (from 45.33 to 91.51 per 1 million population). The volume of repairs increased 2.7 times (from 1,526 to 4,107). The proportion of transcatheter valve replacements increased by 38.9 times (from 0.42% to 16.34%) compared to open surgery. The proportion of replacements using bioprostheses increased from 6.0% to 20.5%.

Conclusion. The Russian Federation has made significant progress in the treatment of acquired heart diseases over the past two decades. Valve replacement has become the predominant type of surgery, overtaking valve repairs, whereas the number of transcatheter valve replacements and replacements using bioprostheses has increased significantly. Further development in the field of cardiac surgery in the Russian Federation should be aimed at amplifying these trends, ensuring equal access to high-tech medical care in all regions, as well as the introduction of quality audit systems and evaluation of long-term outcomes.

Highlights

• Multiplex immunofluorescence imaging panels have been developed for monitoring the remodeling of tissue‑engineered vascular prostheses in baboons using human-specific antibodies.
• Scanning laser microscopy has confirmed that antibodies can detect key elements of newly formed vascular tissue 6 months after implantation of prostheses into the femoral arteries of baboons. The identified elements include endothelial cells, extracellular matrix, smooth muscle–like and fibroblast-like cells.
• The remodeled tissue formed on the basis of TSP is similar in many respects to the native vascular wall. This confirms the effectiveness of the developed panels for preclinical testing and expands the possibilities of detecting remodeling processes in baboon models.

Aim. To develop immunofluorescence assay panels based on human-specific antibodies to enable the detection of tissue-engineered construct remodeling during preclinical trials in baboon models.

Methods. A comparative assessment of the sensitivity of immunofluorescent antibodies was performed using samples of intact human internal mammary artery and explanted tissue-engineered vascular prostheses implanted into the femoral arteries of baboon for six months. The cross-reactivity and targeting capability of human antibodies against CD31, vWF, collagen IV, α-smooth muscle actin, and vimentin were demonstrated in relation to baboon tissues. Immunofluorescence visualization panels for assessing the remodeling of tissue-engineered vascular prostheses were developed. Fluorescence intensity was evaluated using scanning laser microscopy. Fluorescence intensity was assessed using scanning laser microscopy. Statistical data processing was performed using GraphPad Prism 8.

Results. It was demonstrated that the use of human antibodies against CD31, vWF, collagen IV, α-smooth muscle actin, and vimentin enabled the detection of key components of newly formed vascular tissue six months after implantation of tissue-engineered vascular prostheses into the femoral arteries of baboons, including endothelial cells, extracellular matrix, smooth muscle–like cells, and fibroblast-like cells.

Conclusion. The developed multiplex immunofluorescence imaging panels reflected the main features of tissue-engineered construct remodeling in primates, which is similar to the native vascular wall in many parameters, confirming their effectiveness for monitoring the formation of newly formed vascular tissue.

Highlights

• Donation after Circulatory Death (DCD) represents a strategically significant avenue for overcoming the critical shortage of donor hearts, as it allows for a substantial expansion of the donor pool beyond traditional donation after brain death.
• The key technological approaches enabling the clinical implementation of DCD heart transplantation are normothermic regional perfusion (NRP) in situ and ex-vivo machine perfusion (e.g., the OCS system), both aimed at minimizing ischemic damage to the graft.
• Implementing DCD programs in Russia requires addressing a complex set of medical, ethical, and legal issues, including the optimization of legislation, standardization of protocols, and training of multidisciplinary teams, drawing on successful international experience.

Abstract

The critical shortage of donor hearts in the Russian Federation necessitates innovative solutions. Donation after Circulatory Death (DCD) offers significant potential to expand the donor pool beyond traditional donation after brain death. Implementing DCD heart programs in Russia faces complex medical, legal, and logistical barriers. Key challenges include the narrow window for organ recovery, the risk of myocardial ischemic injury, the need to refine protocols for death determination, and addressing ethical concerns. Nevertheless, international experience demonstrates successful DCD heart transplantation utilizing advanced organ preservation technologies (e.g., perfusion systems). Developing DCD in Russia requires optimizing legislation, establishing specialized protocols, training multidisciplinary teams, and enhancing public awareness. Implementing DCD could substantially alleviate the organ shortage and reduce waitlist mortality.

Highlights

• Despitetheachievements of moderncardiac surgery, the level of postoperativecomplicationsremainshigh,whichunderlines the urgency of searching for newmethods of organprotectionin the perioperativeperiod.
• Ischemicreperfusioninjuriesareoneof the keyfactorsprovoking the development of complicationsaftercardiacsurgery,including those performedusingartificial blood circulation.
• Decreasedbioavailability of endogenousnitricoxide(NO)isoneof the consequences of artificial blood circulation,whichcanleadtoincreaseddamage to organsandtissues.

Abstract

Despite significant advances in cardiac surgery, the incidence of postoperative complications remains high. The use of exogenous nitric oxide (NO) is considered a promising method of perioperative organ protection. Experimental and clinical data indicate that perioperative delivery of NO can modulate ischemia–reperfusion injury, activate cGMP-dependent signaling pathways, and limit oxidative stress and inflammatory responses.

This review presents current data on the cardioprotective, nephroprotective, pulmonoprotective, and anti-infective effects of perioperative NO therapy.

Special attention is given to the molecular mechanisms of nitric oxide action, including regulation of mitochondrial function, modulation of endothelial dysfunction, and its effects on hemostasis and the systemic inflammatory response. The pathophysiological mechanisms underlying reduced endogenous NO bioavailability during cardiopulmonary bypass and the role of its exogenous compensation in promoting an organ-protective phenotype are discussed.

Despite encouraging clinical trial results, important questions remain unresolved regarding optimal dosing regimens, duration of therapy, and risk-based stratification of patients for organ dysfunction.

Highlights

• Obesity induces premature senescence of mesenchymal stromal cells through p38MAPK/NF-κB pathway activation with SASP phenotype formation.
• SASP factors (IL-6, TNF-α, MCP-1) promote macrophage polarization to proinflammatory M1 phenotype, creating a vicious cycle of chronic inflammation.
• Accumulation of senescent cells is associated with biological age acceleration by 3–4 years and increased cardiovascular disease risk.
• Senolytic and senomorphic therapy demonstrate promise in experimental models and require clinical validation.

Abstract

Obesity is a significant risk factor for the premature development of cardiovascular diseases and the acceleration of biological aging. The accumulation of senescent cells in adipose tissue, including mesenchymal stromal cells (MSCs) and macrophages, plays a key role in this process. These cells provoke chronic inflammation (inflamaging) and contribute to the development of cardiovascular pathology. As part of the study, an umbrella review was conducted based on the Joanna Briggs Institute methodology and the PRISMA 2020 guidelines. The analysis included 45 systematic reviews and meta–analyses from the PubMed/MEDLINE, Web of Science, Scopus, and Cochrane Library databases (search period 2019–2026). The methodological quality of the work was assessed using the AMSTAR tool‑2. The results showed that obesity triggers premature MSCs senescence through activation of the p38MAPK/NF-kB signaling pathways. This leads to: increased expression of aging markers (p16INK4a, p21Cip1, p53); formation of a secretory phenotype associated with senescence (SASP). SASP factors (IL‑6, TNF‑α, MCP‑1) cause the polarization of macrophages into the proinflammatory M1 phenotype. As a result, tissue inflammation and endothelial dysfunction worsen. In addition, it was found that the accumulation of senescent cells accelerates the epigenetic age by 3–4 years in obese patients (indicators ΔPhenoAge and DNAmGrimAge). Clinically, this is manifested by an increased risk of: atherosclerosis; heart failure with preserved ejection fraction; atrial fibrillation. Thus, the cellular senescence of MSCs and macrophages is an important pathogenetic link in premature cardiovascular aging in obesity. Senolytics (drugs for the elimination of senescent cells) and cenomorphics (agents for the suppression of SASP) may become promising areas of therapy. However, their effectiveness requires further clinical testing.

Highlights

• Combined lipid–lowering therapy, including rosuvastatin and ezetimibe (the true fixed combination is ZENON®), has been proven effective and safe in the prevention of cardiovascular complications in patients with atherosclerotic pathology, including after acute cardiovascular disasters, with diabetes mellitus and the elderly.
• There are few data on the experience of using combined lipid-lowering therapy (statin and ezetimibe) in patients with aortic stenosis, which actualizes the demonstration of cases from real clinical practice in publications.

Abstract

This article presents our clinical experience and reviews existing clinical studies evaluating the efficacy and safety of combination lipid-lowering therapy with a statin and a cholesterol absorption inhibitor (ezetimibe) for the prevention of cardiovascular complications associated with atherosclerosis. Clinical examples of outpatient management of patients with atherosclerosis and concomitant cardiovascular diseases using a fixed-dose combination of rosuvastatin at the maximum tolerated dose and ezetimibe (ZENON®) are presented. These results demonstrated positive results in terms of cardiovascular complication prevention over a 9-month follow-up period, achievement of target lipid profile values, and good tolerability of this combination.

Highlights

• Various methods of over-frequency ventricular stimulation in endovascular interventions on heart valves are analyzed.
• A new method of pacing using an over-stiff guidewire in the left ventricle and a coronary guidewire in the femoral artery is presented in transcatheter aortic valve replacement.

Absract

The publication presents and substantiates the methodology of pacing in TIAC using an ultra-rigid conductor in the left ventricle and a coronary conductor in the femoral artery. A technique for ultra–frequent stimulation of the ventricles of the heart is described, in particular, the use of a coronary artery in the femoral artery, the approach is illustrated by a clinical example. The proposed method makes it possible to successfully perform transcatheter intervention on the aortic valve: it provides stable, ultra-frequent stimulation of the ventricles at small amplitudes, while it does not require additional manipulations, new accesses, special tools and additional material costs.

Highlights

• A prospective randomized trial comparing the effectiveness of two approaches for the treatment of unstable plaque in patients with coronary artery disease was performed
• The most effective method in detecting unstable plaques is optical coherence tomography, which has demonstrated that 66% of patients have high-risk criteria, which underscores the importance of accurate diagnosis and an individual approach to treatment.

Background. The most common cause of acute coronary syndrome is the rupture and thrombosis of an unstable plaque. A plaque with vulnerable plaque characteristics increases the risk of major cardiac events, despite the absence of ischemia. The high resolution of optical coherence tomography allows for the assessment of not only the plaque volume and character but also the thin plaque capsule, an advantage over other imaging methods. Plaque stabilization using PCI remains a widely discussed treatment option and may be beneficial.

Aim. To compare the annual treatment outcomes of patients with mild coronary plaques treated with prophylactic PCI with OMT or OMT.

Methods. All patients with stable coronary artery disease and single-vessel borderline stenosis ranging from 50% to 89% in diameter underwent OCT to identify unstable plaque criteria. If two or more unstable plaque criteria were present, patients were randomized into two groups. One group underwent prophylactic PCI with OMT, while the other group received OMT alone. After 12 months, the two groups were compared for the following endpoints: angina recurrence, myocardial infarction, all-cause death, and target lesion revascularization. A composite endpoint, including all of the above outcomes, was also assessed.

Results. The study included 96 patients with coronary artery disease and angiographically borderline coronary artery disease. Patients with vulnerable plaque criteria according to OCT (n = 64) were randomized to the PCI with OMT or OMT groups with a subsequent follow-up of 12 months. During the 1-year follow-up period, no cases of repeat target lesion revascularization or myocardial infarction were detected. There was one cardiovascular death in the PCI group, while there were no deaths in the OMT group (3.1% and 0%, p = 0.574, respectively). However, the PCI group had a significant advantage in terms of residual angina compared to OMT at the 1-year follow-up stage (12.5% ​​and 43.8%, p = 0.027, respectively).

Conclusions. Prophylactic PCI with OMT has demonstrated benefit in terms of residual angina compared with OMT in the treatment of patients with chronic CAD and the presence of unstable plaque.

Highlights

• Transcatheter edge-to-edge mitral valve repair in patients with a «small» mitral annulus and borderline mitral valve area demonstrated high technical success and a low rate of complications. In most cases, a significant reduction of mitral regurgitation to ≤ grade 2 was achieved while maintaining low transmitral gradients, thereby minimizing the risk of iatrogenic mitral stenosis. One-year follow-up outcomes confirmed the durability of both hemodynamic and clinical benefits in the majority of patients. These findings support the feasibility and safety of transcatheter mitral valve repair in carefully selected patients with anatomically «small» mitral valves when performed in specialized high-volume expert centers.

Aim. To evaluate the efficacy and safety of transcatheter edge-to-edge mitral valve repair in patients with a «small» mitral annulus and initially limited mitral valve area.

Methods. The study included 46 patients with severe mitral regurgitation (grade 3–4) who underwent M-TEER at the A.N. Bakulev National Medical Research Center for Cardiovascular Surgery. The mean age was 68.9 ± 8 years. Most patients had functional MR (atrial or ventricular type) and a “small” mitral annulus with an annular area ranging from 32 to 36 cm² (median 35 cm²), while the mean mitral valve area was 4.1 cm². Clinical and echocardiographic assessments were performed before the procedure, in the early postoperative period, and at 1-year follow-up in 16 patients (34.7%). The evaluation included mitral regurgitation (MR) severity, transmitral pressure gradient, left ventricular remodeling function, and the incidence of complications.

Results. Technical success of M-TEER was achieved in 44 of 46 patients (95.6%). Non-fatal in-hospital complications occurred in 3 patients (6.5%), and no procedure-related mortality was observed. In the early postoperative period, MR severity was reduced to ≤ grade 2 in 95.5% of patients; residual severe MR (grade 3) was present in only 4.5%, and no cases of grade 4 MR were recorded. The median mean transmitral gradient increased from 2 to 3 mmHg, remained within a low range, and did not differ between atrial and ventricular MR. At 1-year follow-up (n = 16), 75% of patients still had MR ≤ grade 2, with no cases of grade 4 MR. The mean transmitral gradient remained stable, and left ventricular ejection fraction was preserved or moderately improved, particularly in patients with ventricular MR. No evidence of progressive iatrogenic mitral stenosis was detected.

Conclusion. Transcatheter edge-to-edge mitral valve repair in patients with a «small» mitral annulus demonstrated high technical success, a low complication rate, and sustained reduction of mitral regurgitation while maintaining low transmitral gradients. M-TEER may be considered an effective and safe alternative to surgery in high-risk patients with borderline mitral valve area. However, such procedures should be performed in expert, high-volume specialized centers with extensive experience in transcatheter valvular interventions.

Highlights

• Venous insufficiency can significantly limit the functions of the lower extremities. However, the effect of varicose veins on functional mobility and balance has not been sufficiently studied, which creates a gap in understanding the full picture of the disease.
• Impaired mobility and balance reduce the quality of life of patients. Restrictions in daily activity make it difficult to perform household tasks, reduce social activity, and can lead to psychological maladaptation.

Background. Venous insufficiency being a common manifestation of varicose vein (VV) frequently negotiate the lower extremity functions yet their influence on functional mobility and balance remains underexplored. Functional limitations and balance disorders may exponentially increase the risk of fall and hence, reducing quality of life, particularly when the venous deficiency progresses.

Aim. To evaluate functional mobility, muscle strength and balance deficit in VV patients with different Clinical-Etiological-Anatomical-Pathophysiological (CEAP) scoring using Time up and go test (TUG), Berg Balance scale (BBS) and manual muscle testing (MMT) scores.

Methods. A pilot study with 15 participants clinically diagnosed with VV was carried out. Participants were categorised according to CEAP guidelines and assessed using TUG, BBS and MMT. Data collected was then analysed to determine the correlation between CEAP stages and functional performance parameters.

Results. Data collected showed that participants with higher CEAP demonstrated substantially prolonged TUG time, reduced BBS and MMT grades. As compared to those scoring low on CEAP classifications. The result indicates a strong visible trend of deteriorating functional mobility, balance, and muscle strength with progressing venous insufficiency.

Conclusion. Statistical data obtained proves a strong connotation between CEAP classification and functional deterioration in VV patients in terms. Early and prompt identification of functional mobility and balance debits is imperative for opportune assistance, fall prevention, and improving patient outcomes.

Highlights

• The most expressed endothelial phenotype markers are vWF, EPCR/CD201, MCAM/CD146, ICAM2/CD102, VE-cadherin/CDH5/CD144, and PECAM1/CD31; two-thirds of endothelial phenotype markers (30/45) are released into the extracellular space even without any stimulation.
• Intact endothelial cells exhibit low basal pro-inflammatory activity, yet having a high potential for pathological activation in response to appropriate stimuli due to the broad expression of inducible cytokine genes and because of rapid secretion of these molecules into the microenvironment.
• The high proportion of secreted proteins composing endothelial basement membrane and subendothelial extracellular matrix relative to the total amount synthesized confirms the pivotal role of endothelial cells in the formation of these histological structures.

Aim. To perform an unbiased bioinformatic analysis of the molecular phenotype of intact endothelial cells derived from the atherosusceptible coronary artery (HCAEC) and the atheroresistant internal mammary artery (HITAEC).

Methods. Lysates of HCAEC and HITAEC were analyzed by whole transcriptome sequencing (RNA-seq) and ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Conditioned medium from HCAEC and HITAEC was also analyzed by UHPLC-MS/MS. Mean transcripts per million was used as the metric of gene expression, whilst protein expression was quantified based on chromatographic peak areas. Bioinformatic analysis of transcriptomic and proteomic data was performed using the Gene Ontology and Reactome databases.

Results. The most highly expressed endothelial phenotype markers in secretome and intracellular proteome of intact arterial ECs were vWF, EPCR/CD201, MCAM/CD146, ICAM2/CD102, VE-cadherin/CDH5/CD144, and PECAM1/CD31. Notably, 30 out of 45 endothelial phenotype markers were released into the extracellular microenvironment even without pathological activation. Most endothelial cell adhesion molecules exhibited low basal expression and were inducible (ICAM1, NRCAM, ALCAM, SELE, VCAM1). Although arterial ECs expressed approximately 40 cytokine genes, only about 10 were synthesized and released at relatively significant levels (including MIF, PTX3, CSF1, CCL2, CCL14, IL-8/CXCL8, and CXCL1). ECs demonstrated high expression and secretion of almost all basement membrane components (approximately 20), as well as a substantial number of extracellular matrix components (approximately 65). Approximately 50 angiogenic and 65 hemostatic molecules were detected in the conditioned media of ECs. Higher number of transcribed genes and synthesized proteins involved in vasodilatory pathways compared to vasoconstrictive pathways indicated a more prominent role of intact ECs in vasodilation.

Conclusion. Intact ECs have high basal bioactivity in maintaining angiogenesis, hemostasis, and the synthesis of endothelial basement membrane and subendothelial extracellular matrix components. Albeit intact ECs exhibit low basal pro-inflammatory activity, they have a high potential for pathological activation in response to the respective stimuli.

Highlights

• Pulmonary artery atresia with intact interventricular septum is a rare congenital heart defect that depends on the ductus.

Resume

Pulmonary artery atresia with intact interventricular septum is a rare and heterogeneous congenital heart disease, belonging to the group of so-called “blue” defects. The anatomical and physiological spectrum of the defect is variable with varying degrees of tricuspid valve and right ventricular hypoplasia, from a simple membranous form with a well-developed RV to severe pancreatic hypoplasia with myocardial sinusoids and right ventricular-coronary dependent blood flow. Transthoracic echocardiography is considered the “gold standard” for diagnosis, while additional imaging techniques like computed tomography and cardiac catheterization can be used to further characterize the structural features of this anomaly. In this review, we present an overview of the morphology and physiology of right-sided heart chambers in patients with pulmonary artery atresia with an intact interventricle septum.

Highlights

• A clinical case of correction of apnea-dependent transient sinoatrial block with episodes of asystole using CPAP therapy is presented.

Abstract

Obstructive sleep apnea syndrome (OSA) is associated with a high risk of sudden cardiac death, as well as a number of significant cardiovascular diseases, including rhythm and conduction disorders. A clinical case of a 45-year-old patient with high cardiovascular risk with transient sinoatrial block of II–III degree and nocturnal episodes of asystole lasting up to 11,256 ms, caused by severe OSA is presented. It has been shown that CPAP therapy eliminates OSA-associated bradyarrhythmias against the background of sinus rhythm, provides stable prevention of nocturnal pauses in the work of the heart, which reduces cardiovascular risks and complications, and also makes it possible to avoid implantation of a pacemaker.

Highlights

• We present the experience of staged endovascular and surgical treatment of aortic coarctation in children with extremely low and very low body weight using access through the common carotid artery.

Absract

In neonates with coarctation of the aorta, there are conditions such as extreme prematurity with extremely low birth weight, or severe comorbid conditions in which it is impossible to apply typical methods of defect correction (such as resection of the narrowed area with anastomosis under cardiopulmonary bypass or without it), it is possible to perform endovascular correction as a bridge to further surgical correction after overcoming critical conditions or achieving optimal growth and weight indicators. Balloon valvuloplasty does not show the preservation of favorable results in the long-term period. Stenting with use coronary stents allows for a critical narrowing of the aortic isthmus quite quickly and safely. However, the choose a vascular access for the stenting procedure remains an unresolved issue. This article presents the results of staged treatment with stenting of coarctation of the aorta through the right artery in two premature small children.