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Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guide-lines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guide-lines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Transthyretin amyloidosis (ATTR-amyloidosis) is a systemic progressive fatal disease, for which a modifying therapy has recently been proposed that delays the progression of the disease and improves the patient’s quality of life. The delay in the diagnosis of ATTR-amyloidosis is associated with the heterogeneity of the manifestations of the disease, as well as insufficient awareness of doctors of different specialties about the disease. A review of recent studies on the symptomatology, diagnosis, molecular genetic characteristics of ATTR-amyloidosis and the most common forms of the disease with the predominant involvement of peripheral nerves and the heart, as well as the kidneys, gastrointestinal tract, and eyes is presented. The international consensus recommendations for the diagnosis of suspected ATTR-amyloidosis using modern methods that facilitate early and accurate diagnosis are discussed. The reasons and the most frequent misdiagnoses of ATTR-amyloidosis, which also lead to a delay in the timely appointment of therapy, are considered. Molecular genetic testing should be considered early in the evaluation of a patient with unexplained peripheral neuropathy and cardiomyopathy. A diagnostic algorithm based on the initial symptoms and manifestations of the cardiovascular and nervous systems facilitates the identification of a patient with clinical suspicion of ATTR-amyloidosis by the general practitioner. Early diagnosis is critically important for patients with ATTR polyneuropathy, since the early prescription of Vindakel (tafamidis), registered in the Russian Federation in 2017, allows a significant clinical effect to be obtained. Timely administration of Vindakel significantly slows down the progression of the disease, improves the prognosis and quali ty of life in patients with ATTR polyneuropathy.

Aim. To evaluate the cost-effectiveness of achieving the target indicator "Reduction of the cardiovascular mortality of the population" of the State Program "Health Development" when using drugs valsartan+sacubitril, dapagliflozin and empagliflozin in patients with New York Heart Association (NYHA) class II-IV heart failure with reduced ejection fraction ≤40% s in 2023-2024.Material and methods. The target population was Russian patients who received preferential medicines in the last two years after an acute cardiovascular disease. The population size was determined on the basis of Russian literary and statistical sources. To predict the cardiovascular death, a parametric modeling method was used based on published data from clinical trials. The amount of drug costs required to prevent one cardiovascular death, as well as to achieve a one target for reducing cardiovascular mortality, was calculated using each of the comparator drugs in the whole country and separately in each region.Results. The cost of drugs for the 1st year of therapy to prevent one cardiovascular death in the case of valsartan+sacubitril was RUB 3,99 million, dapagliflozin — RUB 2,63 million, empagliflozin — RUB 4,43 million. There were following costs required to achieve one target indicator for reducing cardiovascular mortality of the State Program "Health Development" for valsartan+sacubitril, dapagliflozin and empagliflozin:in 2023 — RUB 2197,9 million, RUB 1451,5 million and RUB 2435,9 million, respectively;in 2024 — RUB 627,4 million, RUB 407,7 million and RUB 706,9 million, respectively.Conclusion. Among the agents considered, dapagliflozin seems to be the most cost effective for preventing one cardiovascular death and achieving one of the target "Reduction of the cardiovascular mortality" of the State Program "Health Development" in 2023-2024.

The objective of this advisory board meeting was to discuss the place of vericiguat in the treatment algorithm for heart failure with reduced ejection fraction and the necessary requirements for its successful application in clinical practice.

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.В статье суммируется текущий опыт отдела радионуклидной диагностики и позитронно-эмиссионной томографии ФГБУ НМИЦ кардиологии им. акад. Е.И. Чазова в выполнении сцинтиграфии миокарда с 99mTc-пирофосфатом при дифференциальной диагностике типов амилоидоза сердца. Проанализированы возможные причины ложноположительных, сомнительных и недиагностических результатов исследования, предложены способы их устранения, в том числе путем модификации протоколов планарного и томографического исследований и оптимизации диагностического алгоритма амилоидоза сердца в целом.

Plasma levels of meprin A, IL-6, and IL-18 were measured in 68 patients with acute decompensated heart failure at the time of admission to the hospital and after 1 year. The patients were assigned to groups depending on renal function disorder which was assessed by glomerular filtration rate (GFR). During hospital stay, the plasma levels of meprin A in patients with normal GFR (≥90 ml/min/1.73 m

The aim of the study was focused on the development of a decision rule for classifying patients as functional class (FC) II or III of chronic heart failure (CHF) by discriminant analysis with inflammatory markers. Materials and methods. The study included CHF patients ( n = 61) of both sexes. According to symptom severity, they were assigned to FC II ( n = 20) and III ( n = 41). In addition to conventional clinical and biochemical parameters to evaluate a patient’s state, parameters characterizing inflammation (IL-6, soluble IL-6 receptor, sgp130) were used. Statistically significant differences were revealed with the use of Mann – Whitney U test, Student’s t-test, Pearson’s χ 2 test and Fisher’s exact test. Discriminant analysis was employed to formulate the decision rule. Receiver Operating Characteristic (ROC) analysis was used to evaluate the quality of the developed diagnostic test. The results were considered statistically significant at p < 0.05. Results. Discriminant analysis included significantly different variables (age, brain natriuretic peptide, sgp130, CHF etiology, ischemic heart disease) and additional clinically important variables (diastolic and systolic arterial blood pressure (BP), IL-6). The decision rule for assigning patients to different CHF FC was developed. The optimum cut-off value was found with the use of the ROC curve with a sensitivity of 75.6% and specificity of 85%. Conclusion. The decision rule for assigning CHF patients to FC II or III was developed using discriminant analysis. In addition to conventional clinical parameters, the model included the ones reflecting inflammatory processes (IL-6 and sgp130). ROC analysis revealed high quality of the model.

It is known that micro RNAs are an important regulatory element in the pathogenesis of many diseases, including cardiovascular diseases. Different levels of expression of these molecules in various pathologies makes miRNA a potential diagnostic and prognostic biomarker.Analysis of miRNA expression levels in mononuclear blood cells (MBC) of patients with acute decompensation f chronic heart failure (CHF) of various etiologies and evaluation of the possibility of their use as a biological marker.7 male patients with acute decompensation of CHF with a reduced ejection fraction (EF), NYHA functional class II-IV (FC) according to NYHA [mean (M) EF 29.2%, standard deviation (SD) 13.27%] in age 38 to 65 years old [median (Me) 58 years]. In 3 patients, heart failure developed as a result of dilated cardiomyopathy (DCMP), in 4 patients - against the background of post - infarction cardiosclerosis of the ischemic nature [group of patients with coronary heart disease (CHD)]. The control group - 5 age - matched (from 41 to 57 years old, Me 49 years old) healthy male volunteers. A complete transcript analysis of miRNA expression in MNCs was performed for all patients and healthy volunteers.Differentially expressed miRNAs were determined in patients with CHF (regardless of etiology) compared with healthy individuals: miR-182, miR-144, miR-183, miR-486-5p, miR-143 (log2FC1, FDR p - value.Известно, что микроРНК являются важным регуляторным звеном в патогенезе множества заболеваний, в том числе и сердечно - сосудистых. Разный уровень экспрессии данных молекул при различных патологиях делает микроРНК потенциальным диагностическим и прогностическим биомаркером. Цель. Анализ уровней экспрессии микроРНК в мононуклеарных клетках крови (МНК) пациентов с острой декомпенсацией хронической сердечной недостаточности (ХСН) различной этиологии и оценка возможности их использования в качестве биологического маркера. Материалы и методы. Проведено исследование 7 больных мужского пола с острой декомпенсацией ХСН со сниженной фракцией выброса (ФВ), II-IV функционального класса (ФК) по NYHA [среднее значение (М) ФВ 29,2%, стандартное отклонение (SD) 13,27%] в возрасте от 38 до 65 лет [медиана (Ме) 58 лет]. У 3 пациентов сердечная недостаточность развилась вследствие дилатационной кардиомиопатии (ДКМП), у 4 пациентов - на фоне постинфарктного кардиосклероза ишемической природы [группа пациентов с ишемической болезнью сердца (ИБС)]. Группу контроля составили 5 сопоставимых по возрасту (от 41 до 57 лет, Ме 49 лет) здоровых мужчин - добровольцев. Всем пациентам и здоровым - добровольцам проведен полнотранскриптомный анализ экспрессии микроРНК в МНК. Результаты. Определены дифференциально экспрессирующиеся микроРНК у пациентов с ХСН (вне зависимости от этиологии) по сравнению со здоровыми индивидами: miR-182, miR-144, miR-183, miR-486-5p, miR-143 (log2FC1, FDR p-value.

MicroRNA is a class of non-coding, single-stranded RNA 19-24 nucleotides in length, the main function of which is to inhibit the expression of protein-coding genes at the post-transcriptional level. It is known that microRNAs are an important pathogenetic link in the development of many diseases, including cardiovascular ones. Different levels of expression of these molecules in different pathologies make microRNAs potential diagnostic and prognostic biomarkers. Numerous studies confirm the fact of changes in the profile of microRNA expression in heart failure (HF). However, it is worth noting that the vast majority of these studies included patients with stable chronic HF, while the connection of these molecules with acute HF has received far less attention. Acute HF is the main cause of hospitalization for older patients. However, taking into account the low prognostic ability of existing biological markers of HF, the search for a new biological marker with a high prognostic significance is an important task of modern medicine. The article provides a brief overview of the research on the evaluation of diagnostic and prognostic abilities of a new potential of the biomarker in acute HF.

Early diagnosis of acute kidney injury (AKI) is an urgent problem of providing medical care to patients with acute decompensation of chronic heart failure (ADHF). Aim. To study the possibilities of previously diagnosing acute renal damage in patients with acute decompensation of chronic heart failure with reduced systolic function using biomarkers of acute renal injury. Materials and methods. The study included 60 patients (62.0±11.1 years) with HADS (BNP >500 pg/ml) and a reduced left ventricular ejection fraction (LV 27.05% [23.25; 32.75], c FC III-IV NYHA). The level of creatinine, urea, uric acid, albumin in serum was determined in all patients, as well as a number of biomarkers: lipocalin associated with neutrophil gelatinase (NGAL) and cystatin C (CysC) in serum; kidney damage molecule-1 (KIM-1) and angiotensinogen (AGT) in the urine. Results and discussion. AKI is determined based on changes in serum creatinine concentration or diuresis value. The results obtained indicate a high specificity and sensitivity of the use of biomarkers for the diagnosis of AKI in patients with ADHF. NGAL AUC - 0.833 (p

Heart failure is one of the main health care problems all over the world. Although, there are many drugs with proven effectiveness and hi-tech devices, there is a continuous process of searching new possibilities in heart failure prophylaxis going on because of huge economic burden and impact on life quality. Developing of atrial fibrillation in heart failure patients increases the risks of hospitalization and all-cause mortality. Appearance of new Optimizer Smart® system of cardiac contractility modulation is a perspective way of treatment in patients with heart failure and atrial fibrillation, who are not a candidate or have not got a good result from cardiac resynchronization therapy (CRT).

Prevalence of chronic heart failure (CHF) is continuously growing and is associated with increased incidence of hospitalizations, morbidity and mortality. Furthermore, the increase in the number of rehospitalizations results in greater expenses and worsening of quality of life. In order to decrease the number of unscheduled hospitalizations and the death rate, the outpatient care should be improved, which can be achieved by using telemedical technologies. The aim of this review was collection and analysis of currently available information about the use of telemonitoring for patients with CHF. A systematic search and analysis of reports published from 2010 through 2020 in Web of Science, Scopus, and PubMed/MEDLINE databases was performed.

Takayasu arteritis belongs to the group of systemic vasculitis with a predominant lesion of large - caliber vessels and the development of stenosis of their lumen. In world practice, to establish the diagnosis of arteritis Takayasu apply the criteria proposed by the American College of rheumatologists. Currently, there are no randomized clinical trials related to the disease, and the diagnosis and treatment of patients are based on a number of small studies, a series of clinical cases and expert opinion. The described clinical observation of a patient with Takayasu arteritis is of interest in connection with the detected atrial myocarditis during MRI diagnosis of the heart with contrast, which allows us to discuss the feasibility of this imaging technique in complex and doubtful cases.Артериит Такаясу относится к группе системных васкулитов с преимущественным поражением сосудов крупного калибра и развитием стенозирования их просвета. В мировой практике для установления диагноза артериита Такаясу применяют критерии, предложенные Американской коллегией ревматологов. В настоящее время отсутствуют рандомизированные клинические испытания, касающиеся этого заболевания, и диагностика и лечение пациентов основаны на данных ряда небольших исследований, серии клинических случаев и мнении экспертов. Описанное клиническое наблюдение пациентки с артериитом Такаясу представляет интерес в связи с выявленным миокардитом предсердий при проведении МРТ-диагностики сердца с контрастированием, что позволяет обсуждать вопрос о целесообразности выполнения данной визуализирующей методики в сложных и сомнительных случаях.

Acute decompensated heart failure (ADHF) is based on multilevel pathological pathways, which include hemodynamic overload and venous stasis. Determination of the volemic status is one of the most important tasks in managing such patients. Despite the availability of modern diagnostic markers (physical examination, chest x-ray, and brain natriuretic peptide (BNP) assessment), they do not accurately assess the degree of fluid overload, and therefore there remains a need to find a new, accurate and simple technology for assessing pulmonary congestion. The urgency of this problem has led to the development of a novel non-invasive remote dielectric sensing (ReDS) technology, which is a quantitative method for measuring the total volume of lung fluid by determining the tissue dielectric properties. The use of this technology makes it possible to quickly, non-invasively and quantitatively measure the fluid content in the lungs, makes it possible to optimize the treatment regimen and reduces the number of readmissions. This article presents the results of studies on the efficacy, safety and prospects for using a ReDS technology for the quantitative measurement of total lung fluid in patients with ADHF.

Iron deficiency (ID) is one of the most common comorbidities in patients with heart failure (HF). ID is a strong independent predictor of outcomes in HF patients. ID reduces quality of life, exercise tolerance, and survival in patients with HF, regardless of anemia status. The latest 2021 guidelines recommend initiating ID treatment at a ferritin

Cardiovascular diseases are the main drivers of the morbidity and mortality in Russian Federation. We briefly discussed the poor adherence of the patients and outlined the solutions of this problem.Сердечно-сосудистые заболевания остаются ведущей причиной смертности и заболеваемости среди населения Российской Федерации. Кратко описаны сложности с поддержанием оптимальной приверженности пациентов лечению, даны возможные решения данной проблемы.

Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes.

An online expert meeting held on November 17, 2021 reviewed the results of the randomized, double-blind, multinational, parallel-group EMPULSE trial, evaluating the clinical benefit and safety of the sodium-glucose co-transporter-2 inhibitor (SGLT2i) empagliflozin compared with placebo in patients hospitalized with acute decompensated heart failure (ADHF). Patients were included in the study regardless of ejection fraction (EF) and the presence of diabetes and randomized during hospitalization after stabilization. In addition, the EMPULSE trial used a composite result analyzed using a stratified benefit ratio — Win Ratio analysis. There is evidence of clinical benefit of empagliflozin in hospitalized patients with preserved and reduced LVEF, as well as in patients with newly diagnosed ADHF or with acute decompensation of chronic heart failure (CHF) compared with placebo, regardless of type 2 diabetes presence. The importance of the favorable results of the EMPULSE trial and its significance for clinical practice, which implies the early administration of empagliflozin for inpatients, is noted. A number of proposals have been adopted to accelerate the introduction of empagliflozin into clinical practice for patients with ADHF.

Background. Levosimendan infusion can be used in the treatment of patients with acute decompensated heart failure (ADHF) with a reduction in cardiac output and signs of severe congestion/pulmonary edema.Aim. To study impact of levosimendan on renal function in patients with ADHF with reduced systolic function.Material and methods. The study was a prospective, randomized trial. We enrolled 30 men (age 62.5 [55.8-69.3] years) hospitalized with ADHF with reduced systolic function (left ventricular ejection fraction 500 pg/mL) and systolic blood pressure >125 mmHg. All patients were randomized into 2 groups of 15 people each. In the first group, the patients received an intravenous infusion of levosimendan 0.1 μg/kg/min for 24 hour added to standard therapy. The second group received standard therapy.Results. 24-hour levosimendan infusion significantly increased the glomerular filtration rate levels from 65.4 [45.2-99.2] mL/min/1.73m2 at baseline to 79.0 [66.3-93.1] mL/min/1.73m2 at discharge (p= 0.011), greatly decreased serum creatinine from 1.17 [0.90-1.55] mg/dL at baseline to 1.01 [0.89-1.14] mg/dL at discharge (p = 0.009) and blood urea nitrogen and at the same time improved renal blood flow in patients with ADHF while there were no clinically significant changes in the studied parameters in the standard therapy group.Conclusion. Levosimendan had a positive effect on renal function in patients with ADHF with reduced systolic function.

Histological analysis of endomyocardial tissue is still the gold standard for the diagnosis of cardiac amyloidosis but has its limitations. Accordingly, there is a need for noninvasive techniques to cardiac amyloidosis diagnostics. Echocardiography and magnetic resonance imaging can show characteristics which may not be very specific for cardiac amyloid. Recently, new opportunities of nuclear imaging in risk stratification and assessment of prognosis for patients with cardiac amyloidosis have appeared. During the last two decades different classes of radiopharmaceuticals have been developed based on compounds tropic to the components of amyloid infiltrates. In this paper we describe the current possibilities and perspectives of nuclear medicine techniques in patients with cardiac amyloidosis, including osteotropic and neurotropic scintigraphy, single-photon and positron emission tomography

Background: the incidence of acute kidney injury (AKI) is high in patients with acute decompensated heart failure (ADHF) and is linked with increased morbidity and mortality rates. Predictive biomarkers of AKI could allow improve outcomes in AKI. Purpose: to evaluate the value of serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations for early diagnosis of AKI in patients with ADHF with left ventricular (LV) systolic function. Methods: we enrolled 60 men (average age was 62.0±11.1 years) hospitalized with ADHF with reduced LV systolic function (LV ejection fraction (LVEF) 157.35 ng/mL had 13.8-fold increase in the odds of developing AKI (95% CI, 3.93 to 48.42). Conclusion: sNGAL can be used for early diagnosis of AKI in patients with ADHF with reduced LV systolic function.

The fact that microRNAs play an important role in the development and pathogenesis of cardiovascular disease is beyond doubt. This article provides a brief overview of recent data that relate to microRNA expression in various cardiovascular diseases. Detecting significant changes in the level of expression of these molecules in various diseases means that microRNAs can be considered to be potential biomarkers of human pathologies including heart failure. Studying the relationship between the mechanisms of cardiovascular disease and the level of expression of a variety of microRNAs, as well as establishing their exact relationships with the genes is an urgent problem and requires further research.

Aim. To assess the effect of therapy with sodium glucose co-transporter type 2 inhibitor dapagliflozin in patients with heart failure with reduced ejection fraction (CHrEF) on the state cardiovascular mortality target indicators.Material and methods. All adult Russian patients with NYHA class II-IV HFrEF (left ventricular ejection fraction ≤40%) were considered as the target population. The characteristics of patients in the study corresponded to those in the Russian Hospital HF Registry (RUS-HFR). The study suggests that the use of dapagliflozin in addition to standard therapy will be expanded by 10% of the patient population annually in 2022-24. Cardiovascular mortality modeling was performed based on the extrapolation of DAPA-HF study result. The number of deaths that can be prevented was calculated when using dapagliflozin in addition to standard therapy. Further, the contribution of prevented deaths with dapagliflozin therapy to the achievement of federal and regional cardiovascular mortality target indicators (1, 2 and 3 years) was calculated.Results. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF with the expansion of dapagliflozin therapy by 10% of the patient population annually will additionally prevent 1729 cardiovascular death in the first year. This will ensure the implementation of cardiovascular mortality target indicators in Russia in 2022 by 11,8%. In the second year, 3769 cardiovascular deaths will be prevented, which will ensure the implementation of target indicators in 2023 by 17,2%. In the third year, 5465 cardiovascular deaths prevented, which will ensure the implementation of implementation of target indicators in 2024 by 18,7%.Conclusion. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF will ensure the implementation of implementation of target indicators in 2024 by 18,7%.

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

Chronic heart failure is an important global public health problem. This is associated with extremely poor prognosis, high readmission rates, and substantial treatment costs in patients. The paper gives the main aspects of the setting-up of a specialized service to patients with heart failure.Хроническая сердечная недостаточность представляет собой актуальную проблему мирового здравоохранения. Это связано с крайне неблагоприятным прогнозом, высокой частотой повторных госпитализаций и существенными расходами на лечение больных. Представлены основные аспекты формирования специализированной службы пациентам с сердечной недостаточностью.

Management of patients with terminal heart failure is one of the most serious ongoing problems in cardiac surgery. In addition, the clinical progression of heart failure is often characterized by cardiac rhythm disturbances, with atrial fibrillation and atrial flutter being the most common types of these disorders. The prognosis may be extremely unfavorable if inappropriate tactics of treatment is used. Development of interventional and minimally invasive surgery expanded the possibilities of treatment of such patients. The article looks at some application features of a hybrid approach to treatment of a patient with atrial flutter and a terminal stage of chronic heart failure.Received 3 May 2017. Accepted 24 June 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

Aim. To evaluate diagnostic significance of biomarkers for inflammatory cardiomyopathy (ICM). Material and methods. Totally, 35 patients included with suspected inflammatory cardiomyopathy, chronic heart failure of I-III functional class (FC), decreased systolic function of the left ventricle (EF LV

Аннотация. Растворимая форма гликопротеина 130 (sgp130) является ингибитором транссигнального пути передачи сигнала ИЛ-6 (ин- терлейкина-6). Препятствуя проведению сигнала, sgp130 может оказывать влияние на развитие ИЛ-6-ассоциированных патологий. Цель исследования. Оценить циркулирующие уровни sgp130 у пациентов с различной этиологией и степенью выраженности симптомов хро- нической сердечной недостаточности (ХСН). Материал и методы. В исследование были включены 61 пациент с ХСН и 14 здоровых доноров. Причиной сердечной недостаточности у 29 пациентов была ишемическая болезнь сердца (ИБС), у 19 пациентов артериальная гипертензия (АГ) и у 13 пациентов дилатационная кардиомиопатия (ДКМП). В зависимости от выраженности симптомов ХСН пациенты были отнесены к II (n 20) и III (n 41) функциональным классам (ФК). Результаты. У пациентов с ХСН циркулирующие уровни sgp130 значительно выше, чем у здоровых доноров. В группах пациентов, сформированных в соответствии с этиологией ХСН, концентрации sgp130 достоверно не различались. В группах пациентов, сформированных в зависимости от выраженности симптомов заболевания, уровни sgp130 были значительно выше у пациентов III ФК по сравнению с пациентами II ФК. Логистический регрессионный анализ с включением в модель возраста, пола, показателя фракции выброса левого желудочка (ФВ ЛЖ), АГ, ИБС, сахарного диабета, диастоли- ческой дисфункции, статинов, NT-proBNP (N-терминальный пропептид мозгового натрийуретического гормона), креатинина подтвер- дил статистически значимую связь между уровнями sgp130 и выраженностью симптомов заболевания (ОШ 1,019 (ДИ 1,0061,0031), р 0.003). Между уровнями sgp130 и NT-pro-BNP у всех исследуемых пациентов с ХСН выявлена положительная корреляционная связь. Выводы. Циркулирующие уровни sgp130 повышаются при прогрессировании ХСН вне зависимости от этиологии заболевания.Abstract. he soluble form of glycoprotein 130 (sgp130) is an inhibitor of IL-6 trans-signaling pathway. Sgp130 can affect the development of the IL-6-associated pathologies by preventing the IL-6 signal transduction. Aim. We examined circulating levels of sgp130 in patients with chronic heart failure (CHF) of different etiologies and varying severity of symptoms. Material and methods. The study included 61 patients with CHF and 14 healthy donors. The cause of heart failure was coronary heart disease (CHD) in 29 patients, arterial hypertension (AH) in 19 patients and dilated cardiomyopathy (DCMP) in 13 patients. The patients were assigned to II (n 20) and III (n 41) functional classes (FC) depending on the severity of the CHF symptoms. Results. The circulating levels in patients with CHF were significantly higher than in healthy donors. The levels of sgp130 did not differ significantly in the groups of patients formed according to CHF etiology. Sgp130 levels were significantly higher in patients with III FC compared with those in patients with II FC. The multivariate linear regression analysis including sex, age, left ventricular ejection fraction, diabetes status, statins, arterial hypertension, coronary artery disease, NT-proBNP has revealed the association between sgp130 levels and disease severity: OR 1.019 (95 CI: 1.006-1 0031), p 0.003. The positive correlation between sgp130 and NT-proBNP levels (r0.324, р0.011) was established in all patients. Conclusion. The circulating levels of sgp130 increase with the progression of CHF regardless of the disease etiology.

Transthyretin amyloidosis (ATTR) is a threatening and severe genetic disease characterized by damages to organs and systems caused by a pathological protein transthyretin produced in the liver. Clinical manifestations of this disease vary from injuries of the nervous system to injuries of the cardiovascular system. Prognosis for ATTR-amyloidosis remains unfavorable. The absence of pathognomonic symptoms complicates diagnostics of this disease, which tends to simulate other conditions. At present, medicines exist, which are pathogenetic in the treatment of ATTR-amyloidosis. The article describes a clinical case of ATTR-amyloidosis with primary heart injury complicated with functional class III chronic heart failure during the tafamidis treatment.

Aim. To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. Materials and methods. We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. Results. Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. Conclusion. The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.

Background. Atrial fibrillation (AF) and heart failure (HF) are tightly interrelated. The concurrence of these pathologies can aggravate the pathological process. The geographic and ethnic characteristics of patients may significantly affect the efficacy of different types of therapy and patients’ compliance. The objective of this study was to analyze how the features of the course of the diseases and management of HF + AF influence the clinical outcomes. Methods. The data of 1,003 patients from the first Russian register of patients with chronic heart failure and atrial fibrillation (RIF-CHF) were analyzed. The endpoints included hospitalization due to HF worsening, mortality, thromboembolic events, and hemorrhage. Predictors of unfavorable outcomes were analyzed separately for patients with HF and preserved ejection fraction (AF + HFpEF), midrange ejection fraction (AF + HFmrEF), and reduced ejection fraction (AF + HFrEF). Prevalence of HF + AF and compliance with long-term treatment of this pathology during one year were evaluated for each patient. Results. The study involved 39% AF + HFpEF patients, 15% AF + HFmrEF patients, and 46% AF + HFrEF patients. AF + HFpEF patients were significantly older than patients in two other groups (40.6% of patients were older than ≥75 years vs. 24.8%, respectively, p<0.001) and had the lowest rate of prior myocardial infarctions (25.3% vs. 46.1%, p<0.001) and the lowest adherence to rational therapy of HF (27.4% vs. 47.1%, p<0.001). AF + HFmrEF patients had the highest percentage of cases of HF onset after AF (61.3% vs. 49.2% in other patient groups, p=0.021). Among patients with AF + HFrEF, there was the highest percentage of males (74.2% vs. 41% in other patient groups, p<0.001) and the highest percentage of ever-smokers (51.9% vs. 29.4% in other patient groups, p<0.001). A total of 57.2% of patients were rehospitalized for decompensation of chronic heart failure within one year; the risk was the highest for AF + HFmrEF patients (66%, p=0.017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15.5% vs. 5.4% in other patient groups, p<0.001) rather than ischemic stroke (2.4% vs. 3%, p=0.776). Patients with AF + HFpEF had lower risk to achieve the combination point (stroke + IM + CV death) as compared to patients with AF + HFmrEF and AF + HFrEF (12.7% vs. 22% and 25.5%, p<0.001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and administered treatment had different effects on the risk of unfavorable outcomes depending on ejection fraction group. The clinical features and symptoms were found to be significant risk factors of cardiovascular mortality in AF + HFmrEF, while therapy characteristics were not associated with it. Conclusions. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with the development of unfavorable outcomes. The demographic and clinical characteristics of patients with midrange ejection fraction demonstrate that these patients need to be studied as a separate cohort.

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, pConclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

Since the beginning of the 1960s, beta-blockers have been number one medications in the treatment of cardiovascular diseases. A number of randomized controlled trials (RCTs) demonstrated positive effect of beta-blockers on morbidity and mortality [1]. It is difficult to overestimate the role of beta-blockers in modern cardiology. According to the results of a meta-analysis of 18 RCTs, administration of beta-blockers in patients with a risk of cardiovascular disease was associated with a reduction of the risk of stroke by 29%, coronary heart disease (CHD) by 7%, and chronic heart failure (CHF) by 29% [2]. In combination with ACE inhibitors, antiplatelet agents and statins, beta blockers helped to decrease mortality from acute coronary syndrome by 90% [3].

Heart failure and atrial fibrillation are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with heart failure and atrial fibrillation is increasing every year. Nowadays the question of anticoagulant therapy for this category of patients is being discussed. In our review we summarized data on the guideline adherence and prevalence of long-term anticoagulant therapy in patients with atrial fibrillation and heart failure.

The review analyzes new treatment for patients with chronic heart failure (CHF) with low ejection fraction – cardiac contractility modulation (CCM). CCM is carried out by supplying electric signals to an absolutely refractory ventricular myocardium, to elicit a positive inotropic effect without increasing myocardial oxygen consumption. These effects are independent on QRS duration; consequently, the therapy might be beneficial for patients who are not candidates for cardiac resynchronization therapy (CRT). It should be noted that the use of CCM treatment of CHF should begin only with maximum active therapy when its efficacy is not enough. It is not an alternative, but complement to the most active treatment of patients. Clinical studies primarily focused on patients with normal QRS duration because the CPT is optimal treatment of patients with prolonged QRS. The article focuses on the prerequisites for the development of the method and discusses the results obtained when evaluating the clinical efficacy and safety of treatment of patients with CHF in randomized clinical trials FIX-HF-3 (n=25), FIX-HF-4 (n=164), FIX-HF-5 (n=428). The total number of patients included into these studies was 617 people. Baseline patient characteristics were similar for all 3 studies. All participants received optimal medical therapy, had a normal QRS duration. All patients were II and III functional class (by NYHA). The studies analyzed the changes in NYHA class, ejection fraction, peak oxygen consumption (VO2), the precursor of brain natriuretic peptide (NT-proBNP) level. Quality of life was assessed by the Minnesota questionnaire; the mortality rate was compared with that predicted by MAGGIC scale. CCM therapy had beneficial effect on the survival and quality of life in patients with CHF. However, more data is needed to assess long-term effects of the CCM therapy.

The brief review gives the experience in using the concept of translational medicine in the practical activities of the Russian Cardiology Research and Production Complex in the past 25 years of its existence. It outlines the possible ways of developing this area in Russian medicine to solve crucial scientific and practical tasks.В кратком обзоре представлен опыт использования концепции трансляционной медицины в практической деятельности ФГБУ РКНПК в течение последних 25 лет существования данной организации. Очерчены возможные пути развития данного направления российской медицины для решения актуальных научных и практических задач.Аннотация В кратком обзоре представлен опыт использования концепции трансляционной медицины в практической деятельности ФГБУ РКНПК в течение последних 25 лет существования данной организации. Очерчены возможные пути развития данного направления российской медицины для решения актуальных научных и практических задач.

The article provides information about the class of non-coding RNA (microRNA), their role in the diagnosis of chronic heart failure and the results of a pilot study.

The review presents data on alterations of mitochondrial oxidative metabolism occuring due to heart failure, mechanisms of cytoprotective agent trimetazidine associated with a partial inhibition of the fatty acid oxidation and increased metabolism of pyruvate, reduction of cardiomyocyte apoptosis and oxidative stress are described. The results of clinical studies showing the effectiveness of trimetazidine therapy in ischemic heart decease are reported, as well as the latest data on the effects of prolonged use of trimetazidine on prognosis in patients with heart failure.

By the date, acute heart failure (AHf) is of the most significant problems in whole world healthcare, as it is one of the main causes for hospitalization to specialized units and intensive care units. About 80% of AHf cases are due to acute decompensation (AD) of heart failure (Hf), and if formerly AHf was regarded as a condition actual only for elderly (older than 70), now these are the patients “younger” — economically active (50-65 y.o.), what makes AHf not just medical but social, economical problem, demanding special attention from policies and healthcare. It is crucial to diagnose on-time for risk stratification and correct assessment. Also, mechanisms of AHf are complicated and are not studied completely, that is why till now there is no single strategy for that sort of patients management. Understanding of pathophysiological mechanisms of Hf development has been changed significantly recent decades, from simple hemodynamic model to a conception of systemic multifactorial process, with involved multiple mechanisms of various organs and systems interaction. Hemodynamic overloads, venous congestion, neuro-humoral systems activation, natri-uretic peptides, inflammation, endothelial dysfunction, oxidative stress and its influence on the heart and vessels remodeling, as mechanisms of cellular adaptation are currently the main in AHf pathogenesis reasons.

Heart failure remains one of the main problems in contemporary cardiology, taken high frequency of hospitalizations due to acute decompensation, and worse prognosis for this category of patients. One of the drugs influencing prognosis is serelaxin (recombinant human relaxin-2). Experience of serelaxin usage as 48-hour infusion for patients with ADHF showed rapid positive influence of the drug on clinical signs and symptoms, target organ damage markers (BNP, creatinine), hemodynamics parameters (MPAP).

Aim. To compare clinical and haemodynamic efficacy of ramipril vs enalapril in women with chronic heart failure (CHF). Material and methods. 60 women with non valvular CHF were included in the study. Patients were randomized in groups of ramipril or enalapril taken in addition to standard therapy. CHF severity, heart morphofunctional parameters, life quality, exercise tolerance, biomarkers (brain natriuretic peptide, von Willebrand factor) was estimated in patients initially and after 6 months of therapy. Results. Ramipril average daily dose was 11,4 mg, enalapril average daily dose - 34,2 mg. Dry cough was observed more rarely in patients treated with ramipril than in patients treated with enalapril. There was a trend to higher increase of exercise tolerance due to ramipril therapy in comparison with enalapril one (р=0,062). Ramipril, but not enalapril, reduced a number of patients with diastolic dysfunction (р=0,049). Life quality improvement was higher in ramipril treated patients in comparison with those treated with enalapril (р=0,04). Brain natriuretic peptide and von Willebrand factor levels decreased more significantly in ramipril therapy than in enalapril one (р=0,05 and р

At the online meeting held on September 3, 2020, the results of the international multicenter trial EMPEROR-REDUCED were considered. Number of proposals and recommendations for the further study of cardiovascular and renal effects of empagliflozin and its practical use in heart failure patients were agreed.

Aim.To assess the effect of dapagliflozin in patients with heart failure with reduced ejection fraction (HFrEF) on reducing cardiovascular mortality as the main goal of a federal project on the prevention of cardiovascular diseases.Material and methods.All adult Russian patients with a documented NYHA class II-IV HFrEF (EF £40%) were considered the target population. The characteristics of the patients corresponded to those of the Russian Hospital Heart Failure Registry (RUS-HFR). The study looked at an increase in the dapagliflozin use in addition to standard therapy by 10% of patients annually in 2021-2023 and calculated the number of deaths that could be prevented. Cardiovascular mortality curve was created by extrapolation of the DAPA-HF study results using the Kaplan-Meier method. Further, the contribution of prevented deaths with dapagliflozin to the achievement of regional and federal targets for reducing cardiovascular mortality was calculated for 1, 2, and 3 years.Results.In case of 10% annual increase in dapagliflozin use in patients with NYHA class II-IV HFrEF, this will allow:— to prevent an additional 1,736 cardiovascular deaths in the first year, achieving the target of federal project on the prevention of cardiovascular diseases in 2021 by 5,9%;— to prevent an additional 3,784 cardiovascular deaths in the second year, achieving the target of federal project on the prevention of cardiovascular diseases in 2022 by 12,9%;— to prevent an additional 5,485 cardiovascular deaths in the third year, achieving the target of federal project on the prevention of cardiovascular diseases in 2023 by 18,7%.Conclusion.The use of dapagliflozin in patients with HFrEF will reduce mortality from cardiovascular diseases.