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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.

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.

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.

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.

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.

Relationships and Activities. The Council of Experts was supported by AstraZeneca.

The results of recent trials on acetylsalicylic acid (ASA) efficacy are presented. Data potentially related to the possibility of ASA indications extension is discussed, in particular that referring to the cancer prevention. This ASA indication should be confirmed in additional studies.

Chronic heart failure (CHF) and atrial fibrillation (AF) can rightly be called the epidemic of the XXI century, which are associated with high morbidity and mortality of patients. Common risk factors and pathophysiological mechanisms explain the frequent combination of CHF and AF. So far, a number of issues related to management of these patients, remains unresolved. Data on compliance with clinical guidelines and the prevalence of long-term anticoagulant therapy in this group of patients in our country is limited. The first Russian register of CHF and AF (RIF-CHF) is initiated in order to better address this problem. The results allow to develop the most rational therapeutic and diagnostic strategies and, ultimately, to improve the clinical outcomes of such severe patients.

A comparison of ivabradine and omega-3 polyunsaturated fatty acids, drugs with principally different mechanisms of action, is presented in patients with chronic heart failure (CHF) on the base of GISSI-HF and SHIFT trails results. It is essential to compaire an effect of these drugs on the morbidity and mortality in combined therapy of patients with CHF , because each additional drug may change in compliance to treatment, induces additional costs or may be a reason of new side effects. Additional (to standard therapy) effects of ivabradine and omega-3 polyunsaturated fatty acids are discussed.

Pathological remodeling of the myocardium in chronic heart failure includes the development of pathological cardiac hypertrophy, reactivation of the fetal genetic program, and disorders in cardiac energy metabolism. Coactivator-1α of receptor γ activated by peroxisome proliferator (PGC-1α), a transcription coactivator of nuclear receptors and metabolism master regulator, plays an important role in cardiac metabolism regulation. Studies on the animals models of chronic heart failure have demonstrated the development of pathological cardiac hypertrophy, metabolic disorders, and reactivation of the fetal genetic program; these processes are mutually related. An important role in regulation of these processes belongs to PGC-1α; its low expression indicates low activity and down-regulation of this coactivator. Pathological cardiac hypertrophy, decrease of PGC-1α activity, and reactivation of the fetal genetic program in chronic heart failure are demonstrated.

The authors present the data on the potential of the combination of angiotensin-converting enzyme inhibitors and calcium channel antagonists in the treatment of hypertensive patients with chronic heart failure and preserved left ventricular ejection fraction. The informed choice of lisinopril, as a component of such a combination, is justified.

The issue of blood pressure levels is practically very important in patients with chronic heart failure (CHF). As is known, combination therapy for the latter implies the use of several groups of hemodynamically relevant agents; diuretics are an important component of CHF therapy. However, diuretics are the most unstudied medications in the treatment of patients with CHF in the context of evidence-based medicine. On the one hand, their efficacy and necessity for the treatment of patients with cardiac decompensation are beyond question and, on the other, even if you want, placebo-controlled trials using diuretics look difficult to perform.

Aim. To study the clinical and hemodynamic efficacy of monotherapy with ACE inhibitor perindopril or beta-blocker carvedilol in patients with chronic heart failure (CHF) due to dilated cardiomyopathy (DCMP) of various etiology.Material and methods. Patients (n=69) with DCMP of different etiology were included into the open randomized study. Idiopathic DCMP (IDCMP) was diagnosed in 26 patients and alcoholic cardiomyopathy (ACMP) - in 43 patients. Patients of IDCMP and ACMP groups were randomized for treatment with perindopril (groups 1 and 3, respectively) or carvedilol (groups 2 and 4, respectively). Follow-up was 6 months. End-diastolic and end-systolic left ventricular volume, stroke volume index, ejection fraction (EF) and exercise capacity were determined at baseline and in 2 and 6 months of treatment. Safety of the treatments was also assessed.Results. Group 1: the average CHF class (NYHA) decreased by 20.7% (pConclusion. Monotherapy with carvedilol in patients with ACMP was more effective than this with perindopril. Long-term monotherapy with perindopril or carvedilol in patients with DCMP was well tolerated and safety.

Aim. To determine indications for differential prescription of beta-blockers in patients with chronic heart failure (CHF) and to study efficacy and safety of beta-blockers therapy. Material and Methods. Patients (n=90; 55.6% of men; aged 64.7±1.9 y.o.) with CHF class 3-4 NYHA of ischemic and non-ischemic etiology with inadequate treatment with beta-blockers were included in the study. Patients were randomized into 3 groups depending on received beta-blocker: group 1 (n=30) — bisoprolol, group 2 (n=30) — carvedilol, group 3 (n=30) — nebivolol. Study duration was 6 months. Clinical examination (physical, laboratory and instrumental tests) and assessment of the adverse events was performed at baseline and after 6 months. Multiple regression analysis was performed to determine the probability of efficiency achievement by using different parameters (target heart rate, mortality, side effects, hospitalization, 6-minute walk test, left ventricle ejection fraction (LV EF), glomerular filtration rate). Results. Significant increase in LV EF was found: in group 1 from 32.4±6.1 to 47.2±4.1% (p=0.049); in group 2 from 31.3±8.4 to 46.5±4.2% (p=0.047); in group 3 from 30.3±6.9 to 46.8±4.0% (p=0.043). Class NYHA decreased in group 1 from 3.5±0.5 to 2.3±0.3 (p=0.044); in group 2 from 3.4±0.6 to 2.1±0.2 (p=0.045) and in group 3 from 3.6±0.4 to 2.4±0.4 (p=0.038). The hospitalization rate due to heart failure decompensation was 16.7, 16.7 and 13.3%, respectively. Mortality in groups during 6 months was 6.7, 0.0 and 3.3%, respectively. The efficacy of CHF therapy with betablockers depended on comorbidity and demographic characteristics. The highest refractoriness to CHF therapy was in patients with chronic kidney failure, atrial fibrillation and anemia (odds efficiency was 2.2, 2.9 and 3.1%, respectively). Bisoprolol was the most effective beta-blocker for the CHF patients treatment according to the majority of dependent variables in multiple regression analysis (p=22.13 vs. 20.66 for carvedilol and 18.69 for nebivolol). Conclusion. A differentiated approach to the beta-blocker prescription depending on the initial clinical and demographic patient characteristics can improve efficacy of the CHF treatment.