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The article presents a clinical case of development of mural infective endocarditis (IE) with formation of vegetations in the region of the upper third of the interventricular septum in patient A., 51 years old, with uncorrected tetralogy of Fallot. The patient was admitted with complaints of increased heart rate, interruptions in the heart work, feet swelling, shins up to the upper third, dyspnea at rest, general weakness, fever up to 39 оC, sweating, headache. During transthoracic echocardiography on the upper third of the interventricular septum (IVS) from the side of the RV, an additional echo-positive linear mobile formation 0.9 cm long is visualized, similar to the chords of the tricuspid valve. Thus, based on the identification of 1 major Duke criterion (imaging criterion — the presence of parietal vegetation) and 3 minor criteria (predisposing factors — congenital heart disease of the blue type; fever >38 оC; positive blood culture not meeting the requirements for the major criterion), laboratory and instrumental diagnostic data and anamnesis, the following diagnosis was established: "Secondary infective endocarditis with damage to the upper third of the interventricular septum". Taking into account the sensitivity of the identified microflora, polymyxin and moxifloxacin were prescribed. During therapy, a dry cough and dry wheezing in the projection of the middle lobe on the right appeared. To exclude septic embologenic pneumonia, computed tomography of the chest organs was performed, on which no focal/infiltrative changes were detected. However, a shunt connecting the brachiocephalic trunk with the right pulmonary artery was visualized, which may explain the cause of compensation of hypoxemia that arose due to pathological hemodynamics as a result of high pulmonary stenosis. Given the incomplete effectiveness of therapy, as well as the sensitivity of the infectious agents isolated, a decision was made to change antibacterial therapy to vancomycin in combination with imipenem. Conservative treatment methods allowed not only to compensate for the existing clinical symptoms, but also to achieve reference values of laboratory parameters, despite the impossibility of surgical intervention.

Aim. To assess the influence of addition of nicorandil on long-term cardiovascular complications in patients with chronic coronary artery disease (CAD) in the framework of a prospective observational study.Material and methods. Prospective observational multicenter NIKEA study included 590 patients with stable CAD. All patients were recommended to add nicorandil to their baseline therapy. After 21 months, 547 telephone contacts were made, the life status of 524 people was specified, 23 patients were lost to follow-up. The following complications were registered: death from any cause; non-fatal myocardial infarction (MI); non-fatal stroke; urgent myocardial revascularization; hospitalization due to deterioration of CAD, chronic heart failure (CHF) or atrial fibrillation (AF). In 479 patients, a telephone survey was performed to identify adherence (persistence) to nicorandil– i.e. to verify the continuing the treatment for the prescribed duration.Results. During the follow-up period, 15 deaths were recorded, the causes of which were as follows: 3 CAD (2 MI, 1 left ventricular aneurysm), 1 pulmonary embolism, 2 CHF; 1 stroke, 1 oncology, 1 bilateral pneumonia. In the remaining 6 cases, the causes of death were not known. Cardiovascular (CV) complications were MI (8 cases in 7 patients, 1 patient had 2 MI in the follow-up period, 3 patients from this group died), stroke in 6 patients (7 cases, 1 patient had 2 strokes, 1 patient died). Urgent percutaneous coronary intervention was performed in 3 patients (in 2 patients due to acute MI, in 1 patient due to unstable angina). During the observation period, 21 people were urgently hospitalized due to deterioration of clinical condition. According to the results of a medical survey, by the end of the follow-up period, 237 people were not adherent to prescribed nicorandil, and 242 patients took the recommended medication (adherent patients). The main cardiovascular complications and death from any cause (р

Despite the decline in cardiovascular mortality in Russia over the past 15 years, it remains relevant to study the possibilities of its further reducing. And preventive measures of risk factors reducing play the main role. However, before developing preventive measures, it is necessary to study the prevalence and structure of risk factors in a particular region, since Russia is a huge country and each region is different from another. The study of this issue needs large-scale epidemiological studies, the conduct of which is very difficult in organizational terms. This article presents our own experience in successfully organizing a regional phase of epidemiological research.

Aim. To assess the incidence of adverse outcomes and the role of main risk factors in their development.Material and methods. Prospective, long-term study was conducted with observation period of 36 months. The sample in the MERIDIAN-RO study was formed from the urban and rural population. It included 1622 people aged 25-64 years. The response to the study was 86,1%. Observation and screening of endpoints continued for 36 months. The endpoints were: all-cause death, ischemic stroke, myocardial infarction, coronary artery revascularization.Results. When studying the relationship between various risk factors and outcomes, it was found that they had a significant impact on the combined endpoint (all-cause death + nonfatal ischemic stroke + nonfatal myocardial infarction): risk SCORE >5% (odds ratio (OR) 5,80, 95% confidence interval (CI) 2,31-14,58, p=0,0001, Wald — 23,040), excessive alcohol consumption (OR 714, 95% CI 1,41-36,31, p=0,018, Wald — 2,908), arterial hypertension (OR 4,77 95% CI 1,91-11,90, p=0,01, Wald — 9,000), combination of coronary artery disease/myocardial infarction/stroke in history (OR 11,16, 95% CI 3,98-31,31, p=0,0001, Wald — 22,607) and an apolipoprotein B increase more than 180 mg/dL (OR 28,57 95% CI 732-111,42, p=0,0001, Wald — 24,509).Conclusion. The most significant effect on the combined endpoint (all-cause death + nonfatal myocardial infarction + nonfatal stroke) made: SCORE risk >5%, excessive alcohol consumption, hypertension, combination of coronary artery disease/myocardial infarction/stroke in history and an apolipoprotein B increase more than 180 mg/dL. That should be considered when choosing aims and preventive strategies.

Aim. To study the association of blood pressure (BP) and hypertension (HTN) with salt intake estimated by the survey and the urinary Na+ concentration among men and women 25-64 years old, examined within the ESSE-RF and ESSE-RF-2 studies.Material and methods. Representative samples of the Russian population aged 25-64 years were examined. At the first phase in 2012-2014, 21,888 people (men — 38,2%) were included, and at the second phase in 2017 — 6,714 people (men — 44,7%). The response rate was 80%. We used standard questionnaire. Adding more salt and the consumption of salted foods (sausages, deli meats, and pickled foods) in the criteria “daily or almost daily” was considered excess salt intake (ESI). BP measurement was carried out in a sitting position on the right hand. BP was measured twice with an interval of about 2-3 minutes. HTN was diagnosed at a systolic BP (SBP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or in case of antihypertensive therapy. In ESSE-RF-2, an analysis of the morning urine was additionally performed. Na+ was determined using the EX-Ds ion-selective electrolyte analyzer. All participants were stratified by the quintiles of urine sodium level. Data analysis was performed using the software package R 3.6.1. The models of linear and logistic regression were used. The differences were considered at p

Aim. To assess quality of life (QoL) and its dynamics during nicorandil treatment in patients with stable ischemic heart disease, to study the relationship of treatment adherence and QoL indicators when treated with nicorandil.Material and methods. Observational program NIKEA included 590 patients with angina pectoris. Seattle Angina Questionnaire (SAQ) was used to assess QoL. Patients completed SAQ at the visit of inclusion (V0) and at the visit after 3 months of observation (V3). Potential and actual adherence to therapy was assessed by medical interviews at visits V0, V1 (1 month of observation) and V3. During the visit V0 417 people (from 590 ones enrolled into the study) completed SAQ (71% response); after 3 months (V3) SAQ was filled in by 454 of 552 people who came to this visit (82% response). According to the results of medical interviews, potential adherence (visit V0) was determined in all 590 patients, actual adherence to nicorandil (visits V1 and V3) was assessed in 552 patients who came to these visits. In accordance with the degree of adherence, all patients were divided into 3 groups: (1) adherent to treatment (taking nicorandil for the first three months), (2) non-adherent (who refused to take nicorandil), and (3) partially non-adherent (who started nicorandil, but for various reasons stopped taking the drug).Results. In all patients, regardless of their adherence to the recommended drug, there was an increase in QoL according to all five scales of the SAQ after 3 months of follow-up. Statistically significant positive dynamics of all SAQ indicators was found only in adherent patients (p

Working Group of the NIKEA Program. Ekaterinburg: Akulina E.N.; Izhevsk: Shinkareva S. E., Grebnev S.A.; Krasnodar: Kudryashov E.A., Fendrikova A.V.; Krasnoyarsk: Nemik D.B., Pitaev R.R., Altaev V.D., Samokhvalov E.V., Stolbikov Y.Y.; Moscow: Dmitrieva N.A., Zagrebelnyy A.D., Zakharova A.V., Balashov I.S., Leonov A.S., Sladkova T.A., Zelenova T.I., Shestakova G.N., Kolganova E.V., Maksimova M.A.; Novosibirsk: Moskalenko I.V., Shurkevich A.A.; Omsk: Loginova E.N., Gudilin V.A.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M.; Orenburg: Kondratenko V.Y.; Rostov-on-Don: Kalacheva N.M., Kolomatskaia O.E., Dubishcheva N.F., Romadina G.V., Chugunova I.B., Skarzhinskaia N.S.; Ryazan: Bulanov A.V., Trofimova Y.M., Nikolaeva A.S.; St. Petersburg: Savinova E.B., Ievskaia E.V., Vasileva L.B.; Tula: Zubareva L.A., Berberfish L.D., Gorina G.I., Nadezhkina K.N., Iunusova K.N., Nikitina V.F., Dabizha V.G., Renko I.E., Soin I.A.Aim. To study the adherence to treatment and the factors that affect it in patients with stable coronary heart disease during the treatment with nicorandil. Material and methods. The use of nicorandil in addition to standard antianginal therapy was recommended to patients (n=590) in a prospective, observational, multicenter NIKEA study. Patients completed original questionnaires on adherence, including a Morisky-Green test at the enroll visit. The questionnaires were filled by 423 patients (73% response). The factors that influence adherence were studied.Results. All patients were divided into 3 groups, depending on the adherence to the use of nicorandil: immediately refused to take the drug (n=150; group 1); started, but stopped taking nicorandil in the first 3 months of observation (n=75; group 2); who took nicorandil for 3 months (n=327; group 3). Potentially adherents (intention to treat) were 582 out of 590 (98.6%) patients, and actually adherents – only 327 of 552 (59.2%) patients. The main reason for non-adherence to the beginning of therapy is polypharmacy; to the continuation of the treatment that had just started – adverse events; for termination of long-term therapy – polypharmacy, adverse events and insufficient effectiveness of treatment. Group 3 had initially more severe angina pectoris: more number of angina attacks (p=0.014) and the need of short-acting nitrates (p

Aim. In the circumstances of real clinical practice, to evaluate the changes in life quality (LQ) parameters of the patients with coronary heart disease and stable angina with addition of nicorandil to standard treatment.Material and methods. Study design — prospective, observational, multicenter. In the trial, the physicians participated, from 14 institutions in a range ofRussia regions. Totally, 590 included: 261 (44,2%) females, 329 (55,8%) males. All patients, in addition to the standard antianginal treatment, were prescribed with nicorandil. At the visits V0 (baseline) and V3 (3 months of therapy) they completedSeattle questionnaire (SAQ) of LQ assessment. Five parameters were assessed: exercise intolerance, attacks frequency, stability, attitudes toward disease, treatment satisfaction. At the visit V0 417 questionnaires were completed (response 71%), at V3 — 454 (response 82%).Results. The significant increase was demonstrated, for parameters by SAQ in 3 months of observation, the highest parameters, except the scale exercise intolerance, were found in the group taking nicorandil during 3 months of follow-up (p

Aim. To assess the results of addition of nicorandil to the treatment of ischemic heart disease: clinical course and long-term outcomes, and to evaluate life quality and treatment adherence in stable angina patients. The article provides data on the NIKEA study design and results of antianginal efficacy of the drug.Material and methods. The design is prospective multicenter observational study. Totally, 14 institutions participated, from different Russia regions. Included 590 patients: 261 women (44,2%) and 329 men (55,8%). Mean age 65,1±9,6 y.o. All patients had inclusion criteria and no exclusion criteria. All participants, in addition to standard antianginal therapy, were recommended to take nicorandil dosage 20 mg daily with titration up to 40 mg daily in 1 month of the observation. By the protocol, three office visits were set (inclusion, in 1 month and in 3 months): V0, V1, V3. During the visits, physical examination was done, anthropometry, hemodynamics measurement. Antianginal efficacy was assessed with patients diaries on angina attacks and demand of short-acting nitrates (SAN). At the visits V0 and V3 patients completed Seattle life quality questionnaire in CHD, and at V0 also an original questionnaire was completed for adherence evaluation.Results. Among 590 patients included in NIKEA, 582 (98,6%) confirmed their intention to take nicorandil and 6 refused to buy additional medication. On the planned visits V1 and V3552 patients came: of them 402 started taking nicorandil, and in 1 month 383 continued; in 3 months — 327 patients continued. During the visits V1 and V3 a statistically significant decrease in angina attacks frequency and in demand of SAN was noted (p