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Funding Acknowledgements Type of funding sources: None. In the list of reasons of atherosclerosis, there are no premature ventricular contractions (PVCs). Purpose To study the main arteries hemodynamics in patients with PVCs and to determine their influence on the atherosclerotic process. Methods We studied 286 patients with PVCs (group 1 (142) – patients with PVCs less 3000 per 24 hours, 2 (144) – more 3000 per 24 hours. Groups were similar in age, gender, comorbidities. By Doppler-ultrasound and shygmography we determined the parameters of heart biomechanics and main arteries kinetics (common carotid, posterior tibial artery): speed, acceleration, power, work in each phase of heart cycle in systole and diastole, the periods of dominance of outflow over inflow. We valued the contribute to the circulation of the PVs and first post-extrasystolic contraction. The volume of cardiac output and transmitral blood flow were measured by echocardiography. We identified the moment of extrasysyoles' appearance by apex-cardiography and ECG. We classified the PVCs up to the moment of their appearance in cardio cycle: before the mitral valve opening; in rapid ventricular filling phase before or after the transmitral blood flow peak; in slow ventricular filling phase; others (group, allorhythmia). Results We identified the following hemodynamic effects of PVCs. 1) The main role in hemodynamic and kinetics changes play the time of PVC’ appearance in cardio cycle and the ability of the first post-extrasystolic contraction to reestablish an adequate resulting blood flow. The maximums of parameters were in first post-extrasystolic contraction in PVCs before the mitral valve opening and before the transmitral peak flow. 2) The prevalence of atherosclerotic process was observed in group 2 (p 3) Additional stretching of arteries in the first post-extrasystolic pressure wave. It makes conditions for acute and chronic arteries traumatism. 4) Mechanic damage of endothelium and as a result lipid deposition. The "weak places" – are the places of the main effect of the first post-extrasystolic hydraulic shock: aorta arch in large radius, carotid bifurcation, aorta bifurcation. 5) Appearing the stand waves, interferention and diffraction in the places of already existing atheromas. Atheroma is deforming, the integrity of atheroma’s cover is violated and there’re appearing the atheroma’s complications: dissections, wall thrombus of hemodynamically important stenosis. Conclusion PVCs change intra-arterial hemodynamics and can cause the mechanical injury of intima, as well as the injury of existing atherosclerotic plaques that can lead to progressing of atherosclerosis. We suppose to include the PVCs in the list of risk factors of atherosclerosis.

Funding Acknowledgements Type of funding sources: None. Purpose To study which variant of permanent atrial fibrillation (AF) is the most unfavorable in stroke. Methods We included 202 patients (99 men, 103 women) with non-significant stenosis of carotid bifurcation and permanent AF; control group – 88 patients without AF. All of them were made hemostasiograms, lipids level, transthoracic and thranseophageal EchoCG, 24-hours monitoring of ECG, Doppler ultrasound of brachiocephalic arteries, sphygmography (SG) of common carotid arteries, computer tomography (CT) of the brain with contrast. According to the 24-hours ECG monitoring data, we divided the patients into 2 groups in accordance to the maximum pauses between ventricular complexes in AF: patients with a pause < 1,5 seconds (113); with a pause ≥ 1,5 seconds (89). These groups were identical in sex, age and comorbidities. The patients of both groups were on the same standard therapy recommended by current ESC guidelines including novel oral anticoagulants (NOACs). We observed the patients during 1 year from the onset of investigation to analyze the appearance of verified stroke or transient ischemic attack (TIA) in these patients. Results In EcoCG we excluded the intra-heart thrombi in all cases as well as heart and aorta aneurisms. The atherosclerotic plaques characteristics within the groups were identical. The main factor of the difference between two main groups was the maximum duration of pauses between ventricular contractions in patients with AF. In AF in Doppler ultrasound, there was increase of linear blood flow speed and the volume flow in the area of carotid stenosis in the moments during the spread of the pulse wave after the long pause between ventricular contractions in group 2. The speed was rising up to 2,5 m/sec as it rises in hemodynamically significant stenosis. In 1 year of investigation, we observed the statistically significant higher stroke in group 2 despite of NOACs. Conclusion The appearance of stroke and TIA in AF is higher in patients with 1,5 seconds and more of maximum duration pauses between ventricular contractions. In cryptogenic stroke, the reason of it can be the atherosclerotic plaque defragmentation with further embolism, caused by the additional mechanical impact of increased hemodynamical and kinetic parameters of pulse wave after long pause between ventricular contractions in AF.

Funding Acknowledgements Type of funding sources: None. Purpose To perform the model of main arteries restenosis and to study the arterial hemodynamics using the original device for modeling of intra-arterial circulation. Materials and methods We used an original device developed by us for modeling of intra-arterial circulation. The main part of the device is a prototype of human arterial vessel - rotameter glass tube 365 mm length, with inlet diameter more than outlet (20 mm vs 16.5 mm). An aqueous solution of glycerin is introduced inside closed system had the same viscosity as the human blood. Flexible silicone tubes are connected with rotameter and electric pump with various modes of work (imitation of pulse waves in regular rhythm (RR), extrasystoles (ES), atrial fibrillation (AF)). We hermetically installed in the rotameter imitation of arterial stent – metal construction with spiral oriented parts 68 mm long. Plastic diaphragms 15 mm long with stenosis of the internal lumen of 50%, 70%, and 90% were alternatively put inside the tube to study intra-arterial hemodynamics. 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure sensor connected to an oscilloscope was injected with a dye - clerical ink. Results When imitating AF after the long pause the speed of fluid flow through the diaphragms increased in comparison with the RR with the pendency: if longer pause was than more speed increased. So, with a stenosis of 50%: the speed with a RR was 2.09 m/s, with AF after the pause 1, but 2 s speed was 5.88 m/s; with 70% stenosis: the speed with a RR was 3.24 m/s with AF after the pause 1, but 2 s speed was 7.83 m/s; with 90% stenosis, the speed at RR 8.96 m/s, with AF after the pause 1, but 2 s speed was 13.45 m/s. The pressure measured by piezoelectrical probe increased proportionally to the speed. We observed the appearance of reflected, standing waves in the edge zones of the diaphragm and stent and a turbulent flow of liquid behind the diaphragm and stent. Conclusion These changes in hemodynamics are characterized by proposed concept of "hydraulic shock". Intense mechanical effect of the pressure waves after the long pauses between cardio cycles in AF in the marginal zones of the diaphragm and intra-arterial stent can cause the further growth, progression of atherosclerosis and restenosis in arterial vessels.

Up to 45% of all ischemic strokes (IS) are cryptogenic. Purpose To reveal the possible reasons of cryptogenic IS. Methods We analyzed the cases of computer tomography verified IS in patients admitted the hospital during the period of 3 years. All these 268 patients had unidentified source of IS. We analyzed hemostasiograms, lipids levels, performed echocardiography, Doppler ultrasound of brachiocephalic arteries, 24-hours ECG monitoring and common carotid arteries sphygmography (SG). Results None of the patients had atrial fibrillation, hemodynamically significant stenoses of brachiocephalic arteries or hematological pathology associated with hypercoagulation. 234 (87.3%) patients had atherosclerotic plaques in carotid area bifurcation (in 36 (13.4%) – intima-media thickness was 1.1 mm, in 74 (27.6%)– stenosis Conclusion The appearance of IS is higher in patients with extrasystolic arrhythmia appearing in the cardiocycle before the transmitral blood flow peak. In cryptogenic stroke, the reason of it can be the atherosclerotic plaque defragmentation with further embolism, caused by the additional mechanical trauma of increased hemodynamical and kinetic parameters of pulse wave of the 1st post-extrasystolic contraction. Funding Acknowledgement Type of funding sources: None.

Objectives to determine the hemodynamic changes within arterial vessels in different variants of extrasystole, to analyze whether extrasystole is an additional risk factor for the development of atherosclerosis. Material and methods. The study included 286 patients (175 men and 111 women) with extrasystole of more than 3000 per day and 88 patients with extrasystole of less than 3000 per day as a control group. When selecting eligible patients for the study, we tried to minimize the impact of traditional risk factors of atherosclerosis. The presence of cardiocerebral complications in medical history was also considered. The examination methods used in the study are electrocardiography, phonocardiography, 24-hour electrocardiography monitoring, Doppler ultrasound of the brachiocephalic vessels, lower extremities arteries, renal arteries, transthoracic or transesophageal echocardiography. Stress echocardiography was performed if indicated; as well as renal artery angiography, coronary angiography, computed tomography of the brain with angioprogram. When performing a biochemical blood test, the lipid spectrum and hemostasiogram were necessarily determined. All patients underwent left ventricular apexcardiography, as well as sphygmography, recorded on arteries of elastic type (a. Carotis communis) and muscular-elastic type (a. Tibialis posterior). The clinical examinations were confirmed and modeled using the original "Device for modeling of intra-arterial circulation", developed by us (RF patent No. 202780 dated 05.03.2021). Results. We determined an increase in the main parameters of the heart biomechanics and the kinetics of the main arteries in the 1st post-extrasystolic wave in patients with various types of extrasystole with the following pattern: the earlier extrasystole had appeared in the cardiocycle, the greater was the increase in the parameters under observation. A universal concept of hydraulic shock and possible cases of its formation were described. Conclusion. Extrasystole is an additional risk factor for the onset and progression of atherosclerosis. Hydraulic shock during the passage of the 1st post-extrasystolic wave is a powerful traumatic factor for the walls of the arteries, which can lead to the formation of an atherosclerotic process.

Aim. To determine the changes of parameters of heart biomechanics and kinetics of arteries, to reveal the adverse events of first post-extrasystolic contraction.Materials and methods. In our investigation we included 286 patients. We excluded all the main traditional risk factors of the atherosclerosis. All the patients were branched into two main groups in accordance to the quantity of extrasystoles per 24 hours: I group – less than 3000, II group – more than 3000 extrasystoles per 24 hours. We took the data about complaints, anamnesis, made laboratory and instrumental investigations to reveal the character and severity of atherosclerotic process.Results. We determined that the atherosclerotic process was more advanced and more often in the group II. Also the atherosclerosis was more severe in patients with extrasystoles in the phase of cardiocycle before opening of the mitral valve and before the transmitral blood flow peak. The parameters (acceleration, speed, power, work) that were calculated by apexcardiography and sphygmography increased with the further tendency: if earlier extrasystole appears in cardiocycle, than more changes were observed.Conclusion. The first post-extrasystolic contraction causes the increase of all parameters of heart biomechanics and kinetics of vessels and can be an additional factor of progressing of atherosclerosis.

Objectives to study the mechanism of restenosis after the intra-arterial stenting using the original device for modeling of intra-arterial blood flow. Material and methods. To perform the experiment, we have created the original device simulating the intra-arterial blood flow. A glass tube of rotameter was the imitation of the arterial vessel. The closed system was filled with the liquid imitating blood, specifically the solution of glycerin the same viscosity as the human blood plasma. Using our original model of intra-artetial blood flow, we were able to study the intra-arterial hemodynamics under different conditions of cardiovascular system functioning, including arrhythmias. Results. In extrasystolic arrhythmia, during the spread of the first post-extrasystolic wave, we observed the intensive impact of pressure wave (the indicator was the silk thread) on the vessel walls with forming of reflected and standing waves. Putting the piezo crystal probe of pressure inside the tube, we verified our observations. The increase of pressure during the spread of the first post-extrasystolic wave in multiple measurements had a mean value of 160% in comparison with the pressure during the regular heart rhythm. Conclusion. The hydraulic shock appears during the spread of the first post-extrasystolic wave in the arterial vessel. Its effect on hemodynamics grows in case of the frequent extrasystoles and allorhythmia. The mechanical impact of hydraulic shock in extrasystoles can be the starting point of the restenosis onset and progressing in the intra-arterial stent.

The article describes the device and possibilities of application of the original device developed by us for simulation of intra-arterial circulation. The principles of operation of the device, a wide range of experimental and clinical studies in which it can be applied are outlined. The use of this useful model is illustrated by clinical examples.

Funding Acknowledgements Type of funding sources: None. Aim To identify the difference between the thromboembolic events in different types of atrial fibrillation (AF). Materials and methods We included 188 patients with permanent AF (of them were 99 men and 89 women). According to the data of 24-hours ECG monitoring, all patients were divided into 3 groups depending on the duration of maximum pauses between ventricular complexes in AF: 1. Patients with a pause < 1 second (64 people). 2. Patients with a pause of ≥1, but 3. Patients with a pause ≥ 2 seconds or more (62 people). In control group we included 80 patients without AF. All groups were identical in age, sex and comorbidities. All patients underwent transthoracic or transesophageal echocardiography (we excluded the intra-chamber thrombosis in all the patients as well as the left ventricle aneurisms), Doppler ultrasound of the brachiocephalic vessels, branches of the aorta, arteries of the lower extremities, renal arteries, lipids level. If it was indicated, we performed stress echocardiography, coronary angiography, renal artery angiography, computed tomography of brain with contrast. The patients of all groups were on the standard therapy recommended by current ESC guidelines. We were observing the patients for 1 year after the beginning of the investigation. The endpoints were at 3, 6 and 12 months after the primary visit. During these endpoints, we analyzed the development of thromboembolic complications. Results We analyzed the data obtained on thromboembolic complications in 1 year in patients of 1, 2, 3 groups and compared them with the control group. The most frequent incidence of complications was in group 3 compared with other groups and the control group. We believe that the risk factor for thromboembolic complications is not only the fact of permanent form of AF, but also what type of AF. The most unfavorable is AF with pauses between ventricular contractions of 2 seconds or more. Conclusion We consider to use the proposed functional classification of AF in clinical practice. Determination of the type of AF will largely determine the further management tactics of each patient, the prognosis of the thromboembolic complications. We supplemented the CHA2DS2-VASc score with the new independent risk factor – type of AF – in accordance to the maximum duration of pauses between cardiocycles.

Funding Acknowledgements Type of funding sources: None. Regular heart rhythm restoration after a period of asystole: modeling in experimental cardiology Purpose To study the arterial hemodynamics during the regular heart rhythm restoration after a period of asystole using the original device for modeling of intra-arterial circulation. Materials and methods We used the device for modeling of intra-arterial circulation made by us (Document of invention № RU 202780 U1). The main part of the device is rotameter glass tube - a prototype of human arterial vessel. Electric pump with various modes of work was connected into the closed system with rotameter by flexible silicone tubes. Inside the closed system we introduced an aqueous solution of glycerin diluted to have the same viscosity as the human blood. As indicators for studying the intra-arterial hemodynamics we used intravascular piezoelectric crystal pressure sensor connected to an oscilloscope, 5 mm long silk thread alternately installed inside the tube, and a dye - clerical ink. Results With the electric pump work modes, we were able to imitate the regular heart rhythm (RR) restoration after a period of asystole inside the device for modeling of intra-arterial circulation. We observed the speed of fluid increased in comparison with the RR with the pendency: if longer pause of asystole was than more speed increased. We observed the appearance of reflected, stand waves on the walls of rotameter during the spread of the pulse wave after the long asystole pause. We alternatively put the plastic diaphragm inside the rotameter with internal lumen stenosis of 70% with symmetrical and asymmetrical hole. The speed with a RR was 3.24 m/s, after the pause of asystole 1 s speed was 4.08 m/s, after the pause 2 s speed was 7.36 m/s, after the pause 3 s speed was 9.22 m/s. The pressure measured by piezoelectrical probe increased proportionally to the speed. Conclusion Intense mechanical effect of the pressure waves after the long period of asystole can cause the additional trauma of intima of arterial vessels that can lead to non-stability of atherosclerotic plaques, stimulating of endothelial dysfunction and as a result of atherosclerosis progression with further complications. Changes in hemodynamics we characterized by proposed concept of "hydraulic shock".

Introduction. Atherosclerosis is the main reason of cardiocerebral events, its mechanisms and reasons are still being studied. Hydraulic shock in arrhythmias has not been studied before. Aim. To perform the modeling of hydraulic shock as a risk factor of the main arteries in arrhythmias with original experimental model created by the authors. Materials and methods. We created the original experimental model, it was used to imitate hydraulic shock in arrhythmias. It imitated the real arterial vessel and it allowed to make intra-vessel circulation of liquid in the regular rhythm and in arrhythmias (extrasystole). Results. In extrasystolic arrhythmia imitation in the first post-extrasystolic contraction the speed of liquid flow was revealed to rise in mean value 158% in comparison with the regular rhythm. Conclusion. In extrasystolic arrhythmia during the spread of the wave of the first post-extrasystolic contraction, blood flow accelerates and reflected waves and standing waves form. These hemodynamic changes are characterized by the term hydraulic shock. The use of our original experimental model helps to make the wide range of investigations and studies connected with intra-arterial hemodynamics in different conditions of functioning of cardiovascular system.

Funding Acknowledgements Type of funding sources: None. Aim. To study intra-arterial hemodynamics of the main arteries in atherosclerosis using the original device for modeling of intra-arterial circulation. Material and methods. To study hemodynamics inside an arterial vessel, we used an original device developed by us for modeling of intra-arterial circulation (Document of invention № RU 202780 U1). The main part of the device is a prototype of an artery - a glass tube of a rotameter with a length of 365 mm, an inlet end with a diameter of 20 mm, an outlet end - 16.5 mm. Flexible silicone tubes are attached to the rotameter on both sides, with free ends connected to an electric pump, with various modes of work (imitation of pulse waves at the regular rhythm (RR), extrasystole (ES), atrial fibrillation (AF)). An aqueous solution of glycerin was introduced into a closed system diluted with water corresponding to the viscosity of the blood. A 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure sensor connected to an oscilloscope was injected with a dye - clerical ink. Plastic diaphragms 15 mm long with stenosis of the internal lumen of 50%, 70%, and 90% were alternately hermetically installed in the rotameter. Results. When imitating ES in the first post-extrasystolic contraction (1PEC), the speed of fluid flow through the diaphragms increased in the 1PEC in comparison with the RR. So, with a stenosis of 50%, the speed with a RR was 2.09 m/s, with an ES 0.03 m/s, with 1PEC 3.83 m/s; with 70% stenosis, the speed at RR 3.24 m/s, with ES 0.04 m/s, with 1PEC 5.26 m/s; with 90% stenosis, the speed at RR 8.96 m / s, with ES 0.10 m/s, with 1PEC 12.36 m/s. The pressure increased proportionally to the speed. We observed the appearance of reflected, standing waves in the edge zones of the diaphragm and a turbulent flow of liquid behind the diaphragm. Conclusion. These changes in hemodynamics are characterized by the concept of "hydraulic shock". Intense mechanical effect of 1PEC pressure waves in the marginal zones of the diaphragm can contribute to the further growth and progression of atherosclerosis in arterial vessels. Abstract Figure.

International audience; Despite major advances in cardiovascular research over the past decade, women with type 2 diabetes have a high risk of cardiovascular events. Several factors contribute to the poor prognosis for women, including higher levels of frailty and comorbidities, but their cardiovascular risk is underestimated and there is suboptimal implementation and uptitration of new evidence-based therapies, leading to high morbidity and mortality. Recent studies highlight the need for better management of diabetes in women that can be pursued and achieved in light of recent results from randomised controlled trials demonstrating evidence of the benefits of new therapeutic strategies in improving cardiovascular outcomes and quality of life of women covering the entire cardiovascular continuum. This review critically discusses the multiple benefits for women of new pharmacological treatments, such as glucagon-like peptide-1 receptor agonists, sodium–glucose cotransporter type 2 inhibitors (SGLT2i), proprotein convertase subtilisin/kexin type 9 inhibitors, inclisiran, icosapent ethyl and bempedoic acid in preventing cardiovascular events, and treatments, such as angiotensin receptor neprilysin inhibitors, SGLT2i, vericiguat and omecamtiv mecarbil, for preventing heart failure.

Background Although heart failure (HF) is one of the most common conditions affecting the heart, little attention has been placed on the role of arteries in contributing to the progression of this disease. Purpose We sought to determine the hemodynamic change of arteries in HF patients subdivided according to left ventricular ejection fraction. The major goal was to establish the active compensatory role of arteries in HF Methods Using sphygmography, we systematically studied a cohort of 228 HF patients and 52 healthy controls. We focused on the common carotid as the main elastic artery and the posterior tibial as the main muscular artery (Figure 1). Moreover, we categorized the three HF groups, HFrEF, HFmrEF, HFpEF, into two subgroups (A and B) according to the presence or absence of HF signs at baseline. Results We discovered that all the parameters of measured arterial kinetics, i.e., work, power, acceleration, and speed, were significantly increased (p Conclusions We provide the first documentation of an active compensatory role of arteries during HF. Mechanistically, we explain these findings by a dual activity of large arteries accomplished via an active propulsive work and a concurrent hemodynamic suction. These underestimated arterial functions partially compensate for the heart dysfunction in HF, underlining a key interplay between the heart and the vessels. We propose a new paradigm that we define as “heart and vessels failure” that explicitly focuses on both heart and vessels' interaction during the progression of HF. Funding Acknowledgement Type of funding sources: None. Figure 1. Sphygmograms of CCA and PTAFigure 2. Patients disposition & Results

Purpose of study Using an original device for modeling of intra-arterial blood circulation, to study the features of intravascular hemodynamics with a regular heart rhythm and with various rhythm disturbances. Material and methods We used an original device developed by us to simulate intra-arterial circulation (Document of invention No. RU 202780 U1). The main part of the device is a glass tube of a rotameter with a length of 365 mm, an inlet end with a diameter of 20 mm, an outlet end of 16.5 mm, which is a model of an arterial vessel. Flexible silicone tubes are attached to the rotameter on both sides, with free ends connected to an electric pump, with various modes of operation (imitation of pulse waves with regular rhythm, premature ventricular contractions (PVCs), atrial fibrillation (AF). An aqueous solution of glycerin was introduced into a closed system diluted with water corresponding to the viscosity of the blood. A 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure probe connected to an oscilloscope. Also it was injected inside the tube a dye - clerical ink. Results With electric pump, we simulated the spreading of the pulse wave in regular heart rate, PVCs and AF. We observed the effect of a pressure wave (deflection of a silk thread, the appearance of a turbulent flow when using a dye) on the walls of the rotameter, with the formation of standing, reflected waves during the PVCs and AF. The pressure probe registered an increase in pressure inside the tube during the spread of the 1st post-extrasystolic contraction wave up to 58%, the wave after a long pause of more than 2 seconds with AF by 44% compared to the regular rhythm. Conclusion A device for modeling of intra-arterial circulation allows a wide range of experimental work in cardiology, normal and pathological physiology, and biophysics. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Within the main causes of the secondary arterial hypertensions the main roles play renal, endocrine and hemodynamic. In the list of reasons of the secondary hemodynamic arterial hypertension there’re no extrasystoles. Purpose. To determine the relationship between different types of extrasystoles and the the secondary hemodynamic arterial hypertension. Materials and methods. We observed 132 patients with supraventricular and ventricular extrasystoles. Extrasystoles were divided into groups due to the moment of their appearance in cardiocycle: 1. Extrasystoles before the mitral valve opening. 2,3. Exstrasystoles in phase of fast ventricules filling before and after the peak of transmitral blood flow. 4. Extrasystoles in slow ventricules filling phase. 5. Other extrasystoles (allorrhythmias and group extrasystoles). The reason for that dividing was the different contribution of each type into the hemodynamics and heart output. We analyzed the regular, extraordinary and first post-extrasystolic contractions. Intra-arterial blood flow was estimated by ultrasound-doppler. The moment of extrasystoles appearance was determined by echocardiography, electrocardiography and 24-hours ECG monitoring. The kinetics of vessel wall was calculated by sphygmograms and included speed, acceleration, power and work parameters. The BP measuring was made by Korotkov method that the moment of measuring was in the first post-extrasystolic wave on sphygmogram. We duplicated it after the normalization and calibration of carotid arteries sphygmograms. Results. The main importance to the hemodynamic changes has the moment of extrasystole appearance in cardio cycle and the ability of the first post-extrasystolic contraction to reestablish an adequate resulting blood flow. It is characterized by: stroke volume rising from 5 to 40%; systolic BP increase up to 30% (with formation of the secondary hemodynamic AH) compared with the systolic BP with normal heart rate; rising of arterial walls kinetic parameters (speed, acceleration, power, work); blood flow velocity rising; grown arterial wall deformation. The maximum of these parameters was in first post-extrasystolic contraction with extrasystoles before the mitral valve opening and extrasystoles before the transmitral peak blood outflow. The special hemodynamic situation appears when there’re allorrhythmias when, for example, in case of constant bigeminia, BP is increased in 50% of time, and in case of trigimenia – in 1/3 of time. Conclusion. We believe it’s necessary to include extrasystoles into the list of the reasons of the secondary hemodynamic arterial hypertension. The main features of this type of AH are: unstable BP rising, prevalence growth of systolic BP, direct relationship with extrasystoles’ appearance moment. The risen blood flow of first post-extrasystolic contraction can be the reason of additional arterial walls deformation and complications that may cause the any AH.

Funding Acknowledgements Type of funding sources: None. Aim To determine the relationship between hemodynamic changes in extrasystolic arrhythmia and atherosclerosis of main arteries. Materials and methods We included 286 patients (175 men and 111 women). The investigation was made to reveal the signs of atherosclerosis. All patients were performed 24-hours ECG monitoring, blood lipid spectrum, TTE, TOE, ultrasound doppler of brachiocephalic arteries, abdominal aorta branches, lower extremities arteries, renal arteries. If prescribed - stress Echo, coronary angiography, renal arteries angiography, pancerebral angiography. All patients were made apexcardiography (ACG) and arterial vessels sphygmography (SG) of aa. carotis, ulnaris, radialis, femoralis, tibialis posterior. The main parameters included speed, acceleration, power, work in each phase of cardiocycle. In accordance with amount of extrasystoles per 24 hours all the patients were divided into 2 groups: 1 – less than 3000 (144 patients), 2 – 3000 and more (142). They were grouped due to the age (see table 1 on the picture). Groups were common in age, sex, comorbidities. Results In group 2 the development and severity of atherosclerosis was more in group 2 (see table 2 on the picture). We determined the hemodynamic main parameters increase in first post-extrasystolic contraction with the following tendency: if earlier extrasystole appeared in cardiocycle, than more changes were observed. Conclusion Extrasystoles are additional risk factors of atherosclerosis. Hemodynamic changes after the first post-extrasystolic contraction is the important mechanical trauma factor for the arterial vessels which can take part in atherosclerotic process. Weak places – carotid bifurcation, abdominal aorta bifurcation, large radius of aorta arch. We suppose that it’s necessary to treat the extrasystoles more than 3000 per 24 hours that appear early in cardiocycle (before the mitral valve opening and before the transmitral blood flow peak).

Funding Acknowledgements Type of funding sources: None. Background. New COVID-19 disease is well known by its primary damage of respiratory system. However, it is also possible to involve other organs and systems. Purpose. To determine the cardiac involvement in patients with COVID-19 pneumonia. Materials and methods. We performed echocardiography with speckle tracking in 48 patients. All of them had serologically verified COVID-19 pneumonia with lung involvement 5-60% on CT. None of them were treated by antimalarial drugs. 28 of them were men and 20 women, mean age - 45 ± 4,4 years old. We performed echocardiography in 1 month period from onset of the disease. Results. Most of the patients (30 patients) had enlargement of right heart chambers. Despite of right ventricle enlargement, in none of the patients had reduced right ventricle function (TAPSE 22 ± 2 mm, right ventricle strain -21,2 ± 1,5%). The mean systolic pulmonary artery pressure was slightly elevated (38 ± 2 mm Hg). Left ventricle was enlarged in 9 patients (with mean end diastolic volume 82 ± 5 ml/m2). In 25 of them, the ejection fraction was decreased (44 ± 4%). In all patients with COVID-19 pneumonia, the changes in circumferential and longitudinal strain were observed. Both parameters were decreased. The mean value of circumferential strain was -16,3 ± 1,9%. The longitudinal strain parameter was -14,2 ± 1,4%. 25 patients had enlargement of left atrium (>40ml/m2) and the reservoir strain of left atrium was decreased (-23,3 ± 1,5%) in 29 of them. After 2 months from the onset of the disease, we noticed the normalization of echocardiography data in all patients. Nevertheless, we observed cardiac structural and functional changes in all patients, troponins levels were increased only in 12 patients. Conclusion. We observed cardiac involvement in different degree in all of patients with COVID-19 pneumonia. Changes characterized by atriums and ventricles enlargement, and left ventricle contractile dysfunction. Due to the fact that only part of the patients with COVID-19 with cardiac changes had elevated troponins, we believe that the mechanism of these pathological changes need further research.

The influence of various types of extrasystole on the change in arterial hemodynamics and the morphology of changes in the wall of the mainstream arterial vessels is not well understood. The purpose of the study was to determine the effects of water hammer on the hemodynamics of the main arteries in various types of extrasystoly. The study was conducted on 228 patients (122 men and 106 women) aged 43 to 76 years, the average age was 62 ± 4.3 years. For the analysis, the data apex-cardiography, daily monitoring by Holter, echocardiography, electrocardiography, sphygmography, color Doppler mapping of the vessels of the head and neck and extremities were compared. Water hammer of extrasystoles leads to mechanical damage to the endothelium of the arterial wall and serves as a trigger for inflammation and activation of the process of neolipogenesis, the formation of the atheroma. Additional hydraulic waves contribute to trauma to the vascular wall, growth and increase in area of atheromas. The described morphological changes in the vascular wall, the authors describe as «water hammer syndrome» and analyze its role and pathophysiological mechanisms of the development of vascular complications at extrasystoles and reconstructive operations on arterial vessels.

BACKGROUND: Although heart failure (HF) is one of the most common conditions affecting the heart, little attention has been placed on the role of arteries in contributing to the progression of this disease. We sought to determine the hemodynamic change of arteries in HF patients subdivided according to left ventricular ejection fraction. The major goal was to establish the active compensatory role of arteries in HF. METHODS: Using sphygmography, we systematically studied a cohort of 228 HF patients and 52 healthy controls. We focused on the common carotid as the main elastic artery and the posterior tibial as the main muscular artery. Moreover, we categorized the three HF groups, HFrEF, HFmrEF, HFpEF, into two subgroups (A and B) according to the presence or absence of HF signs at baseline. RESULTS: We discovered that all the parameters of measured arterial kinetics, i.e., work, power, acceleration, and speed, were significantly increased (P

Funding Acknowledgements Type of funding sources: None. Nowadays the term "heart-vessels failure" does not exist. Aim To study the kinetics and hemodynamics of arteries in the patients with heart failure with different ejection fraction. Materials and methods In our investigation we included 74 patients with heart failure with preserved ejection fraction more than 55% (44 were men and 30 women). Mediana age – 71,3 years old. In the control group we included 52 practically healthy people without cardiac and vessels pathologies. We divided patients into two groups (I and II) in accordance to the presence of clinical manifestations of heart failure in them. Group I - with clinical symptoms of heart failure (32), group II –without heart failure symptoms (42). We paid attention to the symptoms of heart failure, myocardial infarction, cardiomyopathies, valves defects, operations on heart in anamnesis. We performed 24-hours ECG monitoring, general blood analysis, biochemical blood analysis (lipids, electrolytes, urine, creatinine, bilirubin, potassium, glucose, NT-proBNP), transthoracic echocardiography, ultrasound doppler of brachiocephalic arteries, abdominal aorta branches, lower extremities arteries, renal arteries, chest radiography, ultrasound investigation of B-lines. If prescribed we performed stress echocardiography, transesophageal echocardiography, coronary angiography, renal arteries angiography, pancerebral angiography, magnet tomography of heart. All patients were registered sphygmography of main arteries: a.carotis communis, ulnaris, radialis, a.tibialis posterior. We analyzed the regular contractions in each type of arteries. The main parameters main arteries kinetics using sphygmography we calculated in automatic mode: speed, acceleration, power, work in period of prevalence of inflow over outflow and in period of prevalence of outflow over inflow. Results We analysed the main parameters of arteries kinetics and hemodynamics in each group of patients as well as in control group. We observed the effects: 1)In group II the parameters of arteries kinetics were higher than in group I. It indicates the active propulsive work of arteries in spreading the stroke volume of the heart. 2)In group I the parameters of arteries kinetics were lower than in control group. It indicates that propulsive function of the arteries is reduced in patients with heart failure. Conclusion Arterial vessels are active, full-fledged participant in cardiovascular system. Vessels make an active work in blood movement from the heart to the distal parts and tissues. The clinical manifestations of heart failure are determined not only the heart function but also the function of arteries that is needed to be examined. In patients with preserved ejection fraction we can observe the symptoms of heart failure, the function abilities of arteries are reduced. The term "heart-vessels failure" should be used and applied not only to the heart but also to the arteries function in their coupling with heart. Abstract Figure.

Background Extrasystolic arrhythmia is not included in the list of risk factors of atherosclerosis. The aim of investigation is to determine the relationship between atherosclerosis of main arteries and extrasystolic arrhythmia. Methods We included 286 patients in our investigation. We performed 24-hours ECG monitoring, blood lipids analysis, transthoracic echocardiography, ultrasound Doppler of brachiocephalic arteries, abdominal aorta branches, lower extremities arteries, renal arteries. If prescribed we performed stress echocardiography, transesophageal echocardiography, coronary angiography, renal arteries angiography, pancerebral angiography. So the investigation was made for the active revealing of atherosclerotic signs. The main parameters of heart biomechanics and main arteries kinetics we calculated using apexcardiography and sphygmography and included: speed, acceleration, power, work in each phase of the cardiocycle by apexcardiography, as well as in period of prevalence of inflow over outflow and in period of prevalence of outflow over inflow in sphygmography. All the patients were divided into two main groups according to the quantity of extrasystoles per 24 hours: 1 group - less than 3000, 2 group -3000 extrasystoles and more per 24 hours. Results We determined that the atherosclerotic process was more advanced and more often in the group 2. The atherosclerosis was more severe in patients with extrasystoles before the mitral valve opening and in fast ventricles' filling phase in cardiocycle. The main parameters of heart biomechanics and main arteries kinetics (speed, acceleration, power, work) calculated by apexcardiography and sphygmography increased with the further tendency: if earlier extrasystole appears in cardiocycle, than more changes were observed. Analyzing the methods of physics for fluid movement - Newton equation for liquids and Reynold number - we demonstrated that in extrasystolic arrhythmia in first post-extrasystolic wave there are the conditions for the turbulent blood flow that can cause the onset and progressing of atherosclerotic process. Conclusions Extrasystolic arrhythmia is an additional risk factor of main arteries atherosclerosis. Especially this thesis is fair for the extrasystoles that appear in cardiocycle before the mitral valve opening and in fast ventricles' filling phase.

Introduction: Advanced heart failure (AdvHF) in HCM was overlooked. Hypothesis: Based on a systematic revision, we described prevalence & outcomes of the main HCM phenotypes responsible for AdvHF, heart transplantation (HTx), LVAD implantation & HF-death. Methods: We classified the HCM profiles responsible for AdvHF in 1) End-stage HCM (ES-HCM) defined by an LVEF≤50%; 2) LVOTO despite optimal medical therapy (OMT) (Refractory HOCM); 3) Nonobstructive HCM with preserved EF (HNOCMpEF). The study screened 130 manuscripts in MEDLINE and EMBASE on AdvHF in HCM patients (pts) published from 2000 till January 2020, in adults. 8 manuscripts were eligible for the analysis. AdvHF was defined by the presence of severe NYHA symptoms (III & IV) because in all the manuscripts this definition was used. Mean follow-up = 7.6 years. Results: Figure 1: Prevalence of phenotypes responsible for AdvHF&HTx/LVAD implantation/HF-Death. Of 205 HCM pts, 119 (58%) underwent HTx, LVAD implantation, or died for HF. Figure 2: Outcome per each clinical phenotype. Conclusions: AdvHF in HCM has an ominous prognosis (58% of pts met HTx/LVAD implantation/HF-death) but with significant differences among the 3 phenotypes. HOCM has a very good outcome, indeed only few cases developed a Refractory HOCM & AdvHF & only 1 died for HF. 29.7% of AdvHF were caused by HNOCMpEF due to massive hypertrophy & restrictive physiology & only 16.4% of them died due to HF. ES-HCM represents the main cause of AdvHF in HCM & the major determinant for poor outcomes among all HCM pts (Only 1/3 of them were event-free). This reflects poor attention and portrays an unmet need for ES-HCM pts. Recently it was demonstrated that an extensive amount of myocardial fibrosis (MF) is the major determinant for ES-evolution. Taken together these findings show the importance of a strict follow-up for HCM pts to timely identify ES-HCM & early start HF OMT. Developing specific therapies to lower the burden of MF & stop adverse remodeling it's crucial.

Type 2 diabetes mellitus (T2DM) portends high risk of atherosclerotic cardiovascular (CV) events and of CV mortality; moreover, this group of patients has a very high probability of developing heart failure (HF). In this review, we discuss new advances in pharmacological treatment both in CV prevention and in HF management with a special focus on T2DM patients. A large number of randomized clinical trials and meta-analyses provided strong evidence about therapeutic strategies acting on glucose metabolism, such as GLP-1 RA and SGLT2i and about lipid-lowering treatment, such as PCSK9i and icosapent ethyl. Moreover, SGLT2i demonstrated strong evidence of benefit particularly in HF management both in diabetic and non-diabetic patients. The pathophysiological bases of multiple mechanisms of benefit of this class of drug explain the unexpected and remarkable results demonstrated both by prevention trials and by trials dedicated only to HF (like DAPA-HF). These, new drugs in the CV therapeutic armamentarium are establishing a new comprehensive approach from prevention to therapy of HF, giving more emphasis on HF classification in four stages (A→D). New therapies, which are on the horizon, promise to further reduce CV mortality and morbidity in HF patients irrespective of diabetic status.

Introduction Exstrasystoles" classifications mostly are based on ectopic centers localization and frequency per time. These classifications are not focus on the functional importance of extrasystolic and first post-extrasystolic reductions. Aim. To make functional classification of extrasystoles based on hemodynamics and kinetics of main arteries. Methods 233 patients were observed with supraventricular and ventricular extrasystoles, which appeared in the phase of isovolumic decrease of intraventricular pressure before the mitral valve opening and in fast or slow ventricules filling phase in cardiocycle. We performed doppler - ultrasound of carotid, radial, ulnaris, posterior tibia, arch of foot arteries and sphygmograms of these arteries. The volume of cardiac output and transmitral blood flow were measured by echocardiography. To know the moment of extrasystoles appearance in cardio cycle and ectopic center localization we used apex-cardiography and electrocardiography. We determined the parameters of heart biomechanics and main arteries kinetics: speed, acceleration, capacity and work in each phase of heart cycle in systole and diastole, and also the periods of dominance of outflow over inflow. We analyzed the peak speed direct blood flow, blood flow volume. Results The increasing of main parameters (speed, acceleration, capacity and work) was observed in first-extrasystolic contraction with the tendency: if earlier extrasystole appeared in cardiocycle than more changes were observed. We can quantitatively characterize different types of extrasystoles which are principally different in the degree of participation of resulting blood flow. We measured the contribution of extrasystolic and first post-extrasystolic reduction. So we classified extrasystoles due to its functional importance: 1. Exstrasystoles before the mitral valve opening. 2. Exstrasystoles in phase of fast ventricules filling before the peak of transmitral blood flow. 3. Exstrasystoles in phase of fast ventricules filling after the peak of transmitral blood flow. 4. Exstrasystoles in slow ventricules filling phase. 5. Coupled and group extrasystoles. Conclusion The main important thing for hemodynamic measuring is the moment of extrasystoles’ appearance in cardiocycle and the ability of the first post-exstrasystolic reduction to reestablish an adequate resulting blood flow. The treatment and cupping of extrasystoles is determined by the degree of hemodinamic disturbance in each variant of arrhythmia. The most changes of blood flow are with extrasystoles before the mitral valve opening. The first poist-extrasystolic reduction causes the significant increase of cardiac output, arteries diameter and non-stability of atheromas.

Background Thromboischemic stroke is a significant medical problem. The most dangerous arrhythmia that causes the thromboembolism is atrial fibrillation. The source of thrombus mostly located in left atrium appendage or apex of left ventricle. But there’re a lot of cases of thromboischemic stroke in patients with atrial fibrillation without any intra-heart thrombus. Purpose To study the possibility of thromboembolic complications in patients with permanent form of atrial fibrillation without intra-heart thrombus. Materials and methods We included 48 patients with permanent form of atrial fibrillation. Mediana age - 68 ± 4,6 y.o. 32 (66,7%) were men and 16 (33,3%) women. All patients were performed 24-hours ECG monitoring to verify the atrial fibrillation. 34 (70,8%) were regularly took warfarin or NOACs to prevent the thromboembolic complications. We used CHADS-2 scale to make the prognosis of 1-year thromboembolic complications. 0 points - 0 (0%) patients, 1 point - 1 (2,1%), 2 points - 2 (4,2%), 3 points - 8 (16,6%), 4 points - 7 (14,5%), 5 points - 18 (37,5%), 6 points - 12 (25,1%). All patients were made transesophageal echocardiography. Only 3 (6,2%) of them had intra-heart thrombus. Intra-arterial blood flow we measured with Doppler-ultrasound. Most of patients – 39 (81,3%) had atherosclerotic plaques of internal carotid artery on one or both sides. In 22 (45,8%) patients were the signs of non-stability of plaques (heterogenic structure, rough surface). We valued the arterial wall kinetic parameters with sphygmography: speed, acceleration, power, work. We analyzed these parameters in different cardiocycles. Results We observed the following patterns: 1. If longer was the pause between cardiocycles in atrial fibrillation then more increase of biomechanical and kinetic parameters was observed. 2. The secondary hemodynamic arterial hypertension at the moments after long pause between cardiocycles. The longest duration of it was observed in bradysystolic atrial fibrillation (up to 38% of time). 3. In patients with hemodynamically important stenosis (about 70%) of internal carotid artery the speed after the long pause in atrial fibrillation is rising up to 4-4,5 meters per second. In comparison with sinus rhythm it is about 2,3 meters per second. Such rising of speed can cause the plaque integrity damage of parietal thrombus fragmentation. 4. Increased arterial wall deformation. The increased biomechanical parameters cause the appearance of additional waves, stand waves that may cause non-stability of plaques with further thromboembolism. 5. During the 1-year observation thromboembolic comlications appeared in 11 (22,9%) patients. Conclusion The source of thromboembolic complications can be non-cardiac in patients with multi-focus atherosclerosis and non-stable plaques.

In recent years, researchers have mainly focused on the humoral and endogenous predictors of atherosclerosis, not paying due attention to anatomical, functional and biomechanical factors. The purpose of the study is an anatomical and functional analysis of the role of extrasystoles as a risk factor for atherosclerosis of the arterial vessels. A total of 270 patients with supraventricular and ventricular extrasystoles were examined. Among the patients there were 162 men and 108 women aged 63.4 ± 6.6 years. The patients underwent sphygmography, electrocardiography, echocardiography and Doppler ultrasound of the arterial main vessels. Anatomical and functional and biomechanical indices of the heart and vessels were determined. The results of the study showed that there are four structural and functional effects of extrasistoly, which play an important role as predictors of atherosclerosis (arterial sprain, mechanical damage to their endothelium, the appearance of additional pulsation waves and the formation of atheroma). The authors believe that the risk factor is not the extrasystole itself, but the pulse wave of the first post-extrasystolic contraction, especially after an early extrasystole, which occurred before the opening of the mitral valve, therefore the treatment tactics and the expediency of its at extrasystoles in many aspects is determined by the degree of hemodynamic disturbances in each specific variant of this rhythm disturbance.