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AIM: To evaluate the impact a fixed-ratio combination of insulin glargine(100U/ml) and lixisenatide(iGlarLixi) on the glycemic control in Russian study T2D population uncontrolled on OAD ± insulin therapy in real-world settings.MATERIALS AND METHODS: The Russian subanalysis of international, multicentre, prospective, observational SUCCESS study included 160 T2DM patients who had initiated iGlarLixi within 1 month prior to study inclusion from 11 regions of the Russian Federation. The primary endpoint — HbA1c change from baseline to month 6. Secondary endpoints: HbA1c change after 12 months, achievement of target HbA1c levels after 6 and 12 months; change in FPG and PPG, change in body weight after 6 and 12 months, iGlarLixi dose dynamics. Safety endpoints: adverse events, serious adverse events, adverse events of special interest, frequency of hypoglycemia during the study period.RESULTS: The average age of patients in the Russian population was 60.8±9.4 years; average duration of T2DM was 11.4 years, mean HbA1c — 9.3±1.5%; mean BMI 33.3 kg/m2. Prior to the study, most patients were on 2 (36.3%) and 3 OADs (27.5%), 32.5% — on insulin therapy. The mean change of HbA1c at month 6 was -1.81%, and -2.03% at month 12. 51.3% patients achieved individual HbA1c targets at month 12, 46.7% of patients achieved the HbA1c target without hypoglycemia and weight gain. The decrease of body weight in 12 months was -3.3±4.4 kg. During the study period, 17 cases of hypoglycemia were recorded (0.11 events per patient-year); 1 severe hypoglycemia (0.01 events per patient-year). The total number of adverse events (AEs) was 43(26.9%), serious AEs - 10 (6.3%).CONCLUSION: According to the results of this prospective real world sub-group analysis, initiation of iGlarLixi in Russian adults with T2DM uncontrolled on OADs ± insulin significantly improves glycemic control with low risk of hypoglycemia and no body weight increase.

Patients on a gluten-free diet are at risk of developing polyhypoavitaminosis and deficiency states, which requires the supplementation of their diet to prevent nutrient deficiencies. The aim of the study: to analyze the dynamics of anthropometric and laboratory parameters, components of the quality of life in children with coeliac disease on the background of a month-long course of administration of hypercaloric mixture for enteric nutrition. Materials and methods: 45 children with coeliac disease aged 2-10 years (mean age 6.3 ± 0.3 years) on a strict gluten-free diet for more than one year. All patients received additional enteric nutrition with a hypercaloric mixture in the volume of 200 ml/day (300 kcal/day) for 1 month as a supplement to the main food ration. Two groups of patients receiving the supplement in 2012-2013 and 2017-2018 were identified. Physical development was assessed under the WHO AnthroPlus programme. The quality of life indicators were assessed using the PedQL 4.0 questionnaire. Results: the total frequency of protein-сalorie deficiency (PCD) before the course of nutritional supplementation was 13 (28.9%) cases, while acute PCD was diagnosed in 6 (13.3%) and chronic PCD in 7 (15.6%) patients. Against the background of the course of nutritious supplementation in children with coeliac disease, there was a significant reduction in weight, height and BMI in both groups. Patients in 2012-2013 initially had a greater gap in weight and height compared to children in 2017-2018. There was an improvement in the sum of the quality of life indicators by 6.3% for children in the first group and by 4.3% for children in the second group against the background of nutritional supplementation. Conclusions: Enrichment of children’s diets with a hypercaloric blend of dietary fiber helps to accelerate the pace of physical development, reduce the number of children with diabetes mellitus, improve hemogram rates and most components of quality of life.

Due to the growth of non-infectious morbidity of the world’s child and adult population, the concept of nutritional programming connecting cardiovascular and certain endocrine diseases with the fetoplacental complex disorders in the antenatal period has been developed over the past 25 years. An increase in the prevalence of obesity and gestational diabetes in pregnant women lays the groundwork for an increase in the prevalence of glucose metabolism disorders and the risk of endocrine pathology in children. Both low weight and overweight at birth evidence the unfavourable course of the intrauterine period. The review discusses the factors contributing to the fetal organs and systems growth retardation, hypovitaminosis D, insulin resistance and possible mechanisms for their development. The authors present the analysis of the data available in the modern literature on the mechanism of the obesity and GDM programming effect on the diseases in new-borns and children.

The prevalence of the excessive weight and obesity increasing in the human population is a significant concern to the public health. The article provides a literature review devoted to pathophysiologic aspects of the obesity and vitamin D deficiency interconnection. A role of adipokines (leptin, adiponectin), cells of the immune system, proinflammatory cytokines in the pathogenesis of obesity and place of vitamin D as an endocrine and paracrine regulator of inflammatory processes in the fatty tissue. An important role of the vitamin D deficiency in the genesis of the insulin resistance is shown that underlies the fatty tissue accumulation and formation of the metabolic profile characteristic of obesity. Direct and indirect vitamin D effect on the insulin synthesis in the pancreatic gland and sensitivity to it of insulin receptors in the body tissues is demonstrated.

The review presents information about the pathophysiological mechanisms underlying disorders of the processes of mineralization of bone tissue in patients with celiac disease. The attention is focused on the role of vitamin D and its active metabolite calcitriol, and also parathyroid hormone in regulating calcium-phosphorus metabolism, which is carried out in target organs – small intestine, kidney, bone tissue. Atrophy of the intestinal mucosa in celiac disease is accompanied not only by malabsorption of calcium, and increased resorption of bone due to increased concentration of PTG. According to various studies on the background of developing the osteoporosis in celiac disease, the risk of bone fractures is significantly increased in patients. Strict adherence to a gluten-free diet allows to normalize both the absorption of calcium, and impaired hormonal mechanisms in bone remodeling in the acute phase, and can reduce the risks of osteoporosis and pathological fractures in patients with celiac disease.

Aim. To determine the reproducibility of the results of instantaneous wavefree ratio (iFR) and angiography coregistration in patients with coronary heart disease (CAD) with multilevel and diffuse lesions of the coronary arteries.Materials and methods. The study included 34 patients with chronic ischemic heart disease (CAD) with diffuse and/or multilevel coronary stenoses >50%. In 41 coronary arteries, two consecutive iFR pullback of the conductor were performed and paired iFR angio-coregistrations were formed, reflecting changes in iFR gradients (Δ iFR) along the entire length of the studied artery. To compare the results of paired studies, the following values were used: 1) indices of distal iFR; 2) maximum Δ iFR; 3) Δ iFR of all stenoses ˃50%.Results. Comparable values of distal iFR were obtained 0,84 [0,78; 0,89] vs. 0,85 [0,77; 0,88]) with an average difference of the first and second measurements of 0,001, maximum ΔiFR (0,08 [0,05; 0,14] vs. 0,08 [0,05; 0,13]) with a mean difference of -0,004 and ΔiFR of all stenoses >50% (0,05 [0,02; 0,11] vs. 0,05 [ 0,02; 0,10]) with an average difference of -0.001. Lin’s concordance correlation coefficient and Intraclass Correlation Coefficients calculated for the three parameters studied showed a good level of agreement (0,97; 0,98; 0,98) with excellent reliability (0,97; 0,98; 0,97).Conclusion. In patients with multilevel and diffuse lesions of the coronary artery, iFR angio-coregistration has a fairly high reproducibility.

Aim. To analyze the use in clinical practice of intravascular coronary assessment methods based on two-year data from the Russian Registry on the Use of Intravascular Imaging and Physiology.Material and methods. Since 2021, the Russian Registry on the Use of Intravascular Imaging and Physiology has included data from 7967 studies in 3932 patients, of which 3086 (38,7%) were studies of intravascular physiology. In 2021, 13 branches from 9 cities participated in the registry, in 2022 — 20 branches from 11 cities. For chronic coronary artery disease, 2484 (80,5%) studies were performed, for acute coronary syndrome (ACS) — 598 (19,4%).Results. In 2022, the registry included 1,9 times more intravascular functional studies compared to 2021. The contribution of different clinics was uneven — 75,7% of studies were performed in three departments. The use of non-hyperemic indexes prevailed over hyperemic ones (58%), and in ACS they were used three times more often. All coronary arteries were examined, most often the anterior descending artery. As a primary diagnosis, 1968 (63,8%) studies were performed, while for the purpose of dynamic control — 122 (3,9%), at the surgical stage — 996 (32,3%). In 85,5% (n=2638) of observations, the functional assessment of stenosis hemodynamic significance directly influenced the treatment tactics.Conclusion. The registry data indicate the significant role of functional methods among intravascular diagnostic options in the practice of domestic clinics participating in the registry. The registry demonstrated their use as a primary diagnosis 2 times more often than for coronary artery stenting. Some indications for the active use of intravascular physiology methods (in acute coronary syndrome, left coronary artery involvement) are currently controversial and require further research.

ABSTRACT Objective: the aim of our study was to determine the optimal instantaneous wave-free ratio (iFR) cut-off points in assessing the functional significance of intermediate coronary artery stenoses in patients with chronic coronary artery diseases (CAD) using non-invasive methods of myocardial ischemia verification as reference. Methods: 60 patients with chronic CAD or suspected CAD and intermediate coronary stenoses (50-70%) were included in the study. 92 borderline coronary stenoses were investigated. iFR measurement was carried out within 10 days after the non-invasive stress test (a combination of stress echocardiography and SPECT). Results: stress-induced myocardial ischemia was detected in 18 patients (30%). iFR values are in the range 0.68 to 1.0, median of iFR - 0.95 [0.9; 0.99]. Area under iFR ROC-curve - 0.95 ± 0.02 (95%CI: 0.885-0.985). The iFR cut-off point 0.92 is optimal and has a sensitivity of 100%, a specificity of 83% and a negative predictive value (NPV) of 100%. The iFR cut-off point 0.86 is associated with a specificity of 100%, a sensitivity of 33% and a positive predictive value of 100%. The values of iFR «grey» zone ranged from 0.87 to 0.92. Conclusion: using non-invasive methods of verification of myocardial ischemia as a reference, iFR cut-off point 0.92 excludes the functional significance of coronary artery stenosis with a NPV of 100%. iFR cut-off point 0.86 confirms the functional significance of the stenosis with a PPV of 100%. It is recommended to measure the fractional flow reserve in the case of obtaining the iFR values of «grey» zone (0,87-0,92). Key words: iFR, CAD, stress-echo, SPECT.

Aim. To study the safety and clinical efficacy of an outpatient coronary angiography in various groups of patients according to a 6-year experience of the laboratory of endovascular diagnostic and treatment methods in the outpatient setting of the NMRC of Cardiology. Materials and methods. 2166 patients which underwent an outpatient coronary agiography from March 2009 to December 2014 were included. The success criteria was the successful completion of the procedure without the occurrence of major cardiovascular complications (death, transmural myocardial infarction; acute cerebrovascular accident, emergency cardiac surgery). Results and discussion. All 2166 patients included in the study were divided into 2 groups: Group 1 - 1316 patients who were discharged home several hours after the study; Group 2 - 850 patients directed from hospitals without catheterization laboratories with the same-day discharge back to the referring hospital. From a clinical point of view, in the second group there were more severe patients. However, the study was successfully completed in all patients in both groups. There were no major adverse cardiovascular complications during the procedure and within 24 hours. In the 1st group, unplanned hospitalization occurred in 2.1% of cases, the cause of which in 93% of cases was the detection during angiography of a critical lesion ≥70% of the left main coronary artery. Conclusion. In our work, the incidence of complications was extremely low and not significantly different in both groups of patients. This is due to the fact that in patients with a more severe symptoms underwent a preliminary stabilization of their clinical condition. The introduction of outpatient technologies will optimize the invasive diagnostics and reduce the costs associated with hospitalization.

Aim. To estimate the diagnostic value of measuring the momentary blood flow reserve (MBFR) versus the surrogate non-invasive standard (SNS) for myocardial ischemia verification (MIV) (a combination of stress echocardiography and single-photon emission computed tomography). Subjects and methods. The investigation enrolled 50 patients with stable angina in the presence of chronic coronary heart disease (CHD) or suspected CHD, in whom coronary angiography (CA) revealed borderline coronary stenoses (50—70% lumen diameters). The examination algorithm had two options. In one option, when included in the study, patients had already CA results not older than 1 month, and MBFR was measured 4—7 days after non-invasive stress tests. In the other option, MBFR in the area of borderline coronary artery stenosis was measured simultaneously with CA; and the noninvasive stress tests were carried out in the following week. A total of 74 coronary stenoses were examined. Results. SNS for MIV was positive in 14 (28%) patients. When comparing with the non-invasive methods of myocardial ischemia verification, the area under the ROC curve for MBFR was 0.961±0.019 (95% confidence interval, 0.888—0.992). The optimal cut-point was 0.92, which is corresponded by a sensitivity of 100% and a specificity of 84%. Conclusion. When compared with SNS for MIV, the method for measuring MBFR has a high diagnostic accuracy.