Russian Journal of Cardiology 2020, 25 (11)

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Russian Journal of Cardiology. 2020;25(11):9

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Russian Journal of Cardiology. 2020;25(11):10

ORIGINAL ARTICLES

INFECTIOUS-IMMUNE PERICARDITIS: CLINICAL ASSESSMENT, DIAGNOSTICS, AND DIFFERENTIATED BASELINE THERAPY WITH HYDROXYCHLOROQUINE

Blagova O. V., Sorokin G. Yu., Sedov V. P., Kogan E. A., Sarkisova N. D., Nedostup A. V.

Abstract

Aim. To study the clinical spectrum of infectious-immune pericarditis, the potential for their invasive and non-invasive diagnosis, as well as long-term treatment with hydroxychloroquine (in comparison with other baseline therapy options).

Material and methods. The study included 44 patients with infectious-immune pericarditis (28 women and 16 men aged 49,4±13,3 years). Patients with transudate and specific types of pericarditis were excluded. Levels of C-reactive protein and anticardiac antibodies were determined Multislice computed tomography of the lung (n=23) and heart (n=16), cardiac magnetic resistance tomography (n=9), scintigraphy (n=14), and if necessary — immunoelectrophoresis, DNA testing, Diaskin-test. Pericardio- and thoracentesis were performed in 3/3 patients, thoracoscopic pericardial biopsy — 1, endomyocardial biopsy — 7. The follow-up period was 14,5 [3; 39,5] months.

Results. Isolated pericarditis was diagnosed in 10 patients (22,7%), myopericarditis — in 34 (77,3%). In 38 patients, pericarditis was exudative: in 24 (63,2%) with a small effusion (≤10 mm), in 10 (26,3%) — with a moderate (11-20 mm), in 4 (10,5%) — with a large (≥20 mm). Fibrin was detected in 18,2% of patients. Pericardial effusion was assessed as acute in 4, subacute — in 8, chronic — in 26 patients. The connection between the disease onset and infection was found in 56,8% of patents, and inflammatory blood changes — in 59,1%. In 80%, the punctate was lymphocytic; endomyocardial biopsy confirmed active/borderline (5/2) lymphocytic myocarditis (virus-positive — in 3 patients). Anticardiac antibody titers were increased in 88,2%. Baseline therapy included NSAIDs (34,1%), colchicine (27,3%), hydroxychloroquine (43,2%), methylprednisolone (56,8%, 16 [16; 21] mg/day), azathioprine (20,5%). The treatment scheme was selected individually. In most cases, combined therapy was carried out. The results of treatment were assessed in 36 patients: an excellent effect was noted in 16 (44,4%) patients, stable effect — in 13 (36,1%), no stable effect — in 7 (19,4%). There were no cases of constrictive pericarditis, acute relapses, cardiac tamponade. Mortality of 6,8% was associated with myocardial injury.

Conclusion. Criteria for the diagnosis of infectious-immune pericarditis were proposed. An increase in the titer of anticardiac antibodies was noted in all types of the disease. Prescription of corticosteroids is justified in many cases, including in combination with colchicine, cytostatics, hydroxychloroquine. Hydroxychloroquine monotherapy is effective for subacute/chronic pericarditis with moderate effusion.

Key words: infectious-immune pericarditis, myocarditis, anticardiac antibodies, endomyocardial biopsy, corticosteroids, hydroxychloroquine.

Relationships and Activities: none.

I. M. Sechenov First Moscow State Medical University, Moscow, Russia.

Blagova O. V.* ORCID: 0000-0002-5253-793X, Sorokin G. Yu. ORCID: 0000-0002-1013-9706, Sedov V. P. ORCID: 0000-0003-2326-9347, Kogan E. A. ORCID: 0000-0002-1107-3753, Sarkisova N. D. ORCID: 0000-0002-5979-1180, Nedostup A. V. ORCID: 0000-0001-9587-6707.

*Corresponding author: blagovao@mail.ru

Received: 13.04.2020

Revision Received: 20.04.2020

Accepted: 21.04.2020

For citation: Blagova O. V., Sorokin G. Yu., Sedov V. P., Kogan E. A., Sarkisova N. D., Nedostup A. V. Infectious-immune pericarditis: clinical assessment, diagnostics, and differentiated baseline therapy with hydroxychloroquine. Russian Journal of Cardiology. 2020;25(11):3840. (In Russ.) doi:10.15829/1560-4071-2020-3840

CARDIAC HEMODYNAMIC DISORDERS IN PATIENTS WITH ACTIVE CHRONIC VIRAL HEPATITIS AND THE EFFECTIVENESS OF ANTIVIRAL THERAPY

Chistyakova M. V.¹, Radaeva E. V.², Zaitsev D. N.¹, Govorin A. V.¹

Abstract

Aim. To study cardiac hemodynamic disorders in patients with chronic viral hepatitis (CVH) and evaluate the effectiveness of antiviral therapy (AVT).

Material and methods. Seventy-nine patients with CVH (mean age, 38,6 years, disease duration, 4,7 years) were examined. The patients were divided into two groups: group 1 (n=42) — normal level of alanine aminotransferase (ALT), group 2 — ALT 3-10 times higher than normal (n=37). Fourteen patients with CVH underwent AVT. Control group consisted of 23 people. Doppler echocardiography was performed. Statistical processing was carried out using Statistica 10.0.

Results. In patients with active hepatitis, atrial volume, end diastolic volume, left ventricular (LV) mass index, LV stroke volume increased, and the tricuspid (TC) annular systolic velocity decreased in comparison with the control and 1st groups. In patients with normal ALT levels, the left atrial volume index increased by 8% in comparison with control group. Concentric remodeling was the predominant variant of LV remodeling in patients with active hepatitis. In patients with active hepatitis, LV lateral wall, interventricular septal (IVS), and TC Em/Am ratio decreased. LV diastolic dysfunction was reported in 12 patients with active and 3 patients with inactive CVH. After AVT, left atrium (LA) volume, IVS thickness, LV mass decreased, while TC and mitral annular systolic velocity increased. The viral load has a relationship with mitral annular systolic velocity (r=0,91, p=0,001) and LV mass (r=0,64, p=0,05).

Conclusion. In patients with active hepatitis, along with LV and LA dilatation and hypertrophy, a relative right atrial increase, a decrease in the right ventricular longitudinal systolic velocity, and the formation of biventricular diastolic dysfunction develop. In patients with inactive hepatitis, only the left atrial volume increased. The established correlations indicate possible LV damage. Antiviral therapy has a beneficial effect on the main structural and functional cardiac parameters.

Key words: liver, viral hepatitis, heart.

Relationships and Activities: none.

¹Chita State Medical Academy, Chita; ²City Clinical Hospital № 40, Moscow, Russia.

Chistyakova M. V.* ORCID: 0000-0001-6280-0757, Radaeva E. V. ORCID: 0000-0002-8856-8017, Zaitsev D. N. ORCID: 0000-0002-2741-3783, Govorin A. V. ORCID: 0000-0003-1340-9190.

*Corresponding author: m.44444@yandex.ru

Received: 26.04.2020

Revision Received: 20.05.2020

Accepted: 21.05.2020

For citation: Chistyakova M. V., Radaeva E. V., Zaitsev D. N., Govorin A. V. Cardiac hemodynamic disorders in patients with active chronic viral hepatitis and the effectiveness of antiviral therapy. Russian Journal of Cardiology. 2020;25(11):3859. (In Russ.) doi:10.15829/1560-4071-2020-3859

NON-COMPACTION CARDIOMYOPATHY. PART I: CLINICAL AND GENETIC HETEROGENEITY AND PREDICTORS OF UNFAVORABLE PROGNOSIS

Vaikhanskaya T. G.¹, Sivitskaya L. N.², Kurushko T. V.¹, Rusak T. V.¹, Levdansky O. D.², Danilenko N. G.², Davydenko O. G.²

Abstract

Non-compaction cardiomyopathy (NCM) is a rare heart disease characterized by a two-layered ventricular wall, comprising a thinner compact epicardial layer and an inner non-compacted layer. However, only structural and morphological data without a thorough clinical assessment does not determine the NCM (regardless of the diagnostic criterion used).

Aim. To study the NCM-related genes, phenotypic and genetic correlations, predictors of life-threatening ventricular tachyarrhythmias (VTA) and adverse clinical outcomes.

Material and methods. Of 93 individuals with identified morphological criteria of NCM (median follow-up, 5 years), the study included 60 unrelated patients (38,5±13,8 years of age; men, 33 (55%); left ventricular ejection fraction (LVEF), 42,1±12,9%) with clinical verification of NCM (≥1 obligate phenotypic trait). Adverse cardiovascular events were taken as the composite end point: life-threatening VTA, death, heart transplantation.

Results. Pathogenic (or probably pathogenic) mutations were detected in 33 (55%) patients with NCM. The most common variants (57,9%) were identified in the sarcomere protein genes (TTN, MYBPC3, MYH7); digenic mutations were found in 21,6% of patients. Digenic mutations were associated with low LVEF and the highest risk of systolic dysfunction (OR, 38; 95% CI, 4,74-305; p=0,0001). Multivariate regression provided a predictive model (R=0,90; R2=0,81; F (5,41) =34,8; p<0,0001) and independent predictors of adverse clinical outcomes of NCM (genetic cause of the disease (pathogenic mutation), LV systolic dysfunction, myocardial fibrosis in 2 or more ventricular segments, and QRS prolongation. Regression and ROC analysis identified electrical predictors of life-threatening VTA (fragmented QRS, QT prolongation, spatial QRS-T angle increase) and morphofunctional markers (myocardial fibrosis, systolic dysfunction).

Conclusion. The study revealed a significant clinical and genetic heterogeneity of NCM with predominant mutations in the sarcomeric protein genes and determined the criteria for identification and prognosis of NCM.

Key words: non-compacted myocardium, non-compaction cardiomyopathy, genetic spectrum, heart failure, ventricular tachyarrhythmias, sudden cardiac death.

Relationships and Activities: none.

¹Republican Science-Practical Centre “Cardiology”, Minsk; ²Institute of Genetics and Cytology, Minsk, Belarus.

Vaikhanskaya T. G.* ORCID: 0000-0002-2127-8525, Sivitskaya L. N. ORCID: 0000-0001-6359-4967, Kurushko T. V. ORCID: 0000-0001-5727-3219, Rusak T. V. ORCID: 0000-0003-4318-9977, Levdansky O. D. ORCID: 0000-0002-3325-0917, Danilenko N. G. ORCID: 0000-0002-3270-3080, Davydenko O. G. ORCID: 0000-0002-9790-2953.

*Corresponding author: tat_vaikh@mail.ru

Received: 30.04.2020

Revision Received: 06.05.2020

Accepted: 13.05.2020

For citation: Vaikhanskaya T. G., Sivitskaya L. N., Kurushko T. V., Rusak T. V., Levdansky O. D., Danilenko N. G., Davydenko O. G. Non-compaction cardiomyopathy. Part I: clinical and genetic heterogeneity and predictors of unfavorable prognosis. Russian Journal of Cardiology. 2020;25(11):3872. (In Russ.) doi:10.15829/1560-4071-2020-3872

POSTOPERATIVE MYOCARDIAL INFARCTION IN LUNG CANCER PATIENTS WITH: INCIDENCE RATE, CLINICAL FEATURES, PROGNOSTIC FACTORS

Bolshedvorskaya O. A.¹, Protasov K. V.², Ulybin P. S.¹, Dvornichenko V. V.^1,2

Abstract

Aim. To study the incidence, clinical features and predictors of postoperative myocardial infarction (MI) after lung cancer surgery.

Material and methods. The retrospective analysis included 2051 patients (1373 males and 678 females, mean age, 65,5 [62-69] years), who underwent thoracotomy for non-small cell lung cancer. At the first stage, the incidence rate of postoperative MI (%) was calculated with 95% confidential interval (CI) in relation to sex, age and extent of surgery. At the second stage, the case-control study was carried out in groups with MI revealed on the first stage (n=33) and without MI (n=130), formed by individual criteria-based matching. A comparative intergroup analysis was performed and prognostic value of 60 clinical perioperative indicators was assessed by odds ratio (OR). The features associated with MI in the univariate regression model were introduced into multivariate stepwise logistic regression. Independent MI predictors was revealed.

Results. The postoperative IM incidence rate amounted to 1,61 [0,67-1,76]%. MI was more frequently diagnosed in men than women (0,29%), and after pneumonectomy (3,92%) compared with less operative extent (0,37%). MI was associated with comorbidities, smoking intensity, right pneumonectomy, preoperative increase in white blood cells, neutrophils and monocytes, blood loss volume, surgery duration, postoperative heart rate, preoperative decrease in serum total protein, postoperative haemoglobin, haematocrit, red blood cells decrease, and intraoperative blood pressure (BP). By means of multivariate logistic regression, the following factors with most accurate MI prediction were established: postoperative heart rate (OR, 4,06 [95% CI 1,58-10,43]), Sokolow-Lyon index (ОR, 1,54 [95% CI 1,14-2,07]), ACS-NSQIP value for cardiac complications (ОR, 3,86 [95% CI 1,36-10,92]), preoperative serum total protein (ОR, 0,17 [95% CI 0,04-0,71]) and white blood cells (ОR 1,54 [95% CI 1,03-2,31]), minimal intraoperative systolic BP (ОR, 0,35 [95% CI 0,15-0,83]).

Conclusion. Postoperative MI incidence in lung cancer patients accounts for 1,61%. Following independent predictors for postoperative MI were established: Sokolow-Lyon index, preoperative serum total protein and leukocytes levels, ACSNSQIP value, minimal intraoperative systolic BP and postoperative heart rate.

Key words: postoperative myocardial infarction, lung cancer, pneumonectomy.

Relationships and Activities: none.

¹Regional Oncological Dispensary, Irkutsk; ²Irkutsk State Medical Academy of Postgraduate Education — branch of Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia.

Bolshedvorskaya O. A. ORCID: 0000-0002-8993-2503, Protasov K. V.* ORCID:0000-0002-6516-3180, Ulybin P. S. ORCID: 0000-0003-3064-8441, Dvornichenko V. V. ORCID: 0000-0002-1777-5449.

*Corresponding author: k. v.protasov@gmail.com

Received: 03.06.2020

Revision Received: 07.06.2020

Accepted: 07.07.2020

For citation: Bolshedvorskaya O. A., Protasov K. V., Ulybin P. S., Dvornichenko V. V. Postoperative myocardial infarction in lung cancer patients with: incidence rate, clinical features, prognostic factors. Russian Journal of Cardiology. 2020;25(11):3946.

(In Russ.) doi:10.15829/1560-4071-2020-3946

MICROCIRCULATION DISORDERS AND STRUCTURAL AND FUNCTIONAL LEFT VENTRICULAR ABNORMALITIES IN PATIENTS WITH TYPE 1 DIABETES COMPLICATED BY KETOACIDOSIS

Mukha N. V., Govorin A. V., Zaitsev D. N., Filev A. P.

Abstract

Aim. To assess the patterns of microcirculation disorders and its effect on the left ventricular (LV) structure and function in patients with type 1 diabetes (T1D) complicated by diabetic ketoacidosis (DKA).

Material and methods. The study included 128 patients with T1D complicated by DKA. Echocardiography was performed according to the standard technique. To study the microcirculation and vascular tone regulation, we used a laser Doppler flowmetry (LDF) using the LAKK-02 machine (Lazma, Russia).

Results. In patients with T1D complicated by DKA, there was an increase in thepassive blood flow modulation with a depression of active factors. The most pronounced changes are recorded in 1-5 days of the disease. Along with this, a spectral redistribution in favour of respiratory and cardiac microcirculation ranges was demonstrated. With DKA, the myocardial remodelling is recorded: an increase in left atrial (LA) size by 5,6%, LV end systolic and diastolic dimension and volume by 5,3% and 6,7%, respectively, LV mass by 17,3% and LV mass index by 17,8%. Decreased LV ejection fraction (EF) in comparison with healthy individuals was

obtained. Significant unidirectional changes in these parameters were revealed in comparison with the T1D patients without DKA.

Conclusion. In patients with T1D complicated by DKA, the microcirculation decreases, as a result of which the adequate tissue supply is limited, vascular resistance and hemodynamic load increases, which leads to LV structural and functional changes.

Key words: type 1 diabetes mellitus, ketoacidosis, microcirculation, cardiohemodynamics.

Relationships and Activities: none.

Chita State Medical Academy, Chita, Russia.

Mukha N. V.* ORCID: 0000-0001-8128-636Х, Govorin A. V. ORCID: 0000-0001-7586-6595, Zaitsev D. N. ORCID: 0000-0002-2741-3783, Filev A. P. ORCID: 0000-0002-3445-7119.

*Corresponding author: mushanatasha@inbox.ru

Received: 02.09.2020

Revision Received: 28.09.2020

Accepted: 14.10.2020

For citation: Mukha N. V., Govorin A. V., Zaitsev D. N., Filev A. P. Microcirculation disorders and structural and functional left ventricular abnormalities in patients with type 1 diabetes complicated by ketoacidosis. Russian Journal of Cardiology. 2020;25(11):4084. (In Russ.) doi:10.15829/1560-4071-2020-4084

CARDIOMYOPATHIES: ECHOCARDIOGRAPHIC PROFILES BASED ON PRINCIPAL COMPONENT FACTOR ANALYSIS IN MEN AND WOMEN

Vardugina N. G.¹, Medvedenko I. V.², Efimova N. M.²

Abstract

Aim. To determine echocardiographic profiles and their prognostic value using factor analysis in men and women with various types of cardiomyopathies (CMP).

Material and methods. The study involved 100 people with CMP — 69 men with a median age of 53 years and 31 women with a median age of 58 years. Among the subjects, six nosological types corresponding to ICD 10 classification were revealed: dilated CMP (DCM), ischemic CMP (ICM), alcoholic CMP, mixed CMP, hypertrophic CMP (HCM) and myocarditis. All persons underwent an echocardiography. Echocardiography results as variables were included in factor analysis. The resulting two factors are presented as the first and second echocardiographic profiles.

Results. The first echocardiographic profile was characterized as the degree of myocardial contractile function reduction. A strong association of the first profile with DCM, alcoholic CMP and myocarditis in men (p=0,001) and DCM in women (p=0,05) was obtained. In some individuals with ICM and mixed CMP, there was no association with the first profile. The second echocardiographic profile reflected the degree of myocardial mass increase and had significant differences only in women (p=0,04). A strong correlation with the second profile was observed in HCM, in the majority of women with ICM and in some persons with mixed CMP. Fatal outcomes in men were recorded in patients with ICM (66,7%), alcoholic CMP and myocarditis, and in women with mixed CMP (11,1%).

Conclusion. For patients with DCM, myocarditis, and alcoholic CMP, the first echocardiographic profile with a risk of death is characteristic. The second echocardiographic profile was inherent in HCM and was associated with a protective effect in women with ICM. The revealed echocardiographic profiles can be extrapolated to nosological types of CMP in men and women in order to verify the diagnosis and prognosis.

Key words: cardiomyopathies, echocardiography, factor analysis, sex differences.

Relationships and Activities: none.

¹South Ural State Medical University, Chelyabinsk; ²Regional Clinical Hospital № 3, Chelyabinsk, Russia.

Vardugina N. G.* ORCID: 0000-0003-4526-8652, Medvedenko I. V. ORCID: 0000-0002-1568-9993, Efimova N. M. ORCID: 0000-0001-7105-2391.

*Corresponding author: centrproff@yandex.ru

Received: 14.09.2020

Revision Received: 18.09.2020

Accepted: 19.09.2020

For citation: Vardugina N. G., Medvedenko I. V., Efimova N. M. Cardiomyopathies: echocardiographic profiles based on principal component factor analysis in men and women. Russian Journal of Cardiology. 2020;25(11):4108. (In Russ.) doi:10.15829/1560-4071-2020-4108

LONG-TERM PROGNOSIS OF LEFT VENTRICULAR RE-REMODELING AFTER SURGERY OF ISCHEMIC CARDIOMYOPATHY: THE POTENTIAL OF TOMOGRAPHIC RADIONUCLIDE VENTRICULOGRAPHY

Shipulin V. V., Mishkina A. I., Gulya M. O., Varlamova Yu. V., Andreev S. L., Pryakhin A. S., Shipulin V. M., Zavadovsky K. V.

Abstract

Aim. To assess the potential of stress tomographic radionuclide ventriculography (T-RVG) in long-term prognosis of left ventricular (LV) re-remodeling after surgery of ischemic cardiomyopathy.

Material and methods. Thirty patients with ischemic cardiomyopathy, before surgical treatment, underwent resting T-RVG and with increasing doses of dopamine (5/10/15 μg/kg/min (5 min/dose). All patients underwent two-dimensional echocardiography before surgery, in the short- (7-14 days) and long-term postoperative period. In the long-term postoperative period (476±36 days), the patients were divided into two groups: group 1 (n=19) — patients with ongoing LV remodeling (increase in the LV end-systolic volume (ESV) or decrease ≤10% relatively short-term postoperative period), group 2 (n=11) — patients with decreased LV ESV >10%.

Results. The results revealed significant differences between the groups in the dynamics (Δ) of the LV ejection fraction (EF) (%) (2 (2;8); 11 (5;12), p=0,02), peak ejection rate (%) (32 (14;51); 63 (34;79), p=0,009), LV dyssynchrony (PSD0 (3 (0;7); -2 (-9;3), p=0,004); Entropy (%) (2 (-1;6); 0 (-4;2), p=0,01)). Univariate regression showed that ΔLVEF (odds ratio (OR), 0,88; confidence interval (CI), 0,8; 0,97; p=0.008), ΔLVPSD (OR, 1,13; CI, 1,03; 1,25; p=0,005), and coronary stenosis >75% (OR, 4,25; CI, 1,57; 11,48; p=0,001) had a predictive value. According to the ROC analysis, the sensitivity, specificity, and AUC were 87%, 64% and 0,727 for ΔLVPSD (threshold >-1); 84%, 46% and 0,691 for coronary stenosis >75% >75% (threshold >2); 65%, 82% and 0,674 for ΔLVEF (threshold ≤4), respectively. The logistic model, which included these parameters and the presence of diabetes, showed a significantly greater AUC (0,907, p<0,05) compared with these indicators taken separately.

Conclusion. Preoperative values of ΔLVEF and ΔLVPSD obtained with stress T-RVG have prognostic significance in relation to LV long-term re-remodeling.

Key words: ischemic cardiomyopathy, remodeling, tomographic radionuclide ventriculography, prognosis.

Relationships and Activities: none.

Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.

Shipulin V. V.* ORCID: 0000-0001-9887-8214, Mishkina A. I. ORCID: 0000-0001-9453-1635, Gulya M. O. ORCID: 0000-0001-5689-9754, Varlamova Yu. V. ORCID: 0000-0002-0193-9453, Andreev S. L. ORCID: 0000-0003-4049-8715, Pryakhin A. S. ORCID: 0000-0003-0532-8091, Shipulin V. M. ORCID: 0000-0003-1956-0692, Zavadovsky K. V. ORCID: 0000-0002-1513-8614.

*Corresponding author: shipartphoto@gmail.com

Received: 07.04.2020

Revision Received: 27.07.2020

Accepted: 07.08.2020

For citation: Shipulin V. V., Mishkina A. I., Gulya M. O., Varlamova Yu. V., Andreev S. L., Pryakhin A. S., Shipulin V. M., Zavadovsky K. V. Long-term prognosis of left ventricular re-remodeling after surgery of ischemic cardiomyopathy: the potential of tomographic radionuclide ventriculography. Russian Journal of Cardiology. 2020;25(11):3831. (In Russ.) doi:10.15829/1560-4071-2020-3831

CLINICAL AND INVESTIGATIVE MEDICINE

CLINICAL PERFORMANCE OF THE ATRIAL FIBRILLATION IN THE RUSSIAN POPULATION DEPENDING ON THE ANTITHROMBOTIC THERAPY: FINDINGS FROM THE GLORIA-AF REGISTRY PHASE 2

Shlyakhto E.V.¹, Villevalde S.V.¹, Ezhov A.V.², Zenin S.A.³, Koziolova N. A.⁴, Korennova O. Yu.^5,6, Novikova T. N.⁷, Protasov K. V.⁸, Chumakova G. A.⁹, Teutsch C.¹⁰, Lu S.¹¹, Lip G. Y. H.¹², Huisman M. V.¹³

Abstract

Aim. To analyze clinical characteristics of patients with nonvalvular atrial fibrillation (AF) in the Russian population, enrolled in the GLORIA-AF registry phase 2, depending on the antithrombotic therapy received, and to assess the potential for patient retention with dabigatran during a 2-year follow-up.

Material and methods. In the Russian Federation, 408 patients were included in the second phase of GLORIA-AF which is a global prospective observational registry of newly diagnosed patients with AF. The patient characteristics are presented depending

on received antithrombotic therapy (dabigatran, factor Xa inhibitors, vitamin K antagonist, antiplatelet agents, or no antithrombotic therapy), with a dabigatran dosing regimen of either 110 mg or 150 mg twice daily. Duration of patient retention on dabigatran therapy was also analyzed during a 2-year follow-up.

Results. Of the 405 patients with recently diagnosed nonvalvular AF, 358 (88%) received oral anticoagulants (OAC), and 47 (12%) patients received antiplatelet drugs or received no antithrombotic therapy. Most patients were treated with dabigatran (n=275, 68%), and 75 (19%) patients received vitamin K antagonist. Clinical and demographic characteristics of patients receiving dabigatran were comparable with those in the general group of the Russian patients. The mean age was 63,5 years. The most common comorbidities in Russian patients receiving dabigatran were hypertension (93%), congestive heart failure (57%), coronary

artery disease (35%). It is noteworthy that 12% and 10% of patients had a previous myocardial infarction and stroke, respectively. The mean CHA₂DS₂-VASc score for stroke risk for these patients was 3,2; 88% of patients had a high stroke risk (score of >2). Of the 275 patients with AF who received dabigatran therapy, 164 (60%) patients received dabigatran at the dose of 150 mg twice daily, and 111 (40%) patients received 110 mg twice daily. Dabigatran doses of 110 mg twice daily were more frequently prescribed for female patients aged 65 years or older and patients with a previous coronary events and impaired renal function, who had a higher CHA₂DS₂-VASc score for stroke risk. There was a higher proportion of AF patients with marked symptoms in the dabigatran 150 mg twice daily group. A median duration of treatment with dabigatran with the initial dosing regimen was 24 months. The estimated dabigatran therapy retention rate was 0,87, 0,81 and 0,73 after 6, 12 and 24 months of follow-up, respectively.

Conclusion. In the Russian Federation, patients with newly diagnosed AF who have an increased risk of stroke are more likely to receive OAC therapy, such as direct thrombin inhibitor (dabigatran), compared to the global cohort of the GLORIA AF Registry Program. Patients in the Russian cohort receiving dabigatran differ from the global cohort of patients by greater comorbidity. At the same time, patients receiving reduced doses of dabigatran, both in the Russian Federation and in the global Registry, are characterized by a greater proportion of patients aged ≥75 years, a higher incidence of previous myocardial infarction, coronary artery disease, heart failure, impaired renal function, higher CHA₂DS₂-VASc score for stroke risk. The potential dabigatran therapy retention rate after 24 months in the Russian Federation and in the global cohort was high and amounted to about 70%.

Key words: atrial fibrillation, GLORIA-AF registry, dabigatran etexilate, therapy retention.

Relationships and Activities. This study was supported by Boehringer Ingelheim. Lip G. Y. H. and Huisman M. V. are the GLORIA-AF co-chairs and joint senior authors.

¹Almazov National Medical Research Center, St. Petersburg, Russia; ²Izhevsk State Medical Academy, Izhevsk, Russia; ³Novosibirsk Regional Clinical Cardiology Dispensary, Novosibirsk, Russia; ⁴E. A. Wagner Perm State Medical University, Perm, Russia; ⁵Omsk State Medical University, Omsk, Russia; ⁶Clinical Cardiology Dispensary, Omsk, Russia; ⁷I. I. Mechnikov North-Western State Medical University, St. Petersburg, Russia; ⁸Irkutsk State Medical Academy of Postgraduate Education — Branch Campus of the Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia; ⁹Altai State Medical University, Barnaul, Russia; ¹⁰Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany; ¹¹Boehringer Ingelheim Inc., Ridgefield, CT, USA; ¹²Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, Liverpool, UK; ¹³Leiden University Medical Centre, Leiden, Netherlands.

Shlyakhto E. V. ORCID: 0000-0003-2929-0980, Villevalde S. V.* ORCID: 0000-0001-7652-2962, Ezhov A. V. ORCID: none, Zenin S. A. ORCID: 0000-0002-1250-8799, oziolova N. A. ORCID: 0000-0001-7003-5186, Korennova O. Yu. ORCID: 0000-

0001-8047-5521, Novikova T. N. ORCID: 0000-0003-4655-0297, Protasov K. V. ORCID: 0000-0002-6516-3180, Chumakova G. A. ORCID: 0000-0003-4725-318X, Teutsch C. ORCID: 0000-0002-8494-2876, Lu S. ORCID: 0000-0002-7209-5075, Lip G. Y. H. ORCID: 0000-0002-7566-1626, Huisman M. V. ORCID: 0000-0003-1423-5348.

*Corresponding author: villevaldes@mail.ru

Received: 22.10.2020

Revision Received: 09.11.2020

Accepted: 11.11.2020

For citation: Shlyakhto E. V., Villevalde S. V., Ezhov A. V., Zenin S. A., Koziolova N. A., Korennova O. Yu., Novikova T. N., Protasov K. V., Chumakova G. A., Teutsch C., Lu S., Lip G. Y. H., Huisman M. V. Clinical performance of the atrial fibrillation in the Russian population depending on the antithrombotic therapy: findings from the GLORIA-AF registry phase 2. Russian Journal of Cardiology. 2020;25(11):4179. (In Russ.) doi:10.15829/1560-4071-2020-4179

ANTICARDIAC ANTIBODIES IN PATIENTS WITH SEVERE AND MODERATE COVID-19 (CORRELATIONS WITH THE CLINICAL PERFORMANCE AND PROGNOSIS)

Blagova O. V.¹, Varionchik N. V.¹, Zaydenov V. A.², Savina P. O.¹, Sarkisova N. D.¹

Abstract

The level and significance of anticardiac antibodies (ACA) in patients with COVID-19 infection have not yet been studied.

Aim. To assess the level of various ACA in patients with severe and moderate COVID-19 infection and to identify the correlation of antibody profile with the clinical performance and prognosis.

Material and methods. The study included 86 (38 women and 48 men) patients aged 20-90 years (60,2±16,6 years) who were hospitalized for moderate and severe COVID-19 infection in April-June 2020. Nasopharyngeal swab confirmed the disease in 59,3% of patients. In addition to the standard examination, electrocardiography and chest scan, level of antinuclear antibodies (ANA), antiendothelial cell antibodies (AECA), anti-cardiomyocyte antibodies, antibodies to anti-smooth muscles (ASMA) and cardiac conduction system fibers. Echocardiography was performed in 17 patients. Mean length of stay was 14 [12; 18] days. Death was considered as the primary endpoint.

Results. Prevalence of heart disease and symptoms (including hypertension and coronary artery disease) was 45,3%. The manifestations of coronavirus heart damage include arrhythmias (supraventricular premature beats, 3,6%; atrial fibrillation, 9,3%), heart failure (9,3%), low QRS voltage (11,4%), repolarization abnormalities (41,9%), pericardial effusion (30%). An increase in troponin levels was observed in low number of patients. All types of cardiovascular disease correlated with the maximum D-dimer level (AUC, 0,752, p<0,01). Titers of two or more types of ACA were increased by 3 or more times in 25 (73,5%) patients. Significant (p<0,05) correlations of ANA level with cardiovascular symptoms/diseases in general (r=0,459), anti-cardiomyocyte antibodies — with the prevalence of pneumonia (r=0,472), shortness of breath severity (r=0,370), respiratory failure (r=0,387), oxygen therapy (r=0,388) and mechanical ventilation (r=0,469), as well as the presence of chest pain (r=0,374), QRS voltage decrease (r=0,415), maximum level of CRP (r=0,360) and LDH (r=0,360). ANA and anti-cardiomyocyte antibody levels strongly correlated with pericardial effusion (r=0,721 and r=0,745, respectively, p<0,05). The mortality rate was 9,3%. Heart failure was one of the death causes in 37,5%. The level of anti-cardiomyocyte antibodies and ASMA correlated with mortality (r=0,363, and r=0,426, p<0,05) and had a predictive value. Mortality in patients with cardiovascular disease was 17,9%, without — 2,2% (p<0,05). The most powerful predictive model for COVID-19 adverse outcomes includes age, diabetes, oxygen therapy extent, maximum leukocyte, C-reactive protein and D-dimer levels. However, a model that includes only age, diabetes, and cardiovascular disease also has sufficient predictive power (correlation coefficient, 0,568, p<0,001).

Conclusion. An increase in ACA titers was detected in 73,5% of patients, correlated with mortality, in most cases reflects the general activity and severity of the disease and can be regarded as part of response in COVID-19. At the same time, a direct correlation with signs of myocardial damage, the presence and volume of pericardial effusion confirms the direct role of ACA in the development of myopericarditis.

Key words: COVID-19, SARS-Cov2, anticardiac antibodies, myocardial injury, myocarditis, pericarditis, prognostic model.

Relationships and Activities: none.

Acknowledgments. The authors express their sincere gratitude to all doctors of the department for the COVID-19 infection treatment № 5 (M. M. Beraya, I. V. Novikova, A. V. Sedov, D. A. Tsaregorodtsev, P. A. Shelukhe, I. G. Yudin) and other infectious disease departments, specialists of diagnostic radiology and functional diagnostics of the Sechenov University COVID-19 hospital.

¹I. M. Sechenov First Moscow State Medical University, Moscow; ²City Clinical Hospital № 52, Moscow, Russia.

Blagova O. V.* ORCID: 0000-0002-5253-793X, Varionchik N. V. ORCID: 0000-0002-8868-0623, Zaydenov V. A. ORCID: 0000-0002-0102-9740, Savina P. O. ORCID: none, Sarkisova N. D. ORCID: 0000-0002-5979-1180.

*Corresponding author: blagovao@mail.ru

Received: 11.08.2020

Revision Received: 17.08.2020

Accepted: 12.09.2020

For citation: Blagova O. V., Varionchik N. V., Zaydenov V. A., Savina P. O., Sarkisova N. D. Anticardiac antibodies in patients with severe and moderate COVID-19 (correlations with the clinical performance and prognosis). Russian Journal of Cardiology. 2020;25(11):4054. (In Russ.) doi:10.15829/1560-4071-2020-4054

INTERNATIONAL REGISTER “DYNAMICS ANALYSIS OF COMORBIDITIES IN SARS-COV-2 SURVIVORS”

(AKTIV SARS-COV-2): ANALYSIS OF 1,000 PATIENTS

Arutyunov G. P., Tarlovskaya E. I., Arutyunov A. G., Belenkov Y. N., Konradi A. O., Lopatin Y. M., Tereshchenko S. N., Rebrov A. P., Chesnikova A. I., Fomin I. V., Grigorieva N. U., Boldina M. V., Vaisberg A. R., Blagonravova A. S., Makarova E. V., Shaposhnik I. I., Kuznetsova T. Yu., Malchikova S. V., Protsenko D. N., Evzerikhina A. V., Petrova M. M., Demko I. V., Saphonov D. V., Hayrapetyan H. G., Galyavich A. S., Kim Z. F., Sugraliev A. B., Nedogoda S. V., Tsoma V. V., Sayganov S. A., Gomonova V. V., Gubareva I. V., Sarybaev A. Sh., Koroleva E. V., Vilkova O. E., Fomina I. Y., Pudova I. A., Soloveva D. V., Kiseleva N. V., Zelyaeva N. V., Kouranova I. M., Pogrebetskaya V. A., Muradova F. N., Badina O. Y., Kovalishena O. V., Gаlova E. A., Plastinina S. S., Lyubavina N. A., Vezikova N. N., Levankova V. I., Ivanova S. Yu., Ermilova A. N., Muradyan R. G., Gostishev R. V., Tikhonova E. P., Kuzmina T. Y., Soloveva I. A., Kraposhina A. Yu., Kolyadich M. I., Kolchinskaya T. P., Genkel V. V., Kuznetsova A. S., Kazakovtseva M. V., Odegova A. A., Chudinovskikh T. I., Baramzina S. V., Rozanova N. A., Kerimova A. Sh., Krivosheina N. A., Chukhlova S. Y., Levchenko A. A., Avoyan H. G., Azarian K. K., Musaelian Sh. N., Avetisian S. A., Levin M. E., Karpov O. V., Sokhova F. M., Burygina L. A., Sheshina T. V., Tiurin A. A., Dolgikh O. Yu., Kazymova E. V., Konstantinov D. Yu., Chumakova O. A., Kondriakova O. V., Shishkov K. Yu., Fil T. S., Prokofeva N. A., Konoval M. P., Simonov A. A., Bitieva A. M., Trostianetckaia N. A., Cholponbaeva M. B., Kerimbekova Zh. B., Duyshobayev M. Y., Akunov A. Ch., Kushubakova N. A., Melnikov E. S., Kim E. S., Sherbakov S. Y., Trofimov D. A., Evdokimov D. S., Ayipova D. A., Duvanov I. A., Abdrahmanova A. K., Aimakhanova G. T., Ospanova Sh. O., Dabylova G. M., Tursunova A. T., Кaskaeva D. S., Tulichev A. A., Ashina E. Yu., Kordukova V. A., Barisheva O. Yu., Egorova K. E., Varlamova D. D., Kuprina T. V., Pahomova E. V., Kurchugina N. Yu., Frolova I. A., Mazalov K. V.,

Subbotin A. K., Kamardina N. A., Zarechnova N. V., Mamutova E. M., Smirnova L. A., Klimova A. V., Shakhgildyan L. D., Tokmin D. S., Tupitsin D. I., Kriukova T. V., Rakov N. A., Polyakov D. S.

Abstract

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients. Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed.

Key words: AKTIV register, SARS-CoV-2, COVID-19, multimorbidity.

Relationships and Activities: none.

Arutyunov G. P.* ORCID: 0000-0002-6645-2515, Tarlovskaya E. I. ORCID: 0000-0002-9659-7010, Arutyunov A. G. ORCID: 0000-0003-1180-3549, Belenkov Y. N. ORCID: 0000-0002-6180-2619, Konradi A. O. ORCID: 0000-0001-8169-7812, Lopatin

Y. M. ORCID: 0000-0003-1943-1137, Tereshchenko S. N. ORCID: 0000-0001-9234-6129, Rebrov A. P. ORCID: 0000-0002-3463-7734, Chesnikova A. I. ORCID: 0000-0002-9323-592X, Fomin I. V. ORCID: 0000-0003-0258-5279, Grigorieva N. U.

ORCID: 0000-0001-6795-7884, Boldina M. V. ORCID: 0000-0002-1794-0707, Vaisberg A. R. ORCID: 0000-0003-3658-5330, Blagonravova A. S. ORCID: 0000-0002-1467-049X, Makarova E. V. ORCID: 0000-0003-4394-0687, Shaposhnik I. I. ORCID: 0000-0002-7731-7730, Kuznetsova T. Yu. ORCID: 0000-0002-6654-1382, Malchikova S. V. ORCID: 0000-0002-2209-9457, Protsenko D. N. ORCID: 0000-0002-5166-3280, Evzerikhina A. V. ORCID: none, Petrova M. M. ORCID: 0000-0002-8493-0058, Demko I. V. ORCID: 0000-0001-8982-5292, Saphonov D. V. ORCID: none, Hayrapetyan H. G. ORCID: 0000-0002-8764-5623, Galyavich A. S. ORCID: 0000-0002-4510-6197, Kim Z. F. ORCID: 0000-0003-4240-3329, Sugraliev A. B. ORCID: 0000-0002-8255-4159, Nedogoda S. V. ORCID: 0000-0001-5981-1754, Tsoma V. V. ORCID: 0000-0002-0662-1217, Sayganov S. A. ORCID: 0000-0001-7319-2734, Gomonova V. V. ORCID: 0000-0002-9816-9896, Gubareva I. V. ORCID: 0000-0003-1881-024X, Sarybaev A. Sh. ORCID: 0000-0003-2172-9776, Koroleva E. V. ORCID: none, Vilkova O. E. ORCID: 0000-0002-1129-7511, Fomina I. Y. ORCID: none, Pudova I. A. ORCID: none, Soloveva D. V. ORCID: 0000-0001-5695-0433, Kiseleva N. V.

ORCID: 0000-0002-0935-8717, Zelyaeva N. V. ORCID: none, Kouranova I. M. ORCID: none, Pogrebetskaya V. A. ORCID: none, Muradova F. N. ORCID: 0000-0002-2723-8081, Badina O. Y. ORCID: 0000-0001-9068-8088, Kovalishena O. V. ORCID: 0000-0002-9595-547X, Gаlova E. A. ORCID: 0000-0002-9574-2933, Plastinina S. S. ORCID: 0000-0002-0534-5986, Lyubavina N. A. ORCID: 0000-0002-8914-8268, Vezikova N. N. ORCID: 0000-0002-8901-3363, Levankova V. I. ORCID: 0000-0002-0788-

4449, Ivanova S. Yu. ORCID: 0000-0002-0720-6621, Ermilova A. N. ORCID: 0000-0002-5704-697X, Muradyan R. G. ORCID: none, Gostishev R. V. ORCID: 0000-0002-2379-5761, Tikhonova E. P. ORCID: 0000-0001-6466-9609, Kuzmina T. Y. ORCID: 0000-0002-0105-6642, Soloveva I. A. ORCID: 0000-0002-1999-9534, Kraposhina A. Yu. ORCID: 0000-0001-6896-877X, Kolyadich M. I. ORCID: 0000-0002-0168-1480, Kolchinskaya T. P. ORCID: none, Genkel V. V. ORCID: 0000-0001-5902-3803, Kuznetsova A. S. ORCID: 0000-0002-1136-7284, Kazakovtseva M. V. ORCID: 0000-0002-0981-3601, Odegova A. A. ORCID: 0000-0001-9691-6969, Chudinovskikh T. I. ORCID: 0000-0002-7515-2215, Baramzina S. V. ORCID: 0000-0001-7274-1252, Rozanova N. A. ORCID: none, Kerimova A. Sh. ORCID: 0000-0002-2806-5901, Krivosheina N. A. ORCID: none, Chukhlova S. Y. ORCID: none, Levchenko A. A. ORCID: none, Avoyan H. G. ORCID: 0000-0002-3335-7255, Azarian K. K. ORCID: none, Musaelian Sh. N. ORCID: none, Avetisian S. A. ORCID: none, Levin M. E. ORCID: 0000-0002-9197-1691, Karpov O. V. ORCID: 0000-0001-7909-0675, Sokhova F. M. ORCID: 0000-0002-6208-2908, Burygina L. A. ORCID: 0000-0002-2613-8783, Sheshina T. V. ORCID: none, Tiurin A. A. ORCID: none, Dolgikh O. Yu. ORCID: none, Kazymova E. V. ORCID: none, Konstantinov D. Yu. ORCID: 0000-0002-6177-8487, Chumakova O. A. ORCID: none, Kondriakova O. V. ORCID: 0000-0002-4092-6612, Shishkov K. Yu. ORCID: 0000-0003-2942-6200, Fil T. S. ORCID: none, Prokofeva N. A. ORCID: 0000-0002-7679-413X, Konoval M. P. ORCID: 0000-0002-8187-6105, Simonov A. A. ORCID: 0000-0002-7915-3880, Bitieva A. M. ORCID: 0000-0002-5383-2367, Trostianetckaia N. A. ORCID: none, Cholponbaeva M. B. ORCID: none, Kerimbekova Zh. B. ORCID: none, Duyshobayev M. Y. ORCID: none, Akunov A. Ch. ORCID: none, Kushubakova N. A. ORCID: 0000-0001-6874-7125, Melnikov E. S. ORCID: 0000-0002-8521-6542, Kim E. S. ORCID: none, Sherbakov S. Y. ORCID: none, Trofimov D. A. ORCID: 0000-0001-7613-7132, Evdokimov D. S. ORCID: 0000-0002-3107-1691, Ayipova D. A. ORCID: none, Duvanov I. A. ORCID: 0000-0003-0789-429X, Abdrahmanova A. K. ORCID: none, Aimakhanova G. T. ORCID: none, Ospanova Sh. O. ORCID: none, Dabylova G. M. ORCID: none, Tursunova A. T. ORCID: none, Кaskaeva D. S. ORCID: 0000-0002-0794-2530, Tulichev A. A. ORCID: 0000-0002-3157-2218, Ashina E. Yu. ORCID: 0000-0002-7460-2747, Kordukova V. A. ORCID: none, Barisheva O. Yu.

ORCID: 0000-0001-6317-1243, Egorova K. E. ORCID: 0000-0003-4233-3906, Varlamova D. D. ORCID: 0000-0002-4015-5109, Kuprina T. V. ORCID: 0000-0002-1176-7309, Pahomova E. V. ORCID: 0000-0002-8335-4626, Kurchugina N. Yu. ORCID: 0000-0003-2988-7402, Frolova I. A. ORCID: none, Mazalov K. V. ORCID: none, Subbotin A. K. ORCID: none, Kamardina N. A. ORCID: none, Zarechnova N. V. ORCID: none, Mamutova E. M. ORCID: none, Smirnova L. A. ORCID: 0000-0002-2083-0373, Klimova A. V. ORCID: 0000-0002-3176-7699, Shakhgildyan L. D. ORCID: 0000-0003-3302-4757, Tokmin D. S. ORCID: none, Tupitsin D. I. ORCID: none, Kriukova T. V. ORCID: none, Rakov N. A. ORCID: none, Polyakov D. S. ORCID: 0000-0001-8421-0168.

*Corresponding author: arut@ossn.ru

Received: 28.10.2020

Revision Received: 05.11.2020

Accepted: 11.11.2020

For citation: Arutyunov G. P., Tarlovskaya E. I., Arutyunov A. G., Belenkov Y. N., Konradi A. O., Lopatin Y. M., Tereshchenko S. N., Rebrov A. P., Chesnikova A. I., Fomin I. V., Grigorieva N. U., Boldina M. V., Vaisberg A. R., Blagonravova A. S., Makarova E. V., Shaposhnik I. I., Kuznetsova T. Yu., Malchikova S. V., Protsenko D. N., Evzerikhina A. V., Petrova M. M., Demko I. V., Saphonov D. V., Hayrapetyan H. G., Galyavich A. S., Kim Z. F., Sugraliev A. B., Nedogoda S. V., Tsoma V. V., Sayganov S. A., Gomonova V. V., Gubareva I. V., Sarybaev A. Sh., Koroleva E. V., Vilkova O. E., Fomina I. Y., Pudova I. A., Soloveva D. V., Kiseleva N. V., Zelyaeva N. V., Kouranova I. M., Pogrebetskaya V. A., Muradova F. N., Badina O. Y., Kovalishena O. V., Gаlova E. A., Plastinina S. S., Lyubavina N. A., Vezikova N. N., Levankova V. I., Ivanova S. Yu., Ermilova A. N., Muradyan R. G., Gostishev R. V., Tikhonova E. P., Kuzmina T. Y., Soloveva I. A., Kraposhina A. Yu., Kolyadich M. I., Kolchinskaya T. P., Genkel V. V., Kuznetsova A. S., Kazakovtseva M. V., Odegova A. A., Chudinovskikh T. I., Baramzina S. V., Rozanova N. A., Kerimova A. Sh., Krivosheina N. A., Chukhlova S. Y., Levchenko A. A., Avoyan H. G., Azarian K. K., Musaelian Sh. N., Avetisian S. A., Levin M. E., Karpov O. V., Sokhova F. M., Burygina L. A., Sheshina T. V., Tiurin A. A.,

Dolgikh O. Yu., Kazymova E. V., Konstantinov D. Yu., Chumakova O. A., Kondriakova O. V., Shishkov K. Yu., Fil T. S., Prokofeva N. A., Konoval M. P., Simonov A. A., Bitieva A. M., Trostianetckaia N. A., Cholponbaeva M. B., Kerimbekova

Zh. B., Duyshobayev M. Y., Akunov A. Ch., Kushubakova N. A., Melnikov E. S., Kim E. S., Sherbakov S. Y., Trofimov D. A.,

Evdokimov D. S., Ayipova D. A., Duvanov I. A., Abdrahmanova A. K., Aimakhanova G. T., Ospanova Sh. O., Dabylova G. M., Tursunova A. T., Кaskaeva D. S., Tulichev A. A., Ashina E. Yu., Kordukova V. A., Barisheva O. Yu., Egorova K. E., Varlamova D. D., Kuprina T. V., Pahomova E. V., Kurchugina N. Yu., Frolova I. A., Mazalov K. V., Subbotin A. K., Kamardina N. A., Zarechnova N. V., Mamutova E. M., Smirnova L. A., Klimova A. V., Shakhgildyan L. D., Tokmin D. S., Tupitsin D. I., Kriukova

T. V., Rakov N. A., Polyakov D. S. International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of 1,000 patients. Russian Journal of Cardiology. 2020;25(11):4165. (In Russ.) doi:10.15829/1560-4071-2020-4165

2017-2019 SUDDEN CARDIAC DEATH REGISTRY OF THE ZABAYKALSKY KRAI POPULATION (ZODIAC)

Zaitsev D. N.¹, Vasilenko P. V.¹, Govorin A. V.¹, Vasilenko E. A.¹, Mukha N. V.¹, Filev A. P.¹, Brizhko A. N.², Petrova N. G.², Sazonova E. A.²

Abstract

Aim. Based on the autopsy data, to analyze mortality patterns of the Zabaykalsky Krai population over a three-year period in the group of out-of-hospital sudden cardiac death (SCD).

Material and methods. The protocols of deceased persons without evidence for violent death were analyzed with distribution into groups depending on age, sex and cause of death. Descriptive statistics were used for statistical processing.

Results. The leading positions (58% of cases) in mortality patterns are occupied by various types of coronary artery disease (CAD). Chronic coronary syndromes were detected in 21%, cardiomyopathy — in 11%, decompensated heart failure — in 7%, myocarditis — in 1% of cases. Acute types of CAD were found in 68,4% in men and 31,6% in women. Among men, the number of such cases increases from 31 to 70 years of age and decreases over 70 years old. Among women, there is an increase in the SCD prevalence in the group over 70 years old. Chronic coronary syndromes were found in 46,4% in men and 53,6% in women. In both groups the number of cases increases with age. The maximum sex differences are observed in the group over 70 years old. The mean age for men is 72,2±8,8 years, for women — 77,2±10,4 years. Blood alcohol was detected in 10,2% of cases. The mean age of the deceased in all age groups of persons with identified blood alcohol was 66,2±12 years. In 1,89% of cases, I46 code (ICD-10) was established. The largest number of deaths among persons of both sexes was registered in the group of 31-40 years old, accounting for 36,8% among men and 13,2% among women. The mean age of the deceased was 35,8±8,4 years. In 28,6% of cases, ethyl alcohol was found in the biological media of the deceased in this group.

Conclusion. Acute and chronic types of CAD make a significant contribution to out-of-hospital mortality. The number of SCD in men is higher than in women and is directly proportional to the age increase, reaching a maximum in the group over 70 years old. Ethyl alcohol, an important trigger of SCD, was detected in 10,8% of SCD cases in 2017, and in 15% in 2018 and 2019.

Key words: sudden cardiac death, registers, out-of-hospital mortality.

Relationships and Activities: none.

¹Chita State Medical Academy, Chita; ²Transbaikal Regional Clinical Bureau of Forensic Medicine, Chita, Russia.

Zaitsev D. N. ORCID: 0000-0002-5444-3398, Vasilenko P. V.* ORCID: 0000-0002-7968-6417, Govorin A. V. ORCID: 0000-0003-1340-9190, Vasilenko E. A. ORCID: 0000-0002-1627-6752, Mukha N. V. ORCID: 0000-0001-8128-636Х, Filev A. P.

ORCID: 0000-0002-3445-7119, Brizhko A. N. ORCID: 0000-0002-1526-5293, Petrova N. G. ORCID: 0000-0002-5436-6505, Sazonova E. A. ORCID: 0000-0002-1367-2370.

*Corresponding author: pavelvasilenkochita@mail.ru

Received: 07.07.2020

Revision Received: 08.08.2020

Accepted: 25.08.2020

For citation: Zaitsev D. N., Vasilenko P. V., Govorin A. V., Vasilenko E. A., Mukha N. V., Filev A. P., Brizhko A. N., Petrova N. G., Sazonova E. A. 2017-2019 Sudden cardiac death registry of the Zabaykalsky Krai population (ZODIAC). Russian Journal of Cardiology. 2020;25(11):3997. (In Russ.) doi:10.15829/1560-4071-2020-3997

OPINION ON A PROBLEM

A PATIENT WITH ATRIAL FIBRILLATION AND COMORBIDITIES IN CLINICAL PRACTICE

Skotnikov A. S.^1,2, Algiyan E. A.², Sizova Zh. M.¹

Abstract

This article focuses on the etiology and pathogenesis of nonvalvular atrial fibrillation in patients with comorbidities such as coronary artery disease, heart failure, type 2 diabetes, and chronic kidney disease. The authors discuss the interconnection of atrial fibrillation and these diseases, and also note the need for protection of such patients (prevention of cardioembolic stroke and other systemic embolism, reduction of coronary risk, improvement of prognosis, slowing the progression of renal dysfunction, increasing medical adherence, etc.) by adequate antithrombotic therapy that does not lose effectiveness and/or safety in presence of multiple diseases and polypharmacy.

Key words: atrial fibrillation, comorbidity, old age, new oral anticoagulants, rivaroxaban.

Relationships and Activities. This publication was supported by Bayer (PP-XAR-RU-0621-1).

¹I. M. Sechenov First Moscow State Medical University, Moscow; ²Scientific-Research Center of Comorbid Pathology “Rational Medicine”, Moscow, Russia.

Skotnikov A. S.* ORCID: 0000-0003-4294-5814, Algiyan E. A. ORCID: 0000-0003-3288-5168, Sizova Zh. M. ORCID: 0000-0002-1242-7074.

*Corresponding author: skotnikov.as@mail.ru

Received: 26.10.2020

Revision Received: 05.11.2020

Accepted: 11.11.2020

For citation: Skotnikov A. S., Algiyan E. A., Sizova Zh. M. A patient with atrial fibrillation and comorbidities in clinical practice. Russian Journal of Cardiology. 2020;25(11):4178. (In Russ.) doi:10.15829/1560-4071-2020-4178

ORGANIZATION OF CARDIAC CARE

IMPROVEMENT OF CONTINUING MEDICAL EDUCATION

Sirotkina O. V., Ischuk T. N., Golubeva I. S., Parmon E. V., Lapotnikov V. A., Shlyakhto E. V.

Abstract

The article discusses the issues of paramedic bachelor’s degree training in the higher education system. There are no analogues of the paramedic qualification abroad. The significance of the education level for the healthcare quality is shown. The authors demonstrated the key features of the developed educational program of paramedic bachelor’s degree training, which includes a large amount of practice.

Key words: paramedic, paramedic-bachelor, bachelor’s degree, applied bachelor’s degree, general medicine, accreditation of medical specialists.

Relationships and Activities. The socially significant project “Improvement of continuous medical training of medical specialists” is supported by the Presidential grants fund.

Almazov National Medical Research Center, St. Petersburg, Russia.

Sirotkina O. V. ORCID: 0000-0003-3594-1647, Ischuk T. N.* ORCID: 0000-0001-7326-8241, Golubeva I. S. ORCID: 0000-0003-0594-4476, Parmon E. V. ORCID: 0000-0002-0852-631X, Lapotnikov V. A. ORCID: 0000-0003-0696-6095, Shlyakhto

E. V. ORCID: 0000-0003-2929-0980.

*Corresponding author: tatischuk@mail.ru

Received: 03.11.2020

Revision Received: 16.11.2020

Accepted: 17.11.2020

For citation: Sirotkina O. V., Ischuk T. N., Golubeva I. S., Parmon E. V., Lapotnikov V. A., Shlyakhto E. V. Improvement of continuing medical education. Russian Journal of Cardiology. 2020;25(11):4176. (In Russ.) doi:10.15829/1560-4071-2020-4176

EXPERT CONSENSUS

INTERNATIONAL REGISTER “DYNAMICS ANALYSIS OF COMORBIDITIES IN SARS-COV-2 SURVIVORS”

(AKTIV SARS-COV-2): ANALYSIS OF 1,000 PATIENTS

Arutyunov G. P.^1,2, Arutyunov A. G.^1,2, Tarlovskaya E. I.^1,3, Ametov A. S.⁴, Vinogradova N. G.³, Garganeeva A. A.⁵, Glezer M. G.⁶, Zhirov I. V.⁷, Ilyin M. V.⁸, Koziolova N. A.⁹, Konradi A. O.¹⁰, Lebedeva A. Yu.², Lopatin Yu. M.¹¹, Nedogoda S. V.¹¹, Salukhov V. V.¹², Sitnikova M. Yu.¹³, Tereshchenko S. N.⁷, Tolstov S. N.¹⁴, Khalimov Yu. S.¹², Khasanov N. R.¹⁵, Chesnikova A. I.¹⁶, Giga V.¹⁷, Paсker M.¹⁸

Abstract

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.

Key words: empagliflozin, heart failure, cardiovascular mortality, chronic kidney disease, EMPEROR-REDUCED trial.

Relationships and Activities. The Expert Council was supported by Boehringer Ingelheim.

¹Eurasian Association of Therapists, Moscow, Russia; ²Pirogov Russian National Research Medical University, Moscow, Russia; ³Privolzhsky Research Medical University, Nizhny Novgorod, Russia; ⁴Russian Medical Academy of Continuous Professional Education, Moscow, Russia; ⁵Tomsk National Research Medical Center, Tomsk, Russia; ⁶I. M. Sechenov First Moscow State Medical University, Moscow, Russia; ⁷National Medical Research Center for Cardiology, Moscow, Russia; ⁸Yaroslavl State Medical University, Yaroslavl, Russia; ⁹Perm State Medical University, Perm, Russia; ¹⁰V. A. Almazov National research medical center of Russian Ministry of Healthcare, Saint-Petersburg, Russia; ¹¹Volgograd State Medical University, Volgograd, Russia; ¹²S. M. Kirov Military Medical Academy, Saint-Petersburg, Russia; ¹³Pavlov First State Medical University, Saint-Petersburg, Russia; ¹⁴V. I. Razumovsky Saratov State Medical University Russian Ministry of Healthcare, Saratov, Russia; ¹⁵Kazan state medical university, Kazan, Russia; ¹⁶Rostov State Medical University, Rostov, Russia; ¹⁷University of Belgrade, Belgrade, Serbia; ¹⁸Baylor University, Dallas, USA.

Arutyunov G. P.* ORCID: 0000-0002-6645-2515, Arutyunov A. G. ORCID: 0000-0003-1180-3549, Tarlovskaya E. I. ORCID: 0000-0002-9659-7010, Ametov A. S. ORCID: 0000-0002-7936-7619, Vinogradova N. G. ORCID: 0000-0002-3391-7937, Garganeeva A. A. ORCID: 0000-0002-9488-6900, Glezer M. G. ORCID: 0000-0002-0995-1924, Zhirov I. V. ORCID: 0000-0002-4066-2661, Ilyin M. V. ORCID: 0000-0001-6278-374X, Koziolova N. A. ORCID: 0000-0001-7003-5186, Konradi A. O. ORCID: 0000-0001-8169-7812, Lebedeva A. Yu. ORCID: 0000-0002-4060-0786, Lopatin Yu. M. ORCID: 0000-0003-1943-1137, Nedogoda S. V. ORCID: 0000-0001-5981-1754, Salukhov V. V. ORCID: 0000-0003-1851-0941, Sitnikova M. Yu. ORCID: 0000-0002-0139-5177, Tereshchenko S. N. ORCID: 0000-0001-9234-6129, Tolstov S. N. ORCID: 0000-0002-4546-9449, Khalimov Yu. S. ORCID: 0000-0002-7755-7275, Khasanov N. R. ORCID: 0000-0002-7760-0763, Chesnikova A. I. ORCID: 0000-0002-9323-592X, Giga V. ORCID: 0000-0003-1049-6321, Paсker M. ORCID: 0000-0003-1828-2387.

*Corresponding author: arut@ossn.ru

Received: 27.10.2020

Revision Received: 09.11.2020

Accepted: 16.11.2020

For citation: Arutyunov G. P., Arutyunov A. G., Tarlovskaya E. I., Ametov A. S., Vinogradova N. G., Garganeeva A. A., Glezer M. G., Zhirov I. V., Ilyin M. V., Koziolova N. A., Konradi A. O., Lebedeva A. Yu., Lopatin Yu. M., Nedogoda S. V., Salukhov V. V., Sitnikova M. Yu., Tereshchenko S. N., Tolstov S. N., Khalimov Yu. S., Khasanov N. R., Chesnikova A. I., Giga V., Paсker M. International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of 1,000 patients. Russian Journal of Cardiology. 2020;25(11):4167. (In Russ.) doi:10.15829/1560-4071-2020-4167

CLINICAL OBSERVATION

COMBINATION OF CHRONIC MYOCARDITIS AND PROGRESSIVE CORONARY ARTERY DISEASE: DIFFERENTIAL DIAGNOSIS AND STEPWISE TREATMENT

Lutokhina Yu. A.¹, Blagova O. V.¹, Sedov V. P.¹, Zaydenov V. A.², Nedostup A. V.¹

Abstract

Aim. To assess the differential diagnosis in a patient with a combination of coronary artery disease and myocarditis and the results of stepwise treatment (including immunosuppressive therapy (IST), and coronary stenting).

Material and methods. A 56-year-old female patient with hypertension, obesity (body mass index, 31,6 kg/m2), diabetes and psoriasis developed shortness of breath after a respiratory viral infection. Primary echocardiography revealed left heart dilatation, ejection fraction (EF) of 21%. Coronary angiography revealed anterior descending artery stenosis of 75%, circumflex artery — 80%, right coronary artery (RCA) — 70%. RCA stenting was performed and cardiovascular and diuretic therapy was started. However, shortness of breath and low exercise tolerance persisted.

Results. In the blood test, anti-endothelial cell antibodies were 1:320, anticardiomyocyte and anti-smooth muscle antibodies — 1:80, anti-cardiac conduction system fibers — 1:320 (N≤1:40). During myocardial perfusion scintigraphy with computed tomography, an uneven distribution of the indicator was noted. Signs of myocardial scarring and indications for further revascularization were not revealed. Cardiac magnetic resonance imaging confirmed a decrease in left ventricular (LV) contractility (LVEF 37%) and moderate dilatation. Biopsy was not performed due to dual antiplatelet therapy. The condition is regarded as infectious-immune myocarditis. IST was started with azathioprine 150 mg/day. We noted dyspnea relief and a stable increase in LVEF to 50-52%. The clinical course was complicated by sick sinus syndrome with pauses up to 6 seconds and presyncope; a pacemaker was implanted. After 5 years from the onset of IST, dyspnea episodes reappeared without exacerbation

of myocarditis. As their cause, ischemia was diagnosed due to the progression of coronary atherosclerosis. Symptoms regressed after repeated coronary stenting.

Conclusion. The presence of moderate coronary atherosclerosis without signs of ischemia and myocardial infarction should not be considered as the only cause of severe systolic myocardial dysfunction. Diagnosis and treatment of myocarditis in combination with coronary artery disease is carried out according to the standard principles and can improve LV systolic function and control the heart failure symptoms.

Key words: coronary artery disease, myocarditis, anticardiac antibodies, heart failure, immunosuppressive therapy.

Relationships and Activities: none.

¹I. M. Sechenov First Moscow State Medical University, Moscow; ²City Clinical Hospital № 52, Moscow, Russia.

Lutokhina Yu. A.* ORCID: 0000-0002-7154-6794, Blagova O. V. ORCID: 0000-0002-5253-793X, Sedov V. P. ORCID: 0000-0003-2326-9347, Zaydenov V. A. ORCID: 0000-0002-0102-9740, Nedostup A. V. ORCID: 0000-0002-5426-3151.

*Corresponding author: lebedeva12@gmail.com

Received: 18.05.2020

Revision Received: 06.06.2020

Accepted: 29.06.2020

For citation: Lutokhina Yu. A., Blagova O. V., Sedov V. P., Zaydenov V. A., Nedostup A. V. Combination of chronic myocarditis and progressive coronary artery disease: differential diagnosis and stepwise treatment. Russian Journal of Cardiology. 2020;25(11):3915. (In Russ.) doi:10.15829/1560-4071-2020-3915

DIFFERENTIAL DIAGNOSIS OF ACUTE MYOCARDIAL INJURY: A CASE REPORT AND DISCUSSION

Boldueva S. A., Evdokimov D. S., Evdokimova L. S., Khomulo A. D., Rozhdestvenskaya M. V.

Abstract

The article describes a case report of acute myocardial injury developed against the background of systemic inflammatory response in a patient with chronic tonsillitis exacerbation, who had no signs of coronary artery atherosclerosis and pathological changes according to cardiac magnetic resonance imaging. The differential diagnosis and discussion of the problem of acute non-ischemic myocardial injury are presented.

Key words: acute coronary syndrome, acute myocardial injury, magnetic resonance imaging, myocarditis.

Relationships and Activities: none.

I. I. Mechnikov North-Western State Medical University, St. Petersburg, Russia.

Boldueva S. A.* ORCID: 0000-0002-1898-084X, Evdokimov D. S. ORCID: 0000-0002-3107-1691, Evdokimova L. S. ORCID: 0000-0002-7731-0109, Khomulo A. D. ORCID: 0000-0002-1918-5661, Rozhdestvenskaya M. V. ORCID: 0000-0002-6298-

547X.

*Corresponding author: svetlanaboldueva@mail.ru

Received: 04.08.2020

Revision Received: 10.08.2020

Accepted: 07.09.2020

For citation: Boldueva S. A., Evdokimov D. S., Evdokimova L. S., Khomulo A. D., Rozhdestvenskaya M. V. Differential diagnosis of acute myocardial injury: a case report and discussion. Russian Journal of Cardiology. 2020;25(11):4046. (In Russ.)

doi:10.15829/1560-4071-2020-4046

ATRIAL CARDIOMYOPATHY — A NEW CONCEPT WITH A LONG HISTORY

Vaikhanskaya T. G.¹, Kurushko T. V.¹, Persianskikh Yu. A.¹, Sivitskaya L. N.²

Abstract

Atrial cardiomyopathy (ACM) is a relatively common but clinically underestimated disorder, which is characterized by an increased atrial size and dysfunction. Previously, ACM was considered a primary disorder, but in 2016 this concept was revised by European Heart Rhythm Association (EHRA) working group with inclusion of secondary atrial remodeling. The EHRA document details aspects of atrial anatomy and pathophysiology, proposes definitions of ACM, histological classification, outlines the molecular mechanisms of atrial arrhythmia and the problems of personalized treatment and optimization of indications for catheter

ablation. Practical application of the proposed ACM classification system, the clinical significance of novel ACM concept and the potential role of this information for a practitioner are presented in this article. Two clinical cases of ACM with “primary” (familial form of ACM due to NPPA gene mutation with primary defect in atrial structure and function) and “secondary” atrial remodeling (ACM caused by a longterm supraventricular tachyarrhythmias due to SCN1B gene mutation).

Key words: atrial remodeling, atrial cardiomyopathy, atrial fibrillation, atrial electromechanical dysfunction, NPPA gene.

Relationships and Activities: none.

¹Republican Science-Practical Centre “Cardiology”, Minsk; ²Institute of Genetics and Cytology, Minsk, Belarus.

Vaikhanskaya T. G.* ORCID: 0000-0002-2127-8525, Kurushko T. V. ORCID: 0000-0001-5727-3219, Persianskikh Yu. A. ORCID: 0000-0003-0279-912X, Sivitskaya L. N. ORCID: 0000-0001-6359-4967.

*Corresponding author: tat_vaikh@mail.ru

Received: 02.06.2020

Revision Received: 02.07.2020

Accepted: 09.07.2020

For citation: Vaikhanskaya T. G., Kurushko T. V., Persianskikh Yu. A., Sivitskaya L. N. Atrial cardiomyopathy — a new concept with a long history. Russian Journal of Cardiology. 2020;25(11):3942. (In Russ.) doi:10.15829/1560-4071-2020-3942

CLINICAL CASE

TRICUSPID VALVE INFECTIVE ENDOCARDITIS WITH MIXED INFECTION, COMPLICATED BY SEPTIC PNEUMONIA, ON THE BACKGROUND OF EXACERBATION OF OVERLAP SYNDROME AND DECOMPENSATED DIABETES

Obrezan A. A.^1,2, Kucheryavenko Yu. M.², Malikov K. N.^2,3, Dolgushev D. A.²

Key words: infective endocarditis, tricuspid valve, mixed flora, sepsis, septic pneumonia, overlap syndrome, rheumatoid arthritis, systemic lupus erythematosus, diabetes.

¹Saint Petersburg State University, St. Petersburg; ²LLC International Medical Center SOGAZ, St. Petersburg; ³Almazov National Medical Research Center, St. Petersburg, Russia.

Relationships and Activities: none.

Obrezan A. A.* ORCID: 0000-0001-6007-3824, Kucheryavenko Yu. M. ORCID: 0000-0002-6922-8746, Malikov K. N. ORCID: 0000-0003-4896-1516, Dolgushev D. A. ORCID: 0000-0002-2732-8079.

*Corresponding author: obrezan2@yandex.ru

Received: 28.08.2020

Revision Received: 12.09.2020

Accepted: 13.10.2020

For citation: Obrezan A. A., Kucheryavenko Yu. M., Malikov K. N., Dolgushev D. A. Tricuspid valve infective endocarditis with mixed infection, complicated by septic pneumonia, on the background of exacerbation of overlap syndrome and decompensated diabetes. Russian Journal of Cardiology. 2020;25(11):4080. (In Russ.) doi:10.15829/1560-4071-2020-4080

LITERATURE REVIES

NEW ASPECTS OF ANTICOAGULANT THERAPY IN ATRIAL FIBRILLATION IN PATIENTS WITH RENAL DYSFUNCTION

Kobalava Zh. D.¹, Lazarev P. V.¹, Vatsik M. V.²

Abstract

Atrial fibrillation (AF) and chronic kidney disease (CKD) are common and interrelated diseases, the combination of which is associated with a poor prognosis. The efficacy and safety of direct oral anticoagulants (DOACs) used to prevent thromboembolic

complications of AF may depend on renal function due to the specific pharmacokinetics of these drugs. This review considers current data on the role of kidneys in the pathogenesis of ischemic and bleeding events, methods of renal function assessment and related classification issues, as well as comparison of warfarin and DOAC therapy, in patients with AF and renal dysfunction of different stages based on the results of randomized controlled trials and actual clinical practice. DOAC use in the context of dynamic deterioration of renal function, supranormal renal function, and their effect on renal outcomes is discussed. International guidelines on anticoagulant therapy in AF and renal dysfunction were analyzed.

Key words: atrial fibrillation, chronic kidney disease, anticoagulants, hemodialysis, pharmacokinetics.

Relationships and Activities: none.

¹Peoples’ Friendship University of Russia, Moscow; ²V. V. Vinogradov City Clinical Hospital, Moscow, Russia.

Kobalava Zh. D.* ORCID: 0000-0003-1126-4282, Lazarev P. V. ORCID: 0000-0003-4769-5834, Vatsik M. V. ORCID: none.

*Corresponding author: zkobalava@mail.ru

Received: 19.10.2020

Revision Received: 03.11.2020

Accepted: 10.11.2020

For citation: Kobalava Zh. D., Lazarev P. V., Vatsik M. V. New aspects of anticoagulant therapy in atrial fibrillation in patients with renal dysfunction. Russian Journal of Cardiology. 2020;25(11):4175. (In Russ.) doi:10.15829/1560-4071-2020-4175

FIXED-DOSE COMBINATIONS IN THE TREATMENT OF HYPERTENSION TO INCREASE ADHERENCE

Morozova T. E., Samokhina E. O.

Abstract

Despite a wide range of antihypertensive drugs, blood pressure (BP) control often remains unsatisfactory, and every year the number of people with uncontrolled high BP increases. One of the strategies aimed at improving medical adherence is the use of fixed-dose combinations of 2 antihypertensive drugs for starting therapy, and, if necessary, 3 drugs. Initiation of therapy with 2 drugs in one tablet is recommended for most patients. A review of algorithms for choosing combinations of antihypertensive drugs in different clinical situations, including in patients with various comorbid conditions, is presented. Simplification of treatment

regimens makes it possible to choose the most optimal solutions in various clinical situations, in particular, with stage I-II hypertension, with a combination of hypertension with chronic kidney disease, as well as with a combination of hypertension with coronary artery disease and a number of other diseases.

Key words: hypertension, antihypertensive therapy, pharmacotherapy, combination pharmacotherapy, fixed-dose combinations, adherence to treatment.

Relationships and Activities: none.

I. M. Sechenov First Moscow State Medical University, Moscow, Russia.

Morozova T. E.* ORCID: 0000-0002-3748-8180, Samokhina E. O. ORCID: 0000-0001-6550-2915.

*Corresponding author: temorozova@gmail.com

Received: 09.11.2020

Revision Received: 13.11.2020

Accepted: 19.11.2020

For citation: Morozova T. E., Samokhina E. O. Fixed-dose combinations in the treatment of hypertension to increase adherence. Russian Journal of Cardiology. 2020;25(11):4184. (In Russ.) doi:10.15829/1560-4071-2020-4184

IMMUNE CHECKPOINT INHIBITOR MYOCARDITIS: A SYSTEMATIC CASE STUDY

Kushnareva E. A., Moiseeva O. M.

Abstract

Myocarditis is a life-threatening complication of immune checkpoint inhibitor therapy. Over the past ten years, drugs in this group have been used in the treatment of a wide range of hematological diseases and solid tumors. With steadily growing life expectancy of cancer patients, problems associated with treatment complications are increasingly coming to the fore. Since 2016, publications have appeared on cases of autoimmune myocarditis during checkpoint inhibitor therapy (CIT), among which there are quite a few single-center retrospective and observational studies. At the same time, the problem of diagnosis and treatment of immune checkpoint inhibitor myocarditis remains unresolved. This paper presents a review on the problem of immune checkpoint inhibitor

myocarditis, as well as the results of a systematic analysis of PubMed database publications.

Key words: checkpoint inhibitors, myocarditis, cardiotoxicity.

Relationships and Activities: none.

Almazov National Medical Research Center, St. Petersburg, Russia.

Kushnareva E. A.* ORCID: 0000-0002-8723-2765, Moiseeva O. M. ORCID: 0000-0002-7817-3847.

*Corresponding author: Kushnareva.cardio@gmail.com

Received: 14.05.2020

Revision Received: 06.06.2020

Accepted: 15.06.2020

For citation: Kushnareva E. A., Moiseeva O. M. Immune checkpoint inhibitor myocarditis: a systematic case study. Russian Journal of Cardiology. 2020;25(11):3910. (In Russ.) doi:10.15829/1560-4071-2020-3910

CARDIAC SARCOIDOSIS: MODERN DIAGNOSTICS AND THERAPY

Shabalin V. V., Grinshteyn Yu. I.

Abstract

Cardiac sarcoidosis (CS) is a potentially life-threatening granulomatous heart disease with unclear etiology and a suspected pathological immune response to an unidentified antigenic trigger in individuals with a genetic predisposition. CS often occurs as a part of systemic sarcoidosis, but in rare cases it can be isolated. The latter phenotype is especially difficult to diagnose, since it requires a differential diagnosis with a number of other myocardial diseases. Depending on the location and area, the clinical performance can vary from asymptomatic to severe cardiac manifestations — decompensated heart failure, malignant arrhythmias and conduction disorders, as well as sudden death. Methods for diagnosing CS are constantly being improved. In the presented review, the emphasis is on modern methods, diagnostic criteria, and approaches to the therapy of CS.

Key words: cardiac sarcoidosis, diagnostic criteria, therapy.

Relationships and Activities: none.

V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia.

Shabalin V. V.* ORCID: 0000-0001-8002-2362, Grinshteyn Yu. I. ORCID: 0000-0002-4621-1618.

*Corresponding author: vlshabalin@yandex.ru

Received: 11.08.2020

Revision Received: 28.08.2020

Accepted: 12.09.2020

For citation: Shabalin V. V., Grinshteyn Yu. I. Cardiac sarcoidosis: modern diagnostics and therapy. Russian Journal of Cardiology. 2020;25(11):4052. (In Russ.) doi:10.15829/1560-4071-2020-4052

CLINICAL GUIDELINES

2020 CLINICAL PRACTICE GUIDELINES FOR STABLE CORONARY ARTERY DISEASE

Russian Society of Cardiology (RSC)

With the participation: Russian National Society of Atherosclerosis, Atherothrombosis National Society, the Russian Association

of Cardiovascular Surgeons.

Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation

Presidium of the Working Group: Barbarash O. L., Karpov Yu. A., Kashtalap V. V.*, Boschenko A. A., Ruda M. M.

Members of the Working Group: Akchurin R. S., Alekyan B. G., Aronov D. M., Belenkov Yu. N., Boytsov S. A., Boldueva S. A., Bubnova M. G., Vasyuk Yu. A., Gabinsky Ya. L., Galyavich A. S., Glezer M. G., Golubev E. P., Golukhova E. Z., Grinshtein Yu. I., Davidovich I. M., Ezhov M. V., Karpov R. S., Korennova O. Yu., Kosmacheva E. D., Koshelskaya O. A., Kukharchuk V. V., Lopatin Yu. M., Mironov V. M., Martsevich S. Yu., Mirolyubova O. A., Mikhin V. P., Nedoshivin A. O., Oleinikov V. E., Panov A. V., Panchenko E. P., Perepech N. B., Petrova M. M., Pozdnyakov Yu. M., Protasov K. V., Savenkov M. P., Samko A. N., Skibitsky V. V., Soboleva G. N., Shalaev S. V., Shaposhnik I. I., Shevchenko A. O., Shevchenko O. P., Shiryaev A. A., Shlyakhto E. V., Chumakova G. A., Yakushin S. S.

Working Group members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.

Key words: coronary artery disease, stable angina, optimal medical therapy, myocardial revascularization, prognosis, quality of life, guidelines.

*Corresponding author: V_kash@mail.ru

For citation: 2020 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25:4076. (In Russ.) doi:10.15829/1560-4071-2020-4076

2020 CLINICAL PRACTICE GUIDELINES FOR ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Russian Society of Cardiology (RSC)

With the participation: Russian Association of Cardiovascular Surgeons

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

Presidium of the Working Group: Averkov O. V. (Co-Chairperson), Duplyakov D. V., Gilyarov M. Yu., Novikova N. A., Shakhnovich R. M.* (Co-Chairperson), Yakovlev A. N.

Members of the Working Group: Abugov S. A., Alekyan B. G., Arkhipov M. V., Barbarash O. L., Boytsov S. A., Vasilieva E. Yu., Galyavich A. S., Ganyukov V. I., Gilyarevsky S. R., Golukhova E. Z., Gratsiansky N. A., Zateishchikov D. A., Karpov Yu. A., Kosmacheva E. D., Lopatin Yu. M., Markov V. A., Nikulina N. N., Panchenko E. P., Pevzner D. V., Pogosova N. V., Protopopov A. V., Skrypnik D. V., Tereshchenko S. N., Ustyugov S. A., Khripun A. V., Shalaev S. V., Shlyakhto E. V., Shpektor A. V., Yavelov I. S., Yakushin S. S.

Working Group members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.

Key words: acute coronary syndrome, ST-segment elevation, myocardial infarction, clinical practice guidelines, reperfusion, percutaneous coronary intervention, thrombolytic therapy.

*Corresponding author: shakhnovich@mail.ru

For citation: Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25:4103. (In Russ.) doi:10.15829/1560-4071-2020-4103

2020 CLINICAL PRACTICE GUIDELINES FOR CHRONIC HEART FAILURE

Russian Society of Cardiology (RSC)

With the participation: National Society of Myocardial Diseases and Heart Failure, Society of Heart Failure Specialists

Endorsed by the Research and Practical Council of the Ministry of Health of the Russian Federation

Presidium of the Working Group: Tereshchenko S. N., Galyavich A. S., Uskach T. M.*

Members of the Working Group: Ageev F. T., Arutyunov G. P., Begrambekova Yu. L., Belenkov Yu. N., Boytsov S. A., Vasyuk Yu. A., Garganeeva A. A., Gendlin G. E., Gilyarevsky S. R., Glezer M. G., Gautier S. V., Gupalo E. M., Dovzhenko T. V., Drapkina O. M., Duplyakov D. V., Zhirov I. V., Zateishchikov D. A., Kobalava Zh. D., Koziolova N. A., Koroteev A. V., Libis R. A., Lopatin Yu. M., Mareev V. Yu., Mareev Yu. V., Matskeplishvili S. T., Nasonova S. N., Narusov O. Yu., Nedoshivin A. O., Ovchinnikov A. G., Orlova Ya. A., Perepech N. B., Samko A. N., Saidova M. A., Safiullina A. A., Sitnikova M. Yu., Skvortsov A. A., Skibitskiy V. V., Stukalova O. V., Tarlovskaya E. I., Tereshchenko A. S., Chesnikova A. I., Fomin I. V., Shevchenko A. O., Shaposhnik I. I., Shariya M. A., Shlyakhto E. V., Yavelov I. S., Yakushin S. S.

Working Group members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.

Key words: chronic heart failure, natriuretic peptides, left ventricular ejection fraction, diagnostics, medical therapy, non-drug therapy, comorbidity, decompensation, hospitalization, quality criteria, guidelines.

*Corresponding author: tuskach@mail.ru

For citation: 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25:4083. (In Russ.) doi:10.15829/1560-4071-2020-4083

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