The cardiac conduction system pacing is a promising method of cardiac pacing. The thematic review highlights the issues of modern additional methods of intraoperative visualization, their advantages and limitations. The availability of additional intraoperative visualization techniques in complex situations and during the training phase is of great help. Their use makes it possible to reduce the number of false septal implantations, complications, and radiation exposure to the operator.

In clinical practice, impaired renal function is often combined with cardiovascular diseases, in particular with atrial fibrillation. As you know, the kidneys perform many functions, including excretory, metabolic and endocrine. The cardiorenal axis is regulated in such a way that an imbalance results in both cardiac and renal remodeling. Therefore, the pathophysiological relationships between the kidneys and the heart are of great clinical importance. Considering the need to create the basis for personalized patient-oriented care, documents on the position of a number of associations and societies dedicated to the treatment of patients with atrial fibrillation and chronic kidney disease are currently presented. Treatment of atrial fibrillation includes prophylactic anticoagulation and pharmacological therapy aimed at maintaining sinus rhythm or correcting the frequency of ventricular responses. At the same time, when choosing the optimal dose of oral direct anticoagulant drugs, there are a number of discrepancies in published regulatory documents of various cardiological and nephrological communities. It should be noted that in recent years there has been no significant improvement in the clinical pharmacology of arrhythmias. Existing pharmacological approaches for the correction of arrhythmias in patients with atrial fibrillation and chronic kidney disease are limited by their limited effectiveness and the possibility of developing dangerous effects, including the proarrhythmic effect against ventricular arrhythmias and organ-toxic complications. The use of catheter and surgical ablation is inhibited by the complexity, cost and high relapse rate in patients with chronic kidney disease. It seems that antiarrhythmic drugs are not given enough attention compared to anticoagulant therapy, especially in patients with atrial fibrillation and chronic kidney disease. This review article discusses approaches to the choice of antiarrhythmic therapy in this category of patients.

Ischemic-reperfusion injuries of organs underlie such common pathologies as ischemic stroke and myocardial infarction and are the cause of death and disability in the population. In addition, ischemic lung damage is observed in pulmonary embolism. Advances in transplantology, as well as the widespread use of coronary artery bypass grafting, raise the problem of ischemia and reperfusion of organs during these manipulations. Progress made over the past three decades in the treatment of stroke and acute myocardial infarction (AMI) has slowed in recent years. Since patients with stroke and AMI are admitted to the hospital with ischemic damage to the brain or heart, it is no longer possible to influence its formation. However, it is possible to affect reperfusion injury to organs. Significant progress in improving the efficiency of kidney transplantation, in the treatment of stroke, pulmonary embolism and AMI can be achieved through the development of new drugs that can effectively prevent reperfusion damage of organs. Synthetic analogues of apelin with a long half-life can become prototypes of drugs with similar action. It has been found that apelins can increase the tolerance of the heart, brain, kidneys and lungs to ischemia/reperfusion (I/R). Apelins inhibit apoptosis and activate cardiomyocyte autophagy. The neuroprotective, cardioprotective, renoprotective, and pulmonoprotective effects of apelins are realized through intracellular signaling, including protein kinases, a mitochondrial variable permeability pore, and ATP-sensitive K+ channels. Enzyme-resistant analogues of apelin are promising peptides for the treatment of AMI, stroke, and I/R damage to the lungs, and kidneys.

Atrial fibrillation (AF) is the most common cardiac arrhythmia among the adult population. There are many possible causes of AF: structural heart disease, inflammatory and autoimmune diseases, obesity, alcohol abuse, diabetes mellitus, obstructive sleep apnea and old age. The ectopic activity of pulmonary vein couplings lies in the pathogenesis of paroxysmal and persistent forms of AF. The role of AF itself in triggering the inflammatory process in the atrium myocardium has also been proven. Despite the large amount of existing data, the search for the causes of AF continues. Previously, AF was considered the outcome of prolonged hemodynamic stress, arterial hypertension and valvular heart disease. Recently, views on the pathogenesis of AF have changed, since patients with metabolic diseases, without hypertrophy and dilatation of the left ventricle, but with disturbances in the structure and function of the atria, most often the left atrium, are increasingly encountered. There is an active search for laboratory markers to identify groups of patients most susceptible to developing AF. Determining the cause of atrial fibrillation and pathogenesis in each patient is important for selecting therapy and determining treatment tactics. Currently, a search is underway for laboratory markers that may be associated with the manifestation of atrial fibrillation, with atriopathy, and the effectiveness/ineffectiveness of catheter treatment for atrial fibrillation. An analysis of clinical studies was carried out based on articles indexed in the Scopus, VAK, Russian Science Citation Index, PubMed, and Web of Science databases.

Despite the increasingly widespread use of endovascular left atrial appendage occlusion (ELAAO) in the treatment of patients with atrial fibrillation (AF), the choice of optimal tactics for performing the procedure, especially subsequent antithrombotic therapy, remains poorly understood. This review was conducted with the aim of critically assessing current ideas about the safety and effectiveness of ELAAO in AF. The results of the most important clinical studies of ELAAO in patients with AF, the provisions of current clinical recommendations for this procedure are discussed. The available data on the possibilities of antithrombotic therapy after ELAAO and the prospects for future research in filling gaps in the evidence base for this technique are reviewed.

The review presents current data on atrial fibrillation (AF) recurrences after catheter-based interventional treatment. The most significant predictors described in various foreign and domestic sources are considered, and the most common in clinical practice scales for assessing the development of AF recurrences after intervention at the pulmonary vein orifices are presented. Unfortunately, currently there is no clear exhaustive validated scale to assess the occurrence of very late arrhythmia recurrence, but due to the high social and medical significance of this problem, the development of this scale represents an actual and demanded direction of modern arrhythmology. An analysis of clinical studies was carried out based on articles indexed in the Scopus, Higher Attestation Commission, Russian Science Citation Index, PubMed, and Web of Science databases.

Heart failure (HF) is a widespread syndrome that leads to a significant decrease in the quality of life of patients. Epigenetics is one of the most promising areas of HF research, which allows us to consider the pathogenesis of this syndrome at a new molecular level. This review summarizes the studies of epigenetic processes (histone modification, DNA methylation, changes in the expression of regulatory non-coding RNAs) that accompany HF development. Epigenetic studies of HF not only confirmed the clinical and etiological heterogeneity of this syndrome, but also expanded the range of potential diagnostic markers and opened up new drug development strategies.

However, the choice of optimal time of DAPT after PCI is still a difficult and urgent problem for the attending physician. An increase in DAPT duration after PCI correlates with a lower frequency of ischemic events. At the same time, with a longer DAPT regime, there is a more significant increase in the risks of postoperative bleeding. Hence, it is important to find a balance between the potential risks of bleeding and the expected benefits in reducing ischemic events, while taking into account the individual clinical characteristics of each patient. Intravascular imaging methods, such as intravascular coherence tomography, allow obtaining a highly informative lifetime morphological assessment of the coronary arteries, the formation of the neointima and the malposition of the implanted stent, which, in turn, can help in choosing the optimal timing of the DAPT and prevention of undesirable side events.

Hypertrophic cardiomyopathy (HCM) is a common, genetically determined myocardial pathology that can manifest itself at any age. The manifestation of this pathology in childhood always means a high risk of sudden cardiac death and the rapid progression of symptoms. The annual mortality in asymptomatic patients over 1 year is 1%. There are many recommendations for the management of patients with obstructive cardiomyopathy, but they are all written for the adult population. Drug treatment of symptomatic patients with this pathology is effective only in 70% of patients. The remaining 30% should be given preference to surgical treatment. It is important for a cardiac surgeon to know the main methods of HCM correction, their advantages and disadvantages. The literature review shows the evolution of methods of surgical correction of obstructive HCM from the middle of the 20th century until now. The main surgical methods for treating left ventricular outflow tract obstruction, correcting SAM-syndrome (systolic anterior motion syndrome) and mitral insufficiency, which have had a great influence on the development of HCM surgery, are presented. A clinical experience of treating left ventricular outflow tract obstruction in children is presented. The most promising method today is “transaortic extended septal myectomy”. Thus, there is a need to evaluate and modify existing methods for correcting obstructive HCM and their complications. Works aimed at their improvement and elimination of shortcomings are promising.

The last 10–15 years have been marked by a rapid increase in the volume of knowledge about the role of the intestinal microbiota in the regulation of various physiological processes. In particular, the interrelations between disturbances in the composition of the intestinal microflora and an increase in the risk of developing cardiovascular diseases were noted. There are also emerging works that demonstrate the possibility of reducing the severity of myocardial ischemia-reperfusion injury as a result of various effects on the composition of intestinal microbiota. This review analyzes the recent literature on the influence of intestinal microbiota on myocardial resistance to ischemia-reperfusion injury. It has been shown that modulation of the intestinal microbiome by changing the nature of nutrition, probiotics, antibiotics, and intestinal microflora transplantation leads to a reduction in the size of myocardial infarction. Normalization of increased permeability of intestinal epithelial barrier with reduction of manifestations of systemic inflammation, changes in the level of secretion of some hormones, increased production of short-chain fatty acids and modulation of bile acid metabolism under the action of intestinal bacterial enzymes are considered as possible mechanisms of cardioprotection mediated by changes in the functional state of microbiota. The concept of increasing myocardial resistance to ischemia-reperfusion injury by modulating the composition of the intestinal microbiota is a completely new scientific direction that requires detailed study in experiment with the possibility of rapid implementation of the results obtained in clinical practice.

Aim: To compare the effectiveness of interventional treatment of atrial fibrillation (AF) in patients with chronic myocarditis identified by endomyocardial biopsy and in patients without myocarditis.

Material and Methods. The study sample included 40 patients. Of these, 27 (67.5%) are men. The age in the sample was 49 (44; 55) years. The study included 25 (62.5%) patients with paroxysmal AF, 10 (25.0%) with persistent and 5 (12.5%) with long-term persistent. All patients underwent surgical treatment of AF using radiofrequency ablation (RFA) or cryoablation (CA). Endomyocardial biopsy was performed in 18 patients to verify the diagnosis. The follow-up period for patients was 12 months.

Results. All patients underwent surgical treatment of AF, in 7 cases (17.5%) CA of the left ventricle (LV) was performed; in 33 (82.5%) cases RFA was performed. According to the biopsy results, signs of myocarditis were detected in 9 patients (22.5%). Focal myocarditis was found in 7 patients, diffuse – in 2. The effectiveness of catheter treatment in general was 72.5%, for CA – 71.5%, for RFA 73.5%. The effectiveness of AF ablation with the presence of detected myocarditis was 88.9%, without myocarditis – 67.5%.

Conclusions. The effectiveness of catheter treatment of AF in patients with signs of myocarditis was 88.9% and was higher than in patients without signs of myocarditis.

Aim: To determine the factors associated with development of justified and inappropriate implantable cardioverter-defibrillator (ICD) activations in patients at high risk of sudden cardiac death based on the remote monitoring system

Material and Methods. We analyzed remote monitoring data from 2014 to 2022 in 132 patients with ICD for primary prevention of sudden cardiac death (SCD). Patients were divided into 2 groups 1 – patients with persistent paroxysmal tachyarrhythmias; 2 – patients without persistent paroxysms of ventricular tachycardia (VT) / ventricular fibrillation (VF). In case of inappropriate shocks, the causes and possible predictors of their development were analyzed.

Results. Of 132 patients, 62 (46.9%) patients appeared to have persistent VT/VF. It was found that the probability of detecting persistent paroxysms of VT/VF decreased with a history of revascularization (p = 0.030) and increased in the absence of amiodarone therapy (p = 0.012), with increasing age (p = 0.035), with decreasing left ventricular ejection fraction (LVEF) less than 35% (p = 0.016). 71 arrhythmic episodes (17.9%) in 27 (20.4%) patients were considered as false detection of tachyarrhythmias. Analyzing the causes of inappropriate electrotherapy, different types of supraventricular tachyarrhythmias in the zone of VT detection (85.9%), including atrial fibrillation (25.4%), in smaller percentage of cases there was discovered T-wave detection 4.2%, noise on the electrode – 2.8%, 7.1% – double counter due to the operation of the cardiac contractility modulation device. When analyzing factors associated with the development of false detection, reliable results were obtained with regard to the presence of a history of atrial fibrillation (p = 0.036), implanted single-chamber ICD (p = 0.028).

Conclusion. The development of persistent ventricular tachyarrhythmias was noted in 47% of patients with ICD as a part of primary prevention of sudden cardiac death, and 20.4% had the development of inappropriate detection and electrotherapy. Predictors of their occurrence have been identified, which can be used as development of strategies for shock minimization.

Aim: To study spontaneous and stimulated by adenosine diphosphate (ADP), adrenaline and collagen platelet aggregation activity, CD40-CD40 ligand system in patients with atrial fibrillation (AF) with previous thromboembolic complications (TEC) and newly diagnosed thrombosis.

Material and Methods. The study included patients with «non-valvular» AF and anamnesis of TEC and newly identified thrombosis on anticoagulants in the period 01.2020-01.2023: 13 patients had anamnesis of TEC (group 1), in 18 patients were initially diagnosed thrombosis/spontaneous atrial echocontrast of high grade (group 2). The comparison group was the healthy individuals (n = 31) (group 3). The spontaneous aggregation ability of platelets and stimulated with solutions of ADP, adrenaline and collagen, the level of CD40 markers, soluble CD40 ligand (CD40L) were studied.

Results. The spontaneous platelet aggregation activity was significantly higher in patients of group 2 compared with healthy individuals with a formation trend of larger aggregates in patients with TEC. When aggregation was induced by collagen, the rate of aggregate formation was significantly lower in the 1st and 2nd groups compared with healthy individuals. When using ADP, a comparable decrease in the degree and speed was noted, and when using adrenaline, only the rate of platelet aggregation was observed in groups 1 and 2. The concentration of soluble CD40L was significantly higher in patients with a history of TEC and newly thrombosis.

Conclusion. Spontaneous platelet aggregation activity and the concentration of soluble CD40L are increased both in patients with past of TEC and in patients with newly diagnosed thrombosis due to AF and anticoagulant monotherapy.

It is known that transient receptor potential (TRP) channels are receptors for reactive oxygen species and components of cigarette smoke, and therefore may be involved in the pathogenesis of chronic obstructive pulmonary disease (COPD).

Aim: To investigate the expression of TRPV1, TRPV4, TRPM8 and TRPA1 channels on peripheral blood leukocytes of COPD patients and healthy individuals and to establish its possible relationships with inflammatory markers and lung function parameters.

Methodology and Research Methods. 23 patients with COPD of varying severity and 17 individuals without bronchial obstruction were examined. The expression of TRP channels on monocytes, lymphocytes and granulocytes was determined by indirect flow cytometry. Plasma concentrations of cytokines were measured in a multiplex assay. Lung function parameters were assessed by spirometry.

Results. Monocytes from COPD patients were characterized by increased expression of TRPV1 (98.8 (97.6; 99.6)% vs. 97.8 (96.3; 98.6)%, p = 0.03) and TRPA1 (99.2 (98.7; 99.8)% vs. 95.1 (94.2; 98.4)%, p = 0.003). In addition, COPD was associated with an increased ratio of TRPV4/TRPM8 expression on monocytes (0.66 (0.51, 0.90) vs. 0.27 (0.12, 0.70), p = 0.02) and granulocytes (0.97 (0.86; 0.92) vs. 0.29 (0.06; 0.89), p = 0.003). TRPV4 expression on monocytes showed correlation with CXCL10 level (ρ = 0.55, p = 0.01), and for TRPM8 inverse relationships were found with the concentrations of IL-6 (ρ = –0.56, p = 0.02) and IL-10 (ρ = –0.55, p = 0.02). We did not find any associations between the expression of TRP channels and lung function parameters.

Conclusion. Increased expression of TRPV1 and TRPA1, as well as an increased TRPV4/TRPM8 ratio on peripheral blood monocytes of COPD patients may indicate the contribution of these receptors to the proinflammatory activation of the cells and indicate possible prospects of TRP channels pharmacological modulation for the purpose of the disease therapy.

Ventricular arrhythmias (VAs) in children are generally idiopathic and have a benign course. Catheter ablation (CA) is increasingly becoming a first-line treatment option in children with idiopathic VAs. Acute ablation success reaches 100% procedures and long-term – 87%. Predictors of outcomes of CA in pediatric patients with idiopathic VAs have not been fully investigated.

Aim: To identify predictors of long-term unsuccessful outcomes of CA in pediatric idiopathic VAs.

Material and Methods. This retrospective study included 164 children aged 7 to 17 years with idiopathic VAs, who underwent CA from 2011 until 2023 in Almazov National Medical Research Centre. Efficiency was assessed in acute period and 6 months after CA.

Results. In this study the acute success was 92% and long-term success was 88,4%. In multivariable models, multifocal VAs (odds ratio: 8,814; 95% CI: 1,943–39,981; p = 0,005), effectiveness of antiarrhythmic therapy (odds ratio: 16,522; 95%CI: 1,959–139,374; p = 0,010) and noninducibility of VAs during procedure (odds ratio: 9,369; 95% CI: 1,400–62,684; 0,021), become predictors of long-term unsuccessful outcomes of CA in pediatric idiopathic VAs.

Conclusion. In our study there were identified independent predictors of long-term noneffective CA in children with idiopathic VAs, such as multifocal VAs, effectiveness of antiarrhythmic therapy, and noninducibility of VAs CA. In patients with presence of two or more ventricular foci and the effectivness of antiarrhythmic therapy, prolongate drug therapy may be more preferable.

Aim: To evaluate the safety and tolerance of single dose or repeated doses administration of domestic class III antiarrhythmic agent Refralon (cavutilide), tablets, by healthy volunteers; and to study it’s pharmacokinetics and absolute bioavailability.

Material and Methods. Healthy male volunteers, aged 18 – 45 years were included in one of 7 cohorts: 1, 2, 4 и 6 mg PO, 1 mg IV (these cohorts included 6 people each), one cohort of 12 people who took 2 mg of the drug per day for 5 days, and one cohort of 6 menfor 10 days. Drug intake/injection, blood and urine tests, sampling for pharmacokinetic analysis, assessment of vital signs, ECG registration at specified points, Holter monitoring of ECG were performed in a hospital setting.

Results. The study included 48 volunteers 32 ± 7,2 years old, mean weight 74,6 ± 4,7 kg. No significant changes in blood and urine tests and vital signs in any of cohorts were registered. Among cohorts of single dose oral intake only maximum dose of 6 mg caused persistent statistically significant increase of the duration of the QT and QTc intervals. In cohort of multiple intake of 2 mg of the drug statistically significant increase of the QT/QTc duration was noted with maximum value on 9-10 days. By this time balance between absorption and elimination processes was achieved.

Conclusion. Duration of the QT/QTc intervals didn’t exceed reference values during the entire study in all cohorts of oral intake of Refralon, either single dose or repeated doses administration. Significant persistent increase of the duration of the QT and QTc intervals was registered only in cohort of maximum single dose of 6 mg intake and during intake of 2 mg of Refralon daily for 5-10 days. Stationary state was achieved by 8-10 day of Refralon intake.

Aim: To study cardiac arrhythmias and morpho-functional changes in patients in 3 months after a coronavirus infection.

Material and methods. 96 patients, mean age 36 years, treated for coronavirus infection, after 3 months underwent Echo and Holter ECG monitoring. Patients were divided into groups depending on the degree of lung tissue damage according to computed tomography (CT): 1st 27 patients CT0, 2nd 39 patients CT1-2, 3rd 30 patients CT3-4; 22 patients control group. Statistics: considering the distribution of features different from normal, nonparametric methods of hypothesis testing were used.

Results. In patients recovered from coronavirus infection a violation of heart rhythm conduction was established after 3 months. An increase in the activity of the sympathetic part of the autonomic nervous system (LF/HF) was found: in patients of group 2, the median value was – 5.9, in group 3 – 6.0; in addition, the global longitudinal systolic strain of the left ventricle decreased (–17.7 and –17.2, respectively). In patients with CT3–4, systolic pressure in the pulmonary artery increased (37.0 mmHg), the size of the left atrium increased, and segmental systolic LV strain decreased in comparison with the studied groups (p < 0.001). Correlations between left ventricular dysfunction and heart rate variability disorders, as well as prolongation of the QT interval (p < 0.001) were established.

Conclusion. Cardiac arrhythmias were detected in patients in 3 months after the coronavirus infection. In patients with moderate and severe disease, the activity of the autonomic nervous system also increases, the global systolic strain of the left ventricle decreases. In addition, patients with CT3-4 increased systolic pressure in the pulmonary artery, increased the size of the left atrium, decreased segmental systolic strain of the left ventricle.

Aim: To determine the association of anthropometric indicators with the severity of dysplastic phenotype in the age group of 14–18 years.

Material and Methods. An anthropometric survey of 382 volunteers was conducted according to the recommendations of Norton, Kevin on 54 indicators. Anthropometric numerical data of individual traits, as well as the calculated percentage and absolute amount of fat, muscle and bone components, and, accordingly, the coefficients of the predominance of ecto-, meso- and endomorphic components in the somatotype structure and indices were processed by methods of variational statistics to obtain averages. The analysis of indicators of physical development of adolescents (height for age, body mass index (BMI) for age) was carried out in accordance with the methodological recommendations of the World Health Organization on the Z-score system using the software “WHO AnthroPlus” v.1.0.4. for children 5–19 years old. The degree of severity of the phenotypic signs of undifferentiated connective tissue dysplasia (UCTD) was formed according to the point system, taking into account the presence of professional sports in the daily life of volunteers in the past and present.

Results. The minimum severity of the dysplastic phenotype was registered in 20% of cases, the average – in 25% of the examined, pronounced signs of UCTD were observed in 55% of boys and girls. In the structure of anthropometric data, the indicators characterizing UCTD were revealed, especially with a pronounced degree of manifestation: high growth, an increase in chest circumference, the ratio of hand to height, foot to height and arm span to height (p < 0.05). Among the surveyed with pronounced signs of UCTD, 59% were engaged in professional sports, namely high-static, medium-dynamic disciplines (gymnastics, figure skating, volleyball, light and weightlifting). In the vector analysis of the components of the catfish examined with an average degree (7–14 points) and a pronounced UCTD phenotype (more than 14 points) are characterized by large endomorphy and mesomorphy indices (p < 0.05). With an increase in the severity of the UCTD phenotype, an increase in the number and change in the quality of associations of the average score of the scale of phenotypic manifestations with anthropometric parameters was registered.

Conclusion. The wide prevalence of phenotypic signs of UCTD in a representative sample of children and adolescents in Tomsk was revealed. The relationship between the frequency of the main signs of UCTD and physical activity has been established. The constitutional features of the physique of persons with preclinical manifestations of UCTD are determined. Associations of the degree of severity of the UCTD phenotype with anthropometric parameters have been recorded. Taking into account the fact of genotypic conditioning of the physique and the hereditary nature of the dysplastic phenotype, as well as the data obtained, an anthropometric examination with the identification of the somatotype can be offered as a screening of UCTD.

Atrial fibrillation is a rhythm disorder with an extensive etiology and not fully understood pathogenesis. Catheter ablation is an effective way to control the rhythm of atrial fibrillation. The results of catheter ablation differ in patients with various comorbidities of the cardiovascular system. Intraoperative changes in the atrial rhythm can be a criterion for the long-term effectiveness of the operation or determine the need for additional effects.

Aim: To assess intraoperative changes in atrial rhythm during catheter ablation of atrial fibrillation in patients with concomitant pathology of the cardiovascular system.

Methodology and research methods. The results of catheter ablation of 451 patients with paroxysmal and persistent atrial fibrillation were analyzed retrospectively for the period from 2016 to 2017. After clinical and anamnestic data analysis, 151 patients with primary isolation of the pulmonary veins were selected. Depending on the concomitant pathology of the cardiovascular system, patients were divided into 3 groups: group 1 – with idiopathic atrial fibrillation, group 2 – atrial fibrillation in combination with isolated essential arterial hypertension and group 3 – atrial fibrillation in combination with ischemic heart disease.

Results. In patients with idiopathic atrial fibrillation, relief of atrial fibrillation with sinus rhythm preservation until the end of surgery was more often observed than in patients with ischemic heart disease (22% vs. 10,6%, р = 0,021). In patients with ischemic heart disease, typical atrial flutter was much more common and there was a need to perform radiofrequency ablation of the cavothricuspid isthmus in addition to isolation of the pulmonary veins (47,9% vs. 18,8% 1 Group 1, р = 0,005, and 24,7% in Group 2, р = 0,01).

Conclusions. The concomitant pathology of the cardiovascular system in patients affects the dynamics of the atrial rhythm during catheter treatment of atrial fibrillation and may take into account the definition of intraoperative tactics.

Aim. To test the hypothesis that early detection of clinically significant patients with high risk of developing intra-abdominal hypertension in cardiac surgery may be based on an increase in the level of fatty acid-binding protein.

Material and Methods. Concentrations of fatty acid-binding protein (I-FABP) were measured in urine samples taken from 82 patients after cardiac surgery with cardiopulmonary bypass. The data were compared with clinical manifestations of the perioperative period, as well as changes in pH and lactate levels in arterial blood.

Results. Statistically significant differences were revealed between the study groups in the cases of increased intra-abdominal pressure, duration of ventilation, and the number of cases of intestinal failure. The level of I-FABP increased in the patients of both groups after removal of the aortic clamp in 2 hours, 12 hours, 24 hours after surgery. 

Conclusions. The I-FABP level can be a valuable marker for early detection of patients with the development intra-abdominal hypertension of after cardiac surgery.  The measurement of I-FABP can serve as a guideline not only for the identification of patients with intra-abdominal hypertension, but also for the initiation of therapeutic measures aimed at minimizing further deterioration of intestinal function.

Early non-invasive diagnosis of structural changes in the heart plays an important role in optimizing approaches to preventing dangerous rhythm disorders at a young age.
Aim: To study the phenotypic features of nonspecifi c connective tissue disorder (NCTD) in relation to the myocardial strain and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with cardiac arrhythmias and NCTD.
Results. There was an association between a local longitudinal left ventricular (LV) strain and pectus excavatum (r₁ = 0.234, p = 0.008), joint hypermobility syndrome (r₁ = 0.406, p = 0.026), spinal scoliosis (r₁ = 0.266, p = 0.003), mitral valve prolapse (MVP) (r₁ = 0.519, p = 0.003), diagnostic threshold of NCTD (r₁ = 0.395, p = 0.031) in patients with arrhythmias and NCTD;
there was an inverse weak to moderate association of body mass index (BMI) and myocardial strain in a number of LV segments. There was a signifi cant relationship between NT-proBNP and diagnostic threshold of NCTD (r1 = 0.496, p = 0.001), mitral valve prolapse (r1 = 0.469, p = 0.002).
Conclusion. Chest deformity, spinal scoliosis, joint hypermobility, mitral valve prolapse and BMI decrease in patients with arrhythmic syndrome and NCTD are associated with the myocardial strain and NT-proBNP level that can be used for the early identifi cation of myocardial remodeling in this patient cohort.

Background. The study shows gender differences in sleep quality and also association of sleep disturbances (SD) with cardiovascular diseases (CVD). The watch work contributes to the biorhythms of the body disorders, including SD. Autonomous nervous system is the key regulator of circadian rhythms.

Aim: To study sleep quality (SQ) in the gender aspect and cardiovascular risk in the workers of the Far North watch.

Material and methods. In Yamburg, the settlement in the Far North (68° 21’ 40” north latitude), 99 males (M) and 81 females (F) with SD and normal sleep, comparable in age, northern experience, level of office blood pressure (BP) were examined. SQ analysis was conducted according to the questionnaire (Pittsburg Sleep Quality Index – PSQI). 24-hour BP monitoring, biochemical blood analysis, ultrasound examination of the carotid arteries, echocardiography, and assessment of autonomic changes was performed.

Results. M significantly more often than F assessed their sleep subjectively better (p = 0.046); M and F with SD had elevated variability of systolic BP at night (p = 0.036; p = 0.039), BP 24-hour profile disorder did not depend on SQ (p = 0.2607), SD in both genders was accompanied by the increase of volumes and indices of left atrium (p = 0.0285; p = 0.0445), enhanced probability of left ventricle diastolic dysfunction for 1.9 times. SD in F enhanced the level of insulin (p = 0.0267), С-peptide (p = 0.0424), NTpro-BNP (p = 0.042) and was accompanied by autonomic dysfunction.

Conclusion. In the conditions of the Arctic watch, SD is often revealed in F, is accompanied by the signs of autonomic dysfunction, more evident in F. 24-hour BP profile disorder typical for the watch work is not connected with SQ and more evident in M. SD in both genders is associated with atrial remodeling, the formation of diastolic dysfunction, but an increase in the frequency of atherosclerotic lesions of the carotid arteries, an increase in vascular inflammation factors, metabolic disorders, and neurohumoral activation, more pronounced in F, which may determine an increased risk of CVD in F in Arctic watch work conditions.

Relevance. The embolic effect of drug-coated balloons has only been demonstrated in preclinical studies.

Aim: To identify intraoperative distal embolism when using drug-coated balloons during revascularization of the superficial femoral artery. To evaluate the effect of drug embolism on microcirculation of the lower extremities within 12 months after treatment.

Material and Methods. Prospective, randomized, single-center pilot study. Twenty patients with symptomatic atherosclerotic femoro-popliteal above the knee lesions were included in the study. The first group underwent percutaneous transluminal angioplasty (PTA) using a drug-coated balloon (DCB), the second group – using a non-drug-coated conventional balloon (CB).

Results. During intraoperative detection of emboli, distal microembolism was recorded in 10 patients (100%) in the DCB group (median number of emboli = 200) and in 8 patients (80%) in the CB group (median number of emboli = 135), p = 0.47. Primary patency in the DCB group was 100%, in the CB group 60% (p log-rank = 0.02). In the shin there was increase in TcPO2 by 12.2% in the DCB group (p = 0.42), and by 37.1% in the CB group (p = 0.001). At the same time, according to the results of TcPO2 on the shin in the DCB group, there was first a slight decrease in indicators compared to the preoperative level by 6% (p = 0.64), followed by an increase of 12.2% after 12 months of observation (p = 0.22). In the DCB group, the sum of SF-36 questionnaire points increased by 22.7% (p = 0.017), and by 25.3% in the CB group, compared to baseline values respectively (p = 0.04).

Conclusion. When using DCB, there is a tendency towards a higher incidence of intraoperative distal embolism and the number of emboli compared with CB. The results of microcirculation studies suggest the presence of distal drug-coated embolism in DCB group.

Relevance. The outcomes of coronary artery bypass surgery (CABG) for coronary artery disease (CAD) depend on different factors, including patient’s quality of life (QoL) before CABG.

Aim: To study QoL and associated factors in CAD patients before CABG.

Material and Methods. A single-center observational study involved CAD patients who were admitted for elective CABG. All patients completed generic quality of life questionnaire SF-36 and specific questionnaire SAQ. Statistical methods included parametric and non-parametric comparisons and multiple regression analysis.

Results. The study included 240 CAD patients (median age 65 years, males – 69%). More than half of the patients had poor physical and psychological health before CABG. Physical limitations and perception of the disease as well as role functioning were most impaired. QoL was worse in women, older patients, with obesity, comorbidity, long-lasting CAD, non-workers and living in sparsely populated areas (p < 0.05). Predictors of poor QoL – female gender (OR 2.574, 95% CI 1.335–4.961; p = 0.005), obesity (OR 1.984, 95% CI 1.075–3.663; p = 0.028) and long–term CAD (OR 1.006, 95% CI 1.002‒0.010; p = 0.006). Predictors of poor physical health – age ≥ 65 (OR 0,823, 95% CI 0.430–1.576; p = 0.001), obesity (OR 2,050, 95% CI 1.041–4.039; p = 0.038) and long–term CAD (OR 1.005, 95% CI 1.001–1.010; p = 0.027). Predictors of poor mental health – age ≥ 65 (OR 1.973, 95% CI 1.050–3.706; p = 0.035) and living in sparsely populated areas (OR 2.213, 95% CI 1.236–3.962; p = 0.008).

Conclusion. Predictors of poor QoL before CABG are female gender, elderly age, obesity, long-term CAD and living in sparsely populated areas.

The Ross procedure has been shown to have excellent long-term outcomes. However, pulmonary autografts remain at risk of dilation in the long-term period. Therefore, the autologous inclusion technique (AIT) and the Dacron inclusion technique (DIT) have been developed. No direct comparison up to date has been reported of these two techniques.

Aim: To compare immediate and medium-term results performing various modified techniques of the Ross operation.

Material and Methods. The following retrospective study included 43 patients (AIT: 22; DIT: 21) aged 18 years and older with an aortic valve (AV) pathology who underwent modified Ross procedures (AIT and DIT) from January 2014 to December 2019, performed by a single surgeon. The main endpoints were: in-hospital mortality, postoperative AV pressure gradients, time of myocardial ischemia and cardiopulmonary bypass, postoperative complications (resternotomy due to bleeding, perioperative myocardial infarction, stroke, sternal infection, conduction disorder requiring implantation of a permanent pacemaker, acute renal failure requiring hemodialysis) and mid-term outcomes (freedom from reoperation, freedom from aortic dilatation ≥ 5 cm). The median follow-up period was 23 (12–68) months.

Results. The main indication for surgery was aortic regurgitation in 32 patients (74.4%). Bicuspid aortic valve was diagnosed in 29 (67.4%) patients. There were 33 (76.7%) males with an average age of 40 ± 11.7 years. There were no lethal outcomes in both groups. There was also no significant difference in postoperative complications. The peak and mean gradients on the AV were significantly lower in the AIT group than in the DIT group (6 and 4 mmHg vs 8 and 7 mmHg, p = 0.04). Five-year overall survival, freedom from reoperation on AV and PV, and freedom from dilatation of the ascending aorta ≥ 5 cm after modified Ross operation were 97.4%, 100%, and 100%, respectively. There was no statistically significant difference between groups in terms of overall survival (p = 0.66).

Conclusion. Both techniques, autologous inclusion and Dacron inclusion, provide excellent immediate and mid-term outcomes in terms of overall survival, freedom from reoperation and freedom from aortic dilation

Due to musculoskeletal diseases progression and increase in spinal injuries, the use of domestically developed multifunctional rehabilitation complexes for functional therapy is becoming increasingly important.

Aim: To analyze existing human gait patterns and select a suitable model for choosing the optimal design and engineering solution for a mechatronic rehabilitation complex, affecting the lower limbs of a person.

Methodology and Research Methods. An analysis of existing technical solutions for rehabilitation complexes was carried out. Brief overview of the main approaches to studying human gait is provided. A model was selected; its detailed description is given for implementation for the robotic rehabilitation complex of functional therapy development.

Results. As a result of the study, data on the position of the legs during gait was obtained and visualization of the walking process was carried out to identify the shortcomings for the selected model. The selected model is implemented in the experimental sample rehabilitation complex.

Conclusion. In the future, it is necessary to refine the model and compare it with a model based on machine learning, and use the most realistic option in rehabilitation complexes.

Introduction. Coronary artery disease (CAD) continues to be the most common pathology in the structure of cardiovascular diseases over the past decades, both in Russia and around the world. In the normal condition, the mitochondria of all body cells have the same function capabilities due to the carriage of the same genome. Therefore, it is possible to assess the respiration activity of cardiomyocyte mitochondria by the respiration of mitochondria from peripheral blood leukocytes.

Aim: To compare respiratory activity of mitochondria of peripheral blood leukocytes in patients diagnosed with coronary artery disease and coronary artery disease with developed cardiac rhythm disorders (CRD).

Material and methods. The studied groups included 45 patients with CAD without CRD and 39 patients with CAD complicated by CRD. Mitochondria were isolated from peripheral blood leukocytes by differential centrifugation. The rate of oxygen loss in pyruvate-malate and succinate incubation buffers was measured when isolated mitochondria were introduced, as well as when palmitic acid was added to the medium. Oxygen consumption rate for the V3 (active phosphorylating) and V4 (nonphosphorylating) metabolic sates was determined, and on their basis respiratory control coefficient was calculating using the formula V3/V4. Statistical data processing was carried out using STATISTICA 13.0 software.

Results. Oxygen consumption rate in mitochondria of patients with uncomplicated CAD and CAD with CRD had no significant differences in either pyruvate-malate or succinate buffers. When palmitic acid was added to the incubation medium, the mitochondria of CAD patients without CRD significantly increased oxygen consumption rate in both incubation media. Mitochondria of CAD patients with CRD did not change oxygen consumption rate in both metabolic states after the addition of palmitic acid in incubation media.

Conclusion. On the basis of the data obtained, it can be concluded that the function capabilities of mitochondria in the complicated course of CAD has been exhausted, which manifests itself in the inability to increase ATP synthesis in response to the introduction of additional substrates.

Introduction. The search for new drugs to reduce effectively myocardial damage during ischemia and reoxygenation is relevant considering that many pharmacological drugs have a number of limitations for patients and their use is accompanied by negative side effects.

Aim: To assess the NO-synthase possible role in the cardiovascular effects mechanism of the standardized active pharmaceutical substance (AFS) of the humic acids (HA) isolated from peat.

Material and Methods. The experiments were carried out on the isolated perfused rat heart model using the Langendorff method. We studied the effect of a standardized sample of peat HA at concentrations of 0.001; 0.01; 0.1 mg/ml on coronary perfusion rate and myocardial contractility parameters. To assess the NO-synthase value in the HA effects realization, the enzyme was pre-inhibited using L-NAME (10 µM/L) before the test sample addition.

Results. HA sample using contributed to an effective increase in the heart coronary perfusion rate due to the NO-synthase signaling mechanism activation. There was some decrease in contractility and end-diastolic pressure associated with the NOsynthase activation because the enzyme inhibition with L-NAME removed all effects of the test HA sample.

Conclusion. The obtained data show to the peat HA have vasodilating properties associated with the NO-synthase activation. The such effect presence indicates on the prospects for further investigation of these compounds cardiotropic properties in the order developing new effective means for improving intracardiac hemodynamics and limiting Ca2+ overload of cardiomyocytes in conditions of ischemia and reperfusion.

One of the ways to reconstruct the arterial wall is endarterectomy with a vascular patch. The use of vascular wall prostheses made from existing materials can lead to complications with the need for reoperation. The search for new materials for the manufacture of vascular patches that have optimal compatibility with the vessel wall is still relevant.

Aim: To study the dynamics and compare the morphological features of remodeling of tissue-engineered vascular patches from silk fibroin (SF) and biological xenopericardium (XP) flaps implanted into the wall of the sheep carotid artery.

Material and Methods. Matrices from a 15% SF solution (n = 2) were prepared by electrospinning. For comparison, bovine pericardial flaps were used (n = 2). Vascular patches were implanted into the wall of the carotid artery in sheep for 2 and 6 months. A histological examination of explanted samples of vascular patches, scanning electron microscopy and confocal microscopy with specific immunofluorescent staining of the preparations were performed.

Results. Based on the implanted SF-patch, neointima and neoadventitia were formed. After 2 months of implantation, the SFmatrix retained its structure; after 6 months, there were signs of moderate biodegradation of the material with the replacement of the vessel wall with its own tissue. There were no areas of calcification or massive inflammation. After 6 months, neointimal hyperplasia was detected in the projection of the implanted SF-patch. Based on the implanted XP-flap, neointima and neoadventitia were also formed. After 2 months, delamination of the implanted XP was revealed. After 6 months, neointimal hyperplasia was found in the projection of the XP-patch.

Conclusion. Remodeling of the SF-patches and XP-flaps implanted into the wall of the sheep carotid artery followed the formation of a three-layer structure resembling the architecture of the vessel’s own wall, with signs of moderate biodegradation of the material. Neointimal hyperplasia is explained by insufficient compliance of the arterial wall and the patch and requires improvement in the composition of the implanted matrix.

Aim: To study in patients the dependence of the exhaled air composition on pathological processes occurring in the respiratory system, including: lung cancer, community-acquired pneumonia and COVID-19.

Material and Methods. The studies were carried out on the basis of a gas analytical complex using the method of neural network data analysis. The gas analytical complex includes semiconductor sensors that measure the concentrations of gas components in exhaled air with an average sensitivity of 1 ppm. Based on signals from sensors, the neural network classifies and identifies patients with certain pathological processes.

Results. The statistical data set for training the neural network and testing the method included samples from 173 patients. Our study collected exhaled air samples from groups of patients with lung cancer, pneumonia, and COVID-19. In the case of lung cancer, the parameters of the diagnostic device have been determined at the level of sensitivity – 95.24%, specificity – 76.19%. For pneumonia and COVID-19, these parameters were 97.36% and 98.63, respectively.

Conclusion. Taking into account the known value of diagnostic methods such as computed tomography (CT) and magnetic resonance imaging (MRI), the sensitivity and specificity indicators of the gas analytical complex achieved during the study reflect the promise of the proposed technique in the diagnosis of tumor processes in patients with lung cancer, COVID-19 and community-acquired pneumonia.

Coronavirus infection causes long-term post-Covid syndrome, which determines the need for medical rehabilitation. The use of modern machine learning technologies to predict the effectiveness of rehabilitation can personalize the process of providing assistance.

Aim: To create a method for constructing a model to predict the effectiveness of patients rehabilitation who have suffered COVID-19.

Material and Methods. The study included 64 patients admitted for inpatient rehabilitation after COVID-19. The average age was 56.92±9.29 years. To obtain information about the patients' health status, a physical examination, six-minute walk test (SHT), clinical and biochemical blood tests, and spirometry were performed in order to obtain information about the health status of the patients. The collected data were anonymized and transformed into a data set for the classification task, the output label of which was a binary attribute indicating the presence or absence of an improvement in the six-minute walk test result by at least 15 %. The proposed method for determining a consistent subset of features was tested by ReliefF, χ²-squared filters and the minimum redundancy and maximum information content algorithm; the binary genetic algorithm NSGA2 was used as a wrapper. The construction of preliminary machine learning models on the found subsets of features using the linear support vector machine was carried out.

Results. In the process of testing the proposed method in the task of predicting the effectiveness of rehabilitation of patients after COVID-19, a subset of signs was identified that made it possible to achieve the maximum value of the concordance coefficient. The found set includes the following characteristics: gender, concomitant diseases, shortness of breath, cough, complaints about the gastrointestinal tract, six-minute walk test result, D-dimer level, assessment of shortness of breath according to the Borg scale.

Conclusion. The proposed method allowed identifying the signs that are of the greatest importance for predicting the effectiveness of patients’ rehabilitation who have had COVID-19.

Background. During the COVID-19 pandemic, remote consulting and monitoring technologies began to be used in medical practice to maintain the proper level of quality of patient care, ensure the efficient use of emergency medical teams (EMT) resources in conditions of increased workload and minimize the risks of infection spread. The Tomsk Region became one of the first regions of the Russian Federation to organize on its territory a Medical center for remote monitoring of patients with COVID-19 and community–acquired pneumonia (hereinafter referred to as the Center).

Aim: To assess the Center’s activities effectiveness based on the analysis of indicators of the load on the EMT service during the COVID-19 pandemic.

Material and Methods. The Center’s activities effectiveness was assessed based on the analysis of the key parameters of its work, as well as the study of the dynamics of quantitative and time indicators of the load on the EMT service. The information base for the study was the daily operational data of subordinate institutions of the Department of Health of the Tomsk region in the period from 01.06.2020 to 31.12.2021.

Results. The positive dynamics of quantitative and time indicators of the work EMT service after the Center’s work start the confirms effectiveness of remote monitoring of the health status of patients with COVID-19. Reducing the number of calls received by the EMT service, due to the redistribution of the “non-core” load and the routing of patients depending on the reasons for treatment and the severity of the condition, allowed to stabilize the work of the ambulance in a critical situation for the industry.

Conclusion. Taking into account the proven effectiveness, the experience of the Tomsk region in creating a Center that provides remote counseling to patients with COVID-19 can be applied as a measure of adaptation of regional health systems in the event of new epidemic threats.

Substantiation of research. Health self-assessment is recognized as a lifestyle indicator that establishes the interpretation of behavioral risk factors and the interest of the population in preventive measures at the population level. The validity of using health self-assessment as a significant indicator of its association with the prevalence of behavioral risk factors for cardiovascular diseases, and particular, with physical activity, is shown both in domestic and foreign scientific literature.

Aim. To determine the associations of parameters of health self-assessment and physical activity of the population of a medium-sized city of Western Siberia in terms of gender differences.

Methods. The analysis is based on the results of studies obtained by extrapolating data from representative samples of the working-age population to the model of the city of Tyumen. The results are based on the analysis of the questionnaire conducted in the framework of cardiological screenings.

Results. It is shown that in a moderately urbanized city of Western Siberia, negative self-assessment of health and complaints about it prevails among women. About 10% of the population of both sexes state sufficient concern for their health. The attitude to physical activity among the working-age population of a medium-urbanized city of Western Siberia is manifested by its low self-esteem with priority among men, and among women by a greater share of lack of leisure in the gender aspect. In the gender aspect, among people who consider themselves healthy, the most negative attitude towards physical activity in terms of positions of a negative attitude towards physical exercise, unsuccessful attempts to do physical exercises, minimal active leisure, low self-esteem of physical activity, as well as its decline over the last year,was established in men. Among people with high self-esteem of health, the prevailing number of men relative to women with a pronounced negative assessment of their physical activity in comparison with other people of their age. Among men, relative to women with low self-esteem of health, the most negative attitude to physical activity was determined in terms of negative attitude to physical exercise, as well as the realization of readiness to perform physical exercises.

Conclusion. Thus, the associative patterns established in the Tyumen population for conventional and non-conventional cardiovascular diseases risk factors represent a scientific basis for some important aspects of regional prevention programs. Such programs should be aimed at the in-depth development of the information block, taking into account medical, social, behavioral and gender differences.