The widespread use of percutaneous coronary intervention (PCI) as a method of treatment for acute myocardial infarction (AMI) has radically reduced mortality in this disease. However, the mortality rate still remains high and, according to some reports, for myocardial infarction with ST segment elevation can reach 7–9%. Today, when using PCI, cardiac reperfusion injury comes to the fore. Unfortunately, drugs used in clinical practice for treatment of AMI are low effective against reperfusion injury of the heart. There is an urgent need to develop drugs with a molecular mechanism of action that is different from those of drugs already used to treat AMI. The prototype for creating such drugs could be polypeptide adrenomedullin. The purpose of this review is to analyze articles devoted to the cardioprotective effect of adrenomedullin in cardiac ischemia and reperfusion. Adrenomedullin has been shown to reduce myocardial infarct size, inhibit cardiomyocyte apoptosis, and prevent the occurrence of post-infarction cardiac remodeling. Adrenomedullin is able to selectively enhance cardiac tolerance to reperfusion injury. It has been shown that the cardioprotective effect of adrenomedullin is associated with activation of Akt kinase, NO-synthase, protein kinase A, an increase in the cGMP level in myocardial tissue and increased NO synthesis in the heart.

The modern high-sensitivity methods for cardiac troponin measurement make it possible to determine their concentration in the majority of individuals in the population, which makes it possible to detect subclinical myocardial damage. Current data on the molecular mechanisms of troponin release explain the associations between troponin levels and the development of adverse cardiovascular events in both asymptomatic individuals and patients with cardiovascular disease.

Aim: To summarize the available data on laboratory methods for determining cardiac troponins and the mechanisms of their release, as well as the opportunities to use them for the diagnosis and prognosis of cardiovascular diseases in various clinical situations. Existing problems in the field of methodology for determining these biomarkers and possible ways to solve them are discussed. This article also addresses the issues of restratification of cardiovascular risk in the general population using cardiac troponins, as well as the use of these markers in groups of patients with a history of cardiovascular disease (patients with coronary heart disease, stroke, chronic heart failure). The use of troponins in these patients may help to individualize primary and secondary prevention. The review demonstrates that cardiac troponins are currently one of the most promising biomarkers of cardiovascular diseases, since they have high reproducibility and specificity, and their determination can influence the management of patients in a wide range of clinical situations.

Aim: To assess work carried out in Russia over the past 5 years to identify the risks of developing cardiovascular diseases using artificial intelligence (AI) methods and technologies.

Materials and methods: A systematic review of the available literature over the past 5 years on the use of machine learning and knowledge representation methods in predicting the development and outcomes of cardiovascular diseases in Russia was carried out based on the Prisma methodology. 221 articles were analyzed.

Results and discussion: The result of the systematic review is an analysis of the presented methods of model building, which ones are most often used, and with the help of which metrics researchers evaluate the quality of the obtained model. Machine learning methods are used most frequently compared to knowledge-based methods (expert systems), 22 articles and 7 articles respectively. Analysing the machine learning methods used, it can be noted that the first 5 places among the methods used in Russia are occupied by neural networks, regression, decision tree, boosting and random forest. Among the models of knowledge representation, ontology and semantic networks, which are often used for structuring and analyzing complex data in various knowledge domains, turned out to be the most widespread in the presented works. Almost all researchers in their papers evaluated the created model on a test sample and considered numerical metrics: accuracy (accuracy of measurement), precision (accuracy of the measuring instrument), completeness (recall), specificity (specificity), sensitivity (sensitivity), AUC (area under the ROC curve), F-measure (F-measure). The discussion is a discourse on the use of different metrics to evaluate different model variants.

Conclusion: The results of the analysis of works using AI for the prevention and diagnosis of cardio-vascular diseases are summarized, and an assessment of their further application is given.

Rationale. Physiological aging has all the factors that contribute to the development of obesity, sarcopenia and osteoporosis through increased fat mass, decreased muscle mass and strength, and decreased bone mass. It is clear that the direct impact of osteosarcopenic obesity poses a potential threat to public health. The effects of muscle and bone loss, combined with the effects of obesity, may well be associated with worse clinical outcomes due to the cascade of metabolic abnormalities associated with these changes in body composition

Aim: To identify the prevalence and dynamics of the components of osteosarcopenic obesity over a three-year period assessed using bioimpedance analysis.

Methodology and research methods. The baseline study included 1124 women and 476 men. The follow-up period was 3 years from the date of the respondent's first visit. The median age of the study population was 56.0 (47.0; 63.0) years. Persons over 65 years old accounted for 17.7% at the baseline stage of the survey and 31.0% at the prospective stage. To determine the components of osteosarcopenic obesity (fat percentage, bone mass), a fat mass analyzer BC-532 (manufactured by Tanita Corporation, Tokyo, Japan) was used. The muscle component was assessed using hand dynamometry, which was performed using a mechanical dynamometer

Results. Osteosarcopenic obesity (OSA, muscle weakness + excess body fat + insufficient bone mass) at baseline was equally common in men and women over 65 years of age (2.2% and 1.4%, respectively, p = 0.679). Among persons under 65 years of age – 0.5% in women and 0% in men (p = 0.607). At the prospective stage, there was an increase in the prevalence of AOM among the population over 65 years of age, due to the female population (24.1% and 1.4% in women and men, respectively, p < 0.001). It should be noted that among people under 65 years of age, the proportion of women with AOM was 4.4%, while among men this pathology was still not detected (p < 0.001). Overall, the prevalence of this multifactorial syndrome at baseline was 0.55% and increased 14.7-fold (to 8.1%, p < 0.001) during the prospective follow-up phase.

Conclusion. Using bioimpedance analysis, over the studied period of time it was revealed that osteosarcopenic obesity at the baseline stage was equally common in men and women over 65 years of age (2.2% and 1.4%, respectively). At the prospective stage, there was an increase in the prevalence of AOM among the population over 65 years of age, due to the female population (24.1% and 1.4% in women and men, respectively). It should be noted that among people under 65 years of age, the proportion of women with AOM was 4.4%, while among men this pathology was not detected for the entire study period.

Background. Currently there is no holistic view of the influence of metabolic factors and endocrine pathology on the development of thromboembolic complications, both arterial and venous, which is probably due to wide clinical variability, as well as the imperfection of diagnostic strategies. In many cases, echocardiography helps to solve the main problem and determine further therapeutic tactics. In connection with the foregoing, in patients with metabolic syndrome (MS), it is especially important to conduct echocardiography, which makes it possible to identify markers of subclinical myocardial dysfunction. The presence of MS in patients with pulmonary embolism (PE) is associated with a significantly higher recurrence rate of PE, confirming the importance of recognizing this risk factor and initiating appropriate therapy to reduce the risk of relapse.

Aim: To carry out a comparative assessment of cardiac hemodynamic parameters in MS and non-massive PE.

Material and Methods. The study included 82 patients: the first group – 52 patients with PE with a submassive or segmental lesion within 6 months before the study; the second group – 14 patients with metabolic syndrome; the third, control, group consisted of 16 patients who did not have diseases of the cardiovascular and respiratory systems.

Results. In a comparative analysis of the data of patients with MS, patients with subsegmental PE and the control group, statistically significant differences were revealed in a number of parameters: the sizes and volumes of the right heart sections were statistically significantly smaller in the MS group than in the PE group, RVSP in patients with MS was statistically significantly lower in comparison with PE, the volume of RA in systole and diastole, the transverse dimension of the right ventricle in systole and diastole was larger in the group of PE and did not differ between patients with MS and controls. Significant differences in the value of a number of TDI indicators in individual segments of the right and left areas were revealed in the group with MS: in the group with MS, the ivct of the RA, LV, and LV was statistically significantly shorter than in the other groups. Compared to the control group, the values of e′ (early diastole) according to TDI from the fibrous ring of the mitral valve (from the septal and lateral walls) were found to be lower in patients with MS and PE, and peak A (late-diastolic filling) was statistically significant lower in the MS group than in the PE group. At the tissue level, a statistically significant slowing of the synchronization time in the LV was noted in the MS, 1st degree obesity and PE groups compared to the control group. At the same time, the isovolumic contraction time of RA and LV was significantly shorter in patients with MS than in patients with PE and the control group. It is worth noting that in patients with MS, although there were changes in the right parts, the changes in the left parts of the heart reliably prevailed. Whereas in patients with subsegmental PE, the changes in the right parts of the heart were more significantly expressed.

Conclusion. A number of echocardiographic parameters have been identified to distinguish between patients with metabolic syndrome and non-massive PE. Echocardiographic indicators that allow to distinguish patients with metabolic syndrome and non-massive PE are: the time of isovolumic contraction of the left and right atria, the left ventricle according to TDI, the size and volume of the right heart, RVSP.

Introduction. Prognostic diagnostics of chronic kidney disease is based on the identification of disease predictors and subsequent development of information tools that help in the work of the doctor.

Aim: To identify predictors of chronic kidney disease according to ultrasound results in children.

Materials and Methods. Data are obtained from a single-center retrospective catamnestic cohort study (2011–2022). The main group included 128 children with chronic kidney disease stages 1–4 years of age. The comparison group consisted of 30 children without diagnosed kidney pathology aged 1 to 17 years. The children of the two groups did not statistically differ significantly in gender and age. The informativeness of more than 50 features, including kidney size, structural parameters, changes in blood flow at different levels of the vascular kidney tree were evaluated. Hypotheses about statistical significance of differences in indicators were tested, correlation analysis was performed, univariate logistic regression models were built, and their ROC analysis was performed. Statistical processing was performed using Python 3.11. The software was provided by TechDepartment (Moscow).

Results. The children of the main group had increased echogenicity of kidney parenchyma, which is not characteristic of the children of the comparison group. Reliable direct associations of moderate severity with the results of the ultrasound study (kidney length, r = 0.369; kidney width, r = 0.407; parenchyma thickness, r = 0.367), with blood flow in the segmental arteries in the middle third according to the results of color Doppler mapping (r = 0.338) with kidney pathology were established. A high direct relationship between vascular resistance at different levels of blood flow (Ri in the trunk and Ri in the segmentary renal arteries r = 0.658 [0.56; 0.726], p < 0.001) was determined.

Conclusion. The identified ultrasound predictors of chronic kidney disease can be used to develop models and nomograms to help doctors identify children at high risk of developing chronic disease.

Echocardiographic assessment of the contractility of the right ventricle (RV) is a difficult task due to its special shape. Two indicators are most often used to assess pancreatic contractility: the amplitude of the systolic displacement of the plane of the fibrous ring of the tricuspid valve and right ventricular fractional area change (FAC) due to good reproducibility and ease of measurement. The correctness of using TAPSE has been increasingly questioned lately.

Aim: To study the association of tricuspid annular plane systolic excursion (TAPSE) with pancreatic contractility, changes in the volume of the right chambers in children with atrial septal defect (ASD) during surgical treatment. To evaluate the relationship of TAPSE with the indicators of anthropometry.

Material and Methods. The examination was performed on the basis of a retrospective analysis of two-dimensional echocardiographic data. Three-dimensional echocardiography (3D echo) was the reference method for assessing RV contractility.

Results. Based on a retrospective correlation analysis of echocardiography data in 729 healthy children aged 1–17 years and 120 children with ASD of the same age, it was found that the maximum relationship between TAPSE was observed with age (r = 0.54) and anthropometric data (r = 0.59). There was a fairly high correlation between the linear dimensions of the right atrium and the right ventricle (r = 0.59). The correlation of TAPSE and RV ejection fraction (EF) according to 3D echo data was absent in the control group and in children with ASD. The indicator was evaluated in the near future (6 days) and in the long term (1–3 years) after surgical correction in 60 children with ASD and 30 with coarctation of the aorta. At all stages after surgery, the indicator decreased in all operated patients, did not recover after 1 year and had no correlation with the pancreatic ejection fraction according to 3D echo data.

Conclusions. In children without structural pathology of the heart, the TAPSE indicator does not reflect the contractility of the right ventricle and depends on anthropometric data and the linear dimensions of the right chambers. TAPSE in ASD children was more depended by volumetric overload of the right chambers than by contractility of the right ventricle. Contractility of the right ventricle in children after cardiac surgery cannot be correctly assessed using TAPSE.

Aim: To investigate the association between red blood cell distribution width (RDW) and in-hospital mortality; to develop a clinical risk model of in-hospital mortality in patients with   acute   myocardial   infarction   (AMI).

Materials and methods. The prospective observational study included 577AMI patients undergoing coronary angiography (CAG) < 24 h after symptom onset and was divided according RDW median. The association between RDW, clinical parameters and inhospital mortality was evaluated using logistic regression and receiver operating characteristic (ROC) curve analysis. A prognostic model was developed by using Bayesian approach and logistic regression analysis with identifying predictors for mortality.

Results. The median age of patients was 65 (interquartile range [IQR]: 56–74) years. 60.7% were male, 47.1% with STelevation. The in-hospital mortality rate was 5.4% (n = 31). Median RDW was 14.2% (IQR 13.5–15.0%). In univariate analysis, RDW was a significant risk predictor of in-hospital mortality (odds ratio [OR] 1.27, 95% confidence intervals [CI] 1.07–1.50, p = 0.005). The area under the ROC curve [AUC] was 0.649 (95% CI: 0.540–0.758, cut-off value 15.11%). In Bayesian multivariate logistic model, age (OR 1.10, 95% CI 1.06–1.14, p < 0.001), ST-elevation (OR 3.22, 95% CI 1.41– 7.35, p = 0.006) RDW (OR 1.26, 95% CI 1.04–1.53, p = 0.021), were identified as risk factors for in-hospital mortality. Overall, the model showed excellent discrimination in predicting in-hospital mortality (AUC = 0.832, 95% CI: 0.779– 0.885, p < 0.001, sensitivity: 87.1%, specificity: 72.2%) and with good calibration (Hosmer-Lemeshow test, p = 0.632).

Conclusions. Elevated RDW value was independently associated with an increased risk of in-hospital mortality in AMI patients undergoing CAG. The model, including age, ST-elevation and RDW for prediction of in-hospital mortality demonstrated high prognostic potential, enabling the identification of patients at high-risk of adverse outcome.

Chronic thromboembolic pulmonary hypertension (CTEPH)   is   a   serious   disease   associated   with   thrombotic lesions of the pulmonary arteries and secondary microvasculopathy, leading to the progression of pulmonary hypertension and heart failure. Pulmonary endarterectomy (PEA)   is   the   preferred   treatment   for   CTEPH.

Aim: To study the reserve capabilities of the cardiovascular and respiratory systems in patients with CTEPH.

Material and Methods. The retrospective cohort observational study included 403 patients aged 19 to 77 years with CTEPH who underwent PEA at the National Medical Research Center named after. ak. E.N. Meshalkin from 2004 to 2021. Parameters of transthoracic echocardiography, pulmonary circulation tensiometry, pulmonary function tests, six-minute walk test and Borg scale were assessed before surgery, after PEA before discharge and after surgery 12 months later.

Results. When comparing transthoracic echocardiography data at the hospital stage after PEA, a decrease in right ventricular systolic pressure was revealed from 82.2 ± 23.1 to 44.9 ± 16.2 mm Hg, leading to an improvement in intracardiac hemodynamics, characterizing the right heart function. These improvements continued into the long-term follow-up. Analysis of pulmonary circulation tensiometry in CTEPH patients after PEA showed that all patients had a significant decrease in mean pulmonary artery pressure from 48.3 ± 14.5 to 27.1 ± 10.7 mmHg (by 1.8 times), which was accompanied by a decrease in pulmonary vascular resistance by 2.8 times and an increase in cardiac output. In the long-term follow-up improvements in the pulmonary circulation tensiometry indicators also persisted. When comparing the indicators of pulmonary function tests, a statistically significant decrease in tidal and minute respiratory volumes was revealed. After PEA six-minute walk test distance increased by 19.0 meters, in the long-term follow-up by 60.6 meters; shortness of breath according to the Borg scale decreased from “severe” to “moderate”, in the long-term follow-up to “mild”.

Conclusion. The results obtained demonstrate the continuation of the cardiovascular and respiratory systems recovery processes in the immediate postoperative period, and further during the year of observation after PEA, indicate significant reserve capabilities of the cardiovascular and respiratory systems, and the potential cure of patients with CTEPH.

Introduction. Resection of the narrowed aortic segment is the treatment of choice for coarctation of the aorta in newborns, but the issue of recurrent coarctation remains relevant (26% of cases in the long term period). The question of the optimal patch type and the necessity of ductal tissue removal remains open.

Aim: To assess the long-term outcomes of surgical treatment of coarctation of the aorta in newborns using patches and native tissue on the aortic arch.

Material and Methods. The study included 105 newborns that underwent surgeries from 2017 to 2023 at the Federal Center for Cardiovascular Surgery (Krasnoyarsk) and Meshalkin National Medical Research Center (Novosibirsk). Three methods were used: arch reconstruction with patch plasty also known as “Norwood Type” (“NP group”), resection with patch plasty (“RPP group”), and resection with end-to-end anastomosis (“REtEA group”). The gradient across the aortic arch was assessed echocardiographically at 6, 12 and 60 months (recoarctation criterion: gradient > 20 mm Hg).

Results. The peak gradient at the isthmus did not differ at 6 and 12 months. Differences were noted during 60 months: in the “Norwood Type” group 18.0 [18.25; 24.25], in the “RPP” group 15.0 [13.13; 21.25], and in the “REtEA” group 13.5 [8.75; 18.62]. The reoperation risk in the “NT” group was 13.3%, higher than in other groups (3.4% and 0%).

Conclusions. Ductal tissue excision and arch enlargement reduce the risk of recoarctation. A residual pressure gradient greater than 23 mm Hg at discharge is a predictor of restenosis.

Introduction. Mitral valve (MV) repair is more preferable than valve replacement because of stable long-term outcomes and low mortality rate. Chordal replacement and transposition of secondary chordae are two methods of MV plasty with similar results. Comparison of the long-term outcomes of these non-resection methods precisely have not provided yet.

Aim: To compare the long-term outcomes of chordal replacement and transposition of secondary chordae techniques in type II mitral regurgitation of Carpentier’s functional classification.

Material and Methods. 58 adult patients with severe type II MR (ERO 43 (30; 50) mm2) due to degenerative valve disease, underwent primary MV repair from 2009 to 2019, were prospectively studied. The mean patient age was 57 (49; 64) years. 21 patients were female. Initially, 94.7% of patients referred to NYHA II III before surgery. Mean follow-up period was 7,2 (2,5) years. The patients were randomized in two groups: 1) chordal transposition (CT) – 30 patients, 2) chordal replacement with polytetrafluoroethylene artificial chordae (CR) – 28 patients. Mitral prosthetic ring implantation was performed in all cases.

Results. There were no any statistically significant differences in main hemodynamic parameters in both groups: left atrium diameter 46,5 (37; 53) mm – 42,5 (42; 45) mm, p = 0,49; left ventricle (LV) myocardial mass index 101(81; 133) g/m2– 81,5 (71,5; 94,5) g/m2, p = 0,15; LV end-diastolic diameter 52,5 (47; 56) mm – 51,5 (48; 52,5) mm, p = 0,64; LV end-systolic diameter 31 (29; 34) mm – 33 (30; 34,5) mm, p = 0,97; LV end-diastolic volume 124 (103; 148) ml – 118 (89,5; 128,5) ml, p = 0,8; LV end-systolic volume 54 (40; 59) ml – 48,5 (30; 54,5) ml, p = 0,37; LV ejection fraction (В) 59,5 (51; 64) % – 62 (58; 66) %, p = 0,16; LV end-diastolic volume index 60,3 (54,7; 73,8) ml/m2 – 57,7 (51,9; 66,1) ml/m2, p = 0,58; LV end-sistolic volume index 26,7(22,1; 27,9) ml/m2 – 23,6 (17,4; 27,9) ml/m2, p = 0,35, GLS LV -13,7 (-11,6; -16,3) % – -15,4 (-13,5; -16,5) %, p = 0,45. Statistically significant difference was detected in mean MV pressure gradient: 3 (2,5; 4) mm Hg in CT group versus 4,5 (3,5; 5) mm Hg in CR group, p = 0,009. LA thrombosis was not recorded in any case according to results of transesophageal echocardiography. Patients in both groups had not recurrent MR more than 1 degree (38,6% patients with MR 1 degree). The next secondary endpoints were achieved in both groups. Death as secondary endpoint: 2 patients in CT group (6,9%), 2 patients in CR group (7,1%), p = 0,91. One patient had a stroke in early postoperative period in CR group. Reoperation with MV replacement was required in 2 patients due to rupture of posterior mitral leaflet chordae in native segment (CT) and rupture of polytetrafluoroethylene artificial chordae (CR), observation period was 36 and 24 months after MV repair accordingly.

Conclusion. Both non-resection techniques are effective methods of MV repair in type II MR with comparable long-term outcomes.

Psoriasis is a chronic immune-inflammatory dermatological disease that affects not only the skin, but can also cause systemic inflammation, increasing cardiovascular endpoints.

Aim: To examine long-term cardiovascular endpoints in patients with coronary heart disease (CHD), psoriasis and their combination in a prospective observational study.

Material and Methods. 3 groups of patients with moderate-to-severe psoriasis (n = 30), coronary artery disease (CHD) (n = 32) and psoriasis + coronary artery disease (n = 28) were enrolled in the study. They were observed for 48 months in terms of unfavourable endpoints (exacerbation of psoriasis, cardiac vascular hospitalizations, death, heart attacks and strokes).

Results. The CHD group had a higher frequency of diabetes mellitus (DM) (30 vs. 3.6%, p = 0.008) and worse systolic blood pressure (SBP) control (142 (134.0–149.8) vs. 136 (128.0–144.6) mmHg, p = 0.048) compared with the CHD comorbidity group. Cardiovascular mortality was higher in patients with CHD compared with the group with psoriasis (p = 0.027) and CHD with psoriasis (p = 0.040). The rate of cardiovascular hospitalizations did not differ in pairs with CHD versus CHD and exacerbations of psoriasis in the groups with psoriasis and psoriasis with CHD (p > 0.05), but the total rate of both types of hospitalizations was higher in the group of patients with CHD and psoriasis (p = 0.009).

Conclusion. In case of comorbidity of psoriasis with CHD, the frequency of cardiovascular hospitalizations and exacerbation of psoriasis increased. CHD reduced the time to the first exacerbation of psoriasis.

Background. The condition of patients after orthopedic surgery requires therapeutic monitoring with correction of concomitant therapy.

Aim: To study changes of the general condition of patients after elective total knee arthroplasty (TKA) and elective total hip arthroplasty (THA) over time through active therapeutic monitoring to optimize management.

Materials and Methods. This prospective cohort single-center study included 782 patients with detailed medical history, information about concomitant diseases and drug therapy. The severity of pain was assessed on a 10-point scale before surgery and then 1 and 3 months after arthroplasty.

Results. The study population included 271 males (34.7%) and 511 females (65.3%). 595 subjects (76.1%) had hypertension (grade 1 – 71 patients, grade 2 – 252 patients, grade 3 – 272 patients). At 1 month after surgery, 18 patients (2.3%) reported instable blood pressure (BP), 43 patients (5.5%) reported a persistent BP decrease requiring a reduction of antihypertensive drugs doses. Before surgery 604 patients (77.2%) were taking non-steroidal anti-inflammatory drugs (NSAIDs); at 1 month a significant (p < 0.0001) decrease in the frequency of NSAIDs was noted – only 332 patients (42.4%) continued taking NSAIDs. At 1, 3 and 6 months after surgery, 17, 27 and 44 patients, respectively, reported an increase of pain severity in the joints of the intact extremity with an increase in the need for NSAIDs; about half of this subgroup also reported an increase in the number of episodes of elevated BP. Correlation analysis after surgery revealed a significant relationship between BP and the pain severity (r = 0.731, p < 0.0001) and the frequency of taking NSAIDs (r = 0.681, p = 0.01), as well as the patient’s activity and the severity of pain in the non-operated extremity (r = 0.782, p < 0.0001).

Conclusion. Patients undergoing elective TKA or THA have a high incidence of hypertension and often take NSAIDs. In the postoperative period, a statistically significant relationship between the severity of pain and NSAIDs use with BP levels, as well as a statistically significant relationship between activity and exacerbation of osteoarthritis of the joints of the non-operated extremity was found. This trend requires continued therapeutic monitoring in the postoperative period from 3 to 6 months for appropriate therapy correction.

Introduction. Arterial hypertension (HT) is the most common risk factor of cardiovascular diseases and leads to increased premature mortality. About half of HT patients do not reach the target values of blood pressure (BP).

Aim: To assess the frequency of failure to achieve the target BP level and to identify non-pharmacological factors associated with inefficient BP control in a clinical sample of patients with hypertension.

Material and Methods. A sequential clinical sample of patients (n = 105, 19–84 years old) with an established diagnosis of HT receiving antihypertensive therapy (AHT), was examined. Clinical data were analyzed in groups with efficient (ECHT, n = 29) and inefficient control of hypertension (ICHT, n = 76) by the time of admission to the hospital.

Results. In the entire sample, the proportion of ICHT (72%) was higher compared to ECHT (28%). The groups did not differ in age, anthropometry, menopausal status in women, and duration of HT, but with an increase in the degree of hypertension, the proportion of patients with NCAH increased. There were more women in ECHT group, and there were equal proportions of men and women in ICHT group. In the ICHT group, we observed higher values of HDLC, more frequent chronic heart failure (CHF) and single atherosclerotic plaques (AP) of carotid and other peripheral arteries; in the ECHT group, the average levels of plasma glucose, glycated hemoglobin, the proportion of smokers were higher, and type 2 diabetes and multiple AP were more common. The AHT (doses, regimen, combinations) was more adequate in the ECHT group. About half of the patients received combination therapy.

Conclusion. In the clinical sample, one third of HT patients receiving AHT, had blood pressure controlled to target at hospital admission. Inefficient blood pressure control was associated with male gender, a higher level of HDLC, the high degree of HT, single AP and CHF. In the efficient control group, smoking, comorbidity with type 2 diabetes, multiple AP, higher glucose levels and HbA1c were more often noted.

Introduction. Interest in the prevalence of cardiovascular diseases among patients with chronic obstructive pulmonary disease (COPD) is due to the presumed close pathophysiological connection between the two nosologies, which induces indepth studies of these connections in this comorbid group of patients.

Aim: To study the levels of oxidative stress markers and antioxidant defense in patients with COPD depending on its phenotype in conditions of cardiorespiratory comorbidity and in its absence.

Material and Methods. Examined 104 patients with COPD, 195 patients with myocardial infarction (MI) in combination with COPD, as well as 110 somatically healthy individuals who formed a control group. All patients with COPD were divided into three subgroups depending on the phenotype of the disease (emphysematous, bronchitis, mixed).

Results. According to the results of the study it was found that the levels of markers of lipid and protein peroxidation were higher and the levels of markers of antioxidant defense were lower compared to somatically healthy individuals both in the group of patients with COPD and in the group of patients with MI on COPD background, which confirmed the increase of protein and lipid peroxidation in both nosologies. The most pronounced imbalance of proand antioxidants was observed in the group of patients with MI on COPD background, which indicates more pronounced oxidative stress in conditions of cardiorespiratory comorbidity. It was also determined that in both groups the processes of protein and lipid peroxidation in bronchitic and mixed phenotypes of COPD are more intense than in emphysematous phenotype. The data on connections of different closeness between indices of peroxidation products, as well as markers of antioxidant defense and anamnestic and functional characteristics of COPD in both groups were obtained.

Conclusion. Intensification of protein and lipid peroxidation processes in bronchitic and mixed phenotypes of COPD regardless of the presence of cardiorespiratory comorbidity allows us to say that these phenotypes are more unfavorable in prognostic plan in comparison with emphysematous phenotype.

Introduction. Chronic kidney disease (CKD) and arterial hypertension (AH), especially its resistant forms, are two closely related and mutually aggravating diseases. The pathophysiology of CKD development in patients with resistant AH is complex and is not limited to the negative impact of hemodynamic, metabolic, neurohormonal and proinflammatory factors. The common pathophysiological mechanism of development of both diseases is visceral obesity, which has both systemic and local negative effects. However, aspects of kidney damage in patients with resistant AH (RAH) require further study, and their understanding may open up new possibilities in a comprehensive approach to nephroprotection.

Aim: To study the relationship between a decrease in the functional state of the kidneys in patients with resistant hypertension and clinical data, the size of systemic and local fat depots, as well as markers of sympathetic activity.

Material and Methods. Sixty-three patients with RAH were included in comparative cross-sectional study. CKD C3 was documented in 19 patients (30%). Magnetic resonance imaging (MRI) (1.5 Tesla) was used to assess the sizes of kidney and abdominal fat depots (thickness and area of subcutaneous and visceral adipose tissue (S SAT and VAT), paranephral adipose tissue thickness (PRAT). In addition to routine examinations, patients underwent measurement of cystatin C levels in the blood and 24-hour blood pressure monitoring. Activity of sympathetic nervous system was assessed by catecholamine’s measuring in urine and blood tests, beta-adrenergic membrane reactivity (β-ARM) of erythrocytes, and systolic BP variability.

Results. Patients with CKD compared to patients without CKD were older, higher pulse BP levels (p = 0.005), fasting glucose (p = 0,007), had smaller kidney sizes (p = 0.046), S VAT (p = 0.025) and PRAT thickness (p = 0.013), and lower kidney diameter/PRAT ratio (p = 0.022). No intergroup differences were found in anthropometric indices, SAT thickness and markers of sympathetic activity. Decreased estimated glomerular filtration rate (eGFR) had quantitative associations with increased PRAT thickness and percent adipose tissue (AT) (r = –0.27, p < 0.05 for both)). High uric acid levels correlated with increased S VAT, PRAT thickness and a set of anthropometric parameters.

Conclusions. The presence of CKD in patients with RAH is associated not only with age, an increase in pulse BP and fasting glucose, but also with an increase in the size of visceral fat depots, and a decrease in the functional state of the kidneys is directly related to an increase in adipose tissue in the perirenal region, the percentage of adipose tissue and an increase in vascular stiffness.

Familial hypercholesterolemia is an autosomal dominant disorder of lipid metabolism, leading to an increase in plasma low-density lipoprotein cholesterol, followed by premature atherosclerosis. In women with familial hypercholesterolemia, pregnancy and lactation pose an additional risk due to the association of physiological changes, pre-existing dyslipidemia, and limited therapeutic options and experience. A clinical case of successful management of a pregnant woman with familial hypercholesterolemia against the background of multifocal atherosclerosis with an assessment of the dynamics of the lipid profile at different stages of pregnancy and after childbirth is presented.

Aortitis and aortic valve insufficiency are referred to as extraskeletal manifestations of ankylosing spondylitis (AS). Torpid course of diseases is the reason for late seeking medical care at the stage of irreversible changes and severe dysfunction of the cardiovascular and musculoskeletal systems. The article presents a clinical case of successful surgical treatment of severe aortic valve insufficiency in a patient with late diagnosed AS. The problems of cardiovascular pathology in AS, interdisciplinary interaction of doctors, choice of antirheumatic therapy and perioperative management of a very high cardiovascular risk patient with AS are discussed.

One of the important goals in the surgical treatment of diseases of the cardiovascular system is to minimize complications. The most dangerous complication is perioperative acute cerebrovascular accident and encephalopathy. The risk of their occurrence increases significantly without careful preoperative and intraoperative assessment. A preoperative computed tomography (CT) scan is the gold standard to rule out aortic calcification. However, CT data are not sufficient for complete visualization of atheromatous changes. Intraoperative ultrasound epiaortic scanning (EpiUS) allows to identify with high accuracy the presence or absence of atheromatous changes in the ascending part and arch of the aorta. At the same time, the use of EU has not become widespread. The article presents 3 clinical cases demonstrating the use of preoperative CT and intraoperative EU in patients undergoing coronary artery bypass grafting. Based on these imaging techniques, the surgical tactics during the operation were changed: changing the cannulation site, using the «Single clamp» technique and operating on a beating heart. Preoperative CT and intraoperative EU together make it possible to choose the correct surgical treatment tactics and thereby reduce the risk of complications.

Introduction. Due to the severity of the state and course of the new coronavirus infection (COVID-19), patients requiring hospitalization were the group at high risk of death during the spread of infection. Their condition, treatment tactics and outcomes were associated with the presence of comorbidities, gender, age and duration of hospitalization. Studying the relationship of these factors with mortality among patients with COVID-19 is essential for effective organization of medical care.

Aim: To analyze factors associated with a high probability of mortality in patients with COVID-19 treated in hospitals from 2020 to 2021.

Material and Methods. 25,028 depersonalized records of patients receiving inpatient medical care in medical organizations of Tomsk region from 2020 to 2021 were studied. The presence of comorbidities, gender, patient age, and number of days of hospitalization were investigated as potential factors associated with a high probability of lethal outcome in patients with a diagnosis of COVID-19. The relationship of potential factors associated with a high probability of mortality according to the period of epidemic rise in COVID-19 incidence was evaluated using classification models.

Results. An analysis of data from patients hospitalized with COVID-19 in Tomsk Oblast hospitals from 2020 to 2021 revealed that the patient's age, length of stay in hospital, and presence of concomitant pathologies are associated with the probability of mortality. Based on the results of the analysis, a profile of a patient hospitalized in a Tomsk region hospital with confirmed coronavirus infection with high risks of lethal outcome was formed: a man aged 70 years or older, who has been hospitalized for 10 days or more and has one or more comorbidities, in particular, diseases of the heart, blood vessels or endocrine system. The models obtained during the study are not suitable for predicting the outcome of the disease in the context of the spread of new COVID-19 strains and require changes in the composition of predictors of prognostic models.

Conclusion. The presented algorithm for analyzing risk factors for lethal outcome in patients with a coronavirus infection can be used in other regions with possible identification of new risk factors and associations with the predominant strain.

Background. Pathological changes in systems and organs after COVID-19 can lead to delayed death. One of the most influenced target systems of post-COVID changes is the cardiovascular system.

Aim: To identify, using machine learning methods, indicators that have predictive value in determining the adverse outcome of subacute COVID-19.

Material and Methods. The study included 212 people admitted after previous severe COVID-19. Retrospectively, the patients were divided into 2 groups: 140 patients discharged from the hospital after improvement in their state and 72 patients died during hospitalization. All patients underwent general clinical, biochemical analyses, assessment of blood coagulation system. The following machine learning methods were used for data analysis: support vector machine, random forest, stochastic gradient boosting. Validation of the obtained models was carried out by the method of 10-fold cross-validation in conjunction with ROC–AUC analysis (Receiver Operation Characteristics – Area Under Curve).

Results. In the created models, the predictors of mortality were urea and body temperature for the random forest and stochastic gradient boosting methods, erythrocyte, eosinophil and monocyte counts, and INR (International Normalized Ratio) level for the support vector machine.

Conclusion. In our study, two predictive models created using machine learning methods random forest and stochastic gradient boosting showed that changes in urea level and body temperature had predictive value. The support vector machine revealed other predictors, namely the number of erythrocytes, eosinophils and monocytes, INR. We used the voting method, on the basis of which the urea level and body temperature were established as informative signs. The random forest and stochastic gradient boosting methods showed similar results, we did not take into account the data obtained using the support vector machine. This approach of choosing a predictive model by voting is often used when evaluating data using artificial intelligence methods. It is possible that an increase in urea levels was a trigger leading to endotheliitis and subsequent myocardial infarction, before acute renal failure developed.

Background. To organize screening of the population for pulmonary tuberculosis, services based on the use of artificial intelligence technologies (AI services) have been developed and registered.

Aim: To evaluate diagnostic metrics and performance of the AI-service as medical decision support system within the framework of routine clinical practice at the scale of a municipal hospital.

Material and Methods. The index test was conducted using the software “Automated analysis program for digital chest X-ray/ fluorography images according to TU 62.01.29-001-96876180-2019” produced by LLC “PhthisisBiomed”.

Results. The index test of the AI service as a system for supporting medical decision-making showed high values of operational characteristics (sensitivity 96%, specificity 61%), significant savings in the time spent on forming conclusions, and high data transfer rate. The choice of the optimal separation point for screening is reasonably based on the metric of maximizing the predictive value of a negative result (sensitivity maximization). When comparing the diagnostic efficiency of AI-service solutions and physicians, it is shown that the area under the ROC curve of AI-service conclusions (0.91–0.93) is not inferior to that of qualified radiologists (0.78-0.91 according to the literature.

Discussion. The use of AI service allows to significantly save the time required to analyze one X-ray image, which is especially important for rapid diagnostics within the framework of screening programs. The use of AI service with high diagnostic efficiency expands the capabilities of radiologists and indicates a transition to a new level of quality of medical care. High speed data transfer allows for better coordination between medical staff and enables faster decision-making for patients.

Conclusions. Detection of pathological changes on radiographs of patients using AI-service has high diagnostic efficiency and can be used within the framework of population screening programs for lung diseases.

Diabetes mellitus is a common disabling disease that, without proper treatment, leads to visual impairment and blindness. This paper presents the analysis of duplicate and modified images in open datasets (datasets that can be freely downloaded on the Internet) containing ocular fundus images with manifestations of diabetic retinopathy.

Aim: To determine the quality and suitability of open datasets available for the query "diabetic retinopathy" on the Kaggle.com platform for use in training machine learning models.

Material and Methods. More than 100 open data sources were analyzed with the total number of ocular fundus images with diabetic retinopathy amounting to almost 2 million. The images were examined by analyzing the hash sums of the files obtained with the SHA-3 algorithm and comparing the file names between the original and resized images.

Results. The study showed that duplicate images were quite common, with a maximum of up to 14 repetitions in different datasets. It was found that 56% of all images are repeated at least twice in different datasets. Authors also searched for modified images, i.e., resized images. The analysis found 9 datasets with such images, which is 24% of the total number of images in the database.

Conclusion. The authors of the article note that the obtained results can be used to optimize the training process and improve the quality of computer vision algorithms in ophthalmology. They also point out the need to develop measures to prevent duplication and modification of images in datasets to ensure their high quality and reliability of neural network model training results, as the creation of datasets without standardization and verification will not lead to improved machine learning results.

Introduction. Cancer is accounting for 16.8% of all deaths and 22.8% of noncommunicable disease-related deaths, approximately. The diagnostic, prognostic, and therapeutic aspects of patient management majorly depend on mutations that drive the oncogenic process. However, evaluating the clinical significance of the variant is a major challenge, as many of them become variants of unknown significance (VUS).

Aim: of the current study is to create a new algorithm for classification of missense variants.

Material and Methods. Data from the NCBI Assembly, Uniprot, GnomAD, and OncoKB databases was processed with Python 3 to assess oncogenicity, population frequency of missense variants, as well as their occurrence in orthologous sequences. We selected 314 known benign polymorphisms and 332 reported pathogenic mutations of BRCA1, BRCA2, DICER1, PIK3CA, and TP53 genes from the ClinVar database for training and testing datasets.

Results. We have developed the algorithm that provides three criteria based on oncogenicity and population frequency of a variant, as well as its occurrence in orthologous sequences for assessing its potential pathogenicity. A variant was classified as neutral if the following was true: a) a variant doesn’t meet the criterion for oncogenicity; b) a variant meets at least one of the remaining criteria. All other variants were deemed to be pathogenic. The new algorithm demonstrates high sensitivity (94.95% (88.61%, 98.34%)) and specificity (96.52% (91.33%, 99.04%)) in classifying benign and pathogenic variants. The algorithm requires a position of a variant to be represented in population databases and to correspond to an appropriately aligned region in a multiple sequence alignment of orthologs, along with two adjacent positions.

Conclusion. The algorithm might be used to evaluate the variants of other oncogenic genes, possibly making the classification of genetic variants more precise, intensifying molecular diagnostics.