The EAC Guidelines represent the views  of the  EAC,  and were produced  after careful consideration  of the scientific  and medical knowledge,  and the evidence  available at the time of their publication.

Aim. TIntroduction. To evaluate in-hospital angiographic  and five-year posthospital clinical outcomes  of percutaneous  intervention strategy without stent implantation with immediate coronary  artery stenting technique in STEMI patients  with massive coronary thrombosis.

Material and methods. The  study  enrolled  116  patients  with primary STEMI myocardial  infarction with the signs  of massive  thrombosis  in the lumen of the main  epicardial  coronary   artery with TIMI thrombus  grade  greater  than 3 after antegrade blood  flow restoration. In the 1st group of delayed intervention at the primary stage the blood  flow was restored by small diameter balloon  inflation and/ or manual vacuum thrombus  aspiration until stable TIMI grade  3 blood   flow  was achieved,  at control  CAG on day 5-6  in 36 people  the stent was not implanted due to insignificance of infarct-related coronary  artery stenosis (stenosis less than 50% according  to QCA). Immediate stent implantation was performed  in 78 patients (group 2). The primary endpoint  was  the incidence  of adverse cardiovascular events, including total mortality, recurrent myocardial infarction, repeated revascularization of the infarct-responsive  artery. Secondary  endpoint: frequency of achieving optimal myocardial perfusion as  measured by  angiography – TIMI blood flow and Myocardial Blush Grade.

Results. The median follow-up  period  was  47  months.  The incidence  of the primary end point (MACE) was 15,8%  in group 1 and 23,1%  in group 2, with no  statistically significant difference  (p=0,408).   Overall mortality (10,5% and 11,7%),  the rate of repeat myocardial infarction (2,6%  and 5,1%),  and the rate of repeat target vessel revascularization (2,6%  and 6,4%)  were without significant advantage between subgroups.  Optimal reperfusion (TIMI-3 and Myocardial Blush Grade 2-3  after primary procedure  was achieved  in significantly (p=0,02)  more patients in group 1 (89%)  than in group 2 (69,2%)  ST segment resolution ≥70% after intervention was achieved in 87%  of cases  in group 1 and in 64,1%  of cases in group 2 (p=0,011).

Conclusion. In STEMI patients  with massive coronary thrombosis, the method of delayed percutaneous  intervention increases  the rate of achieving optimal blood flow  and allows  avoiding  stent implantation in the infarct-related artery in 50% of cases as compared to the method of immediate stenting. Both methods have comparable hospital and five-year clinical risks.

In the complex pathogenesis of idiopathic  pulmonary  arterial hypertension (IPAH), which includes changes  in biochemical  and  biophysical  processes in various cell  types  as  the cause  of structural and  functional  impairment, inflammation and thrombosis  of the pulmonary vessels,  hypoxia also plays an important role due to conformational changes  in hemoglobin  molecules  with changes  in their structure and oxygen  transport function impairment.

Aim: Using the method of Raman (Raman scattering) spectroscopy,  to study changes  in the conformation  and ability of hemoglobin  (Hb) to bind oxygen  in blood erythrocytes from the cubital vein in IPAH patients and healthy people. Materials and methods:  The study included 39 patients with newly diagnosed IPAH with functional  class  I – 2 patients, II – 13 patients, III – 22 patients, IV – 2 patients.  15 patients were treatment naive. In 24 patients a “washout” period of trial therapy was conducted  for 5–7 days. The control group included 10 healthy volunteers.

Results: It  was  established  that the  Raman  spectra  of Hb  of whole  blood erythrocytes and isolated red blood cells (RBC) of IPAH patients have significant differences  from the control  group.  The IPAH group  was characterized  by an increase  in the probability of finding heme in a «dome-shaped  form», which is typical for the deoxygenated  form of Hb, changes  in the conformation  of globin  and the porphyrin macrocycle   were revealed. A significant role in the change in the oxygen-transport function of Hb in IPAH was played  by a change in the conformation  of membrane-bound hemoglobin, which was characterized by an increase in the contribution of symmetrical vibrations of pyrrole rings in hemoporphyrin  relative to the control,  which required further study. Probably, the reason  for the decrease  in the ability of the oxygen  transport function of membrane-bound hemoglobin was the decrease  in the efficiency of electrostatic interaction  with the  protein  of band 3. In clinical case  positive  changes  in spectroscopy  parameters were shown in IPAH patient with the effective  use of selexipag.

Conclusions: For the first time, the possibility  of using a non-invasive method of Raman spectroscopy  to study changes in the oxygen transport function of erythrocytes in IPAH patients has been  proven,  which  can serve  as an additional method in the diagnostic algorithm of this disease.

Background. Septal myectomy  is currently the «gold» standard of surgical treatment  of patients with obstructive  hypertrophic  cardiomyopathy.  In some  cases,  isolated septal myectomy does  not eliminate SAM-induced mitral insufficiency.  Cardiac surgeons  sometimes  perform  combined interventions  on the mitral valve,  such  as  «edge-to-edge» mitral  valve repair.

Aim. Evaluation of the safety and efficacy of combined edge-to-edge  mitral valve repair in septal myectomy  compared  with isolated septal myectomy.

Methods. Recruitment to the study was carried out for the period  from 2019  to 2022  at the Meshalkin National Medical Research  Center of the Ministry of Health of Russia. Twenty patients was performed  combined «edge-to-edge» mitral valve repair with septal myectomy,  20 patients with isolated myectomy were included in the control group. The study assessed immediate and mid-term results after 12 months.

Results. Combined edge-to-edge mitral valve repair demonstrates   better intraoperative efficacy  compared  with isolated  septal myectomy  (95,0% versus  50,0%,  p=0,001),  but is  accompanied  by  increased  transmitral peak (6,8±2,1 vs 4,9±3,2 mmHg, p=0,03) and medium (3,4±1,4 vs 2,5±1,7 mmHg, p=0,05)  gradients. Both techniques are associated  with a low level of hospital mortality and complications  in the early postoperative  period, high survival after 12 months.

Conclusion. Combined mitral valve  repair  using  the  «edge-to-edge» technique is comparable safe to isolated myectomy, but better eliminates SAM-induced  mitral insufficiency.  «Edge-to-edge» mitral valve  repair is characterized  by increased  transmitral gradients.

Objective:  study of the relationship between  arterial hypertension  and arterial stiffness  in women  to identify potential markers of target organ damage and therapeutic targets of antihypertensive therapy.

Materials  and methods: the study involved 161 women who were divided into three groups depending on age and reproductive function. Group 1 consisted of 52 women  aged 18 to 30; group 2 – 54 women  aged 31 years before menopause; 3rd group – 55 women in the postmenopausal period. All women were questioned,  clinical examination, determination of anthropometric data, measurement of carotid-femoral pulse wave velocity, determination of arterial stiffness by volumetric sphygmography, 24-hour blood  pressure monitoring with assessment of aortic stiffness and characteristics of the central pulse wave.

Results: 24-hour blood pressure monitoring revealed arterial hypertension  in 38 (34,8%)  women: 15 (27,8%)  women in the 2nd group and 23 (41,8%)  women in the 3rd group. Correlation analysis revealed the most significant correlations between  the presence  of arterial hypertension (R=0,45-0,71;   p<<0,01)  with central aortic pressure, double product index and average daily aortic pulse wave velocity  in the aorta (PWVao),  regardless  of the state reproductive  function. For women  of reproductive  age  with arterial hypertension,  the  ambulatory vascular stiffness  index (AASI: R=0,36;  p=0,01)  is more  significant, while in the  menopausal period, the  arterial stiffness  index  (ASI:  R=0,33;  p=0,01). Correlation analysis did not reveal significant relationships  between  carotid-femoral pulse wave velocity and cardio-ankle  vascular index (CAVI) with arterial hypertension in women  of the 2nd and 3rd groups.  The relationship between carotid-femoral  pulse wave velocity and arterial hypertension  in women  was confirmed by analysis of variance (p=0,007).

Conclusion: Central aortic  pressure,   carotid-femoral   pulse  wave  velocity, AASI, ASI, PWVao  – direct and indirect indicators  of arterial stiffness  – are interconnected   with  the  presence   of arterial  hypertension   in  women   of reproductive and menopausal age. In this regard, these indicators  are potential markers of target organ damage  in arterial hypertension.

Purpose: to assess the state of mitochondrial membrane potential of blood leukocytes in acute coronary syndrome (ACS) depending on the presence and absence  of type 2 diabetes mellitus (T2DM).

Material and Methods. The study involved 100 people hospitalized at the regional vascular center (RCC) of the Vladivostok  Clinical Hospital No. 1 with a diagnosis  of ACS, aged 35 to 65 years. The control group consisted of 30 apparently healthy volunteers of the same age and sex. At the time of admission,  all patients underwent  studies  for  the diagnosis  of ACS, including an assessment  of the content of troponin I (TrI),  and  the  marker of the precursor  of the cerebral  natriuretic peptide  (NTproBNP) and the membrane  potential of mitochondria  (MPM)  of blood  leukocytes were determined.

Results. Indicators  of the state MMP made  it possible to assess the content of dead and living cells in the blood  of the examined persons.  An increase in non-viable  leukocytes  in the blood  patients with all types of ACS, including myocardial  infarction (MI)  and  unstable  angina  (UA),  was  established. A direct relationship was  found  between  the increase  in the number  of these cells and the content of TrI in MI and a direct  relationship  between it and NTproBNP both  in MI and NS. In patients with ACS, no  significant difference was found between the MMP values of leukocytes depending on the presence of T2DM.

Conclusion. An increase  in the MPMP of blood  leukocytes  in patients accompanies of the redox  balance  disturbance  in ACS. The established relationship between  MPMP indices  in MI and the content  of TrI can  be considered as a confirming fact of the participation of cells with mitochondrial dysfunction in the development of ischemic necrosis. The found relationship between  the increase  in blood  leukocyte  MPMP in patients with ACS and the level of NTproBNP indicates  a certain contribution  of mitochondrial dysfunction of leukocytes to the development of myocardial remodeling, regardless of the clinical form of ACS and the presence of DM2.

The  review  outlines  modern  concepts   of the  relevance  of fixed-dose combination therapy comprising  angiotensin-converting enzyme inhibitor and dihydropyridine calcium  channel  antagonist  as  an antihypertensive component  with the HMG-CoA reductase  inhibitor when treating hypertensive patients. We have identified the realms of its possible  clinical use taking into consideration  the comorbidity  peculiarities. In addition, we provide main features of the current drugs’ clinical pharmacodynamics  and outline their role in real clinical practice.  Nevertheless  the emphasis  was placed on the modern single-pill combination  of amlodipin, atorvastatin and perindopril. We concisely  report the results data collected  from the large, randomized, double-blind major clinical trials regarding the effectiveness of single pill combination  of amlodipine,  atorvastatin and perindopril , primary focusing  on their cardioprotective  features and overall safety profile.

Cardiovascular diseases  are one of the most common  causes of death in both developing and developed countries of the world. Despite the improvement in primary prevention, the prevalence of cardiovascular diseases has continued to grow  in recent years. Therefore, it is extremely important both to study the  molecular  pathophysiology   of cardiovascular   diseases   in  depth  and to find new  methods  for early and appropriate prevention, diagnosis  and treatment of these diseases.  In the last decade,  a large amount of research has focused on the study of microRNAs as potential diagnostic biomarkers, as well as their role in the treatment of cardiovascular diseases. microRNAs are endogenous   small (21-23  nucleotides)  ribonucleotides  involved in the regulation  of protein synthesis  from  amino  acids  based  on matrix  RNA. microRNAs  are involved in the regulation of the expression  of the majority (>60%)  of genes encoding  proteins, mainly due to its suppression, modulate numerous  signaling  pathways and  cellular processes   and  participate in intercellular communication. Along with this, the important role of microRNAs in the cardiovascular system has been proven: participation in the regulation of processes such as angiogenesis, contractility of heart cells, control of lipid metabolism, the rate of fibrosis and atherosclerosis,  which makes it possible to use microRNAs as therapeutic agents. Thus, the article considers  the issue of the availability of several approaches  to treatment involving microRNAs: overexpression of exogenous  microRNAs to reduce the expression of genes with undesirable properties, overexpression  of microRNA inhibitors, the use of «false»  microRNAs or «sponges» that act as competitive  inhibitors. The use of viruses with a positive (semantic)  RNA chain resembling endogenous mRNAs is also considered.

The author pays special attention to the important role of microRNAs in a number of cardiovascular diseases:  microRNA-based  therapy has been demonstrated in the treatment of diseases  such as heart failure, dyslipidemia, acute coronary syndrome,  arterial hypertension,  as well as arterial hypertension caused  by OSA. Studies proving the positive effect of microRNAs on slowing down the development of atherosclerosis  are considered,  which may allow them to be used as new therapeutic agents that can lead to optimization of approaches  to the treatment of cardiovascular  diseases.  Particularly active is the development of drugs based on RNA interference  (RNAi), which  use  recently discovered pathways of endogenous  short interfering RNAs and become  universal tools for  effective  suppression  of protein  expression.   Thus,  the  use  of certain drugs  based  on RNA interference in a number of clinical studies has shown a significant decrease  in the level of non-HDL cholesterol  and triglycerides in the treatment of dyslipidemia  and NT-proBNP  in the treatment of hereditary transtyretin amyloidosis.   This  article  touches   upon  the  issue  of such  an important problem  as  myocardial  infarction. Thus, hypertrophy and fibrosis of the heart significantly contribute  to thickening and increasing  the rigidity of the ventricular walls, leading to remodeling  of the heart and worsening  the prognosis. For this purpose, a biocompatible patch with microneedles (MI) with antifibrotic activity based on microRNA can be used to prevent excessive  cardiac fibrosis after myocardial infarction. Summarizing the above, it is certainly  worth noting that this problem  has been  little studied and requires  further research. Identifying a safe and effective strategy for microRNA-based therapy remains a difficult task, but the new approaches  considered  have enormous  potential for the treatment of cardiovascular  diseases.

Diagnosis  of myocarditis   remains  one of the  most difficult  clinical problems  in cardiology.  In connection  with the coronavirus  infection COVID-19 caused by the acute respiratory virus SARS-CoV-2,  non-invasive diagnosis of myocarditis  is an urgent task. The most  informative method for  diagnosing  myocarditis  is  magnetic  resonance  imaging  [1,2]. The arsenal of MRI includes  a number of pulse sequences that make it possible to identify and evaluate the process  of inflammation in its various phases. Various pulse sequences  (T2-weighted images  or T2-mapping, delayed contrast, T1-mapping) allow not only to diagnose the disease, but also to determine  the stages  of damage.  The ability of MRI to differentiate ischemic and non-ischemic  lesions [3] is used in emergency cardiology for various myocardial injuries.

The peculiarity of this clinical case  is the use of MRI diagnostics  in a patient with a typical clinical picture of acute coronary syndrome  in the emergency department of cardiology. The data of the contrast MRI of the heart allowed the patient to make the correct diagnosis.