The aim of this guideline is to assist physicians in the management of patients with cardiovascular pathology and obstructive sleep-disordered breathing.

   The article consists data on diagnostic tactics for patients with possible sleep-breathing disorders, describes the basic principles of obstructive sleep apnea treatment, and substantiates the clinical significance of obstructive sleep apnea therapy initiating in the management of patients with cardiovascular diseases.

   Introduction. Modern clinical guidelines for heart failure consider a comprehensive approach to treatment using implantation of various devices (cardiac resynchronisation therapy CRT, implantation of cardioverter-defibrillator (ICD), installation of pacemakers (ECS) as well as correction of valve defects. For example, for treatment of severe mitral valve insufficiency the technique of clipping its flaps using MitraClip system is used.

   Objective. To evaluate the effect of mitral valve intervention with the help of MitraClip on the course of chronic heart failure (CHF) in patients with implanted devices.

   Materials and Methods. 73 patients with mitral regurgitation of 3-4 degree, heart failure of II-IV NYHA functional class who underwent implantation of MitraClip system on mitral valve flaps were included in the study. The dynamics of EchoCG parameters, exercise tolerance, diuretic therapy and brain natriuretic pro-peptide level was evaluated during six months. The comparison of the results of follow-up of the group of patients who had previously been fitted with ECS, ICD, CRT (group A) with the data of patients without implanted devices (group B) was carried out.

   Results. Clinical improvement of the course of CCN occurred after 6 months in both observation groups. The mean functional class (FC) of CHF decreased in group A from 2.67 ± 0.8 to 1.81 ± 0.7 (p<0.001) and in group B from 2.72 ± 1.97 (p < 0.001) to 1.86 ± 0.6, exercise tolerance increased significantly (6-minute walk test distance values increased from 299 [178; 340] m to 390 [231.3; 420] m and 235.5 [182.8; 370.3] m (p = 0.04) to 362.3 [270; 412.7] m (p = 0.03), respectively. EchoCG analysis in both groups showed no dynamics of myocardial contractility. In group A there was an increase in stroke volume (SV) from 44 [37; 63] ml to 58.5 [49.5; 84.3] ml (p = 0.03) and a decrease in pulmonary artery pressure (PAP) from 44 [35; 62.5] mm Hg to 39 [29.8; 45] mm Hg (p = 0.02). In group B, in addition to an increase in SV from 57.5 [48.8; 65.3] ml to 61 [52; 74.5] ml (p = 0.03) and a decrease in PAP from 45 [36.5; 59.3] mm Hg to 32 [27.3; 43.5] mm Hg (p < 0.001), an increase in cardiac output (CO) from 4 [3.3; 4.8] L/min to 4.5 [3.6; 5.3] L/min (p = 0.04) and a significant decrease in left atrial and left ventricular dimensions and volumes were obtained.

   Conclusion. Application of the system of MC leaflet clipping for correction of severe MR leads to improvement of clinical condition in patients with CHF both with and without implanted devices. Absence of significant dynamics of heart chamber sizes and volumes according to EchoCG data in patients with implanted devices is most likely due to small sample size.

   Purpose of the study. To study the effect of prophylactic antibiotic therapy on the course of the postoperative period in patients undergoing endovascular closure of patent foramen ovale (PFO).

   Material and methods. The study included 276 patients who were submitted to endovascular closure of PFO. The follow-up duration was 12 months. Depending on prophylactic antibiotic therapy the patients were divided into 2 groups - those who did not receive and those who received prophylactic antibiotic therapy (115 and 161 patients, respectively).

   Results. Cephalosporins were prescribed to patients as prophylactic antibiotic therapy, and in the presence of allergic reactions they were replaced by glycopeptides. In total, patients received 1 to 2 drugs per prophylaxis course. Postoperative complications were present in 37 (22.98 %) patients who received prophylactic antibiotic therapy and 12 (10.43 %) who did not receive prophylaxis (p = 0.007). Access site complications were the most identified, but they were not inflammatory in nature. An elevation of body temperature over 37.1 °C was observed in 19 (11.80 %) patients receiving prophylactic antibiotic therapy compared to 5 (4.35 %) who did not receive prophylaxis (p = 0.03). Meanwhile, marked leukocytosis was absent in both groups. The duration of body temperature elevation did not differ between the groups. They also had a longer duration of hospitalization, 7.00 [6.00; 8.00] bed days, compared to 6.00 [4.00; 7.00].

   Discussion. It has been suggested that hyperthermia may be associated with prophylactic administration of antibacterial drugs causing death of persistent microflora. In patients who did not receive prophylactic antibiotic therapy, their concentration was lower, which did not lead to an increase in body temperature. Since there are no indications on the necessity of prophylactic antibiotic therapy before endovascular closure of PFO in clinical recommendations, it is suggested to evaluate its appropriateness for each patient individually.

   Objective: to perform a comprehensive analysis of the clinical, functional and hemodynamic status of patients with idiopathic pulmonary hypertension (IPAH) to compare the "portrait" of historical and modern subgroups.

   Materials and methods. The study included 120 patients with IPAH observed in the Department of Pulmonary Hypertension and Heart Diseases, E.I. Chazov National Medical Research Center of Cardiology. The pts were divided into 2 subgroups depending on the time of diagnosis and were comparable in terms of the initial functional class (WHO). A comparative analysis of clinical, functional, and hemodynamic parameters was carried out. The diagnosis was established according to the algorithm of the Eurasian (2019) and Russian guidelines for the diagnosis and treatment of pulmonary hypertension (PH) (2020).

   Results. The median time from the onset of PH symptoms to diagnosis in the historical and modern cohorts was 24 months and 13.5 months, respectively, and from the first visit to the diagnosis of IPAH – 13 months and 3.5 months. The median age of patients was 31 years and 40.5 years. In both subgroups, the number of women dominated – up to 86.6 % of patients in the modern cohort. Clinical, laboratory, functional and instrumental tests did not differ significantly between the subgroups. In the structure of concomitant pathology, comorbidity with cardiovascular pathology is most common, in a larger percentage in the modern cohort of patients: hypertension – up to 31.6 %, obesity – up to 25 % and diabetes mellitus – up to 5 %. According to various risk assessment scales, most patients in both subgroups demonstrated intermediate risk at the time of diagnosis, but in the modern cohort, a large proportion of high-risk patients was noted (20.0 %).

   Conclusion. Nowadays, IPAH remains a late-diagnosed disease, which contributes to a later treatment prescription. The clinical "portrait" of patients with IPAH has changed over the years towards older and more comorbid patients, especially with cardiovascular diseases. Timely detection and treatment of concomitant pathology, timely risk assessment are the key to prescribing the most effective treatment regimens, improving the quality of life and prognosis of patients with IPAH.

   Introduction. Cardiac conduction disturbances with the subsequent need for pacemaker implantation are a major clinical problem in the postoperative period of transcatheter aortic valve implantation (TAVI).

   The aim of the study. To develop multifactorial models for predicting the risk of developing cardiac conduction disturbances and pacemaker implantation after TAVI in the early postoperative period on a "training" sample of patients with an assessment of the diagnostic accuracy of the developed model on a "control" sample of patients.

   Material and methods. The study included 337 patients with severe or critical aortic stenosis who underwent TAVI from 2021 to 2022 in the laboratory of hybrid methods in the Department of cardiovascular surgery, Chazov National Medical Research Center, Ministry of Health of the Russian Federation

   Results. In constructing a model for predicting new (not registered before the operation) cardiac conduction disturbances after TAVI, the most significant predictors were: intraventricular conduction disturbances, the size of the aortic root, and the end-diastolic size of the left ventricle. The quality indicators of the model: AUC 0.711 (95 % CI: 0.644-0.778), sensitivity 77.7 % (95 % CI: 67.9-85.6), specificity 56.6 % (95 % CI: 47.8-65.1), PPV 55.3% (95 % CI: 46.5-67.9), NPV 78.5% (95 % CI: 69.1-84.0). Results of testing in the "control" sample: AUC 0.723 (95 % CI: 0.615-0.832). For the pacemaker implantation risk model predictors were: right bundle branch block, coronary heart disease and atrioventricular conduction disturbances. Model quality indicators: AUC 0.789 (95 % CI: 0.683-0.894), sensitivity 94.1 % (95% CI: 71.3-99.8), specificity 53.9 % (95 % CI: 47.0-60.7), PPV 13.8 % (95% CI: 10.8-87.0), NPV 99.2 % (95 % CI: 94.7-99.4). Results of verification on the control sample: AUC 0.795 (95 % CI 0.664-0.925).

   Discussion. The proposed models can be used in practice to assess the risk of developing cardiac conduction disorders and pacemaker implantation in patients who are scheduled to TAVI.

   Many patients with non-ST elevation myocardial infarction have multivessel coronary artery disease, which complicates the course of the disease and is associated with fatal outcomes. Most patients with non-ST elevation myocardial infarction undergo coronary angiography and revascularization during initial hospitalization. However, the decision to perform total or incomplete revascularization and whether to perform total revascularization on admission or at the stage of its implementation is complex and must be adapted to the age, general condition of the patient and comorbidities. Since
the majority of patients with non-STelevation myocardial infarction have multivessel disease, treatment and timing are critical components to ensure favorable outcomes. Early revascularization is associated with improved long-term patient outcomes, but the optimal approach to revascularization in patients with non-ST elevation myocardial infarction with multivessel disease remains poorly understood. However, in this patient population, a multidisciplinary cardiac approach is recommended to determine revascularization options. Published data suggest that evaluation of the risk-benefit associated with future invasive procedures should be based on an analysis of the patient's general condition and cardiovascular risk factors, the ability to identify the culprit artery, the technical feasibility of performing multivessel revascularization, and the location, degree of stenosis, and severity of lesions.Whether multivessel percutaneous coronary intervention or coronary artery bypass grafting provides better outcomes in patients with non-ST elevation myocardial infarction remains largely debatable. In this connection, it is relevant to conduct prospective studies to study the optimal revascularization strategies.

   Progress in the treatment of arrhythmias is associated with the development and implementation in clinical medicine of a number of electrophysiological methods that make it possible to determine and localize the formation and conduction of electrical excitation with a high degree of reliability. At the same time, an increase in the number of invasive procedures can lead to an increase in complications associated with the interventions, which in turn requires radiology specialists to understand the main stages of the intervention technique, and, accordingly, the mechanisms of development of possible complications and their localization.

   The purpose of the article is to present modern research data on the use of computed and magnetic resonance imaging in determining complications during interventional and surgical treatment of cardiac arrhythmias.

   Sudden cardiac death in young people in 20% of cases is caused by cardiomyopathies and channelopathies. One of the forms of channelopathies is Brugada syndrome, a hereditary disease characterized by ST segment elevation in the right precordial leads (V1-V3) and an increased risk of sudden cardiac death in the absence of structural heart disease. Brugada phenocopies are also known – clinical situations that are manifested by electrocardiogram (ECG) patterns identical to true Brugada syndrome. They are caused by different clinical circumstances and form a group of heterogeneous conditions that are often difficult to distinguish from true congenital Brugada syndrome due to identical ECG patterns. The formation of Brugada phenocopy due to hyperkalemia is presented in the literature in various conditions: with renal failure, after extensive trauma, application of medications. The article presents a case report demonstrating a rare cause of sudden cardiac arrest in a young patient without a history of cardiovascular pathology: the occurrence of the Brugada pattern on the ECG due to severe hyperkalemia in adrenal insufficiency. The stages of the differential diagnostic search are described, which made it possible to verify the final diagnosis and prescribe effective hormone replacement therapy. Performing a provocative test with novocanamide allowed us to confirm that the patient had a phenocopy, and not Brugada syndrome. Differential diagnosis of phenocopies of Brugada syndrome – a series of often life-threatening cardiac and non-cardiac diseases and conditions, manifested by similar ECG changes in the form of a peculiar ST segment elevation in leads V1-V3, is often a difficult task. This case represents a phenocopy of Brugada in the setting of severe hyperkalemia with development of cardiac arrest due to adrenal insufficiency, which resolved with correction of electrolyte abnormalities and treatment of the underlying disease. Typical ECGs are presented: a graph of the Brugada phenomenon, hyperkalemia, a sinusoidal curve during cardiac arrest, recorded over time in a patient, and the pathogenetic mechanisms causing the formation of the Brugada pattern in adrenal insufficiency are explained.

   Our observation demonstrates a case of a 40-year-old female with pulmonary arterial hypertension World Health Organization functional class III, who was admitted to NMRC of Cardiology repeatedly due to disease progression including dyspnea worsening, onset of desaturation and chest pain during exertion on riociguat (7.5 mg daily), bosentan (115 mg daily) and selexipag (400 mcg daily) therapy. Computed tomography scan revealed pulmonary capillary hemangiomatosis pattern and the diagnosis was revealed. We performed PAH-specific therapy escalation which resulted in selexipag withdrawal, bosentan dose titration to 250 mg daily with good treatment tolerability. Due to unreleased treatment goals, high-risk status and heart failure progression, the patient was referred to Shumakov National Medical Research Center of Transplantology and Artificial Organs, where successful heart lung transplant was performed in may 2022. The postoperative period elapsed without complication, the patient discharged from hospital and is staying alive in stable condition. Pulmonary capillary hemangiomatosis is a rare cause of pulmonary arterial hypertension with pure prognosis. PAH-specific treatment should be avoided due to increased risk of rapid disease progression and pulmonary oedema. The only one definitive treatment is lung or heart lung transplantation.

   The article (letter to the editor) presents current data on the prevalence of arterial hypertension and dyslipidemia according to domestic and foreign epidemiological studies. It is advisable for a clinical practitioner to consider these two leading cardiovascular pathologies (they are also the most common risk factors for the development and progression of atherosclerosis) together for further active correction with drug and non-drug methods of treatment. According to the studies presented in the article, the association of high blood pressure with the risk of myocardial infarction, stroke, heart failure, sudden cardiac death, atherosclerosis of peripheral arteries, chronic kidney disease, regardless of the age of patients with hypertension, is shown. There is no doubt about the positive effect of long-term maintenance of target blood pressure values in patients with an established diagnosis of arterial hypertension in relation to the prevention of cardiovascular complications.
At the same time, up to 40 % of patients with arterial hypertension are characterized by the presence of one or another type of dyslipidemia. The opinion was expressed about the legality of using the term "lipitension" in connection with the convenience of designating these two pathologies in the form of a single pro-atherogenic comorbidity. The article presents the opinion of a practicing cardiologist, which is the advisability of distinguishing the term "lipitension" (as a pathological-nosological combination (comorbidity) of two leading risk factors in the population of developed countries – arterial hypertension and dyslipidemia. Understanding the commonality of two key factors limiting the prognosis of patients with cardiovascular diseases allows the practitioner to more confidently, with pathogenetic justification, apply the polytablet strategy (containing lipid-lowering and antihypertensive components), which allows not only to achieve more effective control of blood pressure and lipid profile indicators, but also to improve the prognosis and quality of life of patients in the framework of primary and secondary prevention.

   This year Zakria Yakhyavich Rakhimov celebrates his 80^th birthday. Zakria Yakhyavich Rakhimov is a professor of the cardiology department with a course in clinical pharmacology at the State Educational Institution «Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan», chief cardiologist of the Ministry of Health and Social Protection of the Republic of Tajikistan, chairman of the Association of Cardiologists of Tajikistan, Honored Worker of the Republic of Tajikistan, chairman of the Therapeutic Drug Committ ee of the Ministry of Health and Social Protection of the Republic of Tajikistan, member of the Eurasian Association of Cardiologists.