This consensus document summarizes the current role of cardiovascular magnetic resonance (CMR) in contemporary cardiology practice. It integrates the latest evidence, international guideline recommendations, and practical experience regarding the use of CMR in the diagnosis and management of the most common cardiovascular diseases. Particular attention is given to the appropriate clinical indications for CMR, standardized imaging protocols, interpretation of imaging findings, and their impact on clinical decision-making and patient outcomes. The document reviews the application of CMR in ischemic heart disease, cardiomyopathies, myocarditis, inflammatory heart diseases, cardiac tumors, cardio-oncology, and congenital heart disease. Modern techniques for myocardial tissue characterization, including late gadolinium enhancement and parametric mapping, are discussed as essential tools for the non-invasive assessment of myocardial fibrosis, inflammation, infiltration, and viability. Special emphasis is placed on the practical use of CMR in complex clinical scenarios where imaging findings directly influence diagnosis, risk stratification, and therapeutic strategy. This consensus is primarily intended for practicing cardiologists but will also be of value to radiologists, cardiac surgeons, cardiovascular imaging specialists, and other healthcare professionals involved in the care of patients with cardiovascular disease. The authors hope that this document will promote the appropriate and wider implementation of CMR in routine clinical practice, ultimately improving diagnostic accuracy, patient management, and clinical outcomes.

The Objective of the study was to describe the effect of the single-pill combination (SPC) of amlodipine/atorvastatin/perindopril on cardiovascular (CV) risk calculated by SCORE scale in terms of 12-week observational study TARGET

Material and methods. One hundred and three patients out of 409 ambulatory patients with arterial hypertension (HTN) and dyslipidemia from the TARGET study (NCT03722524) were included in the post-hoc analysis. Those patients had no atherosclerotic cardiovascular diseases (ASCVD), diabetes mellitus, chronic kidney disease or family heterozygous hypercholesterolemia, so their CV risk could be calculated by SCORE scale according to the Russian clinical recommendations on HTN from 2020. Patients were treated with the SPC of amlodipine/atorvastatin/perindopril in dosage strength 5/10/5, 5/20/5 or 5/20/10 mg once daily. Assessment by SCORE scale took place on the baseline visit (Visit 0), on the 4-th (Visit 1) and 12 th weeks of the observation period (Visit 2). Uniand multivariate regression models were used to define significant predictors of CV risk change according to SCORE scale.

Results. Median age of the patients was 55.0 (50.5–60.0) years, men and women were equally represented, while 81.6% of the patients were overweight/obese and 64.1% smoked. The objective calculation and physicians’ evaluation of the SCORE risk coincided only in 21.6% cases on the Visit and in 52.9% on the Visit 2. Median CV risk assessed by SCORE decreased from 4.6 (1.7–8.6) at baseline visit to 2.6 (0.8–4.7) by week 4 and to 1.7 (0.7–3.6) by week 12 (both р<0.0001) during treatment with the SPC amlodipine/atorvastatin/perindopril. CV risk decrease was observed in all subgroups of patients regardless of the SPC dosage without any significant intergroup differences. The proportion of patients with low/moderate CV risk increased from 50.9% to 94.1% by the end of the follow-up period. Only achievement of the target blood pressure (BP) level of <140/90 mm Hg by Visit 2 was significantly associated with CV risk decrease in terms of multifactorial regression model.

Conclusion. Treatment with the SPC of amlodipine/atorvastatin/perindopril was accompanied by significant decrease of CV risk assessed by SCORE already by week 4 aintaining the effect by week 12 of the follow-up period in patients without ASCVD regardless of the SPC dosage. CV risk descrease was significantly associated with target BP achievement of <140/90 mm Hg which highlights the key role of BP control in the overall strategy of CV risk mitigation and demonstrates potential advantages of this multitarget polypill in real clinical practice.

Objective. To evaluate the efficacy and safety of the non-immunogenic staphylokinase in patients with ST-segment elevation myocardial infarction (STEMI) in routine clinical practice at the vascular center of Sergiev Posad district hospital.

Materials and Methods. A single-center, prospective, non-interventional observational study (registry) was conducted from January 2021 to March 2025. The registry included patients diagnosed with STEMI who received the nonimmunogenic staphylokinase (Fortelyzin®, SuperGene LLC, Russia) at a dose of 15 mg as a single intravenous bolus. The primary efficacy endpoint was the restoration of coronary blood flow, as assessed by ECG, at 90 minutes. Safety was assessed by the incidence of the following adverse events during hospitalization: death from all causes, cardiogenic shock, recurrent myocardial infarction, lifethreatening arrhythmias, episodes of heart failure decompensation, ischemic stroke, and intracranial hemorrhage. All procedures were carried out in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP).

Results. From January 1, 2021, to March 31, 2025, the registry enrolled 258 patients with STEMI; the mean age was 63.2±11.9 years. 98.4% of patients received thrombolysis at the pre-hospital stage. According to ECG data, reperfusion within 90 minutes was achieved in 75.2% of patients. Percutaneous coronary intervention (PCI) was performed in 98.1% of patients following thrombolysis. One patient (0.4%), aged 68, experienced an intracranial hemorrhage and subsequently died. Pre-hospital mortality was 1.2%; all deceased patients showed no signs of reperfusion. In-hospital mortality was 2.0%. Reperfusion arrhythmia was observed in two patients (0.8%), while cardiogenic shock and worsening heart failure were noted in one patient (0.4%).

Conclusion. The obtained data confirmed the efficacy and safety of the nonimmunogenic staphylokinase in routine clinical practice within the setting of a vascular center.

Objective. To analyze the dynamics of coronary physiology indices — fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) — in the infarct-related artery (IRA) and non-infarct-related artery (non-IRA) during the first 24 hours of ST-segment elevation myocardial infarction (STEMI) and in the early postinfarction period, and to assess their dependence on the presence of microvascular obstruction (MVO) in the infarct zone as determined by contrast-enhanced cardiac magnetic resonance imaging (MRI).

Materials and methods. FFR and iFR were measured in the IRA and non-IRA after primary percutaneous coronary intervention (pPCI) on the IRA in patients with STEMI and at least one 50–85% stenosis in a non-IRA. Papaverine was used to induce hyperemia for FFR assessment. Cardiac MRI was performed on days 3–5 to evaluate the presence and extent of MVO in the infarct zone. Repeated coronary angiography with FFR and iFR measurement was performed at 30–45 days; based on the results, non-IRA stenting was performed when FFR ≤ 0.80 and/or iFR ≤ 0.89. To achieve the study objective, the dynamics of coronary physiology indices in the IRA and non-IRA were assessed in the overall cohort and in subgroups with and without MVO on MRI. Statistical analysis included the Wilcoxon signed-rank test, the Mann–Whitney U test, and Spearman's correlation.

Results. Thirty-two patients were enrolled. MVO was detected in 13 patients (40.6%). No statistically significant changes in FFR or iFR between the index procedure and repeated assessment were found in either the IRA or the non-IRA (p=0.856 and 0.597 for FFR, p=0.092 and 0.511 for iFR, in the IRA and non-IRA, respectively). The presence of MVO with an extent of 2.47% [0.66%; 5.06%] was not associated with significant differences in FFR or iFR dynamics (p=0.488 (FFR), p=0.089 (iFR) in the IRA; p=0.460 (FFR) and 0.144 (iFR) in the non-IRA). MVO extent of 2.47% [0.66%; 5.06%] did not correlate with changes in FFR or iFR in either the IRA or the non-IRA (the most pronounced trend was observed for ΔiFR in the IRA: ρ=−0.529, p=0.063). Categorical classification stability was 92.0% for FFR and 86.0% for iFR.

Conclusion. In hemodynamically stable patients with STEMI and intermediate nonIRA stenoses, FFR and iFR values in both the non-IRA and the IRA after pPCI remain stable during the first 24 hours of MI and in the early postinfarction period. Coronary physiology indices (FFR, iFR) can be used for decision-making regarding non-IRA PCI during the index procedure. In patients with STEMI with a median ejection fraction of 52.5% [49.75%; 58.25%] and MVO extent of 2.47% [0.66%; 5.06%], the presence of MVO did not distort the reproducibility of FFR and iFR measurements in the non-IRA and IRA after pPCI.

Introduction. The widespread use of cardiac implantable electronic devices (CIEDs) has led to a natural increase in the number of patients requiring transvenous lead extraction (TLE) due to infectious complications and system dysfunction. Despite refined techniques, TLE remains a procedure with a risk of life-threatening complications, such as cardiac perforation or major vein rupture, with an associated mortality rate of up to 50%. Several predictive risk scores (MB Score, LED Score, SAFeTY Score, EROS) have been proposed for risk stratification; however, there is no unified consensus regarding their applicability, diagnostic value, or the most significant predictors.

Objective. To conduct a comparative analysis of the prognostic value of existing risk scores (MB Score, LED Score, SAFeTY Score, EROS) and to identify independent predictors of major intraoperative complications during transvenous lead extraction (TLE).

Materials and Methods. A multicenter retrospective study included 300 patients who underwent TLE between 2019 and 2023. All patients underwent preoperative risk stratification using four prognostic risk scores. Statistical analysis included correlation analysis (Spearman's coefficient) and ROC analysis. To assess the independent effect of predictors on the development of major complications, binary logistic regression with forward stepwise selection was used.

Results. Major complications were recorded in 11 (3.7%) patients. A statistically significant positive correlation was found between the development of complications and scores on the MB Score (r=0.156; p=0.007), LED Score (r=0.155; p=0.007), and SAFeTY Score (r=0.13; p=0.024), and EROS Score (r=0.134; p=0.021). ROC analysis demonstrated that the MB Score (AUC 0.737; p=0.008) and LED Score (AUC 0.739; p=0.007) had the best diagnostic performance; SAFeTY Score showed moderate predictive quality (AUC 0.699; p=0.025), while EROS Score showed borderline statistical significance (AUC 0.673; p=0.051). ROC analysis identified additional factors associated with complications: lead age > 126 months, infection duration > 4.5 months, eGFR < 73 mL/min, female sex, diabetes mellitus, passive lead fixation, and the presence of cut or fractured leads. In stepwise logistic regression of the four risk scores, only LED Score was included in the final model (OR=1.087; 95% CI: 1.019–1.159; p=0.011). When the additional factors were tested in the multivariate model, only infection duration > 4.5 months retained independent significance (OR=4.114; 95% CI: 1.120–15.109; p=0.033). Female sex showed a trend toward significance (p=0.056). The remaining factors lost their prognostic significance after adjustment.

Conclusion: TLE is a safe and effective method with a major complication rate of 3.7%. LED Score is the most informative prognostic scale, and infection duration > 4.5 months is an additional independent predictor of complications, supporting the need for timely referral of patients for surgical treatment. Consideration of these factors improves perioperative risk stratification and optimizes the choice of surgical strategy.

This review summarizes current evidence on the role of arterial hypertension, chronic inflammation, and metabolic disorders in vascular and cognitive aging and their relevance to active longevity. The major pathophysiological mechanisms of age-related vascular damage are discussed, including endothelial dysfunction, increased arterial stiffness, chronic low-grade inflammation (inflammaging), metabolic inflammation (metaflammation), impaired cerebral perfusion, and neurovascular dysfunction. Current approaches to the management of modifiable risk factors and the potential role of antihypertensive, cardio- and angioprotective, and metabolic therapies are analyzed. Particular attention is given to the relationship between arterial hypertension and cognitive impairment. Randomized trial evidence suggests that intensive blood pressure control may reduce the risk of mild cognitive impairment, whereas its effect on dementia prevention remains less certain and requires further investigation. The importance of individualized therapeutic targets in older adults is emphasized, taking into account cognitive and functional status, renal function, and frailty. Overall, the available evidence supports comprehensive cardiovascular and metabolic risk management as a key strategy for preventing premature vascular and cognitive aging and preserving functional independence.

Introduction. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common paroxysmal supraventricular arrhythmia in adults, accounting for up to 60% of all supraventricular tachyarrhythmias (SVT). The first-line treatment for symptomatic recurrent AVNRT is catheter ablation (CA). Performance of CA with zero-fluoroscopy (ZF) using three-dimensional (3D) electroanatomical mapping systems is both possible and safe.

Brief description. This article presents a clinical case of successful catheter ablation of right atrial supraventricular tachycardias (AVNRT and atrial tachycardia (AT) originating from the crista terminalis). All stages of the procedure were performed using CARTO 3D electroanatomical mapping (Biosense Webster Inc., USA) with a QDOT MICRO irrigated ablation mapping electrode (Biosense Webster Inc., USA) under (ZF). The first stage involved ablation of the slow pathways of the atrioventricular junction. The second stage involved ablation of a AT wave with a cycle duration (cd) of 456 ms and a right-sided activation front. We made a voltage and activation map of the right atrium, taking into account the morphology and activation pattern of the atrial component along the coronary sinus and the right atrium. Analysis of the activation map shows that the early activation zone on the SVT with a depolarisation time of 456 ms is located in the middle third of the crista terminalis. In this zone, areas of fibrotic changes in the myocardium are recorded according to the voltage map. A series of RF ablations was performed in the zone of interest, with the AT stopped at the moment of ablation, the ECG showed sustained sinus tachycardia at 92 beats per minute.

Discussion. Three-dimensional electroanatomical mapping systems enable the creation of a «digital» twin of the patient’s heart, which allows for the accurate reproduction of the interrelationships between the heart’s anatomical structures. According to the findings of a number of studies and as demonstrated by our clinical case, there is no evidence to support the benefits of performing catheter ablation of right atrial SVTs under constant fluoroscopy.

Conclusion. According to the findings of a number of studies and as demonstrated by our clinical case, there is no rationale for performing catheter ablation of right atrial supraventricular tachycardia under constant fluoroscopy.

Pulmonary embolism (PE) is a leading cause of cardiovascular mortality. PE frequently complicates the postoperative course and may account for up to 0.46% of all surgical procedures. Cancer patients are at particular risk of developing postoperative PE. Among all patients with PE, approximately 5% are classified as high risk. Management of high risk postoperative PE is challenging, as it requires thrombolytic therapy, which carries an extremely high risk of hemorrhagic complications and is considered a relative contraindication. Importantly, 8% of patients with PE may experience recurrent obstructive shock following thrombolytic therapy.
The 2019 European Society of Cardiology guidelines for the management of PE recommend considering alternative reperfusion strategies — catheter directed thrombolysis or surgical embolectomy — in cases of failed thrombolysis or recurrent PE; however, their use is contingent upon the immediate availability of a specialized team and equipment. When other reperfusion modalities are not feasible, repeat administration of a thrombolytic agent may be considered. This strategy is currently not standardized and is not included in existing clinical guidelines; nevertheless, in clinical practice, it is used as rescue thrombolysis in patients with persistent or recurrent hemodynamic instability. Data on its efficacy and safety remain limited and are derived predominantly from case reports and small case series.
Herein, we present a clinical case of a 63 year old patient who developed high risk PE on the third day after abdominal surgery. Systemic thrombolysis with non immunogenic staphylokinase was performed, resulting in transient hemodynamic stabilization. Subsequently, the patient's condition deteriorated again with the development of obstructive shock, which was interpreted as recurrent PE. A second systemic thrombolysis with non immunogenic staphylokinase was administered, after which sustained hemodynamic stabilization, resolution of respiratory failure, and improvement in gas exchange were achieved.
This clinical case is one of the first to demonstrate the feasibility of repeat thrombolytic therapy in patients with recurrent high risk PE in the early postoperative period.