The presence of coexisting chronic non-infectious diseases is associated with reduced quality of life and increased risk of early disability and mortality. The coexistence of two or more diseases in a patient is defined by the term polymorbidity. Currently, there is an increase in polymorbid pathology not only among elderly patients, but also among young and middle-aged people, which entails significant health care costs and has a negative impact on the economy of the country as a whole. Therefore, the problem of polymorbidity and the management of such patients in real clinical practice is urgent and key in the field of public health. According to major foreign and domestic studies, the most common polymorbidity phenotype is the cardiometabolic phenotype. Taking into account the fact that in our country almost every second patient with arterial hypertension has metabolic disorders and, therefore, polymorbid pathology, approaches to the management of such patients should be personalized already from the beginning of drug therapy. In this regard, this review reviews some key pathophysiological mechanisms of the relationship between arterial hypertension and metabolic disturbances occurring in patients with the cardiometabolic phenotype of polymorbidity, presents features of antihypertensive therapy in such patients, in particular, describes in more detail the class of beta-blockers with pathogenetic validity of use in this case. Also, a review of the available clinical trial data concerning the effects of the highly selective beta-adrenoblocker bisoprolol in patients with arterial hypertension is presented, emphasizing its effect on metabolic status and its importance for comprehensive clinical management.

Primary hyperaldosteronism is the leading cause of secondary arterial hypertension of adrenal origin. Its prevalence is underestimated. This leads to late diagnosis, although a timely diagnosis can achieve a complete cure for the patient, ensure control of blood pressure and avoid the development of complications. The article discusses the prevalence of primary hyperaldosteronism, its etiology and pathogenesis, the mechanisms of formation of autonomous secretion of aldosterone, including with the combined production of cortisol. The main clinical effects of aldosterone hypersecretion, its role in the formation of complications in the cardiovascular system and metabolic control are discussed. The assessment of the main clinical effects of aldosterone hypersecretion and its role in the formation of complications from the cardiovascular system and metabolic control is given. The authors remind about risk groups in which screening should be carried out, about the stages of a diagnostic search for suspected primary hyperaldosteronism. For the primary test, a preliminary assessment of the level of plasma potassium is necessary, and if hypokalemia is detected, its correction. If the result of the primary test is false negative, retesting will be carried out with the transfer of patients to antihypertensive drugs with minimal effect on the renin-angiotensinaldosterone system. It is important to remember that confirmatory sodium loading tests are contraindicated in some patients. Computed tomography with contrast in combination with selective venous blood sampling in patients are the most significant methods for the topical diagnosis of primary hyperaldosteronism. The choice of treatment method and its effectiveness depend on their results.

The article discusses the modern therapeutic approach to lowering blood triglyceride levels. The need to consider indications for the use of lipid-lowering therapy in patients with hypertriglyceridemia is caused by the emergence of new evidence-based information. The article describes how elevated blood TG levels are associated with the risk of developing cardiovascular (CV) complications, as well as pancreatitis. The mechanisms of TG metabolism that may regulate the relationship between elevated blood TG levels and the risk of developing CV complications are considered. The findings of large randomized clinical trials, including recent ones, which laid the foundation for the current clinical guidelines for the use of drugs to lower triglycerides levels, are discussed. Indications for fibrate therapy in patients with elevated blood TG levels in various clinical situations are considered. The article emphasizes that the icosapent ethyl ester drug is not currently available in the Russian Federation. According to the latest versions of international guidelines, it is considered a first-line drug to reduce the risk of developing CV complications in patients with an established diagnosis of CVD (i.e. for the purpose of secondary prevention). In this context, the significance of fenofibrate as a drug to lower blood triglyceride levels, specifically in secondary prevention of CV complications, can remain quite high in our country. The appearance of a rosuvastatin and fenofibrate combination drug on the pharmaceutical market of the Russian Federation will increase adherence to the therapy, if a fibrate is required to be added to statin therapy.

The article is devoted to the results of the subanalysis published after release of the AUGUSTUS trial. The most important conclusion of the parent trial is the evidence that weekly aspirin therapy is sufficient to prevent thrombotic complications in the majority of patients with AF and ACS, as well as those undergoing elective PCI, and that aspirin therapy can be extended up to 1 month after PCI only in a part of patients with additional risk factors for ischemic events and a low risk of bleeding. Four years have passed since the publication of the AUGUSTUS trial results, and all subsequent subanalyses of the trial confirmed its results. The safety and efficacy advantages of apixaban over warfarin were shown to be independent of renal function and consistent with the overall trial results. The advantages of apixaban and the association of aspirin with bleeding were similar in both stroke and non-stroke patients with AF and were dose-independent when a dose was reduced to 2.5 mg twice in accordance with the reduction criteria. The advantages of apixaban over warfarin lasted regardless of time spent in the therapeutic range in the warfarin group. The advantages of apixaban over warfarin and the association of long-term intake of aspirin with bleeding rates persisted in patients with high and low baseline risk of bleeding and stroke. All subanalyses of the AUGUSTUS trial confirmed the efficacy and safety of apixaban, as well as the option to discontinue aspirin at the outpatient stage in the majority of patients with AF, who underwent elective PCI or ACS.

Introduction. The clinical significance of atrial fibrillation (AF) is associated with the development of thromboembolic complications that occur when thrombus from the left atrial appendage enter the systemic circulation. Transesophageal echocardiography can detect the left atrial appendage thrombus, but due to lack of availability, high cost and complexity of performing such a routine examination is unlikely. Therefore, the search for predictors of the left atrial appendage thrombosis is relevant, the presence of which may become the basis for a more in-depth instrumental examination of patients with AF.

Aim. To identify predictors of atrial thrombosis in patients with persistent nonvalvular atrial fibrillation.

Materials and methods. The 551 patients with persistent nonvalvular atrial fibrillation underwent transesophageal echocardiography before cardioversion, thrombus in the left atrial appendage was detected in 74 (13.4%) patients. All patients were selected into training (400 people) and validation (151 people) cohorts randomly. Multivariate logistic regression analysis was performed to identify predictors of atrial thrombosis in the derivation cohort.

Results. Five factors influenced the atrial thrombosis independently. They are the ratio of the transmitral velocity to the mitral annulus early Diastolic velocity (E/e’) ≥ 12 (D), the absence or inadequate Anticoagulant therapy (A), atrial Fibrillation, not flutter (F), left atrial volume Index (I), and age ≥ 75 years (DAFI75 scale). The number of predictors corresponds the risk of detecting atrial thrombosis: the area under the characteristic curve was 0.818 (0.768–0.868) in the derivation cohort and 0.847 (0.761–0.934) in the validation cohort. The sensitivity of the DAFI75 criterion ≥ 3 in the derivation and validation cohorts is 91.7 and 92.9%, the specificity is 58.8 and 65.7%, the predictive value of a positive result is 28.2 and 21.7%, and the predictive value of a negative result is 97.6 and 98.9%.

Conclusion. The presence of three or more predictors score DAFI75 allows predicting the absence of atrial thrombosis more than in 97% of case.

Introduction. Combat trauma is one of the factors causing hemostasis disorders in the wounded. Currently, there is insufficient information about the significance of hereditary thrombophilia in the development of venous thromboembolic complications in the wounded.

Aim. To study the effect of polymorphism of genes of components of the hemostasis system on the development of venous thrombosis in wounded with combat trauma.

Materials and methods. The prospective study included men (n = 81) of young age (the average age was 36.0 ± 8.5 years) who received a combat wound and were treated at the Military Medical Academy named after S.M. Kirov. The subjects were divided into 2 groups: the main group included 40 victims (49.4%) who were diagnosed with venous thrombosis during treatment, the control group included 41 patients without signs of thrombosis (50.6%). The study of allelic polymorphism of genes associated with the formation of blood clots was carried out using a real-time polymerase chain reaction based on the study of human DNA in peripheral blood material.

Results. Comparative analysis revealed no statistically significant differences in the frequency of occurrence of the studied genetic variants between the study group and the control group. When assessing the prevalence of polymorphism of the MTHFR and MTRR genes, it was found that the combination of the genotypes “MTHFR 677 CT” and “MTRR 66 GG” is associated with an 8.5-fold increase in the risk of developing VTEO [OR = 8.5; p = 0.029].

Conclusion. Analysis of the test results showed that no relationship was found between individual genetic variants and the risk of developing venous thrombosis in the studied group of wounded despite the high prevalence (prothrombogenic alleles of various genes were detected in 79 servicemen (97.5%)). At the same time, the combination of MTHFR 677 CT and MTRR 66 GG genotypes in that patient population was shown to be associated with a significant increase in the risk of thrombosis.

There is a clear and specific bidirectional relationship between diabetes mellitus and cardiovascular disease. It is known that cardiovascular disease in patients with diabetes occurs 2–5 times more often than in people without diabetes. CVD itself, and it is cardiovascular outcomes, are the main cause of death in patients with diabetes mellitus, both in men and women. In diabetes mellitus, there is a high risk of coronary heart disease, myocardial infarction, arterial hypertension, and acute cerebrovascular accident, and patients with diabetes may experience painless acute myocardial infarction associated with the presence of autonomic cardiac neuropathy. Much more often in diabetes mellitus there are various rhythm disturbances, including paroxysmal forms of atrial fibrillation, which increase the risk of death by 1.8–2 times. Currently, numerous international clinical studies have convincingly demonstrated that improved glycemic control causes a significant reduction in the risk of late macroand microvascular complications of diabetes mellitus. The concept of dysglycemia includes disorders of glycated hemoglobin (HbA1c), fasting glycemia, postprandial glycemia, hypoglycemia, and glycemic variability. Dysglycemia increases the risk of developing type 2 diabetes mellitus and cardiovascular diseases, and their poor prognosis. HbA1c is the “gold standard” for monitoring glycemic control, but this indicator does not provide complete information about daily and intraday changes in glucose levels. Variability (not level) of fasting glucose determines cardiovascular mortality in patients with type 2 diabetes mellitus. Achieving glucose stability may become an additional therapeutic goal for the management of this category of patients with diabetes mellitus, and low glycemic variability is currently assessed as an additional target. Algorithms of specialized medical care for patients with diabetes mellitus recommend that patients with type 2 diabetes mellitus carry out self-monitoring, depending on the type of treatment taken and the degree of carbohydrate metabolism compensation. An important aspect of the technical impact on the adherence of patients to self-control and treatment of diabetes mellitus is the availability of convenient communication between the patient and the doctor, in particular, the possibility of contact remotely via a computer and mobile phone. In conclusion, the possibilities of a new model of the Contour® glucometer line, the Contour® Plus One glucometer, are considered.

Metabolic syndrome (MetS) is a major global public health problem. Abdominal obesity, arterial hypertension, disorders of carbohydrate metabolism and dyslipidemia are widely recognized and the most important components of MetS. The angiopoietin-like system, which includes eight types of angiopoietin-like proteins (ANGPTLs), is recognized as an important regulator of adipose tissue function. Angiopoietin-like proteins types 3 and 4 (ANGPTL3/4) are the most studied in terms of their influence on cardiovascular risks and are of interest in terms of their function in conditions associated with MetS. This review focuses on considering the role of ANGPTL3/4 in the development of each condition from the constellation of abnormalities that characterize MetS. The key role of ANGPTL3/4 as modulators of the interaction between the liver and adipose tissue is demonstrated based on the analysis performed on the current data in the PubMed information. Their involvement in lipid homeostasis, glucose, type 2 diabetes, hypertension, non-alcoholic fatty liver disease and sleep apnea, i.e. in the maximum spectrum of conditions determining MetS, has been considered in detail. It’s been proven that ANGPTL3/4 can act as indepen dent predictors of MetS, demonstrating a potential role as prognostic biomarkers of metabolic disorders. Understanding the peculiarities of ANGPTLs functioning can offer both new diagnostic and therapeutic approaches to diseases with MetS. Close targeting of ANGPTL3/4 and the development of innovative therapies involving blockers of their action have the potential to have a significant impact on the effectiveness of treatment of metabolic disorders in humans in future.

Introduction. Diabetes mellitus is a chronic disease that can impact all aspects of metabolism. Incretin mimetics, such as semaglutide, are a promising group of drugs to treat type 2 diabetes mellitus both through the improvement of glycemic control and additional effects on the cardiovascular system and body weight. The development of a generic semaglutide-containing drug is a burning issue which settlement will increase the availability of semaglutide in the Russian Federation

Aim. To study the comparative pharmacokinetics, bioequivalence, safety and tolerability of a semaglutide containing GP40221 and Ozempic® in healthy volunteers.

Materials and methods. This open-label, randomized, single-dose, parallel group study assessed the bioequivalence of a single dose of 0.5 mg of the study drugs in healthy male subjects under fasting conditions. The conclusion about the bioequivalence of the brand name drug versus the generic drug was made using the classical approach based on the assessment of 90% confidence intervals of the ratios of geometric means of the primary pharmacokinetic parameters (AUC_0-t, С_max) for the active substance of the study drugs.

Results. The results of the study showed that the 90% CI values of the ratios of geometric means of the primary PK parameters of semaglutide were 85.96–109.01% and 89.14–111.40% for AUC_0-t и C_max, respectively, and are well within acceptable limits 80.00–125.00%. The comparable safety of the study drugs containing semaglutide has been proven.

Conclusion. Thus, GP40221 (GEROPHARM LLC, Russia) and Ozempic® (Novo Nordisk A/S, Denmark) can be considered bioequivalent and equally safe based on the results of this clinical study. The results of this study allow us to recommend a drug developer to submit specific data on their study drug GP40221 to the Ministry of Health of the Russian Federation to obtain marketing authorization.

Introduction. The study of vegetative homeostasis requires the accounting of sensitive, non-invasive parameters of multidimensional ambulatory metabolic and cardiorespiratory monitoring, including bioimedansometry, heart rate variability (HRV) and respiratory function (RF).

Aim. To determine concomitant changes in HRV, RF, depending on the level of visceral fat (VF) and the presence of arterial hypertension (AH), associated with gender, age to determine the targets of preventive effects.

Materials and methods. 215 boys and girls aged 18 to 30 years and 93 men and women with hypertension aged 45 to 59 years underwent, bioimpedancometry, HRV monitoring using ten-minute recordings, and the study of respiratory function.

Results and discussion. In young people with a BMI over 25 kg/m², a high level of HF was associated with an increase in LF/ HF and SDANN values, which reflected a reduction in parasympathetic activity and an increase in sympathetic activity, as well as changes in RF with a decrease in the Tiffno index and maximum half-expiratory flow (MHF). In middle-aged individuals with AH and BMI exceeding 25 kg/m², a direct correlation was found between the value of VF and age, waist circumference, diastolic blood pressure, with a higher stress index of cardiac rhythm regulation and more pronounced sympathetic activity in terms of the LF/HF parameter. A lower total HRV, low parasympathetic activity and tension in the regulation of the heart rhythm in persons with AH were detected even with an intermediate value of VF.

Conclusions. The study of autonomic homeostasis required the accounting of the individual dynamics of the parameters of HRV and the RF even within normal values. Changes in HRV associated with an intermediate increase in VF should be monitored with an emphasis on SDANN, LF/HF, stress index and vegetative index, and changes in RF – with an emphasis on the Tiffno index and MHF.

Amiodarone has been used in clinical practice since 1964. The 2020 European guidelines note that amiodarone is recommended for long-term rhythm control in all patients with atrial fibrillation. However, due to its extracardiac toxicity, other antiarrhythmic drugs should be considered first. Information databases were searched for descriptions of amiodarone-induced blue man syndrome. Its pathogenesis is associated with accelerated physiological aging of dermal cells, leading to the accumulation of lipofuscin in lysosomes, or occurs as a result of the direct accumulation of amiodarone and its metabolites in the skin. As part of the review, brief descriptions of the 32 clinical cases found of the blue man syndrome are given. Most publications refer to various countries in Europe and the United States, which suggests that this syndrome develops more often in Caucasians. This syndrome is more common in people over 60 years of age, males predominate among patients. The development of the blue man syndrome is preceded by long-term use of amiodarone and the achievement of a certain cumulative dose. After the abolition of amiodarone, a gradual improvement is noted for 1 year or more. Other side effects of amiodarone are often detected in the presence of the blue man syndrome. Most publications describing the blue man syndrome belong to cardiologists and dermatologists. Given the variety of side effects of amiodarone, pulmonologists, endocrinologists, neurologists, ophthalmologists, gastroenterologists and doctors of other specialties may encounter a blue-gray skin color change.

Introduction. Currently, increased uric acid (UA) levels are considered an independent risk factor for the development of non-alcoholic fatty liver disease. Oxidative stress, chronic systemic inflammation, and insulin resistance characteristic of non-alcoholic fatty liver disease (NAFLD) may represent possible mechanisms for the association between the development of hyperuricemia and NAFLD.

Aim. To clarify the meaning and nature of the relationship between an increase in the level of UA concentration and the development of NAFLD, as well as to evaluate the relationship between uric acid and the risk of cardiovascular complications in patients with hypertension and NAFLD.

Materials and methods. A cross-sectional comparative study was conducted, which involved 120 patients aged from 45 to 65 with hypertension of 1–2 degrees, 1–2 stages (with and without NAFLD (FLI > 60). During the examination, a clinical examination was carried out: analysis of anamnesis data, anthropometry. Lipids and uric acid in blood plasma were also analyzed.

Results. In the group of comorbid patients, there were significantly more patients with excess of the reference values of UA levels in the blood plasma (OR = 2.25: 95% CI 1.08–4.71). ROC analysis showed that with an uric acid level of 369.5 µmol/l, a high risk of developing NAFLD is predicted. The UA/Cr index in patients with hypertension and NAFLD was statistically significantly higher than in patients in the control group. Increase in the MK/Kr index by 1 USD increases the chances of developing NAFLD by 1.54 times (95% CI: 1.11–2.13). Also, an increase in the concentration of sUA level by 1 µmol/l increases the chances of an increase in the 10-year risk of cardiovascular events to 5.0% or more by 0.6%.

Conclusions. With an uric acid level of 369.5 µmol/l, a high risk of developing NAFLD in the study group is predicted. Increase in UA/creatinine index by 1 USD increases the chances of developing NAFLD by 1.54 times. In addition, an increase in the concentration of sUA in the blood plasma by 1 µmol/l increases the chances of an increase in the 10-year risk of cardiovascular events to 5.0% or more by 0.6% in patients with hypertension and NAFLD.

There has been an increase in the population of elderly patients with coronary artery disease (CAD) in recent years. Elderly and, especially, senile patients typically have comorbid conditions, multivessel coronary artery disease and coronary calcification, which make treatment more challenging. The available data from evidence-based medicine is not enough to determine the best treatment strategies for elderly patients, because large randomized clinical trials usually do not include elderly individuals with severe comorbidities. In the presented case, an 80-year-old patient with severe calcification and multivessel coronary artery disease experienced recurrent dissection of the left anterior descending artery (LAD) and stent thrombosis of the left main coronary artery (LMCA) during the second phase of percutaneous coronary intervention, which required the implantation of 8 stents and administration of glycoprotein IIb/IIIa inhibitors, leading to the clinical manifestation of gastrointestinal bleeding. An important feature of the presented case was the necessity to implant a large number of stents, which is a risk factor for restenosis. Various issues are discussed in this case, including the choice of optimal management strategy for an 80-year-old patient with multivessel coronary artery disease. Physicians had to make difficult decisions to achieve a balance between potential benefit and risk. In order to improve the management of elderly patients, further research is needed, as well as the accumulation and discussion of clinical data.

Currently, at least 5,000,000 patients with coronary artery disease undergo percutaneous coronary interventions with stent implantation every year in the world, and more than 200,000 in Russia. Dissection and perforation of the coronary artery are quite rare, but they are very dangerous complications leading to the development of hemopericardium with cardiac tamponade, cardiogenic shock, myocardial infarction, various arrhythmias and death. The frequency of cardiac tamponade in interventional cardiology, according to various authors, ranges from 0.1 to 3.0% of all interventions. The frequency of deaths cited in the literature also varies greatly (0–20–40%). At the same time, there are no special registers that accumulate data on coronary artery perforations in concrete countries and in the world as a whole. Unfortunately, today, there is still no clear algorithm for identifying high-risk patients, the necessary timing of their intensive follow-up is not clear, and the criteria for choosing between conservative, angiosurgical and operative treatment tactics are not defined. In addition to a literary review of recent sources on this topic, the article presents 3 clinical cases of hemopericardium development in elderly patients at different times after percutaneous interventions, with different symptoms and with different outcomes. The observations illustrate the variability of symptoms, the complexity of diagnosis and treatment, and also touch upon the issues of a multidisciplinary approach with the participation of specialists of different profiles (X-ray angiosurgeons, cardiac surgeons, intensive care specialists, cardiologists and doctors of functional diagnostics).

The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.

The COVID-19 pandemic has become a global crisis of unprecedented level for all mankind. The whole process of studying the disease (etiopathogenesis, diagnosis, treatment, prevention, prognosis) was not easy, because COVID-19 is a relatively new nosology that the world has never encountered. Cardiovascular complications in COVID-19 play an important role in the prognosis of morbidity and mortality. As the COVID-19 pandemic spreads, more and more patients with cardiac arrhythmias, arterial hypertension and other cardiovascular complications appear. This may be due to the impact of the SARS-CoV-2 virus on the respiratory, cardiovascular and other systems, as well as the development of inflammation. During the COVID-19 pandemic, there were more patients with arrhythmias. According to some data, the risk of arrhythmias in COVID-19 in hospitalized patients varies from 7.57% to 17.97%. The main causes of arrhythmia in the context of COVID-19 are hypoxia (acute respiratory distress syndrome, pulmonary embolism, the effect of SARS-CoV-2 on chemoreceptors), myocarditis (direct and indirect effects of SARS-CoV-2 on the myocardium), electrolyte imbalance, autonomic dysfunction, cardiotoxic drugs used in COVID-19. There can often be several reasons, and it is quite difficult to figure out which one has become the main one for each patient. This review focuses on the potential mechanisms for the development of cardiac arrhythmias in patients with COVID-19. Cardiologists, therapists and family medicine physicians should be aware of cardiovascular complications in the management of patients with COVID-19, and the prophylactic medical examination of the population.

For several years, there has been a significant increase in the number of patients diagnosed with cardiac amyloidosis or amyloid cardiomyopathy (AC). The reason is the growing concern of specialists about amyloidosis and the increased accuracy of the instrumental methods of examination of patients of cardiological profile. Nowadays, more than 30 types of amyloidosis are known, however, the two main types are most commonly associated with cardiac involvement: amyloidosis of light chains (AL) and transthyretin amyloidosis (ATTR). Regardless of the underlying pathogenesis of amyloid production, cardiac involvement is the main cause of mortality in systemic amyloidosis. In addition to difficulties in early diagnosis, there are difficulties with further management of the disease. With the appearance of specific treatment, different depending on the type of amyloidosis, the problem of symptomatic therapy in these patients has become acute. Heart failure (HF) signs are usually prevalent in cardiac signs. Besides, patients with AC often have various arrhythmias and heart conduction disorders. However, the selection of heart failure therapy in patients with AC is complicated by the development of restrictive hemodynamic phenotype and concomitant autonomic dysfunction, making it impossible to manage standard heart failure therapy. The article presents a clinical case of a patient with a hereditary type of transthyretin amyloidosis with the cardiac involvement, whose main clinical manifestations were heart failure, cardiac rhythm and conductions disorders. This case demonstrates the importance of comprehensive and personalized approach in the management of ATTR-AC, the features of pathophysiology which require special approaches even to management of symptomatic therapy.

Introduction. An assessment of the relationship between the severity of hypertrophy and changes in the myocardial strain at which systolic disfunction is detected in children with hypertrophic cardiomyopathy (HCM) is clearly essential.

Aim. To assess the relationship between hypertrophy and the myocardial strain in children with hypertrophic cardiomyopathy (HCM).

Materials and methods. 61 patients aged between 7 and 17 years with a primary form of HCM underwent an ultrasound examination of the heart using standard techniques. An assessment of the left ventricular systolic function performed using of-line the two-dimensional (2D) speckle-tracking mode with analysis parameters that included global and segmental longitudinal, circumferential, and radial myocardial strains. The analysis of hypertrophy of myocardial segments carried out taking into account the absolute values of the thickness of the left ventricular myocardium in systole and diastole, depending on age, in terms of standard deviation units in the population (Z-score factor).

Results. A decrease in longitudinal strain below the relevant values, an increase in radial strain, and no changes in circular strain were observed when the thickness of the left ventricular myocardium increased over 2.48Z. A further decrease in radial strain was observed when myocardial thickness was over 4.24Z, and circular strain was over 3.16Z. The relationship between myocardial hypertrophy and longitudinal strain had an inverse linear relationship: the lower the strain values, the greater the thickness of the myocardium. With increasing thickness of the myocardium, the radial strain first tended to increase in a compensatory manner, but it decreased when myocardial thickness increased over 4.24Z. The circular strain, as well as longitudinal one, has an inverse linear relationship, but with longer preservation of normal values when myocardial hypertrophy increases.

Conclusion. Children with HCM demonstrate various types of relationships between hypertrophy and myocardial strain, which detection is important for the assessment of the left ventricular systolic function to improve the prognosis and therapeutic approach to the disease. A comprehensive approach to the assessment of myocardial strain in children with HCM should include not only a routine identification of global strain, but also assessment of the segmental strain to detect early signs of myocardial dysfunction. Comparison of measures of various types of strain and the thickness of the left ventricular myocardium has a very important diagnostic value for understanding the degree of changes in its kinetics.

Introduction. Acute decompensation of heart failure (AHF) can cause acute kidney injury (AKI), hyponatremia, episodes of oliguria and polyuria in the treatment of furosemide. These complications lengthen the time of hospitalization, increase the economic costs of treatment and worsen the prognosis. Currently, the relationship of these manifestations in patients with CHF has not been studied.

Objective. To evaluate the effect of AKI on the rate of diuresis and the level of plasma sodium during the complex therapy of AHF.

Materials and methods. Kidney function was assessed in 125 patients receiving complex therapy for AHF. The glomerular filtration rate (GFR) was determined in two ways: by the level of creatinine and cystatin C in blood serum. The number of AKI, hyponatremia, episodes of oliguria and polyuria were studied. An analysis of the relationship between these events was carried out.

Results. At the time of admission to the hospital, the study of GFR by the level of cystatin C showed 2.6 times more AKI than by the level of creatinine. In total, AKI was found in 22.4% of cases, hyponatremia in 24.8%, episodes of oliguria in 18.4%, episodes of polyuria in 24.8%. The analysis showed that there is a connection of violations of the rate of diuresis and hyponatremia with AKI.

Conclusions. Сases of impaired urinary excretion and hyponatremia during AHF therapy are more common in patients with AKI.

For the past 60 years, vitamin K antagonists (VKAs) have been the main drugs used for long-term oral anticoagulant therapy. Because of the significant limitations of AVCs, direct-acting oral anticoagulants (DOAKs) have been developed over the past decade. DOAKs have a predictable pharmacokinetic profile and lack the disadvantages of vitamin K antagonists. Apixaban is an oral direct-acting factor Xa inhibitor used for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) and deep vein thrombosis. Despite the use of recommended dosages, some patients may still experience bleeding or lack the desired anticoagulant effect. With this in mind, it is critical to explore new uses for direct oral anticoagulants and to predict their dosage when used in monotherapy or in combination with other drugs. In addition, recent studies have documented individual variability in plasma POAC levels. DOAC pharmacogenetics is a relatively new area of research. There is a need to understand the role of pharmacogenetics in adapting anticoagulant therapy according to a patient’s genetic characteristics. In this scientific review of current data, we detail the pharmacokinetics and pharmacogenetics of apixaban as well as new data concerning the clinical characteristics that predetermine the necessary dosage and risk of adverse drug reactions (ADRs). Indeed, the results obtained to date from basic and clinical studies certainly indicate an undeniable influence of genomic changes on the pharmacokinetics of POACs.

Chronic heart failure (CHF) is currently a common disease and the search for new approaches to the treatment of various forms of CHF remains relevant. Sacubitril/valsartan is a member of a new class of angiotensin-neprilysin receptor inhibitors (ARNIs) that act on key neurohormonal mechanisms, including the RAAS and natriuretic peptides. Simultaneous inhibition of RAAS and neprilysin provides more effective neurohormonal modulation, preventing clinical deterioration in patients with CHF. New mechanisms of action of sacubitril/valsartan associated with the inhibition of several targets involved in cardiac hypertrophy, fibrosis, cardiac remodeling and apoptosis have been disclosed. Sacubitril/valsartan is recommended for CHF with low ejection fraction (EF) in addition to traditional therapy with ACE inhibitors, mineralocorticoid receptor antagonists, beta-blockers, and also has an independent effect. A number of studies have shown the effect of sacubitril/valsartan on heart remodeling, a decrease in the level of the NT-proBNP biomarker and an improvement in EF, and according to the PARADIGM-HF study, the drug significantly reduced the risk of cardiovascular mortality by 20% and hospitalizations for CHF by 21%, which found confirmation in three meta-analyses. The use of sacubitril/valsartan in CHF with preserved and intermediate EF showed a beneficial therapeutic effect and a decrease in the level of biomarkers, as well as a significant decrease in the frequency of hospitalizations due to CHF by 15–22%, but without a significant advantage in terms of the effect on mortality, which supported by several meta-analyses of studies. A number of large meta-analyses of studies of sacubitril/valsartan in CHF have shown reverse cardiac remodeling and a reduced risk of atrial fibrillation. Thus, the accumulated data substantiate and expand the possibilities of using sacu-bitril/valsartan in CHF.