Novel guidelines presented at the annual congress of the European Society of Cardiology 2019 changed our knowledge on management of the acute pulmonary thromboembolism. They cover the issues of the risk stratification, management strategy in acute phase considering prognostic criteria nad patient’s hemodynamic stability, duration and scheme of the anticoagulation therapy in order to prevent thromboembolism recurrencies, management of patients with malignant tumors and in pregnant women, as well as the diagnostic and treatment approaches in postthrombotic syndrome. In the review, the experts of the Russian Cardiology Society and Russian Respiratory Society discuss the main questions and changes in the Guidelines on the acute pulmonary thromboembolism.

Polysomnography and cardiorespiratory (respiratory) sleep monitoring are the most common diagnostic methods for respiratory sleep disorders. Polysomnography traditionally takes the place of the “gold” standard for detection of all types of respiratory events since its inception. Currently, cardiorespiratory monitoring of sleep is becoming more widespread as a diagnostic method with a minimum set of parameters for determining respiratory events during sleep. The increased use of cardiorespiratory (respiratory) monitoring of sleep is due to 2 reasons: the increased need for diagnosis due to the wide occurrence of respiratory disorders in the population and the conditions of the method (simple use, the need for a sleep laboratory, cheaper cost). However, the method is not indicated to all patients. Potential limitations for cardiorespiratory monitoring of sleep are the lack of sleep recording (information about the structure of sleep and reactions of sleep to respiratory disorders), monitoring of the study by medical personnel, and absence of body position sensor. These factors influence the assessment of the severity of the disease and the verification of certain forms of the disease. Currently, new methods of screening sleep apnea have been formed, based on modern innovative technologies and available in practical medicine. These include the determination of the presence of respiratory events be ECG Holter monitoring during sleep, the recognition of snoring and respiratory events in sleep from an audiometric signal recording and the determination of the probability of apnea with the help of registration movements during sleep (actigraphy).

Respiratory changes caused by obstructive sleep apnea (OSA) syndrome increase the risk of ocular vascular diseases. Hypoxia, hypercapnia, endothelial dysfunction associated with OSA syndrome, promote local impairment of fibrinolysis, cause hypercoagulation and vasospasm, creating conditions for retinal vein occlusions as well as for those of posterior ciliary arteries. 91,5 % patients with retinal vein occlusions and 75 % patients with nonarteritic anterior ischemic optic neuropathy have moderate-to-severe OSA. OSA timely diagnosis and treatment prevent acute vascular pathology of the retina and optic nerve.

Objective. To study the effect of empagliflozin and vildagliptin therapy on endothelial function and arterial stiffness parameters in type 2 diabetes mellitus (2DM) patients without previous cardiovascular events. Design and methods. We studied 34 patients with type 2DM without previous cardiovascular events, which initiated therapy with empagliflozin and 11 patients with type 2DM who received vildagliptin. At baseline and 24 weeks after the treatment, we assessed anthropometric parameters, endothelial function, arterial stiffness, central pressure parameters. We also performed ultrasound examination of the carotid arteries and echocardiography for evaluation of the left ventricular myocardial mass index. The effect of empagliflozin and vildagliptin on the structural and functional parameters of vascular wall was assessed. Results. Empagliflozin unlike vildagliptin treatment significantly improved endothelial function after 24 weeks of treatment (p < 0,05). Conclusions. Empagliflozin seems to possess a specific capacity to improve endothelial function.

Background. Increasing evidence suggests a relationship between the renin-angiotensin-aldosterone system (RAAS) and parameters of calcium metabolism. Probably subclinical changes of the RAAS components activity could be predictors of cardiovascular pathology in patients with primary hyperparathyroidism (PHPT). Objective. To study the activity of the RAAS components and parameters of calcium metabolism in normotensive patients with symptomatic PHPT in the pre- and early postoperative periods. Design and methods. We performed a prospective non-comparative study of 35 patients with confirmed PHPT without concomitant cardiovascular diseases and their traditional risk factors. Patients who took drugs affecting calcium metabolism and RAAS were also excluded. In all patients we assessed the main biochemical and hormonal parameters of calcium metabolism and RAAS preoperatively and 3 days after parathyroidectomy. Results. Normotensive patients with PHPT did not show any correlations of parathyroid hormone and serum calcium levels with RAAS components either before surgery or in early postoperative period, however, a significant decrease in serum aldosterone level was observed 3 days after successful parathyroidectomy (p = 0,004). Conclusions. Further investigation is required to clarify the relationship between calcium metabolism and the RAAS and to identify possible predictors of cardiovascular pathology in PHPT.

Background. Metabolic syndrome (MS) is a pathological condition characterized by abdominal obesity, insulin resistance, arterial hypertension (HTN) and dyslipidemia. MS contributes to type 2 diabetes mellitus, coronary heart disease, stroke and other cardiovascular events. Currently, much attention is paid to the study of the underlying factors, including hormones involved in fat metabolism. The changes in the level of hormones affecting the metabolism of adipose tissue in MS, as well as the relationship of these changes with various MS components, should be studied for the development of effective treatment approaches. Objective. To study the relationship of various MS components with the level of hormones affecting the metabolism of adipose tissue in patients with MS. Design and methods. The study included 88 obese patients (26 males; 62 females), average age 42,0 ± 11,2 years, average body weight 109,7 ± 25,1 kg, body mass index (BMI) 37,9 ± 6,2 kg/m² . Dyslipidemia was detected in 60 patients, carbohydrate metabolism disturbance (impaired glucose tolerance) was recorded in 12 patients, and HTN — in 22 patients. All patients underwent an assessment of the level of hormones involved in the regulation of fat metabolism (glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), ghrelin, leptin, adiponectin), lipid profiles (cholesterol, high-density lipoprotein, low density lipoprotein, triglyceride), fasting venous plasma glucose, insulin. The HOMA-IR index was calculated. Results. Levels of leptin and GLP-1 were increased in MS compared with healthy people, and levels of ghrelin, adiponectin, and GIP were reduced. Women showed a more significant increase in leptin and a less pronounced decrease in ghrelin than in men. BMI positively correlated with the level of insulin, leptin, the HOMA-IR index and negatively with the level of ghrelin. Waist circumference correlated positively with insulin levels and the HOMA-IR index and negatively with ghrelin and adiponectin levels. Ghrelin was associated with glucose level and diastolic blood pressure correlated with the GIP level. Conclusions. Our study confirms the previously established relationships between BMI and waist circumference with the severity of insulin resistance (increased insulin levels and the HOMA-IR index), leptin resistance (increased leptin levels) and the development of adiponectin deficiency. The dynamics of adiponectin and ghrelin were more closely related to the visceral type of obesity. The established relationships between the levels of GIP and ghrelin and relationship of GIP with diastolic blood pressure require further investigation.

Background. Ultrasound assessment of myocardial strain allows non-invasive identification of early stages of heart failure with preserved ventricular ejection fraction. A decline of the left ventricle (LV) global longitudinal strain in hypertension (HT) accompanied by LV hypertrophy (LVH) was reported in clinical samples with manifest HT. Data on the relationship between longitudinal strain and blood pressure (BP) and HT in general population is lacking. Objective. We studied the relationship between LV peak systolic global longitudinal strain (GLS) and strain rate (GSR) in subjects with high and controlled BP from a general population sample aged over 55 years. Design and methods. The cross-sectional study was based on a population cohort (HAPIEE, Novosibirsk). In a random sample (n = 416, aged 55–84 years old) we performed echocardiography and evaluated GLS and GSR of LV by speckle tracking technique. ANOVA multivariable models were applied. Results. In the studied sample, the prevalence of HT comprised 78,9 %. The mean GLS value was –18,7 ± 3,79 %, and it was lower in men than in women (–18,2 ± 3,85 % vs –19,2 ± 3,66 %, p = 0,005). The mean GSR value was –0,84 ± 0,17s^–1 , and did not differ by sex. The absolute value of GLS in HT was lower than in normotensives: –18,5 ± 3,73 % vs –19,9 ± 3,42 %, p = 0,003; this difference was independent of age, sex and LV myocardial mass index (IMM), p = 0,011; but it was attenuated in a multivariable-adjusted model including body mass index (BMI). In HT groups, the GLS was the lowest among those “treated ineffectively” and significantly lower than in normotensives independently of age, sex and myocardium mass index (p = 0,008). The absolute value of GSR in HT was lower than in normotensives: –0,90 ± 0,17 s^–1 vs –0,83 ± 0,17s^–1 , p < 0,001; and persisted in multivariable models. GSR was the lowest among those “treated ineffectively” and significantly lower than in normotensives in multivariable models independently of age, sex, BMI and myocardial mass index (p = 0,017; 0,002). The average values of LV ejection fraction (Simpson) in all groups were above 50 % without significant inter-group differences (p = 0,904). conclusions. In the studied population sample, GLS and GSR of LV were associated with HT; however, the association between GLS and HT was largely explained by BMI. In hypertensives, the lowest GLS and GSR, as well as higher extent of LVH, were found among those treated ineffectively, which might point at the initial reduction of systolic ventricular function in HT with inadequate BP control.

Objective. To analyze the prognostic effects of metabolic and hemodynamic characteristics and adherence to treatment in patients with first grade arterial hypertension (HTN). Design and methods. We have examined twice (with interval 71,3 ± 10,5 months) 67 patients with first grade HTN. Baseline and final investigations included office blood pressure (BP) measurements, heart rate and body mass index calculation, ambulatory BP monitoring. In addition, at baseline we assessed the levels of total cholesterol, low and high density lipoproteins, triglycerides. vascular endothelial growth factor, glucose and insulin. We also performed glucose tolerance test. At follow-up, life style changes and adherence to treatment were assessed via structured questionnaires. Eleven patients with adverse outcomes composed a separate subgroup including 5 with HTN worsening, 2 with angina pectoris worsening, 3 with myocardial infarction, 1 case of sudden death. Results. Insulin levels at glucose tolerance test was higher in patients with adverse outcomes. At baseline, fasting and postprandial heart rate was greater than 80 bpm in 91 % of patients with first grade HTN who developed adverse outcomes and in 21 % in the rest of the group (p < 0,001). Disease progression and complication development were registered only in patients with both high/very high cardiovascular risk and heart rate greater than 80 bpm. Only in patients with very high cardiovascular risk major cardiovascular events were detected. Low adherence to treatment significantly worsened prognosis: the majority (80 %) of patients with adverse outcomes took antihypertensive drugs irregularly; 60 % patients with adverse outcomes reduced level of physical activity. Increment in regular physical activity was found more frequently in patients with serum vascular endothelial growth factor > 200 pg/ml. Conclusions. Heart rate greater than 80 bpm is associated with unfavorable prognostic effect in patients with first grade HTN and high/very high total cardiovascular risk. Disease progression and complication development are more frequent in patients with irregular therapy and/or those who reduced physical activity level.

The development of internal disease as a result of the brain damage was first described more than one hundred years ago, but the role of acute stroke and traumatic brain injury (TBI) in the progression of renal dysfunction has not been studied enough. Within the first 7 days after onset of subarachnoid hemorrhage or TBI, up to 25 % patients develop acute kidney injury (AKI). Other important manifestations of cerebro-renal disorders include central salt-wasting syndrome and syndrome of inappropriate antidiuretic hormone secretion, that both manifest by hyponatremia, but differ in pathogenesis and clinical tactics. In addition, patients with extensive brain lesions are characterized by excessive sympathetic activation with the release of proinflammatory cytokines, such as tumor necrosis factor α (TNFα), interleukin-6 (IL-6) and interferon γ (IFNγ), which also contributes to the development of AKI. Investigation of the main features of cerebro-renal syndrome will contribute to the early diagnostics, choice of the appropriate management strategy (careful and limited use of nephrotoxic antimicrobial drugs, osmotic diuretics and intravenous contrasting in neuroimaging) and to the improvement of the prognosis.

Hypertension and periodontitis are one of the most prevalent infectious diseases worldwide. Hypertension is a key cardiovascular risk factor. In the recent studies, the role of periodontitis in cardiovascular pathology was also proven, However, the relation between these diseases is disputable. The review aims at investigation and systematization of the available evidence about the association between hypertension and periodontitis and the potential underlying mechanisms. We demonstrate that hypertension and periodontitis are co-morbidities, and their interrelation remains significant even when other confounders are considered. Age and the acitivity of periodontitis modify the interrelation, and the key mechanisms include inflammation and oxidative stress leading to the deterioration of vascular function and structure. On the other hand, hypertension-related hemodynamic changes can lead to bone and vascular remodeling of the parodentium which maintains local inflammation. Just a few studies assess the effects of the treatment of periodontitis on blood pressure (BP) levels. The results confirm that the assessment of parodentium and specific treatment (when required) can improve BP control. The individual and population cardiovascular effects of treatment of parodentium pathology should be assessed in complex cardiovascular examination.

Considering high prevalence of prediabetes, exceeding the incidence of type 2 diabetes mellitus, clear algorithms for identifying and managing patients with this pathology is the most important task for doctors of various specialties — therapeutists, cardiologists, general practitioners. The preventive measures are more efficient when started at the stage of prediabetes rather than when type 2 diabetes mellitus has been developed. They help to prevent or delay the development of type 2 diabetes mellitus, its micro- and macrovascular complications, cardiovascular diseases, pathology of muscular-skeletal system and liver. All these measures should be implemented at the stage of primary health care. The resolution presents an algorithm of verifying and management of prediabetes and type 2 diabetes mellitus.