Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

The article is devoted to problems of clinical-diagnostic value of determination of cardio-specific troponins in human biological fluids. Improvement of laboratory instrumentation and emergence of high sensitivity methods of analysis have allowed to identify troponins in urine, dialysate, and oral fluid. In the review we present actual information related to measurement of troponins in blood serum, data on testing of cardio-specific troponins in urine, dialysate, and oral fluid. Special attention is paid to determination of some cardiomarkers in oral fluid with thorough analysis of diagnostic value and effectiveness of the conducted studies.

Natriuretic peptides (NPs) are key diagnostic and prognostic biomarkers for patients with heart failure (HF). The main mechanism for increasing serum NP levels, which is characteristic of heart failure, is secretion in response to myocardial wall distention. At the same time, according to Russian and foreign literature, an increase in NPs is reported in a number of many other conditions that are not associated with HF. The study of these causes and mechanisms is necessary to improve the differential diagnosis of HF.This article discusses the mechanisms of increasing NPs and their diagnostic value in heart failure, as well as a number of other conditions, such as acute coronary syndrome and coronary artery disease, atrial fibrillation, exercise, kidney failure, taking cardiotoxic drugs (chemotherapy) and sacubitril/valsartan. The article also provides data on identifying NPs in non-invasively obtained biological fluids (urine and oral fluid).

Aim. To describe demographic and clinical laboratory characteristics, concomitant diseases and drug therapy of outpatients with heart failure (HF) in the Russian Federation.Material and methods. An interim analysis of a prospective observational multicenter registry study of patients with chronic heart failure in the Russian Federation ("PRIORITET-CHF") was performed. The study included outpatients with HF followed by a general practitioner or cardiologist.Results. Data from 6255 patients were analyzed (31,3% of the study sample; median age, 65 years; men, 65%). HF with reduced ejection fraction (HFrEF) was diagnosed in 42,4%, HF with preserved EF — in 31,9%. In addition, 57,4% of patients were characterized by NYHA class II HF. The most common causes of HF were hypertension, coronary artery disease, and atrial fibrillation or flutter. Of the concomitant diseases, doctors most often reported chronic kidney disease (CKD) (43,2%), obesity (37,8%) and diabetes (26,7%) in HF.Conclusion. In the Russian Federation, among outpatients with HF, there was domination of men, HFrEF phenotype, NYHA class II. The relatively young mean age and frequent associations of HF with cardiovascular risk factors and diseases underscore the importance of timely prevention initiatives. The identified high proportion of patients with CKD requires special attention and separate analysis. Despite the relatively high prescription rate of certain classes of diseasemodifying therapy for HF, the prescription of optimal quadruple therapy and electrophysiological treatments for HFrEF is insufficient.

Certain success has been achieved in the treatment of cancer due to the development of various effective chemotherapeutic drugs. However, an increase in their effectiveness (aggressiveness) was associated with a growth of undesirable effects on the entire human body, in particular, on the cardiovascular system. The damage to the cardiovascular system from chemotherapy in many cases is more significant than from the underlying disease. In recent years, a new direction of medicine has been formed - cardio-oncology. The major groups of cardiotoxic chemotherapeutic agents are anthracyclines, inhibitors of epidermal growth factor receptor type 2 (anti-HER2), antimetabolites, microtubule inhibitors, proteasome inhibitors, platinum-based chemotherapeutic drugs, and angiogenesis inhibitors (inhibitors of vascular endothelial growth factor). This review discusses principal pathophysiological mechanisms of the cardiotoxicity of these chemotherapeutic drugs.