Aim. To compare efficacy and safety of inclisiran, evolocumab and alirocumab in patients with high, very high and extreme cardiovascular risk (according to data from the Federal Research Center for Cardiology and Microbiology, Novosibirsk).Material and methods. This prospective two-year observational comparative included 53 patients (43 men and 10 women) with an average age of 61,2±4,7 years. They were treated with alirocumab at a dose of 75 mg (n=9) and 150 mg (n=25), evolocumab 140 mg (n=10), and inclisiran (n=9). Two patients were diagnosed with definite familial hypercholesterolemia according to DLCN criteria, while five patients had a myocardial infarction. Lipid profile, transaminase, creatinine, and glucose levels were assessed after 3, 6, 12, and 24 months. The primary efficacy endpoint was achievement of target low-density lipoprotein (LDL) values. The secondary efficacy endpoint was recurrent cardiovascular events (myocardial infarction, stroke, urgent coronary and non-coronary artery revascularization, critical ischemia and lower extremity amputation). New cases of diabetes and atrial fibrillation were also monitored. Safety was assessed based on clinical data and laboratory parameters, such as transaminase, total bilirubin, creatinine and blood glucose levels. The follow-up period ranged from 6 months to 2 years.Results. Target LDL cholesterol levels for extreme cardiovascular risk were achieved in 21 of 32 patients, and for very high and high risk levels — in 16 of 21 patients. The average LDL level decreased from 3,71 to 1,47 mmol/L during the period of lipid-lowering therapy, while no differences were found between the treatment subgroups. During the two-year follow-up, no endpoints were observed in the study patients. High compliance and good tolerability of all types of treatment with no adverse reactions, including local ones, were noted. None of the patients discontinued therapy.Conclusion. This single-center study showed that therapy with a PCSK9 inhibitor and inclisiran was well tolerated, and LDL-C reduction was similar to that observed in randomized, placebo-controlled trials.

Objective. To systematize and critically analyze current approaches to the diagnosis and treatment of chronic heart failure (CHF), with a focus on personalized therapeutic strategies and the integration of digital technologies into clinical practice.Material and methods. A systematic search was conducted in PubMed, Scopus, Web of Science, and eLibrary databases for the period 2019–2024. Keywords included: “chronic heart failure”, “CHF pathogenesis”, “personalized CHF therapy”, and “digital technologies in cardiology”. A total of 145 sources meeting the inclusion criteria were selected and analyzed.Results. The review describes the most recent pathophysiological mechanisms of CHF development and examines current pharmacological and device-based therapies, including SGLT2 inhibitors, sacubitril/valsartan, cardiac resynchronization therapy, implantable cardioverterdefibrillators, and mechanical circulatory support devices. Special attention is given to the role of digital technologies, including telemedicine, remote monitoring, and artificial intelligence, in managing patients with CHF.Conclusions. A personalized approach, incorporating pharmacogenetics and the implementation of digital solutions, represents a promising direction for improving the effectiveness of CHF treatment and patient outcomes. Further integration of innovative technologies into clinical practice and addressing the accessibility of novel therapeutic methods are required.

Objective: In this study, we aimed to determine the most significant risk factors for 5-year mortality in patients with paroxysmal and persistent drug-refractory tachysystolic atrial fibrillation after undergoing atrioventricular node ablation (AVNA) in combination with the implantation of a permanent three-chamber pacemaker with an implantable cardioverter–defibrillator function (CRT-D). Methods: This prospective single-center cohort study included 101 patients with chronic heart failure (mean age 62 ± 15.5 years; 70.3% male) with paroxysmal or persistent drug-refractory atrial fibrillation who underwent atrioventricular node ablation and CRT-D implantation. All patients received optimal medical therapy before and after undergoing the procedure. Predictors of 5-year mortality were assessed using exploratory machine-learning methods, including random forest and Shapley additive explanations. Results: During 5-year follow-up, 13 cardiovascular deaths were recorded. Five key predictors of mortality were identified: left ventricular ejection fraction, 6 min walk distance, mean pulmonary artery pressure, systolic relaxation coefficient, and degree of mitral regurgitation. The exploratory predictive model showed high accuracy (92%) in terms of classifying the outcomes. Conclusions: Atrioventricular node ablation (AVNA) combined with CRT-D was associated with the observed long-term clinical outcomes observed in patients with drug-refractory tachysystolic atrial fibrillation. The exploratory machine learning analysis identified key mortality-associated factors, which may support future efforts in personalized risk stratification and hypothesis generation. The combination of AVNA and CRT-D was associated with the observed long-term outcomes in this real-world cohort.

Relevance. Myocardial infarction (MI) remains one of the leading causes of death and disability worldwide. The high prevalence of this atherosclerosis-associated disease is undoubtedly associated with insufficient prevention of cardiovascular diseases, including due to insufficient use of statins. This article highlights the problem of evaluating the use of statins as a means of primary and secondary cardiovascular prevention using the example of myocardial infarction from a sample of patients in the Siberian region.Objective. To evaluate the frequency of statin use in patients before the onset of primary and recurrent type 1 myocardial infarction.Materials and methods. The open continuous cross-sectional study included 294 patients selected from the local registry of acute coronary syndrome, treated at the 1st cardiology department of the Novosibirsk State Clinical Hospital No. 1 in 2021–2023. A multifactorial logistic regression model was used to assess the effect of various factors on the use of statins at the prehospital stage.Results. It was found that in the subgroup of primary MI, the frequency of statin use was 21.8 %, and in the subgroup of repeated MI, the frequency was 38.6 %. An analysis of the factors associated with statin use revealed a statistically significant association with repeated myocardial infarction, OR 2.26 (1.29–3.99), and with dyslipidemia, OR 1.81 (1.02–3.25). Other factors: hypertension, diabetes mellitus type 2, obesity, atrial fibrillation, left ventricular ejection fraction, creatinine levels, age and gender. They have not reached the level of significance. The doses of the drugs corresponded to clinical recommendations; in 70 % of cases, atorvastatin was used, and in 30 %, rosuvastatin was used. Among the patients taking statins, many (more than 2/3 of the patients) did not reach the target values of LDL cholesterol.Conclusions. The present study demonstrates insufficient frequency, intensity and duration of statin therapy among patients hospitalized with primary and recurrent type 1 myocardial infarction, and this indicates a poor state of primary and secondary prevention of this preventable cardiovascular event.

Background. The intravenous administration of tissue plasmongen activator within 4.5 h of the onset of acute ischaemic stroke is known to improve the treatment outcomes significantly. However, in 2015, five large studies simultaneously demonstrated the superiority of a mechanical revascularisation strategy over a drug-based approach. As a results of these studies, the updated guidelines, providing an advantage of mechanical thromboextraction.Aim. To evaluate the effectiveness of the combined system for mechanical thrombus extraction.Methods. We prepared a prototype of a combined system for mechanical thrombextraction in ischaemic stroke. We performed a trial on a laboratory animal in order to assess the efficiency of the system.Results. Our results show that mechanical thrombus extraction using the domestic prototype of the combined thrombextraction system was highly efficient. Complete restoration of blood flow was observed in the previously occluded segment.Conclusion. Our study demonstrated prototype of a combined system for mechanical thrombus extraction effectiveness in preclinical study. Received 10 December 2020. Revised 16 December 2020. Accepted 21 December 2020. Funding: The work is supported by a grant (project No. 056-00042-20-00). Conflict of interest: Authors declare no conflict of interest.