Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Acute coronary syndrome (ACS) is caused by an acute mismatch between myocardial oxygen demand and its supply. This mechanism is largely associated with the progression of coronary atherosclerosis in combination with an inflammatory response, hypoxemia, and blood procoagulation. Patients with the coronavirus disease 2019 (COVID-19), aggravated by cardiovascular diseases and comorbidities, are at high risk of ACS.Aim. To analyze the publications, which reflects the development of ACS in patients with COVID-19, its pathogenesis, and clinical course. Material and methods. Literature data were searched using Google Scholar, PubMed, ScienceDirect, and Cyberleninka services. The analysis included data from clinical guidelines on COVID-19, data from clinical studies, reports, and systematic reviews.Results. This literature review summarizes and systematizes the data presented in modern publications, highlights the aspects of the clinical course and pathogenetic mechanisms underlying ACS in patients with COVID-19.Conclusion. The pathogenesis of COVID-19 is inextricably associated with the widespread cytopathic effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), uncontrolled immune response that causes systemic inflammation, as well as the coagulation system activation. In patients with COVID-19, along with the atherosclerosis, these mechanisms significantly increase the risk of ACS and can worsen its in-hospital course.

Aim. To study the functional state of the terminal arteries and arterioles of the skin using photoplethysmography (PPG) in men with hypertension (HTN) of low and moderate cardiovascular risk (CVR) and to identify morphofunctional diagnostic criteria associated with HTN.Material and methods. A total of 118 healthy men (30-60 years old) underwent clinical and biochemical blood tests, PPG, ultrasound of cardiac and main arteries, 24-hour blood pressure monitoring. According to 24-hour blood pressure monitoring, two groups were formed: the control group — 59 normotensive men, HTN group — 59 men with HTN.Results. According to the PPG data, men with HN had higher normalized augmentation index (Alp75) (3,8 and -5,25%; (p<0,005)), stiffness index (SI) (7,6 and 7,35 m/s) (p<0,05) and reflection index (RI) (36,5 and 28,4%) (p<0,005), respectively. According to multivariate analysis, an increase in RI ≥30,6% (odds ratio, 4,6; p=0,0476) and SI ≥7,9 m/s (odds ratio, 3,69; p=0,019) was significantly associated with HTN. A regression model has been developed that includes age ≥35 years, RI ≥30,6% and SI ≥7,9 m/s, which allows predicting HTN in men with low and moderate cardiovascular risk with a sensitivity of 78% and a specificity of 62,1%.Conclusion. Men with HTN of low and moderate CVR are characterized by an increase in vascular stiffness, tone of smooth muscle cells, terminal muscular arteries and arterioles, and an increase in pulse wave velocity. The developed model can be used to predict hypertension in these patients and determine indications for further examination.

Гендерные различия структурно-функционального состояния микроциркуляторного русла кожи у лиц с впервые выявленной артериальной гипертензией

Aim. To study clinical, medical history and paraclinical characteristics of patients with non-ST elevation myocardial infarction (NSTEMI) after coronavirus disease 2019 (COVID-19).Material and methods. The study included 209 patients with NSTEMI who were admitted to the Demikhov City Clinical Hospital (Moscow). The patients were divided into 2 groups: the experimental one (n=104) — those after COVID-19, the control one (n=105) — those without history of COVID-19. All patients underwent routine diagnostic investigations in accordance with current standards and clinical guidelines.Results. The mean age of patients in the experimental group was 61,8±12,2 years, while in the control one — 69,0±13,0 years (p<0,0001). Myocardial infarction developed 49 days [34.0; 82.0] after COVID-19. Prior exertional angina was observed in 76,9% of patients in the experimental group and in 88,6% in the control one (χ² =4,97; p=0,0258). The level of C-reactive protein in the experimental group was 19,2 mg/l [4,9; 53,0], and in the control one — 5,6 mg/l [0,4; 21,8] (p=0,0007). The average troponin I level in the experimental group was 2,7 ng/ml [1,3; 8,0], while in the control one — 1,8 ng/ml [0,8; 3,5] (p=0,0091).Conclusion. Patients with NSTEMI after COVID-19 were significantly younger compared to patients without a history of COVID-19. They had less common exertional angina prior to MI, while C-reactive protein and troponin I levels were significantly higher than in the control group. In addition, in NSTEMI patients after COVID-19, the estimated pulmonary artery systolic pressure was significantly higher compared to patients without a history of COVID-19.

Aim. To study the structural and functional state of skin microcirculation in working-age men with different phenotypes of hypertension (HTN) of low/moderate cardiovascular risk.Material and methods. A total of 218 healthy men underwent total blood count and biochemical blood tests, volumetric sphygmography, videocapillaroscopy, laser Doppler flowmetry at rest and with const­rictor and dilator tests, photoplethysmography, flow-mediated vasodilation of the brachial artery, cardiac and main artery ultrasound, 24-hour blood pressure (BP) monitoring. Based on the 24-hour BP monitoring, three following groups were formed: normal BP (NBP) group — 72 men, isolated diastolic hypertension (IDH) group — 70, systolic-diastolic hypertension (SDH) group — 76.Results. According to videocapillaroscopy and laser Doppler flow­metry, no reliable intergroup differences were found at the level of capillaries and precapillary arterioles. According to photoplethymography, men with SDH compared to the NBP group had higher AIp75 (augmentation index normalized to 75 bpm) (7,35 vs -5,4%; p<0,001), vascular age (VA) (49 vs 43 years; p<0,001) and reflection index (RI) (38 vs 29,1%; p<0,001), while patients with IDH had higher RI (35,3 vs 29,1%; p<0,001), respectively.Conclusion. Men with IDH and SDH do not have capillary rarefaction, tone changes, or constrictor and dilator activity of skin precapillary arterioles. Men with IDH and SDH are characterized by a higher tone of smooth muscle cells of terminal muscular arteries and distributing arterioles, and men with SDH also have higher arterial stiffness.