Antiarrhythmic therapy is associated with a high risk of adverse effects, including extracardiac and cardiac (particularly proarrhythmic) complications, as well as events related to drug–drug interactions. Currently, safety monitoring during treatment with antiarrhythmic drugs (AADs) includes electrocardiographic surveillance and assessment of hepatic, renal, thyroid, and pulmonary function, along with screening for underlying cardiac pathology, including latent conduction system disorders (eg, congenital long QT syndrome). However, these measures do not always prevent adverse drug reactions. A search was conducted in PubMed and eLibrary for the period from January 2019 through December 2024 (in some cases, because of the limited number of sources, the range was extended). The total search depth spanned 1979–2024. This review summarizes contemporary approaches to safety monitoring for the most commonly prescribed AADs in clinical practice, including class IC agents (propafenone, lappaconitine hydrobromide, and diethylaminopropionylethoxycarbonylaminophenothiazine) and class III agents (amiodarone and sotalol). Prospects for implementing therapeutic drug monitoring and pharmacogenetic testing of AADs are also discussed.

Acute myocardial infarction (AMI) remains a major public health concern worldwide. The aim of this narrative review was to identify and summarize the results of epidemiological studies on AMI incidence in Russia and abroad. Russian and international publications were searched in the databases eLibrary, PubMed, and Google Scholar. The search covered the previous 5 years. The analysis showed that the incidence rate of AMI in the Russian population during the study period remained high, reaching 140.8 cases per 100,000 population by 2022. This rate was lower compared with some CIS countries (Belarus, 174.5 cases) and European countries (Sweden, 288.0 cases; United Kingdom, 288.0 cases; France, 180.2 cases; Hungary, 177.5 cases; Spain, 169.0 cases; Cyprus, 160.0 cases), as well as New Zealand (536.0 cases), the United States (439.9 cases), Japan (389.7 cases), Australia (352.0 cases), Iran (343.0 cases), China (231.6 cases), and Tanzania (172.0 cases). These findings indicate that the incidence of AMI remains high both in Russia and globally, with an upward trend among middle-aged individuals. This highlights the need for future multicenter epidemiological studies of AMI incidence in Russia, particularly among adults aged 45–59 years, to support the development of new diagnostic and therapeutic strategies.

BACKGROUND: Ischemic myocardial dilation (IMD) develops as a result of coronary artery disease and may lead to heart failure with significantly reduced cardiac contractility. Previously we identified genetic factors associated with the risk of developing IMD. We found no data in available sources on the association between anthropometric characteristics and IMD. AIM: The work aimed to identify anthropometric parameters associated with IMD in carriers ща CTLA4 rs231775 polymorphisms. METHODS: The study included 113 patients with IMD (103 men and 10 women). The control group comprised 101 healthy individuals. Evaluation included history taking, physical examination, measurement of anthropometric parameters, and instrumental investigations including coronary artery assessment. DNA was extracted from venous blood samples using the phenol-chloroform method for subsequent genotyping. RESULTS: Among patients carrying the GG genotype, the pyknic body type was significantly more frequent compared with controls (64% vs 9.7%; χ2 = 55.557; p 0.001). In IMD groups, the andromorphic body type predominated, whereas the control group predominantly exhibited gynecomorphic and mesomorphic types. CONCLUSION: The GG genotype of the rs231775 polymorphism in the CTLA4 gene and the pyknic body type are likely associated with IMD.

BACKGROUND: Cardiovascular diseases, including hypertension, cause approximately 17 million deaths annually, with 9.4 million directly attributable to hypertension, which affects nearly 40% of the adult population. Genetic polymorphisms in the renin-angiotensin-aldosterone system play a significant role in the development of hypertension and in response to therapy. Investigating candidate gene polymorphisms involved in renin-angiotensin-aldosterone system pathways may help optimize the selection of antihypertensive therapy at early stages of treatment. AIM: To assess the frequency of single-nucleotide polymorphisms in renin-angiotensin-aldosterone system genes and their contribution to the development of diastolic dysfunction. MATERIALS AND METHODS: A cross-sectional study was conducted in 87 postmenopausal women aged 67 years (interquartile range, 65–70 years). Single-nucleotide polymorphisms in the ADD1, AGT, AGTR1, AGTR2, CYP11B2, GNB3, NOS3 genes were analyzed using real-time polymerase chain reaction. Renin-angiotensin-aldosterone system-related gene polymorphisms were evaluated in patients with and without diastolic dysfunction, as assessed by transthoracic echocardiography. RESULTS: No significant differences in the main clinical characteristics or the structure of antihypertensive therapy were observed between the groups with and without diastolic dysfunction (p 0.05). The current study did not reveal statistically significant differences in the distribution of polymorphic genotypes (p 0.05) The T allele of the CYP11B2 344 C/T polymorphism was significantly more frequent in patients with diastolic dysfunction. A two-locus model including AGT and CYP11B2 gene polymorphisms demonstrated a sensitivity of 66.1% and a specificity of 67.7%. The most effective three-locus model included polymorphisms in AGTR2, CYP11B2, and NOS3, yielding a sensitivity of 80.4% and a specificity of 71.0%. CONCLUSION: Multilocus analysis and a predictive model based on a combination of gene polymorphisms may support the assessment of risk for developing diastolic dysfunction in patients with hypertension. Identifying the contribution of genetic factors to the development of cardiovascular diseases and understanding their clinical relevance may facilitate the personalization of therapy.

BACKGROUND: The clinical course, pathophysiology, and therapeutic options for valvular and subvalvular (accompanied by hypertrophic cardiomyopathy, HCM) aortic stenosis are well known separately, but the rare combination of severe aortic stenosis (AS) and obstructive HCM presents great diagnostic and treatment challenges. The combination of these diseases during transcatheter aortic valve implantation (TAVI) is associated with significantly worse hospital outcomes, including cardiogenic shock, renal failure, and death. There is evidence that TAVI without prior treatment of left ventricular outflow tract obstruction leads to higher mortality due to exacerbation of subvalvular obstruction. AIM: To evaluate changes in hypertrophy of interventricular septum (IVS) in patients with a combination of AS and HCM following TAVI. MATERIALS AND METHODS: The observational, retrospective, single-center, non-randomized study included 20 patients with diagnosed severe AS, preoperative IVS thickness ≥15 mm, and the preoperative ratio of IVS and left ventricular posterior wall thickness ≥1.3, following TAVI. Mean and maximum follow-up periods were 33 and 92 months, respectively. The primary endpoint was decreased IVS thickness following TAVI as determined by echocardiography. RESULTS: The average age of patients was 72.4±5.5 years, more than half of the subjects were women. 60% of patients were diagnosed with coronary artery disease at the time of TAVI. Pre- and postoperative median IVS thicknesses were 17.7±2.2 and 14.4±3.2 mm, respectively. Long-term outcomes of TAVI included a significant decrease in hypertrophy of IVS (p=0.031) IVS thicknesses mainly decreased over the period up to 24 months after surgery. Cox regression analysis found that each year of patient’s age increased the risk of no postoperative decrease in IVS thickness after surgery by 12% every month. CONCLUSION: There was a statistically significant decrease in hypertrophy of IVS in patients who underwent TAVI. In most cases, IVS thickness decreased within 2 years after surgery. Each year of patient’s age increased the risk of no postoperative decrease in IVS thicknesses by 12% every month.

Anticoagulant therapy for atrial fibrillation (AF) plays an important role in preventing thromboembolic events. This review discusses anticoagulant therapy in patients with AF and chronic anemia of varying severity. The search was carried out in PubMed and Library electronic databases from 2010 to 2023. Based on the analysis of full text literature, the authors concluded that currently oral anticoagulants in patients with AF and mild chronic anemia (Hb 90 g/L) and, according to some studies, in patients with moderate anemia (Hb 80 g/L) are considered reasonable. Patients with AF and moderate anemia (Hb 71–80 g/L) require an individualized approach to therapy with oral anticoagulants, since its benefit is not obvious in this subgroup, and the risk of hemorrhagic complications is high. Currently, severe anemia is a contraindication to oral anticoagulants in patients with AF.

BACKGROUND: Until recently, takotsubo syndrome (TS) was considered a fairly benign disease in both early and late periods. However, in recent years, in-hospital complications in the acute period of TS are common and can be life-threatening.
 AIM: Based on clinical and laboratory-instrumental data, this study aimed to build models for predicting the risk of developing in-hospital complications in patients with TS during the acute period.
 MATERIALS AND METHODS: This prospective cohort study included 60 patients with TS, with an average age of 65.5±13.4 years. In the acute period (7–14 days), standard clinical and laboratory examination, peripheral arterial tonometry using the «EndoPAT 2000» apparatus, and psychological testing using validated questionnaires (hospital anxiety and depression scale and Beck depression scale) were performed.
 RESULTS: The integrated model for predicting the risk of acute heart failure (AHF) development (pulmonary edema and cardiogenic shock) identified admission LVEF as the leading prognostic parameter. With LVEF ≤40.5%, the probability of AHF in patients with TS in the acute period was 62.5%, and in patients with TS and QTc interval 487 ms, the risk reached 100%. The sensitivity and specificity of the developed model were 72.7% and 97.4%, respectively. The integrated model for predicting the development of cardiovascular complications (CVCs) revealed that the number of leukocytes in the peripheral blood was the leading risk factor for adverse events in patients with TS in the acute period. With a leukocyte count 11.1×109/L, the risk of CVCs in patients with TS increased to 89.9%, and if the erythrocyte count was 4.69×1012/L or ≤4.29×1012/L, it could reach 100%. The sensitivity and specificity of the resulting model were 92.6 and 97.0%, respectively.
 CONCLUSION: The models proposed in this study for predicting the likelihood of developing severe AHF and the overall risk of CVCs in the acute period of TS are personalized and easy to use, allowing for the selection of optimized treatment techniques.

Around 64 million persons in the world have heart failure (HF). HF patients with left ventricle ejection fraction (LVEF) of ≥50% are classified as having HF with preserved ejection fraction (HFpEF). It is estimated that about fifty percent of all HF is HFpEF. Our aim was to provide evidence of contemporary data regarding diagnosis and management of HFpEF. We conducted literature search through online search such as Google Scholar and PubMed Central (PMC), focusing on diagnosis and management of HFpEF. Several criteria exist for the diagnosis of HFpEF, including EF 50%, evidence of diastolic dysfunction, elevated brain natriuretic peptide. High (≥15) or intermediate (9–14) E/eʹ index indicates the likelihood of HFpEF. SGLT2I decrease E/eʹ, indicating improvement of LV diastolic function as mentioned in several studies. Treatment duration to achieve this effect spans from 3 months to 1 year. SGLT2I have positive effect on echocardiographic parameter HFpEF patients. In the researches included in the review, E/eʹ was mainly used as primary end point.

BACKGROUND: The study focused on the identification of new genetic predictors in the Russian population, particularly associations of the rs1132896 polymorphism of the matrix metalloproteinase type 2 gene (MMP-2) with the development of acute cerebrovascular accident (ACVA).
 OBJECTIVE: To investigate the relationship of rs1132896 gene MMP-2 polymorphisms with ACVA development.
 MATERIALS AND METHODS: The prospective, case–control study enrolled 318 patients with stroke (main group) and 323 controls (control group). The age of the patients in the main group ranged from 32 to 69 [57.0; 51.0–62.0] years. In the control group, the age of the patients ranged from 37 to 68 [55.0; 51.0–62.0] years, which was comparable to that of the main group. Sexual dimorphism was as follows: 191 men (age [56.5; 51.0–62.0]) and 127 women (age [57.0; 51.0–62.0]). The sex composition in the control group corresponded to that in the main group: 214 men (age [55.0; 51.0–62.0]) and 109 women (age [55.0; 51.0–62.0]). The main group underwent clinical examination, computed tomography of the brain, electrocardiography, echocardioscopy, duplex ultrasound scanning of the extracranial brachiocephalic arteries, 24-h monitoring of blood pressure and heart rate, and analysis of the blood coagulation system. Molecular genetic research was conducted at a branch of the Institute of Cytology and Genetics of the Siberian Branch of RAS (Novosibirsk). All patients provided written informed consent to participate voluntarily in the study. The duration of the study was 3 years, starting in 2019. The primary study endpoint was a diagnosis of stroke, verification of concomitant cardiovascular pathology, and risk factors for stroke development. Statistical processing of the results was performed using SPSS Statistics v. 22 (IBM Corp., USA) and MedCalc 22.006 (Microsoft, USA). When comparing extended variables, the Mann–Whitney U-test was used. Discrete values were compared using Pearson’s χ2 test.
 RESULTS: When analyzing statistical significance, a predominance of the homozygous CC genotype was recorded in the group of male patients with stroke: n=24 (12.6%) vs n=20 (9.3%; p=0.0324). In addition, in the group of women, a statistically significant predominance of the heterozygous CG genotype was noted in women with stroke: n=67 (52.8%) vs n=42 (38.5%; p=0.0420).
 CONCLUSION: The homozygous CC genotype in men and the heterozygous CG genotype in women may be genetic predictors of the development of ACVA. The study of genetic factors in the development of ACVA is necessary to create a personalized approach to patient management at the outpatient and inpatient stages of medical care.