Aim. To compare the performance of the CHA2DS2-VASc and the simplified CHA2DS2-VA scores in predicting 1-year thromboembolic events among patients with atrial fibrillation (AF) treated with non-vitamin K antagonist oral anticoagulants (NOACs).

Material and methods. In this single-centre observational cohort study, we followed 212 consecutive patients (median age 76 years, 53.5% female) with non-valvular AF receiving NOAC therapy for 12 months. Baseline clinical characteristics and thromboembolic risk scores were recorded. The primary outcome was thromboembolic events, defined as a composite of ischemic stroke, transient ischemic attack, or systemic embolism. Discriminative performance of the CHA2DS2-VASc and CHA2DS2- VA scores was assessed using receiver operating characteristic analysis and compared with the DeLong test. Cox proportional hazards regression was used to identify predictors of thromboembolic events.

Results. During follow-up, 33 patients (15.6%) experienced thromboembolic events. The median CHA2DS2-VASc score was 5 (IQR 4-6) and the median CHA2DS2- VA score was 4 (IQR 3-5). Event rates increased progressively across higher strata of both scores. The area under the receiver operating characteristic curve was 0.640 for CHA2DS2-VASc and 0.637 for CHA2DS2-VA, with no significant difference between the two scores (p=0.966). Using a cut-off value of ≥4, CHA2DS2-VASc yielded a sensitivity of 93.9% and specificity of 24.6%, while CHA2DS2-VA yielded a sensitivity of 90.9% and specificity of 30.2%. In multivariable analysis including individual score components, impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m²) was the only independent predictor of thromboembolic events (hazard ratio 2.36, 95% confidence interval 1.11-5.02; p=0.026).

Conclusion. In anticoagulated patients with AF, the CHA2DS2-VASc and CHA2DS2-VA scores demonstrated modest and comparable discrimination for 1-year thromboembolic events. A higher score threshold (≥4) identified patients with increased residual risk, while impaired renal function was the only independent predictor of events.

Aim. To conduct a comparative analysis of individual cardiovascular risk (CVR) assessment using three versions of the SCORE scale and to evaluate the associations of risk with regional living conditions.

Material and methods. Individual data from the cross-sectional phase of the ESSE-RF study in 2012-2014, 2017-2018, and 2020-2022 were used for the analysis. The analytical sample included 15,298 women and 10,861 men aged 40-64 years without a history of stroke, coronary heart disease, myocardial infarction, or diabetes, and without missing data. Individual CVR was assessed using the SCORE, SCORE2, and SCORE2-RF scales. The annual Economic, Demographic, Industrial, and Social Indexes of the National Medical Research Center for Therapy and Preventive Medicine were used as regional characteristics. Linear regression was used for quantitative outcomes, and logistic regression for binary outcomes. Logistic regression associations are expressed as odds ratios (ORs) and 95% confidence intervals.

Results. According to the SCORE scale, the proportion of individuals with high/very high cardiovascular risk (CVR) is 2.2% among women and 28.8% among men; according to SCORE2, the proportions are 25.7% and 54.7%; and according to SCORE2-RF, the proportions are 6.8% and 12.9%, respectively. Improvements in demographics (only for women) and social conditions in a region are associated with a reduced likelihood of high/very high CVR. Thus, an increase in the quintile of the Demographic Index is associated in women with a decrease in the likelihood of high/very high CVR: according to SCORE OR=0.81 (0.73-0.90), according to SCORE2 OR=0.94 (0.90-0.97), according to SCORE2-RF OR=0.88 (0.83-0.94). An increase in the quintile of the Social Index in women is associated with a decrease in the likelihood of high / very high CVR: according to SCORE OR=0.85 (0.77-0.94), according to SCORE2 OR=0.95 (0.92-0.99), according to SCORE2-RF OR=0.93 (0.88-0.98). In men, an increasing Social Index quintile is associated with a decreased likelihood of high/very high cardiovascular risk: according to SCORE, OR =0.91 (0.87-0.96), according to SCORE2-RF, OR=0.92 (0.87-0.96).

Conclusion. The study results suggest that the calibrated version of the SCORE2-RF scale is the most acceptable for practical use in preventive cardiology. Regional demographic and social conditions are associated with the profile of cardiovascular risk factors and can potentially be considered as population health factors. For Russia, a geographically diverse country, taking into account regional characteristics of the population allows for differentiation of prevention, as well as its focus and assessment of effectiveness.

Aim. To develop an online calculator of individual NT-proBNP thresholds to diagnose heart failure with preserved ejection fraction (HFpEF) and to pilot it in clinical practice.

Material and methods. At the first stage, an online calculator that computes a personalised NT-proBNP threshold based on age, sex, body mass index (BMI), estimated glomerular filtration rate (CKD-EPI), and the presence of atrial fibrillation was developed. A total of 128 patients (50% women; median age, 71 years) with HFpEF hospitalised at University Clinical Hospital No. 1, Sechenov University, between January and August 2024 were enrolled to validate the calculator. Diagnoses based on guideline-recommended NT-proBNP cutoffs were compared with diagnoses incorporating individualised thresholds from the calculator. Agreement between methods was assessed using Cohen’s kappa, and differences in diagnosis rates were evaluated with McNemar’s test.

Results. When comparing diagnoses based on standard NT-proBNP thresholds with those using individualised values, the diagnosis changed in 38 cases (29.7%): HFpEF was established in 30 patients and excluded in 8. Cohen’s kappa was 0.35. The difference between approaches was statistically significant (p=0.0005). The greatest diagnostic discrepancies were observed in patients younger than 60 years and in those with BMI 30-34 kg/m² and ≥40 kg/m²; statistically significant differences in diagnosis frequency were found only for patients with BMI 30-34 kg/m² (k=0.38, p <0.001). The minimum and maximum calculated NT-proBNP thresholds were 45 pg/mL and 506 pg/mL, respectively, delineating a “gray zone” in which the calculator may be particularly useful for refining diagnosis.

Conclusion. NT-proBNP remains a key biomarker in HFpEF diagnosis; however, patient sex, age, and comorbidities affect its circulating levels. We therefore propose using our online calculator to derive individualized NT-proBNP thresholds for HFpEF diagnosis to reduce diagnostic errors, initiate treatment in a timely manner, and avoid unnecessary medication.

Aim. To determine the 99th percentile value of hs-cTnI in a sample of apparently healthy individuals from the Russian population, considering sex and age, based on standardized IFCC criteria.

Material and methods. Data from the ESSE-RF1 and ESSE-RF2 studies (n=14,035, age 25-64 years) were used. After excluding participants with cardiovascular and chronic diseases, diabetes mellitus, renal dysfunction, and those taking antihypertensive or lipid-lowering medications, 4,356 individuals (1,588 men and 2,768 women) were included in the analysis. Hs-cTnI levels were measured using the Architect i2000sr analyzer (Abbott). Statistical analysis was performed using nonparametric methods; the 99th percentile was estimated using the Harrell-Davis method with bootstrap.

Results. Hs-cTnI concentrations were above the limit of detection in 67.9% of participants. The median hs-cTnI level in the overall sample was 1.5 ng/L [Q1-Q3: 0.9-2.5], with significantly higher levels in men (1.9 [1.2-3.0] ng/L) compared to women (1.3 [0.7-2.2] ng/L) (p<0.001). The 99th percentile values (upper reference limits) were: overall — 16.5 ng/L (95% CI 14.7-19.4); men — 17.1 ng/L (14.6–20.9); women — 16.2 ng/L (13.7-21.5). No significant age dependence of the 99th percentile was observed (p>0.05). Compared to the manufacturer’s reference limits, the obtained values for men were significantly lower (17.1 vs. 34.2 ng/L), while for women they were slightly higher (16.2 vs. 15.6 ng/L).

Conclusion. The 99th percentile values of hs-cTnI in the healthy Russian population differ from the reference levels proposed by the manufacturer, demonstrate sex-specific differences, but do not depend on age. These findings emphasize the necessity of sex-specific stratification of hs-cTnI in the diagnosis of myocardial injury and infarction.

Aim. To evaluate the efficacy and safety of a single intravenous fixed dose of cavutilide 350 μg compared to propranolol in patients with paroxysms of atrial fibrillation (AF) and atrial flutter (AFl)

Material and methods. 70 patients with paroxysmal AF/AFl (36 women and 34 men, mean age 64.8±10.6 years) were divided into two groups. In the first group (n=35) a single intravenous injection of cavutilide 350 μg was administered to restore sinus rhythm (SR). In the second group (n=35) rate-control therapy with propranolol (10-20 mg per os every 3-4 hours) was performed. The main endpoints were SR restoration within 60-min and 24h, time to arrhythmia termination, and absence of AFib/AFl relapses. Safety was assessed by monitoring for major adverse cardiovascular events and proarrhythmia.

Results. Within the first 60-min period SR was restored in 77.1% of patients in cavutilide group and in none of the patients in propranolol group (0; p<0.001). SR was restored in 100% of patients with AFl (n=7) within 1 hour after cavutilide administration. After 24h SR was restored in 88.6% of patients in group of cavutilide versus 45.7% of patients in propranolol group (p<0.001). Median time to SR restoration was 8,0 [5,0; 13,0] minutes in cavutilide group versus 375,0 [232,0; 915,0] minutes in propranolol group (p<0.001). A decrease in heart rate of more than 10 beats/min was observed in 3 out of 4 patients (75%) who did not restore SR after administration of cavutilide, and in 28 out of 35 patients in propranolol group (75% vs 80%; p=0.41). There were 2 cases of asymptomatic decrease in heart rate <50 beats/min. and 3 cases of transient prolongation of QT >500 ms after cavutilide administration. In all 3 cases QT interval decreased to normal values within 1 hour. No AF/AFl recurrencies, proarrhythmia and major adverse cardiovascular events occurred in both groups.

Conclusion. A single fixed dose of cavutilid 350 μg is safe and highly effective for restoration of SR in paroxysmal AF/AFl, outperforming propranolol in likelihood of SR recovery, time to relief, and relapse prevention. Notably SR recovery after administration of cavutilide in 100% of patients with AFl, who are characterized by extremely low efficacy of other antiarrhythmic drugs. The high efficiency and rapid achievements of results, without significant adverse events, indicate the potential prospects for the use of a fixed dose of cavutilide 350 mg in outpatient settings.

Metabotropic glutamate receptor 1 (mGluR1), traditionally studied in the context of neuronal signaling, has recently gained attention as a potential contributor to the pathogenesis of cardiovascular diseases. This review summarises current evidence on the role of mGluR1 in neurodegenerative, oncological, and — most importantly — cardiovascular diseases. We discuss the receptor structure, its classification as a GPCR family member, and the features of its intracellular signaling, including activation of the MAPK/ERK and PI3K/Akt pathways and regulation of transcription factors. It has been shown that, in addition to the central nervous system, mGluR1 is expressed in immune cells, the endothelium, vascular smooth muscle cells, and cardiomyocytes, suggesting its involvement in regulating inflammation, proliferation, and angiogenesis — key processes in atherogenesis. Special attention is given to data on glutamate accumulation in unstable atherosclerotic plaques and its association with local inflammation. We also note the lack of clinical studies evaluating mGluR1 concentrations in patients with coronary artery disease. Further investigation of mGluR1 as a potential biomarker and molecular target in cardiovascular pathology represents a promising direction.

The healthcare system operates under defined key performance indicators that must be met. However, its structure remains inherently fragmented, divided into hierarchical tiers of care delivery. Currently, the quality of care is assessed through disease-specific clinical guidelines. There is a critical lack of comprehensive systems capable of evaluating the quality of an individual patient’s journey across the entire healthcare continuum, particularly for those with multiple comorbid conditions. Patient Journey Mapping (PJM) emerges as a potential solution to this challenge. PJM serves as a methodological tool to consolidate patient-centric data generated during care delivery. Its primary benefit lies in enabling multidimensional assessments of the patient’s health status, the healthcare system’s performance, and the appropriateness of prescribed therapies. A foundational requirement for constructing PJM is robust clinical data, which integrates patient-reported outcomes with objective clinical status indicators. Structured medical registries represent the most reliable source of such data. This non-systematic literature review examines the development of patient pathway models based on medical registries and explores their potential applications for stakeholders, including healthcare systems, private clinics, pharmaceutical enterprises, clinicians, and patients. The analysis highlights PJM’s capacity to enhance care coordination, inform value-based healthcare strategies, and facilitate personalized therapeutic interventions.

Current data describing the features of arginine vasopressin (AVP) system activation in healthy individuals and in patients with chronic heart failure (CHF) are presented. This article presents current data on the cardiovascular effects of interactions between AVP system mediators and specific receptors. Based on an analysis of current literature, the osmotic and non-osmotic pathways of AVP system activation are described in detail, both under physiological conditions and in CHF. The authors are the first in Russian-language literature to use the term “osmotic incompetence” in a broader context, extending beyond the syndrome of inappropriate antidiuretic hormone secretion to describe the mechanism of AVP system activation despite increased plasma osmolality. It is emphasized that despite the potential attractiveness of this mediator of the AVP system as a diagnostic and prognostic marker in various acute conditions and decompensation of chronic diseases, to date, a very small number of studies have been conducted, both in our country and worldwide, devoted to its role in the pathogenesis of various diseases, including CHF. Along with a detailed description of the mechanisms of AVP system imbalance, the authors provide clinical scenarios of osmotic incompetence in patients with various diseases. Particular attention is given to the role of copeptin as a surrogate marker for assessing the activity of the arginine vasopressin system. The authors aimed to highlight the complexity of the relationships between osmosis-dependent and osmosis-independent pathways of AVP activation in CHF, emphasizing the prospects for studying the AVP system, understanding the functioning of which in CHF conditions should lead to the development of targeted therapeutic strategies that can alleviate symptoms, improve treatment results, clinical outcomes and improve the quality of life of patients with heart failure.

Takotsubo syndrome (TS) management is a complex task that requires a comprehensive and differentiated approach, taking into account various clinical scenarios and potential complications. This review analyses current strategies for TS management, covering the treatment of uncomplicated cases, management of lifethreatening complications, and assessment of longterm prognosis. In uncomplicated cases, the primary treatment goal is to stabilise the patient’s condition and relieve symptoms. Firstline medications typically include betablockers and angiotensinconverting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). While the role of betablockers remains a subject of debate within the scientific community, ACEIs/ARBs have shown promising results in improving longterm prognosis and reducing the likelihood of recurrences. Management of patients with complicated forms of TS, particularly cardiogenic shock and intraventricular thrombosis, requires more aggressive therapeutic interventions. In cases of cardiogenic shock, it is crucial to differentiate whether left ventricular outflow tract obstruction is present, as this determines the choice of optimal inotropic support. The detection of intracardiac thrombus is an indication for anticoagulant therapy, with a recommended duration of at least three months or until full recovery of myocardial contractility. Although the overall prognosis for TS is generally favourable, with a high probability of left ventricular dysfunction regression, the risk of disease recurrence persists. To optimise longterm patient management, it is advisable to conduct not only regular monitoring of left ventricular function but also assessment of the patient’s psychoemotional state. However, the lack of conclusive evidence regarding the effectiveness of longterm pharmacological therapy in preventing disease recurrence underscores the need for further largescale studies.

In clinical practice, arterial hypertension often shows inadequate blood pressure control despite standard antihypertensive therapy. Genetically determined variability in pharmacokinetics and pharmacodynamics may contribute to interindividual differences in treatment efficacy and tolerability, yet it is rarely incorporated into routine prescribing. We report a clinical case of a 54-year-old female patient of Kyrgyz ethnic origin with uncontrolled blood pressure on combination therapy and an adverse reaction (peripheral edema) during amlodipine treatment. Pharmacogenetic testing revealed CYP2C9 *1/*3 (potentially reduced formation of the active losartan metabolite), CYP3A5 *3/*3 (a possible association with an increased risk of amlodipine-related adverse reactions), and CYP2D6 *10/*10 (a potential risk of dosedependent adverse reactions with certain beta-blockers). Therapy adjustment based on the obtained profile (switching from losartan to perindopril in combination with indapamide) was associated with achievement of target blood pressure levels without initiation of triple therapy. Pharmacogenetic information may be considered an additional tool to support antihypertensive therapy selection in selected patients.

This clinical case report describes the development of intoxication symptoms (nausea, muscle cramps, generalised weakness) and instability of blood pressure associated with long-term uncontrolled intake of high-dose vitamin D (up to 35,000 IU per week) in a 68-year-old female patient with comorbid conditions: secondary arterial hypertension, primary hyperparathyroidism, and chronic kidney disease stage C3a. Laboratory analysis revealed a typical triad of abnormalities: hypercalcemia (total calcium up to 2.82 mmol/L), elevated parathyroid hormone level (115.4 pg/mL), and a high serum 25(OH)D concentration (70.6 ng/mL). Key evidence of the iatrogenic nature of the symptoms was the complete resolution of complaints and normalisation of blood pressure on the previous antihypertensive therapy following discontinuation of vitamin D intake, as well as recurrence of symptoms upon resumption of vitamin D supplements, even at a lower dose (14,000 IU/day). A notable feature of this case is the development of toxic effects at a serum 25(OH)D level only slightly above the normal range, which underscores the importance of identifying adverse effects when prescribing therapy to patients with comorbidities. This observation highlights the necessity for thorough laboratory monitoring (calcium, parathyroid hormone, 25(OH)D, renal function parameters) prior to and during vitamin D supplementation, particularly in patients with hyperparathyroidism and chronic kidney disease.

Left ventricular non-compaction cardiomyopathy is a rare genetically determined phenomenon associated with impaired myocardial compaction and the risk of developing chronic heart failure, ventricular arrhythmias, and thromboembolism. This report presents the case of a 26-year-old professional boxer, previously considered healthy, who developed edema, progressive dyspnea, and syncope after COVID-19, leading to hospitalisation. Echocardiography revealed chamber dilation, left ventricular wall hypertrabeculation, a noncompacted-to-compacted layer ratio greater than two to one, and a left ventricular ejection fraction of 21 to 28 percent. Contrast-enhanced magnetic resonance imaging confirmed left ventricular noncompaction cardiomyopathy (noncompacted myocardial mass of 23% according to the А. Jacquier et al. criterion) and signs of fibrosis. Treatment was initiated with quadruple therapy for chronic heart failure, diuretics, and rivaroxaban; no thromboembolic events were recorded. On optimal therapy, the left ventricular ejection fraction improved to 44% by November 2025, symptoms significantly regressed, and the patient returned to non-professional training. The case of detecting left ventricular non-compaction syndrome in an athlete is particularly interesting due to the complexity of differentiating between the physiological hypertrophy of an "athlete’s heart" and the excessive trabeculation and non-compaction of the left ventricular myocardium seen in left ventricle non’compaction. Intense training most likely contributed to the functional maladaptation of the left ventricle, and a prior viral infection may have served as a triggering factor in a morphologically altered heart, leading to the subsequent transition to cardiomyopathy against a background of genetic predisposition.

Aim. To assess adherence to previously prescribed pharmacotherapy among patients with chronic noncommunicable diseases admitted for elective inpatient treatment at a federal medical research center.

Material and methods. PRIMULA is a cross-sectional observational study conducted at the National Medical Research Center for Therapy and Preventive Medicine from February 19, 2025 to February 19, 2026. The study included patients admitted to the emergency departmentwho agreed to complete the adherence questionnaire of the National Society of Evidence-Based Pharmacotherapy (NSEBP) and signed informed consent for personal data processing. The questionnaire consisted of 3 modules and required 5-7 minutes to complete. This article presents a preliminary analysis of the data collected during the first 6 months of the study.

Results. Among 3,006 patients, men accounted for 53.6%; the median age was 65 [55;72] years. A total of 1,690 (56.2%) patients were married, 453 (15.1%) were smokers, 724 (24.1%) had a disability, and 1,119 (37.2%) were employed. Before hospitalisation, 849 (28.2%) patients had not been followed up in healthcare institutions, 1,318 (43.8%) had been followed up at their local outpatient clinic, 38 (1.3%) at a research clinic, and 801 (26.7%) at other medical institutions of various profiles (p<0.001). Data sufficient to determine adherence level were available for 2,654 of 3,006 patients. Of these, 2,227 (83.9%) were adherent to therapy, 273 (10.3%) were partially adherent, and 154 (5.8%) were fully non-adherent; 352 patients (11.7%) had incomplete questionnaire data. Overall, impaired adherence was identified in 427 patients (16.1%), corresponding to approximately one in six patients with available data. The most significant reasons for complete non-adherence were adverse effects during therapy, lack of treatment effect, polypharmacy, and doubts about the need for the prescribed treatment; for partial nonadherence, the main reasons were taking a large number of medications, fear of adverse effects, unwillingness to take the prescribed therapy, and forgetfulness. During repeat hospitalisation, impaired adherence was identified in 20 patients, representing 13.1% of those with available repeat questionnaire data (n=153). Analysis of the data obtained made it possible to identify an additional type of non-adherence to therapy, namely hidden non-adherence (n=11).

Conclusion. Impaired adherence to previously prescribed pharmacotherapy is a clinically significant problem already at the stage of elective hospitalization. The brief NSEBP questionnaire may be used as a screening tool to identify overt adherence problems and signs of hidden non-adherence. The findings support the need for systematic assessment of adherence both in the outpatient setting and at hospital admission.