Irina V. Avdeeva

This review focuses on capillary leak syndrome (CLS) as a potential complication of anticancer therapy, its pathogenesis, and possible diagnostic and treatment options. Over the past decade, cardio-oncology, an interdisciplinary field of medicine, has been rapidly developing. Its aim is to assess the underlying cardiac risk in patients with malignant neoplasms and, on the one hand, to manage the complications of anticancer therapy. While the term “cardiotoxicity” has long been known, the concept of “vasculotoxicity” remains somewhat terra incognita for the vast majority of oncologists. One manifestation of vasculotoxicity can be capillary leak syndrome, or CLS. In 1960, the first clinical case of recurrent edema syndrome, combined with manifestations of hypovolemic shock, was described. In the development of CLS, the leading role is assigned to the disruption of endothelial dysfunction, associated immune reactions and a number of inflammatory mediators. Cases of primary CLS are rare, while secondary one is observed in a wide range of conditions, including hematological malignancies, dermatological and systemic diseases, infections, the use of certain medications or exposure to toxins, and postoperative and traumatic events. A total of 243 drugs have been identified that are potentially associated with at least one case of vascular endothelial dysfunction. 560 individual safety reports were compiled for 52 of the 243 drugs. Of these 52 drugs, 45 (86,5 %) were antineoplastic and immunomodulatory agents. Because a large number of CLS cases are associated with antineoplastic treatment, special attention to this serious complication should be paid by oncologists, hematologists, and physicians of all specialties involved in the monitoring of these patients.

Background/Objectives: This study aimed to evaluate the prognostic role of the extracellular volume (ECV) assessed by cardiac magnetic resonance imaging (MRI) in relation to systolic dysfunction and unfavorable remodeling of the left ventricular (LV) at 24 weeks after myocardial infarction (MI) and revascularization. Methods: The study included 154 patients aged 56 ± 8 years who had been diagnosed with their first MI. Cardiac MRI was performed at 7–10 days and after 24 weeks, including assessment of indexed volumes, LV ejection fraction (LVEF), ECV, and patterns of ischemic and reperfusion injury. The study is registered in the international clinical trials registry with the number NCT04347434 (ClinicalTrials.gov). Results: Patients were divided into two groups after 24 weeks: group 1 (n = 24) with LVEF < 50% and group 2 (n = 130) with LVEF ≥ 50%. At 7–10 days, the scar mass in group 1 was 58.5 (39.5; 69.8) g vs. 17.1 (9.2; 29.7) g in group 2 (p < 0.001); microvascular obstruction was present in 23 cases (95.8%) vs. 55 (42.3%) (p < 0.001). After 24 weeks, inter-group differences increased (p < 0.05). Global ECV and remote myocardial ECV were significantly higher in patients with LVEF < 50% both at 7–10 days and after 24 weeks compared to those with LVEF ≥ 50% (p < 0.05). Infarct zone ECV did not differ between groups. Systolic dysfunction after 24 weeks was predicted by global ECV > 38.3% (p < 0.001) and remote myocardial ECV > 33.6% (p = 0.008). Predictors of an increase in end-diastolic volume index > 12% after 24 weeks in the subgroup of patients with initial systolic dysfunction were global ECV > 42.8% (p = 0.017) and remote myocardial ECV > 35.6% (p = 0.012). Conclusions: Global ECV and ECV of the remote myocardium, which exceed a certain level established by a cardiac MRI in the acute stage of MI, are among the predictors of LVEF < 50% and unfavorable LV remodeling in the medium term.

Aim. To evaluate the prognostic role of the extracellular volume (ECV) assessed by cardiac magnetic resonance imaging (MRI) in relation to systolic dysfunction and unfavorable remodeling of the left ventricular (LV) at 24 weeks after myocardial infarction (MI) and revascularization. Materials and methods. The study included 154 patients with primary MI aged 56±8 years. MRI was performed at 7–10 days and after 24 weeks, including assessment of indexed volumes, LV ejection fraction (LVEF), ECV, and patterns of ischemic and reperfusion injury. The study is registered in the international clinical trials registry with the number NCT04347434 (ClinicalTrials.gov). Results. Patients were divided into two groups after 24 weeks: Group 1 (n=24) with LVEF 12% after 24 weeks in the subgroup of patients with initial systolic dysfunction were global ECV >42.8% (p=0.017) and remote myocardial ECV >35.6% (p=0.012). Conclusion. Global ECV and remote myocardial ECV measured by MRI in the acute stage of MI are predictors of persistent systolic dysfunction and unfavorable LV remodeling in the medium term.

Although the term "target organ damage" is used primarily in relation to the diagnosis of hypertension, the fact that vessels are involved in a wider range of diseases is beyond doubt. Over the past 30 years, arterial stiffness has moved from the area of scientific interest to clinical guidelines. The ankle-brachial index is widely used to assess target organ damage. In a number of conditions (diabetes, chronic kidney disease, especially in the end-stage renal failure and hemodialysis), severe medial calcification of the arterial walls develops. As a result, the arteries become non-compressible, which leads to falsely elevated ankle-brachial index (>1,4). Toe vessels are less susceptible to vascular stiffness, which makes the toe-brachial index an accessible alternative in such a situation. The literature review highlights the history of toe-brachial index development as a research method, as well as the predictive value and prospects for further application. Its use offers opportunities for deepening and expanding understanding of the pathogenesis of a wide range of diseases, searching for and testing correction methods and developing effective prevention methods.

Aim. To evaluate the features of antihypertensive therapy (AHT), adherence to therapy and achievement of target blood pressure (BP) in patients with hypertension (HTN) in Russian real-world practice after the implementation of 2024 Russian clinical guidelines on hypertension in adults.Material and methods. During May 2025, 7990 patients with HTN from 19 Russian cities and Tiraspol (Pridnestrovian Moldavian Republic) took part in the BP measurement campaign. Outpatients with HTN over the age of 18 voluntarily participated in the campaign. During the screening, BP and pulse were measured three times using an automatic or mechanical BP monitor. In addition, a questionnaire was filled out on behavioral risk factors, BP self-monitoring skills, medication adherence, AHT, comorbidities and related therapy. The effectiveness of AHT was understood as achieving the target BP level Results. The analysis included 7972 respondents aged 18 to 96 years (median age 62 years [51;71]), including 3372 men (42,3%). Among the participants, 74,4% took AHT, while 62,6% achieved target BP Conclusion. In outpatient practice after the implementation of 2024 Russian clinical guidelines for HTN, an increase in the coverage and efficacy of AHT, and the HTN control is observed compared to the population data of 2020-2022. AHT prescription profile indicates a decrease in the share of monotherapy and an increase in the share of triple combination. The use of single-pill antihypertensive combinations is growing, but remains insufficient. The results obtained demonstrate the importance of discussing with a physician the need to comply with recommendations in hypertensive patients to improve adherence and treatment effectiveness.

Aim. To study the adequacy and effectiveness of lipid-lowering therapy (LLT) prescribed to patients with heterozygous familial hypercholesterolemia (HeFH), including fixed-dose combinations (FDC) of rosuvastatin with ezetimibe, as well as the frequency of achieving target low-density lipoprotein cholesterol (LDL-C) levels.Material and methods. The clinical and demographic data of 3151 patients with HeFH at high or very high cardiovascular risk from the RENAISSANCE registry were retrospectively analysed. Among the 1612 individuals receiving LLT, 477 patients were treated with a combination of rosuvastatin at various doses and ezetimibe 10 mg daily, either as a free combination or as a FDC.Results. The median age of the patients was 46.0 [32.0; 57.0] years. The median LDL-C level was 6.4 [5.3; 7.8] mmol/L. Although LLT was recommended to all participants, approximately half (49%, n=1539) were not receiving treatment. Among the 1612 patients on LLT, 44% (n=703) received statin monotherapy, and 43% (n=697) were treated with a combination of statins and ezetimibe. Of the 477 patients taking rosuvastatin with ezetimibe, the majority were active adults of working age (35-64 years): 335 (80%) vs 86 (20%), p Conclusion. Among patients with НeFH, the use of a FDC of rosuvastatin and ezetimibe is associated with higher treatment adherence and a greater likelihood of achieving target LDL-С levels.

Aim. To identify factors associated with achieving the target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels with polypill therapy (indapamide, perindopril, rosuvastatin) in patients with hypertension (HTN) and dyslipidemia after a coronavirus disease 2019. Material and methods. The study included 62 patients who were divided into following groups: 1 ^st (n=42) — BP and LDL-C target levels were achieved after 24 weeks; 2 ^nd (n=20) — target levels were not achieved. Lipid profile, structural and functional characteristics of arteries were determined. Results. Polypill therapy was characterized by achieving BP and LDL-C target levels in 38,7%, while the addition of amlodipine and ezetimibe increased the effectiveness to 67,7%. In group 1, the carotid intima-media thickness decreased by 11,8%, and in group 2 — by 7% (pst group, the proportion of individuals with normal intima-media values increased, the b stiffness index decreased (-15,2%; pConclusion. Simultaneous achievement of BP and LDL-C target levels with polypill therapy in patients with HTN and dyslipidemia after coronavirus infection was accompanied by a pronounced vasoprotective effect. A multifactorial model was created to predict a decrease in BP and LDL-C to target levels, including age, history of HTN, systolic BP.

Background/Objectives: The aim of this study is to identify markers and develop a multifactorial model for characterizing extensive scar tissue after revascularization in patients with myocardial infarction (MI). Methods: A total of 123 patients with MI were examined. The patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th–10th days from the onset of the disease. At the first stage, we performed a comparative analysis and built a multifactorial model based on the examination results of 92 (75%) patients enrolled from April 2021 to October 2023. These patients formed the group used for model development, or the “modeling group”. The mass of the scar was calculated, including relative to the left ventricular (LV) myocardium mass (M_scar/LVMM, in %). Results: The first subgroup consisted of 36 (39%) patients with a large scar, denoted as “LS” (M_scar/LVMM > 20%). The second subgroup included 56 (61%) patients with a smaller scar, referred to as “SS” (M_scar/LVMM ≤ 20%). Logistic regression was used to identify independent factors affecting scar tissue size. A multifactorial model was created. This model predicts M_scar/LVMM > 20% on MRI. It uses readily available clinical parameters: high-sensitivity troponin I (HscTn I) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and LV relative wall thickness (RWT). We tested the multifactorial model on the “modeling group” (n = 31). The sensitivity was 63.6% and the specificity was 85.7%. Conclusions: These indicates the feasibility of its application in clinical practice.

The aim of this study is to identify markers and develop a multifactorial model for characterizing extensive scar tissue after revascularization in patients with myocardial infarction (MI). 123 patients with MI were examined. The patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, USA) on the 7th-10th days from the onset of the disease. At the first stage, we performed a comparative analysis and built a multifactorial model based on the examination results of 92 (75%) patients enrolled from April 2021 to October 2023. These patients formed the group used for model development, or the “modeling group”. The mass of the scar was calculated, including relative to the left ventricular (LV) myocardium mass (Mscar/LVMM, in %). The first subgroup consisted of 36 (39%) patients with a large scar, denoted as “LS” (Mscar/LVMM >20%). The second subgroup included 56 (61%) patients with a smaller scar, referred to as “SS” (Mscar/LVMM ≤20%). Logistic regression was used to identify independent factors affecting scar tissue size. A multifactorial model was created. This model predicts Mscar/LVMM >20% on MRI. It uses readily available clinical parameters: high-sensitivity troponin I (HscTn I) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and LV relative wall thickness (RWT). We tested the multifactorial model on the “modeling group” (n=31). The sensitivity was 63.6%, and the specificity was 85.7%. This indicates the feasibility of its application in clinical practice.

In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention should be performed within 120 minutes after diagnosis if possible. Timely revascularization helps to preserve left ventricular function, minimizing myocardial damage, which subsequently reduces disability and mortality. There are patients for whom this approach cannot be implemented within the specified time frame for a number of reasons. In such a situation, a pharmacoinvasive strategy is recommended, which involves thrombolytic therapy as the first stage. Current treatment strategies for myocardial infarction have been compared many times. An undoubted advantage in Russia is the availability of domestic staphylokinase agent, which has a good efficacy and safety profile, meeting the requirements for fibrin specificity. Thus, research determining the current place of pharmacoinvasive strategy should be continued to optimize thrombolysis and improve the prognosis in patients with myocardial infarction.