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Aim. To determine the blood concentration of fibrosis biomarkers in patients with atrial fibrillation (AF) in combination with metabolic syndrome (MS) and to analyze the relationship with myocardial fibrosis.Material and methods. This cross-sectional case-control study included 547 patients aged 35 to 65 years: experimental group — patients with MS (n=373), of which 202 patients had AF; comparison group — AF patients without MS (n=110); healthy subjects without cardiovascular diseases and metabolic disorders (n=64). Patients with AF and MS who underwent electroanatomic mapping before pulmonary vein isolation (n=79) were assessed for left atrial (LA) fibrosis severity.Results. It was found that the blood concentration of circulating profibrogenic biomarkers in patients with AF and MS is higher than in patients with AF without MS: aldosterone (135,1 (80,7-224,1) and 90,1 (68,3-120,3) pg/ml, p<0,0001), galectin-3 (10,6 (4,8-15,4) and 5,8 (4,8-8,3) pg/ml, p=0,0001), GDF15 (938,3 (678,3-1352,1) and 671,0 (515,7-879,5) pg/ml, p=0,001), TGF-beta-1 (4421,1 (2513,5-7634,5) and 2630,5 (2020,7-3785,4) pg/ml, p=0,001), CTGF (167,8 (78,9-194,3) and 124,3 (74,4-181,9) pg/ml, p<0,0001), PIIINP (88,5 (58,6120,4) and 58,9 (40,7-86,1) ng/ml, p<0,0001), PINP (3421,4 (1808,1-4321,7) and 2996,1 (2283,8-3894,3) pg/ml, p<0,0001). Patients with paroxysmal AF have higher concentrations of TGF-beta1, CTGF and PINP than patients with persistent and permanent AF. In patients with persistent AF and MS, the concentrations of galectin-3, aldosterone, and PIIINP were higher than in patients with paroxysmal AF, while in patients with permanent AF, they were significantly lower. The plasma concentration of galectin-3 positively correlated with levels of PINP (p=0,465, p<0,0001), PIIINP (p=0,409, p<0,0001), GDF-15 (p=0,369, p<O,O001), CTGF (p=0,405, p<0,0001). According to multivariate regression, of all studied biomarkers, GDF-15 had a greater effect on PIIINP concentration (в=0,234, p=0,038), and galectin-3 — on PINP (в=0,248, p<0,021). Positive correlations of the severity of left atrial fibrosis with the concentration of galectin-3 (p=0,563, p<0,0001), PINP (p=0,620, p<0,0001), TGF-beta-1 (p=0,390, p<0,0001) and CTGF (p=0,551, p<0,0001). According to linear multivariate regression, the most significant effect on LA fibrosis severity among the studied biomarkers is exerted by galectin-3 (в=0,432, p<0,0001), PINP (в=0,343, p=0,001) and PIIINP (в=0,286, p=0,008).Conclusion. An increase in the blood concentration of profibrogenic biomarkers galectin-3, TGF-beta-1, CTGF, PIIINP, and PINP is associated with an increase in LA fibrosis severity and probably has a pathogenetic role in increasing the AF risk in patients with MS.

The paper presents a computational procedure developed for patient-specified blood flow simulation in the proximal anastomosis of femoral-popliteal bypass. The calculations are based on a three-dimensional geometric model constructed from a CT angiography scan of the vascular bed in the anastomotic region and boundary conditions obtained by ultrasound Doppler measurements of the velocity in control sections of the bed. A numerical analysis of 3D pulsating flow structure in a particular model of the proximal anastomosis has been carried out. The model includes sections of the common femoral artery (CFA), the graft, the deep femoral artery and the superficial femoral artery. The Reynolds number based on the CFA inner diameter and the inlet bulk velocity is 880. The sizes and location of stagnant zones, areas with low values of the time-averaged wall shear stress modulus and with high values of the oscillatory shear index are determined. It is shown that the results of the prediction of areas with low values of the time-averaged shear stress modulus are in qualitative agreement with the data of local measurements of neointima thickness formed along the graft wall one year after the operation.

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

This document provides an overview of current problems and trends in the catheter ablation of atrial fibrillation, summarizes the opinions of specialists, obtained during a web-based electronic survey, on aspects and parameters of radiofrequency ablation. The approaches on improving the efficacy and safety of radiofrequency catheter ablation of atrial fibrillation are provided.

Введение. Совместная работа клиницистов, врачей отделений интенсивной терапии, специалистов ультразвуковой диагностики, врачей-рентгенологов является ключевым аспектом диагностики патоло-гических изменений в легких, в особенности сейчас, на фоне пандемии коронавирусной инфекции [1]. Лучевая диагностика в условиях пандемии новой коронавирусной инфекции имеет ключевое значе-ЛЕКЦИИ И ОБЗОРЫ / LECTURES AND REVIEWS

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Background Galectin-3 (Gal-3) and transforming growth factor-beta1 (TGFbeta1) – biomarkers of fibrosis are increased in patients with atrial fibrillation (AFib) and metabolic syndrome (MetS). We propose that both can impact on progression of the arrhythmia. Purpose Objective of the study was to evaluate the role of Gal-3 and TGFbeta1 in predicting the effect of antiarrhythmic pharmacotherapy (APT) and radiofrequency ablation therapy (RAT) in patients with AFib and MetS. Methods 539 AFib patients hospitalized in cardiology department (2015–2016 years) were examined. 204 AFib patients with paroxysmal (n=156) and persistent (n=48) forms 35–60 years old were included in prospective study: 110 had ≥3 components of MetS (IDF, 2005) and 94 without MetS. Serum GAL-3, TGF-beta1 (Enzyme immunoassay) were performed. Antiarrhythmics were applied during 12 months. Antiarrhythmic effect of pharmacotherapy was established if no episodes of AFib were registered during follow-up. 73 patients without effect of APT were treated with RAT with pulmonary veins isolation. Ablation procedure was performed with the system of electroanatomical mapping CARTO3. In the “offline” mode we evaluated areas of low voltage in the amplitude spectrum of 0,2–1,0 mV and divided all patients into groups: I – minimal (<10% of LAarea, n=18), II – mild (10–19% of LAarea,n=26), III – moderate (20–29% of LAarea, n=17) and IV - severe low voltage area (≥30% of LAarea,n=12). After ablation, we analyzed the clinical data and the effectiveness of RAT during 12 months. Results Gal-3 in patients with recurrent paroxysms and without the effect of APT was higher than in patients without recurrent paroxysms (1312,1 [750,2; 2494,3] and 500,2 [410,3; 723,4] pg/ml, p<0,001). TGF-beta1 was also higher in patients without the effect of APT (11521,2 [2950,2; 17642,2] and 2999,5 [1767,4; 5490,2] pg/ml, p<0,001). Patients from IV group had greater low voltage area of LA, than in I group (33,4±2,1 and 6,6±2,4%, p<0,001), but also higher levels of Gal-3 (1201,1 [950,2; 2140,3] and 490,2 [310,3; 523,4] pg/ml, p=0,027) and TGF-beta1 (9497,2 [1257,2; 14672,2] and 3491,5 [1767,4; 8470,2] pg/ml, p=0,04). The multivariate regression analysis demonstrated that Gal-3 is an independent predictor of non-effective antiarrhythmic pharmacotherapy of AFib (OR=2,38, 95% CI: 1,12–5,04, p=0,024). In patients with AFib and MetS who had Gal-3 above 770,5 pg/ml (cut-off point on ROC-curve) the risk of non-effective APT was in 3,6-fold higher during follow-up (RR=3,6, 95% CI: 1,6–7,9, p=0,002). Binomial regression analysis was found that greater % of LA fibrosis corresponds to higher probability of recurrence of AFib after RAT (OR=1,1, 95% CI: 1,03–1,12, p=0,002). Conclusions Galectin-3 and TGF-beta1 in AFib and MetS patients with left atrium severe fibrosis are higher than in patients with minimal fibrosis. We suppose that profibrogenic substances can impact on progression of AFib and non-effectiveness antiarrhythmic pharmacotherapy. Acknowledgement/Funding Governmental grant 17-75-30052