Background. Heart failure (HF) is a well-defined risk factor for early mortality and morbidity after cardiac surgery.We aimed to analyze the evolution of the clinical phenotype of HF at an early stage after heart surgery.Methods. The study included 126 consecutive patients with established chronic HF who fulfilled the cardiac rehabilitation program after undergoing heart surgery (62.23±8.59 years, 67.5% - men). Subjects were divided into 3 groups according to the clinical phenotype of HF: group 1 - HF with reduced left ventricular (LV) ejection fraction (EF) (HFrEF), group 2 - HF with mildly reduced LV EF (HFmrEF) and group 3 - HF with preserved LV EF (HFpEF). All patients were investigated by electrocardiography, transthoracic echocardiography, 6 minutes walk test and assessment of serum NT-proBNP level. Results. Preoperatively, 23.9% of patients had HFrEF, 24.8% - HFmrEF and 51.3% - HFpEF. Analyzing the evolution of the HF phenotype in the early postoperative period, we found that most patients remained in the same group. However, among patients with preoperative HFmrEF, in 22.2% of patients there was an increase in LV EF over 50% and in 22.2% of patients was determined a reduced LV EF, p<0.001. The most obvious positive dynamic of the HF phenotype was attested in patients with HFrEF, where 37% of them presented a mildly reduced LV EF postoperatively, p <0.001. 78.9% of individuals with HFpEF remained in the same group, but 21% showed a decrease in LV EF, p<0.001. Conclusions. At the early stage after cardiac surgery, the most positive evolution of HF phenotype was noticed in the group of patients with HFrEF. Of the 44.4% of patients with HFmrEF who switched to another HF phenotype, only a half reported an increase in LV EF over 50%. The vast majority of patients with HFpEF had the same HF phenotype postoperatively.

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In patients with coronary artery disease, percutaneous coronary interventions (PCI) are the mainstay of treatment for those presenting with acute coronary syndrome (ACS); PCI has also been widely adopted in patients with chronic coronary syndromes. Adjuvant pharmacotherapy, especially antithrombotic therapy, is the key to reducing local thrombotic complications and systemic ischemic events among patients undergoing percutaneous coronary interventions, but is inevitably associated with the occurrence of bleeding events. Prasugrel and ticagrelor are preferred over clopidogrel in patients with ACS in the absence of contraindications. Despite this, clopidogrel remains the most widely used. In this article, the bleeding events that occurred during 6-12 months of dual antiplatelet therapy (aspirin + P2Y12 inhibitor - clopidogrel) in patients who underwent myocardial revascularization by PCI, the factors that favored their occurrence and the use of the prediction score were studied.