I n the light of COVID-19 pandemic caused by SARS-CoV-2 virus, cardiovascular complications become a medical and social problem, the significance of which increases in the post-acute phase. Cardiovascular events against COVID-19 include both acute ischemic and non-ischemic myocardial injury – up to 21%, acute heart failure, rhythm and conduction disorders (up to 15%), venous (up to 7% in patients in the general department and up to 22% in the intensive care unit) and arterial thrombotic complications (up to 11%). The retrospective analysis of medical records of 10 908 inpatients aged 18 to 90 years, who were treated from June 01, 2020 to May 31, 2021 in The 4th City Clinical Hospital named after M.J. Saŭčanka was performed. Prevalence of myocardial injury developed against the background of SARS-CoV-2 was 5.28% (n = 576), it was observed in patients of different age groups, including those without previous cardiovascular history. The article presents an analysis of current worldwide data on pathogenetic aspects of acute myocardial injury in patients with COVID-19. It is noted that cardiac MRI is an effective, accurate and noninvasive method of differential diagnosis of ischemic and inflammatory myocardial injury in COVID-19. The algorithm for differential diagnostics of acute myocardial injury in this category of patients is proposed.

A cute myocardial infarction (AMI) is a starting point for the development of heart failure (HF), which increases the risk of death. The development of HF in AMI patients significantly worsens the prognosis and increases treatment costs, which determines the medical and social significance of the problem. This not only emphasizes the necessity of careful monitoring of AMI patients, but also is a reasonable motivation for the use of multimodal approach to determine the individual risk of heart failure development in patients with AMI, since different pathogenetic mechanisms with different contribution of leading disorders are involved in HF development: microcirculatory dysfunction, inflammation, hemorrhage, edema, remodeling. Multimodal approach is implemented by the identification of clinical, laboratory, angiographic and imaging predictors of HF development. For risk stratification it is necessary to substantiate the optimal combination of prognostic methods to determine the degree of heart failure development risk, the key pathogenetic mechanism of its development and, accordingly, to use the most adequate treatment regimens.

T he main cause of angina in patients without obstructive coronary artery (CA) disease is vasomotor dysfunction, including various pathophysiological endotypes: macro- or microvascular vasospasm, reduced microvascular vasodilation or increased resistance, as well as their combinations. Such patients not only have persistent angina symptoms, leading to frequent hospitalizations and repeated diagnostic tests for obstructive coronary heart disease (CHD), but also an increased risk of adverse cardiovascular events. In such cases, standard antianginal therapy turns out to be less effective, and the development of new pharmacological agents specific for this variant of CHD still remains an unsatisfied need. At the same time, it has been shown that compliance with the treatment protocol corresponding
to a specific disease endotype improves symptom control and quality of life.
Treatment of patients includes lifestyle modification measures with control
of cardiovascular risk factors, and antianginal therapy, the targeting of which requires accurate, in most cases invasive, diagnosis of pathophysiological endotype. An important component of the treatment process is a non-drug effect, especially in patients with refractory angina pectoris. The article discusses various treatment options (including experimental) and their rationale in patients with angina pectoris without obstructive lesions of the СА.

Purpose. To study the incidence and to determine predictors of post cardiotomy low cardiac output syndrome after open-heart surgery.
Methods. A retrospective, observational case-control study was conducted at the Republican Scientific and Practical Center of Cardiology for the period 2015–2017. The study included 1, 540 patients who underwent open-heart surgery. Intraoperatively and in early postoperative period, 46 patients developed postcardiotomy low cardiac output syndrome (PCLCOS) refractory to drug therapy, followed by mechanical circulatory support (the study group), the comparison group consisted of 1, 494 patients.
Results. The incidence of PCLCOS was 2.98%. The predictors of PCLCOS included the following: reoperation OR = 3.65 (95% CI 1.40–9.51), myocardial infarction (30 days) before operation OR = 7.20 (95% CI 2.25–23.01), heart failure NYHA class III/IV OR = 2.38 (95% CI 1.30–4.37), and preoperative local contractility index more than 1.81, OR = 2.92 (95% CI 1.50–5.68).
Conclusion. Postcardiotomy low cardiac output syndrome is still a big issue in cardiac surgery. Despite modern methods of myocardial protection and mechanical circulatory support (MCS), hospital mortality remains extremely high, up to 80%. Prognosis based on predictive models will allow timely selection of the required type of MCS, reducing the incidence of multiple organ failure, and, as a result, adverse outcomes of surgical treatment.

S o far, surgical interventions with artificial circulation remain the most effective treatment method providing favorable long-term outcomes, prognosis and quality of life in patients with coronary heart disease (CHD). Therefore, the main issue of cardiologists and cardiac surgeons is the prognosis of functional recovery of the left ventricle after revascularization, as the treatment strategy is determined by the risk assessment of surgical mortality and perioperative complications. In order to detect hibernating myocardium, we performed a prospective study including 57 patients with CHD and upcoming coronary bypass grafting, mitral valve plasty or prosthesis. All patients underwent stress magnetic resonance imaging, which allowed noninvasive assessment of both structural and functional changes, as well as determination of myocardial functional reserve. The obtained data will allow us to objectively assess the surgical risk during cardiac surgical interventions, which is very important for the prevention of life-threatening cardiovascular complications, as well as increasing the efficiency of surgical treatment in patients with CHD.

T he article presents the outcomes of treatment of patients with cardiomyopathy and pronounced functional mitral insufficiency 6, 12 and 24 months after MitraClip device implantation. We observed that 6 months after the intervention, there was regression of left heart chamber remodeling, as well as positive dynamics of right ventricular ejection fraction and pulmonary artery pressure against the background of mitral valve improvement. The achieved effect of improved intracardiac hemodynamics persisted in 12 months after mitral valve clipping. After 12 months, there were signs of left ventricular remodeling without significant changes in valve characteristics and left atrial parameters. During the first 6 to 12 months after MitraClip implantation, the distance walked in the 6-minute walk test and peak oxygen consumption increased, with retention of high values of these indicators in 24 months of follow-up.

S tudy of cancer patients and assessment of the cardiotoxicity risk of chemotoxic drugs has been performed using the following diagnostic methods: echocardiography with assessment of global myocardial deformation, cardiac magnetic resonance imaging, analysis of cardiac biomarkers and arterial stiffness. Application of the mentioned methods allowed to detect subclinical heart and vascular lesions before the appearance of clinical symptoms in patients resectable breast cancer and systemic treatment.

Purpose. To identify the peculiarities of perfusion disorders, and stratify cardiovascular risk in asymptomatic patients with different variants of adipose tissue distribution.
Materials and methods. Our research included 80 patients with episodes of asymptomatic diagnostically significant ST-segment depression detected during daily electrocardiogram monitoring (daily ECG). These patients were divided into two groups. The first group consisted of 47 patients with abdominal obesity (АО+), and the second group – without АО (АО-). The first group was further divided into two subgroups depending on the volume of epicardial adipose tissue (with and without epicardial obesity): (EO+) and (EO-). Daily ECG monitoring, multispiral computed tomography (MSCT) with calculation of indicators of epicardial adipose tissue and calcium score (CS), stress single-photon emission computed tomography (stress-SPECT) of the myocardium were held. Summed stress score (SSS) was used for cardiac risk stratification.
Results. Daily ECG monitoring revealed that the total duration of ST-segment depression per day and the number of episodes were greater in the AO+ group compared to the AO- group. Perfusion defects were found in 93.75% of patients (including 95.7% in the AO+ group and 90.9% in the AO- group) during SPECT. There were no significant differences in the values and area of the perfusion defect at rest and after the stress test between the AO+ and AO- groups. In the subgroup of patients with EO+, more complex types of rhythm disturbances prevailed. The EO+ group exhibited higher values of CS, stress-SPECT showed induced deterioration of myocardial perfusion, and 21.7% of patients had an SSS score of more than 8, corresponding to a moderate risk of myocardial infarction and cardiac death.
Conclusions. SPECT of the myocardium verified perfusion defects in 93.75% of the patients included in the research. There were no significant intergroup differences in the parameters characterizing myocardial perfusion defects depending on the presence of AO. Myocardial ischemia was more pronounced among patients with EO and was accompanied by significant arrhythmias. The individuals with epicardial obesity exhibited more pronounced calcification of the coronary arteries compared to patients without epicardial obesity. The obtained data indicate that epicardial obesity is a factor that increases cardiovascular risk in patients with silent myocardial ischemia.

Aim. To study metabolic processes in the blood of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), followed by the identification of mechanisms for converting ultraviolet blood modifications (UVBM) into biological reactions.
Methods. In the course of the study, 90 blood samples were taken from patients with NSTE-ACS, whose complex treatment included UVBM with blood collection from the ulnar vein and exposure to mercury lamp radiation (“Nadezhda” device). The course of treatment consisted of 5 procedures performed once a day. The parameters of spectrophotometry, biochemical blood analysis data (electrolyte levels, Ca2+ ions, glucose, blood lipid spectrum) were studied before UVBM, directly during individual procedures and 20–30 minutes after the end of the course.
Results. Changes in the blood oxygenation parameters and the content of metabolic products were analyzed at different stages of UVBM light exposure in NSTE-ACS patients. It was revealed that the absorption of ultraviolet radiation by blood leads to its photomodification, manifested in changes in the partial pressure of blood gases. UVBM affects oxygen metabolism, changes the delivery and consumption of oxygen by tissues, and affects the course of metabolic processes. UVBM refers to physiotherapeutic methods that, when properly dosed, initiate positive changes in the balance between the production of reactive oxygen species acting as physiologically active compounds and their inhibition by antioxidant systems.
Conclusion. The systemic effect of UVBM on the body is manifested in interrelated changes in oxygenation parameters and various metabolic characteristics already during the first and then each of the subsequent procedures. The most pronounced positive changes in the oxygenation parameters and the content of metabolic products were observed during the procedures. At the end of the courses, the effect of UVBM was manifested depending on the concentration of metabolic products compared to the baseline concentration and photoinduced changes in the degree of hemoglobin oxygen saturation. Under the influence of UVBM the concentration decreased at elevated baseline values and increased at reduced. The presence of an interconnection between glucose, cholesterol and the degree of saturation of erythrocyte hemoglobin with oxygen confirms the decisive role

T he publication is devoted to the study of hemostasis system parameters, markers of endothelial function, pro- and anti-inflammatory cytokines in patients with chronic obstructive pulmonary disease depending on the severity of chronic respiratory failure and disorders of arterial blood hemoglobin oxygen saturation. The authors have singled out a group of patients with signs of disseminated intravascular coagulation as a manifestation of immune thrombosis; the relationship of hemostasis disorders with hypoxemia and severe respiratory failure has been established. The authors also singled out a group of patients with the signs of thromboinflammation and demonstrated its role in vascular damage. The algorithm of clinical evaluation of patients with disseminated intravascular coagulation, and thromboinflammation is developed and their further management strategy has been suggested.

Purpose. To study and compare hospital outcomes of surgical treatment of functional (secondary) tricuspid insufficiency, depending on its etiology and on the chosen surgical method of its correction.
Materials and methods. We performed clinical and hemodynamic evaluation of the outcomes of various methods of cardiac surgical treatment of patients with non-rheumatic tricuspid valve (TV) insufficiency (functional) in chronic forms of coronary artery disease (CAD), and delated cardiomyopathy (DCM). The study included 792 patients who during a period from 2011 to 2020 underwent correction of non-rheumatic TV insufficiency (functional): There were 642 participants with CAD, 150 participants with DCM. We assessed their echocardiographic parameters.
Results. In the analyzed sample at the hospital stage, there was a signi ficant decrease in the severity of tricuspid insufficiency after the performed TV repair. We found no influence of the etiology of TV lesion on the incidence of residual tricuspid insufficiency grade ≥ II at the hospital stage. In general, there was no effect of the TV plasty method (annuloplasty or suture techniques) on the incidence of residual tricuspid insufficiency grade ≥ II at the hospital stage. But significant differences were found depending on the specific method of annuloplasty both in patients with CAD and in patients with DCM: the maximum incidence of residual tricuspid regurgitation (TR) grade ≥ 2 was registered after soft ring annuloplasty, the minimum was after annuloplasty with soft semi-ring made of felt strips according to the original method. At the same time, after performing annuloplasty with a soft half-ring made of felt strip according to the original method in patients with DCM, no recurrence of TR grade ≥ 2 was noted in any patient. Also, in the analyzed sample, significant differences were found depending on the type of corrector ring implanted during annuloplasty: when implanting the Plankor-A corrector ring, as well as the Medtronic Contour 3D corrector ring, the frequency of residual TR grade ≥ 2 was minimal, slightly higher with the implantation of the Plankor-T corrector ring, and maximum with the implantation of the Carperntier Edwards MC3 corrector ring.
Conclusion. The etiology of TV lesions does not affect the incidence of clinically significant residual tricuspid insufficiency. In general, the groups of ring and suture plasty methods did not differ in the incidence of residual tricuspid insufficiency grade ≥ II at the hospital stage. But among all methods of annuloplasty, the lowest frequency of clinically significant residual TR was observed after annuloplasty with a soft semi-ring made of felt strip according to the original method.

Purpose. To evaluate the effect of complex treatment of breast cancer (BC) on the parameters of systolic myocardial function, and the efficiency of the prescription of cardiotropic therapy (CT) – a fixed combination of valsartan and carvedilol – in the prevention of the identified changes. To develop a mobile application, namely, an electronic statistical alculator for calculating the left ventricular ejection fraction by Simpson during BC treatment with anthracyclines, using the baseline anthropometric and instrumental data of the patient.
Methods. We evaluated the cardiovascular health of 100 women who received complex treatment of BC. The patients were divided into three groups, depending on the presence of arterial hypertension and the prescription of CT. In the study, all women received a complex evaluation of the cardiovascular health at the beginning and at the end of BC treatment
Results. In the non-CT group after the end of complex BC treatment the following was found: a decrease in the shortening fraction (FS) from 41.0 (38.0; 45.0)% to 38.0 (35.0; 43.0)%, (p < 0.05), in ejection fraction (EF) by Teinholz from 72.0 (69.0; 76.0)% to 68.0 (64.0; 73.0)%, (p < 0.05); in ejection fraction by Simpson from 66.0 (62.0; 71.0)% to 60.0 (57.0; 66.0)%, (p < 0.05); an increase in the vagosympathetic interaction LF/HF index (ratio of low frequency (LF) to high-frequency (HF) components) from 0.8 (0.7; 1.0) to 1.05 (0.8; 1.2), (p < 0.05); reduction of brachial artery diameter change from 12.5 (11.0; 16.0)% to 9.0 (6.0; 12.0)%, (p < 0.05). A model of the prognosis of EF by Simpson during BC treatment was proposed, which included a total dose of doxorubicin calculated per body surface area, early diastolic rate of transtricuspid blood flow, diameter of the trunk of the pulmonary artery, the rate of circular shortening of myocardial fibers, thickness of the intima-media complex of the left carotid arteries, HF, % of brachial artery diameter change. The prognosis model formed the basis for the development of the mobile application for predicting left ventricular systolic function during BC treatment with anthracyclines. We proposed a model for prediction of LVEF by Simpson against during breast cancer treatment, which included the total doxorubicin dose calculated per body surface area, early diastolic rate of transtricuspidal blood flow, pulmonary artery trunk diameter, myocardial fiber circular shortening rate, left carotid artery intima-media complex thickness, HF, percentage of brachial artery diameter change. The prognostic model formed the basis for the development of the mobile application for predicting left ventricular systolic function during BC treatment with anthracyclines.

Purpose. To analyze long-term outcomes of minimally invasive epicardial video-assisted radiofrequency ablation (RFA) of the pulmonary veins (PV) and the posterior wall of the left atrium “box lesion” using Cobra technology in patients with various forms of isolated atrial fibrillation (AF).
Materials and methods. From September 2011 to November 2021, 85 patients (70 male, 15 female) suffering from various forms of idiopathic AF underwent surgery on the basis of the Republican Scientific and Practical Center of Cardiology, Republic of Belarus. The patients were operated on using epicardial video-assisted RFA of the PV and posterior wall of the left atrium “box lesion” using Cobra Adhere (45 patients) and Cobra Fusion (40 patients) devices. Mean age 53.8±8.80 years (28–71). History of AF – the burden of fibrillation before the surgery was 58.6±32.50 months. 35.3% (30 patients) had previously undergone ineffective PV catheter ablation.
Results. There were no lethal cases, as well as conversions to sternotomy, acute cerebrovascular accidents during the hospital period. The follow-up perio was studied in 100.0% of patients, the average follow-up period was 7.1+2.1 years. To evaluate the results, Holter monitoring was used after 3, 6, 12 months. after surgery, then annually, the readings of event monitors and the results of pacemaker programming. Positive results included sinus rhythm (SR) without AF/Atrial paroxysms for more than 30 s, as well as atrial (AAI) or dual-chamber DDD(R) pacing. The effectiveness of RFA of the PV and the posterior wall of the left atrium “box lesion” using Cobra Adhere and Cobra Fusion devices, depending on the initial type of AF in the long-term period (3 years), was: 56.3% /70.6% for paroxysmal AF, 28.0% / 44.4% for persistent AF, 0%/0% for long-standing persistent AF.
Conclusion. The Cobra technology proved to be the most effective in paroxysmal AF, less optimal results were obtained in persistent AF. In general, more consistent results were obtained with the Fusion technology. Efficacy also depended on the length of the follow-up, with the number of patients with sustained sinus rhythm decreasing over time and requiring additional catheter procedures in symptomatic patients.

Purpose. To study the parameters of longitudinal strain of the left ventricular myocardium and dyssynchrony in young patients with ventricular pacing in the long-term postoperative period. Materials and methods. The study included 60 patients aged 18 to 35 with pacemakers. The first group consisted of 30 patients (17 men and 13 women) with permanent pacemakers implanted after surgical correction of congenital heart defect (CHD) due to postoperative atrioventricular block (AV block). The second group included 30 patients (18 men and 12 women) with non-surgical AV block who required the implantation of a permanent pacemaker. All patients underwent echocardiography to determine the longitudinal strain
of the left ventricular (LV) myocardium and assess dyssynchrony. Results. Significant differences were found in the study groups regar - ding regional and total global longitudinal strain (GLS) of the LV myocardium. In group 1, the strain in the apical dual–chamber position (AP2) was –16.1 (–17.0; –10.9)% and –18.3 (–20.1; –15.0)% in the 2nd (U = 287.0, р = 0.016); in the apical three–chamber position (AP3) –15.2 (–17.7; –11.8)% and 18.3 (–20.1; –17.2)%, respectively (U = 258,5, p = 0.004); in the apical four–chamber position (AP4) –14.8 (–17.6; –11.8)% and –17.1 (–18.4; –15.5)%, respectively (U = 189.5, p = 0.000). GLS in the study groups was –15.4 (–16.8; –12.3)%
and –17.9 (–19.0; –16.5)%, respectively (U = 193.5, p = 0.000). The share of patients with GLS over –16% in group 1 after CHD surgical correction was 57%, which is significantly higher than in the group with non–surgical AV block (23%) (χ2 = 6.94, p = 0.008). Interventricular mechanical delay did not differ significantly between the groups, with values of 40.5 (15.0; 54.5) ms and 28.5 (7.0; 53.0) ms, respectively (U = 343.5, p = 0.236). Intraventricular dyssynchrony was more pronounced in group 1 and totaled 121.0 (99.0; 140.0) ms compared to 84.0 (63.0; 106.0) ms in group 2 (U = 192.0, p = 0.000). The width of the QRS complex was significantly greater in group 1 compared to group 2, with values of 140 (140; 160) ms and 140 (130; 140) ms, respectively (U = 302.0, p = 0.028). Conclusion. We found that patients with prolonged ventricular pacing after CHD surgical correction, compared with patients with non-surgical AV block, have significantly lower values of total and regional longitudinal strain, as well as more pronounced dyssynchrony, which indicates the presence of systolic myocardial dysfunction and LV remodeling in this population and suggests an increased risk of developing pacemaker-induced cardiomyopathy (PICM).

N on-communicable diseases have become a global challenge in recent years, and their prevalence is significantly affecting countries worldwide, including the Republic of Belarus. These diseases are influenced by various factors such as behavior, genetics, environment, and social conditions, all of which contribute to the increased likelihood of disease development, progression, and unfavorable outcomes. Risk factors associated with non-communicable diseases include smoking, alcohol abuse, and excessive consumption of salt and sugar. In Belarus, there is a high prevalence of these risk factors, leading to increased morbidity, disability, and mortality rates. Therefore, it is crucial to address the prevention and mitigation of the impact of these risk factors on the human body. A modern approach to tackling non-communicable diseases involves the prevention and control
of these risk factors.
The purpose of this study is to establish and develop the key principles of a concept for reducing harm caused by specific risk factors of non-communicable diseases, such as tobacco smoking, alcohol abuse, and excessive salt and sugar consumption. This concept will serve as the foundation for the national public health policy of the Republic of Belarus. The justification for developing a harm reduction concept stems from assessing the consequences of the high prevalence of noncommunicable diseases and their associated risk factors in Belarus. Furthermore, the study considers global theoretical frameworks, scientific debates on harm reduction, and analysis of successful practices implemented in other countries.
We have developed the key provisions of the Harm Reduction Concept and outlined its prospects for subsequent inclusion in the state program “People’s Health and Demographic Security.” Additionally, we have formulated recommendations for regulators based on regulatory differentiation.

A therosclerosis is a chronic inflammatory disease of the arteries that occurs during a complex interaction between risk factors (low-density lipoprotein cholesterol, obesity, diabetes mellitus, hypertension, smoking, etc.), components of the vascular wall, as well as immune and inflammatory cells. Various cells from intima, media, adventitia and perivascular adipose tissue not only make up an intact and normal arterial vessel wall, but also participate in the inflammatory reaction in atherosclerosis.
The process of atherosclerosis is initiated by activation of the endothelium, followed by a cascade of events (accumulation of lipids, migration and proliferation of smooth muscle cells, transformation of fibroblasts into myofibroblasts). The atherosclerotic plaque causes narrowing of the vessel and leads to cardiovascular complications. The article reviews the results of recent studies that reveal the role of various cells of the arterial vessel wall, as well as cells of innate and adaptive immunity in the development of atherosclerosis.

The article discusses the relationship between depressive disorders and ischemia, as well as changes in the blood coagulation system in patients with depressive disorders. Significant defects in the physiological characteristics of platelets are revealed, including increased reactivity and increased production of platelet factor 4 and p-thromboglobulin. The features of increased vasoconstriction, platelet activation, and thrombus formation are also considered, which may be the basis for the progression of coronary artery disease and mortality after acute myocardial infarction in patients with depression.
Aim. To reveal the impact of anxiety-depressive disorders on the development of cardiac muscle necrosis.
Materials and methods. Experimental and clinical studies have been carried out on patients with necrosis of the heart muscle.
Results. Patients with necrosis of the heart muscle and depression do not immediately seek medical help, unlike patients without depression. This may affect treatment options (e.g., thrombolysis) and the prognosis in such patients.
Conclusion. Further research is needed to determine whether depression causes inflammation, inflammation causes depression, or if a third, as-yet-unknown pathological process causes both inflammation and depression.

O steosarcopenia is characterized by a combination of low muscle mass (sarcopenia) and reduced bone mineral density (osteopenia/osteoporosis). The results of scientific studies conducted in recent years indicate the existence of a relationship between arterial hypertension, disorders of bone metabolism and / or sarcopenia. In particular, it is known that systemic inflammation, oxidative stress, and insulin resistance are involved in the development and progression of both arterial hypertension and sarcopenia. The same factors may play a role in the pathogenesis of osteopenia and osteoporosis, and the pathological mechanisms underlying the increase in blood pressure, as shown in experimental and clinical studies, can additionally influence the decrease in bone mineral density. This review outlines the current understanding of the diagnosis, epidemiology, etiology, and possible mechanisms of the pathogenesis of osteosarcopenia in patients with arterial hypertension.