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.
2023 Том 7, №1

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.
2023 Том 7, №1

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.
2023 Том 7, №1

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.
2023 Том 7, №1

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.
2023 Том 7, №1

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
2023 Том 7, №1

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.
2023 Том 7, №1

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.
2023 Том 7, №1

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.
2023 Том 7, №1

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.
2023 Том 7, №1

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).
2023 Том 7, №1

Aim. To study the effectiveness of treatment with delamanid-containing regimens in patients with multidrug-resistant and extensively drug-resistant tuberculosis and comorbid cardiovascular diseases, to assess the frequency, structure, and severity of adverse events in the cardiovascular system in this group of patients.
Materials and methods. The study included 125 adult patients with multidrug and extensive drug resistance who started treatment with delamanid-containing regimens from July 2016 to February 2018 at the Republican Research and Practical Center for Pulmonology and Tuberculosis and six regional anti-TB institutions. The main group included patients with multiple and extensive drug resistance and comorbid cardiovascular diseases (N = 46). The control group included patients with multiple and extensive drug resistance without comorbid cardiovascular diseases (N = 79). The formulation and coding of the diagnosis (the underlying disease and comorbid diseases (conditions)) corresponded to the International Classification of Diseases (ICD) of the 10th revision. Adverse events were classified according to the international dictionary MedDRA (Medical Dictionary for Regulatory Activities). The severity of adverse events classification complied with CTCAE (Common Terminology Criteria for Adverse Events). The severity of adverse events was determined in accordance with the definitions of ICH (The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use), and the treatment outcomes were identified in accordance with clinical guidelines and WHO recommendations. The study materials were the data from the medical records of the patients in the E-Register “Tuberculosis”. Sputum culture conversion was defined as two consecutive negative test results. Treatment outcomes were classified as successful and unsuccessful. For the analysis of adverse events, each event was considered as a unit of analysis both in the aggregate of all adverse events in the cardiovascular system and in groups of patients. Testing of statistical hypotheses was carried out at a critical level of significance p = 0.05, i.e. the difference was considered statistically significant if p < 0.05.
2022 Том 6, №2

Background. In view of the changes in the pathogenetic vector towards the study of comorbidity, searching for the ways of cardiovascular risk reduction is still relevant nowadays in specific subgroups of patients with moderate, unusual or undetectable risk levels (for example, in patients with accompanying acute surgical diseases of the abdominal cavity)
Aim. Evaluation of arterial blood pressure indices in patients with acute calculous cholecystitis.
Material and methods. The main group consisted of patients with acute calculous cholecystitis who underwent urgent cholecystectomy and were administered cardioprotective therapy (acetylsalicylic acid and atorvastatin). The first comparison group was formed from patients who underwent urgent cholecystectomy, but did not received cardioprotective therapy. The second comparison group was formed from patients who received cardioprotective therapy, but did not undergo cholecystectomy.
2022 Том 6, №2

The objective is to identify factors associated with adverse cardiovascular events in a cohort of patients with a combination of non-compaction (NCCM) and dilated cardiomyopathy (DCM) in order to reveal high-risk patients. Materials and methods. 104 patients with a combination of NCCM and DCM aged 31 to 52 years (median age 41 years; 81 men; 23 women) were examined, who, in addition to traditional clinical research methods, underwent cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement. The endpoints of the study included progression of chronic heart failure (CHF) to functional class (FC) III NYHA requiring hospitalization, ventricular tachyarrhythmias and thromboembolic events.
2022 Том 6, №2

Objectives. To study the effect of complex treatment of breast cancer (BC) on the parameters of the structural and functional state of the cardiovascular system. To develop a model for predicting the ejection fraction (EF) of the left ventricle (LV) measured by the Simpson method after the end of antitumor therapy on the basis of initial laboratory and instrumental data.
Methods. The cardiovascular system was examined in 100 women who received complex treatment of BC. The groups were formed depending on the presence of arterial hypertension (AH) and on the cardiotropic therapy (CT) received: the BC group, the BC+ CT group, the BC+ AH+CT group.
2022 Том 6, №2

Objective. To specify photochemical reactions, occurring in the blood of patients with non-ST elevation acute coronary syndrome (NSTE-ACS), followed by the study of the mechanisms of alterations of ultraviolet blood modification (UVBM) into biological reactions.
Methods. We studied 90 blood samples from patients with NSTE-ACS, receiving complex treatment that included UVBM by mercury lamp radiation with blood taken from the ulnar vein (device “Nadezhda”), the course of treatment consisted of 5 procedures conducted daily. We compared absorption spectra of blood and erythrocytes, results of optical oximetry, spectrophotometry, data of general blood analysis before UVBM, during individual procedures and 20–30 minutes after the end of the course.
2022 Том 6, №2

Chronic respiratory failure (CRF) has traditionally been considered to be the main cause of death in patients with chronic obstructive pulmonary disease (COPD). However, modern epidemiological studies have shown that the leading causes of death in patients with COPD are CHD and chronic heart failure (CHF). Aim: to study the prevalence of CRF and CHF in patients with COPD, to determine the informative value of clinical symptoms in their diagnosis, to work out an algorithm of differential diagnosis of CRF and CHF. Methods: subjects – 100 men with COPD. The median age was 67 years. We performed clinical and laboratory examinations. COPD syndrome was diagnosed upon EchoCG and NT-proBNP results. CRF syndrome was diagnosed by the results of exercise testing with simultaneous measurement of arterial blood hemoglobin oxygen saturation.
2022 Том 6, №2

Introduction. The COVID-19 pandemic continues with over 600 million cases and over 6 million deaths worldwide according to WHO. The state of hypercoagulation is a key feature of the course of COVID-19 which often leads to the development of serious cardiovascular events and adverse outcomes. There is a higher risk of all-cause mortality in the COVID-19 cohort with thrombotic complications, and mortality among patients with COVID-19 and PE is significantly higher than in patients with either condition alone, indicating a life-threatening additive effect of the combination of COVID-19 and PE. Thus, it is necessary to study further the features of inflammation and thrombosis parameters in patients with COVID-19 given the high prevalence of thrombotic complications among this group of patients.
Objective. To define features of inflammation and thrombosis laboratory markers in patients with COVID-19 and pulmonary embolism.
2022 Том 6, №2

Aim. To study cost-effectiveness of different types of stents in the correction of chronic total occlusion (CTO). Methods. The study included 119 patients after successful coronary artery CTO recanalization in 2009–2012. After 6.1±0.9 months and 12.7±1.6 months a control examination was performed (coronary angiography, intravascular ultrasound, optical coherence tomography). Negative events (in-stent restenosis and thrombosis) were analyzed. Taking into account the obtained data, direct costs were calculated including the cost of implants, and the cost of restenosis and thrombosis treatment.
2022 Том 6, №2

Aim. To assess the functional status, the state of ECG parameters, parameters of cardiac hemodynamics and quality of life in patients candidates for ablation of the atrioventricular node with the implantation of pacemakers, resynchronization devices (CRT) due to tachyform of atrial fibrillation.
Materials and methods: the study included 61 patients with a mean age of 59.4 ± 10.4 years, BMI 31.3 ± 5.8; test 6-min. walk 315 ± 173 m. Group 1 pacemaker – patients with implanted pacemaker 19 people, group 2 CRT – 42 people. Quality of life according to the Minnesota questionnaire in the cohort – 49 [32; 65] points (unsatisfactory), CHF FC 2 in general and FC 3 in the pacing group and FC 2 in the CRT group, but no significant differences. The mean QRS duration was 115 [90.146], ms. no significant differences between groups. Only the ratio of R6/S6 and the value of (S1+R6)-(S6+R1) were significantly different in subgroups with different QRS widths, which may be a predictor of the effectiveness of electrocardiotherapy. Ejection fraction (EF) was 32.0 ± 7.6% due to tachycardiomyopathy. Signs of interventricular and intraventricular dyssynchrony were registered.
2022 Том 6, №2