Purpose. To determine the incidence of type 2 myocardial infarction (MI) diagnosis (according to the Fourth Universal Defi nition) and the features of patient management in real clinical practice.Material and Methods. A retrospective study was performed by analyzing the case histories of 153 patients diagnosed with acute coronary syndrome (ACS). Inclusion criteria were the presence of ACS at admission followed by a confi rmed diagnosis of MI during the hospital period according to the Fourth Universal Defi nition of MI and the age of patients > 18 years. Patients with severe comorbidities aff ecting the immediate prognosis and/or being an alternative to the diagnosis of MI were not included in the study.Results. The study showed that emergency coronary angiography was performed in 151 patients (98.7%). A decrease in the renal fi ltration function in the presence of chronic kidney disease was a contraindication to this study found in 1.3% of cases; 12 (8%) patients did not have coronary artery disease or had stenoses of less than 50%; these patients comprised the group of patients with type 2 MI. While analyzing the results of examination in patients with type 2 MI, ST segment elevation was detected in seven patients (58.4%) according to electrocardiography; ST segment depression was observed in one patient (8.3%); complete left bundle-branch block was found also in 1 case (8.3%), three individuals (25%) did not have any changes in the position of ST segment, but had a negative T wave. Analysis of possible etiological factors in the development of type 2 MI showed the presence of sinus tachycardia in two patients (16.7%), severe sinus bradycardia in one patient (8.3%), fl utter paroxysm and atrial fi brillation with tachysystole throughout the ventricles in two patients (16.7%), and history of atrial fi brillation in one patient (8.3%).Conclusion. Type 2 MI was diagnosed in 8% of patients with ACS with and without ST segment elevation where cardiac arrhythmias including sinus arrhythmias may be the potential etiological factors. Limited capabilities of assessing the stability of atherosclerotic plaque in the coronary artery including that in the presence of plaque thrombosis represent a signifi cant negative factor for establishing diagnosis in routine clinical practice.

Aim. To evaluate the potential of using factors associated with type 2 myocardial infarction (MI) for its early diagnosis.Material and methods. This prospective study included 204 patients diagnosed with acute coronary syndrome (ACS). At the time of admission, each patient underwent standard examinations for ACS patients. The 1-year stage consisted of telephone survey of patients on the course of long-term postinfarction period. There were following endpoints: death, recurrent coronary events and hospitalization.Result. Patients with type 2 MI accounted for 10,8% (n=22) of the entire analyzed sample. A model for prehospital diagnosis of probable type 2 MI has been developed. The model included clinical and history data that allow to suggest the type 2 MI course without invasive and laboratory studies. The model included signs (body mass index ≥35, kg/m2, atrial fibrillation+Killip I, hemoglobin <110 g/l within 1 year before MI, chronic obstructive pulmonary disease), the most common in type 2 MI patients according to own data and previous studies.Conclusion. A model of prehospital clinical assessment of MI risk has been developed for making a preliminary diagnosis and forming different patient streams at the admission stage for the final verification of the diagnosis.

Aim. Currently, there is no method which accurately predicts an adverse outcome of heart failure with a preserved left ventricular ejection fraction (HFpEF) upon ST-segment elevation myocardial infarction (STEMI). Here we studied the prognostic significance of procollagen type I C-terminal propeptide (PICP) and procollagen type III N-terminal propeptide (PIIINP) in patients with post-STEMI HFpEF.Material and Methods. The study included 83 patients (60 men and 23 women) with post-STEMI HFpEF (left ventricular EF ≥ 50%) and 20 ageand gender-matched healthy controls. Serum concentrations of PICP and PIIINP were measured on the 1st day of hospitalization using enzyme-linked immunosorbent assay with the following calculation of PICP/PIIINP ratio.Results. Serum PICP and PIIINP on the 1st day of STEMI significantly (3.4-fold) exceeded the values of the control group and were as follows: PIIINP: 26.0 (18.9; 34.9) ng/mL (р = 0.047); PICP: 609.0 (583.0; 635.0) ng/mL (р = 0.049).Conclusion. Elevated values of procollagens indicate that cardiac fibrosis commences within the 24 hours after STEMI onset. The pivotal role of cardiac fibrosis in the formation of diastolic dysfunction suggests the usefulness of serum procollagens to predict the development of HFpEF in a long-term period upon STEMI.