Officially announced by the World Health Organization (WHO) in March 2020, the coronavirus disease 2019 (COVID-19) pandemic is terrifying with the unimaginable rate of spreading and the large number of deaths. More than 171 million COVID-19 cases including more than 3,6 million deaths have been confirmed worldwide since the start of the pandemic. The high incidence of venous thromboembolic events and non-ARDS (acute respiratory distress syndrome) associated death of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, despite prophylactic antithrombotic therapy, may indicate the need for a more intensified personalized regime of preventive measures. Respiratory viruses such as influenza A H1N1, SARS-CoV, MERS-CoV and SARS-CoV-2 are known for their affinity for lung tissue and the ability to lead to viral pneumonia and acute respiratory distress syndrome (ARDS). The analyzed data bring up to the hypothesis that microvascular thrombosis, rather than decreased lung compliance, provides oxygenation impairment in COVID-19 patients. The accumulated experience in the management of patients with SARS-CoV-2 indicates that the pathophysiology of systemic microthrombosis associated with COVID-19 may differ from that in sepsis-induced disseminated intravascular coagulation (DIC). In contrast to sepsis-induced coagulopathy consumption of platelets, clotting factors, fibrinogen, and bleeding are rare in patients with severe SARS-CoV-2, suggesting that DIC is not a common complication of COVID-19. The development of micro- and macrovascular thrombosis of the venous and arterial bed in patients with SARS-CoV-2 makes it possible to consider COVID-19 as a systemic “thromboinflammatory” syndrome. According to the international analytical studies, the proportion of thrombosis and thromboembolic complications ranges from 0.9% to 6.5 in patients with a moderate COVID-19, and from 8% to 69% in patients treated in intensive care unit, the proportion of acute arterial obstruction in SARS-CoV-2 patients ranges 0.39% to 11.1%. The team of authors carried out a retrospective analysis of the medical records of 7607 patients hospitalized in 2020 in the infectious disease departments of the 4th city clinical hospital named after N.E. Savchenko. The proportion of patients with pulmonary embolism (PE) in the final diagnosis was 2.1% (n=163), the proportion of patients with deep vein thrombosis (DVT) was 0.9% (n=68), in the structure of patients with DVT the complication of PE was 58.8% (n=40). The variation in the data of national and foreign studies may apparently be related to different diagnostic tactics in verifying the diagnosis of VTE and DVT: the use of duplex ultrasound vascular examination and/or computed tomographic angiography (CTA) of the lungs as screening techniques, the inclusion of different clinical points (symptomatic and/or asymptomatic VTE) by authors in publications, the lack of uniform approaches to thromboprophylaxis, and population differences in the patient samples. There is an urgent need for more in-depth studies of the pathogenesis and molecular basis of thrombosis in patients with COVID-19 to establish the prognostic value of changes in the hemostasis system associated with SARS-CoV-2. Considering unknown long-term results in COVID-19 convalescents, many studies signaling the presence of disabling consequences and the need for subsequent full medical and non-medical rehabilitation, the search for new biomarkers, such as of coagulation, fibrinolysis, activation of endothelium, that are associated with the course, early outcomes and delayed complications in patients with coronavirus infection (SARS-CoV-2) remains relevant.

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The aim of the study was to investigate the features of clinically suspected myocarditis complicated by the left ventricular systolic dysfunction development. 93 patients with clinically suspected myocarditis were examined. The average age was 36.63 ± 1.15 years. In 43.01 % of patients the disease was accompanied by a decrease in left ventricular systolic function. In the group of patients with left ventricular systolic dysfunction in comparison with those with preserved left ventricular ejection fraction, a significantly lower proportion of men (75 % versus 81 %, respectively, χ2 = 9.3, p < 0,01) and a higher average group age (40.7 ± 1.87 versus 33.6 ± 1.3 years, respectively, p <  0,01) were revealed. The course of the disease in patients with left ventricular systolic dysfunction was characterized by a more frequent development of rhythm disturbances (65 % versus 43.3 %, respectively, χ2  = 4.3, p  < 0,05) and a higher heart rate at admission (94.5 (75‒100) and 85 (70‒89) beats per minute, respectively, p = 0.006). The structural and functional state of the heart according to echocardiography in patients with a reduced left ventricular ejection fraction versus comparison group was characterized by larger heart chambers sizes, more pronounced violations of local left ventricular contractility, more frequent involvement of the right ventricle in the pathological process (56.3  % versus 22.2  %, respectively, χ2   =  6.4, p  < 0,05). The relationships between the left ventricular ejection fraction Весці Нацыянальнай акадэміі навук Беларусі. Серыя медыцынскіх навук. 2020. Т. 17, № 4. C. 452–460 453 and the patient’s age (r = ‒0.36), the value of the heart rate at admission (r = ‒0.32), the severity of heart failure at admission, the degree of impaired local contractility of the left ventricle, the degree of right ventricular function (TAPSE, r  =  0.58), the severity of myocardial fibrosis according to cardiovascular magnetic resonance imaging (r = ‒0.32) were revealed.

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Intravascular ultrasound examination (ICSI) allows to assess the nature of atherosclerotic plaque, the degree of significance and extent of stenosis, as well as to monitor the position of the stent in the lumen of the coronary artery. Insufficient opening of the stent, unrecognized during angiographic control, can lead to thrombosis or restenosis in the early or long term. The clinical case presented in the publication demonstrates the difference between the results of fluoroscopycontrolled stenting and ICSI-controlled stenting during percutaneous coronary intervention (PCI) in a high-risk surgical patient with significant concomitant pathology.