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.

Aim. To identify the features of the structural-functional state of the cardiovascular system in patients with pulmonary embolism (PE) in the presence of chronic heart failure (CHF) syndrome.Material and Methods. The study included 231 patients diagnosed with PE at admission to the hospital. Patients were further divided into subgroups depending on the verification of the diagnosis by computed tomography and the presence of CHF syndrome.Results and discussion. An increase in pressure in the pulmonary artery system contributed to the formation and aggravation of right ventricular systolic dysfunction, which acquired a greater prevalence and severity in the presence of CHF. This was confirmed by the echocardiographic signs of dysfunction of the right heart including increased linear dimensions of right cardiac chambers, right atrium volume index of 32.3 (29.4–37.9) mL/m2 versus 29.1 (26.6–32.3) mL/m2 (U = 1583.00, p < 0.001); greater prevalence of hemodynamic instability (proportion of patients with fainting or presyncope at hospital admission was 32% in the presence of CHF versus 16.7% without CHF; χ2 = 4,49, p < 0.05); and more significant increases in the laboratory markers of right ventricular dysfunction and injury included in the prediction model of adverse PE outcome [brain natriuretic peptide of 395 (204–789) pg/mL versus 104.2 (38.9–212) pg/mL (U = 1162.00, p < 0.001), high-sensitive troponin of 212 (194.5–297.6) ng/mL versus 184.8 (168.0–194.8) ng/mL (U = 279.50, p < 0.01), myocardial fatty acid-binding protein of 0.37 (0.18–1.2) ng/mL versus 0.2 (0.08–0.3) ng/mL (U = 530.00, p < 0.001), copeptin of 0.2 (0.05–0.92) ng/mL versus 0.09 (0.04–0.15) ng/mL (U = 563.00, p < 0.01), and reduced renal function]. 

Dynamics of a coronary artery calcium index as a factor of a cardiovascular risk in chronic terminal hepatopathy patients who need transplantation is determined. A prospective single-center cohort study was done and included 250 patients who need liver transplantation. The observation time was 5.4 ± 3.29 years from the moment of putting a patient on the waiting list. In addition to the assessment of occurrence and dynamics of traditional cardiovascular risk factors, calcium index indicators were determined by the method of multispiral computer tomography at the stage of including a patient into the study and after fve years of dynamic monitoring. The calcium index indicator in chronic terminal hepatopathy patients who need transplantation exceeded the limits of the recommended norm defned by a value of the 75th percentile, in 56.3 % (n = 152) of the examined patients at the stage of putting them on the waiting list. While comparing the coronary calcinosis indicators after fve years of dynamic monitoring the recipients of the liver transplants showed higher values of the calcium index in comparison with the patients with chronic terminal hepatopathy who did not receive the donor organ (CI, AJ-130 – 223 (38; 597) and 141 (4; 176) units respectively, p < 0.05; CI, Volume-130 – 314 (73; 748) and 203 (8; 284) mm2, respectively, p < 0.01), and the patients with metabolic syndrome (CI, AJ-130 – 186 (78; 463) and 74 (21; 192) units respectively, p < 0.01; CI, Volume-130 – 278 (74; 623) and 124 (74; 273) mm2 respectively, p < 0.01) and/or ischemic heart disease (CI, AJ-130 – 274 (102; 683) and 109 (34; 246) units respectively, p < 0.01; CI, Volume-130 – 382 (98; 834) and 382 (98; 834) mm2 respectively, p < 0.01) from the overall population. The obtained results make it possible to suppose that in addition to the radical solution to the liver defciency problem, the performance of orthotopic liver transplantations on patients with chronic terminal diseases accelerates the development of coronary atherosclerosis in the long-term postoperative period.

The aimof the study was to identify clinical and laboratory features of the disease in patients with myocardial infarction with ST-segment elevation and C677T polymorphism in the methylenetetrahydrofolate reductase gene.Material and Methods. A total of 81 patients with ST-segment elevation myocardial infarction were examined. Clinical, laboratory, instrumental, and statistical methods were used.Conclusion. Among patients with ST-segment elevation myocardial infarction, the proportion of persons with homozygous carriership of polymorphic alleles in the MTHFR gene was 30% (genotype 677СС); and 58.02% (genotype 677СT) of patients were heterozygous carriers. Patients with homozygous carriership of polymorphic alleles in the MTHFR gene were characterized by higher values of Big endothelin-1 and homocysteine in serum compared with persons with genotype 677СС: 10.7 (4.5–14.5) pg/mL, 27 (20–28) μmol/L, and 2.7 (2.2–3.8) pg/mL, and 17 (14–20) μmol/L, respectively, p<0.05. A positive moderate force correlation was found between the carriership of polymorphic alleles MTHFR C677T and homocysteine levels (r=0.42, p<0.05) and Big endothelin-1 (r=0.45, p<0.05) in the cohort under study. In patients with homozygous carriership of polymorphic alleles in the MTHFR gene, myocardial infarction was significantly more often complicated by the development of recurrent coronary events in comparison with groups with heterozygous carriership and the absence of polymorphic alleles in this gene: 88.9% (n=8) versus 42.55% (n=20), χ2=6.5, p<0.05 and 28% (n=7), χ2=10.0, p<0.01 respectively.

Цель. Изучить динамику уровня натрийуретического пептида и оксида азота, а также связь этих изменений со структурным состоянием миокарда у женщин, страдающих раком молочной железы (РМЖ). Оценить эффективность кардиотропной терапии (КТТ) – комбинации валсартана и карведилола, в предотвращении выявленных изменений.Материалы и методы. В исследование включено 100 женщин, страдающих раком молочной железы, получивших хирургическое лечение, полихимиотерапию с антрациклинами, лучевую терапию.Пациентки были разделены на 3 группы: РМЖ – получившие только противоопухолевую терапию (55 человек), РМЖ + КТТ – пациентки вместе с лечением рака получали комбинацию валсартана и карведилола и не страдали артериальной гипертензией (АГ) (25 человек), РМЖ + АГ + КТТ – женщины, страдающие АГ, с противоопухолевой терапией получали комбинацию валсартана и карведилола (20 человек).Результаты. В результате исследования в группе без назначения профилактических сердечно-сосудистых лекарственных средств выявлено ухудшение систолической и диастолической функции миокарда левого желудочка, прямая корреляционная связь между уровнем натрийуретического пептида и оксида азота после окончания лечения рака молочной железы (r=0,51, р<0,05). Назначение комбинации валсартана и карведилола в качестве терапии сопровождения противоопухолевого лечения обеспечивало сохранение нормальных значенийфракции выброса левого желудочка, отсутствие нарушений процессов релаксации миокарда, приводило к снижению уровня натрийуретического пептида и оксида азота.Заключение. Комбинация валсартана и карведилола может быть использована с целью профилактики кардиотоксичности противоопухолевой терапии. Purpose. To study the dynamics of changes in the level of natriuretic peptide and nitric oxide, as well as the relationship of these changes with the structural state of the heart in women with breast cancer (ВС). To evaluate the effectiveness of the cardiotropic therapy (CT) – the combination of valsartan and carvedilol – in prevention of the identified changes.Materials and methods. 100 women with breast cancer were included in the study. The patients received surgery, anthracycline chemotherapy, and radiation therapy.The patients were randomized into 3 groups: group BC – with antitumor treatment alone (55 cases); group BC+CT – patients with antitumor treatment, who received carvedilol combined with valsartan and had no arterial hypertension (AH) (25 cases); group BC+AH+CT – patients with antitumor treatment, who received carvedilol combined with valsartan and had hypertension (20 cases).Results. The study revealed a deterioration in the systolic and diastolic function of the left ventricular myocardium, a direct correlation between the level of natriuretic peptide and nitric oxide after the end of cancer treatment in the group without prescribing preventive cardiovascular drugs. The use of the combination of valsartan and carvedilol as a therapy to accompany the antitumor treatment of breast cancer prevents the decrease of the left ventricular ejection fraction, a disorder of the relaxation processes of the myocardium, and reduces the level of natriuretic peptide and nitric oxide. Conclusion. The combination of valsartan and carvedilol may be effective to reduce the cardiotoxicity of antitumor therapy.