Aim. To evaluate the ratio of the fractions of classical, intermediate, non-classical and transitional monocytes in correlation with the concentration of interleukins 4 and 6 in the blood of patients with ischemic cardiomyopathy. Methods. 18 patients with ischemic cardiomyopathy (17 men and 1 woman) aged 47-66 years with circulatory insufficiency of functional class II-III according to the classification of heart failure of the New York Heart Association, were examined. The control group included 14 healthy donors matched by gender and age to patients with ischemic cardiomyopathy without any diseases of cardiovascular system and other systems in an exacerbation stage. In blood of the patients with ischemic cardiomyopathy, the relative content of classical (CD14++CD16-), intermediate (CD14++CD16+), non-classical (CD14+CD16+) and transitional (CD14+CD16-) monocytes was assessed by flow cytometry and the concentration of interleukins 4 and 6 by enzyme-linked immunosorbent assay (ELISA). Results. It was shown that the number of non-classical monocytes in the blood of patients with ischemic cardiomyopathy was 2 times lower than normal (5.05 % [4.08; 6.58] and 10.07 % [9.34; 13.84], respectively, p < 0.01), as well as the concentration of interleukin-4 (0.02 pg/ml [0; 0.04] and 0.15 pg/ml [0.05; 0.65], respectively, p < 0.05). The number of classical monocytes in the blood of patients had a tendency to decrease, and the proportion of intermediate monocytes and the concentration of interleukin-6, on the contrary, were slightly higher than in healthy individuals, and were interdependent (r = 0.61; p < 0.05). The relative content of transitional monocytes in the blood was comparable with that of healthy donors. Conclusions. The subpopulation composition of blood monocytes in patients with ischemic cardiomyopathy is characterized by a deficiency of the fraction of non-classical monocytes with protective properties against endothelium, and interleukin-4 in the blood with a certain increase in the content of interleukin-6 and the number of intermediate cells with ability to cooperate with T-lymphocytes, which predisposes to diffuse atheromatosis of small coronary arteries and diffuse hypoxic myocardial damage in ischemic cardiomyopathy.

Metastases to the heart are extremely rare, and the reported incidence of cardiac metastasis at autopsy ranges from 1.5 to 21.8  %. In cancer patients, cardiac metastases are usually difficult to  diagnose unless the patients do not complain of any related  symptoms. Common tumors with cardiac metastasis potential are  usually carcinomas of the lung, breast, and malignant lymphoma.  The prognosis of a metastatic heart tumor is unfavorable. The  average life expectancy for patients with this diagnosis is less than  six months. In addition, surgical treatment of primary cardiac tumors or metastatic cardiac tumors is associated with high risk of  perioperative lethality. Case report. We present a rare case of  cervical cancer metastasis to the heart in a 33-year-old woman.  Cytological examination revealed no evidence of disease recurrence  14 months after the completion of external beam radiotherapy.  Echocardiography showed a mass in the outflow tract of the right ventricle and findings of severe pulmonary hypertension.  omputed tomography and magnetic resonance imaging revealed a  large right ventricular thrombus. The patient underwent surgery with  artificial circulation. Pathohistological and immunohistochemical studies revealed metastasis of squamous cell carcinoma. The control  echocardiography showed decrease in pulmonary hypertension. No  evidence of right ventricular mass was detected. Conclusion. Cardiac metastasis should be included in the differential diagnosis in patients with complaints of dyspnea and chest pain, especially in cases with history of cancer. Surgical treatment of cardiac metastasis  contributes to the prevention of cardiopulmonary complications and  improvement of survival rates in this group of patients.

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