Aim. The purpose of the study was to evaluate the nonspecific inflammatory markers and study their impact on cardiometabolic risk in patients with arterial hypertension (AH) and metabolic dysfunction-associated steatotic liver disease (MASLD) depending on the presence of sarcopenic obesity.

Materials and methods. This article is a continuation of the article “Sarcopenic obesity in patients with arterial hypertension and metabolic dysfunction-associated steatotic liver disease: focus on inflammation. Part 1” [12]. The second part of the article presents data on the influence of inflammatory markers and proinflammatory cytokines on cardiometabolic risks in patients with sarcopenic obesity, AH and MASLD.

Results. A total of 133 patients with AH and MASLD were included in the study during the recruitment period. Women accounted for 43.6% (n = 58). The mean age of the subjects was 48.0±7.99 years, and the median duration of hypertension was 8.0 (3.0–14.5) years. Patients with sarcopenic obesity had higher values of nonspecific inflammatory markers. This group also had higher blood pressure, liver elasticity, and FLI values. Correlation analysis revealed numerous associations between inflammatory markers, cardiometabolic risks, body composition, muscle strength, and functional indicators in patients with AH and MASLD.

Conclusion. The muscle-to-fat ratio in obese patients, as well as decreased muscle strength and impaired muscle function, may be associated with altered serum concentrations of nonspecific inflammatory markers, suggesting the role of proinflammatory cytokines in both the development and progression of sarcopenic obesity. Specifically, addressing chronic inflammation is considered a key mechanism for treating sarcopenic obesity, atherosclerosis, MASLD, and AH. The study and clinical implementation of therapeutic and preventive measures aimed at preserving muscle mass and strength and minimizing the impact of sarcopenia on the risk of cardiovascular disease in adults with AH and fatty liver disease are among the top priority areas of healthcare.

Despite the successes of preventive medicine associated with the effective impact on modifiable risk factors for diseases of the circulatory system (DCS), the leading cause of mortality worldwide remains ischemic heart disease. Results from clinical studies indicate the varying prognostic value of inflammatory markers in the development and progression of the atherosclerotic process.

Study Objective. To assess the nature of lipidemia, systemic inflammation indices (SIRI, AISI, SII, NLR, PLR, MLR), and the morphological and local mechanical properties of blood cells using atomic force microscopy in patients with stenotic atherosclerosis of the coronary arteries.

Materials and Methods. The study included 58 patients with instrumentally confirmed hemodynamically significant stenosis of the coronary arteries, where revascularization was either technically impossible or rejected by the patients. Of these, 72.4% (n = 42) were men and 27.6% (n = 16) were women. The mean age was (59.1 ± 4.4) years. All patients had their blood lipid profile determined, a complete blood count with leukocyte formula and calculation of inflammatory indices performed, and diagnostics of microhemodynamic disorders conducted. In 10 subjects, the structure and local mechanical properties of fixed formed blood elements (erythrocytes and platelets) were examined using an atomic force microscope.

Results. Among patients with stenotic multi-vessel coronary artery disease, the proportion of individuals with values exceeding the reference range for the neutrophil-to-lymphocyte ratio (NLR) was 22.4%, for the systemic inflammation response index (SIRI) – 58.6%, and for the systemic inflammation index (SII) – 29.3%. A direct, moderate-strength correlation was established between SIRI and the levels of prognostically unfavorable LDL-C (r = 0.49; p < 0.05), signs of atherosclerotic (r = 0.58; p < 0.05) multi-vessel (r = 0.43; p < 0.05) coronary artery lesions. A moderate-strength inverse correlation was found between anti-atherogenic HDL-C and the extent of atherosclerotic involvement of the coronary basin (r = –0.41; p < 0.05).

Conclusion. The identified correlations between the antiand atherogenic characteristics of the lipid profile, the severity of coronary atherosclerosis, and SIRI indicate the contribution of secondary hyperlipidemia and inflammation to the pathogenesis of atherosclerotic remodeling. According to atomic force microscopy of biomaterial from patients with stenosing atherosclerosis of the coronary arteries, it was found that a change in the elasticity of blood cell membranes (erythrocytes and platelets) is associated with an increase in the SIRI, SII, and AISI indices. This preliminary conclusion is based on a limited sample; the results of subsequent studies will be analyzed and presented upon completion of patient enrollment.

Aim: To evaluate cardiac remodeling based on echocardiographic parameters over time in patients with arterial hypertension (AH), with and without progression of atrial fibrillation (AF).

Materials and methods: The study includes 59 patients with AH and paroxysmal AF. The observation period was 20 [19.0; 25.0] months. The criteria for AF progression were considered to be the transition from paroxysmal to persistent or permanent forms, or an increase in the frequency and/or duration of arrhythmia episodes. All patients underwent transthoracic echocardiography.

Results: In patients with AF progression a deterioration in parameters reflecting left ventricular (LV) diastolic function was observed: an increased ratio of the transmitral peak velocity of early filling (peak E) relative to early diastolic septal mitral annular velocity (E/e’_sept) (p = 0.01), the ratio of peak E to the average early diastolic mitral annular velocity (E/e’_avg) (p = 0.02), and the peak tricuspid regurgitation velocity (p = 0.03). In the group without AF progression, there was a decreased prevalence of left atrial (LA) dilatation by the LA volume index LV mass/height² (93.2% vs. 75.0%, p = 0.03). This group also showed a significant reduction in LV myocardial mass (LVMM) (p = 0.0005), LVMM/height2,7 (p = 0.0008), accompanied by a decreased prevalence of left ventricular hypertrophy (LVH) (65.9% vs. 47.7%, p = 0.04). Echocardiographic parameters of LVH correlate with dynamics in both systolic and diastolic blood pressure.

Conclusion: Structural and functional cardiac remodeling is associated with AF progression, while reverse remodeling is associated with a favorable course of arrhythmia.

Aim. To evaluate the applicability of two-dimensional speckle tracking echocardiography (2D STE) for quantitative assessment of global aortic circumferential strain (GCSao) and to study the intraand inter-operator reproducibility of measurements, as well as the diagnostic value of this indicator in patients with thoracic aortic dilation/aneurysm compared with healthy volunteers.

Methods. The study included 51 healthy volunteers (aged 21 [20; 23] years) and 13 patients with an aortic diameter > 45 mm (aged 48 [36; 49] years). All subjects underwent standard transthoracic echocardiography (Vivid E90, M5SC D transducer, 1.5–4.5 MHz) with DICOM loop recording and subsequent offline analysis in EchoPAC PC v201. GCSao (%) was calculated using a previously proposed method. Two experts (E₁ – the developer of the method; E₂ – a physician specializing in functional diagnostics with 10-year work experience) performed independent measurements and repeated them 2 weeks later. Reproducibility was assessed using the intraclass correlation coefficient, the Bland–Altman test. Group comparisons were performed using the Mann–Whitney U test.

Results. GCSao in patients with dilation/aneurysm was statistically lower than in volunteers (−5.31 [7.56; 3.01] % versus −8.79 [10.18; 6.40] %; U = 168; p = 0.005). Intra-operator reproducibility: ICC = 0.915 (E₁) and 0.913 (E₂) – high. Inter-operator reproducibility: ICC = 0.882 (first measurement) and 0.897 (second) – good/high. According to Bland-Altman, the mean difference is close to 0, the limits of agreement are narrow; isolated outliers are associated with the initial stage of mastering the technique.

Conclusion. 2D STE allows for reproducible measurement of GCSao and detection of strain reduction in patients with thoracic aortic dilation/aneurysm. The technique is promising for risk stratification and monitoring; studies of prognostic thresholds and validation against MRI are needed.

Based on the analysis of immediate and long-term results of treatment of a randomized cohort of patients with idiopathic non-paroxysmal atrial fibrillation, the safety and effectiveness of minimally invasive biatrial epicardial bipolar radiofrequency ablation both in the format of hybrid treatment in combination with endocardial ablation of pulmonary veins and in a stand-alone variant have been shown.

Aim: To evaluate the effectiveness of hybrid and staged treatment of idiopathic persistent atrial fibrillation (AF) by analyzing immediate and long-term (2 years) treatment results in a single-center randomized clinical controlled trial.

Methods. A single-center randomized trial included 33 patients with non-paroxysmal AF. All patients underwent minimally invasive video-assisted epicardial radiofrequency ablation (RFA) as the first procedure in accordance with Patent for invention of the Republic of Belarus № 22432 dated 12.06.2016. "The method of bipolar minimally invasive epicardial radiofrequency ablation in patients with isolated persistent atrial fibrillation". Depending on the distribution of the group, the patient received an endocardial ablation procedure either during the current hospitalization, or in the period 3-6 months after the epicardial stage in case of recurrence of atrial arrhythmia (Atrial Fibrillation/Atrial Flutter). The primary endpoints included the frequency of AF recurrence at the hospital stage, the frequency of sinus rhythm retention (SR) at the end of hospitalization, the need for pacemakers, the frequency of major adverse cardioand cerebrovascular events (MACCE). Secondary endpoints included retention of SR at the end of observe, the need to take class I/III antiarrhythmic drugs (AAD) and anticoagulants outside the "blind" period, as well as the need for repeated procedures.

Results. There were no differences in the results between the groups for the primary endpoints. By the time of discharge from the hospital, sinus rhythm (SR) occurred in 100 % of patients. We did not observe major adverse cardiovascular and cerebrovascular events at the hospital stage. AF paroxysms at the end of the study period in patients using class I/III AAD were observed in 2 (13.33 %) cases in the "hybrid" group and 2 (11.1 %) cases in the "staged" treatment group. The need for repeated procedures for atrial arrhythmias was 2 (13.3 %) cases in the "hybrid" treatment group and 5 (27.78 %) cases in the "staged" treatment group. The cumulative mid-term SR retention rate at 1 year was 94.5 % in both groups; after 2 years, the rate was 86.7 % in the "hybrid" treatment group and 88.9 % in the "staged" group.

Conclusion. Epicardial bipolar biatrial ablation has shown high efficacy in the treatment of non-paroxysmal forms of AF, but often requires repeated procedures to eliminate typical atrial flutter. To perform more effective pulmonary veins isolation, it is reasonable to perform separate pulmonary vein ablation in addition to antral ablation. The staged treatment of persistent forms of AF is justified from the clinical and economic point of view.

Despite the successes of preventive cardiology associated with effective impact on modifiable risk factors of heart diseases, the main cause of death worldwide remains coronary heart disease. The development of atherosclerosis is based on the violation of lipid metabolism and local inflammation of the vascular wall. Hematological indexes may be new marker in predicting the severity of atherosclerotic lesion of the coronary arteries.

Purpose. To compare the hematological indices in patients with atherosclerosis of the coronary arteries of varying severity.

Material and methods. The study included 88 patients who were divided into three groups: without coronary artery atherosclerosis (n = 31), with non-stenotic coronary artery atherosclerosis (n = 26), and with stenotic coronary artery atherosclerosis (n = 31). The average age of the patients was 58.5±7.9 years. The following hematological parameters were determined: NLR (neutrophil-lymphocyte ratio), PLR (platelet-lymphocyte ratio), MLR (monocyte-lymphocyte ratio), SII (systemic inflammation index). SIRI (Index of systemic inflammatory response). The data obtained was processed using the statistical packages Excel, Statistica 10.0.

Results. The SIRI hematological index was significantly higher in the group of patients with coronary artery stenosis compared with patients with non-stenosing coronary artery atherosclerosis (1.20 (0.96; 1.74) and 0.85 (0.66; 1.21), respectively, p < 0.007) and patients without coronary artery atherosclerosis (1.20 (0.96; 1.74) and 0.77 (0.54; 1.21), respectively, p < 0.002). The NLR was also higher in the group of patients with stenotic coronary artery atherosclerosis compared to patients without coronary artery atherosclerosis (2.03 (1.67; 2.74) and 1.54 (1.33; 2.03), respectively, p < 0.007).

Conclusion. Hematological indexes, along with traditional risk factors, can become promising and economically accessible biomarkers in routine practice, used in the prediction of the severity of coronary atherosclerosis and the stratification of cardiovascular risk. The introduction of the use of hematological indexes as additional criteria of prognostic models is of scientific and practical interest and requires further study.

Aim: To compare the safety and efficacy of excimer laser coronary angioplasty (ELCA) versus conventional CTO-PCI under routine OCT guidance and speckle-tracking echocardiography.

Materials and methods: a single-center cohort study included 36 ELCA patients and 22 controls without laser. The endpoints included technical success, OCT parameters (MSA, apposition), changes in GLS and LVEF, and a 12-month MACE.

Results: ELCA yielded a larger stent area, a lower malapposition, and greater improvements in GLS and LVEF with comparable safety.

Conclusion: OCT-guided ELCA improves stent geometry and LV functional recovery compared with non-laser CTO-PCI.

Aim. To identify markers of chronic kidney disease (CKD) progression in elderly individuals with chronic ischemic heart disease (CHD).

Materials and Methods. The study included 100 patients with a mean age of 70.2 ± 4.1 years with coronary heart disease. 55 (55,0%) women and 45 (45,0%) men participated in the study. All patients had signs of chronic heart failure (CHF) not higher than functional class (FC) II according to the New York Heart Association (NYHA) and no history of kidney disease. Besides, the patients had comorbid conditions, including diabetes mellitus (DM) in 20 (20,0%) patients, arterial hypertension (AH) in 94 (94,0%) patients, and obesity in 24 (24,0%) patients. CKD was diagnosed using the KDIGO criteria. The laboratory tests included general clinical and biochemical parameters in the serum and urine, as well as levels heart failure markers (brain-derived natriuretic peptide (NT-proBNP)). The statistical processing of the findings was carried out using the STATISTICA 12.0 package (StatSoft Inc., license number AXXR012E829129FA), MedCalc and Microsoft Excel.

Results. Multiple regression and the ODDs Ratio method enabled us to establish a set of criteria for renal impairment progression (p < 0,05) in patients with chronic ischemic heart disease (CHD): biochemical analysis data included levels of cystatin C, total cholesterol, low-density lipoprotein cholesterol, lipoprotein (a), and NT-proBNP in the serum, and daily urine protein levels; clinical data included a history of hypertension, myocardial infarction, angina pectoris, and CHF.

Conclusion: The study results support the need to use a combination of markers available in routine clinical practice to successfully prevent CKD progression, rather than relying on traditional indicators.

This study is devoted to identifying the morphometric characteristics of the heart and various parts of the aorta in adult males and females, as well as assessing correlations between the obtained parameters. The analysis was conducted using echocardiographic medical records from 98 patients (aged 20–76 years, both sexes) who presented to the Republican Scientific and Practical Center “Cardiology” and exhibited minimal structural and functional abnormalities. The investigation focused on morphometric indices of the heart and the aorta. Sex-based differences were identified in aortic valve annulus diameter, aortic diameter at the valve level, aortic arch diameter, left ventricular myocardial mass, left ventricular outflow tract diameter, anteroposterior dimension of the right ventricle, and right ventricular size in the four-chamber view. Statistically significant correlations were found between patient age and diameters of both the ascending and descending aorta, as well as between body surface area and left ventricular myocardial mass. Additional associations were observed between the thickness of the posterior wall of the left ventricle and aortic diameters at the valve level, the ascending aorta, and the aortic arch. The thickness of the interventricular septum was also correlated with right ventricular dimensions. A direct relationship was established between the left ventricular myocardial mass and the diameter of the left ventricular outflow tract. It was found that the heart size is directly proportional to the body surface area, while the aortic diameter is more strongly associated with age. The left ventricular myocardial mass positively correlates with both the diameter of the outflow tract and the aorta. Overall, the strength of the correlations between cardiac morphometric parameters and proximal aortic dimensions was greater in men than in women. The results contribute to existing scientific knowledge about morphometric features of the heart and the aorta and their interrelations in adult individuals of both sexes, and can be applied by clinical specialists in routine medical practice.

Cytokine concentrations were determined in the blood serum of 96 workers diagnosed with respiratory diseases due to exposure to industrial aerosols. When compared with the control group, the levels of pro-inflammatory IL-1β, IL-6, TNF-α, and anti-inflammatory IL-10 showed specific dynamics of these polypeptides in the studied group. Immunological screening may be a component of a model for predicting occupational respiratory diseases.

A study was conducted to investigate the possibility of hardware stimulation of the functional asymmetry of the alpha rhythm in order to increase the effectiveness of neurobiofeedback control in shooters. We discovered the principle of training athletes to achieve a specific psychological state of optimal concentration before a shot based on increasing the alpha activity of the cerebral cortex. The data obtained laid the basis for the judgment that the proposed method of audiovisual stimulation allows accelerating the development of the neurobiofeedback control skill.

The aim of the study. To evaluate the severity of left atrial remodeling by measuring global longitudinal myocardial strain in patients with hypertension and concomitant psoriasis followed by the assessment of the effect on the frequency of cardiac arrhythmias.

Materials and methods. A prospective cohort study was conducted including the patients with hypertension and psoriasis compared with a group of patients with hypertension without psoriasis. The patients underwent a clinical diagnostic examination with an emphasis on daily ECG monitoring, echocardiographic examination to determine the longitudinal deformation of the left ventricle and left atrium. 96 patients with hypertension were examined in the course of the study. The patients were divided into two groups: the main group group 1 (n = 60 patients) – patients with hypertension and psoriasis, the control group – group 2 (n = 36 patients) – patients with hypertension without concomitant psoriasis.

Results. The patients of both groups had a statistically equal distribution by age, gender, and anthropometric characteristics, hemodynamic parameters at the time of inclusion in the study, the duration of hypertension, and the structure of concomitant pathology. In the group of patients with psoriasis, frequent supraventricular extrasystole and paroxysms of unstable supraventricular tachycardia were significantly more common: 43.13 % in group 1 and 26.21 % in group 2 (p = 0.031). Besides, in patients with hypertension and concomitant psoriasis, a decrease in left atrial myocardial strain in the reservoir phase was more frequent (LASr = 23.12 ± 5.64 in the group of patients with psoriasis and 28.31 ± 6.36 in the control group (p = 0.004)), with comparable strain readings in the flow and contraction phases. In addition, in Group 1, there was a greater severity of left ventricular diastolic dysfunction according to tissue dopplerography (E/e’ = 11.42+/–2.47 in Group 1 and 9.21+/–2.22 in Group 2 (p = 0.0065)).

Conclusion. According to our data, patients with hypertension and concomitant psoriasis were significantly more likely to have left atrial strain in the reservoir phase, as well as more pronounced diastolic dysfunction of the left ventricle, assessed by tissue dopplerography, which was combined with more frequent paroxysms of unstable supraventricular tachycardia.

Modern cardiac surgery has made significant advances in the treatment of coronary artery disease. Despite the high effectiveness of treatment, interventional techniques, however, suggest a potential risk of complications, reperfusion injury playing a significant role in this.

The aim of the study was to identify risk factors influencing the development of ischemia-reperfusion myocardial injury during cardiac surgery in patients with coronary heart disease.

Materials and Methods. This prospective study included 162 patients, of whom 25 patients (15.4%) underwent off-pump coronary artery bypass grafting, 81 patients (50%) survived on-pump coronary artery bypass grafting and 56 patients (34.6%) underwent mitral and/or tricuspid valve repair or replacement in addition to myocardial revascularization. Ischemia-reperfusion injury was observed in 58 (35.8%) patients. All patients underwent echocardiography, coronary angiography, magnetic resonance imaging and a comprehensive clinical and laboratory analysis, including markers of cardiovascular risk.

Results: The study revealed that risk factors influencing the development of ischemia-reperfusion myocardial injury, both during cardiac surgery using artificial circulation and during coronary artery bypass grafting on a beating heart, are the left ventricular myocardial mass index (r = 0.75; p = 0.01; r = 0.68; p < 0.05, respectively), points on the SYNTAX Score scale (r = 0.7; p = 0.01; r = 0.56; p < 0.05, respectively), as well as the initial level of high-sensitivity troponin I (r = 0.88; p = 0.001; r = 0.71; p = 0.01; respectively). Intraoperative risk factors for the development of myocardial reperfusion injury include the duration of myocardial ischemia (r = 0.65, p < 0.05) and the duration of artificial circulation (r = 0.72; p = 0.01) during cardiac surgery using artificial circulation.

Thus, a number of risk factors influencing the development of myocardial ischemia-reperfusion disorders during cardiac surgery were established.

The article describes a case of congenital hypoplasia of the left vertebral artery in a 57-year-old patient in combination with a cerebral infarction caused by vertebrobasilar insufficiency. Concomitant diseases: arterial hypertension, dyslipidemia, impaired fat metabolism (BMI – 33 kg/m2), high-risk coronary heart disease according to the SCORE scale. On the eve of hospitalization, he noted a short-term loss of consciousness when bending forward and impaired coordination of movements. Objective status: muscle strength was preserved in all muscle groups; muscle tone was not changed; sensory disorders were absent; he staggered in the Romberg pose; performed the finger test satisfactorily on both sides; his gait was uncertain. CT scans of the vessels of the neck and brain with angiography revealed a narrowing of the left vertebral artery. Its diameter is almost 1/3 smaller than that of similar sections of the right vertebral artery and varies from 1 mm at the C1 level to 2.5 mm in the V4 segment. A defect in the contrast of the left vertebral artery was found due to prolonged soft atherosclerotic plaque without signs of calcification. The left internal carotid artery has an S-shaped bend in the extracranial region at the C1–C2 level. At the mouth of the right internal carotid artery (at the level of the bifurcation of the right common carotid artery), a parietal calcified atherosclerotic plaque with a narrowing of the lumen to 15 % is detected. An MRI scan of the brain revealed a pattern of infarction of the left hemisphere of the cerebellum.

Conclusion: congenital asymptomatic hypoplasia of the vertebral artery is a risk factor for the development of cerebral circulatory disorders. The progression of systemic atherosclerotic vascular lesions contributes to the development of vertebrobasilar stroke.

Orthotopic heart transplantation is a significant achievement of modern cardiosurgery for patients with terminal stage of chronic heart failure, where other treatment methods become ineffective. One of the common complications after orthotopic heart transplantation is atrial arrhythmias, which can significantly complicate the recovery process after surgery. Macro-reentry arrhythmias are one of the most common forms of atrial arrhythmias in this patient group. They are caused by significant changes in the geometry of the atria, which occur as a result of the surgical intervention. Typical isthmus-dependent atrial flutter is more common in the donor organ, but atypical forms with extension along the sutures or in the residual tissue of the recipient’s atria are also observed. In this article, we presented a unique clinical case that illustrates the simultaneous presence of typical isthmus-dependent atrial flutter in the donor heart and atypical atrial flutter in the residual tissue of the recipient’s right atrium. We also discussed the methods of electrophysiological diagnosis of these arrhythmias and the successful treatment using catheter ablation.

Surgical valvuloplasty is not always possible in pediatric patients. Transcatheter “valve-in-valve” and “valve-in-ring” implantations have become common approaches for patients with failed biopros- thetic valves or dysfunctional annuloplasty rings. We present a case of percutaneous Melody valve implantation into a native, previously unreconstructed tricuspid valve. A key feature of this case was the presence of a mechanical valve prosthesis in the mitral position, whose rigid support ring provided stabilization to the fibrous annulus during the implantation of the endovascular valve into the tricuspid position, facilitating stable device positioning.

Non-ST-segment elevation myocardial infarction (NSTEMI) is one of the most common forms of acute coronary syndrome (ACS), characterized by a high risk of cardiovascular events and increased mortality. Despite the achievements of modern medicine in the field of diagnostics and treatment of ACS, predicting adverse outcomes in this category of patients remains an urgent task. The purpose of this article is an overview of modern predictors of adverse cardiovascular events in patients with NSTEMI.