The article presents the main provisions of the European Society of Cardiology (ESC) Guidelines on Cardio-Oncology, developed in collaboration with the European Hematology Association, the European Society for Therapeutic Radiology and Oncology, the International Society of Cardiac Oncology in 2022. This is the first ESC guidelines on cardio-oncology, with 272 new recommendations, making the document very informative and voluminous. In this regard, within the framework of this article, only some concepts, definitions and directions for managing cancer patients will be reflected. The main factors of cardiovascular risk, as well as existing approaches to their assessment in patients before the start of cancer therapy and at the stages of dynamic observation, will be considered in detail. Separately, cardiovascular risk stratification associated with cancer therapy in various categories of patients is given.

According to the Russian epidemiological study EPOСHA-CHF (1998–2017), during a 20-year follow-up, the prevalence of chronic heart failure (CHF) increased from 6.1 to 8.2%. Arterial hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus remain the main causes of CHF. At the same time, acute myocardial infarction (AMI) as a cause of heart failure increased by 3 times. The median survival time among the patients with CHF I-II functional class (FC) is 8.4 years, and 3.8 years among the patients with CHF III-IV FC, which indicates a poor prognosis of CHF of any functional class. Currently, a number of clinical, biochemical, angiographic, and imaging approaches have been proposed to stratify the risk of CHF after AMI, but only a few of them are used in routine clinical practice. Given the increasing contribution of CHF to morbidity and mortality after myocardial infarction, early multimodal risk stratification is needed to develop preventive strategies aimed at averting this complication. This report presents current ideas about the role of clinical risk factors, biochemical and genetic markers of CHF, considered as early predictors of heart failure in patients with acute myocardial infarction.

Aim. To study the effectiveness of treatment with delamanid-containing regimens in patients with multidrug-resistant and extensively drug-resistant tuberculosis and comorbid cardiovascular diseases, to assess the frequency, structure, and severity of adverse events in the cardiovascular system in this group of patients.
Materials and methods. The study included 125 adult patients with multidrug and extensive drug resistance who started treatment with delamanid-containing regimens from July 2016 to February 2018 at the Republican Research and Practical Center for Pulmonology and Tuberculosis and six regional anti-TB institutions. The main group included patients with multiple and extensive drug resistance and comorbid cardiovascular diseases (N = 46). The control group included patients with multiple and extensive drug resistance without comorbid cardiovascular diseases (N = 79). The formulation and coding of the diagnosis (the underlying disease and comorbid diseases (conditions)) corresponded to the International Classification of Diseases (ICD) of the 10th revision. Adverse events were classified according to the international dictionary MedDRA (Medical Dictionary for Regulatory Activities). The severity of adverse events classification complied with CTCAE (Common Terminology Criteria for Adverse Events). The severity of adverse events was determined in accordance with the definitions of ICH (The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use), and the treatment outcomes were identified in accordance with clinical guidelines and WHO recommendations. The study materials were the data from the medical records of the patients in the E-Register “Tuberculosis”. Sputum culture conversion was defined as two consecutive negative test results. Treatment outcomes were classified as successful and unsuccessful. For the analysis of adverse events, each event was considered as a unit of analysis both in the aggregate of all adverse events in the cardiovascular system and in groups of patients. Testing of statistical hypotheses was carried out at a critical level of significance p = 0.05, i.e. the difference was considered statistically significant if p < 0.05.
Results. The effectiveness of treatment with delamanid-containing regimens in the group of patients with comorbid cardiovascular diseases was 88.0%, sputum conversion after 6 months of treatment (abacillation by culture) was observed in 93.0% of patients in this group, when compared no statistical difference was present in the effectiveness of treatment (p = 0.785) of the patients of the main group and those of the comparison group. In the analysis of long-term results, only one patient with cardiovascular comorbidity (3.0%) had a relapse of tuberculosis more than one year after successful treatment. 78.0% of patients of the main study group (with comorbid cardiovascular diseases) and 70.0% of the comparison group manifested cardiovascular adverse events during treatment. The most common adverse event in both groups was prolongation of the QTcF interval, which was recorded in 37.0% of patients with comorbid cardiovascular diseases and in 42.0% of patients without cardiovascular diseases (p = 0.597). Timely correction and careful monitoring of adverse events made it possible to avoid the development of life-threatening conditions in both groups of patients. In this regard, no withdrawal of anti-tuberculosis drugs was registered due to cardiovascular adverse events, including those due to the prolongation of the QTcF interval. The highest frequency of cardiovascular adverse events was detected during the first month of treatment of patients, then, in the course of treatment, it decreased, which may indirectly indicate the absence of a cumulative cardiotoxic effect of delamanid-containing treatment regimens.
Conclusions. Treatment with delamanid-containing regimens in adult patients with multidrug-resistant tuberculosis and comorbid cardiovascular disease was effective and had an overall favorable cardiovascular safety profile comparable to the comparison group. Despite a large number of cardiovascular adverse events, they were manageable at the program level (prevailing at the initial stages of treatment, having light, mild or moderate severity, having been relieved), which made it possible to complete anti-tuberculosis treatment with delamanid-containing regimens.

Background. In view of the changes in the pathogenetic vector towards the study of comorbidity, searching for the ways of cardiovascular risk reduction is still relevant nowadays in specific subgroups of patients with moderate, unusual or undetectable risk levels (for example, in patients with accompanying acute surgical diseases of the abdominal cavity)
Aim. Evaluation of arterial blood pressure indices in patients with acute calculous cholecystitis.
Material and methods. The main group consisted of patients with acute calculous cholecystitis who underwent urgent cholecystectomy and were administered cardioprotective therapy (acetylsalicylic acid and atorvastatin). The first comparison group was formed from patients who underwent urgent cholecystectomy, but did not received cardioprotective therapy. The second comparison group was formed from patients who received cardioprotective therapy, but did not undergo cholecystectomy.
Results and discussion. As a result of the study, the prevalence of patients with arterial hypertension (HTN) in the cohort was revealed. 72% of in-patients had elevated blood pressure (BP) on admission to the surgical department. Despite the positive results on the HTN control at the inpatient stage, the second follow-up revealed hypertensive BP profiles in most patients in the late postoperative period. The analysis of hospitalizations for acute coronary syndrome (ACS) in the late postoperative period also revealed the predominance of hypertensive blood pressure profiles in patients in all study groups.
Conclusion. Development of ACS emerged in circumstances of poor HTN control.

The objective is to identify factors associated with adverse cardiovascular events in a cohort of patients with a combination of non-compaction (NCCM) and dilated cardiomyopathy (DCM) in order to reveal high-risk patients.
Materials and methods. 104 patients with a combination of NCCM and DCM aged 31 to 52 years (median age 41 years; 81 men; 23 women) were examined, who, in addition to traditional clinical research methods, underwent cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement. The endpoints of the study included progression of chronic heart failure (CHF) to functional class (FC) III NYHA requiring hospitalization, ventricular tachyarrhythmias and thromboembolic events.
Results. During the 24-month follow-up period (from 7 to 183) adverse cardiovascular events were registered in 84 (80.7%) patients, of which progression of CHF to FC III NYHA – in 47 (45.2%). Univariate analysis showed that the following characteristics were independent risk factors for the progression of CHF: symptoms of CHF II FC at the initial examination (HR 15.4; 95% CI 1.9-125.3, p = 0.0002), male gender (HR 4.6; 95% CI 1.3-16.1, p = 0.01), LVEF < 40% (HR 1.3; 95% CI 1.1-1.4, p = 0.0004), an increase in left ventricular end-diastolic volume index (LV EDVI) (HR 1.02; 95% CI 1.01-1.04, p = 0.0262), an increase in left ventricular end-systolic volume index (LV ESVI) (HR 1.04; 95% CI 1.01-1.06, p = 0.0080), right ventricular fractional area change (RV FAC) (HR 0.9; 95% CI 0.8-1.0, p = 0.0478) according to transthoracic echocardiogram (TTE) data, a decrease in global longitudinal strain (GLS) level ≤ 11% (HR 4.7; 95% CI 1.2-17.4, p = 0.0207) according to 2D Strain and percentage of myocardial fibrosis according to CMR imaging with late gadolinium enhancement (HR 0.94; 95% CI 0.9-1.0, p = 0.0329).
26 (25.0%) patients developed ventricular tachyarrhythmias, associated with the following risk factors: premature ventricular contractions (PVCs) > 500 bpm (HR 45; 95% CI 7.5-751.2, p = 0.0005), a decrease in the GLS level ≤ 11% (HR 5.3; 95% CI 1.03-27.4, p = 0.0282) according to 2D Strain data.
11 (10.6%) developed embolic events, the predictors of which were: atrial fibrillation/flutter (HR 24; 95% CI 3.0-188.2, p = 0.0037), left atrium volume index (LAVI) (HR 32.2; 95% CI 1.2-956, p = 0.0352) and LVEF < 40% according to CMR (HR 1.33; 95% CI 1.03-1.7, p = 0.0269).
Conclusion. Factors associated with the risk of adverse events are the pre- sence at the initial examination of symptoms of FC II CH by NYHA, male gender, LVEF ≤ 40%, an increase in LAVI ≥ 57 ml/m2, a decrease in GLS ≤ 11%, the presence of myocardial fibrosis according to CMR imaging with late gadolinium enhancement, PVCs > 500 bpm according to 24-hour ECG monitoring, which can be used to identify patients at high risk of adverse cardiovascular events.

Objectives. To study the effect of complex treatment of breast cancer (BC) on the parameters of the structural and functional state of the cardiovascular system. To develop a model for predicting the ejection fraction (EF) of the left ventricle (LV) measured by the Simpson method after the end of antitumor therapy on the basis of initial laboratory and instrumental data.
Methods. The cardiovascular system was examined in 100 women who received complex treatment of BC. The groups were formed depending on the presence of arterial hypertension (AH) and on the cardiotropic therapy (CT) received: the BC group, the BC+ CT group, the BC+ AH+CT group.
Results. The research showed a decrease in LVEF measured by the Simpson method from 66,0 (62,0; 71,0)% to 60,0 (57,0-66,0)%, an increase in LV end systolic diameter from 27,0 (24,0–29,0) mm to 27,0 (25,0–31,0) mm, LV end systolic volume from 27,0 (22,0; 32,0) ml to 28,0 (24,0; 37,0) ml; a decrease in the mitral ratio of peaks early to late diastolic filling velocity from 1,4 (1,1; 1,8) to 1,2 (1,1; 1,5), in the ratio of early to late diastolic mitral annular velocity from 1,4 (1,2; 1,7) to 1,2 (1,0; 1,6); in the of early to late diastolic tricuspid annular velocity from 1,4 (1,2; 1,7) to 1,0 (0,8; 1,1), reduction of the increase in the diameter (d) of the brachial artery (BA) after performing a post-occlusion test from 12,5 (11,0; 16,0)% to 9,0 (6,0; 12,0)%, the reduction of heart rate variability: standard deviation of NN intervals from 57,7 (44,9; 72,9) ms to 54,1 (44,0; 63,3) ms, root mean square of successive RR interval differences from 29,6 (17,5; 43,3) ms to 20,0 (15,2; 28,0) ms, total power of the spectrum from 1326,3 (996,4; 2061,7) to 1132,4 (824,3; 1649,8) ms2/ Hz; power of the high-frequency (HF) from 647,3 (416,8; 921,4) to 443,7 (315,9; 669,0) ms2/ Hz; an increase in ratio of low-frequency to HF from 0,8 (0,7; 1,0) to 1,05 (0,8; 1,2). A Simpson-based EF prognostic model after the end of BC treatment has been developed. It includes the total dose of doxorubicin calculated for the body surface area, the peak early diastolic filling velocity of transtricuspid flow, the diameter of the pulmonary artery, the velocity of circumferential fiber shortening, the intima-medial thickness of the left common carotid artery, HF, % increase of the d of the BA. The developed model has a high prognostic ability.
Conclusions. Breast cancer treatment negatively affects the structural and functional state of the cardiovascular system. The administration of a combination of valsartan and carvedilol prevents the development of adverse changes. The developed EF prognostic model allows to identify patients for the preventive administration of cardiotropic therapy.

Objective. To specify photochemical reactions, occurring in the blood of patients with non-ST elevation acute coronary syndrome (NSTE-ACS), followed by the study of the mechanisms of alterations of ultraviolet blood modification (UVBM) into biological reactions.
Methods. We studied 90 blood samples from patients with NSTE-ACS, receiving complex treatment that included UVBM by mercury lamp radiation with blood taken from the ulnar vein (device “Nadezhda”), the course of treatment consisted of 5 procedures conducted daily. We compared absorption spectra of blood and erythrocytes, results of optical oximetry, spectrophotometry, data of general blood analysis before UVBM, during individual procedures and 20–30 minutes after the end of the course.
Results. We have studied the effect of UVBM on patients with NSTE-ACS. Based on the results of spectral and clinical studies of blood, patterns of its photomodification under the influence of ultraviolet (UV) radiation were found. The spectra of blood absorption and blood oxygenation were evaluated in patients whose complex treatment included five courses of UVBM along with traditional drug therapy. It is noted that UV radiation leads to photomodification of blood, changes in the partial pressure of blood gases, changes in the level of oxyhemoglobin and the degree of hemoglobin oxygen saturation. UVBM is proven as an effective method of non-drug treatment of patients with NSTE-ACS.
Conclusion. UVBM, influencing the oxygen metabolism in patients with NSTE-ACS, increases the oxygen capacity of the blood, reduces the oxygen demand by the tissues. Photoinduced changes in the degree of hemoglobin oxygen saturation are determined by the individual sensitivity of patients to UV radiation and can be controlled by venous blood oxygenation as the best way to individualize therapy.

Chronic respiratory failure (CRF) has traditionally been considered to be the main cause of death in patients with chronic obstructive pulmonary disease (COPD). However, modern epidemiological studies have shown that the leading causes of death in patients with COPD are CHD and chronic heart failure (CHF).
Aim: to study the prevalence of CRF and CHF in patients with COPD, to determine the informative value of clinical symptoms in their diagnosis, to work out an algorithm of differential diagnosis of CRF and CHF.
Methods: subjects – 100 men with COPD. The median age was 67 years. We performed clinical and laboratory examinations. COPD syndrome was diagnosed upon EchoCG and NT-proBNP results. CRF syndrome was diagnosed by the results of exercise testing with simultaneous measurement of arterial blood hemoglobin oxygen saturation.
Results: CHF was established in 45.0% of patients, and right ventricular failure was diagnosed in 42.0% of cases. Patients with CHF and decreased left ventricular ejection fraction (EF), whose prognosis could be improved by evidence-based treatment developed at the present stage, comprised only 12.0%. We revealed the correlation of CHF syndrome with CRF and with disorders of arterial blood hemoglobin oxygen saturation: CHF NYHA III is associated with CRF IIIB and any disorders of arterial blood hemoglobin oxygen saturation, while CHF NYHA II and NYHA I are respectively associated with CRF IIIA and CRF IIB as well as with a decrease in arterial blood hemoglobin oxygen saturation both on exertion and at rest. The informative value of clinical symptomatology was assessed in COPD patients for the diagnosis of CHF and CRF syndromes: the probability of CHF diagnosis based on clinical symptoms is 79.0% and for CRF – 88.0%. A symptom score scale and an algorithm for the diagnosis of CHF and CRF were developed.

Introduction. The COVID-19 pandemic continues with over 600 million cases and over 6 million deaths worldwide according to WHO. The state of hypercoagulation is a key feature of the course of COVID-19 which often leads to the development of serious cardiovascular events and adverse outcomes. There is a higher risk of all-cause mortality in the COVID-19 cohort with thrombotic complications, and mortality among patients with COVID-19 and PE is significantly higher than in patients with either condition alone, indicating a life-threatening additive effect of the combination of COVID-19 and PE. Thus, it is necessary to study further the features of inflammation and thrombosis parameters in patients with COVID-19 given the high prevalence of thrombotic complications among this group of patients.
Objective. To define features of inflammation and thrombosis laboratory markers in patients with COVID-19 and pulmonary embolism.
Materials and Methods. The study included n = 116 patients with COVID-19 hospitalized in 4-th city clinical hospital of Minsk named after N.E. Sauchenko in whom a thrombotic event – pulmonary embolism (PE) – was developed. The mean age of the patients was 64.7 ± 11.3 years, with 53 (45.7%) male and 63 (54.3%) female patients, respectively. The study group consisted of patients with COVID-19 and confirmed diagnosis of PE (n = 37) and the comparison group consisted of patients with COVID-19 without PE (n = 79). Patients in the groups were comparable by sex, age, presence of traditional risk factors, and COVID-19 severity. The parameters associated with thrombosis were analyzed in general blood count, hemostasiogram, biochemical blood analysis at the moment of confirmation or exclusion of PE using computer tomographic angiography of the pulmonary arteries.
Results. Intergroup comparison of laboratory parameters in the group of patients with COVID-19 and confirmed diagnosis of PE in comparison with the group of patients with COVID-19 without PE showed a significantly higher mean group leukocyte count: 10,59 (6,75–12,6)×109/L versus 7,12 (4,50–9,08)×109/L (U = 96,5; p < 0,05); significantly higher mean group level of C-reactive protein (CRP): 120.09 (45.08–164.38) mg/L versus 54.89 (31.14–96.86) mg/L (U = 101.0; p < 0.05); group mean fibrinogen and D-dimer were significantly higher: 7.03 (5.89–8.28) g/L versus 5.98 (4.25–6.80) g/L (U = 99.0; p < 0.05) and 2058.5 (826.0–4026.0) ng/mL versus 982.5 (656.5–1936.0) ng/mL (U = 141.5; p < 0.05) respectively. A higher proportion of individuals with increased prothrombin time was identified: 75.5% (n = 28) versus 32.9% (n = 26) (χ2 = 6.31; p < 0.05). In patients with COVID-19 and PE there was a direct moderate relationship between CRP and D-dimer values (ρ = 0.66; p < 0.05), a direct moderate relationship between CRP and fibrinogen values (ρ = 0.61; p < 0.05).
Conclusion. Patients with new coronavirus infection COVID-19 and PE had a marked increase of inflammatory and thrombotic markers (leukocyte count, CRP, fibrinogen, D-dimer). The relationship between the values of CRP, fibrinogen, D-dimer indicates the association of inflammation with the thrombosis markers level.

Aim. To study cost-effectiveness of different types of stents in the correction of chronic total occlusion (CTO).
Methods. The study included 119 patients after successful coronary artery CTO recanalization in 2009–2012. After 6.1±0.9 months and 12.7±1.6 months a control examination was performed (coronary angiography, intravascular ultrasound, optical coherence tomography). Negative events (in-stent restenosis and thrombosis) were analyzed. Taking into account the obtained data, direct costs were calculated including the cost of implants, and the cost of restenosis and thrombosis treatment.
Results. The highest frequency of in-stent restenosis (p < 0.05) was registered after IntrepideTM (in 57.1% cases) and Prolim® (in 47.4% cases) stent implantation while the similar events in cases of Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® stent implantation were registered in 0–11.1% of cases. There weren’t differences in the thrombosis incidence between studied types of implants (p > 0.05). Based on the data obtained, the stents were classified as devices with low rate of adverse events (Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® – LRAE group), and those with a high rate of restenosis and thrombosis (IntrepideTM and Prolim® – HRAE group).
The average cost of stents in the LRAE group was 2155.1 US dollars. Endovascular correction of in-stent restenosis were performed in 6.3% of cases, thrombosis – in 1.3%, the average direct treatment cost per patient over 12.7±1.6 months totaled 3906.4 US dollars.
In the HRAE group the cheaper devices were implanted (median cost was $1650.8). Repeated PCIs due to restenosis were performed in 52.5% of cases, one patient (2.5%) with verified thrombosis underwent CABG. The average direct treatment cost per patient over 12.7±1.6 months period was 4993.5 US dollars, which was $1,087.1 more than in the LRAE group.
Conclusion. The obtained data indicate higher financial cost during 12.7± 1.6 months follow-up period after IntrepideTM and Prolim® stent implantation in the recanalized CTO areas. This emphasizes the impotance of using coronary stents with proven minimal risks of in-trastent restenosis and thrombosis in CTO cases.

Aim. To assess the functional status, the state of ECG parameters, parameters of cardiac hemodynamics and quality of life in patients candidates for ablation of the atrioventricular node with the implantation of pacemakers, resynchronization devices (CRT) due to tachyform of atrial fibrillation.
Materials and methods: the study included 61 patients with a mean age of 59.4 ± 10.4 years, BMI 31.3 ± 5.8; test 6-min. walk 315 ± 173 m. Group 1 pacemaker – patients with implanted pacemaker 19 people, group 2 CRT – 42 people. Quality of life according to the Minnesota questionnaire in the cohort – 49 [32; 65] points (unsatisfactory), CHF FC 2 in general and FC 3 in the pacing group and FC 2 in the CRT group, but no significant differences. The mean QRS duration was 115 [90.146], ms. no significant differences between groups. Only the ratio of R6/S6 and the value of (S1+R6)-(S6+R1) were significantly different in subgroups with different QRS widths, which may be a predictor of the effectiveness of electrocardiotherapy. Ejection fraction (EF) was 32.0 ± 7.6% due to tachycardiomyopathy. Signs of interventricular and intraventricular dyssynchrony were registered.
Conclusion: patients with tachycardiomyopathy have signs of a significant decrease in the quality of life and cardiac function, however, these changes, apparently, are not due to the width of the QRS complex, the presence of dyssynchrony and the criteria for referring to CRT therapy, but primarily tachysystole and a decrease in the overall contractility of the myocardium.

Cardiac biomarkers are recommended to stratify the risk of surgery in general surgical practice, but their adoption in cardiac surgery patients is limited. The aim of our study is assessing the prognostic possibility and predictive significance of modern cardiac-specific biomarkers (NT-proBNP, sST-2, hsTn-I, Galectin-3, hsCRP and IL-6) in the determining of patient-oriented treatment strategies. In the open prospective cohort study 352 patients with moderate or severe functional ischemic mitral regurgitation (IMR) were included. The inclusion criteria in the study were the reduced myocardial contractility (LV EF < 40%) in chronic CAD patients. CABG combined with mitral valve repair was performed in 239 patients (67.9%), mitral valve replacement in 35 patients (9.9%), and isolated in 78 patients (22.2%). The primary end-point of the study was defined as a complicated postoperative period with worsening of heart failure. Complicated postoperative period has been registered in 80 patients (22.7% of cases). The complicated early postoperative period did not relate to surgical strategies (χ2 = 0.398, p = 0.528). We didn’t find any difference in the degree of left ventricle (LV) remodeling between patients with complicated or not postoperative course (mean LV EDD – 68.2 mm, LV ESD – 56.3 mm, iEDV – 118.9 ml/m2 and iESV – 81.2 ml/m2, p > 0.05). By contrast, all of the used pre-operative biomarker tests differed in the examined groups of patients (p < 0,001). The complicated postoperative course was observed in 24.6% of cases with isolated elevation of NT-proBNP > 136 pg/ml, in 44.4% of cases with isolated elevation of sST2 > 35.8 ng/ml, and 59.3% of cases in combined increase in thresholds and sST2 and NT-proBNP (χ2 = 71.67, p = 0.001). The highest quality of the model and the estimate forecast of the postoperative low-output syndrome was measured for sST2 and NT-proBNP biomarkers (AUC = 0,792, 95% CI 0,709–0,846). The inclusion of both thresholds of sST2 and NT-proBNP retained their reliable influence on the forecast, with the model showed a high level of consent (79.7% of correctly recognized cases).

Objective. To study the structural and functional state of proteins in erythrocyte membranes of AH patients with asymptomatic brain lesions (ABL) and AH patients without brain lesions who suffered from cerebrovascular accident (CVA).
Methods. The study included 47 patients diagnosed with AH. The study groups were formed based on the detected neuroimaging changes in the brain and analysis of the structural and functional state of proteins in the membranes of erythrocytes in patients with AH.
The following groups were identified:
1-рatients with AH without BL
2-patients with AH and ABL
3-patients with previous cerebrovascular accident
Results. A comparative analysis of abnormalities of structural and functional state of proteins in erythrocyte membranes in patients with AH without brain lesions, in patients with AH with asymptomatic brain lesions visualized by MRI, and patients who suffered from cerebrovascular accident showed the following:
1. In patients with AH with asymptomatic brain lesions, and in those suffered from cerebrovascular accident, the value of the maximum reaction rate (Vmax) of AChE in erythrocyte membranes was significantly reduced in comparison with the values of this parameter in patients with AH without brain lesions (Figure 1).
2. The value of Michaelis constant (MC) for AChE in isolated erythrocyte membranes of patients with AH without brain lesions and with asymptomatic brain lesions is increased compared with the group of patients with a history of cerebrovascular accident (Figure 2).
Conclusion. In patients with hypertension, the structural and functional state of proteins in erythrocyte membranes is disturbed, depending on the severity of the damage to the brain.

Cold agglutinins are IgM autoantibodies that bind to antigens on the surface of erythrocytes with higher affinity at low temperatures and lose activity when the temperature increases to 37 °C. In the population, the presence of cold agglutinins can be both asymptomatic and clinically manifested by cold agglutinin disease. If these antibodies are detected in low titers or do not cause clinical symptoms at normal body temperature, they are considered subclinical or asymptomatic. This article presents two clinical cases of detection of cold antibodies in patients directed to cardiac surgery treatment with the use of cardiopulmonary bypass. These cases are of interest due to the lack of clear indications for preoperative screening for cold antibodies. Besides, it remains unclear under what conditions and at what temperature clinically significant agglutination is achieved in cases of systemic hypothermia and with cold blood cardioplegia in case of detection of cold agglutinins. This article also discusses decision-making tactics after obtaining a positive screening result.

Age-related aspects of women’s health have been in the focus of attention of cardiologists, gynecologists, and endocrinologists for many years. The physiological features of the course of the peri- and postmenopausal periods and the possible consequences of estrogen deficiency are already well-studied. For nearly 20 years, there has been a debate about the benefit-risk ratio of menopausal hormone therapy. The evidence for its protective effect on age-related cases is overwhelming: prevention of osteoporosis development, cardiovascular diseases, cognitive decline, and improvement of the overall quality of life. The article presents current data on the association of menopausal hormone therapy with venous thromboembolic complications, depending on the type of estrogen and progestogen components, dose, regimen and methods of application. The feasibility and safety of menopausal hormone therapy in the context of the COVID-19 coronavirus pandemic is considered. The probability of increased risk of thromboembolic complications in case of COVID-19 infection during menopausal hormone therapy has not been proven in clinical practice. The data from the latest publications are presented, indicating the likely positive effect of female sex hormones on the course of SARS-CoV-2 and the recommendations of the leading international communities on menopause measurement regarding the admissibility of menopausal hormone therapy during the pandemic and limited ability to counsel patients.

Despite advances in the field of diagnosis and treatment of patients with coronary heart disease, the incidence of cardiovascular complications remains quite high. The main factor in the development of ischemic diseases of the cardiovascular system is atherosclerosis. Over the past three years, research findings have been obtained indicating that atherosclerosis is an inflammatory disease. It is widely accepted that both innate and adaptive immune responses are important for initiation and progression of atherosclerosis, which mainly consist of monocytes, macrophages, neutrophils, T lymphocytes, and B lymphocytes. Moreover, inflammatory biomarkers such as high-sensitivity C-reactive protein and interleukin-6 are known to predict future cardiovascular events, as well as conventional low-density or high-density lipoprotein cholesterol. Thus, current understanding of the inflammatory mechanisms of atherosclerosis have led us to explore novel therapeutic approaches that reducing vascular inflammation itself could lower the rates of critical cardiovascular events. In this review, we will first outline the mechanisms of atherosclerosis, especially focusing on their inflammatory aspects. Then we will introduce several critical inflammatory biomarkers that contribute to risk stratification of clinical cardiovascular events.

The creation of lipid-lowering drugs has become one of the greatest achievements of medicine over the past 100 years. Nowadays, cardiovascular diseases caused by atherosclerosis are the leading cause of death in most countries. Atherosclerosis is a complex process involving the deposition of lipids and the activation of immune and inflammatory responses that ultimately lead to cardiovascular disease as a result of arterial occlusion. Currently, the main strategy for the treatment of cardiovascular diseases caused by atherosclerosis is lipid-modifying therapy. Although clinical trials of agents that lower low-density lipoprotein cholesterol (LDL-C) (statins, ezetimibe, PCSK9 [subtilisin/kexin 9] proprotein convertase inhibitors) reliably indicate a decrease in cardiovascular events, a relatively high risk of cardiovascular events persists in a significant proportion of patients despite such treatment.

Objective. To study frequency and identify predictors of myocardial ischemia-reperfusion injury in patients with unstable angina and stenting of the coronary arteries.
Materials and Methods. The study included 61 patients with unstable angina and coronary artery stenting. Stenting was performed 3.2±1.4 days after admission to the hospital. The average number of affected vessels was 1.76±0.3 per person, the average number of implanted stents was 1.9±1.32 per person.
The risk according to the GRACE scale at the time of stenting was 100.3±8.46 points. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; platelet, plasma and vascular hemostasis were evaluated. Patients also underwent echocardiography and coronary angiography.
Results. According to MRI with gadolinium, in 31% of patients with unstable angina after coronary artery stenting, ischemia-reperfusion injury of the myocardium in the form of edema was registered. According to coronary angiography, perfusion disorders were detected in 9.4% of all patients, and 31.5% of patients with MRI picture of myocardial edema. In the group of patients with reperfusion injury, it was found that ECG criteria for ischemia-reperfusion injury were registered in 68.4% of patients, ST-segment changes during 24-hour ECG monitoring were revealed in 21% of patients. The presence of angiographic signs of atherosclerotic plaque instability was accompanied by the development of myocardial edema according to MRI (χ2 = 28.515, RR 2.7, p = 0.000, 95% CI 1.724-4.365).
The presence of myocardial edema after coronary artery stenting in patients with unstable angina may be a marker of persistent postischemic myocardial dysfunction and is associated with pathological myocardial remodeling processes.
Conclusion. The developed model for predicting ischemia-reperfusion injury included the baseline level of myeloperoxidase and ECG changes on the first day after stenting. The overall percentage of correct predictions was 83.6%.

According to the World Health Organization, every third adult on the planet suffers from varicose vein disease of the lower extremities (VVD). In the Republic of Belarus there are more than 2 million people with VVD of the superficial veins of the lower extremities, of which about 400,000 reside in Minsk. Trophic disorders are observed in 2% of the total population. According to the RELIEF study (Reflux assurance and quality of life improvement with micronized Flavonoids in chronic venous insufficiency (CVI) – a study conducted from March 1997 to December 1998 in 23 countries with more than 10,000 patients suffering from CVI), 78% patients with symptoms of CVI did not receive treatment. Nowadays, surgical treatment methods for the VVD are very diverse. Currently, in developed countries, there is a trend towards an increase in minimally invasive interventions in the treatment of VVD performed on an outpatient basis. Among the proposed types of invasive methods of treatment, endovenous laser ablation, sclerotherapy, endovenous mechanochemical and radiofrequency obliteration are most widely used.