Globally, stroke and malignancies represent a major public health burden. Cancer and stroke are two clinical manifestations that are related: cancer patients have twice the risk of stroke than the general population [1]. Types of cancer most commonly associated with ischemic stroke are lung cancer, pancreatic cancer, breast cancer and prostate cancer [2]. An analysis of patients with ischemic stroke and concomitant cancer who underwent inpatient treatment at the regional vascular center in Botkin Hospital. A total of 199 patients with ischemic stroke and malignancy were analyzed. 68 patients received reperfusion therapy and 131 patients did not receive reperfusion therapy. As a result of the analysis, it was concluded that reperfusion therapy is possible and necessary for patients with malignant tumors. The risk of developing extracranial hemorrhages associated with the oncological process is extremely low, and the development of intracranial hemorrhagic complications does not significantly worsen the outcome of the disease. The severity of stroke in the presence of cancer was for the most part due to the stroke itself, its size and location, and depended less on the stage of cancer.

Aim. To determine the prognostic value of NT-proBNP and ultrasound assessment of venous congestion according to the VEXUS protocol in patients hospitalized with acute decompensation of heart failure (ADHF) in the intensive care unit (ICU) in relation to adverse outcomes for HF during a year of follow-up.

Materials and methods. A prospective observational study included 150 patients hospitalized with ADHF in the ICU. All patients included in the study at admission and discharge underwent standard physical, laboratory and instrumental examinations, including NT-proBNP, lung ultrasound, assessment of venous congestion according to the VExUS protocol. The assessment of long-term clinical events was carried out by a structured telephone survey 1, 3, 6, 12 months after discharge. The total rate of total mortality and repeated hospitalizations for HF was estimated as the endpoint.

Results. During 1 year of follow–up, 58 events (38 %) were detected, 50 deaths (33 %), 8 repeated hospitalizations (5 %). Patients with events were significantly older, characterized by more pronounced laboratory and instrumental assessment of congestion, diameter of the inferior vena cava, and venous congestion. The following threshold values were identified by ROC curves for predicting outcomes (total mortality + re–hospitalization) − the degree of venous congestion according to the VExUS GRADE protocol >2 and the level of NT-proBNP>10806 pg/ml at admission, the diameter of the inferior vena cava >2.3 cm at discharge.

Conclusion: NT-proBNP>10806 pg/ml and GRADE>2 of venous congestion according to the VExUS protocol in patients admitted to the ICU with ADHF, have prognostic value in relation to the risk of adverse outcomes (total mortality and repeated hospitalizations) during a year of follow-up.

Papillary fibroelastomas represent the second most common group of heart tumors, second only to myxoma. In most patients, the disease is asymptomatic, however, in the case of clinical manifestations, the most common are: embolic syndrome with the development of acute cerebrovascular accident, myocardial infarction. Papillary fibroelastoma is a benign tumor growing from endocardial cells, affecting mainly cardiac valves. To date, echocardiography performed by transthoracic and transesophageal access remains the most accessible method for tumor imaging. The main method of treatment of papillary fibroelastoma is surgery. The prognosis is usually favorable. We present a clinical case of papillary fibroelastoma in a 58-year-old man complicated by type 2 myocardial infarction.

Introduction. Ischemic (ICMP) and dilated cardiomyopathy (DCMP) are the leading causes of chronic heart failure (CHF) with the most frequent indication for heart transplantation. The similarity of these diseases consists in the widespread and high mortality rate due to pathological remodeling of both the left and right chambers of the heart, which is accompanied by the progression of CHF, increasing the risk of sudden cardiac death.

The purpose of the study. To study the relationship of systolic function of the left ventricle (LV) with remodeling of the right heart, renal dysfunction and their relationship with cardiac arrhythmia.

Materials and methods. The study included 72 patients with CHF with reduced ejection fraction (CHFrEF), who were being treated at the N. V. Sklifosovsky Scientific Research Institute of EM in connection with worsening CHF. Group I consisted of 48 patients with DCMP; group II – 24 patients with ICMP.

Results. LV ejection fraction (LV EF) in patients of both groups was <30 %, but it was significantly lower in group I (p=0.001). The EF of the right ventricle (RV) in group I was low and amounted to 24.6 [19.5; 28.5]%. In group I, the volume of the right atrium (PP) and the size of the pancreas correlated with LV EF (r= –0.489, p=0.015 and r= –0.410, p=0.005, respectively); each subsequent increase in the volume of right atrium (RA) by 1 ml increased the likelihood of atrial fibrillation (AF) by 1.018 times (OR: 1.018, 95 % CI: 1.0042–1.033, p=0.011). The estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² increased the chances of ventricular tachycardia (VT) by 9.5 times (OR: 9.5, 95 % CI: 2.32–38.87, p=0.002). Each subsequent decrease in eGFR by 1 ml/min/1.73 m² increased the chances of developing VT by 1.03 times (OR: 0.967, 95 % CI: 0.937–0.988, p=0.036)].

Conclusions. In patients with CHFrEF, regardless of the etiology, a decrease in LV EF leads to structural and functional changes in the right parts of the heart. In individuals with DCMP, an increase in RA volume by 1 ml increases the likelihood of AF by 1.018 times; a decrease in eGFR by 1 ml/min/1.73 m² increases the chances of developing VT by 1.03 times.

Aim. The study aimed at evaluating the role of the left ventricular (LV) longitudinal strain (LS) measurement and the left ventricle myocardial work parameters in predicting coronary artery disease (CAD), and determining the indications for early invasive diagnosis and treatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Materials and methods. The study included 51 patients aged from 41 to 93 years who were admitted at the Institute clinic with a diagnosis of NSTE-ACS. Upon admission, the risk of hospital mortality was assessed using GRACE risk score; standard echocardiography (EchoCG) and speckle tracking echocardiography (ST EchoCG) were performed to assess the LV longitudinal strain and the LV myocardial work parameters, and coronary angiography (CAG) was performed within 48 hours. The comparison group consisted of 20 volunteers without CAD.

Results. According to the risk assessment with the GRACE score, the patients with low and moderate risk made 41 and 47 %, respectively. Local contractility disorders during standard EchoCG were detected in 15 patients (29 %). When analyzing regional parameters of longitudinal strain and myocardial work, the greatest prognostic value in identifying patients with hemodynamically significant changes in the coronary arteries (CAs) was demonstrated by the functional risk area (FRA) of 4 or more adjacent segments with a myocardial work index ≤1400 mmHg x% (sensitivity and specificity 84,2 and 78,1 %, AUC=0,83). In the dysfunctional segments of the risk zone in almost all patients, a paradoxical mechanism of deformation was detected in the form of post-systolic shortening with a post-systolic index (PSI) reaching a value of ≥20 % at least in one of the adjacent segments. The combination of a significant increase in PSI and the detection of FRA limited to 3 segments indicated the acuity of coronary insufficiency, hemodynamically significant stenosis (sensitivity and specificity 84 % and 79 %). When distributing patients, taking into account the data of standard EchoCG and ST EchoCG with the assessment of myocardial work, in the absence of significant disturbances in systolic function, the patients with intact main CAs or insignificant changes in the main CAs prevailed; among patients without visual impairment of contractility, the detected FRA indicated a hemodynamically significant damage of one of the main CAs; a combination of local contractility disorders and additional FRA was associated with multiple CA damage.

Conclusion. The use of ST EchoCG with the assessment of myocardial work and identification of the functional risk area in NSTE-ACS patients makes it possible to predict CAD, detect patients at risk of an unfavorable outcome regardless of the GRACE risk level, determine indications for immediate invasive diagnostics, and choose the optimal method of revascularization.

«Hemostasis disorders, thrombosis and thrombocytopenia in patients with covid-19 and pneumonia with complicated acute renal injury» Relevance. Thrombosis is one of the most dangerous complications of COVID-19 not only at the peak of the disease, but also in the long term. During the pandemic, the issues of medical prevention of thrombotic complications have been repeatedly reviewed, clarified and supplemented, but the only correct tactics for their prevention and treatment do not yet exist.

The purpose of the study. To determine the frequency and nature of the development of venous and arterial thrombosis and thrombocytopenia in severe patients with COVID-19 and pneumonia, complicated by acute renal damage, the course of the disease, including fatal ones.

Material and methods. Data on inpatient treatment and diagnosis of 216 COVID-19 patients with viral pneumonia and signs of acute renal injury (AKI) according to KDIGO 2012 criteria. Group 1. Deceased patients with severe COVID-19 and pneumonia, with unreliable signs of AKI, 75 (men 19, women 56), ratio 1:2.9. Age from 29 to 87 years. Ventilation in 56 (74.7 %) Group 2. Deceased patients with COVID-19 and pneumonia with significant signs of AKI, 77 (men 34, women 43), ratio 1:1.3. Age from 41 to 88 years. Ventilation in 53 (70.7 %) Group 3. Recovered patients with AKI or CKD, 64 (men 41, women 23, ratio 1:0.56, age from 43 to 89 years). Ventilation in 1 (1.6 %). The study of hemostasis. Activated partial thromboplastin time according to the modified method of plasma recalcification reaction according to Baluda V. P. et al. (1980). The level of fibrinogen in blood plasma by the ethanol method according to Breen F., Tullis J. (1982). The concentration of D-dimer in the blood by microlatex agglutination with photometric registration of the reaction (immunoturbidimetry).

Results. In deceased inpatient patients with Covid-19 and pneumonia, a high incidence of arterial and venous thrombosis of various localization was detected, up to 46–56 %. The thrombotic danger was largely associated with an increased level of D-dimer and the duration of its increase in the blood of patients. Thrombocytopenia was diagnosed in 47–58 % of patients and was a significant risk factor for the development of fatal outcomes. In cases of detection of thrombocytopenia in patients below 20 thousand cells in microl., its character was assessed on a 4Ts scale to identify the syndrome of heparin-associated thrombocytopenia. 92–97 % of patients were prescribed heparins, including such fractionated (low molecular weight) ones as enoxaparin, nadroparin, dalteparin and fundaparinux. Only a small proportion of cases of combination of thrombosis and thrombocytopenia (about 2.3 %) were due to the nature of drug therapy and the development of heparin-associated thrombocytopenia syndrome.

Conclusion. The data obtained indicate the high importance of thrombotic mechanisms involving D-dimer in the pathogenesis and outcomes of the disease in groups of deceased patients with covid-19, pneumonia and AKI and the predominant importance of vascular damage in the activation of the thrombotic cascade in them.