ST2 and NT-proBNP are preferred biomarkers in clinical practice for the diagnosis, risk stratification and guided therapy of STEMI and Heart Failure (HF). Purpose of the study was to determine the dynamics of NT-proBNP and ST2 and their correlations with the development of cardiovascular (CV) complications in patients with STEMI.

Methods: In total 60 patients (50 males and 10 females, mean age 60.95±9.26 years) with STEMI were examined. Patients were divided into 2 groups: group I – 22 patients with STEMI complicated with acute HF with Killip class III-IV and rhythm disturbances; group II – 38 patients with STEMI with HF Killip I. NT-proBNP and ST2 concentration in the serum were determined twice, on admission and on the 10^th day of treatment.

Results: At admission mean levels of NT-proBNP were higher in group I patients with CV complications (612.8 [489.5; 860.4] pg/ml – group I) when compared to group II patients without severe CV complications (598.6 [326.6; 913.1] pg/ml – group II, p > 0.05). On the 10th day of treatment serum levels of NT-proBNP decreased to 340 [188; 434.5] pg/ml (group I) and 190.1 [113.3; 355.3] pg/ml (group II), respectively (p > 0.05). Mean levels ofST2 at admission were higher in patients with severe CV complications (61.1 [44.8; 133.6] ng/ml – group I) when compared to group II patients (40.8 [33.1; 64.3] ng/ml – group II, p < 0.05). On the 10th day of treatment mean level of ST2 decreased to 23.7 [18.8; 28.3] ng/ml (group I) and 24 [19.7; 28.7] ng/ml (group II), respectively (p > 0.05). Significant direct correlations of moderate strength were found between ST2 and NT-proBNP levels in group I on day 1 and on the 10th day of treatment (r = 0.32; p < 0.05 and r = 0.36; p < 0.05, respectively). Significant direct correlations of moderate and high strength were found between ST2 and NT-proBNP levels in group II on day 1 and on the 10^th day of treatment (r = 0.367; p < 0.05 and r = 0.768; p < 0.001, respectively). Increase of ST2 and NT-proBNP above its threshold values indicates a significant risk of CV complications (sensitivity – 95.5 %, specificity – 63.2 %, AUC – 0.849, p<0.05).

In conclusion, the concentration levels of ST2 and NT-proBNP at baseline allows to predict more severe course of STEMI and the risk of CV complications. Treatment with optimal medical therapy alows to decrease biomarkers of myocardial fibrosis sST2 lower than 35 ng/ml therefore downturn the posibility of adverse outcome development in STEMI patients.

Objective: Red blood cell (RBC) role is both passive action, oxygen delivery to the tissues as well as carbon dioxide to the lungs and active action involvement in the regulation of vascular tone.

The aim was to investigate pathophysiological and ultrastructural changes of RBC in heart failure (HF) patients with hypertension (HT) and long Covid.

Design and method: In total 12 patients with HF of Coronary Artery Disease origin, HT, and long Covid were examined. Mean age of patients was 62 ± 5.8 years. The control group consisted of 10 apparently healthy people. The functional state and ultrastructure of RBC were studied using electron microscopy.

Results: During ultrastructure examination, structural pathologies of RBC in HF patients with HT and long Covid were revealed. RBC anisocytosis and poikilocytosis as structural damage variations in size and shape were found respectively. Reticulocytes were found much more often in HF patients with HT and long Covid than in the control group. In healthy control group, RBC had a typical discoid shape. In the presence of long Covid, both calcification as a marker of RBC apoptosis and destruction was also detected (Fig.1). Neutrophil extracellular traps (NETs) were found in RBC surrounding (Fig.1).

Conclusions: Altered RBC function has important implications for HF patients with HT and long Covid. RBC has been shown to induce endothelial cell dysfunction and to increase cardiac injury as well as increased inflammatory processes in long Covid. The presence of HF, HT and long Covid leads to RBC calcification and activation of blood cell apoptosis. Prognostic role of RBC calcium distribution in combination with other important prognostic measures, such as biomarkers like Thrombospondin - 1, NT-proBNP and ST2 is subject of interest and requires further research.

A congenital anomaly of coronary vessels in the form of myocardial muscle bridges (MBs) is most commonly located in the left coronary artery’s system, specifically in the middle segment of the anterior interventricular branch. Typically considered a benign condition, it can be asymptomatic. However, the presence of MBs has been associated with various clinical manifestations, some of which pose threats to the life and health of patients, unresolved issues that include medical management tactics for handling such patients, specifics of assisting during complications and determining the need for intervention in asymptomatic cases. This article presents contemporary perspectives on the clinic, diagnosis, and treatment of symptomatic patients with MBs, considering concomitant myocardial ischemia. We presented a case of a 41-year-old male with the myocardial bridge in the left coronary artery characterized by a high degree of systolic compression of the vessel, widespread exercise-induced subendocardial ischemia with abdominal pain and WPW phenomenon.

Background: Data on the results and management strategies in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) in the Low and Lower-Middle Income Countries (LLMICs) are limited. This lack of understanding of the situation partially hinders the development of effective cardiogenic shock treatment programs in this part of the world.
Materials and methods: The Ukrainian Multicentre Cardiogenic Shock Registry was analyzed, covering patient data from 2021 to 2022 in 6 major Ukrainian reperfusion centres from different parts of the country. Analysis was focusing on outcomes, therapeutic modalities and mortality predictors in AMI-CS patients.
Results: We analyzed data from 221 consecutive patients with CS from 6 hospitals across Ukraine. The causes of CS were ST-elevated myocardial infarction (85.1%), non-ST-elevated myocardial infarction (5.9%), decompensated chronic heart failure (7.7%) and arrhythmia (1.3%), with a total in-hospital mortality rate for CS of 57.1%. The prevalence of CS was 6.3% of all AMI with reperfusion rate of 90.5% for AMI-CS. In 23.5% of cases, CS developed in the hospital after admission. Mechanical circulatory support (MCS) utilization was 19.9% using intra-aortic balloon pump alone. Left main stem occlusion, reperfusion deterioration, Charlson Comorbidity Index >4, and cardiac arrest were found to be independent predictors for hospital mortality in AMI-СS.
Conclusions: Despite the wide adoption of primary percutaneous coronary intervention as the main reperfusion strategy for AMI, СS remains a significant problem in LLMICs, associated with high in-hospital mortality. There is an unmet need for the development and implementation of a nationwide protocol for CS management and the creation of reference CS centers based on the country-wide reperfusion network, equipped with modern technologies for MCS.

УДК 616.127-085-2

У 2022 році кількість проведених у клініках України процедур коронарної ангіографії становила 51 084, що на 27,6 % більше, ніж у 2019 році, стентування при всіх формах ішемічної хвороби серця (планове та ургентне) - 27 513, що на 19,7 % більше, ніж у 2019 році, стентування при інфаркті міокарда з елевацією сегмента ST (STEMI) у першу добу від початку симптомів - 16847, що на 12,9 % більше, ніж у 2019 році.