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Acute coronary syndrome remains the leading cause of death in both patients with coronary artery disease and patients with other diseases (such as diabetes mellitus, chronic kidney disease, inflammatory diseases of various etiologies, and others). Early diagnosis of cardiomyocyte damage and necrosis opens up wide opportunities to improve the prognosis of patients with atherosclerotic lesions of the coronary arteries, and also makes it possible to discharge patients without acute cardiovascular pathology from intensive care units with a high degree of probability. The article discusses the evolution of the research and introduction into broad clinical practice of markers of myocardial damage and necrosis, which have largely improved modern clinical practice.

Rationale: The choice of strategy for myocardial protection during procedures with cardiopulmonary bypass and cardioplegic arrest in children is not regulated by clinical guidelines due to insufficient data from clinical studies. The issue of methods to assess myocardial injury remains unresolved. Aim: To assess the frequency and specifics of the development of intraoperative myocardial injury syndrome in children of the first year of life with ventricular septal defect depending on the strategy for cardioplegia. Materials and methods: In a single center, prospective, randomized controlled trial we compared two cardioplegia strategies during surgical closure of ventricular septal defect in infants aged from 1 to 12 months: del Nido blood cardioplegia (n = 102) and cold crystalloid cardioplegia with Custodiol solution (n = 102). The primary endpoint was a persistent over 10-fold increase above the upper limit of the normal in the plasma concentration of high-sensitivity troponin I at 6 hours after surgery persisting after 24 hours. The secondary combined endpoint was myocardial damage verified by persistent increase in troponin I level more than 10-fold above the upper limit of the normal, persisting at 6 and 24 hours, accompanied by new pathological Q waves, acute complete left bundle branch block, abnormalities of the end part of the ventricular complex on the electrocardiography (ST segment elevation 1 mm or ST depression of 1 mm in more than 2 adjacent leads), and a decrease in the global longitudinal strain of the left ventricle by 50% from the initial value at 6 hours after surgery. Results: In 53/204 (26%) patients, the increase in troponin I persisted at 24 hours after the surgery and was associated with electrocardiography abnormalities, changes in the parameters of left ventricle longitudinal mechanics, and in some cases required greater inotropic support. By the end of the 1st postoperative 24 hours, the longitudinal strain of the left ventricle showed more negative changes over time in the Custodiol group compared to that in the del Nido group (-10 [-14.1; -6.27] versus -14.8 [- 16.5; -10]%; p 0.0001). The same was true for the left ventricle global strain rate (-0.71 [-0.9; -0.52] s-1 in the del Nido group and -0.57 [-0.760; - 0.44] s-1 in the Custodiol group; p = 0.0049). The primary endpoint was achieved by 21 (20.6%) and 55 (53.9%) patients in the del Nido and Custodiol groups, respectively (p = 0.032). The combined endpoint in the Custodiol group was achieved by 34 (33.3%) versus 19 (18.6%) patients in the del Nido group (p = 0.049, χ2 = 3.875, DF = 1, φ = 0.191). Conclusion: Del Nido blood cardioplegia compared to cold crystalloid cardioplegia with Custodiol has advantages in terms of preventing intraoperative myocardial damage and minimizing its severity. When assessing myocardial damage, such indicators as left ventricle global longitudinal strain and left ventricle global strain rate are informative, along with an increase in the troponin I level.

Background. High levels of cardiac troponin in the blood indicates myocardial injury, including those caused by intense exercises. Recent studies have shown that an elevation in the troponin concentration in the patients can be caused by the macrotroponin circulation. There is no data in the scientific literature describing this problem in athletes.The aim. To identify the cases and possible causes of high blood levels of cardiac markers in athletes before and after endurance exercises.Materials and methods. The study was conducted on 11 male cross-country skiers aged 15–21 years. The study included two stages: the first was conducted at the end of the preparatory period (November, 2020–2021), the second – in the middle (March) of the 2020–2021 competitive period. At each stage, two blood samples were taken from a vein: the first – in the morning on an empty stomach after a day of rest, the second – 12–14 hours after a high-intensity exercise. In the blood serum, the activity of total creatine kinase (CK), weight concentration of the cardiac isoenzyme of creatine kinase (CK-MB), and concentration of high sensitive troponin I (Tn) were measured.Results. The activity of CK in athletes exceeded the upper limit threshold, and decreased from the preparatory (November) to the competitive (March) period. The concentration of CK-MB in response to exercise increased by 2 times and was not accompanied by the signs of myocardial injury. The most sensitive indicator, responsive to physical activity, was troponin I. However, the highest elevation of Tn in blood of one athlete, both before and after the exercise, was associated with the presence of macrotroponin without signs of myocardial injury.Conclusions. An increase of muscle tissue injury biomarkers in blood, including the heart muscle (CK, CK-MB, and Tn), by 2–4 times is a typical reaction for the body of a cross-country skier to an intense exercise. High levels of troponin in the blood, both before and after training or competition, may be associated with the presence of macrotroponin.

Aim. To study the perioperative dynamics of myocardial injury biomarkers high-sensitivity cardiac troponin I (hs-cTnI), ischemia-modified albumin (IMA) and soluble ST2 (sST2) when taking nicorandil in lung cancer patients with concomitant coronary heart disease (CHD) undergoing surgical lung resection.Material and methods. The study included 54 patients (11 women and 43 men) with non-small cell lung cancer and concomitant stable CHD who underwent lung resection in the volume of lobectomy or pneumonectomy. Patients were randomly assigned to the nicorandil group (oral administration 10 mg BID for 7 days before and 3 days after surgery; n=27) and the control group (n=27). In the study groups, the perioperative dynamics of hscTnI, IMA and sST2, determined in the blood before and 24 and 48h after surgery, were compared. We calculated the incidence of acute myocardial injury in the groups, which was diagnosed in cases of postoperative hs-cTnI increase of more than one 99th percentile of the upper reference limit. The associations of nicorandil intake and acute myocardial injury were evaluated.Results. The groups were comparable in gender, age, basic clinical characteristics, as well as baseline levels of myocardial injury biomarkers. After the intervention, both samples showed an increase in the hs-cTnI and sST2 levels and a decrease in IMA concentration (all p

Oxidative stress is an important mechanism of myocardial damage during ischemia/reperfusion. To investigate the possibility of restoring the redox balance using “indirect” antioxidant effects, the cardioprotective effect Keap1/Nrf2/ ARE system inducers was studied in long-term ischemia/reperfusion in vivo. Material and methods. We used the original synthetic hydrophilic monophenol sodium 3-(3’-tert-butyl-4’-hydroxyphenyl) propyl thiosulfonate (TS-13) and reference drug tert-butylhydroquinone (tBHQ). Male Wistar rats received 100 mg/kg of TS-13 solution (with drinking water) or tBHQ (intraperitoneally) daily for 7 days. Animals of the comparison groups received the corresponding solvents. Local ischemia (45 min, occlusion of the left coronary artery) and reperfusion (120 min) of the heart were simulated in vivo 1 day after last drug administration. The ECG was recorded during ischemia and reperfusion; at the end of reperfusion, the heart was removed, the zone of hypoperfusion and the zone of necrosis were detected. Changes in the expression of the mRNA of Nfe2l2, Nqo1, Hmox1, Gstp1, Rela, and Nfkb2 gene in myocardial tissue were determined by real-time TaqMan PCR. Results and discussion. Pretreatment with TS-13 and tBHQ did not influence the infarct size and the incidence of ventricular arrhythmias. Preliminary administration of tBHQ did not change the genes expression of the studied in myocardial tissue after prolonged I/R. TS-13 administration was accompanied by an increase in the content of the transcripts of the gene that encodes Nrf2 (by 7.64 times) and Nrf2-driven genes Nqo1 (by 6.46 times) and Hmox1 (by 3.63 times); the expression of the Gstp1, Rela, and Nfkb2 genes did not differ from the corresponding values of the control group; compared to animals treated with tBHQ, the expression of the Nfe2l2, Nqo1, Hmox1, Rela, and Nfkb2 genes was 16.23, 4.44, 2.68, 3.17, and 2.64 times higher, respectively. The results obtained cast doubt on the therapeutic importance of the induction of the Keap1/Nrf2/ARE system during prolonged heart ischemia/reperfusion.

This work is devoted to a literature review of published articles, where studies are focused on studying the frequency, structure of complications of cardiovascular diseases in patients with COVID-19, that occurred in vivo and post-mortem: myocarditis, myocardial damage, AMI, and other thrombotic events. Some studies also provide comparative data on COVID-19+ and COVID-19- patients, complication patterns, and mortality rates. The results of the studied materials shows that, the frequency of cardiac complications and the number of deaths are significantly more common in patients with concomitant diseases such as arterial hypertension, diabetes mellitus, obesity, CKD, arrhythmias. Patients over 60 years of age are at increased risk of a severe course of the disease, this is due to the fact that these individuals have concomitant chronic diseases that are decompensated due to an acute infectious process, reducing the adaptive capabilities of the organism, and lead to a deterioration in survival rates.

Acute coronary syndrome remains the leading cause of death in both patients with coronary artery disease and patients with other diseases (such as diabetes mellitus, chronic kidney disease, inflammatory diseases of various etiologies, and others). Early diagnosis of cardiomyocyte damage and necrosis opens up wide opportunities to improve the prognosis of patients with atherosclerotic lesions of the coronary arteries, and also makes it possible to discharge patients without acute cardiovascular pathology from intensive care units with a high degree of probability. The article discusses the evolution of the research and introduction into broad clinical practice of markers of myocardial damage and necrosis, which have largely improved modern clinical practice.

In patients with initially elevated levels of creatine phosphokinase MB (CPK-MB), its increase after percutaneous coronary intervention (PCI) may be due not only to additional injury, but also to natural release during myocardial infarction. Therefore, CPK-MB should be evaluated relative to the initial values.Aim. To compare the CPK-MB dynamics after myocardial reperfusion relative to baseline values and the upper limit of normal (ULN) for the optimal approach to determining myocardial reperfusion injury in patients with acute coronary syndrome.Material and methods. A single center observational study was conducted with the participation of 90 patients hospitalized with a diagnosis of acute coronary syndrome. Patients underwent a biochemical blood test for CPK-MB twice and its dynamics was determined relative to the initial value and ULN.Results. Between the ischemia time and CPK-MB dynamics relative to the initial values, there is a moderate negative correlation. At the same time, the ratio of CPKMB after surgery to ULN is not associated with ischemia time. Analysis of covariance showed that the CPK-MB dynamics, determined relative to the initial values, is 20% dependent on the ischemia time. Individual features of coronary system anatomy, localization of the infarct-associated artery and the subsequent reperfusion procedure together explain the CPK-MB dynamics after surgery by 27%. When the ratio of CPK-MB to ULN is included in the analysis of covariance, all the above factors lose statistical significance.Conclusion. Thus, for a more accurate assessment of myocardial reperfusion injury after PCI, not the upper limit of normal should be analyzed, but the initial values of CPK-MB. In patients with the left heart dominant, as well as in the infarction localization in the system of right or left anterior descending artery, there is a slight change in the marker. On the contrary, more pronounced dynamics is observed in patients with tortuous coronary arteries and with implantation of 2 or more stents. At the same time, the assessment of CPK-MB in relation to ULN is not associated with the ischemia time and does not depend on the clinical and angiographic characteristics and tactics of the operation.

For the diagnosis of myocardial infarction during cardiac surgery, various thresholds for high-sensitivity troponins have been proposed. However, studies show that the actual thresholds can be much higher. The factors associated with increased troponins after coronary artery bypass grafting (CABG) and the relationship of this marker with echocardiographic data remain unexplored.Aim. To determine the clinical value of high-sensitivity troponin T after CABG.Material and methods. The study included 50 patients after CABG. Before and after the operation, a blood test for high-sensitivity troponin T (Cobas E411 analyzer) and echocardiography were performed to determine the left ventricular end-systolic (ESV), end-diastolic volume (EDV) and ejection fraction.Results. Before surgery, in 21 (42%) patients, the marker was higher than the upper normal limit (UNL), by a maximum of 5,9 times. After surgery, 23 (46%) and 2 (4%) patients had more than 10-fold and 35-fold excess of UNL, respectively. When using cardiopulmonary bypass and cardioplegia in all patients, troponin T values were 10 or more times higher than ULN, which is significantly higher (p=0,003 and p=0,018, respectively) than in patients after off-pump surgery. An average positive correlation was found between the number of grafts and troponin T concentration after surgery (r=0,40; p=0,004). At the same time, the relationship with the operation duration was not significant (r=0,19; p=0,191). After the operation, there was a moderate decrease in EDV by an average of 7,4 ml (p0,05).Conclusion. High-sensitivity troponin T may vary depending on surgery tactics, as a result of which it reflects myocardial ischemic injury directly related to surgical procedures. This elevation is not clinically significant. Evaluation of high-sensitivity troponin T, without taking into account other research methods, cannot be used for a differentiated approach in determining perioperative myocardial infarction and used to make clinical decisions in patients after CABG.

In 2017, the European Society of Cardiology outlined the importance of the problem of diagnosing myocardial ischemia-reperfusion injury following coronary artery bypass grafting. Myocardial injury can be accompanied by a critical decline in the cardiac index and an increase in cardiac troponin I plasma levels. The prognostic value troponin I elevation after coronary artery bypass grafting is poorly understood. Objective: to determine the prognostic value of troponin I plasma levels in relation to a fall in the cardiac index after coronary artery bypass grafting (CABG). Task: To determine the probability the cardiac index falling below 2.2 for troponin I levels in the first hours, and on days 1, 2, 3, 4 after CABG. Materials and methods. The single-center, non-randomized prospective study, running from 2016 to 2019, included 336 patients admitted for elective surgical treatment of coronary artery disease. The CABG patients were divided into three observation groups: off-pump (n = 175), on-pump (n = 128), and pump-assisted (n = 33). Troponin I levels were measured in the first hours, and on days 1, 2, 3, 4 after surgery using the Pathfast Compact immunoassay analyzer. Cardiac index was measured by invasive method. Results. In patients with a cardiac index higher than 2.2, troponin I level did not exceed 0.5 ng/mL in the off-pump group, 6 ng/mL in the on-pump group, and 3.5 ng/mL in the pump-assisted group. Patients with cardiac index lower than 2.2 have comparable troponin I levels in all groups - 21 ng/mL. Troponin I thresholds on day 1 after surgery, which, when exceeded, was associated with the likelihood of the cardiac index falling below 2.2, was 3.78 ng/mL in the off-pump group, 9.67 ng/mL in the on-pump group and 17.06 ng/mL in the pump-assisted group. Conclusion. After off-pump CABG, clinically significant myocardial injury should be expected at lower troponin I levels (3.78 ng/mL) than after on-pump CABG (9.67 ng/mL) and pump-assisted CABG (14.7 ng/mL).

The objective: based on the published data to describe the conceptual issues of the problem of perioperative cardiac complications in non-cardiac surgery.Results: changes made to international guidelines over the past 3–4 years based on evidence-based studies and meta-analyzes have been analyzed. The article presents data on the etiopathogenesis of various postoperative cardiac complications, assessment of their risk based on the evaluation of functional activities of patients, cardiac risk indices, and modern biomarkers (B-type natriuretic peptides, cardiospecific troponins). The contemporary recommendations on adjuvant pharmacological cardioprotection and rational pharmacotherapy in the perioperative period are analyzed. The article describes specific parameters of diagnostic, treatment and prevention tactics in patients with coronary heart disease, hypertension, chronic heart failure, heart defects, and implanted electronic devices. It concludes that the implementation of the comprehensive strategy aimed at the reduction of risk of pulmonary complications should ensure the decrease in their frequency and mortality due to them.

The survey based on the last decade literature, guidelines of international and national professional communities summarizes data on myocardial injury after non-cardiac surgery (MINS). It reflects the growing interest in this interdisciplinary problem aroused by MINS widespread occurrence and its close association with after surgery mortality. Observational studies devoted to a search for risk factors and mechanisms of after surgery myocardial injury were scrutinized. The role of asymptomatic increase in cardiac troponins which is stiffly competitive in its clinical and prognostic significance with after surgery myocardial infarction was highlighted. Modern approaches to MINS diagnostics and prevention were set out. The possibilities and prospects for MINS treatment were discussed with regard for the results of the recently completed randomized controlled study MANAGE (2018). Unresolved issues and avenues of further investigations in the field were specified.

Peri-operative myocardial infarction (MI) is the most severe complication of non-cardiac surgery associated with a high post-operative mortality rate. The main risk factors responsible for the development of this complication include concurrent cardiovascular pathology, as well as intra-operative hypertension and tachycardia. Diagnosis MI in the postoperative period is complicated due to an insignificant pain syndrome because of administration of analgesics and the lack of routine monitoring of troponin levels. Maintaining a balance between myocardial oxygen delivery and consumption is a key factor in the prevention of this complication.

The level and significance of anticardiac antibodies (ACA) in patients with COVID-19 infection have not yet been studied.Aim. To assess the level of various ACA in patients with severe and moderate COVID-19 infection and to identify the correlation of antibody profile with the clinical performance and prognosis.Material and methods. The study included 86 (38 women and 48 men) patients aged 20-90 years (60,2±16,6 years) who were hospitalized for moderate and severe COVID-19 infection in April-June 2020. Nasopharyngeal swab confirmed the disease in 59,3% of patients. In addition to the standard examination, electrocardiography and chest scan, level of antinuclear antibodies (ANA), antiendothelial cell antibodies (AECA), anti-cardiomyocyte antibodies, antibodies to anti-smooth muscles (ASMA) and cardiac conduction system fibers. Echocardiography was performed in 17 patients. Mean length of stay was 14 [12; 18] days. Death was considered as the primary endpoint.Results. Prevalence of heart disease and symptoms (including hypertension and coronary artery disease) was 45,3%. The manifestations of coronavirus heart damage include arrhythmias (supraventricular premature beats, 3,6%; atrial fibrillation, 9,3%), heart failure (9,3%), low QRS voltage (11,4%), repolarization abnormalities (41,9%), pericardial effusion (30%). An increase in troponin levels was observed in low number of patients. All types of cardiovascular disease correlated with the maximum D-dimer level (AUC, 0,752, p

Cardiopulmonary bypass and cardioplegia are the most frequently used techniques in cardiac surgery. The level of cardiac mortality in the postoperative period depends on them both directly and indirectly. A review of recent data on the pathogenetic mechanisms of myocardial damage in cardioplegia and cardiopulmonary bypass, methods of its diagnosis and basic strategies of myocardial protection is provided.

Metabolic alterations involved in the hemodynamic changes and myocardial damage that reproduced in the experimental models of ischemia-reperfusion injury, pancreatic necrosis crush syndrome are reviewed. The beneficial effects of the cardioactive hypothalamic peptides that were discovered and studied in H. Buniatyan institute of Biochemistry NAS RA are analyzed. [ABSTRACT FROM AUTHOR]