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Cardiovascular diseases continue to be the main cause of hospital mortality and lead to great disability of the working population. Numerous clinical and experimental studies have shown that inflammation is the main factor causing the growth and progression of atherosclerosis. Despite significant progress in basic therapy aimed at both preventing the development of heart failure (HF) and treating it, the prognosis in patients after their first hospitalization remains extremely unfavorable. HF is the leading cause of morbidity and mortality worldwide. Various stimuli at different stages of HF pathophysiology trigger a cascade of proinflammatory reactions with the release of interleukins, the formation of reactive oxygen species, mitochondrial DNA damage and the induction of autophagy. Based on the presented results from experimental and clinical studies, it can be expected that a better understanding of the molecular aspects in the pathophysiology of HF will open opportunities for the development of new therapeutic monoclonal antibodies.

Objective: The use of checkpoint inhibitors in cancer will continue to expand in the coming years, which is a promising area for future clinical research. However, diagnosis of immune-related side effects is challenging due to its heterogeneous clinical manifestations, which range from subclinical to fulminant manifestations with high in-hospital mortality. A potential mechanism may be proliferation and clonal expansion of antigens by T lymphocytes in tumor cells and affected self-tissues. The exact pathophysiological mechanism remains unclear and the risk profile of patients experiencing cardiotoxicity is unknown. The aim of our work is to focus on the immune side effects of immunotherapy and their mechanisms. Methods: We used PubMed (Medline) database, Google Scholar for evidence search. The search depth was up to 10 years. The search phrases used were: “immune side effects”, “cardiotoxicity of immunotherapy”, “checkpoint inhibitors”. Search result by keywords in the PubMed (Medline) database, Google Scholar found a total of 205 publications. Number publications after removing duplicates amounted to 165. After analyzing the titles and their abstracts, 40 publications met the goal, 17 publications passed the full-text screening. Thus, our review finally included 13 studies. Results: Immune checkpoint inhibitors are the most notable breakthrough in the treatment of cancer, but the wide range of adverse events associated with the immune system should not be ignored. According to the analysis of the studies cardiac adverse are reported in 13.3% of patients receiving such therapy, myocarditis – 2.1% and cardiac arrhythmias – 9%, other cardiovascular pathology is rare. The exact pathophysiological mechanism remains unclear and the risk profile of patients experiencing cardiotoxicity is unknown. Conclusion: Continued intensive efforts by the research communities and interdisciplinary collaborations in oncology and cardiology will help address these challenges and thereby allow immunotherapy to achieve its maximum potential benefit in the treatment of cancer.

Objective: Advances in cancer treatment over the past decades have improved long-term patient survival but increased the incidence of chemotherapy-associated cardiotoxicity (CAC). The study of quality of life (QoL) indicators is becoming a relevant and integral subject for the management of patients receiving high doses of antitumor therapy. In particular, CAC carries a high burden on the healthcare system and the patient's daily lifestyle due to a decrease in the body's functional capacity. Due to the increasing life expectancy of patients with cancer, the issues of maintaining a high QoL are becoming increasingly important. The purpose of the study is to conduct a comprehensive assessment of QoL in patients with breast cancer during neoadjuvant chemotherapy (NAC). Methods: The study included 72 patients with breast cancer who underwent a comprehensive assessment of the cardiovascular system at the National Medical Research Center for Cardiovascular Surgery. A.N. Bakulev" as continuous cardiac monitoring during NAC. To assess the quality of life, all patients filled out the standardized questionnaire SF-36, EQ-5D-5L, as well as indicators on the international Karnofsky and ECOG (Eastern Cooperative Oncology Group) scales. The possible relationship between various indicators of the questionnaire with internationally validated scales, as well as data from the clinical status of patients, was studied. Results: A significant deterioration in the QoL of patients receiving NAC was observed in all analyzed indicators: mental and physical health indicators, Karnofsky scores, ECOG and EQ 5D-5L sharply decreased, the prevalence of general weakness, shortness of breath and decreased exercise tolerance increased. According to scale SF-36, initially low indicators were observed in a large number of patients (80 and 82%, respectively); at the intermediate and final stages, almost all patients showed a deterioration in their condition compared to the outcome (p = 0.0002–0.0001). Predictors of a pronounced negative deviation in QoL indicators are the presence of initial reduced ECOG and Karnofsky scores, as well as the presence of an initial decrease in exercise tolerance, the presence of weakness and shortness of breath. Conclusion: During continuous cardiac monitoring, we demonstrated a deterioration in all indicators of QoL, according to questionnaires and validated international scales during NAC in patient with breast cancer. Predictors of a pronounced decrease in QoL indicators are the presence of initial reduced ECOG and Karnofsky scores, as well as the presence of an initial decrease in exercise tolerance, the presence of weakness and shortness of breath. The Karnofsky scale and ECOG can be adapted for objective assessment of QoL indicators during NAC.

Cardiooncology has been developed as a relatively new branch of medicine that focuses on the prevention and treatment of adverse cardiovascular events associated with cancer therapy. Newer, more efficient data acquisition methods, such as the use of artificial intelligence, are desirable to help assess CVR in cancer patients. By extracting hidden patterns and evidence from large volumes of medical data, artificial intelligence can create new predictors and parameters to predict risks in patients with cardio-oncological diseases.

Patients with concomitant cardiovascular diseases and traditional cardiovascular risk factors (age, male gender, arterial hypertension, diabetes mellitus and obesity) belong to a particularly vulnerable cohort characterized by progressive severe COVID-19 and high hospital mortality. Thorough screening strategies, standardized guidelines, and center-level protocols are needed to identify patients who are at greater risk of postoperative complications and mortality. Therefore, in this review, we consider the possible impact of COVID-19 on the patency of bypass vessels in the coronary arteries, mainly in relation to venous shunts. However, this hypothesis needs to be confirmed and further studied in the framework of clinical randomized trials.

Background. Recent advances in targeted chemotherapy have led to improved outcomes in patients with breast cancer (BC) and reduced overall mortality. Neoadjuvant chemotherapy (NAC) is used to reduce the degree of invasion and dissemination in the body in cancer patients. The traditional approach of assessing serial echocardiography detects significant changes in left ventricular ejection fraction (LV EF) and provides limited predictive sensitivity and specificity for continuous cardiac monitoring. Algorithms for assessing the state of the cardiovascular system, proposed in the world literature, include the assessment of LV EF, tissue Doppler sonography, and the determination of serum biomarker levels. However, the use of this approach in clinical routine practice is limited due to low cost-effectiveness and awareness of physicians. Aim. To conduct a comprehensive assessment systolic and diastolic function, deformity, myocardial tissue harmonics and levels of cardiac biomarkers as a tool for predicting and stratifying the risk of CAH. Materials and methods. The prospective study included 72 patients with a confirmed diagnosis of BC during NAC, who underwent a comprehensive assessment of the cardiovascular system at the Bakulev National Medical Research Center for Cardiovascular Surgery, as a continuous cardiac monitoring in the period from March 2021 to February 2022, the average age of all patients was 47.911.9 years, the stages of the tumor process varied between I and IV. Clinical research methods included the collection of clinical and anamnestic data and sequential analysis of echocardiographic parameters and the level of serum biomarkers. All patients underwent 2D and M-mode echocardiography, pulsed wave Doppler to determine the velocity of blood flow through the mitral valve and TD for the right and left ventricles in accordance with the recommendations of the American Society of Echocardiographers (ASE). LV systolic and diastolic function was assessed according to the ASE clinical guidelines. Peak longitudinal deformation of the LV and the left atrium in various projections was analyzed using the Qlab workstation (Philips Qlab, version 10.5, CMQ; Philips Healthcare, Bothell, Washington, USA). Serum levels of cardiac biomarkers such as brain natriuretic peptide (NT-proBNP) and ST-2 protein (growth stimulating factor) were also analyzed. Fasting blood was used to determine the level of soluble ST-2 and NT-proBNP before NAC, at the intermediate and final stages. Soluble ST-2 was measured using ELISA (R/D Systems, Minneapolis, Minnesota) and NT-proBNP using electrochemiluminescent immunoassay (Elecsys proBNP, Roche Diagnostics, Indianapolis, Ind.) according to the manufacturer's instructions. Results. In our study, we assessed early changes in the LV myocardium during NAC in patients with BC. As can be seen from the figure, the level of both markers begins to increase already during NAC with a subsequent increase after the end of therapy. Thus, NT-ProBNP increased from 74.425 pg/ml to 98.922 pg/ml at the intermediate stage and to 110.721 pg/ml at the final stage. ST-2 increased from 254.5 ng/ml to 293 ng/ml (p=0.00001) and 313 ng/ml. In some patients (24%), at the final stage of the examination, the level of NT-proBNP had pathological values and exceeded 124 pg/ml. The situation is different with LV EF which in group 1 decreases by 11%, and in group 2 by only 6%, but nevertheless significantly. Indicators of LV diastolic function suffer on the background of taking NAC, the main indicators that increased after NAC were the volumes of the left atrium in both groups, the E/A ratio and the systolic filling fraction. Early diastolic lateral wall velocity significantly decreased only in the group with an excessive increase in NT-proBNP after NAC. For other indicators, there was a trend of deterioration in diastolic function. The results of changes in the parameters of LV and left atrium myocardial deformation before and after NAC are also presented. We observe a significant deterioration in overall myocardial deformity and deformity in various positions after NAC. In the analysis of serum biomarkers, the percentage increase in NT-proBNP correlated with the deterioration of LV EF (Spearman coefficient -0.34). A deterioration in the NT-proBNP biomarker of more than 10% has a prognostic value of severe NAC cardiotoxicity with 2=7.17. With multiple regression, a model was obtained where the combination of the following indicators had statistical significance. The degree of change in the other marker ST-2 had significant correlations with the degree of change in CSR, LA volume, total longitudinal strain, strain and strain rate in 4- and 2-chamber studies, as well as LA strain rate. All 72 patients with BC initially had intact LV systolic function before NAC. During NACT, at the stage of the interim study, an increase in the CSR index was noted (p=0.02 compared with the outcome), immediately after the end of the NACT course, further progression of the CSR index was observed (p=0.006 compared with the initial value). EF at the interim study decreased by 4.5% and after the end of NAC by 8.3%. Conclusion. Based on our results, taking into account the entire patient population, NAC undoubtedly causes changes in systolic and diastolic function, a decrease in wall velocity and LV and LA myocardial deformity, and an increase in serum biomarkers. The most sensitive and specific marker of subclinical LV myocardial dysfunction is indicators of diastolic function and deformation of the LV and LA myocardium, as well as the level of serum biomarkers NT-proBNP and ST-2. The variety of clinical manifestations of cardiotoxicity, the long latency period and the progressive nature of the disease emphasize the need for early screening and long-term follow-up of patients after chemotherapy. This algorithm for comprehensive assessment of the cardiovascular system can become a more widely used non-invasive method and an effective tool in predicting a high risk of cardiotoxicity.