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The aim of the work is to evaluate the efficiency of theoretical knowledge and practical skills acquisition by intern doctors using the body interact virtual patient simulator in distance (offline) and traditional (online) form of education. Materials and methods. The study involved 22 interns in the second year of study of the specialty “Internal Diseases”. 17 of them studied in offline format, 5 – in distance (online) format. The efficiency of theoretical knowledge acquisition was evaluated based on the results of the Integrated License exam “KROK 3. General Medical Training”. The efficiency of practical skills acquisition was determined by passing scenarios of providing medical care using the virtual patient simulator “Body Interact”. Results. It has been established that the effectiveness of traditional (offline) and distance (online) learning is comparable in terms of theoretical knowledge acquisition which is evidenced by the comparative results of passing the Integrated License exam “KROK 3. General Medical Training”. The results of passing the state license integrated exam “KROK 3. General medical training” and the virtual patient “Body Interact” had no correlation, which indicates the insufficient representativeness of the test assessment regarding the practical skills acquisition. Traditional (offline) learning is more effective in practical skills acquisition, which is confirmed by the better results of passing scenarios of providing medical care using the virtual patient program “Body Interact” in the group of traditional form of education compared to the group of online learning. Conclusions. Utilizing virtual patient simulation technology such as “Body Interact” in the training of intern doctors not only enhances the acquisition of theoretical educational material but also offers an opportunity to practice practical skills. This is particularly valuable in light of resource constraints resulting from COVID-19 and martial law. Implementing the “Body Interact” virtual patient technology into daily educational practices, especially in the context of distance learning, is advisable.

Aim. The paper aimed to update the study on accelerated biological aging as a complication of cancer therapy with a focus on diagnosing and prognosing the disease course. The authors independently searched scientific literature for the systematic review within databases PubMed, Scopus and Cochrane in the period from 2018 to 2024, using combinations of keywords “cancer”, “biological aging”, “replicative aging”, “antitumor therapy”, “markers of cellular senescence”, “coronary artery calcium” and selected full-text publications written in English and Ukrainian with level 1–3 evidence. People affected by cancer grow old faster. This could be related to malignant growth biology as well as to methods of anticancer therapy received. Cytostatics, targeted, hormonal and immune drugs damage not only malignant, but also benign cells, which leads to violations of replication with sustained cell cycle arrest and other phenotypic signs – macromolecular damage, metabolic changes, production of a specific senescence-associated secretome. Clinically, this is manifested by reduced work capacity, weakness, chronic organ dysfunction, cardiovascular disorders, progression of coronary atherosclerosis, hypertension, diabetes, dyslipidemia, sarcopenia, cognitive disorders, a de novo development of tumors and premature death. Biological markers of cellular senescence include the expression of lipofuscin, Ki67, p21 WAF1/Cip1 or p16 INK4a. A clinical marker of aging is the deposition of calcium salts within coronary arteries based on the Agatston score detected using multidetector computed tomography. Conclusions. A better understanding of the cancer consequences associated with accelerated biological aging might suggest new therapeutic strategies and improve the quality of life among cancer survivors. Rehabilitation measures through changes in diet, caloric restriction, aerobic exercises and pharmacological senolytic therapy should be a part of a patient’s daily routine after completion of radical cancer treatment.

The aim – to determine the diagnostic value of lung ultrasound parameters in predicting outcomes of coronavirus disease 2019 (COVID-19) in oxygen-dependent patients requiring intensive care unit treatment. Materials and methods. We examined 105 patients with COVID-19 who needed supplemental oxygen and were treated in the Department of Anesthesiology and Intensive Care. The age of patients ranged between 39 and 80 years, 63 participants were male and 42 – female. To determine the diagnostic value of lung ultrasound parameters in predicting the severe course of COVID-19 in oxygen-dependent patients, they were divided into groups: Group I – recovered patients (n = 39); Group II – patients with a fatal outcome (n = 66). In all the patients, the diagnosis of COVID-19 was confirmed by RNA-SARS-CoV-2 detection in nasopharyngeal swab specimens. The patients were examined and treated according to the Protocol of the Ministry of Health of Ukraine. The lung ultrasound protocol used in the study included 14 lung examination zones and a score of lung tissue infiltration degree from 0 to 3 points. Statistical processing of the data was performed with Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. In oxygen-dependent patients with severe COVID-19 and a fatal outcome, infiltrative changes in the lung parenchyma were more severe based on the lung ultrasound total score both at the time of admission (p < 0.01) and after 5 days of treatment (p < 0.01). The cutoff score of ≥19 at the time of hospitalization (AUC = 0.753, p < 0.01; sensitivity – 76.9 %, specificity – 68.2 %) and ≥17 after 5 days of treatment (AUC = 0.799, p < 0.01; sensitivity – 71.4 %, specificity – 92.1 %) had a prognostic value for assessing the risk of death in oxygen-dependent patients with severe COVID-19. A lung ultrasound score >19 at the time of admission increased the risk of death by 2.96 times (RR = 2.96, 95 % CI 1.43–2.87, p < 0.001). Lung ultrasound found pleural effusion only in oxygen-dependent COVID-19 patients who died. In the treatment dynamics after 5 days, the rate of pleural effusion detection in this group of patients was three times increased (from 9.1 % to 27.3 %, p < 0.01). Conclusions. The study has revealed the diagnostic value of lung ultrasound parameters in predicting outcomes of COVID-19 in oxygen-dependent patients requiring intensive care unit treatment. Cutoffs of the total score characterizing the degree of lung tissue infiltration have been determined, that allowing to assert a high probability for a lethal outcome of the disease.

Intermittent hypoxia has been studied for many years as a promising non-pharmacological method of cardiovascular disease prevention. Hypoxic effects are accompanied by structural and functional changes in the myocardium. There is a direct link between the duration of hypoxic exposures and the severity of left ventricular myocardial remodeling. A range of histochemical markers of myocardial remodeling (cardiotrophin-1, titin, collagen type 1, annexin V) characterizing parenchymal-stromal relationships in the myocardium has shown high informativeness and prognostic value. The aim of the study was to examine cardiotrophin-1, titin, collagen type 1, annexin V and the morphofunctional state of the left ventricle of the heart in experimental rats exposed to intermittent 15-day (IH15) and 60-day hypoxia (IH60). Materials and methods. Intermittent hypoxia was modeled using 30 normotensive male Wistar rats, 7–8 months old, which were randomly assigned to 3 experimental groups of 10 animals each: 1) INT – a control group – intact animals (196.3 ± 6.8 g); 2) IH15 – 15-day hypoxia (205.6 ± 4.1 g); 3) IH60 – 60-day hypoxia (201.1 ± 5.5 g). The study compared the effects of intermittent hypoxia of varying duration: 15-day and 60-day hypoxia. Experimental modeling of intermittent hypoxia of 2 terms revealed a number of differences between the effects dependent on this factor duration through functional (blood pressure measurement, echocardiography) and immunofluorescent studies. Results. Blood pressure in rats of both groups was in the normotensive range, but an increase in systolic by 10 % and diastolic by 19 % was found in IH60 group compared to IH15 group (p < 0.05). In IH15 group, there was a significant decrease in end-diastolic dimension by 20 %, end-systolic dimension by 22 %, an increase in the thickness of left ventricular posterior wall by 44 % and interventricular septum by 33 % as well as left ventricular mass by 12 %, indicating concentric remodeling of the left ventricle, the development of which was confirmed by a 76 % increase in relative wall thickness compared to that in the control group (p < 0.05). Along with these changes, a decrease in end-diastolic volume by 47 %, end-systolic volume by 48 %, stroke volume by 49 % and cardiac output by 50 % with preserved ejection fraction was revealed (p < 0.05). While the parameters of IH60 rats were characterized by an increase in the thickness of interventricular septum by 33 % and left ventricular posterior wall by 17 %, as well as left ventricle mass by 23 %, relative left ventricular wall thickness was 15 % higher than the control value (p < 0.05). At the same time, diastolic volume was 9 % decreased and systolic volume was 24 % increased (p < 0.05). Also, cardiac output was increased by 58 % compared to that in 15-day hypoxic rats with an 8 % decrease in ejection fraction (p < 0.05). The concentrations of markers in IH60 group exceeded those in IH15, namely: cardiotrophin-1 by 39 %, titin by 70 %, collagen type 1 by 60 % and annexin V by 130 % (p < 0.05). Conclusions. 15-day hypoxia forms concentric left ventricular hypertrophy according to echocardiography findings; the study of marker profile of myocardial remodeling has revealed the development of moderate hypertrophy with increased resilient-elastic properties and decreased intensity of cardiomyocyte death. Remodeling caused by 60-day hypoxia is characterized by the eccentric pattern of changes with severe hypertrophy, significant fibrosis associated with apoptosis of cardiomyocytes. Such morphofunctional state of the myocardium may indicate the initial stages of maladaptation, increasing the risk of heart failure development.

Chronic heart failure remains one of the main causes of mortality and reduced life quality both in Ukraine and around the world. More than 50 % of all patients with chronic heart failure are those with preserved left ventricular ejection fraction. In current guidelines, the criteria for evaluating heart failure with reduced left ventricular ejection fraction are described properly, but the issue of timely diagnosing chronic heart failure with preserved ejection fraction still remains unsolved. This review presents four diagnostic algorithms for this condition, which were presented by international scientific societies in recent years: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure; H2FPEF Score for Heart Failure with Preserved Ejection Fraction (Mayo, 2018); HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) (2019); Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging (2021). The main advantages, limitations and disadvantages of each one are analyzed. All steps of diagnostic evaluation are described in detail. The review is illustrated with patterns of the latest diagnostic approaches.

Calcification is one of the stages of complicated and uncomplicated atherosclerotic plaque development. Determination of calcium deposits in the composition of plaques by the method of multispiral computer tomography allows to assess the coronary atherosclerotic lesion severity. The advantages of the test include a relatively wide availability, low cost and dose of ionizing radiation, as well as no need to inject a contrast agent. Calculation of the coronary artery calcium (CAC) according to the Agatston method is the “gold standard” for quantitative assessment of the coronary atherosclerosis severity. The review highlights modern ideas about the role of the test in primary prevention in people without diagnosed cardiovascular disease. Methodological principles of determining coronary calcium are explained. The principles of test result interpretation and presentation based on the international СAC-RADS scale are described. Data from population studies on the prevalence of coronary calcification in people without cardiovascular disease in different age categories are provided. The results of the prognostic value of CAC based on the analysis of large population studies are presented. The prognostic value of a negative test (CAC = 0) for coronary calcium is discussed. Data are presented on the recommended frequency of repeated examinations in patients with CAC = 0 depending on an individual cardiovascular risk. The data of randomized clinical trials on the expediency of determining coronary calcium in certain age categories are given. The place of the test in international clinical recommendations for the primary prevention of cardiovascular diseases is analyzed. Research findings on a personalized approach to prescribing statins and aspirin based on coronary calcium test results are discussed. Data are provided on improved adherence in patients with coronary calcium screening compared with the standard approach. The limitations and shortcomings of the test are analyzed separately, among which the impossibility of controlling the effectiveness of hypolipidemic therapy with statins in dynamics can be identified. An integrated approach to the role of the coronary calcium test based on the analysis of current international clinical recommendations is provided.

The aim. To evaluate indicators of induced platelet aggregation and D-dimer level in patients with atrial fibrillation (AF) depending on the method of warfarin (WF) dosing. Materials and methods. The study involved 110 patients with AF (mean age 68.72 ± 0.79; men – 57, women – 53). Patients with AF were divided into two groups: the main group – 50 patients with AF and genotype-guided dosing method, the control group – 60 patients with AF and traditional dosing method. CYP2C9, CYP4F2, VKORC1 genetic polymorphisms were determined using multiplex real time polymerase chain reaction, D-dimer concentration – by the method of solid-phase enzyme immunoassay; ADP- and epinephrine-induced aggregation indicators – by the method of G. Born. Results. The percentage (by 24 %), time (by 3 min 6 s) and rate in 30 s (by 19.5 %/min) of ADP-induced platelet aggregation were significantly lower in patients with AF and genotype-guided WF dosing method. D-dimer concentration in patients of the main and control groups did not differ significantly. However, significantly fewer patients with elevated D-dimer values were registered in the group with genotype-guided WF dosing method compared to the group with traditional dosing method: 0 (0.00 %) vs. 7 (11.67 %) at 500 ng FEU/ml cut-off (χ2 = 4.43, P < 0.05), 1 (2.00 %) vs. 9 (15.00 %) at 390 ng FEU/ml cut-off (χ2 = 4.16, P < 0.05), 0 (0.00 %) vs. 7 (11.67 %) at age-adjusted cut-off (χ2 = 4.43, P < 0.05). Conclusions. The obtained results may indicate a potentially lower risk of thrombotic events in patients with AF and genotype-guided WF dosing method compared to the group with traditional dosing method, which confirms the benefit of the widespread use of the pharmacogenetic testing in clinical practice.

Aim. To assess the condition of renal function in hypertensive men in conditions of disorders of purine and carbohydrate metabolism Material and methods. 60 male patients (aged from 18 to 65 years) with stage I–II of arterial hypertension (AH) and purine and carbohydrate metabolism disorders were examined. In these patients, the level of uric acid (UA) in daily urine, fractional excretion of UA, creatinine in daily urine, microalbumin in urine and the cystatin C level were determined. Hemodynamics was studied by daily blood pressure monitoring. Assessment of kinetics and deformation of the myocardium in offline mode using the Xstrain software package integrated into the ultrasound device (Esaote, Italy) was made. Patients were divided into 2 clinical groups – 1 group of AH with hyperuricemia, 2 – AH without uricemia. Statistical analysis of the results was performed using the Statistica 13.0 software package (Statsoft, USA). Results. Correlation analysis in group 1 showed a positive correlation of cystatin C with the average daytime systolic blood pressure (SBP) (r = 0.408) and the variability of diastolic blood pressure (DBP) at night (r = 0.405), urinary microalbumin with the average SBP at night (r = 0.390) and average pulse blood pressure (r = 0.402), LV posterior wall thickness (r = 0.438), LV myocardial mass index (r = 0.621), end-diastolic index (EDI) (r = 0.492), end-systolic index (ESI) (r = 0.426), LV anterior-posterior size (r = 0.385). A negative correlation was established between blood serum SC and ejection fraction (EF) of the LV (r = -0.410), urinary microalbumin with cardiac index (SI) (r = -0.555) and the speed of movement of the lateral (e’ lat) part of the annulus fibrosus mitral valve (r = -0.453). Conclusions. As a result of the studies, the negative influence of hyperuricemia and hyperglycemia in patients with AH on renal function was established. These changes were evidenced by an increase in microalbuminuria level, a decrease in the fractional excretion of UA, an increasing the serum UA level, remodeling of the myocardium, and worsening of the heart systolic function, worsening of the daily blood pressure profile.

The aim. To evaluate the efficacy and safety of warfarin (WF) therapy in patients with atrial fibrillation (AF) using pharmacogenetic dosing method at an anticoagulant monitoring office according to the results of a one-year prospective follow-up. Materials and methods. The study involved 110 patients with AF (mean age 68.72 ± 0.79; men – 57, women – 53). By the method of stratified randomization, the patients with AF were divided into two groups: the main group – 50 patients with AF and genotype-guided dosing method, the control group – 60 patients with AF and clinical dosing method. The outcomes were examined after the one-year follow-up: excessive hypocoagulation episodes (INR > 4) and bleeding. CYP2C9, CYP4F2, VKORC1 gene polymorphisms were determined using multiplex real time polymerase chain reaction; INR was controlled monthly; CHA2DS2-VASC, HAS-BLED, SAMe-TT2R2 scale scores were evaluated; TTR was calculated using the Rosendaal method. Results. The distribution of CYP2C9, CYP4F2, VKORC1 genotypes in the main and control groups were in accordance with the Hardy–Weinberg equilibrium. In patients with AF and genotype-guided dosing, the frequency and risk of excessive hypocoagulation episodes (χ2 = 5.11; P < 0.05; RR = 0.50 (CI 0.27; 0.94)) and bleeding (χ2 = 9.57; P < 0.05; RR = 0.41 (CI 0.22; 0.77)) were significantly lower. However, the groups did not differ in TTR. The validity of genetic-guided dosing was confirmed by the comparability of the medians and the direct correlation between the calculated and therapeutic WF doses (r = +0.57; P < 0.05). There were no relationships between TTR, excessive hypocoagulation episodes, hemorrhagic complications and clinical and genetic factors in the main group. Conclusions. In patients with AF, the use of genotype-guided dosing method in the anticoagulant monitoring office helped to reduce the frequency and risk of excessive hypocoagulation episodes and bleeding as well as eliminate the influence of endogenous and exogenous factors in the personalized management of patients.

The aim of this work is to evaluate the complex therapeutic effect of Thiotriazolin (anticoagulant, antiplatelet, metabolitotropic, endothelioprotective activity) in patients with post-COVID syndrome in comparison with basic therapy. Materials and methods. The studies involved 30 patients aged between 30 to 60 years with post-COVID syndrome. Of these, 15 persons received basic therapy (antibiotics, anticoagulants, acetylsalicylic acid), and other 15 patients received Thiotriazolin in the form of 200 mg tablets twice a day for 30 days against the background of basic therapy. Inclusion criteria were a positive PCR test for COVID-19; if the PCR test was negative, then the patients were enrolled based on the presence of IgM COVID-19 or IgG COVID-19 (with X-ray confirmed pneumonia). The rate of lung damage is up to 45 %. The patients had the following comorbidities: diabetes mellitus in the stage of compensation, arterial hypertension, ischemic heart disease without heart failure. The results of the study were calculated using the standard statistical package Statistica for Windows 13 (StatSoft Inc., № JPZ804I382130ARCN10-J), аs well as SPSS 16.0, Microsoft Office Excel 2003. Results. The inclusion of Thiotriazolin in the complex basic therapy of post-COVID syndrome led to a significant increase in the effectiveness of basic endothelioprotective, anticoagulant and antiaggregatory therapy and contributed to the prevention of thrombus formation. The administration of Thiotriazolin led to a significant improvement in general clinical parameters in patients with post-COVID syndrome – complaints of tachycardia disappeared, blood pressure was stabilized (without additional correction with antihypertensive drugs), weakness and increased fatigue disappeared. Saturation in 14 (93.4 %) patients increased to 97–98 %. In the control group only 7 (46.7 %) of 15 patients had oxygen saturation at 97–98 % level. Conclusions. The introduction of the drug Thiotriazolin in the form of 200 mg tablets twice a day for 30 days into the complex basic therapy of post-COVID syndrome leads to a significant increase in the basic endothelioprotective, antiaggregatory and anticoagulant therapy and contributes to the prevention of thrombus formation against the background of improving the state of the myocardium and vascular endothelium.

Purpose - to evaluate the effectiveness of the combination of valsartan and hydrochlorothiazide and its effect on the structural and functional parameters of the left atrial myocardium in postmenopausal women with arterial hypertension. Materials and methods. An open prospective controlled study included 100 postmenopausal women with uncomplicated arterial hypertension. Transthoracic and speckle tracking echocardiography was performed on a Vivid E9 XDClear Console 4D Expert 100 ultrasound scanner (General Electric, USA) with ECG-synchronization. Ambulatory blood pressure monitoring was performed using the device ABPM-04 (Meditech, Hungary). After 6 months of treatment with the antihypertensive combination of valsartan and hydrochlorothiazide, all women were re-examined in full. Statistical analysis of the results was performed using the Statistica 13.0 software package. All tests were two-way, statistically significant considered differences at P < 0.05. Results. As a result of our study, office systolic and office diastolic blood pressure in postmenopausal women with arterial hypertension significantly decreased (P < 0.001) due to a 6-month treatment with valsartan and hydrochlorothiazide. The target level of blood pressure, according to office measurements, was reached by 64 % of patients. A significant decrease of the SBP time index in the daytime in 1.6 times (P = 0.012), morning rise of SBP (P = 0.021) and the average pulse blood pressure (P = 0.012) was observed. Analysis of the LA deformation dynamics under the 6-month antihypertensive therapy did not reveal significant changes in the longitudinal strain of the LA in postmenopausal women with AH, unlike left ventricular strain. Conclusions. Combined antihypertensive therapy with valsartan and hydrochlorothiazide in postmenopausal women is effective, safe and well-tolerated. The use of this therapy for 6 months does not significantly affect the size and deformation properties of the left atrium, in contrast to the positive structural and functional remodeling of the left ventricle.

Non-compaction cardiomyopathy is a rare heart disease of non-ischemic origin, which is characterized by increased myocardial trabecularity with deep intertrabecular recessions, which contributes to increased thrombogenicity, loss of myocardial contractility and heart failure manifestation. Despite of the increasing number of publications describing this pathology during last years, this form of cardiomyopathy remains underdiagnosed and little known for a wide range of physicians. The purpose of the study was to present the role of speckle tracking echocardiography and cardiac magnetic resonance tomography in the differential diagnosis of non-compaction cardiomyopathy. Results. It was described a clinical case of a 53-year old female with intact coronary arteries, who had been followed up for ten years with a diagnosis of dilated cardiomyopathy after the detection of a left bundle branch block. When performing standard echocardiography, a two-layer structure of the myocardium was found in the apical lateral segments of the left ventricle (LV) with the presence of hypertrabeculated internal layer and diffuse decrease in global LV contractility (three-dimensional ejection fraction 34 %). There was a decrease in LV global longitudinal strain up to 12 % measured by speckle-tracking echocardiography. Analysis of segmental myocardial deformation curves in conditions of left bundle branch block revealed the most prognostically unfavorable dyssynchrony pattern. Cardiac magnetic resonance imaging confirmed the presence of hypertrabecularity with compact to non-compact layer ratio of more than 1/2,5, which verified the diagnosis of non-compaction cardiomyopathy. Conclusions. The clinical manifestations of non-compaction cardiomyopathy are non-specific, therefore instrumental criteria play an important role in the diagnosis. Cardiac magnetic resonance imaging, three-dimensional and speckle-tracking echocardiography are reliable methods for diagnostics and prediction of this disease outcomes.

The inferior myocardial infarctions (MI) of left ventricle (LV) are often complicated with right ventricle (RV) involvement. The traditional echocardiographic parameters lack diagnostic accuracy in assessment of RV function. Speckle tracking echocardiography and three-dimensional echocardiography are promising diagnostic tools in quantification of RV. The purpose of the study was to present the role of speckle tracking echocardiography and three-dimensional echocardiography in patients after inferior MI with RV involvement. It was described a clinical case of a 67-year old male after recent inferior MI with RV involvement. The speckle tracking analysis and three-dimensional echocardiography was performed one and six months after coronary event. The initial study revealed decreased longitudinal strain of RV free wall segments, especially in the apical region. The RV global longitudinal strain was -8,8 % (normal range ≤ -20 %). The RV end-diastolic volume index was 100.9 ml/m2 (normal range 45 %).The analysis on the sixth month revealed improvement of RV contractility in all segments with global longitudinal strain of -14.2 %. The RV volumes decreased by 10 % and EF was raised from 31 to 33 %, reflecting positive cardiac remodeling during follow-up period. Conclusions. Speckle tracking echocardiography and three-dimensional echocardiography provide additional diagnostic information in patients after MI with RV involvement and can be used for patients’ follow-up.

Left atrium (LA) state reflects the severity of cardiovascular remodeling and indicates the degree of compensation in many cardiovascular diseases, including arterial hypertension (AH). Transthoracic echocardiography determines linear and volumetric parameters of LA, but it has limitations in early stages of AH. Speckle tracking echocardiography is a new technique which can identify early subclinical dysfunction of cardiac chambers. The purpose of the study was 1) to assess feasibility, intra- and inter-observer reproducibility of LA longitudinal strain (LS) derived by both P- and R-wave triggering method; 2) to compare LA strain values obtained by P- and R-wave synchronization in hypertensive postmenopausal women. Material and methods. The study involved 65 post-menopausal hypertensive women (mean age – 56.8 ± 8.15 years). All patients underwent a standard transthoracic and two-dimensional speckle tracking echocardiography using Vivid E9 XDClear Console 4D Expert 100 (GeneralElectric,USA). Apical four- and two-chamber views images were obtained during breath hold with ECG synchronization. All statistical analyses were performed using SPSS 20 for Windows (SPSS, Inc.,Chicago,IL). Results. Initial feasibility of echocardiographic data for performing LA strain analysis was 93.85 %. Adequate tracking quality was achieved in 96.93 % of segments by P-triggering and in 96.35 % by R -wave as initial point of analysis. The intra-class correlation (ICC) coefficient for R-triggering was 0.96 (95 % CI 0.89–0.98) for intra-observer and 0.94 (95 % CI – 0.52–0.97) for inter-observer variability. The ICC coefficients for P-triggering were higher 0.97 (95 % CI 0.92–0.99) and 0.96 (95 % CI – 0.9–0.98), respectively. The Bland-Altman statistic confirmed absence of bias in both variants of ECG-triggering. Values ofLA LS calculated by R-triggering method were significantly higher than those ones by P-triggering (P < 0.001). Conclusions. Speckle tracking echocardiography is a reliable technique, which provides quantitative assessment of LA physiology. The P-wave triggering method of LA strain analysis is more reproducible compared with R-wave triggering variant. TheLA LS values differ significantly depending on ECG-triggering type (P- or R wave), providing higher values by R-wave triggering method.

Modern biomedical research conducted in scientific laboratories is a basis not only for studying the pathogenetic mechanisms of diseases formation and progression, today they are widely used for highly informative diagnostic methods development, new medicines creation, and the study of newly developed pharmaceutical compounds influence on the organism with their potential effectiveness assessment. The article highlights new approaches and possibilities for the functional state of small laboratory animals assessing, taking into account modern international requirements for research conduction and findings interpretation.

The symptoms and syndromology of myxomas with clinical features of a rare comorbidity – lung tuberculosis and left atrial myxoma in a 69-old year woman, are described in the article. The description includes the clinical history, transesophageal echocardiography findings, pathomorphological characteristics of myxoma, also photoillustrations of tumor’s macro- and microstructures. The analysis reflects the troubles in differential diagnosis of the clinical case due to non-specific symptoms of both diseases. The discussion provides the information about the possible pathophysiological link between myxoma and tuberculosis and the role of interleukin6 inthis process.

Aim. Thromboembolic complications are the leading cause of mortality in patients with atrial fibrillation. In order to summarize and represent a modern view on the anticoagulation therapy with warfarin recent specialized literature was reviewed. It was found that warfarin therapy is characterized by some difficulties in applying that limit the frequency of its appointment in patients with atrial fibrillation. It was found that the metabolism of warfarin is influenced by many factors, among which important role is given to genetic factors. Conclusions. It is shown that the traditional empirical approach to the warfarin dosing has a number of disadvantages associated with variability in pharmacokinetics, necessity to constant monitor its anticoagulant effect and a high risk of bleeding. Personalized approach of warfarin dosing based on pharmacogenetic testing is promising.

The correction of left ventricular diastolic function abnormalities hasn’t been well investigated in arterial hypertension. The aim of the study was to determine the effects of two antihypertensive combinations (perindopril/amlodipine and losartan/amlodipine) on the state of diastolic function at rest and after exercise in patients with arterial hypertension. Results. The early diastolic transmitral flow velocity and mitral annular tissue doppler velocities increased under fixed-dose combination of perindopril and amlodipine. The combination shortened the transmitral E-wave deceleration time and isovolumetric left ventricular relaxation time. The prevalence of diastolic dysfunction decreased from 55.8% to 31% on therapy with perindopril and amlodipine (p

Purpose: to estimate diagnostic accuracy of C-terminal fragment of type I procollagen (PICP) in hypertensive males with hidden chronic heart failure (CHF). The study included 220 men with uncomplicated arterial hypertension (mean age 52 (46-58) years). The control group consisted of 40 healthy men of similar age. Ambulatory blood pressure monitoring, transthoracic echocardiography and speckle tracking echocardiography was performed to all participants. All patients underwent treadmill test with post-exercise evaluation of left ventricular (LV) filling pressure by tissue Doppler Е/е' ratio to reveal hidden CHF. The post-exercise Е/е'≥13 was considered to be pathological. PICP levels in plasma were determined by ELISA. The PICP concentration was significantly higher in men with hypertension (132,3 (81,3-216,8) ng/ml) as compared with healthy subjects (93.2 (64,7-133) ng/ml) (p=0,0068). The presence of LV hypertrophy did not affect the level of PICP (p=0,58). 16 patients presented pathological result of diastolic stress test revealing signs of hidden heart failure. PICP concentration was 2-fold higher in these individuals as compared with other patients (p=0.01). The ROC-analysis revealed, that optimal cut-off point is 170.2 ng/ml for PICP to detect hidden CHF (area under curve – 0,68±0,08; 95% confidence interval – 0,61-0,74; sensitivity – 68,7%, specificity – 69,6%). The PICP level exceeding 170,2 ng/mL testifies to hidden CHF in hypertensive males.

Aim. Early left ventricle (LV) abnormalities are hardly detectable by means of standard echocardiography in patients with hypertension (HTN) and glucose metabolism disorders. The objective of this study was to assess changes inLVfunction with speckle tracking echocardiography in hypertensive males with different types of glucose metabolism abnormalities. Methods and results. We recruited 158 hypertensive males with different glycemic status. The multidirectionalLVstrain was assessed by two-dimensional speckle tracking echocardiography. The patients with HTN and type 2 diabetes mellitus demonstrated significant reduction ofLVglobal longitudinal strain and early diastolic strain rate despite preservedLVejection fraction. Conclusion. Speckle tracking echocardiography can identify subclinical myocardial alterations in hypertensive males with glucose metabolism abnormalities.

Introduction. Chronic heart failure (CHF) is a complex clinical syndrome associated with high mortality rates. The presence of type 2 diabetes mellitus (DM) is an independent unfavourable prognostic factor in heart failure patients. Chronic heart failure and type 2 diabetes mellitus are closely inter-related conditions through different pathological mechanisms, including platelet activation. The presence of DM in CHF patients can dramatically increase platelet dysfunction. The problem is much complicated by high level of aspirin resistance in diabetic patients. The prevalence of aspirin resistance in CHF with DM has never been studied. The aim of our research was to estimate the prevalence of aspirin resistance in heart failure patients with type 2 diabetes mellitus and to clarify platelets` abnormalities according to glycemic control status. Materials and methods. The criteria for study inclusion were: a more than 1-year documented history of CHF due to coronary artery disease, sinus rhythm, type 2 diabetes mellitus, no change in medication for > 3 months, daily aspirin use 100 mg > 6 months. All patients had previous history of myocardial infarction. Exclusion criteria were: type 1 DM, patients with type 2 DM on insulin therapy and/or thiazolidinediones, major bleedings in anamnesis, chronic renal failure, chronic obstructive pulmonary disease, autoimmune diseases, significant liver failure, cancer. We studied 65 patients with heart failure and type 2 diabetes mellitus (mean age 62±8 years). The control population comprised 35 heart failure patients without diabetes mellitus (mean age 60±9 years). Platelet function was evaluated using standard light transmission aggregometry. Aspirin resistance was defined by known criteria: ≥ 70% ADP- and ≥ 40% epinephrine-induced aggregation. Measurements of CD41, CD41a, CD61 and CD62P were carried out by fluorescent microscopy study. The plasma levels of soluble P-selectin and soluble CD40L were measured by ELISA assays. Results. Age, sex, severity of CHF, left ventricular ejection fraction (LVEF), estimated glomerular filtration rate and cardiovascular treatment were comparable between three groups. Hypertension rate was slightly frequent in patients with CHF and decompensated DM. The patients with CHF and decompensated DM had higher fasting plasma glucose, HbA1cand HOMA-IR levels. The duration of the diabetes was similar. Glucose lowering treatment on admission was comparable between groups. The rate of aspirin resistance was tend to be higher in patients with CHF and DM (by ADP-induced aggregation: 23.1% in diabetic patients vs. 14.3% in non-diabetic patients, P=0.43; by epinephrine-induced aggregation: 36.9% in diabetic patients vs. 31.4% in non-diabetic patients, P=0.66), but the difference was not statistically significant. The compensation of DM didn’t influence on aspirin resistance rate also. The compensation of DM didn’t influence on aspirin resistance rate also. No significant changes in platelets’ parameters were observed between CHF patients without DM and patients with CHF and compensated DM. In contrast, the patients with CHF and decompensated DM presented higher platelet surface CD62P, CD41, CD41a and CD61 expression in comparison to CHF patients without DM. The patients with CHF and HbA1c of more than 7 % showed also higher plasma P-selectin and higher platelet surface CD41 and CD61 expression compared with CHF patients with HbA1c of less than 7 %. Plasma sP-selectin correlated positively with FPG, insulin, C-peptide and HOMA-IR. Platelet surface P-selectin correlated only with C-peptide. Both IIb and IIIa glycoprotein receptors correlated with HbA1c. Conclusions. The rate of aspirin resistance varies from 23 to 37% in patients with chronic heart failure and type 2 diabetes mellitus depending on tests used. Platelet reactivity is associated with glycemic control status in heart failure diabetic patients on long-term aspirin therapy.

Based on underwater observations the establishment of marine protected areas in the Stella Creek and Skua Creek straits were proposed. Selection of areas was carried out in accordance with the protocol NAGISA and acoustic bottom survey of the Argentine Islands water area. Descriptions of the marine protected areas were developed and their categories according to IUCN methodology were defined. Сompliance indices calculated according to the IUCN methodology assign the Stella Creek and the Skua Creek MPAs to the IUCN protected categories Ia and III, respectively. 3D models of the marine protected areas were designed.