Цель. Оценить влияние перенесенной инфекции COVID-19 на клиническое течение хронической ишемической болезни сердца (ХИБС). Материалы и методы. Клиническое обследование, эхокардиография (ЭхоКГ), электрокардиография (ЭКГ) в 60 отведениях, компьютерная ангиография коронарных артерий (КТА КА), магнитно-резонансная томография (МРТ) сердца, коагулограмма, биохимический анализ крови, N-концевой фрагмент мозгового натрийуретического пептида (NTproBNP), тропонин I. Обследовано 135 пациентов с ХИБС, которые были разделены на 2 группы: I группа – перенесшие COVID-19 (85 человек), II группа – не переносившие COVID (50 человек). Результаты обследования сравнивались с данными этих пациентов, полученными в доковидный период. Для оценки влияния различных штаммов COVID-19 на течение ХИБС пациенты I группы были разделены на 4 подгруппы: 2020 г. – 24 человека, 2021 г. – 20 лиц, 2022 г. – 20 лиц и переболевшие повторно – 21 человек. Результаты. В постковидном периоде выявлены изменения плазменного и тромбоцитарного гемостаза, повышенные уровни маркеров воспаления, сохранявшиеся 6–12 месяцев вне зависимости от штаммов коронавирусной инфекции и кратности заболевания. Выявлено прогрессирование атеросклероза КА, ухудшение систоло-диастолической функции обоих желудочков, повышение давления в легочной артерии, увеличение размеров фиброза миокарда. Следствием этих изменений явилось прогрессирование признаков сердечной недостаточности по данным ЭхоКГ, МРТ и NT-proBNР, увеличение зон ишемии миокарда по сравнению с доковидным периодом, развитие неблагоприятных сердечно-сосудистых исходов (инфаркт миокарда, реваскуляризация миокарда, имплантация устройств). Заключение. У пациентов с ХИБС в течение 12 месяцев после COVID-19 сохраняется ухудшение функционального состояния системы кровообращения, что требует их углубленного обследования и проведения вторичной профилактики развития неблагоприятных сердечно-сосудистых исходов. Purpose. To assess the impact of past COVID-19 infection on the clinical course of chronic ischemic heart disease (CHD). Materials and methods. Clinical examination, echocardiography (EchoCG), electrocardiography (ECG) in 60 leads, computed angiography of the coronary arteries (CTA CA), magnetic resonance imaging (MRI) of the heart, coagulogram, biochemical blood test, N-terminal fragment brain natriuretic peptide (NTproBNP), troponin I. We examined 135 patients with CIHD, who were divided into 2 groups: Group I – those who had had COVID-19 (85 people), Group II – those who had not had COVID (50 people). The examination results were compared with the data of these patients in the pre- Covid period. Тo assess the effect of different strains of COVID-19 on the course of CHD, patients of group I were divided into 4 subgroups: 2020 – 24 people, 2021 – 20 people, 2022 – 20 people and those who had been ill again – 21 people. Results. In the post-Covid period, changes in plasma and platelet hemostasis, increased levels of inflammatory markers were revealed, which persisted for 6–12 months, regardless of the strains of coronavirus infection and the frequency of the disease. Progression of coronary artery atherosclerosis, deterioration of systolic-diastolic function of both ventricles, increased pressure in the pulmonary artery, the size of myocardial fibrosis, increased. The consequence of these changes was the progression of signs of heart failure according to echocardiography, MRI and NT-proBNR, an increase in areas of myocardial ischemia compared to the pre-COVID period, and the development of adverse cardiovascular outcomes (myocardial infarction, myocardial revascularization, device implantation). Conclusion. Patients with HIHD within 12 months after COVID-19 continue to deteriorate the functional state of the circulatory system, which requires in-depth examination and secondary prevention of the development of adverse cardiovascular outcomes.

Введение. В сравнении с медикаментозным лечением при имплантации кардиовертеров-дефибрилляторов (ИКД) аритмогенная смертность сокращается на 50%, а общая смертность – на 28%. При этом частота рецидивирующих аритмий и частота ИКД-терапии изучены мало. Цель. Разработка метода прогнозирования желудочковых аритмий у пациентов с ИКД по данным ЭКГ-маркеров электрической нестабильности миокарда. Материалы и методы. Обследовано 76 пациентов с ИКД, из них 71 мужчина (93,4%). Средний возраст – 61,9±12,6 года. Контрольная группа – 151 пациент с ИБС или кардиомиопатией без клинически значимых желудочковых аритмий, средний возраст – 52,4±18,3 года. Контролировали ЭКГ-12, ЭхоКГ, ХМ-ЭКГ и ЭКГ высокого разрешения. Оценивали комплекс следующих ЭКГ-маркеров электрической нестабильности миокарда: фрагментированный комплекс QRS, угол QRS-T >105°, интервал QTкорр. >450 мс, дисперсия QRS >40 мс, альтернация Т-волны >45 мкВ, дисперсия QT >70 мс, дисперсия JT >70 мс, дисперсия Tpeak-Tend >103 мс, турбулентность >0% и замедление сердечного ритма <4,5 мс. Результаты. У 26,1% пациентов с ИКД зарегистрированы пароксизмы желудочковой тахикардии, у 35,0% – превышение QTкорр. >450 мс, у 4,3% – пароксизмы фибрилляции предсердий, увеличение конечно-диастолического диаметра ЛЖ до 62,3±8,4 мм и снижение индекса локальной сократимости до 1,8±0,6 единицы. Уровень электрической нестабильности миокарда у пациентов с ИКД оказался значимо выше, чем у пациентов контрольной группы. Это зафиксировано по таким ЭКГ-маркерам, как фрагментация комплекса QRS, угол QRS-T, дисперсия QRS, дисперсия QT, альтернация T-волны и дисперсия Tp-Te (p<0,022). Разработана модель прогноза желудочковых аритмий у пациентов с ИКД, которая обладает чувствительностью 83%, специфичностью 81% и долей корректного прогноза 80,5%. Обсуждение. У пациентов после имплантации ИКД сохраняется высокая вероятность желудочковых аритмий. У 55,3% пациентов были зафиксированы эпизоды антиаритмической и/или шоковой терапии. В подгруппе с аппаратной терапией ИКД значимо чаще фиксировали электрический шторм (21,8%), сахарный диабет 2-го типа (23,6%) и увеличение конечно-диастолического диаметра левого желудочка (p<0,01). Заключение. Использование ЭКГ-маркеров электрической нестабильности миокарда повышает точность прогноза желудочковых аритмий у пациентов с ИКД. Introduction. Compared to pharmacological treatment during the implantation of cardioverter-defibrillators (ICD), arrhythmic mortality decreases by 50% and overall mortality by 28%. However, the frequency of recurrent arrhythmias and ICD therapy is poorly studied. Purpose. To elaborate a method for predicting ventricular arrhythmias in patients with ICD according to ECG markers of myocardial electrical instability. Materials and methods. A total of 76 patients with ICD were examined, 71 of whom were males (93.4%). Mean age was 61.9±12.6 years. The control group consisted of 151 patients with coronary artery disease or cardiomyopathy without clinically significant ventricular arrhythmias, mean age being 52.4±18.3 years. Electrocardiography (ECG-12), echocardiography, Holter monitoring-ECG, and high-resolution ECG were monitored. A complex of ECG markers of myocardial electrical instability was evaluated, including fragmented QRS complex, QRS-T angle >105°, QTc interval >450 ms, QRS dispersion >40 ms, T wave alternation >45 μV, QT dispersion >70 ms, JT dispersion >70 ms, Tpeak-Tend dispersion >103 ms, turbulence >0%, and heart rate deceleration <4.5 ms. Results. Ventricular tachycardia paroxysms were registered in 26.1% of patients with ICD, QTc interval >450 ms in 35.0%, and atrial fibrillation paroxysms in 4.3%. Left ventricular end-diastolic diameter increased to 62.3±8.4 mm, and local contractility index decreased to 1.8±0.6 units. The level of myocardial electrical instability in patients with ICD was significantly higher than in the control group, as indicated by ECG markers such as QRS complex fragmentation, QRS-T angle, QRS dispersion, QT dispersion, T wave alternation, and Tp-Te dispersion (p<0.022). A model for predicting ventricular arrhythmias in patients with ICD was developed having a sensitivity of 83%, specificity of 81%, and an accuracy rate of 80.5%. Discussion. The probability of ventricular arrhythmias remains high in patients with ICDs. 55.3% of patients experienced episodes of antiarrhythmic and/or shock therapy. In the subgroup with apparatus therapy, electrical storm (21.8%), type 2 diabetes mellitus (23.6%) and increased left ventricular end-diastolic diameter were significantly more frequent (p<0.01). Conclusion. The use of ECG markers of myocardial electrical instability improves the accuracy of predicting ventricular arrhythmias in patients with ICD.

Цель. Изучить особенности течения хронической ишемической болезни сердца (ХИБС) у лиц с постинфарктным кардиосклерозом после COVID-19.Материалы и методы. В исследование включено 45 пациентов с ХИБС и постинфарктным кардиосклерозом из числа лиц, находившихся под динамическим наблюдением в лаборатории ХИБС Республиканского научно-практического центра «Кардиология». Все включенные в исследование пациенты были разделены на 2 группы: I группа (31 человек) – лица, перенесшие инфекцию COVID-19, II группа (14 человек) – пациенты с ХИБС, не переносившие инфекцию COVID. I тест проводился в доковидный период, II тест – в течение 1–3 месяцев после документированного COVID-19. Комплексное обследование включало выполнение эхокардиографии (ЭхоКГ), компьютерной томографической ангиографии (КТА) коронарных артерий (КА), магнитно-резонансную томографию (МРТ) сердца, суточное мониторирование электрокардиограммы (СМЭКГ), общий и биохимический анализы крови.Результаты. Факторами, влияющими на прогрессирование ХИБС у лиц с постинфарктным кардиосклерозом после COVID-19, являлись: сохраняющиеся повышенными более одного месяца уровни С-реактивного белка (СРБ), сердечного тропонина, скорость оседания эритроцитов (СОЭ), Д-димера, что в совокупности способствовало прогрессированию атеросклероза КА. Перенесенная коронавирусная инфекция повлияла на увеличение левого желудочка и правых отделов сердца, ухудшение систоло-диастолической функции обоих желудочков, включая повышение давления в легочной артерии. Следствием этих изменений явилось прогрессирование признаков сердечной недостаточности по данным ЭхоКГ и н-концевого фрагмента натрийуретического пептида (NT-proBN), увеличение зон ишемии миокарда по сравнению с доковидным периодом и более значимая желудочковая аритмия. Purpose. To establish the factors influencing the progression of chronic coronary heart disease (CCHD) in patients with postinfarction cardiosclerosis after COVID-19 infection.Materials and methods. Included 45 patients with CCHD and postinfarction cardiosclerosis from among those who were under dynamic observation in the CCHD laboratory of the Republican Scientific and Practical Centre "Cardiology". All included in the study were divided into 2 groups: group I (31 patients) – after COVID-19, group II – patients with CCHD who did not have a COVID infection – 14. The I test was carried out in the pre-Covid period, the II test – within 1-3 months after documented COVID-19. Examination included echocardiography (EchoCG), computed tomographic angiography (CTA) of the coronary arteries (CA), magnetic resonance imaging.Results. Risk factors influenced on the progression of CCHD in patients after COVID-19 are: increased for more than 1 month levels of C-reactive protein (CRP), cardiac troponin, erythrocyte sedimentation rate (ESR), D-dimer. All mentioned factors contributed to the progression of coronary artery atherosclerosis. The coronavirus infection affected the enlargement of the left ventricle and the right parts of the heart, the deterioration of the systolic-diastolic function of both ventricles, including an increase in pressure in the pulmonary artery. The consequence of these changes was the progression of signs of heart failure according to echocardiography and the n-terminal fragment of the natriuretic peptide (NT-proBNP), an increase in the zones of myocardial ischemia compared with the pre-COVID period, and more frequent and significant ventricular arrhythmia.

An approach and hardware-software set to address parameters of electrical influence on sinocarotid reflexogenous zones have been developed. Exposure represents a flow of electrical pulses affecting transcutaneously reflexogenous zones for optimal hemodynamics, and lower blood pressure in particular.

Multifactorial prophylaxis on the individual basis was conducted for 5 years among the population of 2047 males aged 40-59 years with ischemic heart disease (IHD) or its risk factors. Compared to the comparison group of 2101 subjects, in the study group the investigators achieved a 37%; reduction in the mean population profile of myocardial infarction risk due to less prevalence of 3 main risk factor: arterial hypertension, low physical activity, smoking. Unbalance of the groups by age and education made the effect of the prevention measures on cardiovascular mortality menostrable only at statistical Kox's model.

: Multifactorial prophylaxis on the individual basis was conducted for 5 years among the population of 2047 males aged 40-59 years with ischemic heart disease (IHD) or its risk factors. Compared to the comparison group of 2101 subjects, in the study group the investigators achieved a 37% reduction in the mean population profile of myocardial infarction risk due to less prevalence of 3 main risk factor: arterial hypertension, low physical activity, smoking. Unbalance of the groups by age and education made the effect of the prevention measures on cardiovascular mortality menostrable only at statistical Cox's model.

A standard one-day diet questionnaire survey covered 1025 subjects (490 males and 535 females) aged 20-59 living in the city of Minsk. They were examined in the Research Cardiology Institute of Belarus within the scope of the program on integral prevention of chronic noninfectious disease. The results of the study showed the examinees' diet to be unbalanced with an atherogenic trend: excessive fat, saturated fatty acids, cholesterol against insufficient carbohydrates, starch, polyunsaturated fatty acids. Total energy value of the food and alcohol consumption of the studied population were lower than those of the matched population of Lithuania, Moscow and Tallin. No significant relationship was revealed between alimentary characteristics of the Minsk population and occurrence of ischemic heart disease in the examinees.

The program of coronary heart disease prevention among the population of the administrative district of Minsk was implemented over three years through the managerial, administrative and medical structures. The task team performed the organizational and methodological work and carried out the monitoring of the epidemiological situation with regard to coronary heart disease. 1537 persons underwent primary screening and 1112 were examined after three years. A statistically significant increase in the awareness of the population and doctors of the problems of a healthy lifestyle, improved indices of arterial hypertension control, a tendency toward decrease in the prevalence of arterial hypertension were recorded during the observation period. The behavioral risk factors could not be influenced.

A prospective follow-up within 7 years was performed for 4148 males aged 40-59 from an open population of Minsk who had been subjected to cardiological screening. The frequency of myocardial infarction (MI) in patients with coronary heart disease (CHD) established at screening exceeded that of CHD-free subjects 4.1 times. For separate forms of CHD a relative risk for patients with MI history, angina pectoris of effort (by Roze questionnaire) and isolated ischemic changes on ECG at rest amounted to 8.6, 4.0 and 2.3, respectively. MI was associated with blood pressure, cholesterol levels. A multivariate analysis revealed a significant independent contribution of hypertension, hypercholesterolemia, smoking and age to the risk of MI development in subjects free of CHD at screening. Concrete values of beta-coefficients of the logistic function prognosticating the risk of MI development in the population studied have been determined.

A prospective follow-up within 7 years was performed for 4148 males aged 40-59 from an open population of Minsk who had been subjected to cardiological screening. The frequency of myocardial infarction (MI) in patients with coronary heart disease (CHD) established at screening exceeded that of CHD-free subjects 4.1 times. For separate forms of CHD a relative risk for patients with MI history, angina pectoris of effort (by Roze questionnaire) and isolated ischemic changes on ECG at rest amounted to 8.6, 4.0 and 2.3, respectively. MI was associated with blood pressure, cholesterol levels. A multivariate analysis revealed a significant independent contribution of hypertension, hypercholesterolemia, smoking and age to the risk of MI development in subjects free of CHD at screening. Concrete values of beta-coefficients of the logistic function prognosticating the risk of MI development in the population studied have been determined.

Methods of multidimensional analysis were used to assay the significance of the physiological and behavioral characteristics of the population of the able-bodied men of the city of Minsk as regards the efficacy of interventions carried out. It has been shown that the population takes a more active part in the implementation of measures of conventionally medical nature. Deviations in the health status and physiological characteristics revealed by screening favour a more careful attitude to the perfformance of the recommendations made. The low social status and the presence of pronounced harmful habits are significant predictors of a negative attitude towards preventive interventions.

Methods of multidimensional analysis were used to assay the significance of the physiological and behavioral characteristics of the population of the able-bodied men of the city of Minsk as regards the efficacy of interventions carried out. It has been shown that the population takes a more active part in the implementation of measures of conventionally medical nature. Deviations in the health status and physiological characteristics revealed by screening favour a more careful attitude to the performance of the recommendations made. The low social status and the presence of pronounced harmful habits are significant predictors of a negative attitude towards preventive interventions.

The results are provided on the development and introduction of automated working places on the basis of personal computers for the prevention, follow-up and treatment of patients with arterial hypertension (AH) and ischemic heart disease (IHD) at an industrial enterprise. The process of identifying persons with AH and IHD is automatized. Automated working places on ECG processing, assessment of central and cerebral hemodynamic parameters are introduced. Information load has been developed in the form of a computer game for identifying persons with early stages of AH. A base has been created for storage of the results of regular medical check-ups. The complex has been tested during 2 years in the settings of a health unit at the Lenin tractor plant in Minsk. As a result of comprehensive measures, provisional functional diagnosis expenditures were reduced by 30-70%. Losses due to temporary disability as a result of circulatory diseases were reduced by 26%.

As a result of an epidemiological survey of able-bodied population aged 20-64, serviced by the territorial polyclinic of Minsk with the help of standard methods and standardized procedures, the data on the prevalence of some chronic non-communicable diseases and their risk factors were obtained. The high incidence of ischemic heart disease, arterial hypertension, such risk factors as hypercholesteremia, excess body weight, smoking and lack of exercise, and also their increase with age, suggested the necessity to intensify preventive activities among population. A study was made of the able-bodied population awareness regarding healthy lifestyle and also of the extent to which outpatient physicians fulfil the non-drug therapy recommendations. The data obtained were needed for planning curative and preventive activities with due regard for age-and-sex peculiarities in the distribution of characteristics studied.

Standard methods were used to study interrelations between the prevalence of coronary heart disease (CHD), its risk factors (RF), the course and the somatotype of the test subjects. The study was based on the data obtained during cardiological examination in Minsk of a representative sample of the male population (n = 3761) aged 40 to 59 years. It has been established that the prevalence of CHD, arterial hypertension (AH) and hypercholesterolemia increases consistently on passing over from asthenia to hypersthenia. Proceeding from the data of the exercise tests and analysis of the frequency of combinations of certain forms of CHD in persons belonging to different somatotypes a conclusion has been drawn that CHD runs a graver course in hypersthenic patients. It has also been shown by means of multidimensional analysis that just like RF such as AH, hypercholesterolemia and tobacco smoking, the hypersthenic build up makes a separate and significant contribution to the onset of CHD.