microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2025-24-2-20-26microcirculation-1418Research ArticleОБЗОРЫREVIEWSМикроваскулярные повреждения и внутримиокардиальные кровоизлияния при ишемии/реперфузии сердца. Анализ клинических и экспериментальных данныхMicrovascular Injury and Intramyocardial Hemorrhage in Cardiac Ischemia/Reperfusion. Analysis of Clinical and Experimental Datahttps://orcid.org/0000-0002-1513-8614ЗавадовскийК. В.ZavadovskyK. V.

Завадовский Константин Валерьевич – д-р мед. наук, зав. отделением рентгеновских и томографических методов диагностики

634012, г. Томск, ул. Киевская, д. 111а

Zavadovsky Konstantin V. – Dr. Sci. (Med.), Head, Department of Nuclear Medicine

111a, Kievskaya str., Tomsk, 634012

konstz@cardio-tomsk.ruhttps://orcid.org/0000-0002-4358-7329РябовВ. В.RyabovV. V.

Рябов Вячеслав Валерьевич – д-р мед. наук, профессор, зам. директора по клинической работе, зав. отделением неотложной кардиологии

634012, г. Томск, ул. Киевская, д. 111а

Ryabov Vyacheslav V. – Dr. Sci. (Med.), Professor, Deputy Director for Research and Clinical Services; Head, Department of Emergency Cardiology

111a, Kievskaya str., Tomsk, 634012

rvvt@cardio-tomsk.ruhttps://orcid.org/0000-0002-3699-4807ВышловЕ. В.VyshlovE. V.

Вышлов Евгений Викторович – д-р мед. наук, ведущий научный сотрудник отделения неотложной кардиологии

634012, г. Томск, ул. Киевская, д. 111а

Vyshlov Evgeny V. – Dr. Sci. (Med.), Leading Researcher, Department of Emergency Cardiology

111a, Kievskaya str., Tomsk, 634012

evv@cardio-tomsk.ruhttps://orcid.org/0000-0002-4502-0836СиротинаМ. А.SirotinaM. A.

Сиротина Мария Александровна – аспирант, младший научный сотрудник лаборатории экспериментальной кардиологии

634012, г. Томск, ул. Киевская, д. 111а

Sirotina Maria A. – Postgraduate Student, Junior Researcher, Laboratory of Experimental

111a, Kievskaya str., Tomsk, 634012

sirotina_maria@mail.ruhttps://orcid.org/0000-0003-1808-556XМухомедзяновА. В.MukhomedzyanovA. V.

Мухомедзянов Александр Валерьевич – канд. мед. наук, научный сотрудник лаборатории экспериментальной кардиологии

634012, г. Томск, ул. Киевская, д. 111а

Mukhomedzyanov Alexander V. – Cand. (PhD) Sc. (Med.), Researcher, Laboratory of Experimental Cardiology

111a, Kievskaya str., Tomsk, 634012

sasha_m91@mail.ruhttps://orcid.org/0000-0002-7502-7502МочулаО. В.MochulaO. V.

Мочула Ольга Витальевна – канд. мед. наук, научный сотрудник отделения рентгеновских и томографических методов диагностики

634012, г. Томск, ул. Киевская, д. 111а

Mochula Olga V. – Cand. (PhD) Sc. (Med.), Researcher, Department of Nuclear Medicine

111a, Kievskaya str., Tomsk, 634012

mochula.olga@gmail.comhttps://orcid.org/0000-0002-6418-1643КанА. С.KanA. S.

Кан Артур Семенович – аспирант, младший научный сотрудник лаборатории экспериментальной кардиологии

634012, г. Томск, ул. Киевская, д. 111а

Kan Artur S. – Postgraduate Student, Junior Researcher, Laboratory of Experimental Cardiology

111a, Kievskaya str., Tomsk, 634012

kan989817@gmail.comhttps://orcid.org/0000-0001-5261-8062ВоронковН. С.VoronkovN. S.

Воронков Никита Сергеевич – канд. биол. наук, научный сотрудник лаборатории экспериментальной кардиологии

634012, г. Томск, ул. Киевская, д. 111а

Voronkov Nikita S. – Cand. (PhD) Sc. (Biology), Researcher, Laboratory of Experimental Cardiology

111a, Kievskaya str., Tomsk, 634012

niks.voronkov@gmail.comhttps://orcid.org/0000-0003-0883-466XМочулаА. В.MochulaA. V.

Мочула Андрей Викторович – канд. мед. наук, старший научный сотрудник отделения рентгеновских и томографических методов диагностики

634012, г. Томск, ул. Киевская, д. 111а

Mochula Andrey V. – Cand. (PhD) Sc. (Med.), Senior Researcher, Department of Nuclear Medicine

111a, Kievskaya str., Tomsk, 634012

mochula.andrew@gmail.comhttps://orcid.org/0000-0002-4871-3283МаксимоваА. С.MaksimovaA. S.

Максимова Александра Сергеевна – канд. мед. наук, младший научный сотрудник отделения рентгеновских и томографических методов диагностики

634012, г. Томск, ул. Киевская, д. 111а

Maksimova Alexandra S. – Cand. (PhD) Sc. (Med.), Junior Researcher, Department of Nuclear Medicine

111a, Kievskaya str., Tomsk, 634012

asmaximova@yandex.ruhttps://orcid.org/0000-0002-6020-1598МасловЛ. Н.MaslovL. N.

Маслов Леонид Николаевич – д-р мед. наук, профессор, зав. лабораторией экспериментальной кардиологии

634012, г. Томск, ул. Киевская, д. 111а

Maslov Leonid N. – Dr. (PhD) Sci. (Med.), Professor, Head, Laboratory of Experimental Cardiology

111a, Kievskaya str., Tomsk, 634012

maslov@cardio-tomsk.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation2025090720252422026Copyright © Завадовский К.В., Рябов В.В., Вышлов Е.В., Сиротина М.А., Мухомедзянов А.В., Мочула О.В., Кан А.С., Воронков Н.С., Мочула А.В., Максимова А.С., Маслов Л.Н., 20252025Завадовский К.В., Рябов В.В., Вышлов Е.В., Сиротина М.А., Мухомедзянов А.В., Мочула О.В., Кан А.С., Воронков Н.С., Мочула А.В., Максимова А.С., Маслов Л.Н.Zavadovsky K.V., Ryabov V.V., Vyshlov E.V., Sirotina M.A., Mukhomedzyanov A.V., Mochula O.V., Kan A.S., Voronkov N.S., Mochula A.V., Maksimova A.S., Maslov L.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1418

Острый инфаркт миокарда (ОИМ) до сих пор остается одной из основных причин смертности трудоспособного населения. В его развитии существенную роль играют такие патофизиологические изменения как микроваскулярная обструкция (МВО), микроваскулярное повреждение сердца (МПС) и внутримиокардиальные кровоизлияния (ВМК). ВМК ассоциированы с увеличением размера инфаркта и сократительной дисфункцией. ВМК предшествуют возникновению неблагоприятного ремоделирования сердца и сопровождаются воспалением. Экспериментальные исследования показывают, что ВМК происходят после реканализации инфаркт-связанной коронарной артерии, и их размер зависит от продолжительности ишемии. ВМК сопровождаются сократительной дисфункцией и неблагоприятным ремоделированием сердца. Наиболее вероятной причиной ВМК является МПС. МПС сопровождается увеличением уровня провоспалительных цитокинов в миокарде и плазме крови, а также снижением содержания белков плотных контактов в эндотелиальных клетках коронарных сосудов. Однако нет убедительных доказательств того, что провоспалительные цитокины вызывают МПС. Увеличение уровня провоспалительных цитокинов и МПС может быть двумя независимыми процессами. В этом обзоре мы анализируем клинико-экспериментальные данные о внутримиокардиальных кровоизлияниях и микрокроваскулярных повреждениях сердца при ишемии/реперфузии сердца.

Acute myocardial infarction (AMI) is one of the main reasons of death and disability worldwide. The pathophysiological changes such as microvascular obstruction (MVO), cardiac microvascular injury (CMI), and intramyocardial haemorrhage (IMH) play an essential role in its development. IMH is associated with larger infarct size and contractile dysfunction. IMH precedes the occurrence of adverse remodeling. IMH is accompanied by inflammation. Experimental studies demonstrate that the appearance of IMH occurs after recanalization of the infarct-related artery and its size depends on the duration of ischemia. IMH is accompanied by contractile dysfunction and adverse remodeling of the heart. The most likely cause of IMH is CMI. CMI is accompanied by an increase in the myocardial and plasma proinflammatory cytokine levels and also the downregulation of tight junction proteins in cardiac vascular endothelial cells. However, there is no convincing evidence that proinflammatory cytokines trigger CMI. An increase in the proinflammatory cytokine and CMI can be two independent processes. In this review, we analyse clinical and experimental data on intramyocardial haemorrhage and cardiac microvascular injury during cardiac ischaemia/reperfusion.

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The authors declare that there are no conflicts of interest present.