[Improvement of the technique of positioning the endocardial electrodes of the cardiac contractility modulation device in patients with CHF with reduced ejection fraction and atrial fibrillation].

AIM: To evaluate the efficacy and safety of the advanced technique for positioning the endocardial electrodes of a cardiac contractility modulation (CCM) device. MATERIALS AND METHODS: The CCM system was implanted in 100 patients, of which 60 CCM electrodes were positioned in the most optimal zones of myocardial perfusion, in particular, in the zone of the minor focal-scar/fibrotic lesion (the Summed Rest Score of 0 to 1-2, the intensity of the radiopharmaceutical at least 30%), and in 40 patients according to the standard procedure. Before the implantation of the CCM system, 60 patients underwent tomography (S-SPECT) of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest to determine the most optimal electrode positioning zones and 100 patients underwent transthoracic echocardiography at baseline and after 12 months to assess the effectiveness of surgical treatment. RESULTS: Improved ventricular electrode positioning technique is associated with the best reverse remodeling of the left ventricular myocardium, especially in patients with ischemic chronic heart failure, with less radiation exposure to the surgeon and the patient, and without electrode-related complications. CONCLUSION: At the preoperative stage, it is recommended to perform a synchronized single-photon emission computed tomography of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest before implantation of the CCM device to assess the presence of scar zones/myocardial fibrosis in the anterior and inferior septal regions of the interventricular septum of the left ventricle, followed by implantation of ventricular electrodes in the zone of the minor scar/fibrous lesion, which will allow to achieve optimal stimulation parameters, increase the effectiveness of CCM therapy, reduce the radiation exposure on medical personnel and the patient during surgery.

[Positron emission tomography in cardiological practice].

The utility of positron emission tomography in cardiology currently goes beyond the ischemic heart disease and covers an increasingly wider range of non-coronary pathology, which requires timely expert diagnostics, including chronic heart disease of any etiology, valvular and electrophysiology disorders, cardiooncology. Authors emphasize the importance of the development of positron emission tomography technologies in the Russian Federation. This includes the development and implementation of new radiopharmaceuticals for the diagnosis of pathological processes of the cardiovascular system, systemic and local inflammation, including atherosclerosis, impaired perfusion and myocardial metabolism, and also for solving specific diagnostic tasks in comorbid pathology.

[Difficulties in differential diagnosis of the AL- and ATTR-cardiac amyloidosis. Case report].

The article presents a clinical case describing a complex differential diagnosis of cardiac amyloidosis types and verification of the diagnosis of AL-amyloidosis.

[Myocardial scintigraphy with 99mTc-pyrophosphate in the diagnosis of cardiac amyloidosis: place in the diagnostic algorithm, features of the implementation and interpretation of the study].

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.

[Practical guidelines for the diagnosis and treatment of transthyretin amyloid cardiomyopathy (ATTR-CM or transthyretin cardiac amyloidosis)].

This paper summarizes the data from updated international protocols and guidelines for diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). The invasive and non-invasive diagnosis techniques and their combinations are briefly reviewed; the evidentiary foundations for each diagnostic option and tool are analyzed. The paper describes a customized algorithm for sequential diagnosis and differential diagnosis of patients with suspected ATTR-CM with allowance for the combination of clinical signs and diagnostic findings. Along with the awareness of primary care providers about the red flags of the disease and visualization criteria, as well as providing information to the patients about the possibility of performing therapy of ATTR amyloidosis and the risks of delayed diagnosis, the proposed algorithm enables timely patient routing and prescribing specific treatment.

[Nuclear medicine and molecular imaging in clinical practice: yesterday, today and tomorrow].

Over the past 40 years, nuclear medicine has grown to be the largest non-invasive diagnostic and therapeutic industry in the world, playing a pivotal role in various fields and disciplines of clinical practice and contributing to improved quality of life and patient prognosis. Over the first 20 years of the XXI century, the number of radionuclide procedures in the world has increased significantly, primarily due to innovations in radiopharmaceuticals, continuous improvement of the technical properties of equipment and the expansion of the boundaries of multimodal imaging. The review examines the historical and current trends in the development of nuclear medicine in the world and in Russia, including those related to radionuclide diagnostics, therapy and theranostics.

[Myocardial perfusion single-photon emission computer tomography and coronary angiography results in patients with different pretest probability of ischemic heart disease].

AIM: To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG). MATERIAL AND METHODS: The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019. RESULTS: Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (15%) in 13 patients (5.9%), as intermediate (1585%) in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (15%) in 117 patients (53.2%), including 514% in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization. CONCLUSION: PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.

[Current State and Future Technologies of Nuclear Imaging in Cardiology].

In this review, modern possibilities of nuclear imaging modalities in cardiology are considered. Perspectives of this branch of radiology are described according to the latest technological and methodological inventions and new clinical data.

[The diagnostic value of measuring the momentary blood flow reserve versus non-invasive methods to detect myocardial ischemia in assessing the functional significance of borderline coronary artery stenoses]. / Diagnosticheskaia tsennost' izmereniia momental'nogo rezerva krovotoka po sravneniiu s neinvazivnymi metodami vyiavleniia ishemii miokarda pri otsenke funktsional'noi znachimosti pogranichnykh stenozov koronarnykh arterii.

AIM: To estimate the diagnostic value of measuring the momentary blood flow reserve (MBFR) versus the surrogate non-invasive standard (SNS) for myocardial ischemia verification (MIV) (a combination of stress echocardiography and single-photon emission computed tomography). SUBJECTS AND METHODS: The investigation enrolled 50 patients with stable angina in the presence of chronic coronary heart disease (CHD) or suspected CHD, in whom coronary angiography (CA) revealed borderline coronary stenoses (50-70% lumen diameters). The examination algorithm had two options. In one option, when included in the study, patients had already CA results not older than 1 month, and MBFR was measured 4-7 days after non-invasive stress tests. In the other option, MBFR in the area of borderline coronary artery stenosis was measured simultaneously with CA; and the noninvasive stress tests were carried out in the following week. A total of 74 coronary stenoses were examined. RESULTS: SNS for MIV was positive in 14 (28%) patients. When comparing with the non-invasive methods of myocardial ischemia verification, the area under the ROC curve for MBFR was 0.961±0.019 (95% confidence interval, 0.888-0.992). The optimal cut-point was 0.92, which is corresponded by a sensitivity of 100% and a specificity of 84%. CONCLUSION: When compared with SNS for MIV, the method for measuring MBFR has a high diagnostic accuracy.

[Adenosine triphosphate stress (99m)Tc-MIBI single-photon emission computed tomography in the diagnosis Miocardial Iscemia in patients with Microvascular Angina].

PURPOSE: To assess diagnostic potential of (99m)Tc-MIBI-single-photon emission computed tomography (SPECT) with intravenous adenosine triphosphate (ATP) infusion in comparison with exercise stress (EX) SPECT in patients with microvascular angina. MATERIAL AND METHODS: Patients with angina, positive exercise test and normal coronary angiogram (n=25) were included in the study. Patients underwent a three-phase (99m)Tc-MIBI-SPECT scan: at rest, exercise stress test and pharmacological stress with ATP infusion. Perfusion was graded on scale of 0-4. RESULTS: EX- and ATP-SPECT images showed mild reversible perfusion defects in 43 and 50%, moderate - in 19 and 12.5%, severe - in 5 and 16.7% of patients, respectively. CONCLUSION: Our results demonstrate that adenosine triphosphate stress (99m)Tc-MIBI-SPECT is comparable with exercise (99m)Tc-MIBI-SPECT in detection of ischemia and may be useful tool for diagnosing microvascular angina.

[Adenosine triphosphate stress 99mTc-MIBI single-photon emission computed tomography in the diagnosis of ischemic heart disease].

This review is devoted to possibilities of single-photon emission computed tomography (SPECT) combined with pharmacological test with adenosine triphosphate (ATP) to detect myocardial ischemia in patients with ischemic heart disease (IHD). It contains consideration of contemporary problems and limitations inherent in use of pharmacological stress tests in radionuclide diagnostics; discussion of mechanisms of vasodilating effects of ATP in the context of modern concepts of purine receptors; detailed description of technique of pharmacological testing with ATP, as well as contraindications and possible side effects. Experience of foreign studies with the use of ATP stress testing for verification of presence of ischemia in patients with IHD is also presented.

[An experience of the use of a curative method of cardiac shock wave therapy in patients with ischemic heart disease].

Aim of the study was to assess effects of cardiac shock wave therapy (CSWT) in patients with coronary artery disease (CAD) with refractory stable angina pectoris. Seventeen CAD patients with refractory II-IV class angina (3 women and 14 men, mean age 67.4+/-8.6 years) received the course of 9 procedures of CSWT. All patients had I-III New York Heart Association (NYHA) class congestive heart failure. Before and after CSWT medical examination with life quality assessment by means of the Minnesota Living Questionnaire, echocardiography, veloergometry, myocardial perfusion imaging with single-photon emission computed tomography (SPECT) using 99M-Tc-methyl-iodine-benzyl-guanydin (MIBG) and Holter ECG monitoring was performed. The dynamics of pro-angiogenic factors (VEGF, HGF, FGF-) were also measured by ELISA, and of brain natriuretic peptide (Nt-proBNP) by the electrochemoluminescence method. Most patients (80%) had significant life quality (<0.01) and myocardial perfusion improvement. Episodes of angina pectoris and nitrate intake were more than twice decreased. There was a significant increase in exercise tolerance (p<0.01). Holter ECG monitoring showed decreasing of an average heart rate (p<0.02); no worsening of previous cardiac arrhythmias was observed. The significant (p<0.05) decreases in plasma Nt-proBNP and increases in VEGF concentration were revealed after CSWT. CSWT procedures were well tolerated. The results of our study confirm high effectiveness and safety of CSWT in complex treatment of patients with CAD, resistant angina pectoris, including patients after myocardial revascularization and with heart failure.

[Perspectives of molecular visualization in cardiology].

The lecture concerns prospects of molecular visualization in cardiology. The term molecular visualization, its aims and problems are characterized Methods of molecular visualization involve such non-invasive techniques as ultrasonic investigation, optic visualization, MR tomography, x-ray CT radionuclide examinations (single photon emission computed tomography and positron-emission tomography). The scope of the above methods and their limits in visualization of biomarker target molecules in different pathological processes on the molecular level, cardiovascular diseases (CVD) are outlined. The discussion covers various methodological approaches to molecular visualization of the processes associated with development and progression of atherosclerosis, visualization of atherosclerotic plaques of a high risk underlying myocardial infarction or stroke, thrombosis, inflammation, apoptosis, cardiac failure; with myocardial regeneration after myocardial infarction, angiogenesis and other conditions as well as assessment of effect of novel target approaches to CVD treatment. For each of the processes (atherosclerosis, thrombosis, angiogenesis, apoptosis, gene expression and other pathological conditions) biomarker target molecules are considered. Optimal among them are molecular targets with established biological and clinical significance, target-receptors or enzymes, contrast substances, molecular probes tropic to biomarker molecular targets having adequate affinity and pharmacodynamics which allows molecular visualization in clinical setting. The investigators are faced with many unsolved problems which can be studied with methods of molecular visualization.

[Single-photon emission computed tomography in the diagnosis of myocardial perfusion abnormalities in patients with rheumatoid arthritis: preliminary data].

Increased cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA) may be attributed to the fact that a systemic inflammation existing in this disease may trigger the development of atherosclerosis. 99mTC-MIBI (4,2-methoxyisobutyl isonitrile) is a compound that permits myocardial perfusion to be visualized and has been proposed for the evaluation of the latter in patients with RA. Analysis of the results of the studies revealed transient myocardial ischemia areas in patients who did not take methotrexate while those who used it were found to have diminished perfusion areas that were, however, clinical insignificant.

[Positron emission tomography in the diagnosis of atherosclerotic plaques in cancer patients].

AIM: To assess the capacities of radionuclide diagnosis of atherosclerotic changes in the great vessels in cancer patients. MATERIALS AND METHODS: 18F-fluorodeoxyglucose positron emission tomography (PET) was used to image unstable atherosclerotic plaques in the aorta and great vessels. Whole-body radiodiagnostic studies were retrospectively analyzed in 500 cancer patients of different ages and with different forms of neoplasms. RESULTS: Tomographic images showed atherosclerotic plaques in 21% of the patients with the verified diagnosis of coronary heart disease (CHD) and in 17% without its clinical manifestations. CONCLUSION: The study showed it possible to identify a cardiovascular risk in cancer patients.

[An experience of the use of stem cells in the treatment of patients with myocardial infarction and low ejection fraction].

We present our own experience of assessment of effect of cell therapy on functional state of the myocardium in patients with lowered contractile capacity of the left ventricular myocardium. Intracoronary administration of stem cells in acute myocardial infarction is a safe method of treatment. It does not cause additional damage of the myocardium and does not provoke appearance of malignant arrhythmia. Cell therapy does not affect global left ventricular function. Data we have obtained demonstrate tendency to improvement of myocardial contractile function in dynamics in the majority of studied patients, including patients of the comparison group. This most probably indicates that the given process has been caused by restoration of blood flow to surviving cardiomyocytes after transluminal coronary angioplasty and improvement of function. Confirmation of participation of administered cells in myocardial contraction and improvement of perfusion requires further clinical investigations.

[The role of multidetector computed tomography in detection of myocardial infarction].

UNLABELLED: The aim of the study was to assess the diagnostic value of multidetector computed tomography (MDCT) in detection of myocardial infarction (MI) in acute and chromic stages. MATERIAL AND METHODS: 49 patients with suspected MI were included in the study. In 44 patients the diagnosis of acute MI had been confirmed according to standard criteria. Contrast-enhanced MDCT of the heart and vessels was performed with 4-row MDCT scanner. RESULTS: MDCT detected areas of MI in 39 of 44 patients with proven MI. In 66,7% of cases they were transmural and in 33,3% -- subendocardial. In arterial phase the density of infarcted area was significantly lower than in normal myocardium (mean, 32,6 +/- 3,7 HU versus 101,9 +/- 3,7 HU, correspondingly, p < 0,0001). Mean values of myocardial density in the area of the MI did not change during follow-up (32,6 +/- 3,7 HU vs 41,3 +/- 4,5 HU, ns). In comparison to SPECT, sensitivity and specificity of MDCT in detection of transmural MI were 96,9% and 100%. corr. In the whole group of patients, taking results of troponin test as a gold standard, the sensitivity of MDCT in detection of Q-MI and non-Q MI were 89,1% and 93,5%, correspondingly. CONCLUSION: Cardiac MDCT can reliably detect and localize areas of acute and chronic MI. Contrary to SPECT, it also gives information about stenosis and occlusions in the coronary arteries.

[The role of noninvasive methods of investigation in diagnosis of atherosclerosis].

Visualization of the myocardium with the use of various high technologies gains more and more important significance in diseases of cardiovascular system. Large value for investigations of the heart and blood vessels have acquired methods of echocardiography, magnetic resonance tomography, spiral computed tomography, as well as large spectrum of methods of nuclear cardiology. Contemporary value of instrumental methods of investigation for diagnostics of atherosclerosis is discussed in this paper and diagnostic possibilities of various techniques for assessment of the state of myocardium, pathological changes of vascular wall and for visualization of atherosclerotic plaques (AP) are presented. Advantages and drawbacks of methods, their complex application for objective analysis of changes in AP and their clinical significance are considered. Special accent is made on early diagnosis of pathological derangements, because full value information allows making adequate decisions about subsequent curative measures. It is shown that detection and evaluation of early signs of atherosclerosis appears to be determining factor of efficacy of treatment. In patients without obvious symptoms of ischemic heart disease or at the background of postinfarction cardiosclerosis nuclear cardiology with assessment of myocardial perfusion by single photon emission computed tomography and positron emission tomography (PET) appears rather valuable for assessment of viability even when coronary arteries are unchanged. Important significance for detection of cardiosclerosis has also acquired spiral computed tomography, which allows to reveal calcium in blood vessels. The use of multislice computed tomography in perspective might partially replace coronary angiography especially for assessment of degree of stenoses and patency of grafts. On initial stages of atherosclerosis information on AP structure especially on the presence of inflammatory component is very important. Definite successes become noticeable with application of magnetic resonance tomography for detection of AP. However, probably, further perfection of equipment and methodological approaches with the use of novel contrasts is necessary. In this plane definite successes are achieved by PET and combined examinations by methods of PET/CT integrating advantages of both techniques.

[Prediction of results of antiarrhythmic drug therapy in patients with malignant ventricular tachyarrhythmias, based on the prognostic value of left ventricular contractility parameters].

In 44 patients (3 women and 41 men, mean age 54 +/- 11 years) with malignant ventricular tachyarrhythmias (MVT) we assessed dependence of results of testing of antiarrhythmic drugs and efficacy of their long term use for prevention of recurrences of MVT on topography of derangement of local left ventricular (LV) contractility. Regional LV contractility was assessed with transthoracic echocardiography and radionuclide ventriculography (RNV). Testing of antiarrhythmic drugs was performed under control of repetitive intracardiac electrophysiological studies. Duration of follow-up was 28 (13 - 61) months. According to ROC-analysis most precise markers of positive results of drug testing were values of local ejection fraction (EF) in apical LV segment (10th segment on RNV) above 55%. Signs predisposing to absence of MVT recurrences during long term use of antiarrhythmic drugs were lack of mitral regurgitation (above I degree) according to echocardiography data, values of local EF in segment of lateral LV wall (4th segment on RNV) exceeding 42%, or value of LV end diastolic volume less than 365 ml according to RNV data. Parameters of local LV contractility are most precise markers of results of the use of antiarrhythmic drugs in patients with MVT, their diagnostic value is hair than that of global LVEF. Efficacy of antiarrhythmic drugs at electrophysiologic testing and long term follow-up are associated with different parameters of local LV contractility.

[Myocardial contractility evaluation by radionuclide 4D-tomoventriculography in patients with ischemic heart disease].

AIM: To estimate the capabilities of the new technique radionuclide 4D-tomoventriculography (4D-RTVG) versus conventional methods, such as radionuclide equilibrium ventriculography (REVG), ECG-synchronized single photon emission computerized tomography (SPECT), and echocardiography (EchoCG), in the evaluation of systolic and diastolic dysfunction in patients with coronary heart disease (CHD). MATERIALS AND METHODS: The study included 29 patients (19 males and 10 females) aged 43 to 66 years who had CHD. The diagnosis of CHD was established on the basis of coronary angiographic findings when the signs of coronary atherosclerosis were found. All the patients underwent 4D-RTVG, REVG, myocardial ECG-synchronized SPECT, and Echo CG. RESULTS: There was a strong correlation of the values obtained by 4D-RTVG versus REVG and EchoCG when ejection fraction and left ventricular (LV) end-diastolic volume and the indices reflecting LV blood filling and ejection velocity were estimated. The correlation between the values provided by 4D-RTVG and myocardial ECG-synchronized SPECT females was slightly weaker. CONCLUSION: The findings suggest that 4D-RTVG is highly reliable in evaluating both LV systolic and diastolic functions. That fact the technique is easy-to-use and mini-invasive shows that it may be clinically applied.