[Assessment of the results of left ventricular reconstruction in combination of coronary atherosclerosis and diabetes mellitus]. / Otsenka rezul'tatov rekonstruktsii levogo zheludochka pri sochetanii koronarnogo ateroskleroza i sakharnogo diabeta.

AIM: To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart. PATIENTS AND METHODS: The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3.9 years, average number of shunts 2.9±0.6; Group II - patients without diabetes mellitus (n=52), mean age 55,3 ±7.1 years, average number of shunts - 2.7±0.3). In the preoperative period all patients were examined taking into account the functional class of angina pectoris, with the assessment of the left ventricular ejection fraction, end-diastolic index, end-systolic index, sphericity index. All patients underwent coronary artery bypass grafting and surgical restoration of the normal geometry of the left ventricle according to the Menicanty technique with the target end-systolic index of 60 ml/m2, during which 39 patients from both groups were subjected to intraoperative biopsy of the left ventricular myocardium and right atrial auricle. RESULTS: The intergroup analysis revealed no statistically significant differences in age, angina pectoris class, level of arterial pressure between the groups. Neither were there statistically significant differences in the echocardiographic parameters at the preoperative stage. In the postoperative period, we detected a significant decrease in the end-systolic and end-diastolic volumes of the left ventricle in both groups, with a statistically significant increase of the left ventricular ejection fraction observed only in non-diabetic patients. One year after the operation, such patients still continued to demonstrate more favourable parameters of the systolic and diastolic functions of the left ventricle. A detailed analysis with determining the delta of the alterations in the parameters revealed more significant positive dynamics in the postoperative period in patients with ischaemic heart disease not associated with type 2 diabetes mellitus. CONCLUSION: The obtained findings are indicative of negative dynamics of the course of chronic ischaemic heart disease aggravated by type 2 diabetes mellitus after reconstruction of the left ventricle. Macro- and microangiopathy in type 2 diabetes mellitus significantly deteriorated the myocardial trophism. Subsequent bleedings draw phagocytic cells into the myocardial stroma, thus adversely affecting the further prognosis and course of the disease, since we demonstrated that the presence of inflammatory infiltrate in the myocardial stroma is a key factor of unfavourable outcomes of surgical treatment of patients with ischaemic cardiomyopathy.

[Simultaneous magnetic resonance angiographic and tomographic assessment of atherosclerotic plaques of carotid arteries with paramagnetic contrasting by cyclomang].

The authors studied a possibility of simultaneously performing magnetic resonance (MR) angiography of carotid arteries and contrast-enhanced MR tomography of atherosclerotic plaques of carotid arteries. We examined a total of 16 patients presenting with disseminated atherosclerosis and 8 patients of the control group. Quadrature coils for examination of the head were used in order to sequentially perform MR tomography of the brain, MR angiography of carotid arteries and MR tomography of atherosclerotic plaques of carotid arteries with contrasting by 0.5M cyclomang. Angiography was carried out by means of the technique of 3D GR FFE of rapid gradient echo (TR/TE/FA/ST=10 ms/2.7 ms/20°/1.5 mm). MR tomography of the carotid arteries bifurcation was performed in the T1-weighted spin-echo mode: TR=500-900 ms, TE=10 ms, slice sickness 1-3 mm into the matrix 256x256 voxels, with the voxel size measuring 0.2x0.2x2 mm. The average time of passing of the paramagnetic through the blood vessels of the cerebral hemispheres in the control group amounted to 4.23±0.14 s for the left hemisphere and to 4.27±0.15 s for the right one. The mean time of bolus passing in patients with predominantly unilateral stenosis of the internal carotid artery amounted to 4.89±0.23 on the affected side, equalling 4.56±0.19 s on the unaffected side (p>0.05). In bilateral lesions these indices for the left and right hemispheres amounted to 4.98±0.21 s and 5.01±0.16 s (p>0.05), respectively. Contrast-enhanced MR angiography with cyclomang made it possible in all cases to visualize the localization and character of stenosis. The index of stenosis degree calculated for MR-angiogram highly significantly correlated with the indices of the ultrasonographic examination performed according to the ECST technique both for cases of unilateral (r=0.87, p<0.05) and cases of bilateral stenotic lesion (r=0.85, p<0.05). Inhomogeneous soft plaques with high content of lipids had high values of the enhancement index on contrasting--1.26±0.07, whereas hard fibrous avascular plaques--1.09±0.04 (p<0.05). The total time of the examination amounted to 41±5 min while performing time-fly MR-angiography and to 29±5 min without it. A conclusion was made that simultaneous MR angiography and contrast-enhanced (with Mn-paramagnetic) MR tomography of carotid arteries is possible and appropriate within the framework of a single study using quadratic coil for the head.