[Prognostic significance of equivalent density of calcium deposits of coronary arteries in men with osteopenic syndrome and prior coronary artery bypass grafting: prospective study].

AIM: Determination of the clinical and prognostic value of the equivalent density of calcium deposits (EDCD) of coronary arteries in patients with stable coronary heart disease (CHD) and concomitant osteopenic syndrome (OS) after coronary artery bypass grafting (CABG), based on five-year follow-up. MATERIALS AND METHODS: A prospective study included 393 patients with stable CHD hospitalized for CABG. All patients underwent multispiral computed tomography of coronary arteries to assess the degree of calcification and EDCD, and Х-ray absorptiometry. During the five-year observation we studied mortality and adverse cardiovascular events. The average duration of the observation period was 58.91.8 months. RESULTS: Data were obtained on the correlation of EDCD with the presence of OS (r=0.19; p0.001), a decrease in the T-criterion of the thigh (r=-0.21; p0.001) and lumbar vertebrae (r=-0.19; p0.001). With a decrease in the EDCD of coronary arteries below the level of 0.19 mg/mm3, an increased mortality risk is noted (odds ratio 2.84, 95% confidence interval 1.545.25). Linear regression analysis revealed that predictors of adverse outcomes over the course of a follow-up were the presence of carotid artery stenosis 30%, low left ventricular contractility, elevated triglyceride levels, and low EDCD. CONCLUSION: According to the results of the study the negative prognostic significance of the low EDCD of coronary arteries in relation to mortality, myocardial infarction, and revascularization in patients after CABG, regardless of the presence of concomitant OS.

[Relationship of visceral obesity and coronary calcinosis in ischemic heart disease].

AIM: To assess the relationship between the prevalence of visceral obesity (VO) and the severity of coronary calcification (CC) in patients with verified coronary artery disease (CAD). MATERIALS AND METHODS: 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0. RESULTS: VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve AUC 0.72, 95% CI 0.560.89), in contrast to body mass index BMI (AUC 0.56, 95% CI 0.310.82). CONCLUSION: The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.

[Endovascular repair of a descending thoracic aortic aneurysm: one-year follow-up results]. / Protezirovanie niskhodiashchego otdela grudnoi aorty: rezul'taty godovogo nabliudeniia.

The article deals with the results of successful surgical management of a male patient with a ruptured thoracic aortic aneurysm, posing particular problems as to deciding upon the scope and stages of surgical reconstruction, accompanied by describing the dynamics of clinical and diagnostic parameters, as well as the main events of the postoperative period. This clinical case report was characterized by additional difficulties due to the occurrence of subtotal haemothorax. Also presented herein is a set of comprehensive measures making it possible to successfully complete open reconstruction of the thoracic portion of the aorta and to achieve a satisfactory outcome both during the in-hospital period and within one-year follow up. Besides, elucidated is the state-of-the-art of this problem in the world literature.

Difficulties of Diagnostics of Obstructive Coronary Artery Lesions in Patients with Stable Ischemic Heart Disease and Possibilities of Single-Photon Emission Computed Tomography.

PURPOSE: to assess diagnostic capabilities of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery (CA) lesions, depending on the meeting appropriate use criteria. MATERIALS AND METHODS: We used in this retrospective analysis data from 107 patients with previously diagnosed ischemic heart disease (IHD) or in need to exclude it, who were hospitalized in inpatient departments of the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2012 to 2015. All patients underwent coronary angiography (CAG) and SPECT (the time interval between the studies did not exceed 3 months) for detection of hemodynamically significant CA stenoses. Patients were distributed into two groups according SPECT imaging appropriateness score: group 1-88 patients with score 7-9 (in whom SPECT imaging was appropriate), group 2-19 patients with score 1-6 (in whom SPECT imaging was uncertain, possibly appropriate, or inappropriate. RESULTS: Clinical signs and symptoms of angina pectoris were predominantly found in group 1 patients (p=0.499). Asymptomatic patients were more likely to be found in group 2 (p<0.001). Group 1 patients commonly had high pretest probability (PTP) (over 90 %, p<0.001), whereas group 2 patients commonly had low PTP (5-10 %, p<0.001). Mean PTP was 77 and 58 % in groups 1 and 2, respectively (p=0.003). According to positive SPECT imaging, significant CA lesions were more often found in group 1 compared to group 2 (31.8 and 10.5 %, respectively, p=0.060). Two- and three-vessel disease prevailed in group 1 (25 % and 14.7 %) according the analysis of prevalence and location of hemodynamically significant CA lesions, although the data did not reach statistical significance (p=0.057 and p=0.073). Stenoses >70 % were more commonly detected in group 1, compared to group 2: in anterior descending artery 52.3 vs. 5.3 % (p<0.001), circumflex artery 35.2 vs. 10.5 %; (p=0.034), right coronary artery 34.1 vs. 10.5 % (p=0.041). The sensitivity in both groups was rather low (40 % vs. 25 %), whereas specificity was 83 % in group 1 and 93 % in group 2. CONCLUSION: According to clinical examination, patients with IHD and indications for SPECT imaging more often had obstructive CA lesions (63.6 %), than patients with questionable or no indications (21.1 %). However, rate of positive findings during stress tests with SPECT imaging was low in both groups and did not differ significantly (p=0.06). Despite high specificity of SPECT imaging, its sensitivity was low in both groups.

[Dynamics of Coronary Calcification and Its Association with the Clinical Course of Ischemic Heart Disease and Osteopenic Syndrome].

PURPOSE: to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical course of ischemic heart disease (IHD) during 3-5 years of follow-up in men after coronary artery bypass grafting (CABG). Materials and methods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwent color duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT) of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels was assessed by the Agatston method. After 3-5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followup was 11.7 % (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcification scores. RESULTS: Significant CA calcification prior to CABG was detected in more than half of the patients (57.6 %). Among all clinical and anamnestic factors only one risk factor - smoking was associated with mortality (odds ratio [OR] 9.8, 95 % confidence interval [CI] 1.2-78.1, χ2=6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenic syndrome and BCA involvement. In the group of patients with baseline coronary calcification index >400 there were more smokers (р=0.026) and patients with lesions in >3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage we revealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= -0.24, р=0.06), Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3-5 years after CABG a medium positive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029). Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoral bone as the only significant predictor of calcium score increase during 3-5 years of follow-up. CONCLUSION: Dynamics of calcification of CAs in men with IHD during 3-5 years of follow-up after CABG was multidirectional, but in most cases (66 %) it was progressive. There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone prior to CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary  calcification was found. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral density of femoral bone.

[The association of biological markers with echocardiographic indices in patients with myocardial infarction with ST segment elevation and preserved left ventricular ejection fraction].

AIM: To compare dynamics of biological marker concentrations with echocardiographic data in patients with ST elevation myocardial infarction (STEMI) and preserved LV function during the hospitalization period. MATERIALS AND METHODS: The study successively included 100 patients with diagnosis of STEMI and LV ejection fraction.

Influence of visceral obesity on the secretion of adipokines with epicardial adipocytes in patients with coronary heart disease.

AIM: To study adipokine-cytokine profile of epicardial adipocytes (EAT) and subcutaneous adipose tissue (SAT) in conjunction with the area of visceral adipose tissue (VAT), biochemical and clinical characteristics of patients with coronary heart disease. MATERIALS AND METHODS: Examined 84 patients (70 men and 14 women) with coronary artery disease. In fact the presence of visceral obesity (VO) the patients were divided into two groups. Patients VO the sampling of adipocytes of EAT and SAT, with subsequent cultivation and evaluation of adipokine and provospalitelna activity. Carried out the determination of carbohydrate and lipid metabolism, adipokine and pro-inflammatory status in the blood serum. RESULTS: It was found that adipokine-cytokine profile of adipocytes of EAT and SAT differ. Adipocytes art of the disease on the background characterized by an increase IL-1, TNF-α, leptin-adiponectin relationships and a decrease in the content of protective factors: adiponectin and anti-inflammatory cytokine IL-10. While the SAT adipocytes was characterized by a decrease in the concentration of soluble receptor for leptin and the more pronounced leptinresistance, and the increase in proinflammatory cytokines was offset by the increase in the concentration of IL-10. The presence associated with multi-vessel coronary bed lesion, multifocal atherosclerosis, insulin resistance, atherogenic dyslipidemia, an imbalance of adipokines and markers of inflammation. So the value of the square VAT determined higher concentrations of leptin, TNF-α in adipocytes and serum, lipid and carbohydrate metabolism and a lower content of soluble receptor for leptin. CONCLUSION: Thus, the disease on the background of the status of the adipocytes of EAT characterized as a "metabolic inflammation", and may indicate the direct involvement of adipocytes in the pathogenesis of coronary artery disease, due to the formation of adipokine imbalance and the activation of proinflammatory reactions.

[Aortic bicarotid subclavian trifurcation bypass grafting combined with coronary aortic bypass grafting]. / Aorto-bikarotidno-podkliuchichnoe trifurkatsionnoe shuntirovanie v sochetanii s aortokoronarnym shuntirovaniem.

Presented herein is the result of a successful simultaneous operation: carotid endarterectomy on the left + aortic-carotid prosthetic repair on the left + prosthetic repair of the brachiocephalic trunk + graft-subclavian bypass procedure on the left + graft-coronary bypass prosthetic repair of the anterior descending artery with an autovein and coronary aortic bypass grafting of the right coronary artery with an autovein. The chosen method of surgical correction was characterized by a high level of technical difficulty. Retrospectively, the correctness of the implemented surgical policy was confirmed by the worked out in our institution automated decision-making support system for choosing optimal strategy of revascularization in multifocal atherosclerosis. The carried out treatment made it possible to obtain a satisfactory result persisting over a one-year period of follow-up, having prevented unfavourable ischaemic cardiovascular complications in an extremely-difficult-to-cure patient.

[Role of multidetector computed tomography and stress- echocardiography in assessment of risk of cardiological complications of non-cardiac surgery].

AIM: to compare results of coronary angiography with data of multi-slice computed tomography (MSCT) - angiography, and analyze rate of detection of hemodynamically significant coronary artery lesions during preoperative examination of patients. MATERIAL AND METHODS: We analyzed case histories of 92 patients (median age 59 years) examined prior to surgery on non-coronary vessels or for exclusion of ischemic heart disease. All patients were subjected to selective coronary angiography (CA) and MSCT - angiography. According to results of CA we formed 2 groups - with coronary artery stenoses >70% (n=55, group 1) and <70% (n=37, group 2). In 46 patients (50%) dobutamine stress echocardiography was performed for detection of concealed coronary insufficiency. RESULTS: CA revealed hemodynamically significant stenoses >70% (>50% in left main coronary artery) in 91 of 324 arteries. MSCT angiography detected stenosis >50% in 184 of 324 arteries; in 148 patients results of MSCT were confirmed by presence of hemodynamically significant stenoses at coronary angiography (sensitivity 86%). Absence of lesions or presence of stenoses <50% were noted at MSCT in 368 arteries; in 345 cases this was confirmed by coronary angiography (predictive value of negative result 94%, specificity 91%). Result of dobutamine stress echocardiography was positive in 41% of patients in group 1 and in 20% - of group 2 (<0.001). Sensitivity of stress echocardiography for detection of significant stenoses was 41%, specificity - 80%, negative predictive value - 14%. CONCLUSION: Diagnostic value of MSCT for detection of coronary artery stenoses >70% have better sensitivity, specificity, negative and positive predictive value of compared with stress echocardiography. Results of this study confirm value of MSCT angiography for diagnosis of coronary atherosclerosis and allow to recommend it as a screening method for detection hemodynamically significant coronary artery involvement before extracardiac surgery.

[Evaluation of coronary artery lesion in men with osteopenic syndrome and coronary artery disease].

AIM: To examine the relation between coronary atherosclerosis (CA), coronary artery calcification (CAC), and bone mineral density (BMD) in men with coronary artery disease (CAD). SUBJECTS AND METHODS: The investigation included 74 males aged 60.1 (range, 55-70) years with verified CAD. All the patients underwent X-ray contrast-enhanced selective coronary angiography and coronary artery calcium score (CS) and BMD measurements by osteodensitometry. The severity of a coronary artery lesion was evaluated using the SYNTAX score. According to the T score, the patients were divided into 3 groups: 1) 23 patients with osteoporosis (OP), 2) 30 patients with osteopenia, and 3) 21 patients with normal BMD. RESULTS: Osteopenic syndrome (OS) (OP and osteopenia) was found in 71.6% of the patients with angiographically confirmed CAD. Single-vessel lesion in the coronary bed (CB) was more frequently recorded in the normal BMD group than in the OP one (p = 0.023). Severe CB lesion was more common for the patients with OP (p = 0.029). There were statistically significant differences between the osteopenia and normal BMD groups in the severe degree of CB lesion (p = 0.042). Differences were noted in total CS between Groups 1 and 2 (p = 0.0122). CS significantly correlated with the severity of CA lesion according to the SYNTAX score (r = 0.53; p = 0.002). CONCLUSION: Severe CB lesion in males correlates with CAC and is associated with decreased BMD, suggesting the commonness of the pathogenetic components of AS and OS.

[Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein].

The presented herein clinical case report concerns successful endovascular closure of a iatrogenic lesion of the iliac artery and inferior vena cava with formation of a pathological arteriovenous anastomosis manifesting itself by venous thromboembolic syndrome and severe right-ventricular insufficiency.

[MRT assessment of metabolic and thrombolytic therapy effects on postinfarction left ventricular remodeling].

AIM: To examine effects of trimetasidine on morphofunctional indices of the left ventricle (LV) in myocardial infarction (MI) patients on combined treatment. MATERIALS AND METHODS: Seventy five patients with primary macrofocal MI were randomized into 2 groups. Patients of group 1 (n = 38) received a combination of bisoprolol (beta-blocker) with enalapril (ACE inhibitor) in individual doses under control of blood pressure and blood creatinine level. Group 2 (n = 37) patients received the same combination of drugs and, in addition, trimetasidine in a dose 70 mg/day from postmyocardial day 7-10 for 6 months. Two subgroups from the groups were given systemic thrombolytic therapy (STLT) with streptokinase. MRT and cine-MRT of the heart were made for measurement of LV morphofunctional parameters. RESULTS: Low-field MRT of the heart in MI patients treated with adjuvant STLT (1500000 U within 6 hours after MI onset) and trimetasidine (preductal MB) in a dose 70 mg/day from the disease day 7-10 registered a significant inhibition of pathological LV postinfarction remodeling: a decrease of body surface indexed LV end diastolic volume by 10.3%, systolic volume--by 15.4%, LV myocardial tension--by 14.0%, sphericity index--by 7.1%; an increase in the index of relative wall thickness by 5.3%, cardiac index--by 9.2% compared to the group treated without trimetasidine. CONCLUSION: 6-month therapy with trimetasidine of MI patients leads to a significant regress of morphofunctional changes accompanying LV remodeling. Pathological LV postinfarction remodeling inhibits significantly in MI patients combined treatment of whom included STLT (streptokinase in a dose 1500,000 U within 6 hours after acute MI onset and trimetasidine in a dose 70 mg/day on postmyocardial infarction day 7-10).

Modeling of transcatheter aortic valve replacement: Patient specific vs general approaches based on finite element analysis.

BACKGROUND: There are two main methods used for transcatheter aortic valve replacement (TAVR) FEA modeling for medical devices development: patient specific and general approaches. Advantages and disadvantages of both approaches have never been compared in a single study. METHOD: Here we propose a bioinformatic algorithm to evaluate the accuracy of patient specific and generalized FEA approaches with regards to proximity configuration of the implanted stent reconstructed by computed tomography. In addition, in this study we also assessed the impact of the level of detail on FEA accuracy in the patient specific approach. RESULTS: Our results demonstrate that in certain cases, the generalized approach can ensure the same accuracy as the patient specific approach. Therefore, considering high cost effectiveness of the generalized approach, we identify it as more feasible in the context of TAVR. Furthermore, we suggest that high level of detail can improve the reproducibility of modeling results in the patient specific approach. CONCLUSIONS: Our findings may help medical engineers to better understand the peculiarities of both approaches and therefore make the right decision when choosing a particular approach for computer modeling. Future studies are required to validate our observations.

[Trimetazidine effects on postinfarction remodeling of the left ventricle].

AIM: To study effects of combined therapy including trimetazidine on morphofunctional indices of the left ventricle (LV). MATERIAL AND METHODS: Seventy five patients with primary macrofocal myocardial infarction (MI) were randomized into two groups: 38 patients of group 1 received combination of bisoprolol, a beta-adrenoblocker, and analapril, an ACE inhibitor, in individually adjusted dose under control of blood pressure (BP) and blood creatinine; 37 patients of group 2 received the same combination and trimetazidine in a dose 70 mg/day for 6 months beginning on postinfarction day 7-10. Each group contained a subgroup treated with systemic thrombolytic streptokinase at admission. MR imaging (MRI) and cine-MRI assessed morphofunctional L V parameters. RESULTS: A 6-month therapy with trimetazine resulted in a significant regress of the morphofunctional alterations associated with LV remodeling in postmyocardial infarction patients. CONCLUSION: Combined treatment including systemic thrombolysis with streptokinase within MI hours 0-6, trimetasidine on MI day 7-10 plus 6 months significantly inhibits pathological postinfarction LV remodeling.

Computer-aided design of the human aortic root.

The development of computer-based 3D models of the aortic root is one of the most important problems in constructing the prostheses for transcatheter aortic valve implantation. In the current study, we analyzed data from 117 patients with and without aortic valve disease and computed tomography data from 20 patients without aortic valvular diseases in order to estimate the average values of the diameter of the aortic annulus and other aortic root parameters. Based on these data, we developed a 3D model of human aortic root with unique geometry. Furthermore, in this study we show that by applying different material properties to the aortic annulus zone in our model, we can significantly improve the quality of the results of finite element analysis. To summarize, here we present four 3D models of human aortic root with unique geometry based on computational analysis of ECHO and CT data. We suggest that our models can be utilized for the development of better prostheses for transcatheter aortic valve implantation.