Case report of mild form of a new coronavirus infection in patient with idiopathic pulmonary hypertension.

The article presents a clinical case of mild novel coronavirus infection COVID-19 complicated with bilateral interstitial pneumonia in a female patient with idiopathic pulmonary hypertension.

Evaluation of the Fractional Flow Reserve by Computer Tomography Data: Comparison of the Calculated Parameters with the Results of Invasive Measurements.

Aim      To create a three-dimensional mathematical model of coronary flow in patients with ischemic heart disease based on findings of computed tomography angiography (CTA) with subsequent calculation of the fractional flow reserve (FFRCTA) and comparison of estimated FFRCTA with FFR reference values measured by coronary angiography (CAG).Material and methods  The study included 10 patients with borderline stenosis (50-75 %) as determined by CTA performed with a 640­slice CT-scanner. Based on CTA findings, three-dimensional mathematical models were constructed for further calculation of FFRCTA. Later, an invasive measurement of FFR (FFRINV) was performed for all patients. FFR values <0.8 indicated the hemodynamic significance of stenosis.Results FFRCTA and FFRINV values differed insignificantly in most cases (n=9) and exceeded 5% in only one case. The regression analysis showed a close correlation between estimated and invasively measured FFR values.Conclusion      Preliminary results showed a good consistency of calculated and measured FFR values. Therefore, further development of the method for mathematical modeling of three-dimensional blood flow by CTA findings is promising. Noninvasive evaluation of FFR is particularly relevant for analysis of hemodynamic significance of borderline (50-75 %) coronary stenoses.

Computed Tomography Myocardial Perfusion Imaging With Transesophageal Atrial Pacing Stress Test in Patients With Borderline Stenoses in the Coronary Arteries: a Comparison With Fractional Flow Reserve.

Aim      To evaluate the diagnostic accuracy of cardiac perfusion computed tomography (PCT) with transesophageal electrocardiostimulation (TE ECS) for detection of ischemia in patients with borderline coronary stenosis (50-75 %) compared to measurements of fractional flow reserve (FFR).Material and methods  The study included 25 patients with borderline (50-75 %) coronary stenosis as per data of computed tomography angiography (CTA) or coronary angiography (CAG). Later the patients underwent invasive measurement of FFR and cardiac PCT on a 320-row detector tomograph in combination with the TE ECS stress test.  FFR values <0.8 indicated the hemodynamic significance of stenosis. Myocardial perfusion was evaluated visually based on consensus of two experts.Results All patients completed the study protocol. Cardiac pacing duration was 6 min for all patients. Four patients required intravenous administration of atropine sulphate. PCT with TE ECS detected significant for FFR stenoses with sensitivity, specificity, and predictive value of a positive result and predictive value for a negative result of 47, 90, 87, and 53 %, respectively.Conclusion      PCT with TE ECS in combination with CTA can be considered as an informative method for simultaneous evaluation of the condition of coronary arteries and detection of myocardial ischemia. This method is particularly relevant for assessing the hemodynamic significance of borderline coronary stenoses.

[Computed Tomography Coronary Angiography Possibilities in "High Risk" Plaque Identification in Patients with non-ST-Elevation Acute Coronary Syndrome: Comparison with Intravascular Ultrasound].

Aim      To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods  This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion      According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.

[Possibilities of Stress Computed Tomography Myocardial Perfusion Imaging in the Diagnosis of Ischemic Heart Disease].

Computed tomography angiography (CT-angiography, CTA) allows noninvasive visualization of coronary arteries (CA). This method is highly sensitive in detecting coronary atherosclerosis. However, standard CTA does not allow evaluation of the hemodynamic significance of found CA stenoses, which requires additional functional tests for detection of myocardial ischemia. This review focuses on possibilities of clinical use, limitations, technical aspects, and prospects of a combination of CT-angiography and CT myocardial perfusion imaging in diagnostics of ischemic heart disease.

[The Diagnostic Accuracy of Сoronary Сomputed Tomography Angiography in the Diagnosis of Stable Coronary Artery Disease in Patients Aged 70 Years and Older].

AIM: The purpose of this study was to evaluate the diagnostic accuracy of сoronary сomputed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged ≥70 years. MATERIALS AND METHODS: The study included 390 patients aged ≥70 years with symptoms suggested stable CAD which underwent elective coronary artery angiography (CAG). Initially the prevalence of angiographically significant CAD was estimated according to the gender and chest pain character, and identifications of patients in whom CCTA was appropriate. After that diagnostic accuracy and сost-efficiency of CCTA in the diagnosis of stable CAD in 82 patients with atypical angina and non-anginal chest pain were evaluated. RESULTS: The prevalence of obstructive CAD in patients with typical angina was very high and they were excluded from the final analysis. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA 48 (59%) patients had obstructive CAD. CСTA data matched with results of CAG in all cases. Among 34 patients that had non-obstructive CAD the results of CCTA and CAG matched in 88% cases. CCTA has sensitivity, specificity, positive predictive value, negative predictive value of 100%, 88%, 92% and 100% respectively. The likelihood ratio for positive result was 8.3, likelihood ratio for negative result was 0.3. Positive result increased post-test probability of obstructive CAD from 42% to 86%, negative result reduced post-test probability of obstructive CAD to 0%. CONCLUSION: negative CCTA result in patients aged 70 years and older with atypical angina and non-anginal pain allows to exclude the presence of obstructive CAD.  The likelihood ratio for positive result indicates a moderately difference between the pre-test and post-test probability of the presence of obstructive CAD. In patients aged ≥70 years with atypical angina or non-anginal chest pain which have inconclusive results of functional testing or unable undergo functional testing CCTA allows to increase diagnostic yield of CAG and reduce the frequency of minor complications and diagnostic evaluation costs.

[The State of Vascular Bed, Parenchyma and Perfusion of Lungs in Chronic Thromboembolic Pulmonary Hypertension According to Data of Subtraction Pulmonary Angiography].

AIM: to assess the state of vascular bed, parenchyma, and perfusion of lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using the method of subtraction computed tomography (CT). METHODS: CT pulmonary angiography (CTPA) was performed in 45 patients with verified CTEPH (18 men, 27 women, age 26-79 years) by CT scanner using the "Lung subtraction" standard protocol. Parameters analyzed were characteristics of the state of main pulmonary artery (MPA) and the right ventricle (RV), and calculated CT angiographic (CTA) obstruction and perfusion defect scores. RESULTS: Significant correlation was found between CTA obstruction score and perfusion defect score (r=0.34, p=0.02). Mean pulmonary arterial pressure (mPAP) correlated with MPA diameter (r=0.4, p=0.02), RV wall thickness (r=0.6, p=0.0003) and the ratio of MPA diameter to ascending aortic diameter (r=0.5, p=0.002). Significant correlation was also found between RV wall thickness and pulmonary vascular resistance (PVR) (r=0.4, p=0.04). Neither CTA obstruction score nor perfusion defect score correlated with PVR and mPAP. The data of CT did not correlate with results of 6-minute walk test. CONCLUSION: In patients with CTEPH subtraction CTPA allows carrying out complex diagnostics of the state of vascular bed, parenchyma and perfusion of the lungs.

Determination of predictors of successful recanalization of the chronic occlusions of coronary arteries by means of CT-coronarography method.

The review illuminated actual issues of the diagnostic efficiency of computed tomography (CT) of the coronary arteries in the planning of the procedure percutaneous coronary intervention (PCI) in patients with chronic occlusion of coronary arteries (CTO). The results of researches of detection of predictors of unsuccessful recanalization according to traditional coronary angiography (CAG) and CT angiography were presented. The major CT characteristics of the CTO, which can supplement the coronary angiography data to predict outcomes of the PCI were discussed.

[Myocardial Hypoenhancement on Multidetector Computed Tomography in Patients With Non-ST Elevation Acute Coronary Syndrome].

The purpose of our study was analysis of myocardial hypoenhancement areas (MHAs) found by multidetector computed tomography (MDCT) in patients with non-ST elevation acute coronary syndrome (NSTEACS) and comparison of these findings with results of standard methods of diagnostics of myocardial infarction and ischemia [electrocardiography (ECG) and echocardiography (ECHO)]. METHODS: MHAs were found in 18 of 21 patients with non-ST segment elevation myocardial infarction (NSTEMI) (85.7%) and only in 3 of 22 patients with unstable angina (UA) (13.6%, p.

[Subtraction CT angiopulmonographic assessment of the vascular bed and lung perfusion in patients with chronic thromboembolic pulmonary hypertension: A pilot study]. / Otsenka sosudistogo rusla i perfuzii legkikh u bol'nykh khronicheskoi tromboémbolicheskoi legochnoi gipertenziei s pomoshch'iu subtraktsionnoi KT-angiopul'monografii: rezul'taty predvaritel'nogo issledovaniia.

AIM: To evaluate the vascular bed and lung perfusion in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by computed tomography (CT) and to compare the severity of pulmonary arterial (PA) thrombotic lesions concurrent with parenchymal perfusion disorders with angiopulmonographic findings and clinical and hemodynamic characteristics. SUBJECTS AND METHODS: In the period from November 2015 to May 2016, 22 patients (7 men, 15 women) aged 27 to 67 years with a verified diagnosis of CTEPH were examined using an Aquilion ONE VISION Edition 640 (Toshiba Medical Systems, Japan) CT scanner with a 320-row detector. Perfusion defect in this study was evaluated with the new software allowing one to combine contrast and contrast-free images by a subtraction method. CT data analysis included visual assessment of the vascular bed and lung parenchyma and quantitative assessment with perfusion map construction and semi-automatic determination of the obstruction index (OI) and perfusion defect index (PDI). OI was compared with PDI and mean LA pressure according to the data of right heart catheterization and 6-minute walk test. RESULTS: A statistically significant correlation was found between OI and PDI in patients with CTEPH (Pearson r=0.56; p=0.0065). There were no relationships between mean LA pressure and vascular perfusion indices (OI and PDI) or between vascular perfusion parameters and 6-minute walk test results. CONCLUSION: CT angiopulmonography in conjunction with pulmonary perfusion assessment (within one study) allows evaluation of the severity of vascular lesions and perfusion disorders and determination of the efficiency of treatment in patients with CTEPH.

[A case of primary diagnosis of patent ductus arteriosus at the age of 75 years]. / Sluchai pervichnoi diagnostiki otkrytogo arterial'nogo protoka u patsientov v vozraste 75 let.

The paper describes a case of primary diagnosis of functioning patent ductus arteriosus in a 75-year-old female patient.

[Computed Tomography in the Evaluation of Coronary Atherosclerotic Plaques: Comparison With Intravascular Ultrasound].

PURPOSE: Determination of computed tomography angiography (CTA) informativeness in assessment of state of atherosclerotic coronary plaque (ACP) and identification of signs of its instability compared with intravascular ultrasound (IVUS). MATERIALS AND METHODS: Coronary CTA was carried out in 52 patients with clinical presentation of non-ST elevation (NSTE) acute coronary syndrome on the first day of hospitalization. ACPs were identified in 32 of 52 patients (61.5%). IVUS was performed in 32 patients (mean age 58+/-11.4 years, 27 men, 5 women, 22 with unstable angina, 10 with NSTE myocardial infarction) and 50 plaques in 45 coronary arteries were characterized (39 with spectral analysis of IVUS data). All data were compared with the results of coronary CTA. RESULTS: Sensitivity and specificity of CTA in the detection of stenosis >50% were 97.67 and 71.40%, respectively. Correlation analysis showed a high comparability of methods in determining plaque burden (r=0.80, 95% confidence interval [CI] 0.67 - 0.88, p<0.0001), plaque length (r=0.75, 95%CI 0.60 - 0.85, p<0.0001), and remodeling index (r=0.62, 95%CI 0.40 - 0.77, p<0.0001). Threshold value for "low-density areas" of plaques typical for thin cap fibroatheroma was less or equal 41 Hounsfield units (sensitivity 82%; specificity 86%; area under the curve 0.824; 95% CI 0.615 - 0.947, p<0.0005). CONCLUSION: Coronary CT is a non-invasive method for rapid characterization of ACP. CT results correlate well with IVUS data, including identification of such important signs of plaque instability as presence of "low-density zone" and positive remodeling at the plague level.

[Noninvasive Methods of Detection of Vulnerable Atherosclerotic Plaques in Coronary Arteries].

In most cases direct cause of acute coronary syndrome and sudden death is an intracoronary thrombus formed on a surface of unstable atherosclerotic plaque (UAP). The following are main characteristics of UAP: active inflammation; large lipid rich nucleus occupying a40% of plaque volume; thin (< 65 mm) fibrous cap; erosions of intima over plaque; tear of plaque cap; superficially located calcium nodules; intraplaque hemorrhage. Visualization of UAP in coronary arteries is a very important direction in diagnostics. During recent years both invasive and noninvasive methods of detection of UAP have been actively developed. In this review we present main noninvasive techniques used for detection of UAP: multislice computed tomography, magnetic resonance tomography, positron emission tomography and single-photon emission computed tomography. In the review we have covered main advantages and limitations of each invasive method of UAP detection and delineated perspectives of development of this direction.

[Capabilities of Multidetector Computed Tomography in Assessment of Atherosclerosis of Coronary Arteries].

The prevalence of ischemic heart disease (IHD) as well as high mortality from its exacerbations led to an active search and study of diagnostic methods to predict the possible development of acute coronary events. At the moment, it is proved that the morphological properties of atherosclerotic plaque largely determine the course of IHD. Contemporary multidetector computed tomography (MDCT) is the only non-invasive method which allows to study the state of coronary arteries. In this review we have analyzed capabilities of MDCT in assessing the severity of stenosis and calcification in the coronary arteries, as well as the structure of atherosclerotic plaques, including signs of "instability".

[Assessment of Coronary Plaques in Patients With Acute Coronary Syndrome Without Persistent ST-Segment Elevation].

AIM: to analyze morphological features of atherosclerotic plaques in culprit and non-culprit coronary lesions in patients with non ST-elevation acute coronary syndrome (NSTE-ACS) by multidetector spiral computed tomography (MDCT). RESULTS. In culprit lesions (n = 70) compared to non-culprit lesions (n = 144) frequency of soft plaques (60 vs 43%, p = 0.003), positive remodeling (70.2 vs 54.3%, p = 0.03) and uneven contour (91.7 vs 68.7%, p = 0.0002) were significantly higher. Minimal plaque density was significantly lower and length of plaque was significantly higher in culprit coronary segments (40.1 ± 25.3 vs 74.1 ± 116.8 Hounsfield units [HU], p = 0.02 and 16.8 ± 13.4 vs 13.2 ± 6.9 mm, p = 0.01, respectively). Receiver-operator characteristic curve analysis identified optimal cutoff value of minimum plaque density and length for discrimination between culprit and non-culprit lesion as 40 HU and 13.5 mm, respectively. The combination of soft plaque with a minimal density < 40 HU and uneven contour occurred in one third of culprit lesions and almost two times less in non-culprit (31.67 and 17.91%, respectively, p = 0.04) and was characterized by high specificity (82.1%) and negative predictive value (72.7%). CONCLUSION: The most specific features of culprit lesions in patients with NSTE-ACS were positive vascular remodeling, length > 13.5 mm, minimal CT-density < 40 HU, soft plaque's type and presence of uneven contour, as well as a combination of the last 3 features.

[Informative value of multislice spiral computed tomography in identifying myocardial perfusion defect in patients with acute myocardial infarction].

AIM: To estimate the informative value of multislice spiral computed tomography (MSCT) in the diagnosis of myocardial infarction (MI). SUBJECTS AND METHODS: The study enrolled 171 patients with acute coronary syndrome (ACS), including 121 patients diagnosed with acute ST-segment elevation MI (STEMI), 19 with non-STEMI, and 31 with unstable angina. A comparison group consisted of 52 patients with stable coronary heart disease (CHD) and a control group comprised 17 patients without CHD. Intravenous contrast-enhanced MSCT was performed using a 64-spiral CT scanner. MSCT was carried out in the patients with ACS on days 3-5 of the onset of a pain attack and in the other patients electively. It was redone in 44 patients with acute MI (AMI) 6 months after a primary examination. RESULTS: Left ventricular (LV) perfusion defect was imaged in 94.3% of the patients with AMI and in 10% of those with unstable angina. LV contrast defects were undetectable in the patients from the stable CHD and control groups. The sensitivity, specificity, prognostic value of a positive result, negative prognostic value of a result, and accuracy of MSCT in the diagnosis of MI were 94.3, 97.1, 97.8, 92.5, and 96.70%, respectively. In the patients with STEMI, myocardial perfusion defect was larger and transmural perfusion defect was more common than in those with non-STEMI. Comparison of the values of myocardial perfusion defect size and myocardial density according to the data of primary and repeat MSCT revealed no statistically significant differences: 2.0 (0.50; 5.45) and 1,8 (0.35; 5.00) cm3 (p = 0.15); 41.7 +/- 10.2 and 46.1 +/- 12.2 HU, respectively (p = 0.07). CONCLUSION: Contrast-enhanced MSCT allows visual and quantitative assessments of myocardial perfusion defect in patients with ACS. Myocardial perfusion defect from MSCT data suggests previous MI with a high probability, but does not permit the determination of the duration of the disease.

[The role of multispiral computed tomography in assessment of viability of the myocardium and prognostication of left ventricular remodeling in patients with ST-elevation myocardial infarction].

Aim of the study was to assess perfusion defect and viability of the myocardium by the method of multispiral computed tomography (MSCT) in patients with ST-elevation acute myocardial infarction (AMI) and to assess their prognostic role in development of remodeling of the left ventricle (LV). We included into the study 117 patients with AMI. MSCT with intravenous contrast enhancement was carried out on days 3-4 and at 12 months after AMI. In the arterial phase we estimated volume of myocardial perfusion defect, LV end diastolic and end systolic volumes (LVEDV and LVESV), and LV ejection fraction (EF). Three types of myocardial opacification were distinguished on tomograms in delayed phase of MSCT: type I - subendocardial residual defect (RD), type II - transmural RD, type III - transmural delayed hyper enhancement (DE). Patients were divided in 3 groups: (1) with subendocardial RD (n=63), (2) with transmural RD (n=28), (3) with transmural DE (n=26). Development of LV remodeling was registered if at repeat MSCT LVEDV increased more or equal 20% from baseline. In patients with signs of viable myocardium (group 1) volume of perfusion defect was substantially smaller than in patients with nonviable myocardium (groups 2 and 3): 1cm3 (0.4-2.4) vs. 7.3 cm3 (5.3-10.0) and 6.3 cm3 (5.0-15.0), respectively, p<0.001. Compared with groups 2 and 3 patients of group 1 more often were female (p=0.04), had inferior MI (p<0.001), and spontaneous reperfusion (p<0.001). After 12 months LV remodeling was registered in 19.3% of patients, all had signs of nonviable myocardium in more or equal 3 LV segments. In patients with perfusion defect more or equal 10 cm3 probability of development of LV remodeling exceeded 50%. Disturbances of perfusion abnormalities and number of nonviable LV segments were main predictors of LV remodeling.

[Comparison of characteristics of atherosclerotic plaques in patients with acute coronary syndrome and stable ischemic heart disease: data of multispiral computed tomography].

AIM: To elucidate possibilities of multispiral computed tomography (MSCT) for assessment of morphology of atherosclerotic plaques in coronary arteries of patients with acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD). MATERIAL AND METHODS: Assessment of internal relief of coronary arteries and composition of atherosclerotic plaques was carried out in 85 patients with ACS and 41 patients with SIHD. MSCT was performed with the use of computed tomograph. Visual assessment included determination of plaque type (calcified, soft, and heterogeneous) and contour (regular, irregular). Quantitative assessment included determination of plaque density and index of remodeling. RESULTS: Among patients with ACS we found 194 plaques (60--soft, 72--heterogeneous, and 62--calcified). Plaques in symptom related compared with non-symptom related arteries had higher index of remodeling (1.4 +/- 0.3 and 1.2 +/- 0.2, respectively, p < 0.0001), and more frequently had irregular contour (60.0 and 12.8%, respectively, p < 0.0005). Soft plaques and plaques with irregular contour prevailed in ACS group (68.0%) while calcified plaques were more frequent in SIHD group (66.4%). Plaques with irregular contour were more frequent and index of remodeling was higher in ACS compared with SIHD group (33.5 vs 7.2%, p < 0.0005, and 1.3 +/- 0.2 vs 1.0 +/- 0.2, p < 0.001, respectively). CONCLUSION: According to MSCT data main characteristics of atherosclerotic plaques in patients with ACS were low density and inclusions of microcalcinates. Specific features of plaques in symptom related arteries were irregular contour and positive remodeling index.

[Multislice spiral computed tomography in the planning of transcatheter aortic valve replacement].

Surgical treatment for aortic valve (AV) pathology is an urgent and important problem of modern medicine. The prevalence of valve disease is great and remains steadily high in the population. Due to a large number of patients who cannot undergo open AV surgery, alternative hybrid treatments are recently being actively improved. Multislice spiral computed tomography (MSCT) is mandatory prior to transcatheter AV replacement as the examination results determine if a hybrid treatment can be performed and the access is transfemoral or transapical. MSCT provides the data necessary to determine the sizes and types of AV prostheses. The application of the current systems of 320-640 spiral tomographs will further improve MSCT as the method of choice in examining patients before transcatheter AV replacement.