[A case of arrhythmogenic right ventricular cardiomyo-pathy associated with myocardial inflammation].

Recent years have been marked by a number of published reports that have shown a high frequency of signs of myocardial inflammation in patients with confirmed arrhythmogenic right ventricular cardiomyopathy (ARVC). This article presents a clinical case of typical phenotypic manifestations of ARVC associated with morphometric signs of subacute myocarditis. A 66-year-old man presented to the emergency department with signs of arrhythmogenic shock caused by ventricular tachycardia. Examination detected electrocardiographic signs of (ARVC), visualized signs of right ventricular dilatation, increased trabeculation, and wall fibrosis. Endomyocardial biopsy of the right ventricular wall showed degenerative alterations of cardiomyocytes with perivascular lymphocytic infiltration and areas of granulation tissue. New facts that evidence inflammatory alterations of the myocardium will still require specifying and reconsidering positions of expert consensuses on diagnostics and treatment of ARVC.

[Contrast Echocardiography with a Quantitative Assessment of Myocardial Perfusion in Patients with Previous Q-Wave Myocardial Infarction].

OBJECTIVE:  To assess possibilities of contrast echocardiography with quantitative evaluation of myocardial perfusion in patients with previous Q-wave myocardial infarction. MATERIALS AND METHODS:  We examined 15 men (42-72 years) with coronary artery disease and previous myocardial infarction, and pathological Q-wave in 2 or more ECG leads. Quantification of left ventricular (LV) myocardial perfusion was performed by calculating of the ultrasound signal tissue intensity from the LV myocardial segments during intravenous administration of the ultrasound contrast agent (SonoVue). The Tissue intensive curve (TIC) analysis was done in the end-diastolic period before and on the fourth cardiac cycle after applying the "flash". Changes in the intensity of myocardial perfusion (A4, dB) was estimated as the difference between the intensity values of the ultrasound signal in the myocardial segment during the period of filling the contrast bubbles on 4-th cardiac cycle and before applying the «flash¼. Measurements were performed in 16 segments of the LV. A contrast cardiac magnetic resonance imaging (contrast MRI) was performed in order to verify the LV scar. Fibrotic changes of 50% of myocardial wall or more were considered as signs of post-infarction scar. RESULTS: The dynamics of perfusion and scar presence in 240 myocardial segments were evaluated. The median A4 was 1 dB (range, -20 to 10 dB). MRI revealed 82 of 240 segments with the large-focal scar. The effectiveness of the diagnostic test (quantitative contrast perfusion echocardiography with A4 assessment) to detect myocardial scar was investigated. ROC curve analysis showed good model quality, AUC=0,787 (0,730-0,837); sensitivity 82.9%; specificity 75.3%; p<0.01. The cut-off point for A4 was -1. CONCLUSION:  A new approach to quantitative contrast assessment of perfusion allows to identify perfusion disorders with high efficiency in patients with previous Q-wave myocardial infarction.

[Capabilities of stress echocardiography in diagnosis of cardiovascular pathology and estimation for military service].

Annually about 6,5 thousands of military servicemen retire due to cardiovascular diseases, every second serviceman retires before superannuation. Stress echocardiography in comparison with other imaging studies is cheaper, safer and matches in sensibility and specificity. The prevalence of stress echocardiography and stress systems can make it available in district, central and main hospitals, and clinics of the Kirov Military Medical Academy. It is proposed to expand indications for stress echocardiography for certain contingent soldiers: those senior commanders, aircrew, and divers soldiers at high risk of cardiovascular complications. For training of specialists in the filed of stress echocardiography in the Kirov Military Medical Academy themed cycles for medical ultrasound and functional diagnostics are orginised.

[The dynamics of functional state of the cardio-vascular system during 2 years after aorto-coronary shunting].

The investigation included 45 patients with coronary heart disease operated for aorto-(mammaro)-coronary artery bypass grafting. It was found that surgical treatment resulted in the improvement of subjective symptoms of angina and increased contractile reserve of the myocardium during the first days after surgery. Significantly increased subjective and objective exercise tolerance, improvement of local myocardial contractility, diastolic function and symptoms of myocardial remodeling were registered only within 6 months after surgery. Assessment of the dynamics of the myocardial contractile reserve can be used as an objective criterion of the earliest positive result of surgical treatment of coronary artery disease.