[Apoptosis and hibernation of cardiomyocytes of periscar zone as factor of chronic cardiac aneurysm progression]. / Apoptoz i gibernatsiia kardiomiotsitov perirubtsovoi zony kak faktor progressirovaniia khronicheskoi anevrizmy serdtsa.

Tissue specimen from chronic aneurysms and adjacent myocardium obtained at aneurysmectomy and coronary bypass surgery from 46 patients were subjected to morphological study. Immunohistochemical methods and electronic microscopy were applied for detection of apoptosis and hibernation of cardiomyocytes in 11 cases and histochemical determination of activity of energetic enzymes succinate and lactate dehydrogenase was used in 5 cases. Cardiomyocytes from peri and intra scar layers of myocardium were found to be in a state of hibernation while some of them were in a state of apoptosis. Extent of apoptosis was different in aneurysms on different stages of organization. Number of altered cardiomyocytes was the greatest in immature aneurysms. Basing on these findings apoptosis of hibernating cardiomyocytes was suggested to be one of factors of expansion of sclerotic zone and aneurysm formation.

[Effect of restoration of coronary blood flow on dynamics of myocardial perfusion and function in patients with acute myocardial infarction. Data of gated technetium-99m-sestamibi SPECT]. / Vliianie vosstanovleniia koronarnogo krovotoka na dinamiku perfuzii i funktsii miokarda u bol'nykh ostrym infarktom po dannym sinkhronizirovannoi tomografii s 99mTs-MIBI.

Effects of coronary blood flow restoration on dynamics of myocardial perfusion and function were studied in 50 patients with acute myocardial infarction during 6-month follow-up. Gated SPECT with 99mTc-MIBI (G-SPECT) was performed before onset of reperfusion procedures, in 24 hours, 10 days, 1 and 6 months. In patients with successful reperfusion (n=36) perfusion defect (PD) size decreased by 6.78+/-0.97% (p<0.001) and its severity by 221.3+/-85 std (p<0.001) in 24 hours. In 10 days PD size decreased by 3.9+/-0.88% (r<0.05) and severity by 149+/-39 std (p<0.05), whereas in 1 month PD size decreased by 2,18+/-1,4% (p<0.05), PD severity by 146.3+/-67 std (p<0.05). Successful reperfusion was associated with improvement of contractility: left ventricular ejection fraction increased by 3% (p<0.05) on day 10 of the disease. In patients with failed reperfusion PD size and severity decreased in 10 days by 4.8+/-4.2%, p<0.05, and 276+/-75 std, p<0.05, respectively, in 6 months PD size decreased by 3.1+/-0.9%, p<0.05, left ventricular ejection fraction did not change during follow-up. We conclude that successful reperfusion therapy promotes restoration of myocardial perfusion and improvement of its contractility.

[Viable myocardium: comparative evaluation of surgical and pharmacological treatment of patients with ischemic heart disease, post-infarct cardiosclerosis and chronic cardiac failure]. / Zhiznesposobnyi miokard: sravnitel'naia otsenka khirurgicheskogo i medikamentoznogo metodov lecheniia bol'nykh ishemicheskoi bolezn'iu serdtsa s postinfarktnym kardiosklerozom i khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To compare surgical and drug therapies of viable myocardium in IHD patients with left ventricular dysfunction (LVD), to show how to choose between them basing on the presence or absence of viable myocardium in the dyssenergy zones in such patients. MATERIAL AND METHODS: The study enrolled 55 IHD patients with postinfarction cardiosclerosis, left ventricular ejection fraction under 35%, circulatory disorder class I-III (NYHA classification). Coronary artery bypass operation (CABO) was made in 24 patients, 31 patients received drugs. The examination included dobutamin echo-CG, perfusion myocardial scintigraphy. Viability of the myocardium was assessed before and 6 months after the treatment. RESULTS: The patients were divided by the treatment and number of segments of viable myocardium: group 1--patients with viable myocardium subjected to CABO, group 2--patients with non-viable myocardium subjected to CABO, group 3--patients with viable myocardium treated with drugs, group 4--patients with non-viable myocardium treated with drugs. The greatest rise in LV EF, reduction of the end diastolic volume, end systolic volume of the left ventricle and functional class was observed in group 1. In group 2 these parameters changed less than in group 3. Patients of groups 2 and 4 were similar by parameters of LV global contractility. CONCLUSION: Improvement of central hemodynamics and functional class was the greatest in IHD patients after CABO having viable myocardium. If myocardium is not viable surgical treatment has no advantage over conservative in improvement of the pump cardiac function and is inferior to pharmacological treatment in effect on myocardium function in patients with viable myocardium in dyssynergia zones.

[Comparative assessment of resting myocardial perfusion in patients with postinfarct cardiosclerosis by electron-beam tomography and 99mTc-MIBI myocardial single-photon tomography]. / Sravnitel'naia otsenka perfuzii miokarda v pokoe u bol'nykh s postinfarktnym kardiosklerozom s pomoshch'iu élektronno-luchevoi tomografii i odnofotonnoi émissionnoi komp'iuternoi tomografii miokarda c 99mTc-MIBI.

The purpose of the study was to compare myocardial perfusion assessed by electron beam computed tomography (EBCT) with that obtained by 99mTc-sestamibi single photon emission computed tomography (SPECT) in patients with old myocardial infarction and control subjects at rest. A total of 42 patients with suspected and known ischaemic heart disease (IHD) were included in the study. 20 pts had a history of Q-wave myocardial infarction (MI), 12 pts had an old non-Q-wave MI and 10 served as controls (without perfusion defects on SPECT images at rest). Assessment of the myocardial perfusion by EBCT was performed using the short axis view and multislice mode (MSM) during injection of 50 ml of the nonionic contrast medium at 4 ml/s via cubital vein. Perfusion defects were localized by SPECT according to 6-segment model of the LV (septal, anterior, lateral, posterior, inferior and apical). Overall concordance between EBCT and SPECT was 67% for normal versus abnormal perfusion. Agreement between the 2 methods for each of the 6 segments was 81% (K = 0.62) for the anterior segment, 71% (K = 0.42) for the septal segment, 71% (K = 0.43) for the apical, 69% (K = 0.3) for the lateral segment, 48% (K = 0.13) for the posterior segment and 60% (K = -0.13) for the inferior segment. Discrepancies between the two of techniques were most notable in the posterior region. Beam hardening during passage of the contrast medium through the heart chambers and descending aorta is possible explanation of the artifacts on EBCT images. This study demonstrates that nowadays EBCT is not yet alternative to SPECT in the assessment of the myocardial perfusion in patients and further improvements of scanning techniques are necessary.

[Renal scintigraphy with captopril in the diagnosis of renovascular hypertension]. / Stsintigrafiia pochek s kaptoprilom v diagnostike renovaskuliarnoi gipertonii.

Altogether 16 patients with arterial hypertension (AH) were examined. Of these, 11 were with stenosis of renal arteries, 4 had essential hypertension (EH) and I with nephrogenous parenchymatous AH. To estimate the influence of captopril on the total and separate renal function in patients with and without stenosis of renal arteries and the possibility of the use of the given pharmacological test in the diagnosis of renovascular hypertension (RVH), all the patients underwent renal scintigraphy with 99Tc-DTPA on admission to the hospital and 1-7 days after a single intake of 25 mg captopril per os. Later on in the operated patients the results of the test were compared with the hypotensive effect of the surgery. The rate of glomerular filtration (RGF) was measured according to the Gates method. In patients with stenosis of renal arteries and EH, the total filtration renal function remained unchanged after the intake of a single dose of captopril. In patients with stenosis of renal arteries, there was a significant decrease of the RGF on the side of stenosis made for by an insignificant elevation of the RGF in the contralateral kidney, which was accompanied by an increase of asymmetry of the renograms. In patients with no hypotensive effect of the surgery, the test with captopril was negative, which supports the possibility of this test application in the diagnosis of RVH.