[Prediction of Subclinical Coronary Atherosclerosis in Patients with High and Very High Cardiovascular Risk].

Objective To develop a diagnostic rule for detection of patients (pts) with high probability of subclinical atherosclerosis among those with high or very high cardiovascular (CV) risk.Materials and Methods This cross-sectional study enrolled 52 pts (32 men [62 %]), aged 40 to 65 years [mean age 54.6±8.0]) with high or very high CV risk (5-9 and ≥10 % by The Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT) angiography and calcium scoring. Traditional risk factors (RFs) (family history of premature CVD, smoking, overweight / obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB / ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality.Results All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. 26 multiple linear logistic models for any subclinical atherosclerosis were developed based on obtained diagnostic features. Taking into account R-square = 0.344 (p=0.0008), the best fitting model was follows: subclinical coronary atherosclerosis= -1.576 + 0.234 x SCORE ≥5 % + 0.541 x hs CRP >2 g / l +0.015 x heart rate (bpm) +0.311 family history of premature CVD. The developed algorithm had sensitivity of 63 % and specificity of 80 %.Conclusion The created diagnostic model diagnostic model suggests the presence of subclinical coronary atherosclerosis in patients with high / very high CV risk with a high degree of probability. This easy-to-use method can be used in routine clinical practice to improve risk stratification and management choices in high-risk pts.

[An exploration of potential approaches to improve the diagnosis of subclinical atherosclerosis in patients with high cardiovascular risk].

PURPOSE: The search for optimal approaches to the diagnosis of subclinical atherosclerosis using a wide range of traditional and psychosocial risk factors (RFs), as well as clinical and instrumental diagnostic methods in patients (pts) with high or very high cardiovascular (CV) risk. METHODS: This cross-sectional study enrolled52 pts, aged 40 to 65 years with high or very high CV risk (5-9 and ≥10% by the Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT)angiography and calcium scoring. Traditional RFs (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound, arterial stiffness were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality. RESULTS: All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. It was found that patients with subclinical atherosclerosis significantly more often have a very high (≥10%) CV risk (42.9% vs.16.3%, p<0.05), a long (≥5 years) history of arterial hypertension (47.6% vs. 12.9% , p<0.01) and longer duration of antihypertensive therapy (61.9% vs. 29.0%, p<0.05), higher heart rate in rest (87. ± 14 vs. 77 ± 10 beats/min, p<0.01), increased arterial stiffness according to aortic pulse wave velocity (85.7% vs. 61.3%, p<0.05) and high level of hs-CRP (100% vs. 90.3%, p<0.05). CONCLUSION: Using in routine clinical practice of additional anamnestic (hypertension lasting ≥ 5 years and the intake of any antihypertensive drugs) and clinical-instrumental parameters (high heart rate in rest, hs CRP and arterial stiffness in pts with high and very high CV risk increases effectiveness of early detection of subclinical atherosclerosis.

[Detection of early markers of atherosclerosis in men with various levels of risk of cardiovascular complications].

AIM: to assess rate of additional risk factors, and to elucidate association of early markers of atherosclerosis with total cardiovascular risk in a cohort of working age men. MATERIAL AND METHODS: We examined 200 men aged 40-55 years without overt cardiovascular (CV) diseases and with various levels of CV risk. According to level of total CV risk assessed by European SCORE scale subjects were divided into 3 groups: (1) low and moderate risk (SCORE <5%, n=111 [55.5%]), (2) high risk (SCORE more or equal 5 - <10%, n= 57 [28.5%]), (3) very high risk (SCORE 10%, n=32 [16%]). Examination included measurement of carotid intima-media thickness (IMT) and ankle-brachial index (ABI) by duplex scanning, and coronary artery calcium scoring by multispiral computed tomography (MSCT). RESULTS: There was direct relationship between level of CV risk and presence of additional risk factors (hyperglycemia, hyperuricemia, hyperfibrinogenemia, left ventricular hypertrophy). Early markers of arterial atherosclerosis were detected in 52, 48, and 32 men in groups 1, 2, and 3, respectively. Increased IMT was found in 53.8, 75, and 100% of subjects, respectively, and differences between groups 2, 3 and 1 were significant. ABI <0.9 (diagnostic for peripheral atherosclerosis) was found in 15.4, 41.7, and 62.5% of subjects in groups 1, 2, and 3, respectively. According to coronary calcium score (CS) 67.3 and 48% of men in groups 1 and 2, respectively, had very low probability of development of ischemic heart disease (IHD). In group 3 CS 11-100 was 2-3 times more frequent than in other groups. CS 101-400 (associated with moderately high risk of IHD) was found in 6 and 4% of men in groups 3 and 2, and in none of men in group 1. CONCLUSION: Thus elevation of level of total CV risk was associated with increases of IMT and frequencies of detection of peripheral atherosclerosis as well as of moderately elevated CS.

[Ultrasonic tomography in the diagnosis of non-discrete retroperitoneal tumors]. / Ul'trazvukovaia tomografiia v diagnostike zabriushinnykh neorgannykh opukholei.

The ultrasonic tomography has been used among other methods to diagnose nonorganic extraperitoneal tumours in 114 patients. The results have shown the ultrasonic tomography to be an efficient method permitting one to diagnose the tumours in 91.4% of cases studied. The high diagnostic accuracy of the method (87.7%), the absence of irradiation load noninvasiveness and economy of ultrasonic tomography make it a useful method for screening extraperitoneal nonorganic tumours at early stages of patients observation.

[Computed tomography of the normal male and female lesser pelvis]. / Osobennosti komp'iuternoi tomografii muzhskogo i zhenskogo malogo taza v norme.

The paper is concerned with an analysis of transverse slices of male and female small pelvis in CT-images. A high CT resolution in the characteristics of topical interrelationships of the pelvic organs was shown. A variability of the interrelationships of the pelvic organs with respect to their condition and the value of this factor for correct interpretation of tomograms were shown. A thorough preparation of patients for examination of the pelvic organs is very important for establishing diagnosis, topical characteristics and determination of a degree of dissemination of a pathological process.

[Thermography and computed tomography in the diagnosis of cancer recurrence after rectal extirpation]. / Termografiia i komp'iuternaia tomografiia v diagnostike retsidiva raka posle ékstirpatsii priamoi kishki.

The results of thermography and computed tomography of 168 patients following rectum extirpation for cancer were analysed. Of them 116 had symptoms of cancer recurrence and 52 with a poor prognosis were without signs of recurrence. In the 1st group thermography made it possible to record recurrences in 106 (91.4%) patients whereas computed tomography in 102 (87.9%). In thermography overdiagnosis was observed in 8 (6.9%) cases as a result of chronic inflammatory processes in the small pelvis. In computed tomography erroneous results were obtained in 4 (3.5%) cases. In the absence of recurrence symptoms the use of both methods made it possible to detect tumor recurrences in 11 (21.2%) patients at a preclinical stage. In the authors' opinion, thermography provides an opportunity to assume the presence of a recurring tumor and to make up a high risk group of patients who are in need of an active follow-up and thorough examination using other methods.

[Use of computed tomography for planning intracavitary radiotherapy of cervical cancer]. / Primenenie komp'iuternoi tomografii dlia planirovaniia vnutripolostnoi luchevoi terapii bol'nykh rakom sheiki matki.

CT potentialities for irradiation planning have been demonstrated as a result of a study of 20 cervical cancer patients, Stages I-II, using a computerized tomograph for topometric preparation for intracavitary therapy with afterloading units, and subsequent gamma-beam therapy. Complete information on sections that are necessary for clinicodosimetric irradiation planning, has been obtained with the help of digital radiography, transversal tomography and mathematical reconstruction of secondary sections. The study was performed by inserting a centering mount and metrocolpostat after a preliminary determination of A point on the simulator. An effect of the degree of the bladder filling on the organs located in a given section has been shown. It has been established that the degree of the bladder filling at the level of A and B points does not influence a distance from its posterior wall to the metrostat. It is assumed that intestinal radiation injuries can be prevented by controlling the degree of the bladder filling.

[The role of computed tomography in the diagnosis of rectal cancer recurrences]. / Znachenie komp'iuternoi tomografii v diagnostike retsidivov raka priamoi kishki.

The data on 42 cases of radical surgery for rectal cancer were analyzed. Computed tomography detected rectal cancer recurrences involving lymph nodes and organs of small pelvis in 24 patients. Early preclinical signs of rectal cancer recurrence may be identified by the said method.