[Effects of coronary angioplasty on clinical status, perfusion myocardial contractility in patients with ischemic chronic heart failure].

Chronic heart failure (CHF) remains widespread and prognostically unfavorable complication of various cardiovascular diseases. Most patients with CHF have atherosclerosis of coronary arteries. Main method of treatment of this condition is endovascular revascularization. In this study we conducted detailed analysis of effects of transluminal balloon coronary angioplasty (TBCA) with stenting on clinical-functional status, changes of perfusion and contractility of left ventricular myocardium in patients with CHF of ischemic etiology. We also identified factors producing unfavorable impact on restoration of myocardial perfusion after stenting.

[Adenosine triphosphate stress (99m)Tc-MIBI single-photon emission computed tomography in the diagnosis Miocardial Iscemia in patients with Microvascular Angina].

PURPOSE: To assess diagnostic potential of (99m)Tc-MIBI-single-photon emission computed tomography (SPECT) with intravenous adenosine triphosphate (ATP) infusion in comparison with exercise stress (EX) SPECT in patients with microvascular angina. MATERIAL AND METHODS: Patients with angina, positive exercise test and normal coronary angiogram (n=25) were included in the study. Patients underwent a three-phase (99m)Tc-MIBI-SPECT scan: at rest, exercise stress test and pharmacological stress with ATP infusion. Perfusion was graded on scale of 0-4. RESULTS: EX- and ATP-SPECT images showed mild reversible perfusion defects in 43 and 50%, moderate - in 19 and 12.5%, severe - in 5 and 16.7% of patients, respectively. CONCLUSION: Our results demonstrate that adenosine triphosphate stress (99m)Tc-MIBI-SPECT is comparable with exercise (99m)Tc-MIBI-SPECT in detection of ischemia and may be useful tool for diagnosing microvascular angina.

[Adenosine triphosphate stress 99mTc-MIBI single-photon emission computed tomography in the diagnosis of ischemic heart disease].

This review is devoted to possibilities of single-photon emission computed tomography (SPECT) combined with pharmacological test with adenosine triphosphate (ATP) to detect myocardial ischemia in patients with ischemic heart disease (IHD). It contains consideration of contemporary problems and limitations inherent in use of pharmacological stress tests in radionuclide diagnostics; discussion of mechanisms of vasodilating effects of ATP in the context of modern concepts of purine receptors; detailed description of technique of pharmacological testing with ATP, as well as contraindications and possible side effects. Experience of foreign studies with the use of ATP stress testing for verification of presence of ischemia in patients with IHD is also presented.

[Perspectives of molecular visualization in cardiology].

The lecture concerns prospects of molecular visualization in cardiology. The term molecular visualization, its aims and problems are characterized Methods of molecular visualization involve such non-invasive techniques as ultrasonic investigation, optic visualization, MR tomography, x-ray CT radionuclide examinations (single photon emission computed tomography and positron-emission tomography). The scope of the above methods and their limits in visualization of biomarker target molecules in different pathological processes on the molecular level, cardiovascular diseases (CVD) are outlined. The discussion covers various methodological approaches to molecular visualization of the processes associated with development and progression of atherosclerosis, visualization of atherosclerotic plaques of a high risk underlying myocardial infarction or stroke, thrombosis, inflammation, apoptosis, cardiac failure; with myocardial regeneration after myocardial infarction, angiogenesis and other conditions as well as assessment of effect of novel target approaches to CVD treatment. For each of the processes (atherosclerosis, thrombosis, angiogenesis, apoptosis, gene expression and other pathological conditions) biomarker target molecules are considered. Optimal among them are molecular targets with established biological and clinical significance, target-receptors or enzymes, contrast substances, molecular probes tropic to biomarker molecular targets having adequate affinity and pharmacodynamics which allows molecular visualization in clinical setting. The investigators are faced with many unsolved problems which can be studied with methods of molecular visualization.

[Using nonselective endothelin receptor antagonist in idiopathic pulmonary hypertension].

Idiopathic (primary) pulmonary hypertension (IPH) is a rare disease of unknown etiology, which is characterized by elevated pulmonary artery pressure, increased total pulmonary vascular resistance, frequently a malignant course with evolving right ventricular decompensation, and a fatal outcome. The diagnosis of IPH is established on the increments in the mean resting and exercise pulmonary artery trunk pressure by more than 25 and more than 30 mm Hg at rest and during exercise, respectively, with a normal pulmonary artery wedge pressure. Endothelin receptor antagonists (ERA) are one of the effective classes of drugs for the treatment of patients with IPH. Bosentan is the first drug from the ERA class that blocks the receptors of both types and that has been recommended by the WHO to treat patients with functional class II-IV pulmonary hypertension. The described case demonstrates the possibility of concomitantly using bosentan in a female patient with IPH shortly after ineffective treatment with a calcium antagonist.

[The role of multidetector computed tomography in detection of myocardial infarction].

UNLABELLED: The aim of the study was to assess the diagnostic value of multidetector computed tomography (MDCT) in detection of myocardial infarction (MI) in acute and chromic stages. MATERIAL AND METHODS: 49 patients with suspected MI were included in the study. In 44 patients the diagnosis of acute MI had been confirmed according to standard criteria. Contrast-enhanced MDCT of the heart and vessels was performed with 4-row MDCT scanner. RESULTS: MDCT detected areas of MI in 39 of 44 patients with proven MI. In 66,7% of cases they were transmural and in 33,3% -- subendocardial. In arterial phase the density of infarcted area was significantly lower than in normal myocardium (mean, 32,6 +/- 3,7 HU versus 101,9 +/- 3,7 HU, correspondingly, p < 0,0001). Mean values of myocardial density in the area of the MI did not change during follow-up (32,6 +/- 3,7 HU vs 41,3 +/- 4,5 HU, ns). In comparison to SPECT, sensitivity and specificity of MDCT in detection of transmural MI were 96,9% and 100%. corr. In the whole group of patients, taking results of troponin test as a gold standard, the sensitivity of MDCT in detection of Q-MI and non-Q MI were 89,1% and 93,5%, correspondingly. CONCLUSION: Cardiac MDCT can reliably detect and localize areas of acute and chronic MI. Contrary to SPECT, it also gives information about stenosis and occlusions in the coronary arteries.

[QT rate dependence in norm and myocardial infarction].

AIM: To assess QT/RR relationship in healthy subjects and in patients with acute myocardial infarction (AMI) using long term 12-lead ECG monitoring. MATERIAL AND METHODS: We studied separately diurnal and nocturnal QT interval rate-dependence using a linear model "QT=beta+alphaxRR" in 42 patients with AMI on 2-nd week of the disease and in 14 healthy volunteers. All necessary parameters were automatically calculated from 24-hour 12 lead ECG recordings using special programs. Myocardial perfusion and infarct size were assessed using 99mTc-MIBI gated SPECT. RESULTS: Long-term ECG monitoring permitted: 1) to detect the ECG lead with most pronounced QT/RR relationship delineated by alpha(max); 2) to determine value of "deltaalpha=alpha(max)-alpha(min)", that characterized spatial heterogeneity of QT/RR relationship. In norm diurnal values of alpha(max) were significantly higher than nocturnal ones (0.207+/-0.037 vs. 0.151+/-0.035, respectively; p<0.01). The alpha(max) values correlated with the size of MI (r=0.42-0.43, p<0.01). Therefore in patients with anterior AMI who demonstrated significantly larger defects of 99mTc-MIBI uptake than patients with inferior AMI, diurnal mean value of amax remained high despite therapy with b-blockers (0.225+/-0.037), and nocturnal alpha(max) value significantly exceeded respective amax value in healthy subjects (0.216+/-0.097 vs 0.151+/-0.035, respectively; p<0.01). Patients with AMI demonstrated an increased mean Da value when compared to normal subjects (in anterior AMI 0.098+/-0.057 vs. 0.039+/-0.014, respectively; p<0.001--diurnal period; 0.104+/-0,042 vs. 0.039+/-0.022, respectively; p<0.001--nocturnal period). In anterior AMI Da values correlated with infarct size (r=0.62, p=0.001). CONCLUSIONS: A new approach to the assessment of QT rate dependence with the use of 12-lead Holter monitoring widens possibilities of the method, firstly, because of selection of most informative ECG lead that shows maximal QT/RR relationship dynamic, and, secondly due, to discovery of the new field of ventricular repolarization research by assessment of space dispersion of QT/RR relationship. In patients with AMI when compared with healthy subjects we observed a decrease of QT/RR circadian modulation, increase of the slope and space dispersion of QT/RR rate dependence.

[Cardiac sympathetic innervation in patients with ventricular arrhythmias: an assessment by 123I-metaiodobenzylguanidine scintigraphy].

The aim of this study was to determine the state of sympathetic innervation in patients with ventricular arrhythmias (VA) using 123I-metaiodobenzylguanidine 123I -MIBG) scintigraphy. Fifty six patients (26 men and 30 women, mean age 37.4+/-11,6) underwent single-photon emission computed tomography (SPECT) imaging and planner scintigraphy after injection of 123I-MIBG (activity 148 MBq). They form three groups. Thirty patients with idiopathic VA (IVA) were included in group I: 14 patients with ventricular extrasystoles (VE) and 16 - with ventricular tachycardias (VT). Group II was formed by 17 patients (with dilated cardiomyopathy, n=7 and chronic myocarditis, n=10), 6 of them had VE and 11 - VT. The control group III was formed by 9 healthy subjects with structurally normal heart without VA. We analyzed early (30 minutes) and delayed (4 hours) images after 123I-MIBG administration. The global sympathetic activity (SA) was assessed by heart/mediastinum ratio and washout rate. Regional SA was assessed by extent and severity of defect. In group I 25 of 30 patients (83.3%) had regional SA abnormalities significantly different from controls (p<0.001). At the same time global uptake of 123I-MIBG in this group was not affected. In group II regional SA abnormalities were revealed in all patients (100%) and global reduction of 123I-MIBG uptake - in 14 patients (82.4%). Regional and global SA abnormalities in group II were different from controls (p<0.0001) and patients with IVA (p<0.001). There was no difference in SA abnormalities between patients with VE and VT. Our results suggest that patients with different VA have abnormalities of sympathetic innervation, including patients with structurally normal heart.

[Assessment of antianginal and antiischemic effect of trimetazidine and its effects on myocardial perfusion in patients with ischemic heart disease and stable angina.]. / Otsenka antianginal'nogo i antiishemicheskogo éffekta trimetazidina iego vliianiia na perfuziiu miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei napriazheniia.

AIM: To assess antianginal and antiischemic effects of trimetazidine and its action on myocardial perfusion in patients with ischemic heart disease and stable angina. MATERIAL: Open trimetazidine was given for 3 months to 53 nitroglycerine and beta-blocker treated men aged 47-69 (mean age 60.2+/-0.85) years with ischemic heart disease and stable angina. Stenoses of 1-3 main coronary arteries were found at angiography in 37 of these patients. METHODS: Registration of frequency of anginal attacks and nitroglycerine consumption, treadmill exercise tests and 24-hour ECG monitoring, assessment of severity of myocardial perfusion defects by scintigraphy with (99m)Tc MIBI were used for elucidation of treatment efficacy. RESULTS: After 3 months number of anginal attacks per week decreased from 9.3+/-0.6 to 4.8+/-05% (-48%, p<0.001), weekly nitroglycerine consumption fell from 9.9+/-0.8 to 4.6+/-0.6 pills (-53%, p<0.001), time to ST-segment depression during exercise on treadmill increased from 6.4+/-0.4 to 7.7+/-0.5 min (+16.9%, p<0.001) and total work performed increased from 7.8+/-0.4 to 9.2+/-0.5 METS (+15.2%, p<0.001). According to 24-hour ECG monitoring numbers of episodes of painful and painless ischemia decreased from 4.1+/-0.9 to 1.9+/-0.7 (-56.3%, p<0.002) and their overall duration shortened from 24.3+/-7.0 to 10.6+/-3.9 min (+56.3%, p<0.02). Analysis of heart rate variability revealed significant augmentation of SDNN in 77.8% of patients (from 130.0+/-6.9 to 145+/-8.1, p<0.05). Severity and extent of myocardial perfusion defects decreased in 87.5% of patients by 24,2% (from 476.1+/-78.5, p<0.01) and 20.3% (from 19.7+/-2.4 to 15.7+/-2.0, p<0.01), respectively. CONCLUSION: The use of trimetazidine as complimentary therapy to nitrates and beta-blockers in patients was associated with additional antianginal and antiischemic effects and improvement of myocardial perfusion.

[Impairment of cardiac sympathetic function in patients with acute myocardial infarction and unstable angina]. / Narusheniia simpaticheskoi innervatsii serdtsa u bol'nykh s ostrym infarktom miokarda i nestabil'noi stenokardiei

AIM: To assess the state of sympathetic innervation of the heart in patients with acute coronary syndrome. MATERIAL: Patients with Q-myocardial infarction (MI, n=36), non-Q-MI (n=13), and unstable angina (UA, n=9). METHODS: Each subject underwent single-photon emission computed tomography (SPECT) and planar scintigraphy using iodine-123 metaiodobenzylguanidine ((123)I-MIBG) for assessment of cardiac sympathetic function. We analyzed early (15 minutes) and delayed (4 hours) images after (123)I-MIBG administration. Resting (99m)Tc-MIBI myocardial scintigraphy was performed for evaluation of myocardial perfusion. Location, extent (%) and severity (Un.) of defects were determined using <> program. (123)I-MIBG did not accumulate in myocardium of 3.5% patients. All other patients demonstrated (123)I-MIBG accumulation defects. These defects were colocolized with (99m)Tc-MIBI uptake abnormalities. However both extent and severity of sympathetic innervation defects exceeded those of perfusion defects in all patients. Mean extent and severity of sympathetic neuronal damage areas were the greatest in patients with Q-MI (41+/-8% and 1119+/-377 Un. respectively) and the least in patients with UA (22+/-12% and 602+/-353 Un., respectively). On the contrary the mean extent of areas with sympathetic endings dysfunction but normal perfusion was the largest in UA group and the least in Q-MI group (18+/-11 and 10+/-7%, respectively, p<0,05). CONCLUSION: Impairment of cardiac sympathetic function in patients with acute coronary syndrome could be detected by SPECT with (123)I-MIBG. Locations of (123)I-MIBG and (99m)Tc-MIBI defects were similar but sympathetic dysfunction areas were larger than areas with reduced perfusion. This result suggests higher sensitivity of sympathetic endings to ischemia compared with cardiomyocytes. Myocardial areas with sympathetic endings dysfunction but normal perfusion can be defined as myocardium at risk.

[Evaluation of myocardial perfusion in patients with hypertrophic cardiomyopathy in comparison with clinical and echocardiographic data]. / Otsenka perfuzii miokarda u bol'nykh s gipertroficheskoi kardiomiopatiei v sopostavlenii s sospostavlenii s klinicheskimi i ékhokardiograficheskimi dannymi.

AIM: To study peculiarities of myocardial perfusion in patients with hypertrophic cardiomyopathy (HCMP) in correlation with clinical and echocardiographic data. MATERIAL AND METHODS: 62 patients with HCMP (23 females and 39 males, mean age 44.4 +/- 11.2 years, the disease duration 13.0 +/- 10.4 years) have undergone ECG, 24-h ECG monitoring, echocardiography, perfusion scintigraphy of the myocardium with 99m-TcMIBI at rest and in combination with bicycle ergometry. The patients were divided into two groups: 35 patients of group 1 had moderate left ventricular hypertrophy (the septal thickness in diastole under 20 mm; 27 patients of group 2 had severe hypertrophy (the thickness was over 20 mm). RESULTS: Dyspnea and syncopal states occurred more frequently in patients from group 2. They also had a higher functional class of heart failure (2.0 +/- 0.8 and 1.2 +/- 0.7 for group 1 and 2, respectively, p < 0.05). Cardiac performance was significantly higher in patients of group 1. The size of the left atrium, left ventricular myocardium mass, the septal thickness and thickness of posterior wall of the left ventricle, gradient of pressure in the outflow tract of the left ventricle proved higher in patients of group 2. Deep stable defects of myocardial perfusion were detected in 5 (15%) patients of group 1 and 10 (37%) patients of group 2. Transient defects of myocardial perfusion were found in 9 (26%) patients of group 1 and 12 (44%) patients of group 2. The index of myocardial ischemia in group 1 patients was significantly lower than in patients of group 2 (3.5 +/- 2.2 and 8.3 +/- 2.5, respectively, p < 0.05). CONCLUSION: Patients with severe hypertrophy of the left ventricle had severe clinical picture, low exercise tolerance, marked hemodynamic changes, more frequent defects of left ventricular perfusion defects compared to patients with moderate hypertrophy of the left ventricular myocardium.

[Preliminary data on combined assessment of tolerance to exercise, left ventricular contractile function in ischemic heart disease patients taking bradycardic agents]. / Predvaritel'nye dannye o kombinirovannoi otsenke tolerantnosti k fizicheskoi nagruzke, perfuzii miokarda i sokratitelnoi funktsii levogo zheludochka u bol'nykh ishemicheskoi bolezn'iu serdtsa na fone priema preparatov s bardikardicheskim deistviem.

AIM: To study effects of bradicardia induced by atenolol, diltiazem and ivabradin on exercise tolerance, myocardial perfusion and left ventricular contractile function in patients with stable angina pectoris. MATERIAL AND METHODS: The trial included 7 male patients aged 57 +/- 2.6 years with coronary heart disease, stable angina of functional class II free of cardiac failure and severe arterial hypertension, with a positive and reproducible VEM test after therapy discontinuation. For 10 consecutive days with 5-day intervals, all the patients received atenolol, diltiazem, ivabradin in doses lowering heart rate at rest by 20% from the initial level. Before the treatment all the patients were studied with VEM test, perfusion synchronized single-photon emission computerized tomoscintigraphy of the myocardium (PSSPECT) at rest and exercise. On day 10 of each drug intake PSSPECT and VEM test were performed if the expected heart rate was achieved. RESULTS: Each of the studied drugs resulted in a 22-24% reduction in the heart rate at rest accompanied by a significant rise in exercise tolerance, improvement of performance and myocardial perfusion. There were no significant changes in left ventricular contractility. CONCLUSION: A 20% reduction in resting heart rate due to monotherapy with drugs having a bradicardic effect leads to positive changes in exercise tolerance and myocardial perfusion.

[Atenolol induced bradycardia in patients with stable angina: effects on exercise tolerance, myocardial perfusion and left ventricular contractility]. / Vliianie bradikardii pri monoterapii atenololom na tolerantnost' k fizicheskoi nagruzke, perfuziiu miokarda i sokratitel'nuiu sposobnost' levogo zheludochka u bol'nykh so stabil'noi stenokardiei.

AIM: To assess effects of atenolol-induced heart rate decrease on myocardial perfusion, left ventricular contractility and tolerance to exercise in patients with chronic coronary artery disease. MATERIAL AND METHODS: Twenty eight men (mean age 54,5-/+9,2 years) with stable class I-III angina and positive reproducible result of bicycle exercise test underwent rest/stress 99mTc-MIIBI gated single-photon emission computed tomography (SPECT) before and after 10 days of administration of atenolol (20 patients) or placebo (8 patients). Dose of atenolol was titrated to achieve at least 15% decrease of heart rate from baseline. RESULTS: After 10 days of treatment with atenolol heart rate decreased from 78-/+3.1 to 59-/+1.1 bpm (p=0.01), whereas in placebo group there were no significant changes. Compared with placebo, treatment with atenolol was associated with significant decreases in extent and severity of perfusion defects, ischemic score and number of ischemic segments. No significant changes of parameters of left ventricular contractility occurred. Treatment with atenolol was associated with symptomatic improvement and increase of the total exercise time. CONCLUSION: Heart rate lowering during monotherapy with atenolol was associated with improvement of myocardial perfusion and tolerance to exercise.

[Myocardial microcirculation in patients with systemic lupus erythematosus]. / Sostoianie mikrotsirkuliatsii miokarda u bol'nykh sistemnoi krasnoi volchankoi.

AIM: To examine myocardial microcirculation in patients with SLE. MATERIAL AND METHODS: Examination of 21 SLE patients consisted of perfusion tomoscintigraphy of the myocardium with Tl-201 at rest and in combination with bicycle exercise. Various protocols were used. RESULTS: The majority of SLE patients had resting disorders of myocardial perfusion: 5 had macrofocal scar lesion of the myocardium, 12 had disorders typical for small-focal myocardial fibrosis. Normal distribution of the perfusion occurred in 4 cases. Tomoscintigraphy performed in combination with exercise test revealed in 11 of 15 patients transient perfusion disturbances reflecting transient myocardial ischemia. One third of the patients had changes characteristic of myocardial ischemia due to coronary atherosclerosis. CONCLUSION: SLE patients have disorders of myocardial perfusion including those characteristic of scar lesion, small-focal cardiofibrosis and transient myocardial ischemia of different genesis: due to disorders in microcirculation and atherosclerotic lesion of major coronary arteries.

[Myocardial tomoscintigraphy with 201Tl in the diagnosis of cardiac involvement in systemic scleroderma]. / Tomostsintigrafiia miokarda s 201Tl v diagnostike porazheniia serdtsa pri sistemnoi sklerodermii.

Myocardial microcirculation was assessed in 23 scleroderma systematica patients using 201Tl tomoscintigraphy at rest (23 patients) and upon dipyridamole vasodilation (6 patients). Most patients were found to have impaired blood supply of the myocardium with sites of myocardiofibrosis. In response to dipyridamole introduction improved myocardial perfusion was registered in 4 out of 6 patients, 1 patient showed signs of transient myocardial ischemia, 1 patient had stable defects of myocardial blood supply. It is suggested that some sclerodermic patients may benefit from vasodilators.