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BACKGROUND Numerous studies have shown that coronary reperfusion with primary percutaneous coronary intervention (PCI) improves outcomes in patients with ST-segment elevated myocardial infarction (STEMI). However, the question of the effect on the myocardium as a whole of an isolated intervention on an infarct-related artery in multivessel coronary disease remains incompletely studied.AIM OF STUDY To study the features of perfusion redistribution and myocardial function using perfusion single photon emission computed tomography (SPECT) in patients with STEMI and multivessel coronary disease after isolated PCI on an infarct-related artery.MATERIAL AND METHODS SPECT-ECG (electrocardiography) was performed in 32 patients (27 men and 5 women) with STEMI. According to the ECG results, the location of focal myocardial changes was regarded as “lower” MI in 19 (59%) patients, “anterior” in 13 patients (41%). Coronary angiography revealed a multivessel lesion of the coronary vessels in all of them. The patients were divided into groups according to the location of the infarction and the area of the lesion: group 1 — lower MI (stenting of the right coronary artery (RCA) and its branches) — 19 patients (mean age — 57.7±2.5; median — 55 [51.5; 63.5]), of which 8 with small-focal (1a) and 11 with large-focal infarction (1b); group 2 — anterior MI (stenting of the left coronary artery (LCA) and its branches) — 13 patients (mean age — 55.4±3.5; median — 54 [48.5; 62.5]), of which 5 with small-focal (2a) and 8 with large-focal infarction (2b). SPECT-ECG was performed 3 times: 1st — on days 2–3 after PCI of the infarct-related artery, 2nd — 6 days after PCI, and 3rd — 6 months after PCI.RESULTS After RCA stenting in patients with lower MI and multivessel coronary disease, SPECT-ECG revealed a statistically significant decrease in local contractility of individual segments of the anterior septal and lateral walls (with sufficient revascularization of the RCA system) and worsening of perfusion and right ventricular (RV) volumes. After stenting of the LCA branches in patients with anterior MI and multivessel coronary disease, a statistically significant decrease in local contractility in the basal segment of the diaphragmatic wall was observed, as well as impaired perfusion and an increase in the volume of the RV (with successful revascularization of the anterior interventricular branch). All these findings could be the result of partial steal of the blood supply to neighboring areas and myocardial remodeling after PCI in patients with multivessel coronary artery disease.CONCLUSION 1. According to the data of single-photon emulsion computed tomography synchronized with electrocardiography in the early and late period of myocardial infarction after percutaneous coronary intervention in patients with multivessel coronary disease, there is a significant improvement in perfusion and function of the infarct-associated artery system. 1. Recanalization of only the left coronary artery with remaining stenoses in the right coronary artery in the long-term period can lead to an increase in the size of the cavity of the right ventricle of the heart and uneven distribution of perfusion in its The revealed statistically significant disturbances in perfusion and local contractility of neighboring areas after percutaneous coronary intervention of an infarct-related artery may be the result of steal of the blood supply and early myocardial remodeling in multivessel disease. 3. Disturbances in perfusion and local contractility in neighboring myocardial blood supply pools after percutaneous coronary intervention of an infarct-related artery dictates the need to repeated single-photon emulsion computed tomography synchronized with electrocardiography as early as possible in patients with multivessel coronary disease in order to assess the redistribution of perfusion and myocardial remodeling for timely complete revascularization, preventing recurrent coronary

A case of acute focal myocardial injury in a polymorbid female patient with intact coronary arteries according to direct coronary angiography is reported. Acute focal myocardial injury was detected by ECG-synchronized perfusion single-photon emission computed tomogra-phy (SPECT) of the myocardium, and confirmed by the results of postmortem examination. The article also discusses the possibility of using perfusion SPECT to diagnose acute focal changes against the background of focal inflammatory myocardial infiltration.

Introduction. Cardiovascular diseases rank leading in the world. The decompensation of chronic heart failure is the direct cause of death in most patients. The choice of a definitive treatment tactics is the key factor in these patients.Clinical case. A patient who had experienced myocardial Q-infarction with an ST segment elevation of anterior septal location complicated by the left ventricle anterior wall aneurysm and a decreased myocardial contractility was hospitalized with subcompensated chronic heart failure. Previously, and initially with that hospitalization, the patient was considered a candidate for heart transplantation. After the examination, a decision was made on the possibility of a multi-component reconstructive heart surgery, which was performed with a good clinical effect.Conclusion. The presented clinical case has confirmed the possibility of correcting the combined pathology in a patient with low myocardial contractility obtaining good immediate and long-term (1.5 years after surgery) results.

Aim. To determine the influence of the time gap between acute myocardial infarction with ST-segment elevation and intracoronary intervention performed later than 2.5 hours on myocardium, we studied indicators of perfusion over time with an aid of SPECT, including intraventricular asynchrony (2–4 days and 6–8 months after stent installation). Materials and method. We observed 22 patients with multivessel coronary lesion. The Russian program with the analysis of perfusion, function and the phase images was used in SPECT synchronized with ECG. Results. Showed that the time gap prior to coronary intervention in the acute phase of myocardial infarction may be directly connected with the increase in impaired perfusion during the end-systole and the severity of pathological intraventricular asynchrony without ECG signs. All patients had significantly decreased wall mobility and intraventricular asynchrony together with increased R-R interval in the late period (after 6–8 months) independently from the coronary intervention time. In patients of group 1 (coronary intervention within 6 hours), focal transmural lesions of myocardium significantly decreased. Conclusion. Late revascularization help decrease intraventricular asynchrony reducing the risk of heart failure in future.

Aim. To define influence of the left ventricle (LV) perfusion defects on the clinical status dynamics after coronary angioplasty in patients with the expressed myocardium dysfunction of ischemic etiology. Materials and methods. Examined 86 patients (81 men and 5 women aged from 46 to 73 years) before and in 2–3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III–IV, echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion defects of myocardium estimated with use of ECG-gated single photon emission computed tomography. Predictors were defined: perfusion defects on LV apex (in score), perfusion defects in the area of LAD, LCx and RCA (%), the LV global perfusion defects (in score and %). Results. In 42% of cases 6-minute walk test increased to 3 times; The NYHA class decreased by 2 classes (group 1). In 28 cases 6-minute walk test increased to 2 times and the NYHA class decreased on 1 class. In 22 patients 6-minute walk test increased less than 50% of reference values and there was no dynamics NYHA class (50 patients of the group 2). Initial extent of LV global perfusion defects in group 1 – 41,2 ± 4,0%, in group 2 – 58,3 ± 2,4% (р = 0,0004). Similar values are received for perfusion indicators in the area of LAD and the LV apex. Prevalence of myocardial perfusion defects at rest reflects prevalence of a cardiosclerosis in a cardiac muscle. Conclusion. Degree of LV myocardial perfusion defects in patients with the expressed heart failure of ischemic etiology is the key indicator influencing clinical efficiency of coronary angioplasty. Critical size for definition of the favorable forecast of revascularization are 60% and more perfusion defects testifying that in a cardiac muscle the focal cardiosclerosis prevails over the functioning myocardium.

Humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. These episodes of rejection are often more severe, and more difficult to treat, than classical acute cellular rejection. Hemodynamic compromise, in the absence of acute cellular rejection, called biopsy-negative rejection occurs in 10 to 20% of cardiac allograft recipients. The assessment of hemodynamic compromise can provide functional data in transplant patients that is complementary to myocardial biopsies if the biopsy can miss significant rejection. We present three cases of the biopsy-negative rejection. All patients have studied with gated SPECT phase analysis.

Clinical effectiveness of a new Russian antiarrhythmic agent nibentan, Class III, was studied in various supraventricular arrhythmias. In total, 220 patients with atrial fibrillation (AF), atrial flutter (AFl), supraventricular tachycardia (SVT) and frequent supraventricular extrasystoles (SVE) were examined. ECG monitoring and echocardiography data, electrolyte balance and blood biochemistry were assessed. left ventricular myocardial kinetics and perfusion were studied by computed Tc-99 scintigraphy (Siemens-E. CAM camera, two detectors, 90 degree rotation, 16 gates per cardiac cycle; data analysis with 4DM sped program). Nibentan pharmacokinetics and pharmacodynamics, as well as its metabolite levels, were measured with highly effective chromatography-mass spectrometry. Nibentan was highly effective in various supraventricular arrhythmias, without affecting central hemodynamics or left ventricular perfusion. There was a positive correlation between nibentan administration time, its active metabolite detection, plasma Mg level increase, and QTinterval elongation. Conclusion: Nibentan, a new antiarrhythmic agent, is highly effective for supraventricular paroxysmal arrhythmias (AF, AFl, SVT) management. Due to long QT and ventricular tachycardia risk, nibentan should be administered at cardiac resuscitation departments or intensive care units only.

Aim. To study clinical efficacy of a new, class III, antiarrhythmic agent, nibentan, in various supraventricular (SV) cardiac arrythmias. Material and methods. In total, 153 patients with atrial fibrillation, atrial flutter, or SV tachycardia were examined. Electrocardiography monitoring, echocardiography, electrolyte balance assessment, biochemical blood assay were performed. Left ventricular (LV) kinetics and perfusion was measured by myocardial computer scintigraphy method. The results were processed with 4DM spect program. Results. Nibentan demonstrated high antiarrhythmic activity in various SV cardiac arrhythmias No significant effects on central hemodynamics and LV myocardial perfusion were observed. Conclusion. In this trial, a new medication, nibentan, demonstrated the qualities of a true class III antiarrhythmic agent.

The previouse experimental studies revealed that mezenchimal bone marrow stem cells (MSC) have the ability of differentiating into cardiomiocytes in vitro and in vivo inducting angiogenesis and restoring the impared myocardial function. At that, the cell technology capacities in clinical cardiology remain unstudied.Starting from January 2003 8 patients suffering from heart failure underwent the transplantation of autological MSC with different stages of cultivation: MSC was administered intracoronary to 6 and intramuraly to the post-infarction cardiosclerosis zone. In three cases the MSC were marked with thallium-20 Idirectly before transplantation in order to define the location of MSC during the hours after transplantation. The results of radionuclide scintigraphy demonstrated that in 1, 5 hours after intracoronary administration and in 6, 5 hours after intramyocardial injection MSC remain in the zone of administration. In 1 month after the transplantation the improvement of regional perfusion and diastolic function was observed in old patients. Significant growth of functional ischemia of the left ventricle from 31 to 40 % was observed in patient suffering from ИКМП after intramural administration of MSC. In 1 month after MSC transplantation quality of life and phisical stress tolerance improvement was observed. Intracoronary administered MSC remain in coronary artery, through which MSC was administered. Intracoronary and intramural administration of MSC improves functional indices of retractive myocardial function, increases physical stress tolerance and life quality of patients suffering from chronic heart failure.

Coronary artery disease (CAD) is the main cause of death in renal transplant recipients. The aim of the present study was to determine the frequency and risk factors of post-transplantation CAD and its influence on the long-term results of surgery, as well as to evaluate the efficiency of myocardial revascularization in patients with severe CAD. Analysis of the observation of 479 renal recipients (332 men and 147 women) aged 38.69 +/- 11.2 was performed. The mean follow-up period was 64.56 +/- 37.44 months. Sixty-eight patients had diabetes mellitus. CAD was diagnosed in 14.8% (71 out of 479) renal recipients; in 12.7% of patients it developed de novo and was revealed 32.4 +/- 18.6 months after the surgery. Ten-year survival of renal recipients with CAD was only 39%, while in the group of non-CAD patients it was 75% (p0.0001). Age more than 45, male gender, diabetes mellitus, hypercholesterolemia, infections, pre-existing left ventricular myocardial hypertrophy, and renal transplant dysfunction were defined as significant risk factors of CAD de novo. Multi-factor Cox model found only age more than 45 (p0.009), male gender (p0.00001), and hyperlipidemia (p0.0058) to be independent risk factors of CAD. Myocardial revascularization was performed in 29 patients with coronary lesions: 27 patients underwent percutaneous transluminal coronary angioplasty with stenting and 2 patients underwent coronary artery bypass grafting (5 and 52 months after renal transplantation). However, angioplasty had to be repeated in 6 out of 27 (22%) patients within 3 to 6 months. The average follow-up duration was 23 months (2 to 74 months) after revascularization. Prolonged effect (more than 12 months) was achieved in 17 out of 29 (58.6%) patients. None of the patients developed myocardial infarction after revascularization. Two patients died 28 and 35 months after angioplasty due to extracardial complications (hepatic cirrhosis and an oncological disease); one patient died 78 months after repeated revascularization from progressive cardiac insufficiency while receiving dialysis due to a relapse of renal transplant insufficiency. Thus, CAD develops in 14.8% of renal transplant recipients; in 12.7 of patients it develops de novo. There are conventional and nonconventional post-transplantation CAD risk factors, which include renal transplant dysfunction and post-transplantation infections. Association with myocardial hypertrophy, observed in a significant number of patients, is a feature of post-transplantation CAD. Coronary revascularization, angioplasty with stenting in particular, may be considered to be an effective method of CAD treatment in renal transplant recipients.

To estimate sympathetic activity in patients with ischemic heart disease (IHD) complicated by chronic cardiac failure (CCF) depending on the volume of viable myocardium measured by dobutamine stress echocardiography (DSE).Planar myocardial I-231-MIBG scintigraphy and dobutamine stress echocardiography were made in 16 patients (9 males and 7 females) aged 43-75 years with CCF (NYHA class II-III) and ejection fraction under 35%. The ratio maximal MIBG absorption in the left ventricular myocardium to maximal MIBG absorption in the mediastenum (H/M) and lung (H/L) were estimated.By DSE the patients were divided into two groups: responders in whom contractility improved by 4 and more points (9 patients) and non-responders in whom contractility improved by less than 4 scores (7 patients). The groups did not differ by clinical and hemodynamic parameters but group 2 patients had significantly lower H/M and H/L than group 1 patients (1.38 +/- 0.02 and 1.08 +/- 0.06 against 1.61 +/- 0.09 and 1.25 +/- 0.12, respectively, p0.05). A direct correlation was found between MIBG absorption (H/M, H/L) and ejection fraction on minimal dobutamine doses (r = 0.77, p0.01; r = 0.87, p0.001), gain in ejection fraction (r = 0.77, p0.01; r = 0.45, p0.05), and inverse correlation between MIBG absorption (H/M, H/L) and dyssynergia index on minimal dobutamine doses (r = -0.80, p0.001; r = -0.87, p0.0001).Patients with CCF demonstrate a correlation between sympathetic activity and volume of viable myocardium, inotropic reserve.

Myocardial perfusion was studied in 12 patients with mitral valve prolapse concurrent with cardiac arrhythmias by using two-dimensional 201Tl myocardial scintigraphy at rest and during exercise test. Signs of myocardial ischemia were revealed only in one case. Five patients were found to have steady-state perfusion defects whose extent correlated with the depth of mitral valve prolapse. There was an irregular distribution of myocardial blood flow, which ceased on exercise in 10 out of 12 patients. Patients with ventricular premature contraction displayed a decreased reserve of myocardial blood flow as compared to those with supraventricular premature contraction, presumably by enhancing myocardial perfusion at rest.

A method for quantitative determination of the percentage of left ventricular myocardial 201Tl isotope uptake at rest and during dipyridamole test was first used in patients with dilated cardiomyopathy and coronary heart disease complicated by circulatory insufficiency or chronic myocarditis. This method makes it possible to judge the level of myocardial blood flow and perfusion reserve in these diseases. The most common differences were found between patients with coronary heart disease and those with chronic myocarditis. The patients with chronic myocarditis exhibited the greatest sizes of perfusion defects, highest values of 201Tl uptake at rest and a lower myocardial perfusion reserve during dipyridamole test. In response to exercise, most patients with chronic myocarditis had diminished perfusion defects, whereas those with coronary heart disease displayed increased defects. The myocardial perfusion was varied in patients with dilated cardiomyopathy. Some patients had a scintigraphic pattern close to that in patients with chronic myocarditis and others had a pattern identical to that in patients with coronary heart disease.

Holter monitoring was performed in 61 patients with essential hypertension. Painless, silent ST segment depression was found in 34 patients. Exercise myocardial scintigraphy indicated the occurrence of transient perfusion defects without abnormal clearance (Group 1) and those with abnormal clearance (Group 2). The patients from Group 1 showed more severe myocardial hypertrophy, higher platelet aggregation, coronary atherosclerosis was detected in 1 case. The patients from Group 2 exhibited less myocardial hypertrophy, lower platelet aggregation. Coronary atherosclerosis was revealed in 4 cases. The patients from the two groups had elevated plasma norepinephrine levels at the onset of silent myocardial ischemia.

After equiponderant radionuclide ventriculography the parametric images (phasic and amplitude) of heart function were estimated in 20 patients with dilated cardiomyopathy and in 17 patients with coronary heart disease associated with cardiomegaly. The patients with dilated cardiomyopathy and those with coronary heart disease showed principal differences in local disturbances of the amplitude of movements of left ventricle myocardium walls. While assessing synchronism of myocardial contraction in the patients with dilated cardiomyopathy the presence of the zones of myocardial asynchronism appeared to be a suggestive sign. At the same time the phenomena of asynchronism were not directly connected with impairment of heart conduction and became aggravated as dilatation of the left ventricle progressed, being often coupled with the ECG signs of cicatrical alterations in the myocardium, which came on the phasic images in the form of dyssynergia areas.

During 16-h electrocardiographic monitoring of 29 patients with stage II (WHO) essential hypertension and left ventricular hypertrophy, the episodes of painless "silent" myocardial ischaemia were registered in 12. In these patients a bicycle ergometry test, transoesophageal atrial pacing, isotope ventriculography at rest and during isometric exercise, and coronary angiography in 3 cases, were performed. A comprehensive evaluation of findings revealed the presence of coronary insufficiency not accompanied by pain syndrome. Absence of angiographic signs of coronary stenosis in 3 patients subjected to coronary angiography suggests the presence of relative coronary insufficiency at least in these patients.

Radionuclide ventriculography using the technique of first label passage through cardiac cavities was performed in 60 male patients (mean age 46.8 years) who had suffered myocardial infarction (MI) 3-8 months prior to the investigation. Total and local left-ventricular functions were assessed on the basis of the ejection fraction. In MI survivors, cardiac contractility was reduced significantly as compared to that of clinically normal subjects. No significant differences of ejection fraction could be found in patients with various MI localization. A close relationship was established between the number of low-contractility areas and total ejection fraction magnitude. Post-infarction patients and subjects with abnormal Q wave on their electrocardiograms exhibited the greatest number of hypokinetic areas. Patients with low post-infarction scar localization had more normo-kinetic areas. The number of hyperkinetic areas was somewhat greater in patients with anterior MI, this difference, however insignificant, probably having compensatory value.

A study of 20 patients with essential hypertension, stage IIB, asymmetrical myocardial hypertrophy and chest pains has suggested that the pain syndrome, presenting as "possible angina", positive functional tests and reduced label accumulation around the ventricular septum may be indicative of coronary insufficiency.

Possible use of loading myocardial 201T1 scintigraphy is considered for patients with blocked left peduncle of His' bundle. The procedure is shown to be of considerable value for the prognosis of coronary heart disease in such patients.

Clinical use of the quantitative method of evaluation of myocardial perfusion reserve capacities was analysed in patients with ischaemic heart disease, dilating cardiomyopathy and essential hypertension. Using Tl(201) myocardial scintigraphy, the indicator accumulation in the myocardium was quantitatively evaluated and the interrelationship between the myocardial mass, myocardial perfusion and its reserve capacities in patients with dilative cardiomyopathy was established. It was noted that myocardial perfusion changes in patients with CHD and essential hypertension depend on changes in the cardiac pump function.