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Introduction. In conditions of the Emergency Cardiology Department, a timely and differential diagnosis of myocardial pathology is especially important in the absence of visible focal changes and significant coronary artery stenosis. This group of patients includes recipients of a transplanted heart, when it is difficult to count on the high sensitivity of perfusion images alone. This can be explained by the diffuse, balanced distribution of ischemia.Objective. To present the possibilities of perfusion myocardial single photon emission computed tomography synchronized with electrocardiography for a detailed assessment of the functional condition of both ventricles of the transplanted heartMaterial and methods. We have presented three clinical case reports of the patients with different pathology of the transplanted heart who referred themselves to the emergency cardiology clinic and underwent electrocardiographysynchronized perfusion myocardial single photon emission computed tomography for diagnostic purposes.Results. In all the cases presented, the radionuclide study influenced making the diagnosis and changing the treatment tactics. In the first case, it was possible to identify focal myocardial changes, for which coronary angiography and percutaneous coronary intervention with thromboextraction were immediately performed. In the second case, the image analysis reflecting the function of the myocardium (polar maps of wall movement and systolic thickening) allowed us to note a low efficacy of treatment for the transplanted heart rejection. In the third clinical case, the initial single photon emission computed tomography suggested the inflammatory nature of changes in the myocardium, which was verified by the results of endomyocardial biopsy.Conclusion. In the presented clinical cases, the urgently performed electrocardiography-synchronized perfusion myocardial single photon emission computed tomography made it possible to perform invasive interventions in time and thereby contribute to the recovery of the graft functional state and patient's condition improvement.

Aim. To evaluate the intersystemic (between the myocardium of the left coronary artery system and the right coronary artery system redistribution mechanisms of perfusion in the myocardium after revascularization in patients with coronary artery disease with focal cardiosclerosis using gated single photon emission computed tomography. Сardiosclerosis foci were initially identified by magnetic resonance imaging. Material and Methods. The study included 17 patients with coronary artery disease with multivessel coronary disease and large-focal cardiosclerosis according to the results of magnetic resonance imaging with contrast; the diagnosis of left ventricular aneurysm was established in 14 patients, the focal subendocardial cardiosclerosis was diagnosed in 3 patients. For various reasons, all patients underwent myocardial revascularization without the left ventricle reconstruction (coronary artery bypass grafting in 10 patients, percutaneous coronary intervention in 7 patients). Magnetic resonance imaging was used as the gold standard for focal cardiosclerosis before revascularization. All patients before and after revascularization underwent gated single photon emission computed tomography with MIBI scan. During the initial analysis of peaks on the profile slices of coronal and transversal midsections passing along the lateral walls of the left and right ventricles, we did not notice a clear visualization of in 8 patients (group 1), while an increased MIBI scan accumulation in the right ventricle myocardium was clearly visualized in 9 patients (group 2). Based on the peaks height of profile curves, we compared changes in the maxima of radiopharmaceutical accumulation before and after revascularization in the lateral walls of the left ventricle and right ventricle. All studies were performed using the original Cardiac Functional Imaging medical program in order to obtain quantitative information about the myocardial function of both the left ventricle, and also the right ventricle. This program made it possible to highlight the right ventricle area even in the case of its weak visualization through the initial formation of parametric images, where the right ventricle area was visualized. Results. When comparing the revascularization results of the two groups, we noted that the left ventricle ejection fraction increased significantly only in patients without initial visualization of the right ventricular myocardium. Left ventricle ejection fraction did not change after revascularization in patients with initially increased accumulation of the radiopharmaceutical in the right ventricle. Globally, only an improvement in the diastolic function of the left and right ventricles was noted in the latter group of patients. In addition, an increase in the right ventricular uptake level was noted for patients with focal cardiosclerosis and the initially increased uptake in the right ventricle after the maximum possible complete myocardial revascularization, which may indicate a redistribution of perfusion in favor of a more intact right ventricular myocardium. Conclusions. 1. In patients without signs of increased visualization of the right ventricle (group 1) after revascularization, we revealed a statistically significant increase in the left ventricle ejection fraction (p-value=0.024), a decrease in the end-systolic volume (p-value=0.024), an increase in the motion in segments corresponding to the peri-infarct scar zone (p-value=0.016), and a change in systolic thickening in the segment of the basal parts of the anterolateral wall (p-value=0.046). 2. Initially increased visualization of the right ventricle in patients with extensive focal cardiosclerosis in the myocardium of the left ventricle suggests the absence of the left ventricle ejection fraction increase after myocardial revascularization. 3. An increase in the visualization of the right ventricle after complete myocardial revascularization indicates an intersystemic redistribution of perfusion in favor of the preserved myocardium of this part of the heart.

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