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Dilation cardiomyopathy (DCMP) remains a disease with poor prognosis.Aim. To study the importance of risk stratification improvement for fatal outcomes, especially sudden cardiac death (SCC), with the aim for on-time prevention procedures, as the previously proposed non-invasive electrophysiological predictors — heart rhythm turbulence (HRT) and variability (HRV), microvolt alternation of T wave (mTWA), deceleration capacity (DC) and acceleration capacity (AC) in DCMP are not studied well enough.Material and methods. During 4 years there was follow-up of 54 DCMP patients and sinus rhythm at the age 42 [30;58] year-old (36 males) and control group — 54 persons with no cardiovascular pathology (32 males, mean age 47 [27;64] y.o.). At baseline the Holter monitoring was done, of ECG with HRV, HRT, DC, AC, mTWA assessment, and echocardiography. Patients took standard treatment of chronic heart failure (CHF); part of cardioverter-defibrillator (CD) implanted was 18,5%.Results. Mean ejection fraction (EF) in the main group was 32% [22;38], signs of CHF had 93% of patients. Those with DCMP differed from the main group by significantly lower values of SDNN, pNN50, DC, TO, TS, higher AC and mTWA in early morning. During 4 years there was 1 SCD, and 7 died from CHF progression; there was 1 adequate shock in CD patient (totally 9 deaths). Comparing to those survived, died patients had had lower EF, HRV, DC, maximal mTWA values, higher end diastolic volume, CHF class, AC, mTWA, number of episodes of non-sustained ventricular tachycardia (nsVT) in morning. Under monofactorial analysis there was significant influence on fatal outcome risk of the following (in order of declining significance): EF (odds ratio (OR) 32), SDNN (OR 21), DC (OR 9), AC (OR) 7, pNN50 (OR 6), nsVT (OR 5,2; p=0,05). In multifactor analysis the only independent predictor of fatal outcomes was the decrease of EF of the left ventricle less than 26% (sensitivity 80%, specificity 90%).Conclusion. DCMP patients, comparing to persons with no cardiovascular pathology, have decreased HRV and DC, increased AC, more common pathological HRT, increase of mTWA in early morning, and in those died these specifics was more prominent. In monofactor analysis the non-invasive electrophysiological predictors associated with poor DCMP prognosis, were AC, SDNN DC, pNN50, nsVT. However the most significant and the only independent predictor of fatal outcomes in DCMP patients is the decrease of EF. If to apply the EF less than 26% as a criteria of high risk, it predicts the 32 times increase of fatal outcomes risk with sensitivity 80% and specificity 90%.

The main clinical presentation of noncompaction myocardium (NCM) as nosologic unit are thromboembolic syndrome, heart failure, mostly ventricular arrhythmias and ischemia itself, related to insufficient myocardium blood supply under the noncompacted layer. Also, there are only sporadic cases of myocardial infarction described (MI), including “idiopathic”, in NCM.Aim. To check the prevalence of acute MI in patients with NCM, the specialties of clinical picture, diagnostics, and its probable specific mechanisms, influence on prognosis and its ways of prevention.Material and methods. Totally, 10 patients included, 7 males and 3 females, mean age — 46,3±15,8 y. o., (30 to 76 y. o.) among 85 patients with verified NCM diagnosis, set in accordance with harmonized visual criteria, and developed MI on this background. In 4 cases the NCM is confirmed with three visualizing criteria (EchoCG, MSCT, MRI of the heart), in 4 other — with the two. Mean follow-up was 10,5 [1,75; 32,25] months — from 1 month to 1 year. All patients underwent ECG, ambulatory ECG recording by Holter, EchoCG, assessment of antibodies against various heart antigens, PCR for DNA of parvovirus and B19, as well as herpes group, in blood; 7 coronary arteriographies, 7 MSCT of the heart, measurement of Troponin (n=7), morphological investigation of the heart with PCR-diagnostic of viral infection (n=6), MRI (n=5) and myocardium scintigraphy with 99mТс (n=6).Results. In 4 among 10 patients the development of MI was the first presentation of NCM. Prevalence of coronary atherosclerosis in those with MI and NCM was 20%, however in most cases development of MI was not related with coronary atherosclerosis. Intracardiac thrombosis was verified in 60% of patients with MI, embolism to other organs in 30%. The following mechanisms of MI established: 1) thromboembolism to coronary arteries if thrombi are present in the left chambers of the heart (atrium a. w.a. ventricle), verified in 1 patient at autopsy, and is suspected in other five; 2) concomitance of myocarditis, incl. viral, with microvasculitis development and thrombosis of intramyocardial arteries and focal necrosis in ischemized myocardium (n=6); 3) thrombosis of coronary arteries with presence of hemodynamically significant atherosclerosis (probably 1 patient); 4) sudden worsening of blood supply under noncompacted layer under the circumstances of low cardiac output by secondary origins.Conclusion. MI is typical and unrare complication of NCM: its prevalence reached 11,8% in separate registry of 85 patients with NCM syndrome. Four probable mechanisms of MI (necrosis) in NCM (embolism, thrombosis, myocarditis, microcirculation disorder) might be comorbid. The development of MI leads to serious worsening of the baseline systolic dysfunction and ventricular rhythm disorders: mortality among MI patients with NCM is 20% with the mean time of follow-up 10,5 months. As a preventive matter against MI in NCM should be concerned the anticoagulants at least for atrial fibrillation and in systolic dysfunction, on-time diagnostics and myocarditis management.

Aim. The nosological diagnostics in patients with the baseline syndromic diagnosis “dilated cardiomyopathy” (DCMP) with the use of myocardial biopsy and evaluation of complex treatment (cardiotropic, antiviral, immune suppressing, surgical), including virus-positive and virus-negative patients with myocarditis.Material and methods. Totally, 220 patients included with DCMP syndrome, 69 women and 151 men (31,4% and 68,6%), from 16 to 77 y. o. (mean age — 47,5±12,5,) with dilation and systolic dysfunction of the left ventricle (LV); end diastolic size (EDS) more than 5,5 cm; ejection fraction (EF) less than 50%, and absence of exclusion criteria. Mean EDS was 6,5 [6,0; 7,1] cm, EF — 30,3±10,1%, dp/dt 659 [535; 774,25] mmHg, VTI — 10,8±3,9 cm.The assessments were done of the anticardial antibodies via immune enzyme assay (IEA) and PCR-diagnostics of viral genome in blood of 95,5% patients, tread-mill test (5,9%), coronary arteriography (41,8%), MSCT (67,7%), MRI (22,3%), scintigraphy with 99mТс-MIBI (31,4%), genetic consultation and DNA-diagnostics via sequencing by Senger (21,8% and 16,8%). Morphological study of myocardium was done in 84 (38,2%) patients, incl. 52 endomyocardial biopsies (EMB) with PCR for parvovirus B19 genome and herpes viruses.Results. By the data of clinical-morphological assessment, viral genome in blood was revealed in 21% patients, in myocardium — 52%, definite myocarditis was set in 48%, possible — 8%, genetical DCMP — in 12%, myocarditis with genetic cardiomyopathy — 23% (incl. those with pathogenic mutations in genes MYBPC3, DSP, DSG2, LMNA, EMD, DES, TTR, DTNA), idiopathic DCMP — in 9%. In 59% patients myocarditis was primarily chronic, in more than one third of patients there was combination of several causes for DCMP (incl. alcohol). Short-term and long-term results of treatment were evaluated in 127 patients with myocarditis: 52 virus-positive by blood and/or myocardium (myocarditis morphologically proved in 73,1%) and 75 virus-negative (biopsy in 30,7%), that differed by a little lower EDS LV and lower EF. Significant differences by immunity activation (titres of anticardial antibodies) were not found; in 7% there was isolated viral myocarditis, in 34% — viral-immune; in 59% — immune. If viruses were found, therapy ordered with acyclovir, gancyclovir, entecavir, i. v. immunoglobulines; elimination of virus from the blood reached in 81% of patients. If there was tolerance to cardiotropic therapy and high immune activity, immune suppression therapy (IST) was ordered: in 51% of virus-positive and 62,7% virus-negative patients: steroids 30 [22; 40] and 24 [16; 32] mg/day, azathioprin 1-2 mg/kg, hydroxychloroquine 200 mg/day. In 12,0 [6,0; 20,0] months it was found that only in IST group there was remarkable decrease of CHF FC, LV sizes, MPPA and increase of EF LV from30,3±10,6% to 39,2±11,9% independently from presence or absence of viral genome. In absence of IST such dynamics was not found. The best results were found in virus-negative patients receiving IST (mortality 9,8%, need for surgical treatment 21,3%), the worst — in virus-positive patients without IST (66,7% and 61,1%, respectively).Conclusion. Nosological nature of DCMP syndrome can be defined in most cases; usually there is myocaditis in its origin. IST in high immune activity of myocarditis (high titers of anticardial antibodies) leads to significant increase of EF, decrease of the left ventricle size, MPPA, mortality and necessity of surgery in virus-negative, as in virus-positive patients.

Aim. To evaluate the possibility to increase the effectiveness and safety of anticoagulation therapy in nonvalvular atrial fibrillation (AF) under the circumstances of an office for anticoagulation control located at the University Clinics.Material and methods. Observational prospective study (registry), included 325 patients with nonvalvular AF, taking various anticoagulation drugs for the prevention of thromboembolic complications (TEC). Mean duration of follow-up is 24±12 months.Results. At the current moment about 95% of patients continue taking anticoagulants and follow-up in the office of anticoagulation control. Totally there were 37 bleedings marked, of those 19 minor and 18 major. By the general quantity of bleeding cases there is no significance in the difference between warfarin and “novel” anticoagulants (NOAC) (p>0,05). Major bleedings significantly more common in warfarin group than in NOAC (p

Aim. To analyze the results of first 50 endomyocardial biopsies (EMB) in general care clinic, to clarify the selection criteria and procedure role in management decision in patients with various noncoronarogenic diseases of myocardium. Material and methods. Totally 50 patients included, who had been underwent EMB during 2007-2014 (31 men, mean age 44,3±13,5). Investigation included the level of anticardiac antibodies (n=49), DNA of herpes group viruses and parvovirus B19 by PCR in blood (n=40) and myocardium (n=49), scintigraphy of myocardium (n=20), MDCT (n=21), MRI (n=17), coronary arteriography (n=22), genetician consultation (n=15). EMB of the right ventricle was done using biopsy forceps STANDARD 5.5 F 104 FEMORAL (Cordis). The materials were coloured with hematoxyline-eosine, picrofucsine by Van Hison, Schiff reactives, Pearls, red congo. The study was approved by the Ethics Comitteeof FMSMU. Results. Indications for EMB were set for 3 groups of patients: 1. With dilated cardiomyopathy (DCMP) as a syndrome, including the probability of acute/ subacute myocarditis (n=7), allergic myocarditis (n=1), myocarditis with myocardial infarction (n=1), vasculitis (n=3), possible myocarditis in long-lasting course of DCMP (n=9), in patients with non-compact myocardium, myodystrophy of Emeri-Dreyfus and possible arrhythmogenic dysplasia of the right ventricle (n=7). 2. With "idiopathic" rhythm and conduction disorders (n=18), including high probability of myocarditis (n=13), vasculitis (n=2), necessity for differentiation of myocarditis and genetic cardiomyopathies (n=3). 3. With the syndrome of primary myocardial hypertrophy (n=3). EMB was informative in all patients, myocarditis found in 82,6%.Conclusion. The criteria for high diagnostic value of EMB is nosological way of selection. In addition to current scenarios it is aimfull to perform EMB if clinically significant ischemia with non-changed coronary arteries, with suspected myocarditis in patients with genetic cardiomyopathies, inborn defects, CHD and other established heart diseases. The EMB results define the tactics of medication and surgical treatment.

The work has studied opportunities for ТЕ EPS in serial testing of antiarrhythmic drugs testing to prevent recurrent arrhythmia in patients with atrial fibrillation. Antiarrhythmic drug adjustment was performed in 85 patients with paroxysmal atrial fibrillation. Serial testing implied the usage of all 4 series of antiarrhythmic drugs. Individual effective antiarrhythmic therapy was adjusted in 83 (98 %) patients. Class I drug appeared to be most effective (in 89 % patients) with the best individual result for Cordarone which achieved effect in 61 % cases when administered as 600-800 mg daily. To obtain most reliable results of pharmacological antiarrhythmic therapy adjustment in patients with paroxysmal atrial fibrillation during diagnostic transesophageal electrical stimulation (TEES) and during serial testing of antiarrhythmic drugs it is rational to use "non-aggressive" methods of atrial fibrillation induction: accelerating, frequent and programmed atrial stimulation with one or two delayed stimuli.

The aim of the study was to estimate the effectiveness of transesophageal electrophysiologic assay in diagnostics of paroxysmal nodal reciprocating tachycardias compared to intracardiac electrophysiologic assays and working out treatment strategies in patients with supraventricular paroxysmal tachycardias.We have studied 100 patients with nodal reciprocating tachycardias. Diagnostic transesophageal stimulation was performed in all, and intracardiac electrophysiologic assays to elaborate the nature and mechanism of tachycardias in 85. Effective antiarrhythmic treatment was adjusted by using transesophageal electrophysiologic assays. Series of tests supposed the usage of all 4 classes of antiarrhythmic drugs.Comparative analysis of the data obtained showed the in most cases there was no reliable difference between anterograde functional and effective refractory periods of various parts of the conductive system, as measured by transesophageal and intracardiac electrophysiologic assays. We have worked out principal electrophysiologic criteria of diagnosing paroxysmal nodal reciprocating tachycardias based on transesophageal assays.Individually effective antiarrhythmic treatment was managed in 96% cases. Class I drugs proved most effective (in 70% patients), and propranolol had the best individual result in the daily dose of 20-40 mg (in 50% patients).