Search

Progress in the treatment of arrhythmias is associated with the development and implementation in clinical medicine of a number of electrophysiological methods that make it possible to determine and localize the formation and conduction of electrical excitation with a high degree of reliability. At the same time, an increase in the number of invasive procedures can lead to an increase in complications associated with the interventions, which in turn requires radiology specialists to understand the main stages of the intervention technique, and, accordingly, the mechanisms of development of possible complications and their localization. The purpose of the article is to present modern research data on the use of computed and magnetic resonance imaging in determining complications during interventional and surgical treatment of cardiac arrhythmias.

Aim. The study aimed to conduct a systematic review and meta-analysis of randomized clinical trials (RCTs) to determine the effect of pulmonary vein isolation (PVI) on the prognosis of patients with atrial fibrillation (AF) and chronic heart failure with reduced ejection fraction (HFrEF).Material and methods. We searched PubMed (MEDLINE), Google Scholar, and the Cochrane Library databases for studies that compared PVI with a conservative rhythm/heart rate (HR) control strategy in patients with AF and HFrEF. The primary endpoint in the major RCTs examining the effect of PVI on the prognosis of patients with HFrEF was a composite endpoint of all-cause mortality or HF-related hospitalization. Hazard ratios (HRs) based on Cox regression analysis were used as the baseline survival rates for the meta-analysis. To determine the weighted mean differences in improvement in left ventricular ejection fraction (LVEF) in the PVI and non-PVI groups, a pooled analysis of the mean LVEF changes with standard deviations taking into account the number of subjects in the compared groups was performed.Results. For this systematic review, 11 studies were selected from 2216 publications, which included 2379 patients. Three RCTs (n=968) were subjected to meta-analysis on time-to-event outcomes. The average follow-up period was 34 months. According to the meta-analysis, PVI was associated with a significant reduction in the risk of composite endpoint (HR: 0,53; 95% confidence interval (CI): 0,33-0,85; p=0,009). In addition, PVI compared with drug rhythm/rate control was associated with a significant reduction in the all-cause mortality risk (HR: 0,55; 95% CI: 0,34-0,89; p=0,01). Finally, a meta-analysis of 10 RCTs (n=1516) found a significant improvement in LVEF compared with drug rhythm/HR control or atrioventricular node ablation with biventricular pacing. The weighted mean difference in the LVEF change over time after 6-12-month follow-up was 5,25% (95% CI: 4,03-6,47; p

Aim. To evaluate the accuracy of virtual stenting in predicting the physiological effect of percutaneous coronary intervention (PCI) for multilevel coronary artery disease (CAD).Material and methods. In order to define PCI strategy, 34 patients with multilevel CAD underwent assessment of instantaneous wave-free ratio (iFR) with mapping. Using the virtual stenting, predicted iFR (priFR) was assessed. After stent implantation, the factual iFR (fiFR) was re-assessed. A discrepancy between the priFR and fiFR by 0,03 was considered the threshold level of a significant difference and "poor agreement" criterion between measurements.Results. Mean iFR before PCI was 0,77±0,11; after PCI, this indicator increased significantly and amounted to 0,94±0,04 (p

Aim. To conduct a systematic review and meta-analysis to investigate the prognostic role of left atrial (LA) strain assessment using speckle-tracking echocardiography to predict postoperative atrial fibrillation (POAF) in patients undergoing coronary bypass grafting (CABG).Material and methods. We searched the PubMed (Medline) and Google Scholar databases for studies investigating LA strain measures obtained by speckle tracking echocardiography as predictors of POAF in patients after CABG. To determine the difference in the weighted average LA strain parameters, an analysis was made of the global LA strain, peak atrial longitudinal strain (PALS), left atrial conduit strain (LACS) and left atrial contractile strain (LACtS). Odds ratio (OR) values were received from multivariate models reporting association between PALS and POAF and described as pooled estimates with 95% confidence intervals (CI).Results. Twelve studies from 404 publications were selected for this systematic review and meta-analysis. A total of 1093 patients were included in the analysis, with a mean age of 60,5 years. A meta-analysis showed that patients with POAF had lower global LA strain than patients without POAF (difference in weighted values, 5,03%; 95% CI: -6,89 to -3,16; p

Aim. To analyze the right ventricular (RV) functionality in a cohort of heterogeneous cardiac surgical patients with left-sided valvular heart disease and determine the contribution of RV dysfunction in the complicated postoperative period according to echocardiography.Material and methods. A single-center prospective study of patients with left heart defects operated on in 2022 was conducted. Age ranged was 20-81 years, with a median age of 58 years. The study was conducted on a PHILIPS EPIQ CVx system using an X5-1 probe.Results. To estimate the risk of a complicated postoperative period depending on various indicators of RV systolic function assessment, ROC-analysis was performed. The ROC curve of the RV free wall longitudinal strain (RV FW LS) was characterized by the highest AUC value among other RV functional measures, equal to 0,81±0,06 (95% confidence interval (CI): 0,68-0,93), p

Aim. To conduct a systematic review and meta-analysis to compare clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) using conventional coronary angiography (CAG) or fractional flow reserve (FFR)-guided PCI. In addition, FFR-guided PCI and PCI guided with instantaneous wave-free ratio (iFR) were compared.Material and methods. PubMed, Google Scholar databases were searched for studies comparing clinical outcomes in patients with CAD undergoing CAG-guided or FFR/iFR-guided PCI. Dichotomous data analysis was presented as odds ratio (OR) with 95% confidence interval (CI). Adjusted hazard ratio (HR) values from studies with similar evaluation criteria were pooled for meta-analysis.Results. Six randomized controlled trials (RCTs) from 184 publications were selected for this systematic review and meta-analysis. A total of 2193 patients (mean age, 64,2 years, mean follow-up, 28,0 months) were included. Analysis of RCTs showed that CAG-guided and FFR-guided PCI did not have a significant difference in the incidence of major adverse cardiovascular events (MACE) (OR: 0,78; 95% CI: 0,61-1,00; p=0,05; I2=0%), all-cause death (OR: 0,86; 95% CI: 0,51-1,44; p=0,57; I2=0%) or emergency revascularization (OR: 0,69, 95% CI: 0,46-1,04, p=0,08, I2=0%). However, FFR-guided PCI was associated with a reduced risk of subsequent MI compared with CAG-guided PCI (OR: 0,70; 95% CI: 0,50-0,99; p=0,04; I2=0%). In addition to the results of previous RCTs, we conducted a metaanalysis of 3 observational studies. In total, the CAG-guided and FFR-guided PCI groups included 165012 and 11450 patients, respectively. A meta-analysis showed that FFR-guided PCI was associated with a reduced risk of all-cause mortality (HR: 0,74; 95% CI: 0,63-0,87; P=0,0003) and MI (HR: 0,75; 95% CI: 0,61-0,94; p=0,01). In addition, there was no significant difference between iFRand FFR-guided PCI in terms of MACE (OR: 0,97; 95% CI: 0,76-1,23; p=0,81), all-cause mortality (OR: 0,66; 95% CI: 0,40-1,10; p=0,11), MI (OR: 0,83; 95% CI: 0,56-1,24; p=0,37) or emergency repeated revascularization (OR: 1,16; 95% CI: 0,85-1,58; p=0,34).Conclusion. FFR-guided PCI is associated with a reduced risk of all-cause mortality and subsequent MI compared with CAG-guided PCI. At the same time, the iFR-guided PCI is not inferior to the FFR-guided method in terms of MACE rate.

Aim. To develop and evaluate the effectiveness of models for predicting mortality after coronary bypass surgery, obtained using machine learning analysis of preoperative data.Material and methods. As part of a cohort study, a retrospective prediction of in-hospital mortality after coronary artery bypass grafting (CABG) was performed in 2182 patients with stable coronary artery disease. Patients were divided into 2 following samples: learning (80%, n=1745) and training (20%, n=437). The initial ratio of surviving (n=2153) and deceased (n=29) patients in the total sample indicated a pronounced class imbalance, and therefore the resampling method was used in the training sample. Five machine learning (ML) algorithms were used to build predictive risk models: Logistic regression, Random Forrest, CatBoost, LightGBM, XGBoost. For each of these algorithms, cross-validation and hyperparameter search were performed on the training sample. As a result, five predictive models with the best parameters were obtained. The resulting predictive models were applied to the learning sample, after which their performance was compared in order to determine the most effective model.Results. Predictive models implemented on ensemble classifiers (CatBoost, LightGBM, XGBoost) showed better results compared to models based on logistic regression and random forest. The best quality metrics were obtained for CatBoost and LightGBM based models (Precision — 0,667, Recall — 0,333, F1-score — 0,444, ROC AUC — 0,666 for both models). There were following common high-ranking parameters for deciding on the outcome for both models: creatinine and blood glucose levels, left ventricular ejection fraction, age, critical stenosis (>70%) of carotid arteries and main lower limb arteries.Conclusion. Ensemble machine learning methods demonstrate higher predictive power compared to traditional methods such as logistic regression. The prognostic models obtained in the study for preoperative prediction of in-hospital mortality in patients referred for CABG can serve as a basis for developing systems to support medical decision-making in patients with coronary artery disease.

Aim. To conduct a systematic review and meta-analysis of the efficacy and safety of combined oral anticoagulant therapy with vitamin K antagonists (VKA) and antiplatelet therapy with aspirin compared with VKA monotherapy in patients after mechanical valve replacement.Material and methods. We searched the PubMed, Google Scholar databases for studies comparing the risk of thromboembolic events, major bleeding, and mortality in VKA monotherapy versus combined aspirin and VKA therapy in patients with mechanical valve replacement.Results. Eight randomized clinical trials were selected for this systematic review and meta-analysis. In total, 4082 patients were included in the analysis (mean age, 50,8 years, men — 2484 (60,9%)). A meta-analysis showed that the addition of aspirin to VKA, compared with VKA monotherapy, significantly reduced the incidence of thromboembolic events (odds ratio (OR) 0,47; 95% confidence interval (CI): 0,33-0,67; p

Aim. To conduct a systematic review and meta-analysis in order to evaluate the prognostic value of left ventricular global longitudinal strain (LV GLS) and LV mechanical dispersion (LVMD) in ischemic and nonischemic cardiomyopathy.Material and methods. We searched PubMed, Google Scholar and Embase for studies on the prognostic value of LV GLS and LVMD in ischemic and nonischemic cardiomyopathy. Hazard ratios (HR) from included studies were pooled for metaanalysis.Results. Twelve studies were selected from 314 publications for this systematic review and meta-analysis. In total, 2624 patients (mean age, 57,3 years; mean follow-up, 40,8 months) were included in the analysis. Meta-analysis showed that decreased LV GLS was associated with an increased risk of ventricular arrhythmias (VAs) (adjusted HR: 1,10 per 1% of GLS; 95% CI: 1,01-1,19; p=0,03) and major adverse cardiovascular events (MACE): adjusted HR: 1,22 per 1% of GLS; 95% CI: 1,11-1,33; p

Aim. To analyze the factors affecting the accuracy of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) in case of suspected prosthetic valve endocarditis (PVE).Material and methods. The results of PET/CT performed in 66 patients after heart valve replacement were analyzed: 55 patients with suspected PVE (≥3 months after surgery) and 11 comparison groups without PVE (2 months after surgery). In the group with suspected PVE (n=55) at the time of the study, 27% (15/55) had a normal body temperature, 85% (47/55) — no leukocytosis. In 16% (9/55), the examination was performed from 3 to 6 months after surgery and in 67% (37/55) — against the background of long-term antibiotic therapy (ABT). The final diagnosis of PVE was made on the basis of clinical (including 6±3 followup), laboratory, instrumental, and intraoperative (n=40) data: confirmed — in 37 patients; ruled out — in 29 patients. In order to determine the influence of factors on obtaining false PET/CT results, the odds ratio was calculated.Results. In the group with suspected PVE (n=55), the PET/CT results made it possible to establish and rule out PVE in 92% (34/37) and 67% (12/18) of patients, respectively. In 16% (9/55) of patients, false positive (n=6) and false negative (n=3) results. Thus, the sensitivity, specificity and diagnostic accuracy of PET/CT in the diagnosis of PVE were 92%, 67% and 84%, respectively; positive and negative predictive values — 85% and 80%. The analysis of the odds ratio did not reveal the relationship of low inflammatory activity, the interval between surgery and PET/CT from 3 to 6 months, and long-term ABT before PET/CT with false PET/CT results (p>0,05). In the comparison group without PVE (n=11), 91% (10/11) received false positive PET/CT results, and one patient received a true negative result.Conclusion. The data obtained indicate the high informative value of PET/CT in the diagnosis of PVE. Interval >2 months between surgery and PET/CT significantly reduces the accuracy of PET/CT results. Other factors analyzed in the presented group did not affect the accuracy of PET/CT results.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

The absence of consensus regarding the reference values of right ventricular free wall longitudinal strain (RVFWLS) and its predictive value prompted us to conduct a systematic review and meta-analysis of publications on the predictive role of this parameter in patients with pulmonary hypertension (PH).Aim. To study the independent predictive value of RVFWLS in PH patients using 2D/3D speckle tracking echocardiography.Material and methods. Firstly, 317 publications (PubMed) and 857 Google Scholar results were selected. Of the initially identified search results, 12 articles were analyzed. The papers were cohort designed.Results. The total number of patients with PH was 1281. The mean age of patients was 54,7±6,8 years. Four studies compared the RVFWLS with a control group (n=251). The mean RVFWLS were -17,0±2,4% and -24,7±2,2% in the experimental and control groups, respectively. A meta-analysis of the difference between the mean RVFWLS values in experimental and control group patients showed its total increase in PH subjects of 8,06% (95% CI: 5,18-10,94%; p

The differences in mortality rates between Moscow and St. Petersburg require study.Aim. Ranking and comparison of cardiovascular mortality in Moscow and St. Petersburg in 2015 and 2018.Material and methods. Data on the population and mortality rates was assessed according to the Brief nomenclature of causes of death of Federal State Statistic Service. Eleven out of 35 nomenclature lines related to cardiovascular disease (CVD) are represented by 4-digit ICD codes, the rest are represented by groups with 3- and/or 4-digit codes. Standardized mortality rates (SMRs) were calculated based on the European standard. Comparison of SMR differences between Moscow and St. Petersburg in 2015 and 2018 was carried out using the nonparametric Wilcoxon test.Results. The proportion of CVD in all-cause SMR in both cities is about 50%. There were no significant differences in SMR (2018-2015) between Moscow and St. Petersburg for 35 CVDs. The first 3 ranking places in the CVD pattern both in Moscow and St. Petersburg were occupied by CAD, different types of chronic CAD, and stroke. In 2015, their proportion was 58,3% and 48,9% and in 2018, 52,7% and 58,7%. Other causes varied significantly in relation to SMR and ranks in different years, which is probably due to different approaches to determining the code of death cause. The SMR and myocardial infarction contribution to cardiovascular mortality decreased.Conclusion. Differences in cardiovascular mortality between Moscow and St. Petersburg remain. To understand the mortality causes and to develop effective programs to reduce it, it is necessary to eliminate the identified defects.

Aim. To determine the predictive role of estimated pulmonary artery systolic pressure (ePASP) in COVID-19 patients.Material and methods. A retrospective study of inpatients with documented COVID-19 infection was carried out. Maximal follow-up period was 63 days. The study included 108 patients (men, 62; women, 46; mean age, 62,9±15,5 years). At admission, mean NEWS score was 6,0, blood oxygen saturation — 92%. Echocardiography was performed according to standard protocol using Vivid E9 ultrasound system (GE Healthcare). Quantitative measurements were performed according to the current ASE and EACVI guidelines. Statistical analysis was performed using the IBM SPSS Statistics v.26 software (developed by IBM Corporation).Results. Using the CHAID technique, a classification tree was developed and the strongest predictor of an unfavorable outcome was determined (ePASP). Threshold ePASP values, associated with an increased mortality risk were established (42 mm Hg and 50 mm Hg). Three groups of patients were selected based on the main predictor (50 mm Hg). The increased mortality risk was noted in groups 2 and 3 compared to group 1 of patients and amounted to 31,8% and 70% versus 3,9%, respectively. There was also a correlation between the severity of CT lung parenchymal lesions according to computed tomography and the study groups of patients (36% [30-49%] — group 1, 50% [36-76%] — group 2, and 84% [56-92%] — group 3, p=0,001). In groups 2 and 3, the following complications were significantly more frequent: acute respiratory distress syndrome, acute heart failure, multiple organ system failure, venous thrombosis, disseminated intravascular coagulation. In group 3, acute renal failure and systemic inflammatory response syndrome developed significantly more often than in group 1.Conclusion. A comprehensive echocardiography has proven its availability and safety in assessing the condition of COVID-19 patients, allowing to obtain relevant information on pulmonary hemodynamics. Transthoracic echocardiography reduced the risk of complications from invasive diagnostic methods and allowed to abandon the use of the Swan-Ganz pulmonary artery catheter in the studied group of patients. As a result, a relationship was noted between the increase of ePASP and the severity of clinical performance and lung tissue damage according to computed tomography, changes in laboratory blood tests, the severity of the comorbid profile, an increase in respiratory support need.

Objective: To identify specifics of mitral valve anatomy in patients with mitral insufficiency of various origin using the Mitral Valve Quantification (MVQ) technique for an optimal choice of mitral valve repair strategy. Materials and methods: The study included 30 patients (17 male and 13 female) with organic or functional mitral regurgitation of various grades (mean age, 48 ± 5 years). The patients were categorized into three groups depending on the etiology of mitral insufficiency. The first group included 15 patients with degenerative mitral valve regurgitation, the second one included 9 patients with ischemic mitral regurgitation, and the third one was a control group with 6 patients with minimal mitral regurgitation and no structural heart abnormalities. A geometrical model of the mitral valve was developed by the MVQ technique with a Philips iE33 ultrasound machine. In all patients, we assessed the geometrical parameters of the mitral annulus, the type of leaflet defects and chordal apparatus of the mitral valve, leaflet coaptation length, and the angle between the aortic and mitral valves. Results: The following patterns were found at comparison of the geometrical parameters of the fibrous mitral annulus. Compared to other groups, the patients with ischemic mitral regurgitation had higher antero-posterior diameter and commissural diameters (48.7 and 45.7 mm, respectively; р

Aim. To compare long term results of different methods of myocardial revascularization in patients with stable ischemic heart disease.Material and methods. In the study, 352 patients included, with stable ischemic heart disease: mean age 57,6±7,7 y.o. underwent coronary bypass operation (CBG) — group 1 (n=183) and percutaneous coronary interventions (PCI) — group 2 (n=169) with drug eluting stents implantation (1st generation — Taxus, Cypher), with high treatment adherence — medication treatment in postsurgery period. Each group was selected to 2 subgroups: 1 subgroup with 1-2 vessel disease, 2 subgroup with main left coronary artery stem disease and/or severe multivessel disease. Primary endpoints: all-cause mortality, cardiac mortality, non-fatal myocardial infarction, non-fatal stroke. Secondary endpoint: repeated revascularization or appearance of indications to it. Mean time of follow up after CBG was 37,9±6 months.Results. In long term period there were no differences in survival between groups CBG and PCI neither in 1-2-vessel lesion (95,5% vs. 96,8%), nor with stem stenosis or multivessel disease — 95,6% vs 94,1%. Also, there were differences in survival rate depending on the grade of patient comorbidity, regardless revascularization method. There were no differences in groups 1 and 2 in cardiac mortality, nonfatal events. Emerging of indications for repeated myocardial revasculariztion was significantly higher in subgroups with multivessel disease: free from revascularizations, respectively, 97,1% vs 88,0%, in CBG and PCI (p=0,34).Conclusion. Long term survival after PCI with drug eluting stents of 1st generation in comparison to CBG, does not show significant differences in patients with different severity of coronary arteries lesion and high adherence to treatment. However there is dependence on comorbidity evel. Repeated revascularization of myocardium is needed more oftenly after endovascular interventions in stem lesion and/or multivessel disease.

Background. Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need.Aim. To triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting.Material and methods. This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented ischemic heart disease (IHD) who underwent PCI with drug-eluting stent implantation. All patients received dual antiplatelet therapy with acetyl salicylic acid and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting, as well as CYP2C19 genotyping after patient’s discharge and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and in-stent restenosis.Results. Twenty-three patients experienced MACE. According to univariate regression analysis we found following MACE predictors after PCI: diabetes mellitus (p=0.049), P2Y12 Reaction Units (PRU) according to VerifyNow® (p=0.01), number of stented arteries more than 2 (p=0.01), number of implanted stents more than 2 (p=0.01), baseline levels of plasminogen activator inhibitor-1 (PAI-1) (p=0.03) and von Willebrand activity (vWF) (p=0.01). Using multivariate analysis we demonstrated that concomitant diabetes mellitus, PRU ≥202, PAI-1 level ≥75.95 ng/ml, von Willebrand factor activity ≥155.15% are independent predictors of adverse cardiac events after PCI in stable IHD patients. Other clinical characteristics and laboratory indices, including CYP2C19*2 carriage, showed no significant impact on outcomes after elective PCI. Conclusions. Background diabetes mellitus, high on-treatment platelet reactivity (according to VerifyNow®), PAI-1 and vWF presenting activity may be useful for MACE prediction over 28 months of follow-up after PCI with drug-eluting stent implantation.

Aim. To evaluate the influence of gene СYP2C9 activeness via losartan test on the warfarin dosage management in earlier and long-term post-operational periods.Material and methods. Totally 33 patients included with artificial heart valves. All patients underwent assessment of genes carriage by polymorphic marker СYP2C9 by PCR after preparing of DNA from whole blood. The activeness of СYP2C9 was assessed with losartan concentration and its metabolite (E-3174) in urine after single intake of losartan 50 mg.Results. The level of losartan and its active metabolite (E-3174) in urine was a prognostic marker determining therapeutic dose of warfarin in cardiac surgery patients in long-term post-operation period.Conclusion. The СYP2C9 assessment by losartan concentration and E-3174 in“losartan test” might help to determine warfarin treatment dosage in delayed postoperational period that might improve the efficiency and safety of pharmacotherapy in valve prosthesis patients.

Aim. The present study aims to provide a systematic review and meta-analysis to investigate the prognostic role of assessing the severity of myocardial fibrosis using delayed contrast-enhanced magnetic resonance imaging in nonischemic dilated cardiomyopathies.Material and methods. We searched PubMed, Google Scholar for studies that examined the predictive value of quantifying late gadolinium enhancement (LGE) areas in patients with nonischemic dilated cardiomyopathy. Unadjusted hazard ratios (HR) from studies with similar scoring criteria were pooled for meta-analysis.Results. Nine studies were retrieved from 782 publications for this systematic review and meta-analysis. In total, 2389 patients (mean age, 51,9 years; mean follow-up, 39,3 months) were included in the analysis. Meta-analysis showed the extent of LGE was associated with an increased risk of arrhythmic end point (HR: 1,09/1% LGE; 95% CI: 1,02-1,18; p=0,01), major adverse cardiovascular events (HR: 1,07/1% LGE; 95% CI: 1,01-1,13; p=0,03) and all-cause mortality (HR: 1,09/1% LGE; 95% CI: 1,04-1,13; p

Aim. To evaluate the results of surgical treatment of patients with ischemic heart disease in combination with intraoperative intramyocardial introduction of the human gene VEGF165 (angiostimulin). Material and methods. Twenty four patients enrolled in the study were examined using 12-lead ECG, echocardiography, treadmill exercise test, single-photon emission computed tomography of the myocardium with Tc-99m-tetrophosmine, fluorodesoxyglucose (FDG) positron-emission tomography of the myocardium, selective coronarography. Out of 24 patients, 10 patients have been reexamined so far. The effect of the treatment was assessed by the data obtained at the treadmill test, transthoracic echocardiography, myocardial scintigraphy and FDG. Results. All the patients demonstrated a clinical response. The class of effort angina improved, the dose of the prescribed nitric drugs was decreased, exercise tolerance and total stress time rose, quality of life improved. Myocardial scintigraphy registered reduction of the total area and better accumulation of the radiopharmaceutical under load and at rest 3 and 6 months after the operation including myocardial areas which had not been revacularised at coronary artery bypass grafting but had been treated with the preparation of the human gene VEGF165. Conclusion. The results of the study suggest that therapeutic angiogenesis may be an alternative impact on those myocardial areas which are suppled by the affected but ineligible for bypass grafting coronary arteries.

Aim. 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). Material and methods. 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. Results. 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 (7patients). 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, p < 0.05). A direct correlation was found between MIBG absorption (H/M, H/L) and ejection fraction on minimal dobutamine doses (r = 0.77, p < 0.01; r = 0.87, p < 0.001), gain in ejection fraction (r = 0.77, p < 0.01; r = 0.45, p < 0.05), and inverse correlation between MIBG absorption (H/M, H/L) and dyssynergia index on minimal dobutamine doses (r = -0.80, p < 0.001; r = -0.87, p < 0.0001). Conclusion. Patients with CCF demonstrate a correlation between sympathetic activity and volume of viable myocardium, inotropic reserve.