Search

Introduction.As a significant number of patients with heart failure (HF) does not respond to cardiac resynchronization therapy (CRT), a lot of research has deservedly focused on optimization, and better patient selection. The ideal resynchronization depends on different factors, from device programming to heart features and left ventricle (LV) lead position. Analysis of the 12-lead electrocardiogram (ECG) is the most simple method which can provide important information on LV lead location, presence of scar at LV pacing site, and fusion of intrinsic activation or RV pacing with LV pacing.Purpose. To analyze the electrophysiological and structural heart features and their correlation with the ECG pattern during biventricular (BV) pacing in patients with HF and CRT devices.Methods. The study included 47 patients (mean age 62.3±8.9 years) with LBBB, QRS duration ≥ 130 ms, left ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during months. All patients had undergone CRT-D implantation. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR), 12-lead ECG, non-invasive cardiac mapping (NICM) (with obtaining the zone of late LV activation (ZLA)) were undertaken prior to CRT devices implantation. NICM with cardiac CT and evaluation of LV lead position, ECG pattern during BV pacing (#1 - fusion complex with increased or dominant R wave, independent of QRS duration, #2- QS pattern with QRS duration normalization, and #3- QS pattern with increased QRS duration) were undertaken after CRT devices implantation. Response to CRT was estimated by echo and was defined as decrease in LV end-systolic volume by > 15% after 6 months of follow-up.Results. CRT was effective in 28 patients (59.5%). According to the results of NICM, zone of late LV activation more often was located at 5,6,11,12 segments, and LV pacing site - at 6,7,12 segments of LV. In the “response” group overlap of scar zone and zone of late LV activation was observed (p=0.005). The presence of scar tissue in the LV pacing site was associated with CRT non-response (pConclusions. A comprehensive examination, including the study of the structural and electrophysiological heart features is important for the optimal positioning the LV lead and subsequent CRT device programming. The simple analysis of the QRS pattern during BV pacing can show whether biventricular pacing is adequately performed and can reveal inadequate CRT programming and LV lead positioning.

P urpose To demonstrate the value of chest computed tomography (CT) in patient with severe COVID-19 viral pneumonia in choosing the optimal treatment strategy Materials and methods Chest CT dynamic studies of a patient with severe bilateral polysegmental viral COVID-19 pneumonia were performed The analysis of CT scans images series is provided Results The presented clinical case demonstrates the influence of the lung CT results in choosing the optimal therapy, including the cytokine storm prevention using the interleukin-6 (IL6) receptor inhibitors The dynamic observation of the lungs in monitoring of the intensive therapy results was performed The changes of CT patterns depending on the disease stage and results of treatment was studied Conclusion The paper shows that CT diagnostics for coronavirus COVID-19 infection helps not only in making an accurate diagnosis, but also is necessary in dynamics for monitoring the course of the disease, including helping to determine treatment tactics to prevent the development of a cytokine storm Ц ель исследования Продемонстрировать возможности компьютерной томографии (КТ) легких в диагностике и динамическом наблюдении для выбора оптимальной тактики лечения тяжелого течения вирусной COVID-19 пневмонии Материалы и методы Предоставляется клинический опыт динамического наблюдения пациента с двусторонней полисегментарной вирусной COVID-19 пневмонией тяжелого течения, с помощью КТ легких Проведен анализ серии компьютерных томограмм органов грудной клетки в динамике Результаты В представленном клиническом примере продемонстрированы возможности мониторинга показателей КТ легких для решения вопроса о выборе терапии, в том числе о применении ингибиторов рецептора интерлейкина-6 (ИЛ6) для предотвращения развития «цитокинового шторма», а также дальнейшего наблюдения за результатами интенсивной терапии Изучена динамика КТ-паттернов в зависимости от стадии течения и результатов лечения вирусной пневмонии Заключение В работе показано, что КТ-диагностика при коронавирусной инфекции помогает не только в постановке точного диагноза, но и необходима в динамике для мониторирования течения болезни, в том числе помогает определиться с тактикой лечения для предотвращения развития «цитокинового шторма»

To demonstrate chest CT changes during the dynamic observation of patients with severe viral COVID-19 pneumonia in the acute period and 6 months after recovery Materials and methods We present a clinical experience and follow-up of two patients with severe bilateral viral COVID-19 pneumonia, using chest computed tomography (CT) in the acute period and 6 months after recovery Series of chest computer tomograms were analyzed in dynamics CT was performed using a low-dose protocol on a Toshiba Aquilion ONE tomograph Total patient radiation dose was less than 6 2 mSv, with an average of 1 5-1 6 mSv per study Results The ability of monitoring of chest CT indicators is demonstrated for making the choice of therapy in the acute period, as well as to assess the long-term consequences 6 months after recovery The dynamic of CT patterns was studied depending on the stage of the course and results of treatment of viral pneumonia Differences of outcomes are shown on patients with a similar clinical course of the disease six months after the same type of treatment Conclusion CT diagnostics for coronavirus infection helps not only in making an accurate diagnosis, but is also necessary in dynamic for monitoring the clinical course and evaluating residual changes after viral pneumonia

Left atrial Intramural hematoma (LAIH) is rare complication cardiac invasive procedures. The article analyses the mechanism of formation of this pathology. The case of the LAIH after percutaneous coronary intervention (PCI) is presented. The patient complained of intensive chest pain. When performing ECHO, LAIH was found. LAIH occupied a large part of the cavity left atrium. The conservative supervision of the patient was chosen despite the compession of the left inferior pulmonary vein and symptoms of the acute heart failure. The successful symptomatic treatment was conducted. Taking into consideration the recent PCI dual antiplatelet therapy was not interrupted. LAIH gradually regressed. Five weeks after the desease began, the patient was discharged from the hospital. Nine months after almost full lysis of LAIH was observed. The discussion section is devoted to the issues of diagnosis, the choice of medical tactics, the necessity of surgical treatment and the stop of antitrombotic theatment.

Aim. To assess the effect of the size and pattern of myocardial structural injury, determined by magnetic resonance imaging (MRI), on response to cardiac resynchronization therapy (CRT) in patients with ischemic and non-ischemic heart failure (HF).Material and methods. Forty seven patients with ischemic and non-ischemic HF (age 62,3±8,9 years (mean±SD), 44,6% females and 55,4% males), left ventricle (LV) ejection fraction 130 ms, and sinus rhythm were included in the study. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) was undertaken to evaluate myocardial scar prior to CRT devices implantation. All CMR analysis was performed on CVI42 software. According to signal intensity, fibrosis zone and “grey zone” were defined for quantitative analysis (proportion and mass) of injury. Scar zone included fibrosis zone and “grey zone”. Scar location was assessed using a 16-segmentLV model. Response was defined as a reduction inLV end systolic volume of >15% at 6 months follow-up and HF functional class amelioration.Results. In nonresponse group there was significantly higher proportion and mass of total scar (median 4% [2,5; 19] vs 24% [7; 44], p=0,012,6 g [3,5; 32,5] vs41 g [8; 86], p=0,013)), fibrosis zone (median 0% [0; 3,5] vs 8% [0; 19], p=0,01,0 g [0; 6] vs14 g [0; 34], p=0,014) and “grey zone” (4% [2,5; 15] vs 15% [7; 23], p=0,018,6 g [3,5; 27,5] vs23 g [8; 39], p=0,25). Response proportion in non-ischemic HF patients was higher than in ischemic HF patients (78,5% vs 28,5%, pConclusion. Response to CRT is significantly higher in non-ischemic than in ischemic HF patients. Nonresponse to CRT is associated with posterolateral scar, regardless of the HF origin. In patients with non-ischemic HF, size of fibrosis zone is lower in the responder group. In patients with ischemic HF, size ofLV structural injury does not affect the CRT efficiency, but lateral scar is associated with CRT nonresponse.

Purpose To investigate the impact of coronary anatomy and pPCI parameters on the most prognostically significant MRI measures of acute MI with ST segment elevation (MVO, infarct size). Methods The study included 52 patients with STEMI and primary percutaneous coronary intervention (pPCI) of infarct-related arteries (IRA). On Days 3–7 contrast-enhanced cardiac MRI was done. Tissue analysis of scans was performed evaluating infarct size, presence and size of MVO. Results The study included 52 patients with first STEMI within 3 hours of symptom onset EF was 49.0±11.0%, and in the comparator group – 45.7±10.5%, p=0,2). MRI-measured infarct size was significantly higher in the group where pPCI was done >3 hours of symptom onset: 18.1±1.7% of the LV mass, compared to the early reperfusion group – 10.9±1.9% (p=0.009). MVO magnitude was also higher in the later pPCI group (2.6±0.64% vs 0.03±0.3% in the comparator group), (p Complete occlusion of IRA was associated with higher IS (16,97±3.3 vs 12.05±1.4, p=0.02). There was no reliable correlations between IRA patientcy and MVO magnitude (p=0.7). Conclusions In this study pPCI timing, in groups of below and more than 3 hours after symptom onset, had no significant impact on EF, as determined by MRI. However, pPCI timing exceeding 3 hours significantly influenced infarct size, the occurrence and magnitude of microvascular obstruction. LAD being the IRA was associated with larger IS, higher risks of MVO development. Patient IRA was associated with smaller IS as determined by MRI. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Healthcare Russian Federation

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): A.L. Myasnikov Institute of Clinical Cardiology, Russian Cardiology Research and Production Complex, Ministry of Health of Russia, Moscow, Russia Background A growing number of publications describe the role of cardiac MRI in STEMI prognostic assessment. Infarct size, microvascular obstruction (MVO) and myocardial heterogeneity are among the most prognostically significant MRI parameters in MI. Primary PCI (pPCI) is the current standard of STEMI treatment. The impact of clinical factors on the development of MVO, myocardial heterogeneity and infarct size remains insufficiently investigated. Purpose To investigate the impact of certain medical history aspects, clinical and laboratory parameters on the most prognostically significant MRI measures of acute MI (MVO, infarct size, myocardial heterogeneity). Methods The study included 52 patients with first STEMI within Results 85% patients were men, with mean age of 59.09 ± 7.7 years. All patients underwent pPCI for reperfusion. The median time from symptom onset to pPCI was 3 hours. We analyzed the influence clinical and laboratory factors impacting cardiovascular prognosis on the development of MVO, infarct size, and myocardial heterogeneity. Odds ratios demonstrated no significant relationship between arterial hypertension (OR 2.10, CI 0.57-7.79 р=0,2), smoking (OR 1.01 CI 0.32-3.20, р=0.9), obesity defined as BMI >30 kg/m2) (OR 0.83 CI 0,50-1.39, р=0.16) and MVO development. However, diabetes mellitus had significant effect on MVO development (OR 4.34 CI 1.34-14.03, р=0.01). With regards to laboratory parameters, relationship between hs-Troponin elevation > >8400 pg/mL and MVO occurrence (OR 7.00, CI 0.79 – 61.74, р=0.04). Correlation analysis demonstrated association between myocardial heterogeneity and BNP (r 0.612, р We also analyzed the factors associated with infarct size and found correlation between this parameter and BNP levels (r 0,553, p = 0,0003), as well as MVO magnitude (r 0,383, p = 0,005). Inverse correlation was found between infarct size and history of hypertension (r -0.380, p = 0.0054) Conclusions Type 2 diabetes mellitus, was found to be an independent predictor of microvascular obstruction on MRI. Elevation of hs-Troponin >8400 pg/mL was found to be associated with MVO development. Correlation data analysis demonstrated that high BNP may indicate higher infarct size and myocardial heterogeneity values (r 0.612, р

Objective: to assess the diagnostic meaning of cardiac magnetic resonance imaging (CMR) in various clinical forms of myocarditis. Materials and methods. 11 (8 men, mean age 32.8±11.1 years) patients (pts), hospitalized with suspected acute coronary syndrome, while an acute myocardial infarction was excluded during the examination (group I); 48 pts (31 men, 43.1±12.7 years), with clinical and instrumental signs of dilated cardiomyopathy (DCM) - group II; and 20 patients (12 men, 39.5±14 years), with episodes of ventricular tachycardia (group III) underwent cardiac magnetic resonance imaging (CMRI). In 38 patients endomyocardial biopsy (EMB) was performed. Results and discussion. According to EMB, signs of active myocarditis were revealed in 10 (34.5%) group II pts and in 3 (37.5%) group III pts; signs of resolved myocarditis - in 8 (27.6%) patients in group II and in 3 (37.5%); minimal morphological changes - in 11 (37.9%) patients of group II and in 2 (25%) patients of group III. In 9 (81.9%) patients of group I MRI data allowed to establish the diagnosis of acute myocarditis. Signs of active inflammation from MRI data were detected in myocardium 5 (10.4%) in group II pts and 7 (35%) in group III pts. In 22 (45.8%) pts in group II and 10 (50%), CMR data corresponded to the picture of resolved myocarditis. In 21 (43.8%) cases of group II and 3 (15%) of group III, MRI revealed minimal structural changes. In pts with clinical and instrumental signs of DCM and/or ventricular tachycardia MRI allows to identify signs of "active myocarditis" with a sensitivity of 37.5% with a specificity of 83.4%. At the same time, in cases of resolved myocarditis and minimal morphological changes MRI has high sensitivity (70 and 71.5%) and specificity (71.5 and 75%, respectively). Conclusion. CMR has high diagnostic significance in patients with infarct-like course of myocarditis. In patients with clinical syndrome of dilated cardiomyopathy or arrhythmias, the sensitivity of MRI in detecting active myocarditis is low (37.5%) with high specificity (83.4%). In cases of minimal structural changes in the myocardium and resolved inflammation, CMR is a good alternative to EMB.

Heart sarcoidosis diagnosis presents great difficulties due to the absence of specific clinical manifestations. Most often, the diagnosis is established during autopsy. Magnetic resonance imaging (MRI) of the heart with contrast enhancement is one of the most informative methods of intravital diagnosis of cardiac sarcoidosis. In this article, two clinical cases, shows the role of MRI of the heart with contrast enhancement in the diagnosis of cardiac sarcoidosis.

Alterations of heart rhythm are a common clinical event. They can be caused by almost any kind of heart disorder. Atrial fibrillation (AF) is the most common type of abnormal heart rhythm. Prevalence of AF in the general population is 1-2%, and given that AF incidence rate continues to increase it can be predicted that the number of patients will be doubled within the next 50 years. This review provides the most recent diagnostic and treatment methods, including both unique domestic antiarrhythmic drugs and non - drug methods for AF treatment which were developed and implemented in clinical practice at NMRC of Cardiology of the Ministry of Health of the Russian Federation.Нарушения ритма сердца - широко распространенное клиническое явление. Их возникновение может быть обусловлено практически любым видом сердечной патологии. Фибрилляция предсердий (ФП) является наиболее распространенной формой нарушений ритма сердца. Распространенность ФП в общей популяции составляет 1-2%, и продолжающийся рост заболеваемости позволяет прогнозировать удвоение количества больных в течение ближайших 50 лет. В данном обзоре представлены новейшие диагностические методики и методы лечения, включающие как уникальные отечественные антиаритмические препараты, так и немедикаментозные методы лечения ФП, разработанные и внедренные в клиническую практику в НМИЦ кардиологии Минздрава России.

To perform comparative analysis of right ventricular (RV) structure and function in patients with various cardiovascular diseases using modern echocardiographic technologies in comparison with magnetic resonance imaging (MRI).The study included 85 patients. Group 1 consisted of 32 patients with idiopathic pulmonary hypertension (IPH) (mean age 35.910.2 years). Group 2 included 27 patients with arterial hypertension (AH) grade 3 (mean age 58.612.3 years). Group 3 consisted of 26 patients with chronic heart failure (CHF) (mean age 56.115.3 years). Control group included 28 healthy volunteers (mean age 38.710.9 years). The main method was transthoracic echocardiography (TTE) using modern technologies, such as three-dimensional echocardiography (3DE), tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). In some patients and healthy volunteers 3DE data were compared with MRI data.Patients with IPH and CHF had minimal RV ejection fraction (EF) both according to 3DE and MRI. Correlation analysis revealed close correlation between RV volumes and EF according to 3DE and MRI. Minimal values of systolic indicator STV according to TDI were observed in patients with CHF. In all groups, including control group, the highest values of STV were obtained at the level of the basal segments and the lowest values at the level of apical segments. STE revealed the same pattern as TDI. According to STE minimal RV strain was observed in IPH and CHF groups and significantly differed not only from control group, but also from AH group.The lowest values of RV EF and strain were observed in IPH and CHF groups. There were no significant differences in these indicators between the groups, that dictates the need for thorough assessment of RV structure and function not only in patients with precapillary, but also with postcapillary pulmonary hypertension. The results of the study confirm good comparability of 3DE and MRI in assessing RV volumes and EF.Цель.Провести сравнительный анализ структурно-функционального состояния правого желудочка сердца у больных с различной сердечно-сосудистой патологией по данным современных эхокардиографических технологий в сопоставлении с магнитно-резонансной томографией (МРТ). Материалы и методы.В исследование включены 85 пациентов. Первую группу составили 32 пациента с идиопатической легочной гипертензией ИЛГ (средний возраст 35,910,2 года); 2-ю 27 человек с гипертонической болезнью (ГБ) 3-й степени (средний возраст 58,612,3 года). Третья группа 26 пациентов с хронической сердечной недостаточностью ХСН (средний возраст 56,115,3 года). Контрольную группу (КГ) составили 28 здоровых добровольцев (средний возраст 38,710,9 года). В качестве основного метода исследования выбрана трансторакальная эхокардиография (ЭхоКГ) с использованием современных технологий, таких как трехмерная ЭхоКГ (3D-ЭхоКГ), тканевая миокардиальная допплерография (ТМД), спекл-трекинг ЭхоКГ (СТЭ). У части больных и здоровых добровольцев данные 3D-ЭхоКГ сопоставлены с данными МРТ. Результаты.Минимальные значения фракции выброса (ФВ) правого желудочка (ПЖ) как по данным 3D-ЭхоКГ, так и по данным МРТ выявлены в группах ИЛГ и ХСН. При проведении корреляционного анализа между значениями объемов и ФВ ПЖ по данным 3D-ЭхоКГ и МРТ выявлена достоверная тесная корреляционная связь. Наименьшие значения систолического показателя Sтк по данным ТМД наблюдались в группе ХСН. Во всех группах, в том числе в КГ, наибольшие значения показателя Sтк регистрировались на уровне базальных сегментов, наименьшие на уровне верхушечных сегментов. По данным СТЭ выявлена такая же закономерность, как и при использовании ТМД. Наименьшие показатели деформации миокарда ПЖ по данным СТЭ отмечались в группах ИЛГ и ХСН и достоверно отличались не только от КГ, но и группы с ГБ. Заключение.Наименьшие значения ФВ и деформации миокарда ПЖ наблюдались в группах ИЛГ и ХСН. Достоверных отличий по этим показателям между указанными группами не выявлено, что диктует необходимость тщательной оценки структурно-функционального состояния ПЖ не только у пациентов с прекапиллярной, но и с посткапиллярной легочной гипертензией. Результаты проведенного исследования подтверждают хорошую сопоставимость 3D-ЭхоКГ и МРТ в оценке объемов и ФВ ПЖ.

Aim To evaluate factors associated with unfavorable predictive characteristics of ST-segment elevation acute myocardial infarction (STEMI) as per data of magnetic resonance imaging (MRI).Material and methods The study included 52 patients with STEMI who underwent a primary percutaneous coronary intervention (pPCI). Contrast-enhanced cardiac MRI was performed for all patients on days 3-7. Delayed contrast-enhancement images were used for assessing infarct size, presence of microvascular obstruction (MVO) areas, and heterogeneity zones.Results Multifactorial analysis showed that independent predictors of MVO were type 2 diabetes mellitus (DM) (relative risk (RR) 1.9, confidence interval (CI): 1.1–3.26, р=0.012), increased levels of brain natriuretic peptide (BNP) (RR 2.04, CI: 1.39–2.99, р=0.004) and creatine kinase (CK) (RR 2.06, CI: 0.52–0.80, р=0.02), and infarct size (IS) (RR 2.81; CI: 1.38–5.72, р=0.0004). Construction of ROC curves provided the quantitative values of study indexes, at which the risk of MVO increased. For BNP, this value was ≥276 pg/ml (sensitivity, 95.7 %; specificity, 37.9 %); for CK ≥160 U/l (sensitivity, 74.1 %; specificity, 61.9 %); and for IS ≥18.8 % (sensitivity, 79.3 %; specificity, 69.6 %). Correlation analysis of risk factors for increased size of the heterogeneity zone showed significant correlations of the heterogeneity zone size with older age of patients (r=0.544, рConclusion Risk of MVO formation as per MRI data increased in the presence of type 2 DM and IS ≥18.8 % (р0.05).

to work out an approach of preoperative drug preparation for CAD patients with low LVEF and varying degrees of compensation for CHF, to study the possibility of using levosimendan (L) in this preparation.We studied 82 patients with severe angina pectoris, multivascular coronary disease, extensive postinfarction zone, LVEF ≤35%, chronic heart failure and proven viable myocardium, which performed CABG. All patients received long - term standard CHF therapy before surgery: loop diuretic, ACE/ARA, beta - blocker, aldosterone antagonist. In the first, retrospective part of the study (39 pts), it was determined which factors could be associated with perioperative AHF. In the second, prospective part (43 pts), the course of the operation and the early postoperative period in patients with compensated and uncompensated heart failure were compared; uncompensated pts received L 2 days before surgery in addition to standard therapy. The third, retro - prospective part of the study (37 pts) was the assessment of operation outcome in patients only with uncompensated pre - operative CHF, but with different preoperative drug preparation.Statistically significant direct influence on the perioperative AHF development was provided by the combined clinical sign - venous pulmonary congestion+orthopnea (p.Цель исследования: определить тактику предоперационной медикаментозной подготовки больных ишемической болезнью сердца с низкой фракцией выброса левого желудочка (ФВЛЖ) и разной степенью компенсации хронической сердечной недостаточности (ХСН), изучить возможности использования левосимендана (Л) в этой подготовке. Материалы и методы. Исследовано 82 пациента с тяжелой стенокардией напряжения, многососудистым поражением коронарных артерий, обширным постинфарктным рубцом, ФВЛЖ ≤35%, ХСН и доказанным жизнеспособным миокардом, которым выполнено коронарное шунтирование (КШ). Все пациенты до операции получали длительную стандартную терапию ХСН: петлевой диуретик, ингибиторы ангиотензинпревращающего фермента/антагонисты рецепторов ангиотензина, бета - блокатор, антагонист альдостерона. В первой, ретроспективной части исследования (39 больных) определяли, какие факторы могут быть ассоциированы с периоперационной острой сердечной недостаточностью (ОСН). Во второй, проспективной части (43 больных) сравнивали исход операции и течение раннего послеоперационного периода у пациентов с компенсированной и некомпенсированной ХСН; вторые дополнительно к стандартной терапии за 2 сут до операции получали Л. Третьей, ретропроспективной частью исследования (37 больных) была оценка этих же показателей у пациентов с некомпенсированной ХСН при разной предоперационной медикаментозной подготовке. Результаты. Статистически значимое прямое влияние на развитие периоперационной ОСН оказал комбинированный признак - воспалительные заболевания легких (ВЗЛ) + ортопноэ (р.

Cardiac resynchronization therapy (CRT) is a contemporary and established treatment for patients with symptomatic heart failure, severely impaired left ventricular (LV) systolic dysfunction and a wide (>150 ms) complex. As with any other treatment, the response to CRT is variable. The degree of preimplant scar burden and scar localization to the vicinity of the LV pacing stimulus are known to influence response and outcome. As well as providing measurements of global and segmental cardiac function, coronary venograghy, CMR also permits localization and quantification of myocardial perfusion and scars. This review explores on the role of CMR in the assessment of patients undergoing CRT, with emphasis on risk stratification and RV and LV leads deployment.

Aim.To compare the results of non-invasive activational mapping in patients with “idiopathic” ventricular arrhythmias (IVA) with the data on myocardial structure obtained by late enhancement magnetic resonance tomography (MRI).Material and methods.Twenty eight IVA patients, mean age 37 y. o. [26; 45], with ventricular arrhythmias of the heart (VA) of 2nd or higher grade by Lown, and 5 healthy volunteers (HV), mean age 29 [29; 30], underwent surface epiand endocardial non-invasive mapping (SEENIM) of the heart with the system for noninvasive electrophysiological investigation of the heart “Amicard 01C” with the analysis of duration of the activation-recovery interval (ARI) of the ventricles, and high resolution MRI (voxel 1,25x1,25x2,5mm) with delayed contrasting.Results.The number of VA in IVA group was 20196 [11479; 29834] for 24 hours. In 11 patients there were episodes of non-sustained ventricular tachycardia (VT). By SEENIM, predominating morphological type of ventricular ectopic activity in 22 patients sourced from the right ventricle myocardium (RV), of those in 20 from outflow tract of the LV (OTLV). There was significantly prolonged ARI in OTLV patients with IVA comparing to HV (pConclusion.In most of IVA patients the source of VA was outflowing tract of the RV. The revealed prolongation of the ARI of this area in IVA patients can be an important factor of IVA onset. Small foci of LV fibrosis, found in late enhancement MRI of the heart and episodes of so called idiopathic VT, might be the earliest presentation of the “tachycardiopathy” at the step of pathology development when there are no signs of LV dilation.

Russian Society of Cardiology (RSC)With the participation: Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian FederationTask Force: Gabrusenko S.A. (Chairman), Gudkova A.Ya.* (Chairman), Koziolova N.A. (Chairman), Alexandrova S.A., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Zaklyazminskaya E.V., Irtyuga O.B., Kaplunova V.Yu., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Saidova M.A., Sanakoev M.K., Stukalova O.V.

Background. In the recent years, there has been an increasing number of publications postulating that data on left atrial (LA) structure obtained by late gadolinium enhancement magnetic resonance imaging (LGE MRI) can improve the management of patients with atrial fibrillation (AF). At the same time, similar data regarding healthy LA myocardium is limited. Aim. To assess structural and functional properties of LA in healthy volunteers (HV) using cardiac magnetic resonance (CMR) (including LGE MRI); to compare these properties in patients with AF and HV. Materials and methods. We included in this study 53 patients with AF (28 without signs of cardiovascular disease, 28 with hypertension) and 23 HV of similar age. All enrolled persons underwent MRI. Cine-MRI was used to assess end diastolic volume of LA (LA EDV), LA ejection fraction (LA EF), left ventricular diastolic index (LV DI). High resolution LGE MRI was performed 15-20 min after gadoversetamide injection using IR 3D gradient echo pulse sequence with fat saturation (TI 290-340 ms, TE 2.44 ms, TR 610-1100ms). On obtained images LA was segmented semiautomatically. LA fibrosis quantification was performed using developed software LGE Heart Analyzer. The extent of fibrosis was represented as percent of LA myocardium volume. Fibrosis location was determined on reconstructed rotating 3D LA model. Results. Compared with patients HV had lower LA EDV (59 [54; 78] ml and 79 [65.5; 86.6] ml, р=0.043, respectively), higher LA EF (56.1 [49; 63.2] % and 44.5 [34.5, 54.5] %, р=0.03, respectively), and lower extent of LA fibrosis (0.7 [0.05; 3.5] % and 9.1 [1.7; 18] %, р

Introduction As a significant number of patients with heart failure (HF) does not respond to cardiac resynchronization therapy (CRT), a lot of research has deservedly focused on optimization, and better patient selection. The ideal resynchronization depends on different factors, from device programming to heart features and left ventricle (LV) lead position. Analysis of the 12 lead electrocardiogram (ECG) is the most simple method which can provide important information on LV lead location, presence of scar at LV pacing site, and fusion of intrinsic activation or RV pacing with LV pacing. Purpose To analyze the electrophysiological and structural heart features and their correlation with the ECG pattern during biventricular (BV) pacing in patients with HF and CRT devices. Methods The study included 47 patients (mean age 62,3±8,9 yrs) with LBBB, QRS≥130 ms, LV ejection fraction (LVEF) ≤35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 months. All patients had undergone CRT-D implantation. Late-gadolinium enhancement-cardiovascular magnetic resonance, 12 lead ECG, non-invasive cardiac mapping (NICM) (with obtaining the zone of late LV activation were undertaken prior to CRT devices implantation. NICM with cardiac CT and evaluation of LV lead position, ECG pattern during BV pacing (#1 - fusion complex with increased or dominant R wave, independent of QRS duration, #2- QS pattern with QRS duration normalization, and #3- QS pattern with increased QRS duration) were undertaken after CRT devices implantation. Response to CRT was estimated by echo and was defined as decrease in LV end-systolic volume by >15% after 6 months of follow-up. Results CRT was effective in 28 patients (59,5%). According to the results of NICM, zone of late LV activation more often was located at 5,6,11,12 segments, and LV pacing site – at 6,7,12 segments of LV. In the “response” group overlap of scar zone and zone of late LV activation was observed (p=0,005). The presence of scar tissue in the LV pacing site was associated with CRT non-response (p Conclusions A comprehensive examination, including the study of the structural and electrophysiological heart features is important for the optimal positioning the LV lead and subsequent CRT device programming. The simple analysis of the QRS pattern during BV pacing can show whether biventricular pacing is adequately performed and can reveal inadequate CRT programming and LV lead positioning.

Purpose Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI) studies were performed on healthy individuals to establish signal intensity thresholds for reproducible left atrial (LA) patchy LGE detection. Using established criteria, differences in LA patchy LGE between healthy volunteers (HV) and patients with atrial fibrillation (AF) or hypertension were analyzed. Methods Fifty-three patents with AF (mean age 56 years, 60% men), 25 patients with hypertension and no history of AF (mean age 54 years, 40% men), and 28 HV (mean age 50 years, 52% men) were enrolled in an observational, non-interventional, case-control prospective study. LA patchy LGE quantification was performed using LGE MRI (1.5 T scanner, voxel size 1.25x1.25x2.5 mm) and the custom-built software based on estimation of LA voxel image intensity ratio and comparison with threshold value obtained from HV data. Results Based on analysis of healthy individuals' data, the optimal threshold value for the left atrial patchy LGE quantification was determined at 1.38. Patients with AF had a higher extent of LA patchy LGE (9.1 [1.72; 18.58] %) than patients with hypertension (3.81 [0.57; 9.51] %) and HV (0.78 [0.05; 3.5] %). The predominant location of LA patchy LGE in AF was in the pulmonary vein ostia region, in hypertension - LA posterior wall, and in HV - lower part of LA posterior wall. In AF patients, the extent of LA patchy LGE correlated with LA end-diastolic volume (r=0.37) and LA ejection fraction (r=-0.4), in HV - with age (r=0.66) and LA end-diastolic volume (r=0.4). Conclusion AF and hypertension are associated with higher extent and different location of LA patchy LGE compared to changes caused by natural aging. The extent of LA patchy enhancement correlates with LA dilatation.

Catheter ablation is presently the main method for interventional treatment of atrial fibrillation (AF). Despite improvements of the method and accumulation of personnel’s experience, incidence of recurrent AF following catheter interventions remains high. This review addresses a possibility of using contrast-enhanced cardiac magnetic resonance imaging to increase the effectiveness of interventional treatment of arrhythmia.

Rationale: Atrial fibrillation (AF) is the most common type of arrhythmia. Left atrial abnormalities in AF require further investigation. Aim: To evaluate characteristics of myocardial structure of the left atrium by magnetic resonance imaging (MRI) with delayed contrast enhancement in patients with AF associated with essential hypertension (EH), in those without any cardiovascular disorders, and in patients with AF after cryoablation of the pulmonary artery orifice. Materials and methods: The study enrolled 53 patients with AF (mean age 56 years). Twenty eight of them had AF without any associated cardiovascular disorders (lone AF, or LAF group), 25 patients had AF related to EH (AF + EH group). Three patients had undergone anti-arrhythmic intervention. Cardiac MRI was performed in all patients with high resolution late gadolinium enhancement (LGE) at 15–20 min after i.v. gadoversetamide (0.15 mmol/kg). For LGE MRI, we used a novel high resolution inversion recovery (inversion times 290–340 ms) magnetic resonance pulse sequence with isotropic voxel (size 1.25 . 1.25 .2.5 mm) and fat saturation. Left atrium walls were segmented semi-automatically on the LGE images. Left atrium fibrosis quantification was performed with the original software LGE Heart Analyzer, developed in Russian Cardiology Research and Production Complex (Moscow). Results: Left atrium fibrosis (mean, 9 [1.7; 18] %) was found both in patients with AF + EH and with lone AF. There was a trend towards more significant left atrial fibrosis in the group of AF + EH, compared to that in the lone AF group (10.972 [6.98; 19.366] % vs 4.37 [0.893; 18.575] %, respectively, p = 0.1). The extent of left atrium fibrosis correlated with left atrium dilatation (r = 0.37, p < 0.001) and with the decreased ejection fraction (r = -0.4, р < 0.001). The patients who had undergone an antiarrhythmic intervention, demonstrated formation of intensive LGE zones in the ablation areas. Conclusion: Quantification of atrial myocardial fibrosis by high resolution LGE MRI in AF patients is feasible with the use of the original software LGE Heart Analyzer.

Cardiac involvement is a well-known feature of neuromuscular diseases. Most commonly cardiac manifestations occur later in the course of the disease. Occasionally severe cardiac disease, including conduction disturbances, life-threatening arrhythmias, and cardiomyopathy, with its impact on prognosis, may be dissociated from peripheral myopathy. We report a case of bundle branch reentrant ventricular tachycardia as primary manifestation of myotonic dystrophy and discuss associated diagnostic and treatment challenges.

Introduction: Arrhythmia can be the only clinical manifestation of the myocarditis due to virus infection. Treatment strategies of such patients are not well developed yet. Coxsackievirus–adenovirus receptor (CAR) persists on the surface of working cardiomyocites and takes part in electrical conductance. Also CAR is a virus provider to the myocardium cells. Recently CAR was found on the surface of platelets the cells which can take part in host defense process by internalization of different particles, including viruses. Viral myocarditis diagnostic is difficult and based on the endomyocardial biopsy (EMB) which can be performed not in the all cases. That's why the search of new peripheral markers is still actual. Case presentation: 48-year-old man was admitted with progressive during 4 years cardiac rhythm and conduction disturbances. The symptoms of heart failure (NYHA class II) and atrial fibrillation (AF) with HR 36-60 bpm with pauses more than 4 seconds were observed. There was revealed decreased LVEF (35%) by ECHO and lesions typical for myocarditis by CMRI with late gadolinium enhancement. The patient refused from EMB. There was elevation of IgG antibodies (against HSV1-2, EBV, CMV), and DNA of EBV and HH6 was revealed by PCR in whole blood. The platelet aggregation test revealed high level of their functional activity. Immunofluorescent analysis showed that 12% of platelet were with internalized HSV1-2 viruses, and the surface of 25% of platelets was CAR positive. The pacemaker (VVI) was implanted and besides the antiviral treatment with valaciclovir (1000 mg daily during 10 days) adding to basic therapy of CHF was prescribed. Ten months later the patient revealed the regress of CH symptoms, increased LVEF 42%, stable sinus rhythm. The level of CMV and EBV IgG in serum decreased. The numbers of platelets with viruses inside decreased dramatically and only 3% of platelets were CAR positive. Conclusion: The chronic viral myocarditis might be a reason of progressive heart rhythm and conduction disturbances. Antivirus therapy showed its effectiveness in this case. Detection of virus persistence inside platelets and CAR on platelets surface can be useful in viral myocarditis diagnostic and in the estimation of antiviral treatment efficacy.