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In this manual, the authors focused on the principal methods for diagnosis of peripheral artery disease in cardiological patients, from the interview and physical examination to functional tests and vascular visualization. Diagnostic and prognostic value of each method, its potentialities for reducing the risk of cardiovascular events (CVE), including myocardial infarction (MI), ischemic stroke (IS) or extremity amputation in critical ischemia, and overall mortality are discussed. The authors provided current information about a possibility of reducing the risk of CVE by intensifying the antithrombotic therapy according to results of the COMPASS study.

Unlabelled: The aim of the study was to assess the diagnostic value of multidetector computed tomography (MDCT) in detection of myocardial infarction (MI) in acute and chromic stages., Material and Methods: 49 patients with suspected MI were included in the study. In 44 patients the diagnosis of acute MI had been confirmed according to standard criteria. Contrast-enhanced MDCT of the heart and vessels was performed with 4-row MDCT scanner., Results: MDCT detected areas of MI in 39 of 44 patients with proven MI. In 66,7% of cases they were transmural and in 33,3% -- subendocardial. In arterial phase the density of infarcted area was significantly lower than in normal myocardium (mean, 32,6 +/- 3,7 HU versus 101,9 +/- 3,7 HU, correspondingly, p < 0,0001). Mean values of myocardial density in the area of the MI did not change during follow-up (32,6 +/- 3,7 HU vs 41,3 +/- 4,5 HU, ns). In comparison to SPECT, sensitivity and specificity of MDCT in detection of transmural MI were 96,9% and 100%. corr. In the whole group of patients, taking results of troponin test as a gold standard, the sensitivity of MDCT in detection of Q-MI and non-Q MI were 89,1% and 93,5%, correspondingly., Conclusion: Cardiac MDCT can reliably detect and localize areas of acute and chronic MI. Contrary to SPECT, it also gives information about stenosis and occlusions in the coronary arteries.

To study the dynamics of signal-averaged ECG and late potentials (LP) in the first month of myocardial infarction (MI) and the impact of coronary reperfusion on them, examinations were made of 98 patients with primary myocardial infarction, in 69 of whom coronary reperfusion was achieved. LP was found to be detectable just in the first hours of MI, their stabilization (steady-state appearance or cessation) mainly occurred at day 3 of the onset. LP detection at this time allowed them to be predicted before the patients' discharge (70% sensitivity and 95% specificity, 82% predictive value in the first 24 hours of MI, LPs are characterized by more instability than those in the subsequent period of the patients' hospitalization. Thrombolytic therapy and coronary artery patency have no impact on the frequency of LP recording and parameters of signal-averaged ECG. No significant difference was found in the frequency of recording LP in anterior and inferior MI before discharge. The frequency of LP recording does not depend on the sex and age of a patient, the maximum creatine phosphokinase levels, and the presence of postinfarction angina pectoris and heart failure.

To examine the impact of exercise test (bicycle ergometry) and exercise-induced transient ischemic changes in ST segment on signal-averaged ECG parameters, the authors studied a homogeneous group including 65 patients (62 males and 3 females) with a 2-3-week history of primary myocardial infarction. The findings showed that induced myocardial ischemia caused no significant changes in signal-averaged ECG and late potentials, exercise might induce late potentials without clear-cut ECG signs of myocardial ischemia. It was also indicated that exercise-labile late potentials were significantly more frequently associated with the development of ventricular arrhythmias than steady late potentials.