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Aim. To define influence of the left ventricle (LV) perfusion defects on the clinical status dynamics after coronary angioplasty in patients with the expressed myocardium dysfunction of ischemic etiology. Materials and methods. Examined 86 patients (81 men and 5 women aged from 46 to 73 years) before and in 2–3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III–IV, echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion defects of myocardium estimated with use of ECG-gated single photon emission computed tomography. Predictors were defined: perfusion defects on LV apex (in score), perfusion defects in the area of LAD, LCx and RCA (%), the LV global perfusion defects (in score and %). Results. In 42% of cases 6-minute walk test increased to 3 times; The NYHA class decreased by 2 classes (group 1). In 28 cases 6-minute walk test increased to 2 times and the NYHA class decreased on 1 class. In 22 patients 6-minute walk test increased less than 50% of reference values and there was no dynamics NYHA class (50 patients of the group 2). Initial extent of LV global perfusion defects in group 1 – 41,2 ± 4,0%, in group 2 – 58,3 ± 2,4% (р = 0,0004). Similar values are received for perfusion indicators in the area of LAD and the LV apex. Prevalence of myocardial perfusion defects at rest reflects prevalence of a cardiosclerosis in a cardiac muscle. Conclusion. Degree of LV myocardial perfusion defects in patients with the expressed heart failure of ischemic etiology is the key indicator influencing clinical efficiency of coronary angioplasty. Critical size for definition of the favorable forecast of revascularization are 60% and more perfusion defects testifying that in a cardiac muscle the focal cardiosclerosis prevails over the functioning myocardium.

Aim of the study is to show the pathogenetic importance of myocardial revascularization and to estimate quantitatively effi ciency of the treatment of cardiac allograft vasculopathy after heart transplantation.Materials and methods. 30 percutaneous coronary interventions (PCI) were performed to recipients of heart transplant (8 men and 7 women, aged from 18 to 56 years), who were diagnosed with cardiac allograft vasculopathy by coronary angiography within the time period from 1,5 to 12 years after heart transplantation. Before revascularization and one week after tolerances to physical activity, volume characteristics of the left ventricle were defi ned and diastolic function of heart was estimated. Average term of observation after stenting was 35,5 ± 5,5 months.Results. Tolerance to physical activity (from 76,6 ± 8,5 to 116,9 ± 9,6 W), its duration (from 5,4 ± 2,2 to 8,5 ± 4,1 min) and rate pressure product – RPP (from 198 ± 15 to 247 ± 24 P < 0,05) increased. There was a restoration of diastolic function (Ve/Va from 0,57 ± 0,18 to 1,15 ± 0,2 P < 0,05). Signifi cant distinction in time frames of vasculopathy development, frequency and reasons of repeated interventions depending on age of patients is revealed. In the group of patients younger than 30 years of age (7 patients), the time interval between heart transplantation and vasculopathy development is twice shorter, than in more senior patient group, over 45 years old (8 patients). Young patients showed the expressed tendency to develop stent restenosis (20 coronary interventions).Conclusion. Dynamics in functional condition of the left ventricle as a result of revascularization confi rms the leading role of miocardial ischemia in pathogenesis of transplant insuffi ciency due to vasculopathy. The signifi cant factor infl uencing upon long-term result of coronary intervention is the age of the patient.

The decision to install cardiac resynchronization device in patients may be associated not with the apparent clini- cal effectiveness, but for other reasons that require medical consultation. This may be due to the need to create a «bridge» to heart transplantation (HT), for example. In order to predict the outcome of CRT, we observed 54 pa- tients with HF, III–IV functional class NYHA, on the waiting list for HT. Cardiomyopathy was diagnosed in 36 patients, various forms of ischemic heart disease was diagnosed in 17 patients, all with the ECG determined left bundle branch block with QRS complex duration of less than 120 ms. All patients performed gated SPECT before and after CRT with standard methods of research. LVEF at baseline did not exceed 35%. Monitoring was continued for 2 years after the start of the CRT. The results were divided into two groups. Group 1 consisted of patients who need HT for 2 years, in spite of the CRT (11 patients). Group 2 consisted of patients who have an increase in LVEF of at least 10% after CRT (28 patients). When comparing the initial and final performance with the help of the Main- Whitney in both groups, most significant differences were found in the assessment of myocardial perfusion relation- ships lateral walls of LV and RV. The decrease in the ratio between the level of perfusion of the lateral walls of LV and RV < 2,0 reduces the effectiveness of CRT, and within two years, there occured a need for a heart transplant.

The differentiation of the cases of the right ventricular failure in transplanted heart should be complex and challenging. The 28-year old man with dilated cardiomyopathy underwent orthotopic heart transplantation. After transplantation developed right ventricular failure. The biopsy (n = 5) didn’t reveal any signs of myocardial rejection. There were noted some signs of inflammation in lateral right ventricular wall only by gated SPECT. The right ventricular failure increased and 6 months later there was successfully performed the heart retransplantation on the patient. The virusological study revealed the Epstein–Barr virus in myocardium. The explanted heart research excluded limphoproliferative disease by immunogystochemical tests. The final diagnosis is myocarditis.

Humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. These episodes of rejection are often more severe, and more difficult to treat, than classical acute cellular rejection. Hemodynamic compromise, in the absence of acute cellular rejection, called biopsy-negative rejection occurs in 10 to 20% of cardiac allograft recipients. The assessment of hemodynamic compromise can provide functional data in transplant patients that is complementary to myocardial biopsies if the biopsy can miss significant rejection. We present three cases of the biopsy-negative rejection. All patients have studied with gated SPECT phase analysis.