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Background. Over the past few years, scientific data have demonstrated that patients with non-obstructive coronary artery disease can have high risk for adverse cardiovascular events (ACE) despite the absence of severe coronary obstruction. From this point of view, some patients require special monitoring and treatment; we have to find new methods for stratification of the risk of ACE. Aims to study the association of coronary artery calcification (CCA) with indicators of myocardial blood flow (MBF) and myocardial flow reserve (MFR) in patients with non-obstructive coronary artery disease (CAD). Methods. The study included patients (n = 52) with non-obstructive CAD ( 50%), identified by CCTA. All patients received dynamic myocardial SPECT according to the two-day rest-stress protocol with the radiopharmaceutical agent 99mTc-methoxy-isobutyl-isotnitrile and the pharmacological stress-test (adenosine triphosphate 160 mcg/kg/min) to determine quantitative indicators of MBF and MFR. Depending on the calcium index (CI), three groups of patients were formed: 1 without CCA (CI = 0 Agatston units), 19 patients; 2 Mild CCA (CI = 1100 Agatston units), 21 patients; 3 Moderate CCA (CI = 101400 Agatston units), 12 patients. Results. The study included 52 patients (age 55.0 9.8 years, 36 men). The groups differed statistically significantly (p 0.05) in terms of quantitative scintigraphic parameters: stress-MBF, MFR and MBF. When analyzing the groups in pairs, it was found that stress-MBF and MBF were significantly lower in the group with moderate CCA compared to the group without CCA, and MFR was lower in the group with moderate CCA compared to the groups without CCA and with mild CCA. Correlation analysis revealed significant relationships between CI and scintigraphic parameters: stress-MBF ( = 0.46; p = 0.003), MFR ( = 0.48; p = 0.001), MBF ( = 0.48; p = 0.0008), SSS ( = 0.34; p = 0.02) and SDS ( = 0.28; p = 0.046). Conclusions. Even with non-obstructive CAD, identified by CCTA, there is a decrease in MBF and MFR inversely proportional to the level of CI, which can be considered as an early marker of impaired vasodilation reserve of the vascular wall, which develops in atherosclerosis of the coronary artery.

Background. The results of a growing number of international studies support the assumption that the prevalence of coronary microvascular dysfunction is much higher than previously thought, including in patients with heart failure with preserved ejection fraction. Aim. To study the role of coronary microvascular dysfunction in the pathogenesis of heart failure with preserved ejection fraction in patients with non-obstructive lesions of the coronary arteries. Material and methods. The study included 73 patients with non-obstructive lesions of the coronary arteries. Dynamic single-photon emission computed tomography was used to evaluate the parameters of coronary blood flow reserve. Coronary microvascular dysfunction was defined as the presence of reduced coronary blood flow reserve 2. The distribution of patients was carried out depending on the reserve of coronary blood flow: the first group (n=35) included patients with a reduced reserve 2, the second group with preserved reserve 2 (n=38). Statistical processing of the study results was carried out using nonparametric methods: in the analysis of quantitative indicators, the MannWhitney test was used; in the analysis of qualitative features, the analysis of contingency tables using the Pearson 2 test was performed. To search for relationships between variables, correlation analysis with the calculation of Spearman's correlation coefficients was used. Results. In 82.9% of cases, patients in the first group had heart failure, while in patients in the second group, it was diagnosed only in 44.7% of cases (p=0.014). The values of the coronary blood flow reserve correlated with the size of the left atrium (r=0.527; p=0.001), the E/A (r=0.321, p=0.012) and E/e' ratio (r=0.307; p=0.021). In patients with heart failure, the levels of coronary blood flow reserve correlated with the functional class: in patients with functional class I (n=21), the values of this indicator were 2.87 (2.52; 2.94), with class II (n=8) 1.98 (1.65; 2.16), with functional class III (n=17) 1.51 (1.23; 1.69). Conclusion. The presence of coronary microvascular dysfunction is associated with a higher incidence of heart failure with preserved ejection fraction; values of coronary blood flow reserve correlate with parameters of diastolic dysfunction.

To evaluate the role of matrix metalloproteinases (MMP)-2 and 9 and the gene polymorphisms of MMP-2 (rs243865) and MMP-9 (rs3918242) in the course of anthracycline-induced cardiotoxicity (AIC) in women without previous cardiovascular diseases (CVD) during 24-months.A total of 114 women (47.0 [44.0; 52.0] years old) with AIC of NYHA class I-III who received doxorubicin for breast cancer were enrolled.After 24 months patients had breast cancer remission and were divided into 2 groups: group 1 comprised women with adverse course of AIC (n = 54), group 2 comprised those without it (n = 60). Serum levels of MMP-2 were higher by 8% (p = 0.017) MMP9 by 18.4% (p 0.001) in group 1 than in group 2. In group 1 the levels of MMP-2 increased (p 0.001) from 376.8 (329.5; 426.7) to 481.4 (389.8; 518.7) pg/mL, and MMP-9 increased (p 0.001) from 23.6 (21.4; 24.6) to 26.0 (23.3; 27.0) pg/mL at 24 months. In group 2 the both MMP-2 and MMP-9 level decreased at 24 months. Based on ROC-analysis, the levels of MMP2 ≥ 388.2 pg/mL (AUС = 0.64; р = 0.013) and MMP-9 ≥ 21.25 pg/mL (AUС = 0.9; р 0.001) were identified as predictors for adverse course of AIHF. The presence of C/C genotype of MMP2 (OR = 4.76; p = 0.029) and C/C genotype of MMP-9 (OR = 15.2; p 0.0001) were related with adverse course of AIHF and higher levels of MMP-2 and MMP-9.Gene polymorphisms of MMP-2 (rs243865) and MMP-9 (rs3918242) and serum levels of MMP-2 and MMP-9 levels in women without previous CVD were associated with adverse course of AIC during 24 months.