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The purpose of this guide is to assist cardiologists in the management of patients with chronic heart failure (CHF) in accordance with the available modern evidence base. This manual contains data on the diagnosis, treatment, and rehabilitation of patients with chronic heart failure and data on acute decompensation of heart failure.

Aim. To evaluate the features of myocardial perfusion according to stress CMR with adenosine triphosphate (ATP) in patients with type 2 diabetes mellitus (DM) and obstructive and non-obstructive coronary arteries (CA).Materials and Methods. Stress СMR with ATP was provided in 55 patients with a suspected or known ischemic heart disease. 39 patients of them had DM type 2. All patients were provided with invasive coronary angiography or non-invasive CT angiogram to evaluate lesions of CA. Study protocol included providing myocardial perfusion in a rest and stress with ATP in dose 160 mkg/ kg/min during 3-6 min.Results. The detection of stress-induced perfusion defects was statistically significantly associated with the obstructive CA lesions of more than 50% (p

Aim. To evaluate the potential of qualitative and semi-quantitative analysis of stress adenosine triphosphate perfusion cardiac magnetic resonance imaging (MRI) in patients with obstructive coronary artery disease (CAD) with stenosis ≥50%.Material and methods. Cardiac adenosine triphosphate perfusion stress MRI was performed in 49 patients with suspected or diagnosed CAD. The images were assessed qualitatively and semi-quantitatively. A zone of reduced signal intensity during the first passage of a contrast bolus with stress was taken as a stress-induced perfusion defect. Semiquantitative analysis was based on the construction of signal intensity curves of the contrast agent entering the left ventricular cavity and into the myocardium.Results. The detection of stress-induced perfusion defects according to cardiac stress MRI was significantly associated with coronary artery stenosis ≥50% (p

Aim. To study the relationship between the presence and size of microvascular obstruction (MVO) and the prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) within one year.Material and methods. The study included 50 patients with a first STEMI who underwent PPCI on the infarct-related artery. After 3-7 days and 12 months, contrast-enhanced cardiac magnetic resonance imaging was performed to assess left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and MVOs. After 12 months, patients were rehospitalized and prognosis was assessed based on data on cardiovascular events.Results. Patients with MVO had a significantly lower LVEF in the acute period of MI (44,1±10,6%) compared to patients without MVO (52,9±10,5%), p=0,0209, as well as during reassessment after a year (44,8±11,1%) compared with patients without MVO (58,9±8,0%), p=0,0004. A significant inverse correlation was found between LVEF in the initial and repeat examination and MVO size in the initial examination as follows: ρ=-0,42 (95% confidence interval (CI): -0,66 — -0,12, p=0,008) and ρ=-0,61 (95% CI: -0,78 — -0,34, p=0,0001). There was also a significant inverse correlation between LVEF and MVO size at reassessment, ρ=-0,40 (95% CI: -0,65 — -0,07, p=0,0205). A significant direct correlation was identified between MVO size in the acute MI period and LVEDV one year later, ρ=0,35 (95% CI: 0,02-0,62, p=0,0409). The development of a left ventricular (LV) aneurysm was registered in 40% of patients with MVO during the initial study and was not registered among patients without MVO (p=0,0039).Conclusion. MVOs was associated with post-infarction LV aneurysm. An increase in MVO size correlated with a decrease in LVEF and an increase in LVEDV both in the acute period and one year after MI.

Caseous calcification of the mitral annulus (CCMA) is a rare form of degenerative lesion of the mitral valve fibrous ring. It’s a biochemical transformation of calcification area accompanied with formation of masses of a curdled consistency (caseosis). It is usually located in the area of the posterior mitral valve. In most cases, it is asymptomatic or minimally symptomatic, and is an incidental finding during imaging studies. The causes and pathogenesis of CCMA are unknown, however, there is a connection with disorders of calcium and phosphorus metabolism and there is no connection with an valve infection. There is no specific treatment. In cases where CCMA leads to significant disturbances of cardiac hemodynamics and/or there is a high probability of ebolism, it needs to be treated surgically.Differential diagnosis is carried out with other cardiac mass.

Diagnosis of myocarditis remains one of the most difficult clinical problems in cardiology. In connection with the coronavirus infection COVID-19 caused by the acute respiratory virus SARS-CoV-2, non-invasive diagnosis of myocarditis is an urgent task. The most informative method for diagnosing myocarditis is magnetic resonance imaging [1,2]. The arsenal of MRI includes a number of pulse sequences that make it possible to identify and evaluate the process of inflammation in its various phases. Various pulse sequences (T2-weighted images or T2-mapping, delayed contrast, T1-mapping) allow not only to diagnose the disease, but also to determine the stages of damage. The ability of MRI to differentiate ischemic and non-ischemic lesions [3] is used in emergency cardiology for various myocardial injuries.The peculiarity of this clinical case is the use of MRI diagnostics in a patient with a typical clinical picture of acute coronary syndrome in the emergency department of cardiology. The data of the contrast MRI of the heart allowed the patient to make the correct diagnosis.

Introduction. The presence of diabetes mellitus in patients with acute infarction significantly worsens short- and long-term prognosis, but the features of the course of the infarction in this category of patients have not been fully studied.Objective. To compare clinical, functional and structural myocardial characteristics of patients with acute ST-segment elevation myocardial infarction with and without diabetes mellitus.Materials and methods. The study included 91 patients with revascularized ST-segment elevation myocardial infarction (41 patients with diabetes mellitus). All patients underwent cardiac MRI with contrast, including myocardial T1 mapping, tissue analysis of left ventricular myocardium with determination of infarct zone, heterogeneous zone, edema zone, pre- and post-contrast T1 values, extracellular volume values of healthy myocardium and infarct zone.Results. The presence of diabetes in patients with AMI was associated with increased EDV LV: 153 ± 38 and 181 ± 58 ml (p = 0.007), increased ESV LV: 76 ml [54–93] and 87 ml [71–122] (p = 0.035). Infarct size was significantly larger in patients with diabetes than in those without diabetes: 37 ± 15 g (95% CI: 33–41) and 47 ± 21 g (95% CI: 40–53), p = 0.017. Patients with acute infarction and diabetes mellitus had higher extracellular volume values in both healthy myocardium: 24% [22–27] and 28% [24–30], p = 0.002, and in the infarct zone: 48% [40–58] and 58% [50–61], p = 0.016.Conclusions. In patients with ST-segment elevation myocardial infarction with diabetes mellitus, the infarct size, the edema area, and the value of the extracellular volume fraction both in the infarct area and in the preserved myocardium were larger than in patients without diabetes, which may underlie the development of myocardial dysfunction and further progression of heart failure.

Introduction. High-resolution contrast-enhanced cardiac magnetic resonance imaging reveals left atrial fibrosis, the severity of which may be related to the effectiveness of catheter ablation.Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before balloon cryoablation and compare the results with the effectiveness of the intervention.Materials and methods. The study included 89 patients with persistent form of atrial fibrillation. The patients were randomized into two groups: in the 1st, the pulmonary veins cryoablation was performed (n = 39 (53.4%)); in the 2nd, the pulmonary veins and posterior wall of the left atrium cryoablation was performed (n = 34 (46.6%)). All patients before cryoablation underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence. The clinical efficacy of the intervention was evaluated after 12 months after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 0.7% [0; 3,07]. Overall efficiency of the intervention rate was 57.1%. Cryoablation was most effective (59.5%) in patients severity of fibrosis less than 20% and least effective (50%) severity of fibrosis more than 20%. Risk factors for atrial fibrillation recurrence after cryoablation were: early atrial fibrillation recurrence, female sex, the maximum atrial fibrillation duration more than 3 months, stroke/TIA.Conclusion. The severity of left atrial fibrosis more than 20%, early recurrence of atrial fibrillation in the first 3 months after the cryoablation, female sex, the duration of the maximum atrial fibrillation episode more than 3 months, and a history of stroke/transient ischemic attack may be associated with recurrence of AF during the period observation 3–12 months.

Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before and after balloon cryoablation and compare the results with the effectiveness of the intervention.Material and methods of research. The study included 28 patients with persistent form of atrial fibrillation. All patients before and after magnetic resonance imaging underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence (voxel size 1,25x1,25x1,25 mm) before and after cryoablation.The severity of atrial fibrous lesion was calculated automatically using a specialized LGE HEART Analyzer program using algorithms based on the myocardial contrast index with a threshold value of 1.38. The clinical efficacy of the intervention was evaluated after 12 months and the relationship was determined structural changes in the myocardium of the left atrium according to contrast magnetic resonance imaging data before and after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 1,5 [0,16; 9,3]%. In Utah patients, stage 1 fibrosis was detected in 71,4% (n=20), stage 2 in 14,3% (n=4), stage 3 in 3,6% (n=1), stage 4 in 10,7% (n=3). 3 months after cryoablation, there was an increase in the severity of fibrosis of 2,7 [1,02; 18,8]% (p

Aim. To develop diagnostic criteria for proximal left bundle branch block (LBBB) based on non-invasive methods and to determine the significance of these criteria in predicting the effect of cardiac resynchronization therapy (CRT).Material and methods. To develop criteria, 58 patients (21 men, mean age, 76,1±7,1 years) with LBBB occurred immediately after transcatheter aortic valve implantation (TAVI) were included. To assess the significance of the developed criteria, the second group included 22 patients (11 men, mean age, 57,9±9,3 years) with dilated cardiomyopathy (DCM), who had indications for CRT. The effectiveness of CRT was assessed by echocardiography 6 months after implantation. All patients in the DCM group and 15 patients in the TAVI group underwent superficial epiand endocardial non-invasive mapping using Amycard 01C EP Lab (EP Solutions SA, Switzerland). Patients in the DCM group underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) before device implantation.Results. The criteria for proximal LBBB included 3 electrocardiographic features: QRS complex >130 ms in women and 140 ms in men, QSor rS-configuration in V1 lead, notch in two or more lateral leads (I, avL, V5, V6), and 2 mapping criteria: characteristic location of block line and delayed activation point. In the DCM group, the criteria were positive in 13 of 22 patients (59%). The developed criteria for proximal LBBB showed a relatively strong, significant relationship with the positive effect of CRT (сhi-square test =5,46, p=0,02, Cramer test =0,5, odds ratio (OR)=15,0, 95% confidence interval (CI), 1,32-169,9, p=0,002). An additional analysis showed that both the criteria for proximal block and CRT effect are associated with myocardial fibrosis according to MRI. In particular, intramural stria-shaped contrast accumulation in the interventricular septum leads to a change in characteristic of proximal block mapping phenomena — displacement of delayed activation point (chi-square test =13,9, p

Background: According to numerous studies, from 30% to 50% of patients with chronic heart failure (CHF) are resistant to cardiac resynchronization therapy (CRT) and cardiac contractility modulation (CCM), despite their careful selection in accordance with current guidelines. It is of interest to study neurohormones characterizing myocardial (NT-proBNP) and fibrosis (sST2) as potential additional markers of CHF patients' “response” to CRT and CCM.Aim: To evaluate the potential to use NT-proBNP and sST2 biomarkers in CHF patients combined with transthoracic echocardiography (Echo) and contrast magnetic resonance imaging (MRI) parameters of the heart to predict a positive response to CRT and CCM devices.Materials and methods: The study included 51 patients (41 men, 10 women) aged 58 ± 12 years (26 to 79 years) with ischemic heart disease post acute myocardial infarction (n = 22) or non-ischemic cardiomyopathy (n = 29), left ventricle (LV) ejection fraction (EF) < 35%, and CHF II–III NYHA functional class despite ≥ 3 months of optimized medical therapy. The patients were assessed by serum biomarkers NT-proBNP and sST2 measurements, transthoracic Echo, and contrast- enhanced cardiac MRI. After the diagnostic assessment, CRT defibrillators (CRT-D) were implanted to 39 patients and CCM to 12 patients. After prospective follow-up of the patients for 18 to 24 months, predictors of the response to each device type were analyzed in univariate, multivariate, and ROC analysis.Results: The response to CRT-D was found in 21 (54%) patients, to CCM in 7 (58%) patients. Multivariate analysis showed the following predictors of the response of patients to CRT-D were: 1) sST2 < 50 ng/mL, 2) NT-proBNP < 3900 pg/mL, 3) < 3 LV segments with fibrosis (by MRI) and 4) anteroposterior dimension of the left atrium < 4.8 cm (by Echo). Any 2 of these 4 characteristics made it possible to predict the response to CRT with an accuracy of 87% (sensitivity 90%, specificity 83%). The predictors of the response to CCM were: 1) sST2 < 30 ng/ml, 2) LV end diastolic diameter < 78 mm (Echo), 3) age < 56 years, 4) body mass index < 27 kg/m2. Any 2 of these 4 characteristics predicted the positive response to CCM with an accuracy of 92% (sensitivity 86%, specificity 100%).Conclusion: The preoperative sST2 level was the only universal marker of the response to either CRT (< 50 ng/mL) or CCM (< 30 ng/mL) devices in CHF patients with reduced LVEF. The results indicate the potential for improved efficacy of these devices with their earlier implantation after the onset of the heart disease, as well as provided that maximal control CHF in these patients has been achieved.

Disclaimer The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Aim.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). Materials and methods.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. Results.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. Conclusion.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.

Disclaimer The EAC/NSHFMD Guidelines represent the views of the EAC and NSHFMD, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and NSHFMD is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/NSHFMD Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/NSHFMD Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/NSHFMD Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/NSHFMD Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support/ conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.E.B. Wataman professor, Dr. of Sci. (Med.) (Moldova); E.K. Kurlyanskaya, Cand. of Sci. (Med.) (Belarus); A.M. Noruzbaeva professor (Kyrgyzstan); V.A. Azizov professor (Azerbaijan); Zelveyan P.A., Dr. of Sci. (Med.) (Armenia)

Among the large number of benign tumors of the heart myxoma most frequently diagnosed neoplasm intracavitary (occurs in 50%). The clinical picture of a myxoma is extremely various. Often it is diagnosed as a casual find. Usually the diagnosis is established according to an echocardiography. Magnetic resonance imaging is used for inspection of patients with suspicion on myxoma in cases when information of echocardiography is not enough and before surgical treatment. We present clinical follow-up 58 years old patients with left atrial myxoma, which before surgical treatment has executed a heart MRI.

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.

Russian Society of Cardiology (RSC)With the participation: Association of Cardiovascular Surgeons of Russia, Russian Respiratory Society, Federation of Anesthesiologists and Resuscitators, Association of Rheumatologists of Russia, National Congress of Radiation Diagnosticians.

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%, p

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

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 Federation Task 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.

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 (p

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.

The patient with the verified diagnosis of idiopathic pulmonary hypertension, functional class III (WHO) was treated by anticoagulants, diuretics, calcium channel blocker. After one year of adding endothelin receptor antagonist bosentan there was noticed the negative dynamic with right heart chambers dilation, appearing of heart failure signs. By 11 months of the combined pathogenetic therapy with bosentan and phosphodiesterase type 5 inhibitor sildenafil there was achieved the significant improvement of the functional and hemodynamic status. This positive dynamics remained within the next 3 years of observation.

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.

Aim. To identify the features of myocardial scar and fibrosis associated with the occurrence of malignant ventricular tachyarrhythmias (VTs) in high-risk patients with ischemic (ICMP) and non-ischemic cardiomyopathy (NICMP). Materials and methods. This prospective study included 50 patients (41 men, 9 women), age = 60 ± 13 years, 30 patients of them with ICMP and 20 patients with NICMP, who underwent echocardiography (Echo) and contrast magnetic resonance imaging (MRI) of the heart followed by implantation of cardioverter-defibrillators (ICD) or resynchronizing devices with defibrillator (CPTD) to prevent sudden cardiac death. Results. Sustained VTs were reported in 20/30 (67%) patients with ICMP and in 5/20 (25%) patients with NICMP on follow-up [26 (22-37) months]. Successive univariate and ROC-analyses of Echo and MRI-indices between patients with and without recurrence of VTs found different results for ICMP and NICMP patients groups. In ICMP patients the VTs were associated with wide transmural fibrosis on contrast MRI that covered 3 or more segments of left ventricular. These segments were preferably localized in the middle parts of the inferior and inferolateral segments of the left ventricle. The independent predictors of VTs in NICMP patients were non-transmural fibrosis at 4.5% of the left ventricular mass by contrast MRI as well as low left ventricular ejection fraction (less than 26%) by Echo. Conclusion. To determine the indications for implantation of the ICD and CRTD for primary prevention of sudden cardiac death, it is advisable to take into account not only the value of ejection fraction of left ventricular, but also the features of the fibrosis of the left ventricle by contrast MRI of the heart.

Idiopathic (primary) pulmonary hypertension (IPH) is a rare disease of unknown etiology, which is characterized by elevated pulmonary artery pressure, increased total pulmonary vascular resistance, frequently a malignant course with evolving right ventricular decompensation, and a fatal outcome. The diagnosis of IPH is established on the increments in the mean resting and exercise pulmonary artery trunk pressure by more than 25 and more than 30 mm Hg at rest and during exercise, respectively, with a normal pulmonary artery wedge pressure. Endothelin receptor antagonists (ERA) are one of the effective classes of drugs for the treatment of patients with IPH. Bosentan is the first drug from the ERA class that blocks the receptors of both types and that has been recommended by the WHO to treat patients with functional class II-IV pulmonary hypertension. The described case demonstrates the possibility of concomitantly using bosentan in a female patient with IPH shortly after ineffective treatment with a calcium antagonist.