Yu.V. Varlamova

Platonov A. S. ¹ , Kunitsyn S. A. ¹ , Popov S. V. ¹ Aim. To assess the impact of coronary atherosclerosis in patients with atrial fibrillation (AF) on the radiographic density of epicardial adipose tissue (EAT), and to determine its prognostic value. Material and methods. The study included 69 patients (median age 47 (40; 58) years; 48 men) with AF (group 1) scheduled for radiofrequency ablation (RFA). The comparison group (group 2) included 37 patients with non-obstructive coronary artery disease (NOCAD) without arrhythmias, and the control group included 20 patients without coronary atherosclerosis and arrhythmias. All patients underwent computed tomography coronary angiography (CTCA), followed by EAT segmentation and calculation of EAT volume and radiographic density. Patients with AF were followed for 12 months after RFA to assess for arrhythmia recurrence. Results. In patients with AF, the EAT volume was significantly higher (141,0 (113,3; 187,5) cm ³ vs 107,5 (86,9; 126,1) cm ³ , pConclusion. In patients with AF and NOCAD, EAT radiographic density are lower compared to patients with AF without coronary atherosclerosis and the control group. In the studied sample of patients, EAT radiographic density did not demonstrate significance in the prognosis of AF recurrence after RFA of arrhythmia.

Aim. To evaluate the association of computed tomography measurements (volume and density) of epicardial adipose tissue (EAT) with the blood concentration of adipokines, proinflammatory cytokines and catecholamines in patients with atrial fibrillation (AF).Methods. We included 32 patients (median age 58.5 (52.5; 64.0); 18 men) with AF scheduled for radiofrequency ablation. All patients underwent multispiral computed tomographic coronary angiography and segmentation of the EAT. In addition, the concentration of adiponectin, leptin, resistin, interleukins 1b, 6, 8 and methanephrine in the blood was determined by enzyme immunoassay.Results. А negative correlation was established between the volume and the density of EAT (r= - 0.5, pConclusion. The results of the study showed an association between EAT X-ray density and the concentration of leptin, interleukin-8 and metanephrine in AF patients.

Introduction. Thoracic aortic aneurysm (TAA) ranks 17^th among all causes of a death. Over the past decade, the incidence rate of TAA increased several times and occurs in about 10 out of 100 thousand people per year. The search for the causes that lead to TAA is an urgent task. Local mechanical stress on the aortic wall leads to significant molecular and cellular changes in its tissue.Aim: To investigate the relationship between biomechanical properties and histological changes in the TAA tissue.Material and Methods. Thirty patients with TAA were included in the study. During surgery, fragments of the resected ascending aorta were obtained from each patient and subjected to uniaxial biomechanical testing to failure on an Instron 3343 testing machine (Instron, USA). Ultimate tensile stress at failure (σv, MPa), ultimate strain at failure (ε, mm/mm × %) and area under stress-strain curves (S, cm²) were calculated. In addition, the intraoperative material was fixed in formalin for histological examination of cellular and tissue changes in the aneurysm area. Inflammatory changes, the severity of aortic wall fibrosis and collagen/elastin ratio were assessed.Results. Atherosclerotic changes of the thoracic aortic wall were found in 43.3% (subgroup 1), aortitis – in 3.3%, connective tissue dysplasia – in 53.3% (subgroup 2) of the patients. Patient with inflammatory changes of the aortic wall was excluded. The biomechanical properties of the aorta were not statistically different between groups. A correlation was found between age with ε_circ (r = –0.49) and S_circ (r = –0.54) and S_long (r = –0.5). A correlation was also found between ε_circ and the degree of fibrosis in the medial layer of the aortic wall (r = –0.5) and collagen/elastin ratio (r = –0.61).Conclusions. Atherosclerotic changes in the aortic wall do not change the biomechanical properties of the TAA. However, structural changes in the medial layer of the aortic wall in the aneurysm zone result in reduced of its mechanical strength.

Objective: to compare intra- and inter-operator reproducibility of thoracic aorta (ThAo) morphometric parameters, calculated by multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).Material and methods. The prospective study included 20 patients with ascending aorta (AAo) dilatation (≥45 mm). All patients underwent MSCT- and MRI-angiography in electrocardiogram-gated mode. Mean diameter (Dmean) and cross-sectional area (CSA) were measured at different ThAo levels in the systole and diastole along the inner contour of the vessel. All measurements were performed by two radiologists. Each of them took measurements twice at an interval of at least 1 month. The reproducibility of repeated measurements was studied using intraclass correlation coefficient. Results. The analysis of the systolic frame revealed significant differences between the methodsfor measuring Dmean (MRI: 42.5 (41.0–47.8) mm; MSCT: 37.7 (34.7–40.3) mm; p = 0.003) and CSA at the level of the sinotubular junction (MRI: 14.8 (12.7–17.9) cm²; MSCT: 11.4 (10.3–13.3) cm²; p = 0.009), AAo CSA(MRI: 17.6 (14.6–20.8) cm²; MSCT: 19.6 (16.7–21.5) cm²; p = 0.035) and Dmean at the level proximal to left subclavian artery (LSA) (MRI: 31.5 (31.0–34.0) mm; MSCT: 31.7 (27.3–32.9) mm; p = 0.041). For the diastolic frame, significant differences between the methods were observed when measuring AAo CSA (MRI: 17.0 (14.5–19.7) cm²; MSCT: 19.7 (15.3–21.8) cm²; p = 0.025), Dmean (MRI: 30.5 (29.3–32.8) mm; MSCT: 29.8 (27.1–31.3) mm; p = 0.05) and CSA at the level proximal to LSA (MRI: 7.5 (6.9–7.9) cm²; MSCT: 7.4 (5.9–7.8) cm²; p = 0.007), as well as CSA at the left atrium level (MRI: 4.9 (4.2–5.0) cm²; MSCT: 5.1 (4.67–5.5) cm²; p = 0.042). For MSCT-angiography, good intra- and inter-operator reproducibility of measurements at all ThAo levels was obtained. For MRI-angiography, there was a strong intra- and interoperator variability in determining Dmean and CSA at the levels of aortic arch and descending aorta.Conclusion. Aortic cross-sectional area showed the best intra- and inter-operator reproducibility and comparability of measurements between MSCT- and MRI-angiography

Purpose: to compare the indicators of elasticity of the thoracic aorta, determined by ECG-Gated-CT angiography, in patients with ascending aortic aneurysm and dilatation. Materials and methods. The study included 20 patients with dilatation of the ascending aorta (40 mm ≤ maximum aortic diameter (D _max ) < 50 mm) (group 1a), 30 patients with non-syndromic aneurysms of the ascending aorta (n = 30, D _max ≥ 50 mm) (group 1b), as well as 19 patients with normal aortic sizes (D _max < 40 mm) as controls (group 2). All patients underwent multispiral computed tomography angiography of the aorta in ECG-Gated mode (ECG-Gated -CT). Maximum systolic and diastolic aortic diameters (D _max ) were measured at different levels of the thoracic aorta, followed by calculation of the difference between them and calculation of the circular deformation (CS), compliance, stiffness (Stiff), wall distensibility, longitudinal deformation (LS). Results. Moderate negative correlation between the age of the patients and CS at all levels of the thoracic aorta (r _maximum = –0.33, r _minimum = –0.41) was revealed. Groups 1a and 1b did not differ significantly in all parameters. Group 1a differed from the control group (p < 0.05) in Stiff at the level of the aortic annulus (AA) (0.07 [–0.14; 0.15] vs –0.04 [–0.1; 0.06]), as well as CS at the level of AA and sinuses of Valsalva (SV ) (0.49 [–2.94; 3.36] vs –1.18 [–4.51; 3.87]), and group 1b – in CS at the level of SV (3.73 [0.24; 6.56] vs 0.13 [–1.42; 3.04]) and proximal part of the descending aorta (distal to the left subclavian artery) (5.48 [1.27; 8.40] vs 1.97 [–0.32; 6.08]), also in LS (5.96 [–8.98; 9.25] vs –2.58 [–7.75; 1.89]) at the level of the aortic arch. Conclusion. According to ECG-Gated-CT angiography, the indicators of elasticity of the thoracic aorta in patients with ascending aortic aneurysm and dilatation did not differ. Compared with the control group, patients with aneurysm of the ascending aorta showed an increased pulse deformity of the non-dilated aortic arch.

The article is devoted to the analysis of the current status of nuclear cardiology in the Russian Federation. The data on the number of facilities performing radionuclide investigations for the diagnosis and monitoring of the treatment of cardiovascular diseases, their staffing and equipment are given. The statistics of the conducted nuclear cardiology tests for 2018-2020 are given, as well as their methods, features and diagnostic significance are described.

The article is devoted to the analysis of the current status of nuclear cardiology in the Russian Federation. The data on the number of facilities performing radionuclide investigations for the diagnosis and monitoring of the treatment of cardiovascular diseases, their staffing and equipment are given. The statistics of the conducted nuclear cardiology tests for 2018-2020 are given, as well as their methods, features and diagnostic significance are described.

Aim. To investigate the relationship between radiological characteristics of epicardial adipose tissue (EAT) and myocardial sympathetic activity, as well as to study their association with late recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA).Material and methods. This prospective study included 26 people with persistent and long-standing persistent AF scheduled for interventional AF treatment. Before the RFA procedure, all patients underwent cardiac 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy to assess the myocardial sympathetic innervation and contrast-enhanced cardiac multislice computed tomography to assess pulmonary vein anatomy, left atrial volume, and EAT volume. Clinical follow-up, including 12-lead electrocardiography (ECG) and 24-hour ECG monitoring, was carried out 3, 6 and 12 months after RFA.Results. After the end of follow-up, the patients were divided into two groups: with AF recurrence (group 1, n=8) and without AF recurrence (group 2, n=18). Multivariate logistic analysis found that only the 123I-MIBG washout rate (odds ratio, 1,0943; 95% confidence interval, 1,0138-1,1812) proved to be an independent predictor of late AF recurrence after RFA. ROC analysis revealed that a 123I-MIBG washout rate >21% with a sensitivity of 75% and a specificity of 83,3% (AUC=0,844; pConclusion. Parameters of myocardial sympathetic activity, assessed by 123I-MIBG myocardial scintigraphy, are associated with late AF recurrence after RFA in patients with persistent and long-standing persistent AF. There were no reliable data confirming associations between myocardial sympathetic innervation and radiological EAT indicators, as well as the effect of the latter on the risk of AF recurrence after RFA.

Aim      To evaluate the predictive value of indexes of left ventricular mechanical dyssynchrony (MD) as determined by data of electrocardiogram (ECG)-gated myocardial perfusion scintigraphy (ECG-MPS) for prediction of the efficacy of resynchronization therapy (RT) in patients with chronic heart failure (CHF). Material and methods  This prospective study included 32 patients with nonischemic CHF and standard indications for RT. All patients underwent complete clinical an instrumental examination, including 24-h ECG monitoring and echocardiography (EchoCG). In order to evaluate the left ventricular (LV) myocardial perfusion, contractile function, and MD, myocardial perfusion scintigraphy was performed for all patients at rest prior to RT. In addition to the perfusion defect size at rest and hemodynamic parameters, LV MD was determined. The following indexes were used for analysis of dyssynchronization: phase standard deviation (PSD), phase histogram bandwidth (HBW), and phase histogram asymmetry and steepness. The treatment efficacy was evaluated by the clinical status of patients (clinical condition evaluation scale for CHF patient) and EchoCG at 6 months following RT. The criteria for a positive response to RT were an increase in LV ejection fraction (EF) by 5% and/or a decrease in the LV end-diastolic volume by 15% compared to preoperative values. Results According to ECG-MPS findings, all patients had scintigraphic signs of severe CHF with dilated LV cavity (end-diastolic volume, EDV 246 [217; 269] ml) and also of pronounced mechanical and electrical dyssynchrony. The values of mechanical dyssynchrony were PSD 53 [41; 61], HBW 176 [136; 202], asymmetry 1.62 [1.21; 1.89], and steepness 2.81 [1.21; 3.49]. The QRS duration was 165 [155; 175] msec. Furthermore, the LV perfusion was moderately impaired (perfusion defect size 4 [3; 10] %). Mean follow-up duration after implantation of the resynchronizing device was 6±1.7 mos. According to the selected criteria, 20 (63 %) patients were considered as responders and 12 (37 %) patients as non-responders. Before implantation of the cardiac synchronizing device, responders and non-responders differed only in LV MD (PSD 44 [35; 54] vs. 63 [58; 72]; p=0.0001); HBW 158 [118; 179] vs. 205 [199; 249]; p=0.0001; asymmetry 1.77 [1.62; 2.02] vs. 1.21 [0.93; 1.31]; p=0.0001; steepness 3.03 [2.60; 3.58] vs. 1.21 [0.19; 1.46]; p=0.0001), respectively. A one-factor logistic regression analysis showed that MD values were statistically significant predictors of a positive response to RT. A multi-factor logistic analysis of phase histogram steepness (odds ratio, OR 1.196; 95 % confidence interval, CI 1.04–1.37) and PSD (OR 0.67; 95 % CI 0.47–0.97) were identified as independent predictors for the response to RT. According to results of the ROC analysis, a PSD 1.54 may predict the effectiveness of RT (AUC= 0.92; р=0.0001). Conclusion      LV MD parameters determined with ECG-MPS allow predicting the effectiveness of RT in patients with nonischemic CHF. In this patient group, high values of standard deviation and low values of phase histogram steepness were independent predictors for the absence of response to RT after 6 mos. of follow-up.

Congenital pulmonary venolobar syndrome (CPVS) is one of the most rare and difficult to diagnose combination of vascular abnormalities, combining venous, arterial, pulmonary and cardiac pathology. About a quarter of patients with CPVS have concomitant congenital heart defects (coarctation of aorta, tetralogy of Fallot, patent ductus arteriosus or ventricular septal defect). Other congenital abnormalities include bronchogenic cysts, horseshoe lung, additional diaphragm, and hernias. There are descriptions of isolated cases of this disease in the literature. The article represents an extremely rare case of CPVS associated with intra-thoracic heterotopic liver tissue in an 8-month-old boy.