Kardiologiya最新文献

{"title":"[Potential of Magnetic Resonance Imaging in Diagnostics of Transient Constrictive Pericarditis].","authors":"K M Beseliia, Z M Magomedova, F Kh Eldzharkieva, M S Dolgaya, D Yu Shchekochikhin, E S Pershina, A A Bogdanova, A N Volovchenko, D A Andreev","doi":"10.18087/cardio.2025.1.n2736","DOIUrl":"https://doi.org/10.18087/cardio.2025.1.n2736","url":null,"abstract":"<p><p>The article addresses the diagnostic criteria based on magnetic resonance imaging (MRI) in transient constrictive pericarditis (TCP), a rare form of constrictive pericarditis characterized by temporary signs of constriction. Constrictive pericarditis evident as myocardial thickening and fibrosis results in impaired diastolic filling and can manifest itself with symptoms similar to those of other pathologies, such as restrictive cardiomyopathy. The article presents two clinical cases of TCP, where the role of MRI in the diagnosis and monitoring of patients is highlighted. For diagnostics, echocardiography and MRI were used along with laboratory tests, including the tests for inflammation markers and troponin. MRI allows not only to visualize changes in the pericardial structure but also to monitor changes in the condition, which is important for choosing the treatment tactics. In both cases, symptoms were successfully resolved, and the patients' condition was normalized with drug therapy. The results highlight the importance of early diagnosis and proper management tactics to prevent irreversible changes in the pericardium and heart failure.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"65 1","pages":"67-72"},"PeriodicalIF":0.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Significance of the Characteristics of Atherosclerotic Plaques Left after Percutaneous Coronary Intervention in the Development of Cardiovascular Events in Patients With Acute Coronary Syndrome According to Computed Tomographic Angiography of the Coronary Arteries.","authors":"I N Merkulova, A A Semenova, N A Barysheva, T S Sukhinina, S A Gaman, T N Veselova, E A Bilyk, N S Zhukova, M A Shariya, E B Yarovaya, R V Ievlev, I I Staroverov, D V Pevsner, S K Ternovoy","doi":"10.18087/cardio.2025.1.n2693","DOIUrl":"https://doi.org/10.18087/cardio.2025.1.n2693","url":null,"abstract":"<p><strong>Aim: </strong>To determine the characteristics of atherosclerotic plaques (ASP) remaining after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), that are significantly associated with cardiovascular events (CVE), according to computed tomography angiography (CTA) data.</p><p><strong>Material and methods: </strong>CTA was performed in 249 ACS patients on days 3-7 of the disease (in 41 patients, on a 64-slice CT scanner, and in the rest, on a 320-slice CT scanner). CTA data of all patients were analyzed on a Vitrea workstation. Patients with at least one noncalcified atherosclerotic plaque were included.</p><p><strong>Results: </strong>During 39.1 [18.0; 57.4] months of follow-up (from 7 days to 128 months), 71 of 249 (28.5%) ACS patients had the primary endpoint (PEP), which included non-fatal myocardial infarction, unstable angina, cardiac death, PCI, and ischemic stroke. According to the univariate Cox analysis, 14 of 30 CTA characteristics of ASP turned out to be significant predictors of achieving the PEP: the number of involved arteries (HR=1.314, CI: 1.06-1.628, p=0.013, C=0.59); the total length of ASPs (HR=1.013, CI: 1.005-1.022, p=0.002, C=0.62); the number of ASPs with obstructive stenosis (HR=1.286, CI: 1.095-1.509, p=0.002, C=0.61); the minimum density (HR=0.968, CI: 0.949-0.987, p=0.001, C=0.64); a minimum density &lt;30 HU (HR=2.695, CI: 1.495-4.869, p=0.0009, C=0.62); the number of ASPs with a minimum density &lt;30 HU (HR=1.391, CI: 1.186-1.633, p=0.00005, C=0.64); the number of ASPs with a minimum density ≤46 HU (HR=1.211, CI: 1.043-1.407, p=0.012, C=0.58); the presence of a low-density area &lt;30 HU (HR=2.387, CI: 1.389-4.101, p=0.001, C=0.57); the number of atherosclerotic plaques with a low-density area &lt;30 HU (OR=1.912, CI: 1.317-2.775, p=0.001, C=0.57); the number of atherosclerotic plaques with spotty calcifications (HR=1.384, CI: 1.134-1.688, p=0.001, C=0.59); the maximum length (HR=1.014, CI: 1.001-1.028, p=0.041, C=0.61); the maximum stenosis (HR=1.018, CI: 1.002-1.033, p=0.025, C=0.61); the presence of a low-density area ≤46 HU (HR=2.049, CI: 1.24-3.386, p=0.005, C=0.57); the number of ASPs with a low-density area ≤46 HU (HR=1.643, CI: 1.191-2.265, p=0.002, C=0.58). [HR, hazard ratio; CI, 95% confidence interval; C, Harrell's C statistics]. According to the multivariate analysis, the first 10 of the listed CTA characteristics retained their prognostic significance, while the predictive significance was found for the \"total plaque burden\", a conditional characteristic we first proposed, which is the sum of the areas (burden) of all plaques identified by CTA in the patient.</p><p><strong>Conclusion: </strong>14 CTA characteristics of ASPs in patients with ACS are significant predictors of future CVE, and 11 of them are independent of known risk factors.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"65 1","pages":"11-19"},"PeriodicalIF":0.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remodeling of the External Respiratory System in Chronic Heart Failure - a Factor of Pathogenesis and a Therapeutic Target.","authors":"Yu L Begrambekova","doi":"10.18087/cardio.2025.1.n2767","DOIUrl":"https://doi.org/10.18087/cardio.2025.1.n2767","url":null,"abstract":"<p><p>During the development of chronic heart failure (CHF), the lungs and the external respiratory system (ERS) as a whole undergo significant remodeling. These changes are most clearly manifested during physical exercise (PE), when the requirement for ventilation increases, and the ERS works under stress. Patients with CHF during exercise are characterized by the so-called pattern of frequent shallow breathing, when minute ventilation increases mainly due to an increase in the respiratory rate, and the depth of breathing increases to a much lesser extent than in individuals without CHF. The pattern of frequent shallow breathing is an adaptive response that prevents rapid exhaustion of the respiratory muscles (RM) due to the decreased compliance of the lung tissue and airways, and, accordingly, increased work of breathing typical of patients with CHF. In such conditions, tachypnea becomes the only available mechanism for maintaining the required ventilation volume. As the exercise load increases, the inability to adequately increase the depth of breathing contributes to the growth of physiological dead space, and the ventilation efficiency drops. The progressive decrease in the ventilation efficiency is evident as a paradoxically low level of carbon dioxide released relative to the ventilated volume. Such \"working conditions\" lead to hyperactivation of the inspiratory metaboreflex, which causes a whole pathogenetic cascade, including sympathicotonia, deterioration of the blood supply to the motor muscles and hyperactivation of their metaboreflex, which leads to further limitation of exercise tolerance. Sympathicotonia characteristic of CHF enhances the activation of carotid chemoreceptors. Along with hypocapnia, this can lead to the development of periodic breathing and central sleep apnea to further worsen the prognosis. Progressive sympathicotonia, hypoxia, endothelial dysfunction, and chronic inflammation result in aggravation of skeletal muscle myopathy. Thus, the condition of RM is at least an important, if not the leading factor in the pathogenesis of impaired exercise tolerance, which requires continuous therapeutic treatment. Such treatment cannot be of a \"rehabilitation\" nature, i.e., be used for a limited time, but must be performed on a permanent basis. The search for optimal methods of the respiratory and skeletal muscle training in order to weaken the mutually reinforcing connection between the carotid chemoreflex and muscle metaboreflex, as well as the search for such forms of their implementation, in which they will become a permanent part of the treatment, is extremely important for successful management of CHF patients.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"65 1","pages":"41-49"},"PeriodicalIF":0.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Structure of Concomitant Pathology in Patients With Hypertrophic Cardiomyopathy in The Older Age Group. Review and Clinical Observations].","authors":"G A Shakaryants, Yu N Belenkov, V Yu Kaplunova, E I Tashina, D A Tyurina, N V Khabarova, A V Vysokykh, J M Kasaeva, L V Chkotua, E V Privalova","doi":"10.18087/cardio.2025.1.n2715","DOIUrl":"https://doi.org/10.18087/cardio.2025.1.n2715","url":null,"abstract":"<p><p>Advances in modern drug and surgical treatment of patients with hypertrophic cardiomyopathy (HCM) have resulted in a significant increase in the life expectancy of these extremely severe patients. Therefore, in addition to the genetic markers, major neurohumoral systems and morpho-functional parameters of intracardiac hemodynamics, the course and prognosis of the disease are influenced by concomitant pathology. In infancy and early childhood, HCM is associated with tumors of chromaffin tissue of various localizations; however, the older the patient, the greater the likelihood of developing metabolic syndrome, secondary atherosclerosis and ischemic heart disease (IHD), and hypertension, which significantly complicates the verification of the HCM diagnosis. We have previously described cases of IHD secondary to HCM, which significantly affected the course and prognosis of both diseases. However, in old age, other comorbidities may also occur in addition to the diseases described above. Based on long-term observation of a large cohort of patients, this article analyzes a wide range of HCM combinations with pathology of other organs and systems, including malignant neoplasms, which makes significant adjustments to the treatment of both the underlying disease and cancer. The material is presented in the form of a brief review of literature on this topic and our own clinical observations and studies.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"65 1","pages":"58-66"},"PeriodicalIF":0.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors of Long-Term Prognosis for Cardiovascular Complications in Patients After Acute Myocardial Infarction, Based on the Plasma Proteome.","authors":"E L Kordzaya, A S Kononikhin, E N Nikolaev, E J Vasilieva, A A Komissarov","doi":"10.18087/cardio.2024.12.n2801","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2801","url":null,"abstract":"<p><strong>Aim: </strong>To study the plasma proteome of patients with type 1 acute myocardial infarction (AMI) to identify potential markers for long-term prognosis of the risk for developing cardiovascular complications.</p><p><strong>Material and methods: </strong>The study included 64 patients with type 1 AMI with and without ST segment elevation who underwent primary percutaneous coronary intervention upon admission. The following information on cardiovascular events was collected for 36 months after admission: death from cardiovascular pathology, recurrent AMI, stroke, repeat myocardial revascularization and/or endarterectomy. Peripheral blood sampling followed by a plasma proteome analysis using chromatography-mass spectrometry was performed in all patients before hospitalization.</p><p><strong>Results: </strong>During 36 months after hospitalization, cardiovascular complications were detected in 23 (36%) patients. These patients were included in the group with an unfavorable prognosis, while the remaining patients made up the group with a positive prognosis. A mass spectrometric analysis of the plasma proteome and comparison of the groups identified seven differentially represented proteins. Also, a multivariate regression analysis, ROC curves, and Kaplan-Meier models showed that four proteins (apolipoprotein C1, complement factor H, di-N-acetylchitobiase, and ficolin-2) were predictors of the risk for developing cardiovascular complications in the long term. An integrated parameter was developed that took into account the plasma concentrations of all four above proteins. This parameter was used to construct a model for assessing the risks of unfavorable long-term prognosis in AMI patients with a sensitivity of 87% and a specificity of 78%.</p><p><strong>Conclusion: </strong>The study results demonstrated that plasma concentrations of apolipoprotein C1, complement factor H, di-N-acetylchitobiase, and ficolin-2 are reliable prognostic markers for assessing the risks of cardiovascular events in patients with AMI in the long term.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"59-67"},"PeriodicalIF":0.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Severity of Coronary Artery Disease With Traditional Risk Factors, Clinical Characteristics and Carotid Plaque Burden in Patients With Acute Coronary Syndrome.","authors":"L L Bershtein, M D Lunina, D S Evdokimov, T V Nayden, V E Gumerova, I N Kochanov, A A Ivanov, S A Boldueva, E D Resnyanskaya, E V Zbyshevskaya, A E Evtushenko, V Kh Piltakyan, S A Sayganov","doi":"10.18087/cardio.2024.12.n2686","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2686","url":null,"abstract":"<p><strong>Aim: </strong>To study the associations between risk factors, clinical characteristics, severity of brachiocephalic artery (BCA) atherosclerosis and severity of coronary artery (CA) disease in patients with acute coronary syndrome (ACS).</p><p><strong>Material and methods: </strong>The study included patients with any type of ACS and obstructive coronary artery disease confirmed by coronary angiography. A quantitative analysis of coronary angiography data was performed with an assessment of the number of CAs with significant stenosis and calculation of the SYNTAX score. The major clinical and laboratory parameters that are risk factors for atherosclerosis and/or affect the cardiovascular prognosis were assessed; for patients with ACS without ST segment elevation (NSTE-ACS), the risk score was calculated by the GRACE scale. The BCA ultrasound examination was performed with a quantitative analysis of atherosclerotic burden.</p><p><strong>Results: </strong>The study included 312 patients aged 64 [56, 72] years; the proportion of men was 69.2%. The frequency of lesions of 1, 2 and 3 coronary arteries was 34.6, 35.3, and 30.1%, respectively; the SYNTAX score was 14 [9, 21]. According to the results of univariate analysis, the number of stenotic CAs and the SYNTAX score were associated with age, smoking history, history of ischemic heart disease, diabetes mellitus (DM), the presence of non-stenotic CA lesions, the GRACE score in NSTE-ACS, and the Charlson comorbidity index. An inverse correlation was found for the level of physical activity and a slightly weaker one for the glomerular filtration rate and high-density lipoprotein cholesterol (HDL-C). In multivariate models, the only independent predictors of the number of stenotic CAs were HDL-C (odds ratio, OR 0.37, 95% confidence interval, CI 0.17-0.81; p=0.012) and the smoking history (OR 1.30, 95% CI 1.12-1.52; p=0.001), a coefficient of determination of the model R2 of 18%, SYNTAX score with a history of myocardial infarction (ß=6.40, 95% CI 3.22-9.58; p&lt;0.001), insulin-dependent DM (ß=9.44, 95% CI 3.50-15.38; p=0.002), GRACE score for NSTE-ACS (ß=0.06, 95% CI 0.01-0.11; p&lt;0.014), and a coefficient of determination of the model R2=20%.</p><p><strong>Conclusion: </strong>Patients with ACS show significant, independent associations of the severity of coronary atherosclerosis with HDL-C, smoking duration, history of myocardial infarction, insulin-dependent diabetes, and the GRACE score in NSTE-ACS. Variability in the severity of CA lesions is only to a small extent determined by risk factors, clinical characteristics, and the severity of concomitant carotid atherosclerosis.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"44-50"},"PeriodicalIF":0.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The Influence of Antithrombotic Therapy on the Risk Factors for Cardiovascular Complications in Patients With Coronary Artery Disease And Diabetes Mellitus. Emphasis on Hypercoagulation].","authors":"I V Zotova, A O Cherkasov","doi":"10.18087/cardio.2024.12.n2843","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2843","url":null,"abstract":"<p><p>Comorbid diabetes mellitus (DM) in patients with ischemic heart disease (IHD) is a serious factor that significantly impairs the life prognosis and increases the risk of cardiovascular complications (CVC) as well as the likelihood of death. The residual risk of developing CVC in such patients is largely determined by the high thrombotic status, that is associated with hypercoagulation characteristic of DM. Hypercoagulation causes activation of both platelet and coagulation pathways, which leads to an increased susceptibility to thrombosis. In this context, the combined administration of the anticoagulant rivaroxaban (Xarelto®) 2.5 mg and acetylsalicylic acid (ASA) can significantly reduce this risk by affecting both mechanisms of thrombus formation and thereby improving the prognosis. Rivaroxaban 2.5 mg in combination with ASA is the only available strategy to intensify the antithrombotic therapy in patients with stable IHD and DM with no history of ischemic events. Importantly, such therapy should be initiated as early as possible to prevent clinically significant CVCs and improve patients' quality of life.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"86-95"},"PeriodicalIF":0.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic Thromboembolic Pulmonary Hypertension Drug Treatment].","authors":"S N Ivanov, A M Chernyavsky, A G Edemsky, O Ya Vasiltseva","doi":"10.18087/cardio.2024.12.n2784","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2784","url":null,"abstract":"<p><p>The main treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is radical surgery, pulmonary thromboendarterectomy (PEA). However, about 40% of patients with CTEPH are inoperable due to distal pulmonary vascular lesions or the severity of hemodynamic disorders. Almost 30% of patients with CTEPH experience persistent or recurrent pulmonary hypertension after surgery, that requires a drug treatment with PAH-specific drugs. This review presents current data on the use of targeted therapy in patients with CTEPH. The review addresses the place, indications, and the evidence base for using the main groups of specific drugs, including stimulators of soluble guanylate cyclase, phosphodiesterase type 5 inhibitors, endothelin receptor antagonists, and prostacyclin analogues.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"77-85"},"PeriodicalIF":0.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Left Ventricular Ejection Fraction Decrease in Patients With ST-Segment Elevation Myocardial Infarction.","authors":"K G Pereverzeva, S S Yakushin, I E Tishkina, A A Nikiforov, L V Nikiforova, M V Laut","doi":"10.18087/cardio.2024.12.n2729","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2729","url":null,"abstract":"<p><strong>Aim: </strong>To identify predictors and construct a model for predicting left ventricular (LV) ejection fraction (EF) in patients with ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Material and methods: </strong>This was a prospective registry study of patients with STEMI admitted within the first 24 hours of the disease onset. Patients were evaluated and treated according to the current clinical guidelines. On the first day of STEMI, concentrations of growth stimulating factor, proprotein convertase subtilisin-kexin type 9 (PCSK9), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin I and C-reactive protein were measured. Echocardiography was performed on the first day and on day 10-12 of admission; LVEF was calculated by the Simpson method. The study included 138 patients; 3 patients were excluded from this part of the study due to death before repeat echocardiography. Based on the LVEF value on day 10-12 of STEMI, the patients were divided into the groups with preserved LVEF (pLVEF) ≥50% (n=34), reduced LVEF (rLVEF) ≤40% (n=21), and moderately reduced LVEF (mrLVEF) 41-49% (n=80).</p><p><strong>Results: </strong>The ordinal regression analysis showed that the factors influencing LVEF in STEMI patients included a history of chronic heart failure, Killip class II-IV acute heart failure at the index hospitalization, the development of LV dilation and postinfarction aneurysm, and an increase in NTproBNP. Based on the obtained estimates of the regression parameters, a prognostic model was constructed that showed the highest sensitivity of the model for predicting rLVEF, 94.4%, mrLVEF, 92.9%, and a lower sensitivity for predicting pLVEF, 62.5%.</p><p><strong>Conclusion: </strong>In the presence of a history of chronic heart failure, Killip class II-IV acute heart failure, developed LV dilation and postinfarction aneurism, and elevated NTproBNP, patients with STEMI are expected to have lower LVEF values.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"27-34"},"PeriodicalIF":0.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Atherosclerotic Plaques Left after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome. Assessment According to Computed Tomographic Angiography of the Coronary Arteries.","authors":"I N Merkulova, A A Semenova, N A Barysheva, S A Gaman, T N Veselova, E A Bilyk, T S Sukhinina, M A Shariya, E B Yarovaya, G E Svinin, Z B Bashankaeva, I I Staroverov, D V Pevsner, S K Ternovoy","doi":"10.18087/cardio.2024.12.n2690","DOIUrl":"https://doi.org/10.18087/cardio.2024.12.n2690","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate characteristics of atherosclerotic plaques (ASP) remaining after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) by coronary computed tomography angiography (CCTA).</p><p><strong>Material and methods: </strong>Among 249 patients (193 men) with ACS aged 58±10 years, 183 (73.5%) had myocardial infarction, 66 (26.5%) had unstable angina. CCTA was performed after PCI at 3-7 days after the onset of ACS according to the standard protocol: in 41 patients, on a 64-slice tomograph (Aquilion 64, Toshiba, Japan) and in 208 patients, on a 640-slice tomograph with 320 rows of detectors (Aquilion ONE Vision Edition, Toshiba, Japan). CCTA of all patients was performed on a Vitrea workstation. Patients with at least one non-calcified ASP were included.</p><p><strong>Results: </strong>Among all ASPs, non-calcified ASPs predominated, 609 of 785 (77.6%), including 400 soft and 209 combined ones. Signs of obstruction (stenosis ≥50%) were noted in 72.2% of non-calcified ASPs. ASPs were characterized by a pronounced burden, 69 [61.4; 74.2]%, and a low minimum density, 31 [23; 37] HU, which was consistent with mature plaques with a lipid core. Various signs of ASP instability were observed in 6-35.3% of cases. There were 2 [2;3] (1 to 6) affected coronary arteries (CAs) and 3 [2;4] (1 to 7) ASPs, including calcified ones, per patient. 77.7% of ASPs were located in the CA proximal and middle segments. Obstructive stenosis was detected in 92% of patients. The number of ASPs with obstructive stenosis ranged from 0 to 7 per patient, with a median of 2 [1;3]. In 44% of patients, stenosis was 70% or more. The maximum burden of non-calcified ASPs was high, 74.3±12.1%; their maximum and total length were 13.8±10.4 mm and 26.5±19.7 mm, respectively; and the ASP minimum density was low, 25 [17;32] HU. ASPs with a low-density area of ≤46 HU and ≤30 HU were detected in 24.9% and 14.8% of patients, respectively. Other CCTA signs of instability were quite common: punctate calcifications in 52.2% of patients, coronary positive remodeling in 37%, the presence of \"ring-like enhancement\" in 16.1%, an uneven plaque contour in 26.7%, and at least one sign of ASP instability in 73% of patients.</p><p><strong>Conclusion: </strong>After PCI, patients with ACS still have rather many ASPs, including those with CCTA signs of instability, with stenosis &gt;50%; more than a third of the plaques had stenosis &gt;70%; the plaques were extended and localized mainly in the proximal and middle sections of the main CAs.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 12","pages":"3-11"},"PeriodicalIF":0.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}