Страница 69 nary syndrome. We investigated the results of studies where the role of detection of "indirect" signs of instability in coronary plaques by computed tomography in prognosis of acute coronary events was assessed. We analyzed the studies where computed tomography and intravascular ultrasound (the reference method in the determination of morphological and structural features of the coronary plaques) were compared. We described the occurrence of "indirect" signs of instability detected by computed tomography in vulnerable plaques identified by intravascular ultrasound.
Aim To identify clinical, echocardiographic, and angiographic factors related with an increase in the frontal QRS-T angle (fQRS-T) and the spatial QRS-T angle (sQRS-T) in patients with inferior myocardial infarction.Material and methods The study included 128 patients aged (median [25th percentile; 75th percentile]) 59.5 [51.5; 67.0] years diagnosed with inferior wall acute myocardial infarction. fQRS-T was calculated as a module of difference between the QRS axis and the Т axis in the frontal plane. sQRS-T was calculated by a synthesized vectorcardiogram as a spatial angle between the QRS and Т integral vectors.Results The fQRS-T for the group was 54.0 [18; 80] and sQRS-T was 80.1 [53; 110]. The correlation coefficient for fQRS-T and sQRS-T values was 0.42 (p<0.001). Both fQRS-T >80° and sQRS-T >110° compared to their lower values were associated with a higher frequency of history of postinfarction cardiosclerosis (44% and 12 %, respectively; p<0.05), a lower left ventricular ejection fraction (51 [47; 60]% at fQRS-T >80° and 55 [50; 60]% at fQRS-T <80° (p<0,05); 49 [44; 57]% at sQRS-T >110° and 57 [51; 60] % at sQRS-T <110° (p<0.01); more frequent development of acute heart failure (16 and 2 %, respectively; p<0.05); and early postinfarction angina (13 and 2 %, respectively; p<0.05). The increased fQRS-T was associated with a higher incidence of damage to the circumflex artery (45 and 20 %, respectively; p<0.05). The increased sQRS-T was associated with a history of arterial hypertension (97 and 76 %, respectively; p<0.05), chronic heart failure (22 and 3 %, respectively; p<0.05), chronic kidney disease (19 and 4 %, respectively; p<0.05), and a larger myocardial lesion (mean number of damaged segments by echocardiography was 3.8 [2; 6] at sQRS-T >110° and 2.6 [1; 4] at sQRS-T <110°; p<0.01). sQRS-T was significantly greater in multivascular damage (87 [68; 121]° than in one- or two-vascular damage (72 [51; 100]°; p<0.05). sQRS-T values were significantly lower with spontaneous reperfusion (66 [29; 79] than without spontaneous reperfusion (77 [55; 115]°; p<0.05).Conclusion In patients after inferior wall acute myocardial infarction, increases in fQRS-T and sQRS-T were associated with more severe damage of coronary vasculature, decreased left ventricular ejection fraction, and more severe course of disease.
Aim To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.
Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction. Although the prognosis is excellent in most cases, rare cases of serious complications can occur. We present a case of a 81-year - old woman with Takotsubo Syndrome complicated by ventricular septal rupture that was successfully closed with an occluder Occlutech with good immediate and long - term outcomes.
ель исследования. Определение жизнеспособности миокарда методом ком-пьютерной томографии (КТ) у больных острым инфарктом миокарда (ОИМ) с подъемом сегмента ST и оценка динамики функциональных параметров ле-вого желудочка (ЛЖ) в зависимости от типа отсроченного контрастирования миокарда.Материалы и методы. В исследование были включены 117 больных c первич-ным ОИМ. КТ с внутривенным контрастным усилением выполняли на 3-5 сутки ОИМ и через 12 месяцев. В артериальную фазу оценивали объем дефекта контрастирования миокарда, конечный диастолический объем (КДО), конечный систолический объем (КСО) и фракцию выброса (ФВ) ЛЖ. В отсроченную фазу исследования (через 7 минут после введения контрастного препарата) оценивали признаки жизнеспособности мио-карда. Больные были разделены на группы в зависимости от типа отсроченного кон-трастирования миокарда: 1 тип (жизнеспособный миокард) -нет отсроченного гипер-контрастирования (ОГК); 2 тип -определяется ОГК с зоной резидуального дефекта кон-трастирования (РДК); 3 тип -определяется трансмуральное ОГК.Результаты. У больных с признаками жизнеспособного миокарда (1 тип) объем дефекта контрастирования в артериальную фазу был значительно меньше, чем у боль-ных с нежизнеспособным миокардом (2 и 3 типы): 1 см3 [0,4-2,4] против 7,3 см3 [5,3-10,0] и 6,3 см3 [5,0-15,0] соответственно, p<0,001. Через 12 месяцев в группе с 1 типом контрастирования наблюдалось значительное увеличение ФВ ЛЖ по сравнению с ис-ходными данными (63,4 ± 7,6% и 56,3 ± 6,6%, p<0,001), а в группах со 2 и 3 типами до-стоверной динамики ФВ ЛЖ не определялось. Через 12 месяцев постинфарктное ремо-делирование ЛЖ было зарегистрировано у 22 из 51 больного (43,1%) с признаками не-жизнеспособного миокарда (2 и 3 типы), среднее количество сегментов с признаками нежизнеспособного миокарда у этих больных составило 4,0 [4,[5][6]0].Выводы. КТ является надежным методом оценки жизнеспособности миокарда у больных ОИМ. Трансмуральное ОГК миокарда по данным КТ может служить предикто-ром постинфарктного ремоделирования ЛЖ. Отсутствие ОГК у больных ОИМ свиде-тельствует о наличии жизнеспособного миокарда и улучшении функциональных и мор-фологических параметров ЛЖ в постинфарктном периоде.Ключевые слова: острый инфаркт миокарда, нежизнеспособный миокард, ремо-делирование левого желудочка, компьютерная томография.Контактный автор: Веселова Т.Н., e-mail: tnikveselova@gmail.com.
During several recent decades spontaneous coronary artery dissection (SCAD) has been known as one of causes of development of acute coronary syndrome (ACS). It has been assumed that this condition is extremely rarely met and is associated with pregnancy and postpartum period. The use in clinical practice of high sensitivity troponin, coronary angiography (CAG) in early period of ACS, in conjunction with the growing awareness of doctors about this pathology led to a revision of the viewse on prevalence of the disease. At present SCAD is considered as one of the causes of ACS in young and middle-aged women. In this review we present results of studies of pathogenesis, diagnostics, and treatment of SCAD, describe various angiographic types of this disease, and discuss problems of choice of optimal strategy of management of patients with SCAD.
Background: Cardiovascular computed tomography (cardiovascular CT) is currently used as a fast non-invasive method for the visualization of coronary plaques and walls and the assessment of lumen stenosis severity. Previous studies demonstrated the high negative predictive value of CT for the exclusion of coronary lumen stenoses. In this study we hypothesize that coronary CT angiography (CTA) represents a reliable method as diagnostic procedure in acute coronary syndrome (ACS) even in emergency settings. Methods: 36 patients (51 lesions) with ACS who underwent cardiovascular CT, intravascular ultrasound (IVUS) and invasive coronary angiography (ICA) within 48 h were included. The percentage of coronary stenoses were measured and compared by three methods. Influence of available predictors that can potentially affect the measurement results was assessed. Results: Cardiac CTA provided comparable results to IVUS (mean difference -0.45%, PPV: 98%, NPV: 75%). ICA tends to estimate lower stenoses degrees than cardiac CTA and IVUS (mean difference 13.19% and 13.64%, respectively). The final diagnosis and positive remodeling did not lead to any significant influence on measurements. Conclusions: The cardiovascular CT results show that even in emergency settings it is possible to identify morphological changes as sequels of coronary artery sclerosis with comparable results to the reference method IVUS. Deviations of IVUS and cardiovascular CT from ICA are comparable and can to a large extent be explained by differences in the measurement technique.
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