Coronary Bed Research Articles

The importance of baseline fractional flow reserve to detect significant coronary artery stenosis in different patient populations.

Fractional flow reserve (FFR) assessment compares the blood flow on either side of a blockage in the coronary artery and indicates how severe the stenosis is in the artery. Intravenous adenosine is widely used to achieve conditions of stable hyperaemia for the measurement of FR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially. Therefore, FFR has some limitations, such as the side effects of adenosine and the long procedure time. In addition, there are not enough studies on the evaluation of the baseline ratio of distal coronary pressure to aortic pressure (Pd/Pa) according to standard cut-off values in coronary stenosis under special clinical conditions. This study aimed to assess the diagnostic power of the baseline FFR value for critical coronary stenosis and to determine its predictive value in special patient groups. This retrospective study included 158 patients, who were stratified as Q1 (< 0.89), Q2 (0.89-0.92), Q3 (0.93-0.95) and Q4 (> 0.95) based on baseline FFR values. The baseline Pd/Pa value, the change in adenosine FFR and the raw FFR change were recorded. Its predictive value was also calculated for specific patient groups. The threshold value of baseline FFR level for predicting critical stenosis was ≤ 0.92 with a sensitivity of 92.8% and a specificity of 82% (upper limit of Q2 cartilage). Patients with a baseline FFR value ≤ 0.92 had a 58.4-fold greater likelihood of a critical outcome compared with patients with a baseline FFR value > 0.92 (OR: 58.4; 95% CI: 20.3-124.6). In patients with a baseline FFR ≤ 0.92, the Q1 group had a 10.23-fold higher odds of critical stenosis compared with the Q2 group (OR: 10.23; 95% CI: 2.14-48.84). The same values had similar diagnostic power for all specific patient groups. The baseline FFR value could be used to predict critical coronary stenosis in our patients and had similar value for predicting lesion severity in all the subgroups.

Clinical and prognostic value of leptin resistance in the hospital period of myocardial infarction

Aim. To evaluate the prevalence of leptin resistance (LR) and its clinical and prognostic value in association with metabolic disorders and features of the proinflammatory state in the hospital period of myocardial infarction.Materials and methods. The study included 114 men diagnosed with ST segment elevation myocardial infarction (MI). On day 1 and 12 of MI, the levels of leptin and leptin receptor were measured in patients, and the free leptin index (FLI) was calculated. Leptin resistance (LR) was recorded at leptin &gt; 6.45 ng / ml and FLI &gt; 25. A comparative analysis of clinical and anamnestic characteristics, biochemical parameters, and cardiovascular prognosis was carried out between patients with and without LR. Statistical data processing was carried out using the Statistica 10.0 software package and SPSS 17.0 for Windows.Results. The prevalence of LR in the hospital period of MI was 64%. LR was associated with cardiovascular pathology in the family history, arterial hypertension, dyslipidemia, and obesity. The presence of LR was accompanied by a significant increase in the level of glucose, free fatty acids (FFA), and interleukin (IL)-6 on day 1 of MI and by a significant rise in insulin, C-peptide, tumor necrosis factor (TNF)-alpha, and plasminogen activator inhibitor-1 (PAI-1) throughout the hospital stay. Patients with LR were characterized by multi-vessel and more severe lesions of the coronary bed and were more often subject to early post-infarction angina, recurrent MI, rhythm and conduction disturbances during hospital stay for MI.Conclusion. Patients with MI are characterized by high prevalence of LR during the hospital stay. LR is associated with cardiovascular risk factors, metabolic disorders, formation of insulin resistance, and increased proinflammatory and prothrombogenic factors. The identified features in the presence of LR probably contribute to the development of adverse cardiovascular events in the hospital period of MI.

Transit-time flowmetry measurement features of coronary bypass grafts after multiple percutaneous coronary interventions

The functionality of coronary bypass grafts after surgical myocardial revascularization in patients with coronary heart disease directly depends on the state of the target coronary arteries. In the presence of widespread and diff use atherosclerotic lesions or microcirculatory dysfunctions, a high frequency of coronary bypass dysfunctions is noted in the near future. In some cases, shunt dysfunction can lead to severe hemodynamic instability, accompanied by acute circulatory disorders.Aim: To assess the function of coronary bypass grafts during myocardial revascularization using the method of ultrasonic flowmetry in patients with and without a history of multiple percutaneous coronary interventions (PCI).Material and methods. The retrospective study included 47 patients who underwent coronary artery bypass surgery. A total of 145 coronary bypass grafts were performed. All patients were divided into 2 groups. Group 1 (PCI group) included patients after multiple previous PCI (n = 25; 74 coronary bypass grafts), group 2 (without PCI) included patients without previous PCI (n = 22; 71 coronary bypass grafts). All patients underwent intraoperative ultrasonic flowmetry of coronary bypass grafts using the VeriQ system (Medistim, Norway).Results. When analyzing the status of coronary bypass grafts in patients after multiple PCI, a significantly low mean volumetric blood flow rate was noted (29.5 ± 8.3 ml/min and 48.2 ± 11.6 ml/min, respectively, p = 0.0001) and lower diastolic filling (55.2 ± 8.2% and 71.9 ± 7.1%, p = 0.0001). Also in the group of patients after multiple PCI, there were 2 (2.7%) cases of revision of the distal anastomosis due to a high pulsatile index and low volumetric blood flow velocity. However, no such events were noted in the group without PCI.Conclusions. Previous percutaneous coronary interventions are compromising factors for the state of the coronary bed, which reduces the functional status of coronary bypass grafts and may increase the perioperative risk of surgical myocardial revascularization.

Quantitative assessment of myocardial blood flow by dynamic single photon emission computed tomography: relationship with ECG changes and biochemical markers of damage in patients with acute myocardial infarction

Aim: To study the relationship of microcirculatory changes in coronary bed and electrocardiographic and laboratory signs of damage to myocardium in patients with acute myocardial infarction (AMI).Methods. The observational study included patients with newly emerged AMI. Depending on the ECG changes, the patients were divided into two groups: 1) with ST segment elevation (n = 75) (STEMI) and 2) without ST segment elevation (n = 44) (NSTEMI). All patients underwent electrocardiography, analysis of biochemical markers of myocardial damage, dynamic single photon emission computed tomography (SPECT) and myocardial perfusion imaging.Results. The study included 119 patients (age 62.5 ± 10.4 years, 63% men). STEMI patients had heavier perfusion defects at rest, 5.00 (3.00;9.00) and 0.00 (0.00;1.00), and after pharmacological stress test, 7.00 (5.00;13.00) and 2.50 (0.00;5.00), also they had more reduced stress myocardial blood flow (MBF), 1.09 (0.83;1.59) and 1.67 (1.36;2.46) ml/min/g, flow difference (FD), 0.36 (0.01;0.72) and 1.14 (0.63;1.72) ml/min/g, and myocardial flow reserve (MFR), 1.78 (1.11;2.19) and 2.57 (2.13;3.31), according to compared to NSTEMI patients. Correlation analysis revealed significant relationships between stress MBF and CPK after 24 hours and 4 days: r = –0.34 and r = = –0.31, troponin I upon admission and after 24 hours – r = –0.4 and r = –0.3; MFR and FD and troponin I upon admission – r = –0.41 and r = –0.41.Conclusion. Quantitative parameters of myocardial perfusion determined by early dynamic myocardial SPECT are associated with electrocardiographic changes and biochemical markers of myocardial damage and allow an adequate assessment of the severity of the disease in patients with AMI.

Dilation of the Infarct-Related Coronary Artery to Reduce the Incidence of the No-Reflow Phenomenon in STEMI Patients

Background: The pathogenesis of slow/no-reflow phenomena is a critical socio-medical problem due to high mortality and work disability rates in patients with ST-segment elevation myocardial infarction (STEMI). Slow/no-reflow phenomena are multifactorial involving 4 key elements: 1) distal embolization of the coronary bed of the infarct-related coronary artery; 2) ischemic damage to the myocardium; 3) reperfusion injury of the heart muscle; 4) individual (genetic) susceptibility of the microcirculation to injury. Objective: To analyze the outcomes of percutaneous coronary interventions (PCI) in patients with STEMI and TIMI 0 blood flow of an infarct-related coronary artery based on the strategy to restore antegrade blood flow (balloon predilation or dilation of an infarctrelated artery). Materials and methods: We analyzed treatment outcomes of 209 patients with STEMI and TIMI 0 blood flow. The patients were grouped based on the PCI strategy: group 1 included 147 patients who underwent balloon angioplasty to restore antegrade blood flow, and group 2 included 62 patients who underwent dilation of an infarct-related coronary artery. Results: Our study found that direct stenting in STEMI patients was associated with statistically significantly lower risk of slow/noreflow phenomena (P = 0.001, Pearson’s χ2) and, as a result, better functional outcomes of treatment (chronic heart failure grade classified according to Strazhesko-Vasilenko and by left ventricular ejection fraction) that were also statistically significant (P = 0.001, Pearson’s χ2). Conclusions: Our study demonstrated that the risk of slow/no-reflow phenomena in patients with TIMI 0 blood flow of an infarctrelated coronary artery was statistically significantly lower (P = .001, Pearson’s χ2) in the group of patients who underwent dilation of an infarct-related coronary artery to restore antegrade blood flow. Functional outcomes (chronic heart failure grade and overall survival) were also better in this group of patients (P = .001, Pearson’s Chi-square). Moreover, dilation of an infarct-related coronary artery was associated with preserved left ventricular ejection fraction compared with the group of patients who underwent balloon angioplasty to restore antegrade blood flow (P &lt; 0.001, Pearson’s χ2).

Features of coronary pathology and its relationship with myocardial fibrosis markers in patients with resistant hypertension

Aim. To evaluate the severity of coronary atherosclerosis and its association with biochemical markers of fibrosis in patients with coronary artery disease (CAD) and resistant hypertension (RHT).Material and methods. The study included 39 patients with CAD and RHT. All patients underwent 24-hour blood pressure (BP) monitoring, office BP numbers were measured. Laboratory diagnostics included routine tests, as well as determination of serum lipocalin, plasma concentration of matrix metalloproteinases 2 and 9 (­MMP-2, MMP-9), tissue inhibitor of matrix metalloproteinases-1 (TIMP 1). Coronary atherosclerosis in patients was assessed retrospectively according to medical records with an assessment of the protocols of invasive coronary angiography and multislice computed tomography, performed no more than a year ago from the moment of inclusion in the study with no clinical signs of CAD progression. Obstructive atherosclerosis was considered a coronary artery narrowing by more than 50%.Results. Considering the results of previous coronary angiography, the patients were divided into two groups. In the first group (n=20), coronary artery stenosis was &lt;50%, in the second (n=19) &gt;50% (p&lt;0,05). The compared groups of patients were comparable in sex, age, duration of hypertension, blood pressure level, and the number of antihypertensive drugs taken. There were no differences in blood lipid profile, basal glycemia, uric acid levels, and the frequency of previous cerebral accidents. However, the incidence of diabetes in group 2 was significantly higher (p&lt;0,05). Additionally, there was a significant difference in serum levels of lipocalin and MMP-2 with higher values of these indicators in patients with coronary atherosclerosis stenosis (p=0,02).Conclusion. In patients with RHT with symptoms and signs of myocardial ische­­mia, the incidence of obstructive coronary atherosclerosis according to coronary angiography is 50%. Diabetes in this category of patients indicates a more frequent obstruction of coronary bed. An increase in the level of MMP-2 and lipocalin in this category of patients is associated with more severe coronary damage and can be considered as an indirect indicator of obstructive coronary atherosclerosis.

Impact of a New Cardiac Catheterisation Laboratory at Ipswich Hospital on Treatment of Acute Coronary Syndromes and Bed Occupancy

Impact of a New Cardiac Catheterisation Laboratory at Ipswich Hospital on Treatment of Acute Coronary Syndromes and Bed Occupancy

Comprehensive analysis of clinical and paraclinical parameters of coronary blood flow in patients with acute types of coronary artery disease and type 2 diabetes

Aim. To study clinical and paraclinical parameters and lesions of the coronary bed in patients with acute types of coronary artery disease (CAD) and type 2 diabetes (T2D).Material and methods. The study included 102 patients of both sexes with acute CAD. Patients were analyzed in two following groups: the first (mean age, 56,6±0,96 years, men/women 34/16) consisted of 50 patients with acute coronary syndrome (ACS) and type 2 diabetes, the second (mean age, 58,7±1,01 years, men/women 37/15) — 52 patients without T2D. Along with the assessment of behavioral and biological risk factors for CVD, clinical and hemodynamic parameters and the results of coronary angiography were analyzed.Results. In patients with ACS and T2D, the duration of T2D was 5,6±3,7 years. Somatic comorbidities were registered in 74% in the first group, and in 53,8% in the second. According to echocardiography, in the group of people with ACS and T2D, the left ventricular ejection fraction was lower, and the mean pulmonary artery pressure was higher compared to the group without T2D. Stenosis of the distal coronary artery third in patients with T2D occurred in 78% of cases, and in patients without T2D — in 42%; the differences were significant (p&lt;0,001). Diffuse CAD also prevailed in the first group and amounted to 58%, and in the second — 27%. The SYNTAX score was higher in patients with T2D compared with the group of people without T2D — 29,2 and 22%, respectively (p&lt;0,001).Conclusion. In patients with ACS and T2D, the prevalence of pulmonary hypertension and left ventricular systolic dysfunction was revealed. The features of the coronary flow in patients with T2D with ACS were predominantly the distal type of lesion, as well as an increased risk of angioplasty complications, assessed using the SYNTAX score.

Coronary type of blood supply to the calf's heart

The high variability of branching of the heart vessels in animals is a proven and irrefutable fact in veterinary morphology. In individuals of the same species and breed, quite high discrepancies can sometimes occur in the topography of the coronary arteries of the heart. When studying the coronary bed of the heart of animals, we recorded a case of the presence of a right-handed type of blood supply in a two-month-old Blackand- White calf in the absence of a left coronary artery. In this regard, we set ourselves the goal of studying the features of the vascularization of the right half of the heart in a two-month-old Black-and-White calf with a right-sided type of blood supply.To achieve this goal, the heart of the corpse of a two-month-old Black-and-White calf, obtained from a private farm in the Leningrad Region, was studied. The study was conducted at the Department of Animal Anatomy, St. Petersburg State University of Veterinary Medicine. To study the vascularization of the heart of the studied animal, classical and modern anatomical techniques were carried out, such as fine anatomical preparation, photography, and the manufacture of corrosion preparations using latex.According to the results of the study, it was found that in the absence of the left coronary artery in the studied two-month-old calf of the Black-and-White breed, the right coronary artery completely and completely compensates for its absence. The presence of the right interventricular artery was established, which has such branches as the artery of the right septomarginal trabecula and atrioventricular branches that supply blood to the tricuspid valve area and the right septomarginal trabeculae of the heart. It was determined that the vessels that vascularize the structures of the right atrium and right ventricle in their topography in the studied individual are inferior in the number of S-shaped bends and sharp corners in comparison with the arteries of the left half of the heart, which can reduce the risk of developing coronary pathologies in the right half of the heart. It was established that the subsinus artery differs from the generally accepted classical topography and plunges into the thickness of the myocardium of the right ventricle and interventricular septum, and practically does not pass as part of the subsinus sulcus.

Regional differences in the level of inflammation between right and left sided coronary arteries: a cardiac CT study of epicardial fat attenuation index

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022). Background Pericoronary fat attenuation index is a novel CT-derived marker used to quantify vascular inflammation at the level of coronary vessels. It has prognostic value for major adverse cardiovascular events and provides improvements in cardiac risk assessment beside classical risk factors and coronary artery calcium score. However, the influence of local factors related to coronary circulation in the right versus left coronary bed, on the development of pericoronary inflammation, has not been elucidated so far. Purpose The aim of the study was to evaluate the regional differences in the level of inflammation between right and left sided coronary arteries. Methods In total, 153 patients (mean age 62 years, male patients 70.5%) who underwent clinically indicated coronary computed tomography angiography (CCTA) were included in the study. All the plaque features classically associated with vulnerability were evaluated for identification of high-risk plaques. Fat attenuation index (FAI) and the corresponding FAI score (which takes into consideration the risk factors and age) were calculated for all cases at the level of the left anterior descending artery (LAD), circumflex artery (Cx) and right coronary artery (RCA). Results A total of 459 coronary arteries were included in the analysis and both FAI and FAI score were higher at the level of RCA compared with LAD and Cx. FAI score was 15.23±11.97 at RCA vs 10.55±6.78 at LAD and 11.48±6.5 for Cx, p = 0.02. Also, a significantly higher value of FAI at the level of RCA was noted in comparison with the other two coronary arteries: −76±7.68 HU for RCA compared to −73.04±8.9 HU for LAD and −71.25±7.47 HU for Cx, p&amp;lt;0.0001. This difference was maintained in all the study sub-group analysis: for patients undergoing CT scan after COVID infection (−75.49±7.62 HU for RCA vs -72.89±9.40 HU for Cx and −71.28 ±7.82 HU for LAD, p = 0.01), or patients with high-risk plaques (20.98±16.29 for RCA vs 11.77±7.68 for Cx and 12.83±6.47 for LAD, p = 0.03). Conclusion Plaques located in different coronary territories exhibit different vulnerability patterns and different levels of inflammation. RCA seems to have a more pronounced susceptibility to inflammation, right coronary plaques exhibiting higher scores of inflammation in the territories surrounding coronary plaques.

Pathophysiological effects of SARS-CoV-2 infection on the cardiovascular system and its clinical manifestations-a mini review.

Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 may have a mild presentation, with few symptoms, or progress to a severe condition, characterized by generalized inflammation, systemic microvascular involvement, coagulopathy, and pulmonary and cardiovascular complications. Men present with more severe symptoms than women, especially men who are older and who present with comorbidities such as hypertension, diabetes mellitus, and a history of atherosclerotic diseases. Owing to its association with endothelial dysfunction, inflammation, thrombosis, and microvascular obstruction, SARS-CoV-2 infection can cause lesions in several organs, including the myocardium and the coronary arterial bed, which can result in clinical manifestations involving the cardiovascular system. In this mini review, we summarize the effects of SARS-CoV-2 infection on the cardiovascular system in both children and adults and characterize the various clinical manifestations associated with this disease.

Growth differentiation factor 15 (GDF15) preconditioning but not post-conditioning protects the hearts towards ischemia-reperfusion injury

Growth differentiation factor 15 (GDF15) is a stress-responsive cytokine, which can be produced under certain pathological situations, mainly related to inflammatory stress, aging and disease. While clinical data suggest that GDF15 is a powerful prognosis factor in several high-risk cardiovascular situations, experimental studies rather consider this cytokine as a cardioprotective molecule. We aimed to clarify the direct cardiac effects of GDF15 during ischemia-reperfusion (I-R) injury, at concentrations found in patients with high cardiovascular risk, such as these of patients presenting with acute myocardial infarction or stroke. Wistar male rats (200–400 g) were used for both in vivo and ex vivo ischemia-reperfusion and anesthetized with isoflurane. In vivo rats were injected with either saline (Control groups) or 2.5 μg/kg of GDF15 (GDF15 groups), 20 minutes before ischemia in the preconditioning protocol, or at the end of ischemia in the post-conditioning protocol. Myocardial ischemia was induced by the transient ligation of the left anterior descending artery for 30 min followed by 24 h of reperfusion. In a second set of experiments, rat's hearts were isolated and perfused ex vivo on a Langendorff model with either saline (Control groups) or 2000 ng/L of GDF15 upstream the coronary bed (GDF15 groups) for 10 minutes before ischemia or during reperfusion following 30 minutes of global normothermic total ischemia. GDF15 decreased the infarct size in vivo as well as in ex vivo when administrated before ischemia but not at the end of it. Moreover, in our ex vivo model, only GDF15 preconditioning induced a better recovery of most contractile parameters after ischemia (P < 0.05 for all parameters). These results demonstrate that exogenous GDF15 preconditioning decreased cardiac cell death in vivo but also ex vivo, the latter situation involving that inflammatory, endocrine, and nervous systems are not interfering. Suggesting that GDF15 exerts direct cardioprotective properties towards ischemia-reperfusion injury.

Analysis of factors influencing the values of parameters of intraoperative flowmetry of coronary bypass grafts: retrospective single-center cross-sectional study

Оbjective. This study determines the factors that can affect the value of the parameters of intraoperative flowmetry of coronary bypass grafts.&#x0D; Material and methods. TTFM is a routine procedure accompanying coronary artery bypass grafting at the Federal State Budgetary Institution FTSSSh (Penza). This retrospective study included 995 consecutive patients who underwent isolated coronary artery bypass grafting of the left coronary artery. The exclusion criteria were damage to the right coronary artery bed, the emergency nature of the operation, and the combined pathology of the valvular apparatus. Patients who underwent anastomosis revision due to flowmetry parameters changes were also excluded from the study. Intraoperative assessment of coronary artery bypass grafts was performed using VeryQ and MiraQ MediStim flowmeters (Norway).&#x0D; Results. A total of 1733 arterial and 479 venous grafts were evaluated. The following factors influenced the average volumetric blood flow velocity value: composite shunting of the border stenosis increases the chance of reducing the volumetric blood flow below the threshold value by 1.841 times (OR=1.841; p=0.018), the combination of occlusion and borderline stenosis with composite shunting increases the chance of reducing the volumetric blood flow velocity by 3.91 times (OR=3.91; p=0.041), an increase in the diameter of the bypassed artery by 1.0 mm reduces the chance of a decrease in blood flow volume velocity by 53.7% (OR=0.423; p=0.05).&#x0D; Conclusion. The following factors influence the peripheral resistance index: coronary artery diameter (OR=0.21; p=0.001), degree of artery proximal stenosis (OR=0.987; p=0.034), the vascular wall condition (OR=2.25; p=0.05), type of conduit used (OR=0.298; p=0.002), and shunting method (OR=1.699; p=0.017). The following factors influence the mean volumetric blood flow velocity value: bypass method (OR=1.841; p=0.018), a combination of occlusion and borderline stenosis in composite bypass grafting (OR=3.91; p=0.041), and the bypassed artery diameter (OR=0.423; p=0.423; p=0.05).

Characteristics of changes in the coronary arteries in patients with acute coronary syndrome on the background of chronic obstructive pulmonary disease

Aim. Study of the nature and characteristics of changes in the coronary bed in patients with acute coronary syndrome (ACS) and chronic obstructive pulmonary disease (COPD).Materials and methods. The study included 85 patients with ACS: group 1 included 47 patients with ACS and COPD, group 2 included 38 patients with ACS. All patients underwent a comprehensive clinical, instrumental and laboratory examination.Results. In the majority of patients of group 1 (76.6%), two- and three-vessel lesions of the coronary bed were revealed, and arterial stenoses were multiple, located mainly in the middle and distal parts of the arteries. In (76.3%) patients of the 2nd group, one- and two-vessel lesions of the coronary bed with localization of stenoses mainly in the proximal and middle segment of the coronary arteries (CA) were revealed. The total number of stenosis and hemodynamically significant stenosis was higher in group 1 compared to group 2 (p=0.01). Extended stenoses were more common in group 1 patients (p=0.04). Damage to the CA of the 2nd order was also higher in the 1st group of patients (p=0.01). The 1st group was divided into two subgroups: 1A (26 people) − patients with COPD of moderate severity and 1B (21 people) − patients with severe COPD. In patients of subgroup 1B, a more significant lesion of the coronary bed was noted due to an increase in the total number of stenoses (p=0.02), hemodynamically significant stenoses (p=0.01), localized in the proximal (p=0.04) and distal (p=0.02) segments of the coronary artery, in the branches of the 2nd order (p=0.02), as well as occlusions and critical stenoses of the coronary artery (p=0.02).Conclusion. The severity of COPD in patients with ACS significantly affects the number of hemodynamically significant proximal and distal stenoses, as well as branches of the second order coronary arteries, which reduces the effectiveness of surgical treatment and worsens the prognosis of patients with comorbidities.

Role of Myocardial Bridging in Myocardial Ischemia: Case Report

INTRODUCTION: Myocardial bridging (MB) is considered a benign pathology, however, its existence is often associated with angina pectoris, myocardial infarction, ventricular tachycardia and sudden cardiac death. The clinical significance of MB is determined by the dynamic stenosis of the coronary artery, which depends on the rate and strength of heart contractions and is poorly visualized by instrumental methods, which impairs timely diagnosis and early administration of the adequate treatment. A clinical case of a combined damage to the coronary bed in a 58-year-old patient is presented: MB of the anterior interventricular artery (AIVA) causing dynamically significant narrowing of the tunnel artery and hemodynamically insignificant atherosclerotic lesion of the coronary arteries. MB was typically located in the mid-segment of the AIVA. The diagnosis of the anomaly of the coronary bed was established after coronary angiography: MB of AIVA led to stenosis of the tunnel segment to 80% and was the cause of angina attacks. Stenting of the AIVA with a drug-coated stent was performed. The effectiveness of the stenting can be referred to a peculiar feature of this case, since in the treatment of this pathology the preference is given to myotomy and coronary artery bypass grafting as more effective methods. The follow-up period was 7.5 years; after stenting of the tunnel segment of the AIVA the anginal attacks did not recur.&#x0D; CONCLUSION: The described clinical case demonstrates the role of MB in the development of myocardial ischemia. With timely diagnosis of the coronary blood flow disorders, successful revascularization and adequate pharmacotherapy in accordance with the current clinical recommendations, the prognosis is good.

Электрокардиографические изменения в раннем периоде после плановой реваскуляризации миокарда

INTRODUCTION: To date, highly effective methods of myocardial protection have been developed, which are widely used in cardiac surgery. At the same time, the problem of perioperative myocardial infarction still exists and is one of the causes of adverse cardiovascular events and mortality, both at the hospital stage of treatment and in the long-term period. A factor leading to such a complication may be acute dysfunction of the coronary bypass graft, the timely detection and elimination of which will reduce the negative consequences of myocardial damage. The relevance of the study results from investigation of the relationship between the angiographic data and the character of ischemic changes on the electrocardiogram of patients with and without proven acute dysfunction of coronary bypass graft. AIM: Identification of the most pathognomonic electrocardiographic signs of dysfunction of coronary bypass grafts in the early postoperative period after planned myocardial revascularization. MATERIALS AND METHODS: The study included 196 (1.86%) of 10,550 patients operated for coronary artery disease in Chelyabinsk Center of Cardiovascular Surgery from 2011 to 2020, who underwent emergency angiography after planned coronary artery bypass graft surgery due to the appearance of signs of myocardial damage in the early postoperative period. Depending on the type of angiographic findings and the chosen treatment tactics, patients were divided to 3 groups. Group I (n = 86) included patients in whom angiography revealed defects in the area of large bypassed coronary arteries, of them 60 patients underwent endovascular treatment, and 26 patients underwent repeated open surgery. Group II (n = 33) consisted of patients in whom bypass graft dysfunction was noted, but, however, due to the small diameter or pronounced diffuse lesion of the bypassed coronary arteries, all the patients underwent conservative therapy. Group III included 77 patients in whom hemodynamically significant defects in grafts and native arteries were not identified. RESULTS: When studying postoperative electrocardiographic data, it was found that significant differences between the groups were obtained only in the occurrence of ventricular arrhythmias (P1–2 = 0.027; P2–3 = 0.01). As for other pathological electrocardiographic signs and their combinations, no statistical differences were found. CONCLUSIONS: An isolated electrocardiographic study in the early postoperative period does not permit to identify patients with dysfunction of coronary bypass grafts. It is necessary to develop a diagnostic algorithm, including instrumental and laboratory methods, for accurate diagnosis of myocardial ischemia caused by impaired graft function or pathological deformation of the coronary bed due to surgical procedures.

Is del Nido cardioplegia safe in isolated coronary bypass surgery? It may be possible with this method

Objectives: This study aimed to share the early results of the del Nido (DN) solution used with a different method in patients who underwent isolated coronary bypass. Patients and methods: The retrospective study included 150 patients (123 males, 27 females; mean age: 59.8±9.7 years; range, 38 to 84 years) who underwent isolated coronary bypass operation between January 2020 and May 2022. The DN solution was applied differently from the practice in the literature. Seventy-five percent of the dose calculated according to the body weight of the patients was administered at the first moment. The remaining amount was continued to be given through the saphenous veins as distal anastomoses were made. When the cross-clamp was lifted, all grafts were tied to the aorta cannula, and the coronary vascular bed was cleared. Follow-up of patients was done routinely. Results: The mean preoperative ejection fraction was 49.9±5.6, and the mean postoperative ejection fraction value was 50.3±5.0 (p=0.079). A statistically significant difference was found between the preoperative troponin level and the postoperative troponin level at 6 h (p&lt;0.001). However, there was no significant difference between the postoperative 6 h and the postoperative 24 h. Spontaneous rhythm occurred at the termination of cardiopulmonary bypass in most of the patients (97%). No permanent pacing was required in any patient. An intra-aortic balloon pump was used in nine patients, and extracorporeal membrane oxygenation was used in two patients. Two patients died in the early period. Conclusion: The use of DN with this method seems to be a reliable alternative to eliminate hesitations in isolated coronary bypass surgery.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ КЛИНИКО-АНАМНЕСТИЧЕСКИХ И ЛАБОРАТОРНО-ИНСТРУМЕНТАЛЬНЫХ ХАРАКТЕРИСТИК ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА, ПРОЖИВАЮЩИХ В УСЛОВИЯХ КРАЙНЕГО СЕВЕРА И УМЕРЕННОЙ КЛИМАТИЧЕСКОЙ ЗОНЫ

Introduction.Climatic conditions of the Far North are a factor in the early development and progression of coronary artery disease. Aim. To study the clinical-anamnestic and laboratory-instrumental characteristics of patients with coronary artery disease living in the Far North and the temperate climate zone. Material and methods. An observational analytical study of 302 patients with coronary artery disease admitted to the hospital for coronary angiography was performed. Group 1 (n=168) included patients living in the Yamalo-Nenets Autonomous Okrug, group 2 (n=134) included patients living in the temperate climate zone. The clinical status of patients, drug therapy, laboratory data, and coronary angiography results were assessed. Student’s t-test, Mann-Whitney U-test, χ2 test or Fisher’s exact test were used when comparing indicators between the groups.. Results and discussion. In group 1, despite the younger age of patients, a history of myocardial infarction and chronic heart failure with a low left ventricular ejection fraction were more often recorded, which may be due to the so-called “polar tension syndrome”, which triggers pathological mechanisms of remodeling of the cardiovascular system. In elderly patients in group 2, hypertensive crises were more often recorded, and systolic blood pressure was higher and did not reach the target values. There were no differences in the nature of the lesion of the coronary bed. In both groups, a high incidence of hyperlipidemia was established and elevated levels of homocysteine, matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1, which are markers of atherosclerotic plaque instability and rapid progression of atherosclerosis, were registered. There were no differences in adherence to statin therapy, but the average dose of atorvastatin in group 2 was 2 times lower than in group 1. Group 1 patients were more adherent to taking antiplatelet agents, mainly due to middle-aged patients. Conclusion. In patients with coronary artery disease living in the Far North, despite their younger age, myocardial infarction and severe heart failure were more often found. All patients had a high incidence of hyperlipidemia and elevated levels of immune inflammation biomarkers. Regional differences in prescribed therapy and in the formation of patients’ adherence to treatment were revealed.

ПОРАЖЕНИЕ КОРОНАРНОГО РУСЛА, БИОЛОГИЧЕСКИЙ ВОЗРАСТ И УРОВЕНЬ МИКРО-РНК У БОЛЬНЫХ СТАБИЛЬНОЙ ИБС С ПОГРАНИЧНЫМИ СТЕНОЗАМИ КОРОНАРНЫХ АРТЕРИЙ

Objective. To compare the nature of coronary vascular bed lesion, vascular wall stiffness depending on passport and biological and age ratio, and to study microRNA (miRNA) levels in different clinical phenotypes stable coronary artery disease (CAD) (pt) with borderline coronary artery (CA) stenosis. Material and methods. 258 stable angina 1-3 class patients (51 - 19.8% women and 207 - 80.2% men) with borderline CA stenosis and the presence of hypertension were included in the comparative descriptive trial of three parallel groups. All pts along with clinical examination and ultrasound of the heart underwent selective coronary angiography. The passport and biological age ratio were evaluated using a VaSera VS-1500N. Determination of miRNA levels was carried out using the PCR method in real time. Statistical calculations were carried out using the RStudio program (version 2022.07.2+576, USA) and the R language (version 4.1.3 (2022-03-10), Austria). Results. One with the CAD phenotype without diabetes mellitus (DM) and obesity (n=115 (44.6%)), the CAD phenotype with type 2 (n = 55 (21.3%)) and CAD with metabolically unfavorable obesity phenotype (MUOP) ([n=88 (34.1%)) prevailed among PTs with borderline CA stenosis when conducting a random sample. The features of the coronary vascular bed lesion are stenosis of the anterior descending artery and the circumflex artery especially in the distal segments in CAD and DM pts. The frequency of the right CA lesion was higher in CAD with the MUOP phenotype, also with more pronounced distal segments. Pts with biological age predominance are characterized by an unborable course of the disease, as a well as cardiometabolic profile. MiRNA concentration assessment revealed increased miRNA-221 levels in CAD with MUOP pts and increased miRNA-22 and -126 levels in CAD and DM pts. Conclusion. Stable patients with CAD with borderline CA stenosis represent a serious condition in prognostic terms due to a long history of hypertension and expressed cardiometabolic associations and a frequent increase in biological age. The assessment of the miRNA levels of these pts is of great interest and represents a promising direction for use in diagnosis and treatment.

The role of increased serum creatinine level in adverse outcomes of endovascular revascularisation in patients with acute coronary syndrome

Ischemic kidney damage as part of acute coronary syn-drome (ACS) largely contributes to the development of un-favorable outcomes not only of the underlying disease, but also of endovascular procedures, aggravating the patient’s condition and prognosis. This study is aimed at assessing the long-term results of coronary stenting for ACS in pa-tients with a sharp increase in serum creatinine levels wit-hin 48 hours after the intervention. Purpose: to evaluate the relationship between an increase in serum creatinine levels after coronary stenting of an infarct-related artery and the development of adverse outcomes in the long term. Materials and methods: 51 patients with ACS took part in the study. Serum creatinine was assessed before and wit hin 48 hours after coronary stenting. Subsequent-ly, after 3–6 months, patients underwent repeat coronary angiography to assess the patency of the coronary bed. Results: based on repeated coronary angiography, we identified the development of angiographic restenosis in those patients who demonstrated a significant increase in serum creatinine levels within 48 hours after stent implan-tation. In the group of patients without restenosis, creati-nine values before and after revascularization were com-parable. Conclusion: we noted that kidney damage due to acute coronary syndrome in combination with the intro-duction of a large volume of contrast agent can contribute to the development of unfavorable outcomes of coronary sten ting in the long term, namely, in-stent restenosis