Репозиторий Университета

© 2019 All rights reserved. Objective: to compare strategies of invasive treatment of patients with non-ST elevation acute coronary syndrome (NSTEACS) hospitalized in 2014 and 2015. Materials and methods. We have analyzed treatment strategy used in patients with NSTEACS hospitalized in cardio-reanimation department of a city hospital during one month in two successive years (January 2014 and November 2015). We have compared indications to, and timing of coronary angiography, numbers of performed percutaneous coronary interventions (PCI) and coronary artery bypass grafting surgeries. Results. Portion of patients subjected to invasive procedures in 2014 was 26 %, in 2015-42 %. All 32 primary procedures were PCIs. An increase was due to delayed interventions (24-72 hours), which were not performed in 2014. We also more often used selective multivessel coronary stenting, what facilitated availability of invasive treatment for elderly patients. Hospital mortality of patients with NSTEACS decreased from 16 to 7 %.

© 2018 Media Sphera Publishing Group.All right reserved. Aim: to assess the state of vascular bed, parenchyma, and perfusion of lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using the method of subtraction computed tomography (CT). Methods. CT pulmonary angiography (CTPA) was performed in 45 patients with verified CTEPH (18 men, 27 women, age 26-79 years) by CT scanner using the "Lung subtraction" standard protocol. Parameters analyzed were characteristics of the state of main pulmonary artery (MPA) and the right ventricle (RV), and calculated CT angiographic (CTA) obstruction and perfusion defect scores. Results. Significant correlation was found between CTA obstruction score and perfusion defect score (r=0.34, p=0.02). Mean pulmonary arterial pressure (mPAP) correlated with MPA diameter (r=0.4, p=0.02), RV wall thickness (r=0.6, p=0.0003) and the ratio of MPA diameter to ascending aortic diameter (r=0.5, p=0.002). Significant correlation was also found between RV wall thickness and pulmonary vascular resistance (PVR) (r=0.4, p=0.04). Neither CTA obstruction score nor perfusion defect score correlated with PVR and mPAP. The data of CT did not correlate with results of 6-minute walk test. Conclusion. In patients with CTEPH subtraction CTPA allows carrying out complex diagnostics of the state of vascular bed, parenchyma and perfusion of the lungs.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Purpose: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning. Examination also included echocardiography. Results. In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, postinfarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

© 2018 Russian Electronic Journal of Radiology.All right reserved. The literature data which demonstrate the possibilities of using computed tomography (CT) with contrast agents for the analysis of the deceased patients' bodies are presented. It is shown that postmortem CT angiography significantly expands the possibility of so-called noninvasive autopsy. The information on the features of the use of different types of con-trast agents as well as the main methods of postmortem CT angiography are presented. The use of targeted postmortem CT angiography allows to study the features of blood supply and to identify pathological changes in blood vessels of certain organs, in particular, coronary heart disease and cerebrovascular lesions. CT angiography of the whole body, especially multiphase postmortem CT angiography, allows to visualization of the cardiovascular system as a whole. The use of CT angiography is most effective for determining the source and volume of internal bleeding, the severity of thrombosis and the degree of stenosis of blood vessels, the type and prevalence of vascular malformations. We noted the complexity of the application and possible artifacts of postmortem CT angiography. It was concluded that postmortem CT angiography can be used to analyze of the bodies and clarify the tanatogenesis of deceased patients. We accented that postmortem CT angiography cannot fully replace the traditional autopsy despite its high specificity and sensitivity with regard to visualization of fatal bleeding.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: Assessing the dynamics of vulnerability of atherosclerotic plaques in patients with angina pectoris on atorvastatin therapy (40 mg for 10-12 months) based on coronary computed tomography angiography (CCTA) data. Materials and methods: The study prospectively enrolled 74 patients with angina pectoris not medicated with statins. All patients underwent CCTA. 30 patients with vulnerability of atherosclerotic plaques were selected for further observation and atorvastatin was administered to them at dose of 40 mg. Repeated tomography scans were recorded 10-12 months later. Images were analyzed by "Vitrea" workstation in a blind manner. Statistical processing was performed on SPSS version 11.5 software (BioStat). Results: Statistically insignificant decrease in: total plaque volume (from 188.64 ± 35.8 to 184.96 ± 34.45 mm3), low-attenuation plaque (from 60.46 ± 12.87 to 57.06 ± 12.34 mm3), degree of stenosis (from 41.6 ± 3.16 to 40.65 ± 3.26%), spotty calcification (from 86.0 to 90%), remodeling index (from 1.25 [1,0;1,4] to 1.1 [1,0;1,4]), napkin-ring sign (from 69.76 to 60%), irregularity of the contour (from 79.1 to 65%). LDL levels decreased from 3.23 ± 0.33 to 2.76 ± 0.27 mmol/L. Statistically significant decrease of total cholesterol was from 5.75 ± 0.45 to 4.42 ± 0.57 mmol/L. The study also revealed statistically significant positive correlation between decrease of LDL levels and total plaque volume decrease (R=0.51, P=0.002), mainly because of lowattenuation components. Conclusion: We review our experience of using CCTA for noninvasive monitoring of vulnerability of atherosclerotic plaques in dynamics and show that atherosclerotic plaques stabilize on long-term atorvastatin treatment.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The review illuminated actual issues of the diagnostic efficiency of computed tomography (CT) of the coronary arteries in the planning of the procedure percutaneous coronary intervention (PCI) in patients with chronic occlusion of coronary arteries (CTO). The results of researches of detection of predictors of unsuccessful recanalization according to traditional coronary angiography (CAG) and CT angiography were presented. The major CT characteristics of the CTO, which can supplement the coronary angiography data to predict outcomes of the PCI were discussed.