[Noncompaction myocardium as a primary phenomenon or consequence of myocardial dysfunction: clinical masks of the syndrome]

Noncompaction myocardium (NCM) is a genetic heterogeneous primary cardiomyopathy which affects both children and adults and can be either isolated or combined with other congenital heart disorders. It has common pathogenesis of symptoms but is distinguished by pronounced clinical polymorphism. We have observed 25 adult patients (15 men, 10 women aged from 20 to 62 years, mean age 42.9+/-13.3 years) with NCM syndrome. Heart failure have been found in 96% of patients (functional class [FC] I in 7, II - in 6, III in 7, and IV - in 4 patients). Ninety two percent of patients have ventricular extrasystoles, 32% - atrial fibrillation, 28% - FC I-III angina. Mean end diastolic left ventricular dimension is 6.5+/-0.8cm, ejection fraction 29.7+/-13.0%, mean pulmonary artery pressure - 42.6+/-13.5 mm Hg. Intracardiac thrombosis have been found in 24% of patients. In 7 patients morphological study of myocardium has been performed. NCM syndrome was diagnosed at initial investigation just in 1 case. We distinguished the following clinical masks (variants of diagnosis) of NCM: 1) clinically not manifest, is revealed at accidental examination (4%); 2) exists under mask of "idiopathic" rhythm disturbances (8%); 3) has a mask of ischemic heart disease; 4) is revealed in patients with acute or subacute myocarditis (12%); 5) has a mask of dilated cardiomyopathy (52%); 6) NCM in patients with other primary cardiomyopathies (hypertrophic, restrictive, genetic myopathy, arrhythmogenic right ventricular dysplasia). Combination of NCM with congenital heart defects has been found in 20% of patients. In 56% of cases myocarditis was diagnosed (it was viral in no less than 44%). Only in 32% of patients it is possible to consider presence of isolated NCM syndrome. This paper contains discussion of problems of diagnostics (including morphological) and treatment in the presented group of patients, significance of myocarditis for development of decompensation, role of NCM in patients with other primary cardiomyopathies, possibility of compensatory (secondary) character of NCM in severe systolic dysfunction.

[MR-fetography: new possibility of fetal evaluation]

PURPOSE

To evaluate the use of MR-fetography sequences in identifying the major fetal structures and to compare thick and thin-slab acquisitions for their diagnostic value.

MATERIALS AND METHODS

21 consecutive, pregnant women with suspected fetal pathology underwent fetal MRI using a 1.5 Tesla MRI unit. Heavily T2-weighted, SSFSE sequences with a long echo train (MR-fetography) was acquired in a thick and thin-slab modus. Thick and thin-slab acquisitions were reviewed by two experienced radiologists with regard to the overall image quality, graded according to a three-scale grading system (3 - good, 2 - moderate, 1 - poor), and evaluation of major fetal structures; visibility scores for each were calculated and compared.

RESULTS

Overall image quality was graded good in 71.4%, moderate in 23.9% and poor in 4.8% for thick-slab images and good in 81%, moderate in 4.8%, poor in 4.8% for thin-slab images. The visibility scores of the thick /thin-slab images for evaluation of the main fetal structures were as follows: for the spinal canal 2.8 +/- 0.4/2.9 +/- 0.36 (p > 0.05), spinal cord 2.4 +/- 0.75/2.7 +/- 0.66 (p < 0.05), posterior fossa components (brainstem, cerebellum, basal cisterns) 2.4 +/- 0.6/2.7 +/- 0.58 (2.3 +/- 0.66/2.7 +/- 0.66, 2.5 +/- 0.6/2.8 +/- 0.54, 2.6 +/- 0.51/2.7 +/- 0.56; p < 0.05), stomach 2.8 +/- 0.44/2.9 +/- 0.48 (p > 0.05), urinary bladder 2.8 +/- 0.44/2.8 +/- 0.54 (p > 0.05), and umbilical cord 2.9 +/- 0.3/2.7 +/- 0.56 (p < 0.05).

CONCLUSION

Heavily T2-weighted MR-fetography renders a reliable quick survey/ overview of fetal anatomy, contours and size. Thick-slab images display the entire fetus in one projection while thin-slab images provide evaluation of smaller anatomical structures (e.g. spinal cord, posterior fossa components) without suffering from volume averaging effects or overlay projection phenomena.

[Evaluation of the efficiency of neoadjuvant chemotherapy in patients with breast cancer from the results of magnetic resonance imaging]

The immediate efficiency of neoadjuvant chemotherapy was analyzed in 16 patients with Stages IIb-IIIb breast cancer, by applying magnetic resonance imaging. The latter allows the time course of tumor changes and the efficiency of neoadjuvant chemotherapy to be estimated with high accuracy.

[Primary lymphoma of the heart: difficulties in diagnosis and treatment]

Primary lymphoma of the heart (non-Hodgkin's lymphoma primarily of B-cells affecting first the heart and pericardium) is a rare disease which accounts for 1.3-2.0% of all primary tumors of the heart. A case is reported of a 43-year-old male patient with a cardioverter-defibrillator implanted at the age of 38 years for management of ventricular tachycardia paroxysms and AB-block of the second-third degree. The patient also had hypertrophic cardiomyopathy, moderate pressure gradient on the pulmonary artery valve and pericardial effusion. Later he had two cardiac tamponades (serous punctuate). From the age of 42 years breathlessness, right ventricular wall thickness, right heart pressure and pulmonary artery pressure aggravated. The patient has undergone ballon plastic surgery of the pulmonary artery valve. At the age of 43 computed tomography detected massive tumor of the heart and mediastinum first diagnosed as sarcoma but later specified as lymphoma. Endobronchial biopsy specimens contained the tissue of diffuse large B-cell lymphoma, the liver and lymph nodes were also involved. After the first course of effective polychemotherapy (CHOP) the patient died of mesenterial thrombosis. Diagnostic difficulties and problems of treatment policy are discussed.

Bose-Einstein condensation of semi-hard bosons in the S = 1 dimerized organic compound F(2)PNNNO

An analysis of the energy spectrum and magnetization curve of the two-dimensional organic antiferromagnet F(2)PNNNO with a spin-one dimerized structure shows that the behavior of the compound in an external magnetic field can be explained within a lattice boson model with an extended Pauli exclusion principle, i.e. no more than two bosons per dimer. The unusual magnetization curve observed experimentally in the compound reflects a sequence of phase transitions intrinsic for a lattice boson system with strong on-site and inter-site repulsions due to a tuning of magnon density by the applied magnetic field.

[Clinical-morphological changes of venous system of the heart in dependence on the stage of chronic heart failure]

Cardiac venous system (CVS) in chronic heart failure (CHF) undergoes whole row of morpho functional changes, but investigations of CVS are practically absent. We studied CVS of patients with Doppler echocardiography and magnetic computer tomography of the heart. The state of peripheral venous system was assessed by measurement of peripheral venous pressure (PVP) with Waldman apparatus. Morphological changes of VCS were studied with light microscopy. All patients were distributed in groups in dependence on CHF stage. We assessed coronary sinus (CS) and large cardiac veins. In CHF PVP was significantly elevated, dimensions of CS and lumen of large cardiac veins substantially increased, and significant morphohystological changes of cardiac veins were noted. Detected changes of VCS in these patients depended on the stage of CHF.

[Differential diagnosis of liver focal formations at diffusion MRI]

PURPOSE

To define the role of diffusion-weighted imaging and MRI contrast enchanced in the differential diagnostics of focal liver lesions.

METHODS AND MATERIALS

Forty patients with focal liver lesions (23 metastases, 32 cysts, 24 hemangiomas) underwent MRI at 1.5 T scanner. The protocol included T1, T2-imaging, DWI. For DWI we used b = 50, 400 s/mm2. Coefficient of signal intensity (kSI) for different sequences was counted by the formula: kSI = (SIa-SIb)/(SIa + SIb), where SIa was the lesion signal intensity, SIb was SI of normal liver parenchyma.

RESULTS

Metastases had maximal kSI of DWI with b = 400 (kSI = 0.44 U) and minimal signal intensity of T1-WI (kSI = 0,29 U). On T1-W images the cysts differed greatly from liver parenchyma and from other focal lesions (kSI = 0,37 U), but hemangiomas hardly differed from metastases on this sequence (kSI, for these lesions was equal, 0.14 U). Using DWI made the differential diagnosis of different liver lesions easier because their kSI were significantly different: kSI for cysts was 0.68 U, kSI of hemangiomas was 0.61 U, kSI of metastases was 0,30 U. We need more studies for define the role of MRI contrast enchanced in the differential diagnostics of focal liver lesions.

CONCLUSION

DWI plays an important role in differential diagnostics of focal liver lesions and should be included in protocol of examination of patients with liver pathology.

[Diagnosis of malignant pericardial mesothelioma]

Continuing growth of rate of detection of primary tumors of the heart has been noted recently. Prevalence of cardiac tumors in European population according to data of different authors varies from 25 to 5500 cases per 1 million of autopsies. Malignant mesothelioma belongs to most rarely met tumors. In most cases pericardial malignant mesothelioma possesses high secretory capacity what allows to suspect tumorous process in hemorrhagic pericarditis with recurrences after repetitive punctures. The paper contains description of a patient with malignant pericardial mesothelioma. Special feature of this case has been atypical clinical course of the disease complicated by development of acute myocardial infarction of posterior left ventricular wall.

[The peripheral and intracardiac venous system of the heart in chronic heart failure]

AIM

To evaluate the cardiac venous system (CVS) and its changes in chronic heart failure (CHF), by applying noninvasive studies.

SUBJECTS AND METHODS

CVS was studied by Doppler echocardiography in 160 patients and by multispiral computed tomography (MSCT) in 41. For evaluation of the peripheral venous system (PVS), a Wildman apparatus was used to measure peripheral venous pressure. According to the stage of CHF, all the patients with this condition were divided into 3 groups. The cardiac venous sinus and cardiac veins were evaluated in control and CHF groups.

RESULTS

In CHF, PVS and CVS substantially change and significantly depend on the stage of CHF.

CONCLUSION

These investigations give more insight into the pathogenesis of CHF. On treating a patient with CHF, the CVS should be studied thoroughly and by all available techniques.

[Modification of coronary sinus in patients with chronic cardiac insufficiency]

Both venous and arterial beds undergo a number of morphofunctional changes in patients with cardiovascular pathology, but they rarely attract attention of researchers. The available data indicate that the cardiac venous system (CVS) plays an important role in the development of chronic cardiac insufficiency (CCI) and dictate the necessity of its in-depth studies. We examined CVS in 160 patients by Doppler echo-CG and in 41 ones by spiral CT. The patients were allocated to 3 groups depending on the stage of CCI (IIA, IIB and III stages, III-IV functional class). The state of their coronary sinus (CS) was compared with that of healthy subjects. The state of CS varied considerably depending on the stage of CCI. It is concluded that patients with CCI need their CVS to be studied by all available methods.

[Echocardiography and magnetic resonance tomography of the heart in diagnosis of noncompaction of left ventricular myocardium]

Left ventricular (LV) noncompaction (NC) is a rare form of cardiomyopathy which initially was diagnosed by transthoracic echocardiography (EchoCG). This paper presents description of 15 patients with diagnosis of LVNC. Aim of the study was to compare results of EchoCG with data of magnetic resonance tomography (MRT) of the heart in diagnosis of LVNC. We used the following EchoCG criteria of LVNC: (1) two layer structure of thickened LV wall with ratio of noncompacted to compacted layers more or equal 2, (2) numerous, excessively prominent trabeculations with deep intertrabecular recesses, (3) intertrabecular discontinuity on color doppler flow imaging. It was established that in assessment of ratio of noncompacted and compacted layers both methods were informative and can replace or supplement each other in diagnosis of LVNC.

[An experience of the use of stem cells in the treatment of patients with myocardial infarction and low ejection fraction]

We present our own experience of assessment of effect of cell therapy on functional state of the myocardium in patients with lowered contractile capacity of the left ventricular myocardium. Intracoronary administration of stem cells in acute myocardial infarction is a safe method of treatment. It does not cause additional damage of the myocardium and does not provoke appearance of malignant arrhythmia. Cell therapy does not affect global left ventricular function. Data we have obtained demonstrate tendency to improvement of myocardial contractile function in dynamics in the majority of studied patients, including patients of the comparison group. This most probably indicates that the given process has been caused by restoration of blood flow to surviving cardiomyocytes after transluminal coronary angioplasty and improvement of function. Confirmation of participation of administered cells in myocardial contraction and improvement of perfusion requires further clinical investigations.

[Possibility of an emission computer tomography for an estimation cerebral perfusion at patients with carotid stenoses before and after stenting]

THE PURPOSE

To estimate possibilities for studies of cerebral perfusion with brain scintigraphy for revealing and an estimation of features of change brain perfusion at patients with a cardio-cerebral vascular pathology before and after carotid stenting (CAS).

MATERIAL AND METHODS

11 patients with established (after carotid angiography) stenosis of internal carotid artery and coronary artery disease have been studied with SPECT with analogue HMPAO teoxim--Tc99M after intravenous introduction 700 MBk up to and in 5 days and in the remote period after stenting. For analysis of results the program "Neurogam" have been used. Standartized perfusion maps have been created.

RESULTS

Before performing CAS various variants of the image cerebral perfusion maps have been obtained: from diffuse insignificant reduction in both hemispheres of a brain up to the regions hypoperfusion, characteristic for ischemic changes. Regions of hypoperfusion on the side opposite to a stenosis or occasion were revealed. SPECT, performed after cas on 5th day or after 2-3 months found increase of general brain perfusion, disappearance of symmetric both asymmetric regions hypoperfusion and reduction of a degree local hypoperfusion on the side of stenting.

CONCLUSIONS

Maps of brain perfusion before and after CAS adequately reflect microcirculation of a brain with local changes of perfusion. Use of perfusion parameters gives possibility to estimate changes of brain perfusion before and after CAS in patients with combined carotid and coronary pathology.

[The role of multidetector computed tomography in detection of myocardial infarction]

The aim of the study was to assess the diagnostic value of multidetector computed tomography (MDCT) in detection of myocardial infarction (MI) in acute and chromic stages.

MATERIAL AND METHODS

49 patients with suspected MI were included in the study. In 44 patients the diagnosis of acute MI had been confirmed according to standard criteria. Contrast-enhanced MDCT of the heart and vessels was performed with 4-row MDCT scanner.

RESULTS

MDCT detected areas of MI in 39 of 44 patients with proven MI. In 66,7% of cases they were transmural and in 33,3% -- subendocardial. In arterial phase the density of infarcted area was significantly lower than in normal myocardium (mean, 32,6 +/- 3,7 HU versus 101,9 +/- 3,7 HU, correspondingly, p < 0,0001). Mean values of myocardial density in the area of the MI did not change during follow-up (32,6 +/- 3,7 HU vs 41,3 +/- 4,5 HU, ns). In comparison to SPECT, sensitivity and specificity of MDCT in detection of transmural MI were 96,9% and 100%. corr. In the whole group of patients, taking results of troponin test as a gold standard, the sensitivity of MDCT in detection of Q-MI and non-Q MI were 89,1% and 93,5%, correspondingly.

CONCLUSION

Cardiac MDCT can reliably detect and localize areas of acute and chronic MI. Contrary to SPECT, it also gives information about stenosis and occlusions in the coronary arteries.

[Comparison of non-invasive electron-beam and multislice CT angiography efficacy for detection of coronary artery stenosis]

AIM

To compare diagnostic value of electron-beam CT (EBT) and multislice CT (MSCT) angiography in detection of coronary artery stenosis in patients with coronary artery disease (CAD).

MATERIAL AND METHODS

140 CAD patients who had undergone EBT (n = 97) or 4-slice CT (n = 43) coronary angiography and conventional coronary angiography as a gold standard were included in the study.

RESULTS

Sensitivity and specificity of EBT angiography in coronary stenosis detection (proximal and mid segments) were 86 and 97%, respectively. Sensitivity and specificity of MSCT angiography were 87 and 98%, respectively. 6 and 7% of coronary segments were excluded from the study because of bad image quality in EBT and MSCT groups, respectively.

CONCLUSION

No significant difference was registered in diagnostic value of EBT and 4-slice MSCT angiography in coronary artery stenosis detection.

Aneurysm of aortocoronary bypass graft: two clinical case reports

The article deals with the description of two clinical case reports of a rare complication following operations of aortocoronary bypass grafting, i. e., aneurysms of aortocoronary bypass grafts. The diagnosis of an aneurysm of the bypass graft was in both cases made by means of modern methods of radiodiagnosis, namely, electron-beam tomography and multislice helical computed tomography.

[Diagnostic value of CT angiography in coronary arteries stenosis detection]

BACKGROUND

Noninvasive imaging of coronary arteries is very important. CT angiography (multislice computed tomography and electron beam computed tomography -- MSCT and EBT) is most reliable method for noninvasive coronary visualization.

PURPOSE

The aim of our study was to evaluate the diagnostic value of CT angiography in coronary arteries stenoses detection in patients with coronary arteries disease (CAD).

MATERIALS AND METHODS

140 patients with CAD who underwent EBT (n=97) or 4-slice CT (n=43) coronary angiography and conventional coronary angiography as a gold standard were included in the study.

RESULTS

Sensitivity and specificity of CT angiography in coronary stenoses detection (proximal and mid segments) were 86% and 97%, respectively. Positive and negative predictive values were 90% and 96%, respectively. Overall accuracy was 95%. 6.2% of coronary segments were excluded from the study because of unsatisfactory image quality.

CONCLUSIONS

CT angiography is noninvasive method for coronary stenoses detection with high sensitivity and specificity. Nevertheless EBT and 4-slice CT angiography can not replace conventional coronary angiography because of lower temporal and spatial resolution, artifacts in patients with arrhythmias and huge coronary calcification.

Cognitive function and the emotional state of stroke patients on antihypertensive therapy

Combined antihypertensive therapy based on 2.5-5 mg of cilazapril (an angiotensin-converting enzyme inhibitor) to normalize arterial pressure (ABP) was studied in 22 patients (12 male, 10 female) aged 49-74 years (mean 63 +/- 7 years) with stroke (18 patients) or transient ischemic attacks (three patients). Magnetic resonance tomography (MRT) including perfusion studies, along with neuropsychological studies and assessment of emotional status (Beck depression inventory, Spielberger anxiety scale), were performed before and after treatment. After six months of treatment, patients showed normalization of ABP (systolic pressure decreased from 154.7 +/- 12 to 128 +/- 23 mmHg, diastolic from 90.3 +/- 9.6 to 79.4 +/- 23 mmHg). There were no side effects and no patient experienced stroke. MRT revealed no signs of new foci and there were no significant changes in brain blood flow. By the end of treatment, improvements in cognitive functions were noted on the Mini Mental State Examination, the 10-word memory test, the Boston naming test, or the Wisconsin card-sorting test, though there were no changes in the patients' emotional status.

[Detection of left atrial auricular thrombus in patients with atrial fibrillation and risk factors of thromboembolic complications: the role of transesophageal echocardiography and multispiral computer tomography]

Transesophageal echocardiography (TEE) is routinely used for visualization of left auricular thrombi in patients with atrial fibrillation (AF). Multispiral computed tomography (MSCT) with the use of contrast preparations is a novel method of visualization of intracardiac structures. Forty three patients (27 men, 16 women aged 46-81 years) with duration of atrial fibrillation > 48 hours and scheduled for sinus rhythm restoration were included in this study. TEE and MSCT were carried out in all patients during first 3 days of hospitalization. If according to both methods there were no thrombi in the left auricle cardioversion was performed. If data of one of the methods were suspicious of left auricular thrombus cardioversion was not performed. In these patients both investigations were repeated after 8 weeks of therapy with warfarin. If initially detected mass decreased or disappeared at the background of indirect anticoagulants, it was considered to be a thrombus. In 1/3 of patients repeat examination allowed to reject initial diagnosis of left auricular thrombosis. Simultaneous application of TEE and MSCT detected more thrombi than the use of either of these methods. Rate of detection of thrombi in left atrial auricle with the use of both methods was 32%.

[Safety of magnetic resonance imaging after coronary stenting]

Magnetic resonance imaging (MRI) is contraindicated to some patients with certain types of metallic devices and implants (e.g. cerebral surgical clips, defibrillators). There are some controversies concerning safety of MRI in patients with metallic coronary stents in cases when MRI examination is performed earlier then one month after stent implantation. Analysis of published data has shown that MRI performed with systems having field strength up to 3 Tesla does not cause migration and heating of both bare and coated stent and is not associated with increased risk of coronary artery thrombosis. MRI can be performed safely in first days after coronary stent implantation. Small local artifacts on MRI images do not influence interpretation of the data (except for cases of coronary magnetic resonance angiography).

[Study of the impact of intramyocardial implantation of stem cells on myocardial perfusion and contractility in patients with coronary heart disease concurrent with postinfarct cardiosclerosis and chronic heart failure]

OBJECTIVE

to study of intramyocardial implantation of cultured bone marrow stem cells on myocardial perfusion and contractility in the surgical treatment of patients with coronary heart disease (CHD) and chronic heart failure (CHF), by synchronized single-photon emission computed tomography (SSPECT) of the myocardium.

SUBJECTS AND METHODS

The study included 11 patients. Intramyocardial injection of cell injections into the myocardial periscarring areas was made at coronary bypass surgery. All the patients underwent 99mTc myocardial SSPECT MIBI before and 3, 6, 12 months after surgery.

RESULTS AND CONCLUSIONS

Implantation of bone marrow stem cells into the left ventricular myocardium favorably affects left ventricular remodeling and contributes to the improvement of myocardial perfusion and contractility, as evidenced by 99mTc.