The present review summarizes the data of modern studies on the capabilities of non-invasive evaluation of myocardial tissue, which is widely used in clinical practice for diagnosis of various nosologies. The quantitative assessment of myocardial fibrosis via T1 mapping and extracellular volume fraction can replace myocardial punch biopsy. The paper presents the data of quantitative measurements that help to assess the morphological changes in the hearts of professional athletes and the dynamics of exercise-induced myocardial remodeling.

Despite the profound development of the theory explaining atherosclerosis pathogenesis, many questions still remain open. Modern ideas about the nature of atherosclerotic lesions in the vascular wall are largely based on the results of N.N. Anichkov’s research where hypercholesterolemia is considered the key point. Numerous theories of atherosclerosis have been proposed to date. However, the lipid-infiltrative idea, established over 100 years ago, remains dominant, and, despite the involved controversies, this concept lays the foundation for the therapeutic and preventive measures in cardiovascular diseases.

Aim. The purpose of this review is to remind the reader of the biological significance of cholesterol, which performs essential vital functions in the body; to discuss some controversial points of view and contradictory facts regarding the etiological role of hypercholesterolemia in atherogenesis, which call into question the appropriateness of using blood cholesterol content as an indicator of disease severity and the possibility to assess the treatment effectiveness based on cholesterol level dynamics. 

Aim. The aim of this study was to evaluate the prevalence of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), their combination, and relationship to the clinical and anamnestic characteristics in patients with primary STEMI after coronary reperfusion.

Material and Methods. A single-center observational cohort study comprised a total of 60 patients with primary STEMI and successful coronary reperfusion within 12 hours of the onset of symptoms. All patients were studied using a contrast-enhanced cardiac magnetic resonance imaging (CE-MRI) at day 2 after STEMI. The study protocol was registered on ClinicalTrials.gov (Identifier: NCT03677466).

Results. The total occurrence rate of MVO and IMH phenomena was 68.3% including MVO only in 17% of patients, IMH only in 15% of cases, combination of MVO and IMH in 36% cases, and without a microvascular myocardial injury in 32% of cases. The patients with MVO only and combination of MVO and IMH experienced a longer time of ischemia versus patients without these conditions: 205 (140–227) and 193 (95–400) versus 130 (91–160) min (p = 0.049). On the contrary, the time of myocardial ischemia did not differ between patients with IMH only (113 min) and patients without it. Then, patients were assigned to the group of pharmaco-invasive strategy of coronary reperfusion (PIS) (n = 39) and the group of primary percutaneous intervention (PPCI) (n = 21). The incidence of MVO only and IMH only was equal in PIS and PPCI groups: 17.9% versus 14.2% and 12.8% versus 19.1% in PIS and PPCI groups, respectively. The tendency to a decrease in the incidence of combined MVO and IMH was observed in PIS group compared to PPCI group: 30.8% versus 47.6% (p = 0.09).

Conclusion. The combination of MVO and IMH phenomena in patients with primary STEMI after coronary reperfusion developed more often than each of these phenomena separately. The development of MVO only and combination of MVO and IMH was associated with a longer duration of myocardial ischemia. A total frequency of combination of MVO and IMH phenomena in patients with primary STEMI after coronary reperfusion was as high as 68.3%. Combination of these phenomena developed more frequently than each of them separately: 36% versus 17% (MVO only) and 15% (IMH only). No difference was observed in the duration of myocardial ischemia between the groups with MVO only and without it. The thrombolysis did not increase the occurrence of IMH in PIS group compared with PPCI group. There was a tendency to a decrease in the incidence of combination of MVO and IMH in PIS group compared to PPCI group: 30.8 versus 47.6% (р = 0.09). 

Aim. The aim of the study was to investigate the features of cerebral edema in cases of venous ischemic stroke with cerebral venous sinus thrombosis.

Material and Methods. The study included 33 patients with venous stroke as a result of cerebral venous sinus thrombosis. Comparison group comprised 33 patients with arterial ischemic stroke. The control group included 33 individuals. Neuroimaging included native computed tomography (CT) of the brain at admission and at days 5–7, perfusion CT (MSCT 64) within the first 40 minutes of admission to the hospital, and magnetic resonance imaging (MRI) of the brain (1.5T) within the first 24–48 hours of the disease.

Results and Discussion. The relationships were found between the early intercellular edema development according to diffusion MRI and a signal inversion on diffusion-weighted imaging (DWI) (a decrease in the perifocal zone against the background of a high signal of cytotoxic edema), an increase in the signal with the average upper limit of apparent diffusion coefficient (ADC) range (0.82 ± 0.05) * 10-3 mm2 /s differing only from the central zone, and moderate plethora of perifocal zones (with an increase in rCBV and rCBF by 27–28%) according to perfusion CT. These phenomena could be unfavorable factors for the development of edema and probable hemorrhage (in 27% of cases in venous stroke versus 9% in arterial stroke), but were accompanied by a more favorable clinical outcome of venous stroke (improvement in 66% of cases with a complete regression of neurological deficit in 25% versus 57% without complete regression of symptoms in arterial) with a lower incidence of necrosis/infarction (in 50% of cases versus ¾ of cases of ischemic stroke). The presence of a significant correlation between the parameters of lesion area and the relative values of CT-based perfusion and MRI-based diffusion (r = 0.44; p < 0.05) suggested that the early vasogenic edema and hyperemia were the elements of a pathophysiological mechanism for the development of cerebral venous ischemia, which, unlike arterial ischemia, is secondary in nature, associated with mechanical arterial vasoconstriction due to intercellular edema.

Conclusion. Probably, vasogenic edema in most cases of venous stroke, developing almost simultaneously with cytotoxic edema, does not reach the peak of pathological changes and stop in development at the stage of ionic edema with a functional impairment of permeability of the anatomically intact blood-brain barrier when it can reverse. The progressive development of vasogenic edema is a factor for the deepening of ischemia to necrosis/infarction and secondary hemorrhagic transformation. 

Objective. Resistant hypertension (RHT) is often associated with kidney injury and chronic kidney disease, especially in diabetic patients. Early detection of renal changes contributes to avoiding severe cardiovascular complications, but imaging characteristics of renal dysfunction in RHT remain unclear. The aim of the present study was to determine the relationships between the renal parenchyma volumes and biomarkers reflecting kidney function in a cohort of patients with RHT.

Material and Methods. The study comprised 34 patients with RHT meeting the inclusion criteria. Evaluation of renal function was based on the measurements of estimated glomerular filtration rate (eGFR) and serum levels of creatinine and cystatin C. Renal sizes were assessed by MRI based on absolute and normalized parenchymal kidney volumes.

Results. Primary MRI-based changes in renal parenchyma in patients with RHT demonstrated altered cortical surface, attenuated cortical thickness, lower renal volumes, and round shape of the kidneys compared with the reference characteristics. Positive correlation of moderate power was found between eGFR value and all parameters characterizing renal parenchyma. The strongest direct correlation was found between eGFR and bsa-TKV (r = 0.6166, p = 0.000); ht-TKV correlated with eGFR (r = 0.4751, p = 0.007) and creatinine (r = –0.4302, p = 0.016). According to linear regression analysis, ht-T-Cortex-V < 32.4 was a key element of MRI-presentation of renal dysfunction in patients with eGFR below 60 mL/min/1.73 m2 (sensitivity of 83.3%, specificity of 60.7%, p = 0.03).

Conclusion. MRI study allowed to detect early renal parenchymal changes suggesting the presence of association between renal function and renal parenchymal volume in RHT patients. For the first time, the study revealed MRI-pattern of renal dysfunction in RHT. 

Aim. To evaluate the results of surgical intervention planning using three-dimensional models based on magnetic resonance imaging in patients with postinfarction left ventricular aneurysms.

Material and Methods. Two groups of patients with postinfarction left ventricular aneurysm (PLVA) were included in the study, totaling 41 patients. The first (experimental) group included 17 patients diagnosed with PLVA by magnetic resonance imaging (MRI), and surgical intervention planning was performed using a 3D model of the heart. The control group comprised 24 patients in whom PLVA was diagnosed by echocardiography (TTE) or ventriculography, and surgical intervention planning was performed using traditional two-dimensional slice images.

Results. Comparison of full perfusion under cardiopulmonary bypass (CPB) showed statistically significant differences between the groups: this parameter was 60 [56; 68] min in group 1 vs. 71 [61; 84] min in group 2, which was significantly higher (p = 0.043). There were no significant differences in total operation time (280 [265; 320] min in group 1 vs. 263 [248; 283] min in group 2, p = 0.055), overall CPB time (93 [86; 109] min in group 1 vs. 104 [83; 109] min in group 2, p = 0.653), and partial CPB time (31 [26; 39] min in group 1 vs. 27 [21; 32] min in group 2, p = 0.127).

Conclusion. The use of 3D models to support surgeons for PLVA correction makes it possible to determine the type of reconstructive surgery, practice the main stages of the upcoming intervention, and reduce the time of full perfusion under CPB during its implementation. 

Currently, there are practically no works that are devoted to the analysis of different types of damage to ischemic and nonischemic patterns in patients with acute myocardial infarction (AMI), depending on the nature of atherosclerotic lesions of the coronary arteries.

In this regard, the aim of this work was to evaluate the frequency of ischemic pattern of heart damage in patients with AMI depending on the presence of obstructive coronary artery disease.

Material and Methods. The study retrospectively included patients with a working diagnosis of acute coronary syndrome (ACS) who underwent contrast-enhanced cardiac magnetic resonance (MR) imaging (CMR) during the first week after hospitalization. A 1.5 T CMR was performed using a standard protocol. T2-WI, T1-WI, and IR-images were visually assessed for edema and scar/necrosis, respectively. The pattern of acute ischemic damage to the left ventricular (LV) myocardium was an increase in the signal intensity on T2-WI as a sign of myocardial edema and late gadolinium enhancement (LGE) with a typical ischemic nature of contrast enhancement: subendocardial/subtransmural/transmural. The non-ischemic nature of myocardial injury was defined as intramyocardial/subepicardial LGE.

Results. Based on invasive coronary angiography (ICA) data, patients were divided into two groups: group of myocardial infarction (MI) and coronary artery disease (MICAD group) and group of MI and non-obstructive coronary arteries (MINOCA group). It was found that the frequencies of occurrence of subendocardial pattern of cardiac LGE in early CMR did not differ in the groups of AMI patients against the background of obstructive and non-obstructive coronary artery disease (CAD). The most characteristic MR-pattern in MICAD patients was transmural LGE, including that in combination with microvascular obstruction (MVO). The most characteristic MR-pattern in MINOCA patients was mid-wall/insertion point LGE. Subepicardial LGE occurred with equal frequency in MICAD and MINOCA patients.

Conclusion. The most pathognomonic MR-pattern of myocardial damage in AMI against the background of obstructive CAD was the transmural type of LGE with or without the phenomenon of MVO. Identification of the subendocardial type of LGE in patients with MINOCA allowed to stratify these patients into a higher risk group with a further change in treatment tactics. 

Aim. To compare the immediate results of off-pump versus on-pump coronary artery bypass grafting (CABG) using autoarterial conduits.

Material and Methods. From January 2018 to September 2021, 178 coronary artery bypass grafting operations using autoarterial conduits were performed in the Department No. 1 of the Federal Center for Cardiovascular Surgery (Krasnoyarsk). The operation was performed on a beating heart in 88 patients (group 1) and using cardiopulmonary bypass in 90 patients (group 2). The majority of patients were males in both groups: 76 (86.3%) and 75 (83.3%) patients (p = 0.287). The patients were comparable in age (61.6 ± 7.7 and 60.2 ± 7.5 years, p = 0.237), body mass index (30.9 ± 5.7 and 29.8 ± 5, p = 0.18), and the presence of concomitant diabetes mellitus (30 (34%) and 19 (21.1%), p = 0.052). There were significantly more patients with hemodynamically significant lesions of the brachiocephalic arteries in group 1 (27 (30.7%) versus 13 (14.4%), p = 0.009) and calcification of the ascending aorta (24 (27.3%) versus 11 (12.2%), p = 0.011). The number of hemodynamically significant affected coronary arteries did not differ between the groups: 2.6 ± 0.7 versus 2.5 ± 0.5 (p = 0.393).

Results. Both internal thoracic arteries were used in situ or in the form of Y-grafts in both groups depending on the number of distal anastomoses. Hospital mortality was 2 patients (2.2%), both from group 2 (p = 0.161). The groups were comparable in the number of distal anastomoses (2.7 ± 0.7 and 2.7 ± 0.6, p = 0.532), the incidence of acute perioperative myocardial infarction (1 (1.1%) and 1 (1.1%), p = 0.987), neurological complications (1 (1.1%) and 2 (2.2%), p = 0.576), and bleeding requiring resternotomy (1 (1.1%) and 3 (3.3%), p = 0.325). Deep sternal wood infection was absent in both groups.

Conclusion. Autoarterial coronary artery bypass grafting is an effective method of myocardial revascularization in both the beating heart surgery and in cardiopulmonary bypass conditions. This method should be considered an operation of choice for patients with multiple coronary artery disease. The performance of operations in the conditions of cardiopulmonary bypass does not affect the increase in the number of cardiocerebral events in the postoperative period. 

Introduction. Autovenous graft is considered the gold standard for prolonged occlusive lesions of the arteries in the femoralpopliteal segment. However, the vein is not always anatomically suitable for bypass grafting; it may have been previously used in previous operations, for example, in coronary artery bypass grafting. Open surgery is always more traumatic than endovascular surgery. Conventional nitinol stents show unsatisfactory results in the femoral-popliteal position due to the high percentage of reocclusions associated with their breakage during physiological movements in the leg joints. The modified method of making interwoven nitinol stents allows improving their biomimetic properties and reducing the percentage of breakages and, accordingly, reocclusions.

Material and Methods. There was a retrospective analysis of 437 patients with prolonged atherosclerotic occlusive lesion in the femoropopliteal segment (> 20 cm). There were two groups: a group of bypass surgery and a group of endovascular intervention. The pseudo-randomization method of propensity score matching was used to align the groups according to various criteria.

Results. Primary and secondary patency rates for one- and two-year follow up were comparable between the two groups. A subgroup analysis of above-knee intervention showed that a two-year secondary patency rate was significantly higher in the endovascular intervention group than in the bypass group (90.9% vs. 77.5%, p = 0.048). The subgroup analysis of interventions below the knee joint showed that the patency rates at two years of primary and primary-assisted patency were significantly higher in the endovascular intervention group than in the bypass group with an artificial expanded polytetrafluoroethylene (ePTFE) graft (66.7% versus 42.4%, p = 0.046 and 76.7% versus 45.5%, p = 0.011, respectively). The autovenous graft showed better results for primary patency compared with the endovascular intervention group, but the difference was statistically insignificant (77.2% versus 66.7%, respectively, p = 0.3).

Conclusion. The analysis of obtained results suggests that the primary endovascular strategy may be recommended for all prolonged occlusive lesions of the femoropopliteal segment above the knee joint gap. For lesions below the knee joint, the autovenous bypass grafting remains the operation of choice, but in the absence of a suitable autovenous graft, the primary endovascular strategy may also be recommended. Additional large multicenter randomized trials are required to refine these recommendations.

Objective. The aim of this study was to identify predictors of adverse events after ascending aortic replacement for the aortic aneurysms in the early postoperative period.

Material and Methods. The analysis included 151 patients with ascending aortic aneurysm who underwent non-hemiarch or hemiarch repair. The following adverse outcomes were selected: postoperative delirium, respiratory failure, bleeding, multiple organ dysfunction syndrome, and in-hospital mortality. Predictors of adverse clinical events were identified by constructing uni- and multivariate logistic regression.

Results. Significant predictors of early outcomes and mortality after ascending aortic replacement were as follows: female gender, atrial fibrillation, low glomerular filtration rate, chronic obstructive pulmonary disease, aortic root repair, multiple organ dysfunction, duration of cardiac arrest, operation time, and reoperation for bleeding.

Conclusions. The risk factors of adverse outcomes after ascending aortic replacement were decreased kidney function, atrial fibrillation, female gender, aortic root repair, and increased duration of cardiac arrest and operation time. 

Subchondral insufficiency fracture of the knee is a new type of stress fracture, which was previously referred to as spontaneous osteonecrosis of the knee (SONK).

Aim. To determine the informativeness of radiography and magnetic resonance imaging in subchondral fracture of knee insufficiency.

Material and Methods. The study comprised 150 patients including 48% of men and 52% of women. The age of patients ranged from 46 to 82 years. The patients underwent radiography and magnetic resonance imaging of the knee joint followed by the calculation of sensitivity, specificity and accuracy of the methods.

Results. The most common stress fracture of insufficiency was found in the medial condyle of the femur (79%) with the second most common in the lateral condyle of the femur (12%). Most fracture zones (7.9%) were localized in the medial condyle of the tibia, and only 1.1% of fracture zones were in the lateral condyle of the tibia. The informativeness of radiography was low: sensitivity of 68.4%, specificity of 30.0%, and accuracy of 55.1%. Parameters of magnetic resonance imaging informativeness were as follows: sensitivity of 100%, specificity of 99.0%, and accuracy of 98.0%.

Conclusion. Magnetic resonance imaging is the method of choice for stress fracture knee insufficiency because it demonstrated very high indicators of informativeness. 

Background. Patients with COVID-19 and senile asthenia syndrome (SA) are characterized by extremely high comorbidity, heterogeneity, atypical course of the disease, and large number of complications. We carried out a comprehensive assessment of the quality of life (QOL) in patients with COVID-19 and SA considering the high prevalence of this category of patients and the absence of such studies.

Material and Methods. Group 1 included 37 patients with SA and history of COVID-19 three months after discharge from the hospital. Group 2 included 35 patients with CA and history of COVID-19 six months later. Control group comprised 34 patients with SA aged over 65 years who did not have COVID-19. The assessment of QOL was carried out according to the SF-36 questionnaire.

Results. There was a decrease in absolutely all indicators of physical and psychosocial aspects of health three months after discharge from the hospital. There was a more pronounced decrease in the scales of physical functioning (PF), role-physical functioning (RP), general health (GH), and mental health (MH) after six months. There was a lower QOL in female population according to most scales (PF, RP, GH, MH, and role-emotional functioning (RE)) regardless of the time from the moment of discharge from the hospital, and a higher incidence of depression compared to men.

Conclusions. All QOL indicators of patients with SA and history of COVID-19 decreased within the first three months after discharge from the hospital. At the same time, after six months, a decrease in physical status was most pronounced, while the indicators of mental sphere reduced only according to the MH scale. At three and six months after discharge, the quality of life in the male population was higher than in the female population according to the same evaluation scales (PF, RP, GH, MH, and RE). The best indicators of pain scale in men were characteristic only for the first group of patients, whereas there was no statistically significant difference according to the social functioning and MH data. There was a higher incidence of depression in the female population, while the prevalence of anxiety was higher at three months after discharge than after six months. 

This article describes a clinical case of the heart rhabdomyoma in an adult patient diagnosed in early childhood. The result of the continued tumor growth was cardiac arrhythmia in the form of ventricular extrasystole with runs of ventricular tachycardia. Authors also present a literature review on the frequency of occurrence, morphology, clinical manifestations, and diagnosis of this type of heart tumors, including using dual-energy computed tomography and cardiac magnetic resonance imaging with intravenous contrast enhancement. 

Clinical examples for variants of cardiovascular complications of a new coronavirus infection (COVID-19) are presented when they are visualized by means of magnetic resonance imaging (MRI) of the heart and chest organs with paramagnetic contrast enhancement and synchronization with ECG and respiration signal. The syndromes of post-COVID focal infarct injury and diffuse inflammatory lesion are identified. The picture of MRI visualization of coronary atherosclerotic plaque is presented. The results of quantitative processing of cardiac MRI in these two different syndromes of post-COVID cardiological complications are presented. The presented clinical examples indicate the need for cardiac MRI to monitor patients and assess the long-term cardiovascular effects of COVID-19.

Here we present a clinical case of cardiac sarcoidosis. The article discusses the difficulties of differential diagnosis in patients emergently hospitalized in the cardiology department with recurrent chest pain, no changes in the electrocardiogram (ECG), and a presumptive diagnosis of acute coronary syndrome without ST segment elevation (NSTE-ACS). A careful history taking, invasive coronary angiography, and contrast-enhanced (gadolinium-based contrast media) cardiac magnetic resonance imaging (CMR) contributed to the correct diagnostic decision in search for and identification of cardiac sarcoidosis in the patient. 

Aortic stenosis is the leading entity in the structure of valvular pathology in adult population with the frequency ranging from 2 to 4% in the general population. The distinct features of this defect include slow progression and frequent lack of correlation between the severity of stenosis according to clinical and instrumental data. The article presents the case of successful transcatheter aortic valve implantation by transapical access in a 71-year-old patient with symptomatic low-flow, low-gradient aortic stenosis, heart failure with preserved left ventricular ejection fraction, a history of coronary artery bypass grafting, severe concomitant pathology, and recent moderate COVID-19 coronavirus infection. The complexity of management of elderly patients with combined pathology is updated, and a multidisciplinary approach to clinical decision-making in a high-risk clinical situation is demonstrated. 

Prosthetic vascular graft infection is a formidable complication after cardiac surgery. Until now, the question on the tactics of managing such patients remains open, as well as the timing of each of the treatment methods such as conservative antibiotic therapy and surgery. In addition, the choice of a method of surgical treatment in itself poses new questions for specialists in regard to what methods to adhere to including prosthesis-preserving technique, prosthesis explantation and its replacement with a synthetic or biological graft, and the use of omentum to cover the infected bed. We present a case of treating a patient with an infected synthetic valve-containing conduit after Bentall de Bono operation and aortic rupture with the formation of false aneurysms. Attention is drawn to the prolonged clinical patient condition manifesting with fever, and the lack of data suggesting an infectious process according to positron-emission tomography and blood cultures. We chose a homograft of the ascending aortic and aortic arch with aortic valve as a conduit. It is also of interest that cultures of infectious prosthesis and aortic valve did not reveal any infectious agent. Aggressive antibiotic therapy in combination with surgical replacement of the infected prosthesis with a cryoprepared allograft allowed for successful treatment of patient without complications. 

We report the successful endovascular treatment of true left main bifurcation lesion in a patient with chronic coronary syndrome using the DK-CRUSH technique. We describe technical aspects of bifurcation stenting with intracoronary imaging using optical coherence tomography. Here, we review the current state of the problem of choosing the optimal technique for endovascular treatment of patients with true left main true bifurcation lesion. 

Introduction. Integration of multimedia results of diagnostic examinations into the information model of diagnostic and treatment process makes it possible to teach medical decision-making taking into account all available information about the patient.

Aim. The purpose of this work was to use multimedia results of instrumental examination methods to form and verify the level of effective diagnostic decision-making.

Material and Methods. A significant array of multimedia information arising in the course of treatment and diagnostic process was derived from databases of diagnostic units and was important for medical decision-making. The model was supplemented with clinically and demographically relevant studies of other patients when necessary. The multimedia components were integrated into the virtual simulations with two different trajectories of information presentation to the trainees depending on the purpose of further use.

Results. At the first stage of the project, the multimedia components were integrated into linear models of completed cases to demonstrate medical decisions to the trainees. The multimedia components were presented as the fragments of magnetic resonance imaging (MRI) data, echocardiography and vascular ultrasound recordings, scanned electrocardiograms (ECG), angiography results, X-ray images, tomograms, and results of other visualization methods of patient examination. Each multimedia file was accompanied by a textual conclusion made by a relevant specialist. At the second stage, the multimedia components were integrated into the models with a branched trajectory of information presentation. The course of disease and the patient’s condition could change depending on the decisions made, which means that there are alternative scenarios of the therapeutic and diagnostic process unlike the real invariant treatment of the patient. This possibility is especially important for the formation of medical decision-making competencies in safe conditions of simulation. To elaborate clinical diagnostic tasks, the authors developed a rating system quantifying the effectiveness of the decisions.

Discussion. Building physician competencies in the educational process through repeated decision-making under changing conditions is crucially important for the health and lives of patients and can be effectively implemented using simulation technologies. Web access to this content is strategically important for the use of virtual patients with multimedia diagnostic results to practice decision-making skills in clinical disciplines.