A study of foreign and domestic literature devoted to the application of texture analysis of magnetic resonance images of the heart was performed. The analysis included publications selected by key words and their combinations: cardiac magnetic resonance imaging (MRI), myocarditis, myocardial infarction, cardiomyopathy, radiomics, and texture analysis. Radiomics and texture analysis, as a new and rapidly developing direction of in-depth analysis of digital medical images, is developing, the number of publications on this topic is growing every year and the topic is not losing its relevance. Radiomics is a promising method of image analysis that aims to improve the diagnosis and prognosis of diseases by extracting a large number of quantitative features that can be missed by the human eye in the visual analysis of images. Radiomics biomarkers derived by extracting data from magnetic resonance images of the heart could be a valuable tool for assessing myocardial viability, myocardial lesions in myocarditis and cardiomyopathies.

The data obtained from chest computed tomography (CT) can be analyzed not only visually, but also quantitatively. Quantitative assessment allows a more accurate and objective evaluation of the disease severity. Densitometry is the most researched way to quantify CT data – automatic analysis of lung densities expressed in Hounsfield units. This review is focused on the types of diseases that can be characterized by the formalization of the diagnostic task and application of densitometry, as well as on the limitations of the method and the ways to cope with them.

This analytical review considers the clinical aspects of the application of virtual reality (VR) technologies in the cognitive rehabilitation of patients with cardiovascular diseases. It is shown that VR-training is one of the actively developing rehabilitation methods. Its use has great potential for the treatment of cognitive disorders of a wide range (stroke, vascular cognitive disorders, cardiac surgery patients). Promising in the development of personalized approach in the cognitive rehabilitation of cardiac patients is the estimation of the initial level of cognitive reserve as an indicator of the possible activation of neuroplastic processes against the background of cognitive training using a virtual environment.

Cardiology is one of the fields in which telemedicine technologies were first developed and introduced into everyday clinical practice. One of the main advantages of telemedicine is the possibility of remote monitoring of patients for the purpose of secondary prevention of cardiovascular diseases. This review presents the current trends of telemedicine technologies in the observation of patients undergoing percutaneous coronary interventions for acute myocardial infarction, an analysis of current clinical studies on this issue.

Key points: 1. The article shows the important role of telemedicine technologies in working with cardiological patients.

2. The use of telemedicine consultations improves survival, quality of life, functional status and reduces the profile of cardiovascular risk, as well as reduces repeated hospitalizations and mental disorders.

3. The review of scientific research sets up to review the current clinical recommendations of scientific communities on the management of patients with cardiovascular diseases and raises the question of the need for widespread introduction of telemedicine technologies.

Cardiovascular magnetic resonance is widely used due to its possibilities for noninvasive cardiac tissue characterization. In recent years native myocardial T1- and T2-mapping techniques have been implemented in routine practice. These techniques provide quantitative analysis of myocardium and allow detection and evaluation of myocardial damage without the need for gadolinium-based contrast agents. In this review we would like to discuss application of native T1- and T2-mapping in different types of heart disease.

Introduction. Early assessment of the effect of targeted therapy in patients with non-small cell lung cancer (NSCLC) and a mutation in the EGFR gene is important for the timely correction of antitumor therapy.

Aim: To study the possibilities of combined positron emission and computed tomography with 18F-fluorodeoxyglucose (PET/ CT with 18F-FDG) using the RECIST 1.1 and PERCIST 1.0 criteria. In a comparative assessment of the effect of various targeted therapy options in patients with NSCLC and a mutation in the EGFR gene.

Material and Methods. The study included 86 patients with stage II-IV NSCLC, including 56 patients with a mutation in the EGFR gene. Of these, 32 patients received targeted monotherapy with tyrosine kinase inhibitors (TKI) – gefitinib or erlotinib and 24 patients received combination therapy (TKI + bevacizumab). The control group consisted of 30 patients who received platinum-containing chemotherapy drugs in combination with bevacizumab. The effect of antitumor therapy was evaluated using the combined PET method/CT with 18F-FDG using RECIST 1.1 and PERCIST 1.0 criteria. The results of the study were compared before the start of treatment and after 4-6 weeks of treatment.

Results. In the repeated study of PET/CT with 18F-FDG, a partial positive response to the treatment of both tumor foci and affected regional lymph nodes according to the metabolic criteria PERCIST 1.0. was observed 1.3–1.8 times more often than when using the anatomical criteria RECIST 1.1. (p = 0,049). The frequency of а positive response to treatment in patients receiving targeted monotherapy was quite comparable to that in patients in the control group (43.7 and 40.0%, respectively). Based on 18F-FDG repeat PET/CT and PERCIST 1.0 metabolic criteria in patients receiving combined targeted therapy, a partial positive effect of treatment (58.3%) was observed 1.4 times more often, and disease progression was 4 times less common than in the subgroup of targeted monotherapy and in the control group (p = 0,043).

Conclusions. Possibilities of early assessment of the effect of antitumor therapy using PET/CT with 18F-FDG increase when using the metabolic criteria PERCIST 1.0 – more sensitive than the anatomical criteria RECIST 1.1. According to PET/CT with 18F-FDG in patients with NSCLC and a mutation in the EGFR gene, the effect of combined therapy of TKI in combination with bevacizumab significantly exceeds not only the result of targeted monotherapy, but also the effect of chemotherapeutic treatment of patients in the control group.

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.

Aim: To determine the possibility of identifying patients with significant coronary artery disease (CAD) by evaluation of the global left ventricular (LV) myocardial work indicators by constructing pressure-strain loops during exercise stress echocardiography.

Material and Methods. The study included 136 patients aged 36 to 84 years, of which 97 (71%) men, with suspected or previously confirmed CAD, who underwent stress echocardiography on the treadmill according to the Bruce protocol. LV myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global myocardial work efficiency (GWE) were evaluated using the technique of constructing pressure-strain loops at rest and at peak exercise. All patients underwent selective coronary angiography, according to the results of which they were divided into 3 groups: 51 patients without coronary artery lesions – the control group, 57 patients with single-vessel CAD and 28 patients with multi-vessel CAD. Significant lesion was defined as ≥ 70% artery luminal narrowing. All tests were two-sided and P-values < 0.05 were considered statistically significant.

Results. Compared with the control group, patients with single-vessel CAD at rest had significantly less GWE and more GWW. In these patients GWI, GCW and GWE at peak exercise were significantly lower, and GWW was significantly higher. In patients with multi-vessel CAD, all global LV myocardial work indicators significantly differed from the control group both at rest and at peak exercise. The optimal cutoff value of GWI at peak exercise to predict significant CAD was 2553 mmHg% with a sensitivity of 62% and a specificity of 95% (AUC 0.79 ± 0.05, p < 0.001).

Conclusions. The evaluation of global LV myocardial work indicators by constructing pressure-strain loops can be used in exercise stress echocardiography to improve the selection of patients requiring coronary intervention.

Introduction. Type 2 diabetes is the most common form of endocrine disease. Diabetes is a well-established risk factor for stroke. Carotid endarterectomy (CEE) is the main method of preventing a serious complication of stroke in patients with carotid stenosis. Consequently, the assess of type 2 diabetes on the results of CEE is an urgent problem of angiosurgery.

Aim: To assess effect of type 2 diabetes on cerebrovascular reserve capacity and brain structure in patients with carotid atherosclerosis by ultrasound and magnetic resonance diagnostic.

Material and Methods. 44 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA), who underwent ultrasound and magnetic resonance examinations of the carotid arteries at the pre- and postoperative stages were included in this study. Two groups were formed: group I (n =15) – with a verified diagnosis of type 2 diabetes, group II (n = 29) – without diabetes. To assess the cerebrovascular reserve, functional hypercapnic and hyperoxic tests were performed.

Results. The analysis of the results showed statistically significant differences in the ICA blood flow in both groups. Intergroup comparison before surgery in the middle cerebral artery on the side of hemodynamically significant stenosis revealed a statistically significant difference in pulsation and peripheral resistance index. In the common carotid arteries on both sides, significant intergroup differences were found in the velocity parameters of blood flow after the CEE operation. The reactivity index in patients with surgical stenosis with type 2 diabetes in the hyperoxic test was statistically significantly different on the side of the stenosis compared to the same indicator in the group without diabetes. There were no statistically significant differences in the hypercapnic test. The value of reactivity index indicates a negative or paradoxical reaction.

Conclusion. The use of simple and accessible functional tests to assess cerebrovascular reserve, plaque structure and changes in the brain in patients with type 2 diabetes at the stage of preoperative preparation according to ultrasound and MRI studies allows us to correct the treatment and subsequent protection of the brain at the stage of surgery to prevent possible complications.

The relevance of the work is due to the lack of systematic data on the features of lung damage in patients with chronic obstructive pulmonary disease (COPD) and type II diabetes mellitus (DM2).

Aim: To identify the main radiation phenotypes of lung tissue damage in patients with chronic obstructive pulmonary disease and type II diabetes mellitus.

Material and Methods. We conducted a one-stage observational study, with the analysis of clinical data, laboratory and instrumental studies (pulmonary function tests, computed tomography), in patients with chronic obstructive pulmonary disease in combination with type II diabetes mellitus (57 people).

Results. In patients with a combination of COPD and type II diabetes mellitus, the predominance of predominantly bronchitic type of COPD over emphysematous was revealed, with the presence of statistically significant links between a number of patterns (the presence of air trapping, bronchiolitis) and laboratory results (the number of eosinophils in the blood, the number of leukocytes in the blood and sputum, the number of macrophages in sputum, levels of IL-33, TNF-α, CRP, IFN-γ/IL-4 ratio), which may reflect the influence of different pathogenetic aspects of inflammation on the formation of structural changes in the lung tissue).

Conclusion. For patients with a combination of chronic obstructive pulmonary disease and type II diabetes mellitus, the presence of a bronchitic COPD phenotype with the absence of confluent and destructive forms of pulmonary emphysema is more characteristic. The wide prevalence of the bronchitic COPD phenotype in patients with concomitant type 2 diabetes mellitus may be due to predominant changes in the small airways, the development of microangiopathy, as well as an infectious factor, since patients with type 2 diabetes mellitus, in general, are more susceptible to infections, including respiratory.

Introduction. A high prevalence of decreased liver attenuation has been shown in patients with COVID-19, but there is no unequivocal estimate of the effect of disease severity on it. There has been no evaluation of the liver status both before and after COVID-19.

Aim: To study the impact of COVID-19 on liver attenuation by two computed tomography (CT) scans: before and after the onset of pneumonia.

Material and Methods. Retrospective cohort study was performed. Data of COVID-19 outpatients were analyzed. Inclusion criteria: two chest CT scans, alanine aminotransferase (ALT), aspartate aminotransferase (AST) blood values, polymerase chain reaction to verify SARS-CoV-2. A PCR positive result was a criterion for the COVID-19 presence. The criteria for absence were a negative PCR result on an oropharyngeal swab for SARS-CoV-2, and absence of a lung lesion on both CT scans. The endpoint was a decrease in liver density of more than 10 HU. Two comparison groups have been identified following the achievement of the endpoint. Liver attemuation was analyzed by automatic segmentation, with values less than 40 HU being considered pathologic.

Results. Data from 499 patients were selected and two comparison groups were formed: group 1 – liver attenuation decreased by more than 10 HU in the dynamics and group 2 – control group. Liver attenuation on baseline CT was 8.4 HU higher (95% confidence interval (CI) 5.5-11.2; p-value < 0.001) in group 1 versus group 2. Regression analysis showed an association between a decrease in liver attenuation 10 HU or more on follow-up and low liver attenuation on primary CT (odds ratio 0.26 (95% CI 0.1-0.69), p-value = 0.002). Other factors had no significant effect on the liver attenuation change.

Conclusion. COVID-19 has no effect on liver attenuation, which may indicate that there is no significant effect of the virus on liver status.

Aim: To study contractility of the left ventricle (LV) in prematurely born children of early and preschool age who received treatment in intensive care units, neonatal intensive care units and pathology of newborns in the neonatal period.

Material and Methods. The study included 155 children, of which 108 children aged from one to five years old, born with very low body weight and extremely low body weight; and 47 children of the same age, born full-term and healthy. Study design: pilot, cross-sectional, retrospective, case-control study. EchoCG was performed using the Vivid E9 ultrasound system (GE, Healthcare) with M5S matrix probe (1.5–4.6 MHz). The LV global circumferential (GCSMV, GCSPM, GCSApex), and longitudinal strain, as well as the global strain of the endocardial, middle and epicardial layers of the LV were assessed. in the systole “clockwise”) was found in 33.33% of children with a history of bronchopulmonary dysplasia, and in 28.13% of children who received mechanical ventilation during the neonatal period. In 25 (69.44%) of 36 children with signs of anemia in the neonatal period, there was a decrease in deformation along the circumference of the LV epicardial layer. In 13 (86.67%) of 15 clinical observations with signs of transient hypothyroidism in the anamnesis, a decrease in deformation along the circumference of the epicardial layer was revealed.

Conclusion. Factors “body weight at birth”, “fetal growth retardation”, “anemia, use of mechanical ventilation in the neonatal period”, “transient hypothyroidism”, “development of bronchopulmonary dysplasia” in children of early and preschool age born prematurely with very low and extremely low body weight, adversely affect the formation of LV contractility and rotational mechanics in the postnatal period, exacerbating the disorders caused by the immaturity of the child’s heart tissue and the implementation of other pathogenetic mechanisms in prematurity, which requires medical supervision of this clinical group in polyclinic conditions.  

Aim: To evaluate the parameters of left ventricle (LV) myocardial deformation (longitudinal, circular and radial) in patients with symptomatic severe aortic stenosis (AS) with preserved LV ejection fraction after transcatheter aortic implantation valve (TAVI) in the early postoperative period.

Material and Methods. The study included 31 patients after TAVI out of 69 with symptomatic severe AS. Echocardiography (EchoCG) using two-dimensional speckle tracking technology was performed before TAVI and in the early postoperative period (within 5 ± 1,7 days).

Results. There were no significant differences in the analysis of deformation parameters before TAVI and in the early postoperative period. There was a tendency to increase the longitudinal deformation of the LV, including the longitudinal deformation of the basal, middle and apical segments in individual patients. The longitudinal deformation of the left atrium did not change after TAVI.

Conclusion. There were no significant changes in deformation parameters in elderly and senile patients with severe AS and preserved LV ejection fraction and with reduced LV deformation (longitudinal, circular and radial) after minimally invasive TAVI in the early postoperative period. There is a tendency to increase the global longitudinal deformation of the LV.

Introduction. A lead implantation into the cardiac conduction system (CCS) is currently the most physiological method of pacing. However, despite the availability of specialized lead and delivery systems, the proportion of non-targeted implantations is very significant. There is a need for an intraoperative visualization technique. The lead position is monitored by electrophysiological and fluoroscopic methods, which, obviously, are not enough.

Aim: To optimize the implantation of leads in the conduction system of the heart through the use of intraoperative merge visualization technique (IVT).

Material and methods. Two study groups are formed as part of the protocol of a prospective study. In the patients of the study group leads were implanted into the CCS using the IVT; in the control group - by traditional method. After implantation, in all patients the position of the lead using a transthoracic echocardiography (TTE), ECG was assessed. Computed tomography (CT) was performed in patients of study group before and after implantation. In patients of control group CT was performed after implantation.

Results. The full study protocol was completed in 10 patients of the study group and in 10 patients of the control group. All patients of the study group confirmed the lead implantation into the interventricular septum (IVS) using TTE and CT; into the CCS using ECG. The duration of the surgery was 87.5 [70; 120] min, fluoroscopy time – 225 [125; 421] sec. Complications, non-target implantations were not registered. In the control group, the duration of the surgery was 100 [100;110] min, the time of fluoroscopy was 775 [500;1230] sec.; stimulation of the CCS was confirmed in 4 (40%) patients; recorded 2 (20%) cases of perforation of the IVS, 1 (10%) case of implantation in the area of the apical part of the right ventricle, 1 (10%) intraoperative dislocation of the right ventricular lead, 1 (10%) case of hemopericardium in the early postoperative period. The average measurement error according to the intraoperative imaging technique compared with MSCT: the distance from the LV endocardium to the lead was 0.98 ± 0.51 mm, the distance from the lead to the tricuspid valve ring was 3.1 ± 0.92 mm. According to trans-thoracic echocardiography, there weren’t structural and functional changes in the tricuspid valve, newly emerged local areas of the myocardium with impaired contractility were detected in patients of the two groups. There weren’t significant changes in sensitivity thresholds, stimulation, and postoperative dislocations of the leads.

Conclusions. The use of IVT allows to reduce the number of “off-target” implantations, the time of fluoroscopy, the radiation exposure of the operator and the duration of the surgery.

Introduction. Ascending aortic aneurysms with bicuspid and tricuspid aortic valves have completely diff erent nature of origin. There is a large number of studies focusing on the negative effect of bicuspid aortic valve on the prognosis of this disease. However, studies regarding the impact of tricuspid aortic valve on ascending aortic aneurysms are extremely rare. In this regard, the purpose of our work was.

Aim: To analyze the early results of simultaneous surgical treatment.

Material and Methods. The retrospective study included 73 patients with aortic valve stenosis in combination with ascending aortic aneurysm. Patients were divided into two groups: group 1 comprised patients with bicuspid aortic valve and aortic aneurysm; group 2 comprised patients with tricuspid aortic valve and aortic aneurysm. All the examined patients underwent prosthetics of the aortic valve with simultaneous prosthetics of the ascending aorta as planned. Echocardiographic parameters and multispiral computed aortography were evaluated before and after surgery.

Results. The patients were comparable in baseline characteristics. The incidence rates of acute cerebrovascular accident, respiratory failure requiring prolonged respiratory support, acute kidney injury, and bleeding requiring re-operation were 3.7 vs. 0% (p = 0.918), 1.9 vs. 0% (p = 0.492), 1.9% vs. 0% (p = 0.492), and 0% vs. 5.3% (p = 0.128) in groups 1 and 2, respectively. There was no hospital mortality in any of study groups. There was no aortic valve prosthesis dysfunction in the early postoperative period.

Conclusion. Reconstructive surgeries for ascending aortic aneurysm with simultaneous prosthetics of the tricuspid aortic valve were characterized by satisfactory immediate clinical results comparable to patients with a bicuspid aortic valve.  

Introduction. Multispiral computed tomography (MSCT) coronary angiography (CAG) is a highly informative method of visualizing atherosclerotic plaques in the coronary arteries and assessing their structure. At the same time, this method has a few significant drawbacks associated with the intravenous administration of iodine-containing radiopaque agents as well as high radiation exposure. The radiomic analysis of contrast-free MSCT images allows calculating many additional quantitative parameters, which can potentially be associated with atherosclerotic plaque instability and the degree of coronary artery stenosis. At the same time, the prognostic and diagnostic value of radiomic characteristics has not been investigated.

Aim: To assess whether there is an association between radiomic indexes of EAT on non-contrast MSCT cardiac images with the degree of atherosclerotic coronary artery stenosis in patients with stable CAD, as well as the incidence of acute coronary syndrome (ACS) within 5 years in this category of patients.

Material and Methods. We retrospectively reviewed 100 MSCT-CAG studies performed to diagnose coronary heart disease in patients. 39 patients with signs of coronary stenosis up to 50% and registered in Tomsk medical information systems (MIS) for at least 5 years were selected, as well as 15 people without signs of coronary arteries (CA) atherosclerosis as a control group. Epicardial adipose tissue (EAT) volume was assessed and 837 radiomic characteristics were calculated on non-contrasted MSCT cardiac images of all patients (54 people). The presence or absence of ACS within 5 years after MSCT-CAG in each patient was monitored according to Tomsk MIS data. Statistical analysis and comparison of indices were performed in control group (group 2) and study group (group 1), as well as in subgroups of patients who had suffered AMI (group 1a) and those who had not (group 1b).

Results. When comparing group 1 with the control group, significant differences (p < 0.05) were found for all radiomic parameters, density, and volume of EAT. Correlation analysis did not reveal any relationship between the radiomic characteristics of EAT and the degree of coronary artery stenosis, as well as the calcium index. According to the results of the MIS of Tomsk analysis, group 1 was divided into 2 subgroups: without ACS (group 1a; n = 27 (50%)) and with ACS (group 1b; n = 12 (22%)). When comparing subgroups 1a and 1b, there were no significant differences in the volume and density of EAT (p > 0.05), however, 8 out of 837 radiomic parameters differed significantly. Multiple regression analysis has shown that the Size Zone Nonuniformity gray level zone matrix (SZN-GLSZM) and Gray Level Variance (GLCM) gray co-occurrence matrix are independent predictors of the development of ACS within 5 years. According to the results of the ROC analysis, the logistic model with the inclusion of radiomic data showed high sensitivity and specificity in predicting the development of ACS (cut-off point <8025.7; specificity 96%, sensitivity 75%, AUC = 0.806, p < 0.001 for SZN; cut-off point <4.08; specificity 93%, sensitivity 83%, AUC = 0.861 for GLV; p < 0.001).

Conclusion. SZN GLSZM and GLV GLCM radiomic features on non-contrast MSCT images of EAT are associated with the incidence of ASC in patients with coronary artery atherosclerosis. Radiomic analysis of EAT could potentially be used for personalized assessment of the ACS risk.

Aim: To compare the indicators of structural remodeling and intracardiac hemodynamics in people without previously diagnosed chronic non-communicable diseases, depending on body mass index (BMI).

Material and Methods. We analyzed the data of 123 people aged 21 to 59 years who did not have chronic non-infectious diseases and did not take any drug therapy that affects the indicators of central and peripheral hemodynamics, as well as lipid, carbohydrate and fat metabolism. All the examined persons were divided depending on the BMI into 2 groups, comparable in sex, but with age differences. The first group consisted of 60 people (75% women) with a BMI < 30 kg/m², whose median age was 40 years (Q₁–Q₃: 35–48 years). The second group included 63 subjects (76.1% women) with BMI ≥ 30 kg/m² at the age of 48.5 years (Q₁–Q₃: 38–54 years). Structural and functional parameters of the heart were assessed during transthoracic echocardiography, which was performed on the Philips EPIQ CVx 2D ultrasound machine by one specialist.

Results. In the group of persons with increased BMI, the average values of the left ventricular relative wall thickness (RWT LV) were higher – 0.37 [0.34; 0.40] versus 0.41 [0.37; 0.47], p = 0.01; left ventricular mass index (LVMI) – 64.0 [53.0; 76.5] g/m² and 27.0 [23.1; 30.9] g/m^2,7 vs. 82.0 [70.0; 92.0] g/m² and 38.1 [34.5; 46.5] g/m^2,7, p = 0.01; epicardial fat (EF) – 5 [4; 6] mm vs. 8 [5; 10] mm, p = 0.01, left ventricular global longitudinal strain (LV GLS) –21.8 [–23.6…–19.7]% vs. –19.2 [–21.2…–18.2] %, p = 0.01. Statistically direct correlations of BMI with LVMI g/m^2,7  (ρ = 0.746; p = 0.01), EF (ρ = 0.563; p = 0.01), LV GLS (ρ = 0.418; p = 0 .01), RWT (ρ = 0.438; p = 0.01). With an increase in BMI by 1 kg/m², one should expect an increase in the thickness of EF by 0.172 mm, longitudinal deformation of the LV by 0.151%, RWT by 0.003, LVMI, g/m² by 1.200, LVMI g/m^2,7 by 1.116.

Conclusion. The increase in BMI is associated with changes in structural remodeling and systolic function of the LV. In individuals with increased BMI, to determine structural remodeling and changes in the geometry of the heart chambers, it is necessary to use growth indexing, to determine indicators of GLS LV, to determine the thickness of EF in order to detect intracardiac hemodynamic disorders in the early stages and timely prevention of complications.

The widespread use of the term “cardiomyopathy” in modern cardiology dictates the need to systematize and concretize the use of this term. Based on the approximation of changes in the function, cavities and thickness of the walls of the chambers to known dilated, hypertrophic and restrictive cardiomyopathy, imaging methods in cardiology have made it possible to combine many pathological changes in the chambers of the heart into certain sets of visual perception and to form the concepts of phenotypes and phenotypes of most heart diseases.

Aim: To develop quantitative criteria for phenotypic changes in the left ventricle (LV), which can be used to control the dynamics of the disease and evaluate the effectiveness of treatment based on the results of a retrospective analysis of a large volume of digital data of echocardiographic studies in patients with myocardial diseases and healthy individuals.

Material and Methods. A retrospective analysis of echocardiography protocols for the period 2009–2021 was performed in 13023 healthy individuals aged 2 days to 59 years and 317 patients with various heart diseases: hypertrophic, dilated and restrictive cardiomyopathies, and LV non-compaction myocardium aged 4 days to 60 years.

Results. Criteria have been developed and proposed for the quantitative assessment by Z-index of pathological phenotypes of the left ventricle, which have a high (more than 95%) negative specificity in healthy individuals of any age and a positive one in patients with cardiomyopathies. The ability to quantify the dynamics of the course of diseases occurring with manifestations of restriction, dilation and LV hypertrophy was shown.

Aim: To assess the relationship between initial plasma chitotriosidase (CHIT) activity and the dynamics of computed tomography (CT) data: lung injury volume, liver and spleen density in COVID-19 hospitalized patients.

Material and Methods. The sub-analysis of the study registered in the Clinical Trial Registry with number: NCT04752085 was performed. The data of patients with available CT data of the chest on admission and at least once in dynamics during the period of hospitalization and the initial level of CTS in the blood plasma were analyzed. The density of the liver and spleen was determined in the scanned upper abdominal images, followed by the calculation of the ratio of the density of the liver to the density of the spleen.

Results. A total of 121 patients were enrolled in this sub-analysis. Their baseline characteristics were as follows: median age 62 [53;70], males 48,7%. Between the day of admission and 7 [6;9] days of hospitalization, there was a significant increase in mean liver density from 52,04 [45,4; 56,7] to 57,5 [49,8; 62,7] HU and L/S ratio (liver to spleen ratio) 1,05 [0,91; 1,14] to 1,13 [0,99; 1,28], p < 0,001. The dynamics of the volume of lung tissue damage was multidirectional and, in general, did not change significantly. CHIT activity among patients whose lung injury volume increased during the hospitalization was significantly lower (65 [27; 119] nmol/ml/h) compared with patients whose lung injury volume did not change or decreased (124 [53; 232] nmol/ml/h), p = 0.006. The risk of lung injury progression was higher in patients with baseline CHIT level less than 100 nmol/h/ mL, (HR 3.1, 95% CI 1.4–6.9).

Conclusion. Insufficient increase of CHIT activity can be associated with progression of lung injury, but does not affect the evolution of liver and spleen density as measured by CT.

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.

Aim: To study the possibility of applying surface-enhanced Raman spectroscopy (SERS) in the search for pharmacodynamic biomarkers to predict patients' response to antiplatelet therapy (AT).

Material and Methods. The study included 152 healthy volunteers and patients with cardiovascular disease (CVD). They were divided into four groups: healthy volunteers did not receive (group 1) and receiving (group 2) acetylsalicylic acid (ASA); patients with CVD receiving (group 3); and who did not receive AT (group 4). Gold particle-modified nanostructured titanium surfaces were developed to obtain SERS spectra of the platelets. To obtain GRS spectra of platelets, an original optical sensor was developed based on a nanostructured titanium surface modified with gold particles.

Results. Statistically significant differences were detected in some SERS spectra intensities between both group 1 vs group 3 and group 1 vs group 4 at four SERS frequency shifts (FS): 485, 505, 990, 1465 cm^–1. Correlations were found between the SERS spectra of group 2 and the results of aggregometry under the Coll/ADP activator. The SERS spectra of all participants and the results of aggregometry under the P2Y activator; the SERS spectra of the patients in group 4 and the results of aggregometry under the P2Y activator also were found.

Conclusion. SERS spectroscopy can be used to detect and differentiate changes in the molecular structure of platelets after exposure to CVD or AT. The SERS spectrum intensities most suitable for the study of AT pharmacodynamic effects are 485, 505, 990 and 1465 cm^–1. The detected spectral changes of peripheral blood platelets in patients with CVD correlate with the aggregometry changes obtained using a P2Y activator cartridge.

Background. The diagnosis of ischemic stroke is of high importance in modern medical practice. One of the most promising methods for solving this problem is the introduction of machine learning algorithms into physicians’ work as an auxiliary tool for the interpretation of beam images.

Aim: To compare automated computed tomography (CT) image analysis systems in detecting middle cerebral artery stroke.

Material and Methods. The study included three anonymized (A, B, C) machine learning algorithms. Analytical validation was carried out on a database of one hundred patients admitted in St. Petersburg vascular center with suspected middle cerebral artery stroke, who underwent noncontrast head CTs. Ischemic stroke in half of the patients was confirmed on the basis of clinical examination findings and CT-angiography and CT-perfusion. The study evaluated the performance indicators (sensitivity, specificity, positive predictive value, negative predictive value, accuracy) for detecting a set of signs of early ischemic changes (by automatic segmentation and predicting a score on the ASPECTS scale). The article also provides a graph that allows you to evaluate the quality of a binary classification – characteristic curves (ROC-curves).

Results. The meta-analyses showed all the considered automated algorithms did not reach the threshold values of accuracy (range from 0.67 to 0.75) required for programs according to clinical guidelines (0.80). The algorithms showed variability in sensitivity and specificity. One of the automatic analysis systems (A) had a high sensitivity (0.88), but at the same time a low specificity (0.46), which indicates its overtraining and a tendency to overdiagnoses. The remaining algorithms (B, C) showed low sensitivity (0.6; 0.55) and high specificity (0.9; 0.8).

Aim: To assess the change in the left ventricular (LV) diastolic function (DF) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) during 6-month follow-up after renal denervation (RDN) according to echocardiography in conjunction with changes in hemodynamic parameters.

Material and Methods. A single center prospective interventional study with renal denervation included 30 patients with RHTN and T2DM. All patients underwent measurement of office and 24-hour blood pressure (BP), echocardiography according to the standard method with an assessment of LV DF.

Results. At 6 months after RDN, a significant antihypertensive effect was noted (p < 0.05), as well as an improvement in LV DF in the form of a decrease in E/e` by 1 c.u. was observed in 50% (15) patients. A significant decrease in the average E/e` was documented (–1.3 [95% CI –2.55; –0.08], р = 0.038). There were no changes in the indexed volumes of the left atrium (р = 0.940). The baseline values of E/e` had correlation with the level of mean pulse BP 24h (r = 0.51, р = 0.001) in the absence of significant relationships with other ABPM parameters. A decrease in systolic BP 24h by 3 mm Hg and an increase in nocturnal systolic BP fall by 1.6% were accompanied by a decrease in the average E/e` by 1 unit. According to the ROC-analysis, baseline level of nocturnal systolic BP fall 5.5% or less associated with a decrease in the E/e` ratio by more than 1 unit.

Conclusion. Renal denervation in patients with RHTN and T2DM is accompanied by a favorable effect on LV diastolic function during 6-month follow-up, closely related to the hemodynamic effects of the procedure such as a decrease in systolic and pulse BP 24h, as well as improvement in the circadian rhythm of BP.

Introduction. Protozoal intestinal infections are quite common in the modern world. They cause severe clinical manifestations, and in some cases, more often, in countries with a hot climate, lead to death. This is due to the ability of the pathogen to enter the human body through water, fecal-oral or alimentary routes. In this regard, the development of a new safe and effective enterosorbent for protozoal diseases affecting the gastrointestinal tract is relevant.

Aim: To study the effectiveness of the combined enterosorbent based on hydroxyapatite and compare the effectiveness of its use with colloidal silicon dioxide (Polysorb) in relation to protozoa (eimeria) in an experiment on rabbits.

Material and Methods. The development of a combined enterosorbent based on calcium hydroxyapatite and experimental treatment of laboratory animals (rabbits - 40 animals) infected with protozoal disease - eimeriosis was carried out. Four groups were formed: healthy control, infected control, infected experimental group, infected comparison group (comparison drug – Polysorb). The therapy was carried out for 5 days. The drugs were administered orally.

Results. It is shown that the use of a combined enterosorbent based on calcium hydroxyapatite in a daily dose of 0.05 g per 1 kg of body weight led to a decrease in the intensity of invasion of the gastrointestinal tract of rabbits by oocysts by 80% compared with the control, and the use of colloidal silicon dioxide in a daily dose of 0.1-0.2 g per 1 kg of body weight by 49% compared with control.

Conclusion. The combined preparation based on calcium hydroxyapatite effectively reduces the intensity of invasion by oocysts of the gastrointestinal tract of rabbits in the experiment. Its intensity efficiency exceeds the intensity of colloidal silicon dioxide by 31%.

The conducted study indicates the priority use of the drug fabomatizole to protect living systems from the negative effects of lead acetate.

Aim: To study the mechanisms of fabomatizole effect on the nature of changes in redox reactions, NO-forming function of the endothelium, cholesterol metabolism and functional parameters in rats with lead intoxication.

Material and Methods. The study was carried out on 60 Wistar rats. Lead intoxication was induced by intramuscular administration of lead acetate at a dose of 5 mg/kg of animal weight for a month. At the end of the intoxication period, Fabomatizol was administered at a dose of 10 mg/kg for a month. Next, blood and tissue samples were taken from rats to determine the activity of oxidative, antioxidant, enzymatic systems, nitric oxide metabolism, and blood lipid spectrum.

Results. The data obtained showed that intramuscular administration of fabomatisol in case of lead intoxication has an antioxidant effect and inhibits lipid peroxidation (LPO) activity. Under the influence of fabomatizol, nitric oxide metabolism andtotal nitric oxide metabolites (NOx) content significantly increased, and a negative correlation was found between the malondialdehyde level, superoxide dismutase activity and NOx. At the same time, the study found a decrease in the expression level of eNOS as the cause of a reduced concentration of NOx in the blood. L-arginine availability for eNOS was disturbed by atherogenic low density lipoprotein (LDL). Treatment with fabomatizol against the background of lead intoxication caused a decrease in total cholesterol, LDL cholesterol and an increase inhigh density lipoprotein cholesterol. By inhibiting lipid peroxidation in the cells of the renal and hepatic tissues, fabomatizol contributed to the restoration of lipid-protein interactions and the functional activity of Na and K-activated ATPase in the renal interstitium. Simultaneously, there is an activation of Na,K-ATP-ase in the hepatocyte and a decrease in the level of organ-specific enzymes in the blood plasma.

Conclusion. The results obtained are evidence of the antioxidant properties of fabomatisol in lead intoxication, its ability to induce the activity of antioxidant system (AOS enzymes, stimulate the NO-forming function of the endothelium, NOx production and the activity of the membrane enzyme – Na,K-ATP-ase in the renal and hepatic tissues and reduce the level of organ-specific enzymes in blood plasma.

Bone marrow edema is MR images is defined by the presence of hypointense infiltration on T1-weighted images and clear high signal intensity on fat-saturated T2-weighted sequences (T2 FSE FAT SATURATED, T2-weighted short-tau inversion recovery (T2w-STIR)).

Aim: To demonstrate the features of manifestation of “bone marrow edema” at different severity and character of traumatic injury of the knee.

Materials and Methods. A series of clinical cases with subchondral bone involvement in the form of “bone marrow edema” resulting from trauma is presented using the example of the knee joint as the most common area of MRI for differential diagnosis.

Results. The features of “marrow edema” of the femoral and tibial condyles were analyzed using clinical examples. It was shown that the severity and nature of injury can be judged by the nature of the edema, presence of linear hypointensities, articular surface deforms and the bone defects.

Conclusion. Evaluation of “bone marrow edema” revealed on MRI examination in case of pain syndrome after a knee joint injury allows timely clarification of the diagnosis and adequate treatment.

Introduction. This article reviews the results of the development and implementation of organizational solutions aimed at reducing the time of providing routine medical care to patients in outpatient settings and increasing its availability. Among the reasons negatively affecting the waiting times for medical care are complex routing schemes and the high level of administrative overhead that accompanies each stage of the treatment and diagnostic process.

Aim: To develop and evaluate the effectiveness of measures to improve the system of organization of planned medical care on the example of medical organizations of Tomsk region.

Material and Methods. The study included medical organizations providing primary health care in outpatient settings (31 institutions). The study was conducted in stages: 2018–2019 the main set of measures (creation of offices of the organization of planned care) was developed and implemented, 2020–2021 – summarized interim results, 2022 – performance assessment was carried out. For comparative analysis all medical organizations were divided into 2 groups (group A and group B) depending on implementation of planned activities. Statistical processing was performed using the Statistica 10.0.228.8 software package.

Results. It was found that the waiting time for a doctor’s consultation Group A reduced by 5.5% (p = 0.025) in 2019 compared with 2018, in contrast to Group B. The waiting time for a routine diagnostic examination in Group A also reduced by 16.6% in 2019 compared to 2018 (p = 0.041), while no differences were found between waiting times for routine diagnosis in Group B for the same period (p = 0.101).

Summary. The study has shown that the problems of accessibility of planned medical care can be effectively solved through the creation of a patient flow management system at all stages of the treatment and diagnostic process.