Aim. To study the clinical manifestations, incidence of life-threatening complications, and their possible mechanisms and outcomes of left ventricular non-compaction (LVNC) in adults.Material and methods. This study included 125 adult patients with LVNC, 74 men (59.2%) and 51 women (40.8%) aged 46.4±15.1 years. Echocardiography (EchoCG) (n=125), Holter monitoring (n=125), cardiac magnetic resonance imaging (MRI) (n=60), and contrast-enhanced multislice computed tomography (MSCT) of the heart (n=90), and, if indicated, coronary angiography (CAG) (n=33) and myocardial scintigraphy (n=27) were performed. The diagnosis of LVNC was confirmed in 74 cases using two methods, and in 21 cases, using three imaging methods. DNA diagnostics was performed in most patients. For most patients, the level of anticardiac antibodies and the genome of cardiotropic viruses were determined in the blood. Mean left ventricular (LV) ejection fraction (EF) was 38.6±14.0%; LV end-diastolic volume (EDV) was 158.1±67.8 ml; LV end-diastolic dimension (EDD) was 6.1±0.9 cm; and left atrial (LA) volume was 97.1±38.1 ml. The mean follow-up period was 14 months [4.0; 41.0]; from 1 month to 10 years.Results. Death rate was 14.4%; heart transplantation was performed in 5.6% of cases. Nonsustained ventricular tachycardia (VT) was detected in 45.6% of cases and sustained VT in 13.6%. The presence of VT was associated with poor R-wave progression in the precordial ECG leads, low QRS voltage, QRS duration >105 ms, NYHA chronic heart failure functional class (CHF FC) ≥2-3, LV EF <40%; LV EDD >6.1 cm, the presence of myocarditis, and higher death rate. Cardioverter defibrillators, including cardiac resynchronization therapy defibrillators (CRTD), were implanted in 38 patients. Appropriate defibrillator shocks were associated with frequent premature ventricular contractions (PVCs). The incidence of thrombosis and embolism was 22.4%. Their predictors included CHF FC ≥2-3, RV anteroposterior dimension >3.1 cm, LA volume >98 ml, E/A >1.65, LV EDD >6.3 cm, LV EDV >153 ml, LV EF <35%, and myocardial necrosis of unknown origin (in patients without coronary atherosclerosis). The incidence of myocardial necrosis in LVNC was 16.0%. The mechanisms identified, in addition to coronary atherosclerosis, were embolism in unchanged coronary arteries, secondary myocarditis, and the presence of genetically determined thrombophilia.Conclusion. LVNC is associated with a high risk of life-threatening conditions, such as ventricular arrhythmias, thrombosis and embolism, and myocardial necrosis, that are typical complications of LVNC in adults. Reassessing the predictors for the risk of thromboembolic and arrhythmic events, specifying the indications for implantable cardioverter defibrillator and anticoagulants, and actively identifying and treating concomitant myocarditis are essential.

The state of the heart after a coronavirus disease 2019 (COVID-19, coronavirus disease 2019) is very diverse and in some cases requires a complex differential diagnosis. We described a 35-year-old smoking male patient who, by the end of the first month after COVID-19, developed left ventricular dysfunction with decrease in ejection fraction to 25-30% and persistent left bundle branch block (LBBB). Echocardiography also detected local contractility disorders. A significant increase in blood anticardiac antibody titers was noted. Myocardial biopsy revealed active lymphocytic myocarditis, coronavirus ribonucleic acid, while coronary angiography revealed extensive stenosis of the anterior interventricular artery. On the first day after balloon angioplasty and stenting, the disappearance of LBBB block was noted with the appearance of deep negative T waves in the precordial leads, which did not allow ruling out a previous myocardial infarction. As a result of treatment of heart failure and steroid therapy, the structural and functional cardiac parameters and the electrocardiography were completely normalized by the end of the second year of treatment. Only a transient LBBB remained at high loads. Cardiac computed tomography after 2 years showed no delayed contrast agent accumulation in the myocardium, and coronary stenosis up to 30%.The mechanisms of complex myocardial and coronary damage (including the role of coronaritis in the atherosclerosis progression) after COVID-19 are discussed.

Aim. To study the place of NCM in the structure of DCM, its clinical features and influence on prognosis in comparison with other forms of DCM syndrome.Methods. The NCM registry includes 125 patients, mean age 46.4±15.1 years, 74 men and 51 women, median follow-up 14 [4.0; 41.0] months. The DCM registry included 365 patients, mean age 46.4±15.1 years, 253 men and 112 women, median follow-up 14 [5; 43.75] months. The examination included electrocardiography (ECG), ECG Holter monitoring, echocardiography, blood anti-heart antibody level evaluation, and additionally cardiac computed tomography, magnetic resonance imaging, DNA diagnostics (in the MYH7, MYBPC3, TPM1, TNNI3, TNNT2, ACTC1, TAZ, ZASP (LDB3), MYL2, MYL3, DES, LMNA, EMD, TTR gene panel), coronary angiography, right ventricular endomyocardial biopsy.Results. The proportion of patients with DCM phenotype in the NCM registry was 40% (n=49), another 11% (n=15) had NCM diagnosed simultaneously with acute/subacute myocarditis. Lethality in these subgroups was 12.2% and 33.3%, respectively, and was significantly higher than in asymptomatic, ischemic and arrhythmic variants of NCM. In the DCM registry, the proportion of patients with NСM was 21% (n=78), and increased left ventricular (LV) trabecularity was detected in another 18% (n=64). DCM patients with and without NСM did not differ by baseline echocardiographic parameters, heart failure class, and cardiotropic therapy. Pathogenic mutations were detected in 14% of DCM patients with NCM and only 3% of other patients with DCM (p<0.001). Only in patients without NCM the presence of mutations had a significant effect on lethality. The patients with NCM compared with the others DCM patients showed significantly lower increase in EF in early and late period (from 31.0±10.2 to 34.8±11.0 and 37.1±10.9% [р<0.05] vs from 31.8±9.7 to 38.8±11.3 and 42.3±12.4% [р<0.01] respectively), a greater incidence of premature ventricular beats (1568 [105;7000] vs 543.5 [77.75; 3194], p<0.05), appropriate defibrillator shocks and sudden deaths (17.9 vs 5.9%, p<0.001), intracardiac thrombosis (21.8 vs 13.5%, p=0.069) despite a greater frequency of anticoagulants (73.1 vs 57.4%, p<0<05). There were no significant differences in death (19.2 vs 18.5%) and transplantation (7.7 vs 3.8%) between patients with and without NCM. There were no cases of NCM regression.Conclusion. NCM is an independent form of DCM syndrome, which is characterized by higher frequency of pathogenic mutations, arrhythmic events, worse response to cardiotropic therapy, higher frequency of intracardiac thrombosis. The absence of mortality differences can be explained by the higher frequency of preventive interventions in this category of patients with DCM (prescription of anticoagulants, defibrillator implantation, heart transplantation).

Бокерия Л.А., Мерзляков В.Ю., Шурупова И.В., Ширинская О.Г., Гагарина Н.В., Петросян К.В., Мироненко М.Ю., Санакоев М.К., Андреев В.Б., Кудзоева З.Ф. Проблема конкурентного кровотока после аортокоронарного шунтирования у детей с болезнью Кавасаки и гигантскими аневризмами коронарных артерий. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2022; 23 (3): 348–58. DOI: 10.24022/1810-0694-2022-23-3-348-358 HTML

Aim. To assess the changes in cardiology diagnostics scope in the Russian Federation during the coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), including questions about changes in the workflow of diagnostic laboratories and the scope of cardiac diagnostics from March 2019 (pre-pandemic) to April 2020 (first wave of the pandemic) and April 2021 (recovery stage), 15 Russian medical centers from 5 cities took part.Results. The decrease in the diagnostics scope by April 2020 by 59,3% compared to March 2019, by April 2021, stopped and was replaced by growth (+7,1%, the recovery rate, 112,1%). The greatest increase was in routine examinations, such as echocardiography (+11,6%), stress echocardiography (+18,7%), stress single photon emission computed tomography (+9,7%), and to a lesser extent resting computed tomography angiography (+7,0%) and magnetic resonance imaging (+6,6%). The performance of stress electrocardiography, stress magnetic resonance imaging and positron emission tomography for the diagnosis of endocarditis in April 2021 compared to March 2019 decreased by 10,3%, 63,2% and 62,5%, respectively.Conclusion. Due to the resumption of patient admissions for cardiac examinations during the ongoing COVID-19 pandemic, with the anti-epidemic measures taken and certain changes in the workflow, there has been a recovery in the diagnostics scope in most of the included centers.

Aim. To assess the impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation.Material and methods. Fifteen Russian medical centers from 5 cities took part in an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), containing questions regarding alterations in cardiovascular procedure volumes resulting from COVID-19 in March-April 2020.Results. A number of outpatients undergoing cardiac diagnostic procedures was noted in 80% of clinics. Cardiovascular procedure volumes in the period from March 2019 to March 2020 in general decreased by 9,5%, and from March 2019 to April 2020, by 56,5%. Stress electrocardiography decreased by 38,4%, stress echocardiography by 72,5%, stress single-photon emission computed tomography by 66,9%, computed tomography angiography by 49,7%, magnetic resonance imaging by 42,7%, invasive coronary angiography by 40,7%. The decrease in diagnostic procedure volumes in selected regions (Tomsk Oblast, Kemerovo Oblast, Tatarstan) was not so pronounced compared to Moscow and St. Petersburg (-20,7%, -75,2%, -93,8% in April 2020, respectively, p<0,001).Conclusion. The first wave of the COVID-19 pandemic caused a sharp decrease in the number of diagnostic cardiac procedures in Russia. This has potential longterm implications for patients with cardiovascular disease. Understanding these implications can help guide diagnostic strategies during the ongoing COVID-19 pandemic and minimize the future losses.

Aim . To assess the impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation. Material and methods . Fifteen Russian medical centers from 5 cities took part in an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), containing questions regarding alterations in cardiovascular procedure volumes resulting from COVID-19 in March-April 2020. Results. A number of outpatients undergoing cardiac diagnostic procedures was noted in 80% of clinics. Cardiovascular procedure volumes in the period from March 2019 to March 2020 in general decreased by 9,5%, and from March 2019 to April 2020, by 56,5%. Stress electrocardiography decreased by 38,4%, stress echocardiography by 72,5%, stress single-photon emission computed tomography by 66,9%, computed tomography angiography by 49,7%, magnetic resonance imaging by 42,7%, invasive coronary angiography by 40,7%. The decrease in diagnostic procedure volumes in selected regions (Tomsk Oblast, Kemerovo Oblast, Tatarstan) was not so pronounced compared to Moscow and St. Petersburg (-20,7%, -75,2%, -93,8% in April 2020, respectively, p<0,001). Conclusion . The first wave of the COVID-19 pandemic caused a sharp decrease in the number of diagnostic cardiac procedures in Russia. This has potential longterm implications for patients with cardiovascular disease. Understanding these implications can help guide diagnostic strategies during the ongoing COVID-19 pandemic and minimize the future losses.

Abstract Background Left ventricular noncompaction (LVNC) is characterized by high frequency of heart failure, arrhythmias, thromboembolism and ischemia. Purpose To estimate frequency, predictors, outcomes of adverse events in patients with LVNC. Methods 120 patients with LVNC were included (male, 58.3%); mean age, 45.9±15.0 years. To diagnose LVNC EchoCG (n=120), CT (n=85), MRI (n=55) were performed. The mean LV EF was 39.0±13.9%, LV EDV 155.5±65.0ml, LV EDD 6,03±0.8cm, LA volume 96.3±38.4ml. The median follow-up was 15 [4.0; 41.0] months. We also performed NGS sequencing, followed by Sanger sequencing. Results Pathological mutations in genes MYH7, MyBPC3, LAMP2, DES, DSP, TTN were found in 10% of patients. The main clinical manifestations were chronic heart failure NYHA II-III (66.7% of patients), ventricular arrhythmias (PVCs>500/day in 46.7%, sustained/unsustained VT in 49.2%), AF 30.8% (paroxysmal, n=18; persistent, n=11; permanent, n=9), ischemia (angina pectoris in 20%, myocardial necrosis in 13.3%), intracardiac thrombosis without anticoagulants (19.2%), embolism (6.7%), AV block degree II-III (11.7%), bundle branch blocks (37.5%), sinus node dysfunction (10%). VT frequency was associated with lower LV EF (34.6±13.4 v 42.8±13.1 p=0.001), higher NYHA functional class (class 2.5 [2.0; 3.0] v class 2 [0.75; 3.0], p<0,01), low voltage ECG (20.3% v 5.2% p<0,05), poor R-wave progression (42.4% v 20.7% p<0,01), QRS duration (110ms [100; 140] v 100ms [90; 110], p=0,001), myocarditis presence (66.1% v 37.9% p<0.01) and higher mortality (22% v 6.9% p<0.05). AF correlated with the size of LA (AUC 0.712), and RA (AUC 0.716), p<0.001. Pacemakers were implanted in 7 cases, ICD in n=25 (20.8%), CRTD in n=9 (7.5%). Appropriate ICD shocks were recorded in 26.5%. In two patients without ICD sudden cardiac death occurred. Radiofrequency ablation was performed in 5 cases, in 3 of them without effect. Patients with thromboembolic events (renal, pulmonary, myocardial infarction, stroke) had significantly lower LV EF (31.8%±11.4 v 41.0±13.9%, p<0.005), higher NYHA functional class (class 3 [1.75; 3.0] v class 2 [1.0; 3.0], p<0.05), greater LV EDD (6.34±0.83 v 5.9±0.81, p<0.05), E/A ratio (2.15±0.8 v 1.5±0.84 p<0.01), lower VTI (10.19±2.9 v 12.8±3.6 p<0.05). The main MI mechanisms were embolism, thrombosis, myocarditis, inadequate myocardium perfusion. Six patients (5%) underwent heart transplantation. The mortality rate was 14.2% (17 patients) due to myocardial infarction, arrhythmias, heart failure. Conclusion Thromboembolic events, arrhythmias and ischemia are typical adverse events of LVNC. Non-sustained/sustained ventricular tachycardia, myocardial infarction is significantly associated with increased mortality. LV dilation, systolic and diastolic dysfunction increases the frequency of thromboembolism in these patients. Low voltage ECG, poor R-wave progression, QRS duration and myocarditis should considered predictors for arrhythmias in LVNC patients.

The first presentation of the combination of non-compaction cardiomyopathy with a restrictive-dilated phenotype and massive chronic tuberculous pericarditis, which for a long time was under the guise of hydropericardium in congestive heart failure in a patient of 30 years, is performed. The absence of congestion signs in a large circle of blood circulation became the reason for diagnosis of agnogenic pericarditis and pericardial puncture. A large volume (>1 l) and lymphocytic nature of effusion, its bilateral character, post-tuberculous changes and calcifications in the lungs, and intrathoracic lymphadenopathy testified in favor of the tuberculous etiology of the process. The negative result of all laboratory tests for tuberculosis (Diaskintest, exudate PCR test, fluorescence microscopy, inoculation on liquid media, Ziehl-Neelsen stain) and the high risk of thoracoscopic biopsy did not allow to immediately verify the diagnosis. It was made only after repeated elimination of 3,5 l of hemorrhagic exudate and the detection of mycobacterial DNA by PCR. As a result of quadruple tuberculostatic therapy, a remission of the process was achieved (there is no fluid in the pericardial cavity).

Loeffler's endocarditis remains is a very rare disease, develops due to eosinophilic inflammation predominantly of the endocardium with an outcome in fibrosis and massive thrombus formation and. He is generally characterized by an unfavorable prognosis. Clinical case of a 42-year-old patient with Loeffler endocarditis is presented. The development of the disease was preceded by a polyvalent allergy, mild dry eye syndrome and pansinusitis with a single eosinophilia of blood up to 16%. The reason for the hospitalization was the appearance of biventricular heart failure. During the previous year, the level of blood eosinophils remained normal, a threefold increase in the level of eosinophilic cationic protein was observed once. A 20-fold increase in the pANCA level, a 2.5-fold increase in the level of antibodies to DNA, an antibody to the nuclei of cardiomyocytes 1:160 were detected. The diagnosis was made on the basis of electrocardiography data (low QRS voltage, atrial hypertrophy), echocardiography, multispiral computed tomography and magnetic resonance imaging of the heart (thickening and delayed contrasting of the endocardium, massive thrombosis of the left ventricular apex with obliteration of its cavity, encapsulated fluid in the pericardium with compression of the right ventricle). Systolic dysfunction, severe signs of restriction and arrhythmias were absent. Trombectomy, tricuspid valve plasty, pericardial resection, suturing of an open oval window were performed. Signs of active inflammation with single eosinophils, vasculitis, perimuscular sclerosis, endocardial sclerosis were detected in morphological and immunohistochemical studies of endo-, myo-, pericardium. Viral genome was not found. The therapy with methylprednisolone 24 mg/day, azathioprine 75 mg/day was started. Six months after the operation, the symptoms of heart failure are completely absent, the thrombosis did not recur.

Aim. To evaluate the prevalence of myocarditis in adult patients with non-compaction myocardium (NCM) of the left ventricle (LV), and its influence on the disease course, results of treatment and outcomes.Material and methods. To the study, 103 adult patients included, with NCM, 61 males, mean age 45,6±14,9 y. o. (from 18 to 78). Mean end diastolic LV size was 6,0±0,8 сm, EF LV 38,8±14,5%. Diagnosis of NCM had been done by echocardiography, multispiral computed tomography (n=81) and magnetic resonance tomography (n=39). DNA-diagnostics was performed by NGS method with further Senger sequencing. Pathogenic mutations were found in 9% of patients in the genes MYH7, MyBPC3, LAMP2, DES, DSP, TTN. The investigation also included anticardiac antibodies, genome of cardiotropic viruses by PCR, coronary arteriography (n=26), scintigraphy (n=25). Morphological assessment of the myocardium was done in 19 patients (12 endomyocardial biopsies), 1 intraoperation biopsy, 3 explanted hearts, incl. 2 after biopsy, and 5 autopsies. Mean follow-up 12 [2; 32] months.Results. Myocarditis was found in 53,4%, incl. virus-positive in 32,7% of those, with morphology done for 19 patients (active myocarditis in 10, borderline in 6; with minimal signs of activeness in 3). Viral genome in myocardium found in 8 patients (42,1%). The prevalence of myocarditis 44,4% in an arrhythmic variant of NCM, 12,5% in chronic ischemic, 57,5% in dilation cardiomyopathy, 50,0% in NCM patients with other cardiomyopathies. Special cases were acute/subacute myocarditis in NCM (10,7% of all), acute necrosis (infarction) in 4,9%. Comorbidity with myocarditis in NCM led to significantly more severe LV dysfunction (CHF FC 2 [1; 3] v 1,75 [0; 2], p<0,01, EF 33,8±13,5 v 44,7±13,6%, p<0,001), more prevalent non-sustained ventricular tachycardia (67,3% v 29,3%, p<0,01), proper shocks (38,9% v 0, p<0,05), deaths (16,4 and 4,2%, OR 5,75, 95% CI 1,21-27,43, p<0,05) and transplantation (7,3% v 2,1%, p>0,05). Only in myocarditis patients, as a result of basis (antiviral, immune suppression) and cardiotropic therapy there was significant increase of EF (in acute myocarditis from 25,4±7,9 to 38,6±9,5%, p<0,01), decrease of LV size and pulmonary systolic pressure.Conclusion. Myocarditis is typical phenomenon developing in patients with the primary, i. e. genetically verified NCM. The nature of myocarditis in NCM varies (primary infectious-autoimmune, secondary as a response on genetic/ischemic damage of cardiomyocytes), however regardless of this, it leads to significant worsening of structural and functional parameters, increase of the life-threatening arrhythmias rate, and outcomes (death + transplantation, proper shocks), demanding for active basic therapy.

Aim. To study the role of contrast-enhanced multispiral computed tomography (MSCT) of the heart in diagnostics of myocarditis in patients with the syndrome of dilation cardiomyopathy (DCMP) comparing to morphological investigation of myocardium. Material and methods. Into the main group of study, 127 patients included (92 males, 46,9±11,8 y.o.) with DCMP syndrome (mean end diastolic size (EDS) of the left ventricle (LV) 6,6±0,8 cm, mean ejection fraction (EF) 29,7±9,5%, 3 [2; 3] FC by NYHA). All underwent 320-slice MSCT of the heart with i.v. contrast, 50 underwent morphological investigation of myocardium (endomyocardial byopsy in 30, intraoperational in 7, autopsy in 9, explanted heart study in 4). Also, viral infection markers were studied, as the level of anticardiac antibodies, EchoCG (all patients), scintigraphy (n=42), magnete-resonance tomography (MRI) (n=21), coronary arteriography (CAG, n=48). Comparison group included 18 patients (12 males, 69,2±8,5 y.o.) with coronary atherosclerosis (stenosis form 40%) by MSCT and absence of DCMP criteria (mean EDS LV 4,7±0,5 cm, mean EF LV 59,3±4,9%, 0 [0; 2] FC by NYHA). Results. By the data from complex investigation, myocarditis as the main cause of DCMP syndrome was diagnosed in 79 (62,2%) patients of the main group, its comorbidity with genetic cardiomyopathies — in 19 else (15%). In MSCT of the heart the areas of lower accumulation were found in 4 patients from main group (3,1%, type 1 by the proposed evaluation score), delayed accumulation of the contrast in myocardium — in 72 (56,7%) patients: in 12 subendocardial (type 2), in 4 intramyocardial (type 3), in 44 subepicardial (type 4), in 12 transmural (type 5); in 51 patient there was no delayed accumulation. Sensitivity and specificity of all types of delayed accumulation in diagnostics of myocarditis were 63,3% and 78,7%, positive and negative predictive value 86,1% and 50,7%, subepicardial and transmural types — 49,0%, 83,0%, 85,7%, 43,8%, respectively. While comparing the data of MSCT directly with morphological study of myocardium, diagnostic significance of all types of delayed accumulation in myocarditis revealing was 66,7%, 84,6%, 87,5%, 61,1%, subepicardial and transmural types — 52,4%, 92,3%, 91,7%, 54,5%, respectively. By MSCT in the main group also the non-compaction myocardium was found (n=29, 22,8%), coronary atherosclerosis (n=33, 26,0%), confirmed by CAG in 16 patients. Presence/absence of delayed accumulation by our proposed score correlated with 1) diagnostical signs: duration of illness (r=-0,185, p<0,05), acute onset (r=0,196, p<0,05), connection of onset and infection (r=0,332, p<0,001); 2) functional signs as the class of heart failure (r=0,183, p<0,05), VTI (r=-0,303; р<0,05); 3) mortality rate (r=0,176, p<0,05). Conclusion. MSCT with the evaluation of delayed contrast accumulation (and synchronic CT-angiography of coronary arteries) can be used for non-invasive diagnostics of myocarditis in patients with DCMP syndrome, including if MRI contraindicated. Delayed accumulation of contrast in myocardium correlates with myocarditis presence, the grade of functional disorder and prognosis.

Aim. To investigate whether intravenous contrast-enhanced multislice spiral computed tomography (computed tomography) (MSCT) versus myocardial morphological examination can diagnose myocarditis and the non-inflammatory causes of dilated cardiomyopathy (DCM) and evaluate prognosis in patients with the latter. Subjects and methods. A study group consisted of 130 patients, including 95 men (46.8±11.9 years), with DCM (mean left ventricular (LV) end-diastolic dimension (EDD), 6.6±0.8 cm; mean LV ejection fraction (EF), 29.8±9.3%; NYHA functional class (FC) III (II; III)). All the patients underwent intravenous contrast-enhanced 320-slice CT of the heart; myocardial morphological examination was made in 48 patients (endomyocardial biopsy in 29 patients, intraoperative biopsy in 7, and autopsy in 9, and study of the explanted heart in 3). In addition, cardiotropic viral DNA in the blood and myocardium and the level of anticardiolipin antibodies were determined; echocardiography (in all the patients), scintigraphy (n = 45), magnetic resonance imaging (MRI) (n = 21), and coronary angiography (CG) (n = 46), and a genetic consultation were performed. A comparison group comprised 20 patients, including 14 men (69.3±9.2 years), with coronary atherosclerosis (40% or more stenoses) according to MSCT findings in the absence of criteria for DCM (mean LV EDD, 4.8±0.5 cm; mean LV EF, 59.4±4.6%). Results. Morphological/comprehensive examination showed that myocarditis as a cause of DCM was diagnosed in 76 (65%) patients; its concurrence with genetic cardiomyopathies was in 17 more patients (17%). MSCT of the heart revealed lower accumulation areas in 2 (1.5%) patients (type 1 based on the proposed rating scale), delayed myocardial contrast agent accumulation (DMCAA) in 81 (62.3%): subendocardial accumulation (type 2) in 8, intramyocardial accumulation in 4 (type 3), subepicardial accumulation in 52 (type 4), and transmural accumulation in 15 (type 5); DMCAA was not noted in 49 patients. DMCAA was not found in the comparison group. As compared with biopsy, the sensitivity, specificity, predictive value of positive and negative results of the tests in detecting active myocarditis for all the types of DMCAA were 77.4, 47.1, 72.7, and 53.3%, respectively; those for types 3-5 of DMCAA were 77.4, 52.9, 75.0, and 56.3%; those in detecting all the morphological types of myocarditis were 68.3, 28.6, 84.8, and 13.3%, and those for types 3-5 were 65.9, 28.6, 84.4, and 12.5%, respectively. Comparison of the data of MSCT and those of comprehensive examination in all the patients with DCM, the diagnostic significance in detecting myocarditis for all the types of DMCAA was 70.6, 67.9, 88.9 and 38.8%, respectively; that for DMCAA types 3-5 was 60.8, 67.9, 87.3, and 32.3%. In the study group, MSCT also identified the non-compacted myocardium (n = 31 (23.8%)), coronary atherosclerosis (n = 31 (23%)), which is confirmed by CG findings in 15 patients. The patients with DMCAA significantly more frequently showed a relationship with previous infection, acute onset, significantly higher NYHA FCs, end-diastolic and end-systolic LV volumes, and insignificantly lower LV EF. During a mean follow-up periods of 12 (6; 37.25) months, the overall mortality rate was 17.7% (23 deaths); the death + transplantation index was 20% (n = 26). All the types of DMCAA were found to be significantly related to prognosis: in the DMCAA group, the mortality rate was 21.5% versus 7.8% in the non-DMCAA group (odds ratio 3.22; 95% confidence interval, 1.02 to 10.21; p < 0.05). Conclusion. MSCT with the assessment of delayed contrast enhancement (and simultaneous CT coronary angiography) can be used for the non-invasive diagnosis of myocarditis in patients with DCM, including that in the presence of contraindications to MRI. DMCAA correlates with the presence of myocarditis, its activity, the degree of functional disorders, and prognosis.