Цель исследования – поиск ранних ультразвуковых маркеров острого повреждения почек (ОПП) и изучение их взаимосвязи с данными эхокардиографии у пациентов в раннем послеоперационном периоде после аортокоронарного шунтирования (АКШ). Материал и методы. Проанализированы результаты обследования 108 пациентов до и после АКШ: 14 (13%) – с ОПП и 94 (87%) – без осложнений. Всем пациентам проведены ультразвуковое исследование (УЗИ) почек с допплеровским картированием и эхокардиография до операции и на 1-е сутки послеоперационного периода. Результаты. Анализ показал значимое снижение скоростных параметров, а также повышение индекса резистентности (RI) и пульсационного индекса в группе больных с ОПП по сравнению с группой контроля (р < 0,001). В группе с ОПП (n =14) выявлена прямая корреляция между RI и уровнем креатинина (R = 0,830, р < 0,05). Определено пороговое значение RI для прогнозирования ОПП – 0,76 с чувствительностью 71% и специфичностью 96% (AUC = 0,930). При сравнительной оценке данных допплерографии почек и эхокардиографии в группе с ОПП выявлена обратная корреляция между RI и сердечным индексом (R = -0,874, р < 0,05). Заключение. Использование методов комплексного УЗИ почек и сердца позволяет выявлять ранние признаки ОПП и проводить динамический мониторинг состояния пациентов в раннем послеоперационном периоде после АКШ. HTML

Endovascular surgery for aortic valve defects has proven itself well in elderly patients with severe comorbidities competing with the underlying disease. However, the risk of dysfunction resulting from structural degeneration of bioprosthetic heart valve and prosthetic valve endocarditis remains high. Repeated surgeries are associated with complications, but open surgery is the only method of treatment in this group of patients. Objective : to describe a series of reinterventions for prosthetic valve dysfunction occurring after TAVI. Material and methods . From 2015 to 2022, at the Department of Emergency Surgery for Acquired Heart Diseases (Head, Professor R.M. Muratov), Bakulev Research Center for Cardiovascular Surgery, 6 reoperations were performed in patients who had previously undergone transcatheter aortic valve implantation (TAVI). The average age of patients at the time of TAVI and at the time of reoperation was 70.6 years (62–83) and 74.3 years (70–84), respectively. The EuroSCORE II predicted risk of mortality at the time of reintervention was 42.2% (21.7–87.6). The mean time to reoperation was 42 months. Indications for reoperation were early active prosthetic endocarditis (4 cases) and structural valve degeneration (2 cases). Results . At the hospital stage, 1 patient died of acute heart failure; the operation was performed for vital indications in conditions of extreme initial severity. In three patients, the early postoperative period was uneventful. One patient required intra-aortic balloon counterpulsation (IABP) due to heart failure, and 1 patient was implanted with permanent pacemaker. The average time of hospitalization was 14 days. Patients with active prosthetic endocarditis received a 6-week course of antibiotic therapy. The function of the implanted valves was satisfactory. Conclusions . Aortic valve replacement after previous TAVI is an emergency operation and represents the only way to treat valve dysfunction. Under active prosthetic endocarditis, timely surgery can save this patient cohort.

Purpose: To analyse the prognostic value of the initial volumetric PET biomarkers – the total metabolic tumor volume (MTV) and the total lesion glycolysis (TLG) – in classic Hodgkin's lymphoma (cHL) and determine their optimal threshold values for prognosis. Material and methods. This retrospective study included 62 cHL patients with different stages who underwent staging with 18 F-FGD PET/CT. The follow-up period was from 6 to 61 months after the baseline PET/CT, 41 patients remained in remission, 10 patients had refractory course, 11 relapsed. The examinations were processed with automatic (multi-foci segmentation – MFS) method to obtain MTV and TLG using two fixed absolute thresholds (SUV max ≥ 2.5 and SUV max ≥ 4.0) and one relative threshold (41% of SUVmax). Results. In subgroups with disease remission (n = 41) and refractory course or relapse (n = 21), statistically significant differences between MTV and TLG with the two thresholds were found – SUV max ≥ 2.5 and 41% of SUV max (p < 0.05). When using threshold of SUV max ≥ 4.0 statistically differences between the mean of MTV and TLG were no detected. Univariate analysis revealed correlation between progression-free survival and volumetric PET biomarkers (MTV and TLG) with three thresholds (SUV max ≥ 2.5, SUV max ≥ 4.0, and 41% of SUV max ). Conclusion. In cHL high values of initial volumetric PET biomarkers – MTV and TLG – calculated with three thresholds (SUV max ≥ 2.5, SUV max ≥ 4.0, and 41% of SUV max ) are associated with unfavourable prognosis – a high probability of refractory disease course or relapse. The optimal prognostic thresholds values of MTV and TLG in the analysed group were determined respectively: SUV max ≥ 2.5 – 204 cm 3 and 961, at 41% of SUVmax – 105 cm 3 and 620.

ОБЪМНЫЕ ПЭТ-БИОМАРКЕРЫ ПРИ ЛИМФОМЕ ХОДЖКИНА

ПРОГНОСТИЧЕСКОЕ ЗНАЧЕНИЕ ОБЩЕГО МЕТАБОЛИЧЕСКОГО ОБЪЕМА ОПУХОЛИ (MTV) И ОБЩЕГО УРОВНЯ ГЛИКОЛИЗА (TLG) ПРИ КЛАССИЧЕСКОЙ ЛИМФОМЕ ХОДЖКИНА С ИСПОЛЬЗОВАНИЕМ АВТОМАТИЧЕСКОГО МЕТОДА ВЫДЕЛЕНИЯ ПАТОЛОГИЧЕСКИХ ОЧАГОВМетелкина М.В. 1 , Мухортова О

HTML Асланиди И.П., Шурупова И.В., Мухортова О.В., Трифонова Т.А., Пурсанова Д.М., Шавман М.Г. Отдел ядерной диагностики Центра им. А.Н. Бакулева: современные достижения и взгляд в будущее. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2021; 22 (2): 162–70. DOI: 10.24022/1810-0694-2021-22-2-162-17

HTML Асланиди И.П., Пурсанова Д.М., Мухортова О.В., Шурупова И.В., Катунина Т.А., Екаева И.В. Интерпретация результатов позитронно-эмиссионной томографии, совмещенной с компьютерной томографией, с 18F-фтордезоксиглюкозой, в диагностике инфекции сосудистых протезов. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2021; 22 (1): 66–73. DOI: 10.24022/1810-0694-2021-22-1-66-73

ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнить эффективность блокировки физиологического накопления 18F-ФДГ при трех различных вариантах подготовки к ПЭТ/КТ. МАТЕРИАЛ И МЕТОДЫ В анализ включены результаты 200 ПЭТ/КТ, выполненных по поводу подозрения на инфекционные процессы в сердце и сосудах (ИПСС) (n=100) и онкологическим пациентам без ИПСС (n=100). Все пациенты с подозрением на ИПСС соблюдали строгую безуглеводную диету в течение 48 ч с периодом голодания >15 ч перед ПЭТ/КТ. В 20 случаях осуществлялось внутривенное введение низкомолекулярного гепарина (50 Ед/кг) за 15 мин до введения 18F-ФДГ. Подготовка пациентов контрольной группы была стандартной для онкологических больных — строгая безуглеводная диета в течение 12 ч с периодом голодания >6 ч. Проанализированы 3 группы пациентов: 1) с подозрением на ИПСС, прошедшие специальную подготовку без введения гепарина (n=80); 2) с подозрением на ИПСС, прошедшие специальную подготовку с введением гепарина (n=20); 3) онкологические пациенты с 6-часовым периодом голодания (n=100). РЕЗУЛЬТАТЫ Полной блокировки физиологического накопления 18F-ФДГ в миокарде удалось достичь у 90% (72/80), 75% (15/20) и 58% (58/100) больных в анализируемых группах соответственно. Интенсивное физиологическое накопление 18F-ФДГ в миокарде определялось только в группе без специальной подготовки (29% (29/100)), что препятствовало оценке интракардиальных зон интереса во всех случаях. ВЫВОД Интенсивное физиологическое накопление 18F-ФДГ в миокарде снижает точность результатов ПЭТ/КТ при подозрении на инфекционные процессы в сердце, поэтому специальная подготовка пациента к ПЭТ/КТ имеет ключевое значение. Разработанная подготовка, включающая строгую безуглеводную диету в течение 48 ч и период голодания >15 ч, позволила достичь полной блокировки физиологического накопления 18F-ФДГ в 90% случаев. Эффективность дополнительного использования гепарина перед введением 18F-ФДГ для блокировки физиологического накопления препарата в миокарде в анализируемой группе не подтвердилась.

Purpose. To investigate the semi-quantitative assessment of 18F-fluorodeoxyglucose PET/CT in patients with prosthetic valve infectious endocarditis (PV IE) and without it. Material and methods. The analysis included results of 18F-FDG PET/CT examinations performed in 50 patients with PV – with surgically confirmed IE (n=30) and with malignancies used as control group (n=20). PET/CT results were assessed visually and semiquantitatively with calculation of parameters of 18F-FDG uptake intensity in the PV area – SUVmax and SUVratio. SUVratio was calculated as SUVmax in the CIED to SUVmean in the reference zone – aortic blood pool and liver parenchyma. Results. Visual analysis of PET/CT results revealed abnormal 18Ffluorodeoxyglucose uptake in all patients with IE (n=30); in the control group the uptake was normal in all cases (n=20). In semiquantitative analysis all parameters in the PV zone, SUVmax and two types of SUVratios, were higher in patients with confirmed IE, compared to patients without it (p<0.001). ROC-curve analysis for thresholds of SUVmax and two types of SUVratios for the diagnosis of PV IE by PET/CT with optimal sensitivity and specificity was determined: SUVmax = 3.35 (86% and 90%, respectively), SUVratio using aorta = 1.95 (89% and 85%), SUVratio using liver = 1.45 (82% and 85%). Conclusion. According to the obtained data, both visual analysis and semiquantitative assessment of 18F-fluorodeoxyglucose PET/CT images showed a good diagnostic performance in the detection of PV IE. The optimal parameter for the diagnosis of IE PV is the SUVratio using aorta with threshold of 1.95 (AUC=0.961).

Aim. To analyze the factors affecting the accuracy of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) in case of suspected prosthetic valve endocarditis (PVE).Material and methods. The results of PET/CT performed in 66 patients after heart valve replacement were analyzed: 55 patients with suspected PVE (≥3 months after surgery) and 11 comparison groups without PVE (2 months after surgery). In the group with suspected PVE (n=55) at the time of the study, 27% (15/55) had a normal body temperature, 85% (47/55) — no leukocytosis. In 16% (9/55), the examination was performed from 3 to 6 months after surgery and in 67% (37/55) — against the background of long-term antibiotic therapy (ABT). The final diagnosis of PVE was made on the basis of clinical (including 6±3 followup), laboratory, instrumental, and intraoperative (n=40) data: confirmed — in 37 patients; ruled out — in 29 patients. In order to determine the influence of factors on obtaining false PET/CT results, the odds ratio was calculated.Results. In the group with suspected PVE (n=55), the PET/CT results made it possible to establish and rule out PVE in 92% (34/37) and 67% (12/18) of patients, respectively. In 16% (9/55) of patients, false positive (n=6) and false negative (n=3) results. Thus, the sensitivity, specificity and diagnostic accuracy of PET/CT in the diagnosis of PVE were 92%, 67% and 84%, respectively; positive and negative predictive values — 85% and 80%. The analysis of the odds ratio did not reveal the relationship of low inflammatory activity, the interval between surgery and PET/CT from 3 to 6 months, and long-term ABT before PET/CT with false PET/CT results (p>0,05). In the comparison group without PVE (n=11), 91% (10/11) received false positive PET/CT results, and one patient received a true negative result.Conclusion. The data obtained indicate the high informative value of PET/CT in the diagnosis of PVE. Interval >2 months between surgery and PET/CT significantly reduces the accuracy of PET/CT results. Other factors analyzed in the presented group did not affect the accuracy of PET/CT results.

OBJECTIVE:To investigate diagnostic role of 18F-fluorodeoxyglucose PET/CT in patients with suspected vascular graft (VG) infection.MATERIAL AND METHODS:A prospective analysis included data of 30 PET/CT examinations for suspected infection of aortic VG (n=27) and bypass grafts (n=3) after surgical treatment (median 48 months). In 77% (23/30) of cases, the diagnosis was initially «possible» (n=11) or «rejected» (n=12) in accordance with common diagnostic criteria. All PET/CT results were verified by clinical, laboratory and intraoperative («=20) data. VG infection was confirmed in 18 patients and ruled out in 12 cases.RESULTS:PET/CT confirmed VG infection in 94% (17/18) and excluded in 50% (6/12) of cases. False PET/CT results were obtained in 23% (7/30) cases: false positive in 6 cases and false negative in 1 case. Thus, sensitivity, specificity and diagnostic accuracy of PET/CT were 94%, 50% and 77%, respectively; positive and negative predictive value - 74% and 86%. PET/CT results allowed correct reclassifying 33% (10/30) of cases. VG infection was confirmed in 73% (8/11) of patients with initially «possible» diagnosis and excluded in 17% (2/12) of patients with initially «rejected» infection. Moreover, whole body PET/CT revealed unknown inflammation foci outside VG in 73% (22/30) of cases. These data were applied to correct treatment approach in 80% (24/30) of cases.CONCLUSION:Our results showed high efficacy of 18F-fluorodeoxyglucose PET/CT in the diagnosis of VG infection. Despite low specificity, this technique has high sensitivity and accuracy that allowed reclassifying 33% of cases.

Цель. Изучить диагностические возможности позитронно-эмиссионной томографии, совмещенной с компьютерной томографией (ПЭТ/КТ), с 18F-фтордезоксиглюкозой (18F-ФДГ) в оценке распространенности инфекционного процесса у больных с подозрением на инфекционный эндокардит протезированного клапана (ИЭ ПК).

ОСОБЕННОСТИ ВИЗУАЛЬНОЙ ОЦЕНКИ РЕЗУЛЬТАТОВ ПЭТ/КТ С 18F-ФТОРДЕЗОКСИГЛЮКОЗОЙ ПРИ ПОДОЗРЕНИИ НА ИНФЕКЦИОННЫЕ ПРОЦЕССЫ В СЕРДЦЕ И СОСУДАХАсланиди И