AIM:Development of a "Risk Score Scale" (RSS) to assess the risk of Major Adverse Cardiovascular Events (MACE) based on computed tomographic angiography (CTА) of the coronary arteries in patients with acute coronary syndrome. MATERIALS AND METHODS:The study included 249 pаtients with acute coronary syndrome (77.5% of men, age 58.2±10.7 years). Myocardial infarction occurred in 73.5% of patients, unstable angina - in 26.5%. After percutaneous coronary intervention CTA was performed by 320 - row CT scanner. 30 CTА characteristics were determined. RESULTS:During 39.1 [18.0; 57.4] months of follow-up, 28.5% patients had combined primary endpoint events (PEE) including nonfatal myocardial infarction, unstable angina, cardiac death, unplanned percutaneous coronary intervention, ischemic stroke. RSS was developed by ROC analysis of the significant CT predictors of PEE, which were determined using a univariate Cox model. The uncensored period was 305 days - 26 PEE. Using the Yuden method, cut-off values, AUC values, and other indicators were calculated for predictors. RSS included the following 8 most optimal predictors with their cut-off values and score values: "number of coronary arteries with plaques" >1.5 - 1.0 point; "maximum plaque length" >14.5 mm - 1.16 points; "total length of plaques" >22.5 mm - 1.17; "maximal coronary stenosis" >77.5% - 1.23; "number of plaques with ≥50% stenosis" >3,5 - 1.1; "minimum plaque density" <29.1 HU - 1.33; "number of plaques with spotty calcifications" >1.5 - 1.23; "number of low attenuation plaque <30 HU" >0.5 - 1.00. For the resulting RSS calculated threshold value was 3 points. A score of >3 points indicates a high risk of MACE: odds ratio 7.2, 95% CI 2.6-19.7 (p<0.0001). CONCLUSION:The use of RSS is a new and practically significant technique that makes it possible to improve the risk stratification of adverse outcomes.

Objective. To compare characteristics of myocardial electrical dyssynchrony in patients with long-term right ventricular pacing and iatrogenic left bundle branch block (LBBB) following transcatheter aortic valve implantation (TAVI) using non-invasive activation cardiac mapping (NIAM); to evaluate the effect of pacing electrode location on cardiac activation maps. Material and methods. The study included 50 patients. The main group consisted of 30 patients with implanted pacemakers and right ventricular pacing (RVCP) rate of 100%. The control group consisted of 20 patients with LBBB after TAVI (TAVI-LBBB group). All patients underwent NIAM to construct isochronous maps. We assessed ventricular endo- and epicardium activation time (AT), activation time difference (ATD), localization of late activation points (LAPs), and conduction block lines (CBLs). In the RVCP group, additional analysis of activation map formation was performed with different stimulating electrode positions (apical, middle third of interventricular septum, basal). Results. The RVCP group was characterized by more severe electrical dyssynchrony: QRS duration 157 versus 140 ms (p=0.001), interventricular activation delay on the epicardium 17.8 versus 12 ms (p<0.001). Ventricular myocardial activation maps in the RVCP group were highly variable. LAP zone typical for LBBB was detected in only 30% of patients (versus 90% in the TAVI-LBBB group), and conduction block line was absent in 20% of cases. Full compliance with LBBB criteria according to NIAM data was found in only 10% of patients with RVCP. Within the RVCP group, electrode position did not affect topography of LAP and CBL. However, apical pacing resulted in the shortest endocardial interventricular activation delay (18 ms) compared to basal and mid-positions (41 ms and 50 ms; p=0.035, respectively). Conclusion. Ventricular electrical activation during cardiac pacing is not equivalent to that in LBBB after TAVI. These processes are characterized by more severe electrical dyssynchrony and variability of activation maps. Apical electrode position, despite small endocardial conduction delay, creates effect of “pseudosynchrony of onset” followed by significant slowing of impulse propagation across the epicardium. These differences indicate that ventricular pacing forms independent pathophysiological model of ventricular myocardial electrical dyssynchrony distinct from that in proximal LBBB after TAVI.

Aim. To study the potential of assessing left ventricular (LV) myocardial perfusion using volumetric computed tomography (VCT) with adenosine triphosphate (ATP) test in patients with non-obstructive coronary artery disease (NOCAD) during combined therapy. Material and methods. Cardiac VCT with ATP test, combined with computed coronary angiography, was performed in 46 patients with an established diagnosis of NOCAD. At the time of enrollment, all patients were recommended lipid-lowering therapy to achieve target lipid profile parameters, antianginal and antithrombotic therapy. Results. Changes of LV myocardial perfusion parameters depending on achievement of target low-density lipoprotein cholesterol (LDL-C) demonstrates reliable decrease in the number of LV myocardial segments with perfusion defects (2 [0; 3] vs 6 [3; 8], p<0,001) and increase in transmural perfusion coefficient (TPC) in the stress phase (1,14±0,12 vs 1,02±0,07, p=0,004). Moderate negative correlation was revealed in patients with NOCAD between the mean TPC value in the stress phase and LDL-C level (n=45, rho=-0,56; p=0,001). Significant improvement of LV myocardial perfusion was demonstrated among patients receiving combination therapy. Conclusion. Combination therapy is significantly associated with improved LV myocardial perfusion parameters. When the target LDL-C level is reached, it is accompanied by a significant TPC increase and a decrease in the number of segments with perfusion defects in patients with NOCAD according to VCT with an ATP test.

Aortic coarctation is a form of generalized arteriopathy and is not limited to narrowing of the aorta. It can develop as a local stenosis, or as an extended one, in the form of hypoplasia of the aortic segment [1].The symptoms and signs depend on the severity of the aortic coarctation. Patients with aortic coarctation who have reached adolescence live to an older age. In the second half of their life, they may develop complications associated with long-term hypertension [2].Often, the identification of this rare adult malformation is associated with certain difficulties or is an accidental finding in a patient with arterial hypertension. According to modern clinical recommendations [1, 2, 4], the methods of diagnosis of aortic coarctation are physical examination (in particular, determination of the gradient of blood pressure on the arms and legs [5]), ECHO-KG, CT and MRI.CT and MRI are methods of clarifying diagnostics that allow to verify the defect and determine its morphological features. However, classical radiography in older patients with isolated aortic coarctation in the vast majority of cases has such characteristic signs that it allows you to suspect a defect from an overview image in a direct projection.The purpose of this report is to draw attention to the possibilities of classical X–ray examination in detecting aortic coarctation in adults. Classical X-ray examination is still the leader in the structure of radiation studies in the Russian Federation, it is performed frequently, therefore, knowledge of the X-ray semiotics of this rare congenital defect will contribute to its earlier detection.

Aim: to evaluate the parameters of left ventricle (LV) myocardial perfusion using volumetric computed tomography (VCT) of the heart with an adenosine triphosphate (ATP) test in patients with coronary artery disease with non-obstructive lesions of the coronary arteries (INOCA) over time against the background of optimal drug therapy (ODT). Material and methods. The study of VCT of the heart with ATP, combined with CT-CAG, was carried out at 2 points in 46 patients with an established diagnosis of INOCA. The study protocol included myocardial perfusion at rest and against the background of a pharmacological load of ATP at the rate of 160 mcg/kg/min with an infusion duration of 3-5 minutes. Results. There was no significant difference in the median number of LV myocardial segments with perfusion defects (DP) assessed over time (4.5 [3;7] vs 4[3;8], p=0.751). However, in patients adherent to therapy, compared with patients who did not comply with the ODT regimen, there was a statistically significant difference in the change in the number of segments with DP over time (−1 vs +2 segments, p=0.020). In dynamics, the global coefficient of transmural perfusion (TPR) did not increase statistically significantly: at rest – mean difference 0,00 [95%CI −0,02; 0,01], p=0.7, with stress – mean difference 0.01 [95%CI 0,00; 0.02], p=0.2. At the same time, it is noteworthy that patients with worsening TPR were less adherent to the prescribed ODT. Against the background of ODT, there was a significant positive dynamics in improving the quality of life according to the average value of all scales of the questionnaire (69±17 vs 75±14, p=0,006). MACE during long-term follow-up occurred in 2 %. Conclusion. In patients with INOCA, against the background of ODT, positive dynamics are observed in the form of improved parameters of LV myocardial perfusion, according to cardiac VCT with ATP, and improved quality of life over time.

Objective. To determine the characteristics of atherosclerotic plaques (ASP) remaining after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), significantly associated with cardiovascular events (CVE), according to computed tomography angiography (CTA). Material and methods. CTA was performed in 249 patients with ACS on days 3-7 of the disease (in 41 patients, on a CT tomograph with 64 rows of detectors, in the rest, with 320). CTA analysis of all patients was performed on the Vitrea workstation. Patients with at least one non-calcified atherosclerotic plaque were included. Results. During 39.1 [18.0; 57.4] months of follow-up (from 7 days to 128 months), 71 of 249 (28.5%) patients with ACS achieved the primary endpoint (PEP), which included: non-fatal myocardial infarction, unstable angina, death from cardiac causes, PCI, ischemic stroke. According to univariate Cox analysis, out of 30 CTA characteristics of atherosclerotic plaques, 14 turned out to be significant predictors of achieving PCT: the number of involved arteries (OR=1.314, CI: 1.06-1.628, p=0.013, C=0.59); the total length of atherosclerotic plaques (OR=1.013, CI: 1.005-1.022, p=0.002, C=0.62); the number of atherosclerotic plaques with obstructive stenosis (OR=1.286, CI: 1.095-1.509, p=0.002, C=0.61); minimum density (OR=0.968, CI: 0.949-0.987, p=0.001, C=0.64); minimum density <30 HU (OR=2.695, CI: 1.495-4.869, p=0.0009, C=0.62); the number of atherosclerotic plaques with a minimum density <30 HU (OR=1.391, CI: 1.186-1.633, p=0.00005, C=0.64); the number of atherosclerotic plaques with a minimum density <= 46 HU (OR=1.211, CI: 1.043-1.407, p=0.012, C=0.58); the presence of a low-density area <30 HU (OR=2.387, CI: 1.389-4.101, p=0.001, C=0.57); the number of atherosclerotic plaques with a low-density area <30 HU (OR=1.912, CI: 1.317-2.775, p=0.001, C=0.57); the number of atherosclerotic plaques with punctate calcifications (OR=1.384, CI: 1.134-1.688, p=0.001, C=0.59); maximum length (OR=1.014, CI: 1.001-1.028, p=0.041, C=0.61); maximum stenosis (OR=1.018, CI: 1.002-1.033, p=0.025, C=0.61); the presence of a low-density area <= 46 HU (OR=2.049, CI: 1.24-3.386, p=0.005, C=0.57); the number of atherosclerotic plaques with a low-density area <= 46 HU (OR=1.643, CI: 1.191-2.265, p=0.002, C=0.58). [OR - odds ratio = Hazard Ratio; CI - 95% confidence interval. C - Harrell's C-statistic]. According to the multivariate analysis, the first 10 of the listed CTA characteristics retained their prognostic significance, and the predictive significance appeared in the "total burden of atherosclerotic plaques" - the conditional characteristic we first proposed, which is the sum of the areas (burden) of all plaques detected in a patient during CTA. Conclusion: 14 CTA characteristics of ASP in patients with ACS are significant predictors of future CVD, 11 are independent of known risk factors.

Objective. Assessment of renal artery stenosis significance in patients with resistant arterial hypertension using non-invasive diagnostic methods and to compare them with the results of selective angiography and methods of physiological assessment of renal artery stenoses. Materials and methods. Prospectively, 156 patients with drug-resistant arterial hypertension and signs of renal artery stenosis detected by doppler ultrasonography of renal arteries were included in the study. Subsequently, 25 patients were excluded from the study due to multiple variant renal blood supply and bilateral renal artery stenosis. The remaining patients (n=131) underwent selective angiography of renal arteries, and 66 of them additionally underwent CTA of renal arteries with intravenous contrast. If the artery narrowing was 90% or more (n=27) in diameter, the stenosis was considered hemodynamically significant and further stenting of the affected artery was performed, and in case of 60-90% stenosis (n=52) additional assessment of functional significance of the stenosis was performed by measuring translesional pressure gradient, fractional blood flow reserve, instantaneous blood flow reserve (iFR) and Pd/ Pa ratio. Results. Among all patients (n=131), in whom the doppler ultrasonography of renal arteries showed signs of unilateral renal artery stenosis, after angiography combined with additional methods of functional significance assessment, hemodynamically significant renal artery stenosis was confirmed in 41% of cases (n=54). Thus, the sensitivity of doppler ultrasonography of renal arteries in detection of hemodynamically significant stenoses was 74%, prognostic value of positive 78% and negative result 64% (p<0,001). According to CTA (n=66) renal artery stenosis was confirmed in 56 patients. The results of CTA of renal arteries in 88% of cases coincided with the results of selective angiography, and using additional functional methods hemodynamically significant stenosis was confirmed in 32 (48%) patients. The sensitivity of CTA in detection of hemodynamically significant stenoses of renal arteries was 69%, specificity 91%, prognostic value of positive and negative results was 91 and 68% respectively. According to selective angiography, out of 131 patients, 24 patients had no renal artery stenosis, 28 patients had stenosis <60%, 27 patients had renal artery stenosis >90% and 52 patients had stenosis 60-90%. Patients with stenosis <60% were not considered candidates for renal artery stenting.

Aim. To assess the relationship between left ventricular (LV) myocardial perfusion parameters according to adenosine triphosphate (ATP) stress computed tomography myocardial perfusion (CTP) with clinical parameters in patients with non-obstructive coronary artery disease (CAD).Material and methods. ATP CTP was performed in 74 patients with documented non-obstructive CAD. Myocardial perfusion was assessed using qualitative and semiquantitative methods. The volume of myocardial ischemia was assessed depending on the number of segments with perfusion defects. The study protocol included assessment of LV myocardial perfusion at rest and in stress with ATP administration at a constant rate of 0,16 mg/kg/min, for a total duration of 4-5 min. All patients underwent the following examinations: electrocardiography, Holter monitoring, echocardiography, blood tests. The results of myocardial perfusion were compared with age, sex, atherosclerosis risk factors, angina clinical picture, and the results of additional examination methods.Results. Transient LV myocardial perfusion defects were visualized in 100% of patients during ATP CTP with subendocardial location of varying severity. The transmural perfusion coefficient (TPС) was significantly reduced globally and segmentally in the stress phase in all patients (p<0,0001). ST segment depression according to Holter monitoring was associated with a greater LV ischemia volume. When dividing patients into 3 groups depending on the number of affected segments, no significant differences were found according to the intergroup analysis between the LV myocardial ischemia volume and the average values of atherosclerosis risk factors.Conclusion. LV myocardial perfusion defects were detected in 74 patients with an established non-obstructive CAD. No significant differences were found between the LV myocardial ischemia volume and the main risk factors for atherosclerosis, but there was an association between ST segment depression and LV myocardial ischemia volume, a significant decrease in global and segmental TPC with ATP stress test.

Aim To evaluate characteristics of atherosclerotic plaques (ASP) remaining after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) by coronary computed tomography angiography (CCTA). Material and methods Among 249 patients (193 men) with ACS aged 58 +/- 10 years, 183 (73.5 %) had myocardial infarction, 66 (26.5 %) had unstable angina. CCTA was performed after PCI at 3-7 days after the onset of ACS according to the standard protocol: in 41 patients, on a 64-slice tomograph (Aquilion 64, Toshiba, Japan) and in 208 patients, on a 640-slice tomograph with 320 rows of detectors (Aquilion ONE Vision Edition, Toshiba, Japan). CCTA of all patients was performed on a Vitrea workstation. Patients with at least one non-calcified ASP were included. Results Among all ASPs, non-calcified ASPs predominated, 609 of 785 (77.6 %), including 400 soft and 209 combined ones. Signs of obstruction (stenosis >= 50 %) were noted in 72.2 % of non-calcified ASPs. ASPs were characterized by a pronounced burden, 69 [61.4; 74.2] %, and a low minimum density, 31 [23; 37] HU, which was consistent with mature plaques with a lipid core. Various signs of ASP instability were observed in 6-35.3 % of cases. There were 2 [2;3] (1 to 6) affected coronary arteries (CAs) and 3 [2;4] (1 to 7) ASPs, including calcified ones, per patient. 77.7 % of ASPs were located in the CA proximal and middle segments. Obstructive stenosis was detected in 92 % of patients. The number of ASPs with obstructive stenosis ranged from 0 to 7 per patient, with a median of 2 [1;3]. In 44 % of patients, stenosis was 70 % or more. The maximum burden of non-calcified ASPs was high, 74.3 +/- 12.1 %; their maximum and total length were 13.8 +/- 10.4 mm and 26.5 +/- 19.7 mm, respectively; and the ASP minimum density was low, 25 [17;32] HU. ASPs with a low-density area of <= 46 HU and <= 30 HU were detected in 24.9 % and 14.8 % ofpatients, respectively. Other CCTA signs of instability were quite common: punctate calcifications in 52.2 % of patients, coronary positive remodeling in 37 %, the presence of << ring-like enhancement >> in 16.1 %, an uneven plaque contour in 26.7 %, and at least one sign of ASP instability in 73 % of patients. Conclusion After PCI, patients with ACS still have rather many ASPs, including those with CCTA signs of instability, with stenosis >50 %; more than a third of the plaques had stenosis >70 %; the plaques were extended and localized mainly in the proximal and middle sections of the main CAs.

Objective. Assessment of renal artery stenosis significance in patients with resistant arterial hypertension using non-invasive diagnostic methods and to compare them with the results of selective angiography and methods of physiological assessment of renal artery stenoses.Materials and methods. Prospectively, 156 patients with drug-resistant arterial hypertension and signs of renal artery stenosis detected by doppler ultrasonography of renal arteries were included in the study. Subsequently, 25 patients were excluded from the study due to multiple variant renal blood supply and bilateral renal artery stenosis. The remaining patients (n=131) underwent selective angiography of renal arteries, and 66 of them additionally underwent CTA of renal arteries with intravenous contrast. If the artery narrowing was 90% or more (n=27) in diameter, the stenosis was considered hemodynamically significant and further stenting of the affected artery was performed, and in case of 60-90% stenosis (n=52) additional assessment of functional significance of the stenosis was performed by measuring translesional pressure gradient, fractional blood flow reserve, instantaneous blood flow reserve (iFR) and Pd/ Pa ratio. Results. Among all patients (n=131), in whom the doppler ultrasonography of renal arteries showed signs of unilateral renal artery stenosis, after angiography combined with additional methods of functional significance assessment, hemodynamically significant renal artery stenosis was confirmed in 41% of cases (n=54). Thus, the sensitivity of doppler ultrasonography of renal arteries in detection of hemodynamically significant stenoses was 74%, prognostic value of positive 78% and negative result 64% (p<0,001). According to CTA (n=66) renal artery stenosis was confirmed in 56 patients. The results of CTA of renal arteries in 88% of cases coincided with the results of selective angiography, and using additional functional methods hemodynamically significant stenosis was confirmed in 32 (48%) patients. The sensitivity of CTA in detection of hemodynamically significant stenoses of renal arteries was 69%, specificity 91%, prognostic value of positive and negative results was 91 and 68% respectively. According to selective angiography, out of 131 patients, 24 patients had no renal artery stenosis, 28 patients had stenosis <60%, 27 patients had renal artery stenosis >90% and 52 patients had stenosis 60-90%. Patients with stenosis <60% were not considered candidates for renal artery stenting.

Caseous calcification of the mitral annulus (CCMA) is a rare form of degenerative lesion of the mitral valve fibrous ring. It’s a biochemical transformation of calcification area accompanied with formation of masses of a curdled consistency (caseosis). It is usually located in the area of the posterior mitral valve. In most cases, it is asymptomatic or minimally symptomatic, and is an incidental finding during imaging studies. The causes and pathogenesis of CCMA are unknown, however, there is a connection with disorders of calcium and phosphorus metabolism and there is no connection with an valve infection. There is no specific treatment. In cases where CCMA leads to significant disturbances of cardiac hemodynamics and/or there is a high probability of ebolism, it needs to be treated surgically.Differential diagnosis is carried out with other cardiac mass.

Aim. To develop diagnostic criteria for proximal left bundle branch block (LBBB) based on non-invasive methods and to determine the significance of these criteria in predicting the effect of cardiac resynchronization therapy (CRT).Material and methods. To develop criteria, 58 patients (21 men, mean age, 76,1±7,1 years) with LBBB occurred immediately after transcatheter aortic valve implantation (TAVI) were included. To assess the significance of the developed criteria, the second group included 22 patients (11 men, mean age, 57,9±9,3 years) with dilated cardiomyopathy (DCM), who had indications for CRT. The effectiveness of CRT was assessed by echocardiography 6 months after implantation. All patients in the DCM group and 15 patients in the TAVI group underwent superficial epiand endocardial non-invasive mapping using Amycard 01C EP Lab (EP Solutions SA, Switzerland). Patients in the DCM group underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) before device implantation.Results. The criteria for proximal LBBB included 3 electrocardiographic features: QRS complex >130 ms in women and 140 ms in men, QSor rS-configuration in V1 lead, notch in two or more lateral leads (I, avL, V5, V6), and 2 mapping criteria: characteristic location of block line and delayed activation point. In the DCM group, the criteria were positive in 13 of 22 patients (59%). The developed criteria for proximal LBBB showed a relatively strong, significant relationship with the positive effect of CRT (сhi-square test =5,46, p=0,02, Cramer test =0,5, odds ratio (OR)=15,0, 95% confidence interval (CI), 1,32-169,9, p=0,002). An additional analysis showed that both the criteria for proximal block and CRT effect are associated with myocardial fibrosis according to MRI. In particular, intramural stria-shaped contrast accumulation in the interventricular septum leads to a change in characteristic of proximal block mapping phenomena — displacement of delayed activation point (chi-square test =13,9, p<0,001, Cramer test =0,79) and displacement or absence of conduction block lines (chi-square test =6,92, p=0,009, Cramer test =0,56) and prevents the CRT effect (OR =8,67, 95% CI, 1,05-71,57 p=0,03).Conclusion. Proximal LBBB is only one of the factors determining the effectiveness of CRT. Proximal LBBB may mask significant myocardial structural changes that prevent the CRT success.

A case of a patient with myocardial perfusion improvement according to volume computed tomography (VCT) of the heart with triphosadenine infusion against the background of optimal therapy, including nicorandil for 3,5 years, is presented. In a patient with an established diagnosis of non-obstructive coronary artery disease (CAD) in 2019, stress-induced myocardial ischemia of left ventricular (LV) septal and lateral area was detected. Repeated investigation 3,5 years later against the background of optimal therapy showed an ischemia decrease in the form of the disappearance of previously detected defects in the basal segments of the anteriorlateral and inferior-lateral walls and the middle segments of the anterior-septal and inferior-lateral walls of the LV.

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge.Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI "National Medical Research Center of Cardiology" of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale.Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8 +/- 12.5, median 57 years [49.0; 64.0]; men, 55.4%) agreed come for an outpatient visit and to participate in the "COVID-19-follow-up" program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%; 10/17) had CVDrelated hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) - coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance.Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

ХАРАКТЕРИСТИКА ПОРАЖЕНИЯ КОРОНАРНЫХ АРТЕРИЙ ПО ДАННЫМ ОБЪЕМНОЙ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ У ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМКолесникова О

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge.Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI “National Medical Research Center of Cardiology” of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale. Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8±12.5, median 57 years [49.0; 64.0]; men, 55.4%) agreed come for an outpatient visit and to participate in the “COVID-19-follow-up” program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%; 10/17) had CVD-related hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) – coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance.Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients.

Purpose. Assessment the state of the lungs using CT in the dynamic follow-up of patients who have suffered from viral COVID-19 pneumonia in the delayed period after 6-10 months, and to identify the relationship of residual lung changes with the clinical condition and results of external respiratory function (ERF). Materials and methods. We examined 78 patients who had suffered from bilateral polysegmental viral COVID-19 pneumonia in April-May 2020, using multi-spiral computed tomography (CT) of the lungs. All patients had a medical history, performed CT scans of the lungs in the acute and delayed (6-10 months after hospitalization) phases, and a study of FVD in the delayed phase. The analysis of a series of tomograms of the lungs in dynamics was carried out. We developed an severity score of the lung condition (LungSS), expressed in the total score, which was calculated based on the score of typical patterns characteristic of viral Covid19-pneumonia, as well as residual changes and areas of fibrosis. LungSS was calculated for each patient in the acute and delayed follow-up periods. Results. The present study shows the dynamics of lung changes in the delayed period 6-10 months after the viral Covid19-pneumonia. Residual lung changes were detected in 66 people (84,6%). Of these, 35,9% of patients have areas of fibrosis, but most of the residual changes are linear and small-nodular seals (76,9%). The frequency of detection of residual reticular changes and consolidation was low (15,3%, 1,3%, respectively). Attention is drawn to the relatively frequent detection of areas of "Ground-glass opacity "(10,8%). In patients with severe and critical course of viral Covid19-pneumonia (CT3 and CT4), LungSS in the delayed follow-up period did not significantly differ from that in patients with mild and moderate course (CT1 and CT2) of the disease (4,5 [0,22], 2,5 [0,16], accordingly, p=0,61). There was no significant correlation between the detected residual lung changes in the delayed period and ERF. Conclusion. In a significant part of patients (84,6%) who have suffered from COVID19 viral pneumonia, residual changes in the lung parenchyma persist, mainly in the form of linear seals and to a lesser extent fibrosis. These changes did not have a reliable relationship with the results of the FVD. LungSS proposed in this study reflects the dynamic picture of lung changes in the acute and delayed period, and can be a good indicator for monitoring patients who have suffered from COVID-19 viral pneumonia.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить динамику атеросклеротических бляшек (АСБ) в коронарных артериях у больных с острым коронарным синдромом (ОКС), используя метод компьютерной томографической ангиографии (КТА). МАТЕРИАЛ И МЕТОДЫ В исследование включено 40 пациентов с ОКС (средний возраст — 61,9±11 лет) после проведения чрескожного коронарного вмешательства (ЧКВ) по поводу симптом-связанного поражения (ССП). Всем больным выполнена КТА коронарных артерий (КА) на томографе с 320-рядным детектором, первичная — через 3—6 сут от начала заболевания, повторная — через 17±6,2 мес. Определяли степень стеноза, структуру, а также известные КТ-признаки нестабильности АСБ: кольцевидное усиление, положительное ремоделирование, включения микрокальцинатов, неровность контура. РЕЗУЛЬТАТЫ Выявлено 68 (66,7%) мягких и 34 (33,3%) комбинированных АСБ. Тип бляшек в большинстве случаев не подвергался изменениям, лишь 4 (3,9%) бляшки превратились из мягких в комбинированные. К концу наблюдения увеличились следующие параметры: степень стеноза на уровне АСБ с 58,3±16,3 до 60,4±16,1% (p=0,049), бремя бляшки с 74,2±11,1 до 75,9 ±11,2%, (p=0,043), протяженность с 10,0 [7,2; 14,0] мм на 0,25 [0,00; 1,00] мм (p=0,008). Значения средней и минимальной рентгеновской плотности бляшек, индекса ремоделирования КА по исходным данным составили 64,0 [56,0; 71,0] HU, 30,0 [21,5; 38,5] HU и 1,3 [1,2; 1,49]. Статистически значимые изменения этих показателей не выявлены. Наиболее тесная корреляция наблюдалась между динамикой бремени АСБ и степени стеноза (rho=0,611, p<0,001), средней и минимальной плотностью бляшки (rho=0,8, p<0,001). Исходная частота выявления различных КТ-признаков нестабильности в симптом-несвязанных бляшках составила 17—45%. В дальнейшем появление или исчезновение хотя бы одного из них отмечено в 24 (24,2%) бляшках. Продемонстрирована взаимосвязь между появлением показателей положительного ремоделирования и кольцевидного усиления (U=0,236, p<0,001), а также между исчезновением показателей неровности контура и положительного ремоделирования (U=0,102, p=0,008). ВЫВОДЫ За период наблюдения показано среднегрупповое (относительно совокупности атеросклеротических бляшек) статистически значимое увеличение степени стенозирования коронарных артерий на уровне бляшки, бремени, протяженности атеросклеротических бляшек. При остром коронарном синдроме после чрескожного коронарного вмешательства по поводу симптом-связанного поражения различные компьютерно-томографические признаки нестабильности атеросклеротических бляшек определяются довольно часто — в 17—45%. В дальнейшем появление или исчезновение хотя бы одного признака нестабильности отмечается в 24,2% случаев. Выявленные статистически значимые взаимосвязи между появлением или исчезновением пар признаков нестабильности отражают процессы «дестабилизации» и «стабилизации» структуры атеросклеротических бляшек. Полученные нами результаты подтвердили возможности метода компьютерной томографической ангиографии коронарных артерий в оценке структурных характеристик и признаков нестабильности атеросклеротических бляшек, оставшихся после чрескожного коронарного вмешательства по поводу симптом-связанного поражения, и их динамики.