In the interests of practical healthcare, routine classifications should be modified as rarely as possible. At the same time changes should be discarded only on sufficient grounds, for example, when there are no obvious advantages of a new classification over the existing ones or they can no longer be modified by introducing fundamental changes and amendments. In this regard, the evolution of approaches to the classification of chronic heart failure (CHF) is prominent. It becomes particularly relevant due to the fact that currently experts of the Russian Society of Cardiology (RSC) are actively discussing a new draft classification of CHF. The authors of the lecture gave a brief historical insight and reviewed the main classifications of CHF used in North America, Europe, and Russia. The new classification of CHF proposed by RSC experts, which is actually a modified classification of North American colleagues, does not have obvious advantages over the currently used CHF classification in Russia (since 2002). The latter is based on the classification by Vasilenko – Strazhesko which is familiar to domestic internists, since it has become an indispensable part of their clinical practice and has stood the test of time. In addition, its underlying principles provide the potential for its flexible modification.

Aim: to develop a graphic risk meter scale concerning major adverse cardiovascular events (MCVEs) during the 5-year post-infarction period, taking into account patients’ compliance to the treatment.Patients and Methods: the analyze was conducted on the data from a prospective five-year follow-up of patients (n=115) who experienced a myocardial infarction (MI) and were registered in the database of the Registry of Acute Myocardial Infarction (Tomsk). The following endpoints were analyzed: repeated MI, hospitalization for exacerbation of coronary heart disease, advanced chronic heart failure (CHF), and cardiac arrhythmias.Results: the study identified a set of factors that had a significant impact on the clinical course of the post-infarction period. CHF (diagnosed before the development of index MI) increased the chances of adverse course of post-infarction period in 9.5 times. The lack of achievement of systolic blood pressure target values increased the risk of cardiovascular complications in 5 times. The patients’ age of 75 years and older increased the possibility of an adverse postinfarction period course in 8.5 times. The predictor that favorably affected the post-infarction period course was an integral indicator equal to the product of the specific weight of vital drugs (in the general structure of prescriptions) and the treatment compliance degree. This indicator reduced the risk of MCVEs by 61% for each unit value, i.e. with the highest possible compliance to therapy that meets the recommendations; an adverse course risk of the post-infarction period decreased by 2.5 times.Conclusion: the results emphasize the importance of compliance with medical recommendations by patients who have experienced MI. The proposed graphic risk meter scale can be used to predict the development of adverse MCVEs during the 5-year post-infarction period. KEYWORDS: coronary heart disease, myocardial infarction, cardiovascular risk, treatment compliance, Morisky-Green test, disease prognosis.FOR CITATION: Kuzheleva E.A., Fedyunina V.A., Alexandrenko V.A. et al. Prediction of adverse cardiovascular events in the post-infarction period, taking into account treatment compliance. Russian Medical Inquiry. 2020;4(7):431–436. DOI: 10.32364/2587-6821-2020-4-7-431-436.

The purpose:to follow-up the pathological changes in the cardiac muscle using contrast-enhanced MRI (in comparison with endomyocardial biopsy), in patients with chronic heart failure due to dilated cardiomyopathy.Materials and methods.This study comprised 29 pa tients (as 51.1 ± 11.03 years old). Everybody underwent cardiac contrast- enhanced MRI, at admission and in 6 month, the endomyocardial biopsy was carried out in 19 patients.Results.Myocarditis with different degrees of activity was revealed in 14 patients, from the results of a histological examination of the cardiac muscle. The patients were assembled to two groups, depending on the severity of the inflammatory changes; the data were compared with the results of the endomyocardial biopsy. In the group of patients with a moderate degree of activity of the inflammatory process, myocardial fibrosis prevailed, in the group of patients with pronounced activity it was oedema, with a relatively smaller volume of myocardial fibrosis. In six months of monitoring, the number of pathologically altered segments of the myocardium increased (from 2.7 ± 1.7 to 3.05 ± 1.7) and the thickness of the paramagnetic contrast uptake to the cardiac muscle also increased (from 4.4 ± 1.4 to 4.8 ± 1.9 mm), despite the specific therapy kept carried out this time. Conclusion.The development of dilated cardiomyopathy and chronic heart failure, in a significant number of cases causes of inflammatory changes in the myocardium, followed by manifestation of dilated cardiomyopathy, and the progression of fibrotic changes in the myocardium was observed even after elimination of the causative agent.

The aim of the study was to evaluate the capabilities of contrast-enhanced magnetic resonance imaging (MRI) with the use of open MRI scanners for detection of atherosclerotic plaques in patients with extensive atherosclerosis and myocardial infarction which occurred two to six months prior the examination. Twenty four patients with angiologically verified coronary atherosclerosis comprised the patient’s group including 11 patients with predominant involvement of right coronary artery (RCA) and 13 patients with predominant atherosclerosis of left circumflex coronary artery. All patients received contrast-enhanced MRI study of the heart by using T1-weighted spin-echo with end-diastolic ECG gating (MRI scanners AZ-360 with 0.38T field and Magnetom Open with 0.22T) Thin 7-8-mm axial slices of the whole heart were obtained in four-chamber position in all patients; short axis slices were obtained in 16 out of 24 patients. Acquisition parameters were as follows: repetition time (TR) of 450-890 ms; echo time (ET) of 15-25 ms; 256х256 matrix; slice thickness of 7-8 mm; cross-dimension field of view of 25х25 cm; and voxel size of 0.1 to 0.12 mm. Paramagnetic (Optimark, Mallinckrodt Inc.) was injected as 2 mL of 0.5-M solution per 10 kg of body weight. For the atherosclerotic plaque itself and arterial wall beyond the plaque, the index of image enhancement (IE) was calculated as follows: IE = intensity of T1 w SE scan with paramagnetic / Intensity of T1 w sE scan initial. When analyzed visually, the T1-weighted contrast-enhanced MRI images in patients with coronary atherosclerosis provided clear delineation of coronary artery stenosis due to the significant uptake of paramagnetic by the plaque itself. In patients from the control group free of atherosclerosis, the RCA IE and LCA IE were 1.08+0.06 and 1.09±0.07, respectively. The atherosclerotic plaque in infarction-related LCA demonstrated IE as high as 1.52+0.23, whereas the plaque in infarction-related RCA was enhanced with IE=1.43±0.17. Also, the plaque-free areas of infarction-related arteries demonstrated mild but elevated enhancement with IE=1.18+0.10. In this small group, no significant correlations were revealed between IE and degree of stenosis or LV contractility indices. The authors conclude that contrast-enhanced MRI of coronary atherosclerotic plaques is recommended as an addition to inversion recovery protocol that provides effective imaging of paramagnetic uptake by damaged myocardium.

Follow-up (10 years) results of 72 CAD patients (mean age 54,8±5,9) after coronary bypass grafting are given in the article. We assessed influence of arterial hypertension, smoking, overweight and dyslipidaemia on mortality and development rate of unfavourable cardiovascular events. The most unfavourable influence on the prognosis of CAD patients after coronary bypass grafting exerted smoking which increased mortality cases by 6 times and high level of high density cholesterol (g3.5 mmol/l).

It was assessed the influence of aterogenic dislipoproteinemia on recurrent angina pectoris after stricture formation of coronary arteries (CA) in patients with IHD at prolonged (14 months) therapy witsymvastatin and without it. After stricture formation of CA in 14 months 60 patients with IHD have been examined. In 1st group 29 patients were treated with symvastanin in a dose of 20 mg per a day after stricture formation of CA, in 2nd group (the controls) 31 patients haven't been given statins. Dynamics of lipid spectrum, frequency of recurrent angina pectoris, restenosis and AIM, confirmed angyographically were assessed. In 14 months of stricture formation of CA in 1st group there wasn't recurrent angina pectoris in 69% of patients at the background of decreased aterogenic lipid spectrum, in 2nd group this index composed 49%. As it was revealed statins gave higanti-ishemic efficacy in the most patients, decreasinrecurrent angina pectoris in three times and TFN by 69,6%. In 1st group there were no deaths, one patient (3,5%) had AIM. In 2nd group after some period two patients (6,5%) had AIM, one patient had died. Frequency of restenosis composed 12 and 41%, correspondingly, need in repeated revascularization was in 2,7 times lower in patients, treated with statins.

Efficacy of balloon angioplasty, coronary bypass surgery and conservative therapy in postmyocardial infarction patients with single coronary artery disease was assessed in 3 year prospective study. Positive clinical effect persisted after coronary artery bypass grafting (CABG) in 78 and 73% of patients and after balloon angioplasty in 60 and 40% of patients in 1 and 3 years, respectively. Significant decreases of number of anginal attacks (by 94.1 and 74.1%, respectively), nitroglycerin consumption (by 93.6 and 74.8%, respectively) and dimensions of ischemic perfusion defects (by 68.8 and 33.7%, respectively) were observed 1 year after both CABG and angioplasty. Lowering of exercise tolerance (by 11.1%), increase of nitroglycerin consumption (by 15.8%) and worsening of myocardial perfusion (by 9%) were observed after 3 years in conservatively treated patients.

Post-myocardial infarction patients with multivessel coronary artery stenoses were prospectively followed-up for 5 years after coronary artery bypass grafting (CABG). Characteristics of the state of coronary vascular bed, of microcirculation in the ischemic myocardium, and of central hemodynamics were correlated with peculiarities of angina development, dynamics of cardiac pump function and exercise tolerance. Myocardial perfusion scintigraphy with thallium-199 showed that transient perfusion defects increased during follow up from 4,5+/-11,0 to 10,8+/-1,6% (p<0,01). Patients with exercise tolerance less than 50 W after CABG significantly more often (p<0,01) had low (<1,0 mmol/l) high density lipoprotein cholesterol.

AIM:The study of efficacy of rehabilitation and clinical-instrumental characteristics of coronary failure in patients with ischemic heart disease (IHD) of high functional classes and moderate dyslipoproteinemia early (1.6 months) and late (1 and 3 years) after coronary by-pass operation.MATERIALS AND METHODS:The examination covered 119 males with IHD (mean age 51.8 +/- 6.9 years) 1.6 months and 3 years after coronary by-pass operation. Lipid spectrum of blood plasma, frequency of anginal attacks, 24-h nitroglycerin requirement, results of bicycle exercise and loading myocardial scintigraphy were assessed. The patients were divided into two groups. In 82 patients of group 1 total cholesterol ranged within 3 years after the surgery from 5.2 to 6.5 mmol/l, 37 patients of group 2 had no lipid disorders.RESULTS:Within 12 months after direct myocardial revascularization, the groups had similar clinical-instrumental characteristics. 3 years after the operation, patients of group 1 exhibited a rise in anginal attacks frequency, nitroglycerin requirement, size of unstable perfusion defects by 84.6, 88.8 and 26.4%, respectively. Exercise tolerance diminished by 18.7%.CONCLUSION:Moderate defects in lipid metabolism influence progression of coronary failure. This becomes especially pronounced within 3 years after coronary by-pass operation.

184 ischemic heart disease (IHD) patients, all males, were investigated before, one month and one year after coronary artery bypass grafting. Significant changes in central hemodynamics and in exercise tolerance were noted in the course of rehabililation. These were more significant in patients with multiple atherosclerosis lesions of the coronary bed whereas clinical effect was more favourable in patients with favourable course of IHD. The above trends in hemodynamics, exercise tolerance and clinical symptoms following surgical revascularization were observed during the first 6 months.

184 ischemic heart disease (IHD) patients, all males, were investigated before, one month and one year after coronary artery bypass grafting. Significant changes in central hemodynamics and in exercise tolerance were noted in the course of rehabilitation. These were more significant in patients with multiple atherosclerosis lesions of the coronary bed whereas clinical effect was more favourable in patients with favourable course of IHD. The above trends in hemodynamics, exercise tolerance and clinical symptoms following surgical revascularization were observed during the first 6 months.