Aim. To evaluate the efficacy and safety of posterior wall isolation using the cryoballoon ablation in patients with persistent and long-standing persistent forms of atrial fibrillation in comparison with pulmonary vein antrum cryoballoon isolation.

Methods. One hundred seventeen (n=117) patients with persistent (n=73) and long-standing persistent (n=44) atrial fibrillation, median left ventricular ejection fraction was 58,0% [54,0; 60,0]. The median size of the left atrial was 4,2 cm [4,00; 4,60]. A comparative analysis of the results of cryoballoon isolation supplemented with isolation of the posterior wall of the left atrium – group A (61 patients) and classic cryoballoon pulmonary vein antrum cryoballoon isolation – group B (56 patients) was performed.

Results. In one-year follow-up the efficacy of cryoballoon isolation supplemented with isolation of the posterior wall of the left atrium was significantly higher – 73,8% (n=45) than in cryoballoon pulmonary vein isolation – 67,9% (n=38) (p=0,030). There were no statistically significant differences in complication rates between the groups. No life-threatening complications were recorded during this study.

Conclusion. Both methods showed comparable safe results. Isolation of the posterior wall using cryoballoon in addition to pulmonary vein isolation is a more effective method of catheter treatment of persistent and long-persistent forms of atrial fibrillation in comparison with classic cryoballoon isolation of the atrial fibrillation.

Aim. To study the characteristics of cardiopulmonary reserve in patients with chronic thromboembolic pulmonary hypertension (CTEPH) with concomitant atrial fibrillation (AF) and to evaluate the relationship between the level of peak oxygen consumption (V´О₂ peak) and the course of the hospital period after pulmonary endarterectomy

Material and methods. A total of 124 male patients with CTEPH aged 52.8 (43.2–64.1) years were examined. 1st group (29 people) included patients with concomitant AF, and 2nd group (95 people) included patients without AF. Before surgery, patients underwent a cardiopulmonary exercise test (CPET).

Results. According to the CPET data, in the 1st group the values of V´О₂ peak, V´О₂ peak at the anaerobic threshold, V´О₂/HR peak, threshold power and duration of physical activity (PA) were lower in comparison with the 2nd (p<0.05). The ventilatory equivalent for carbon dioxide (V´E/V´CО₂ peak) in the 1st group was higher than in the 2nd (p<0.05). Tolerance to PA in the 1st group was also lower in comparison with the 2nd group due to the lower threshold power and shorter duration of the load (p<0.05). V´О₂ peak values are inversely associated with the development of heart failure (OR 0.56 (0.36-0.82; p=0.002)), prolonged mechanical ventilation (OR 0.43 (0.34-0.71; p=0.001)) and hospital mortality in the early postoperative period (OR 0.82 (0.75-0.94; p=0.03)).

Conclusion. Patients with CTEPH with concomitant AF are characterized by lower reserves of the respiratory and cardiovascular systems compared to patients without AF due to lower values of V´О₂ peak, V´О₂ peak at the anaerobic threshold, V´О₂/HR peak and a higher value of V´E/V´CО₂ peak. The comorbid group is characterized by lower tolerance to PA in comparison with the group without AF. V´О₂ peak values are inversely related to the development of heart failure, prolonged mechanical ventilation and hospital mortality in the early postoperative period.

Goal. To conduct a comparative assessment of renal function, risk factors and the incidence of contrast-induced nephropathy (CIN) in patients with MINOCA and MICAD, including taking into account the value of the left ventricular global function index (LVGFI).

Material and methods. The study involved 170 patients diagnosed with myocardial infarction. The diagnosis was established in accordance with the Fourth Universal Definition. According to the results of coronary angiography (CAG), patients were divided into 2 groups: 1 – myocardial infarction without coronary artery obstruction (MINOCA), n=73,2 – myocardial infarction with coronary artery obstruction (MICAD), n=97, who, according to indications, underwent stenting of the infarct-associated coronary artery. According to the magnitude of the LVGFI, patients are divided into 2 subgroups: 1 – low LVGFI (<31,2%), 2 – normal LVGFI (>31,2%). The glomerular filtration rate (GFR) was estimated according to the formula CKD – Epi 2011 at admission, 24 hours and 48 hours after the procedure. The CIN criterion is an increase in serum creatinine levels by 26,5 mmol/l or more within 48 hours after administration of an X-ray contrast agent (RVC).

Results. In patients with MICAD, the risk of AKI CIN is the same. Patients with MICAD required a higher amount of PCI (89.8 ml, p<0.001). The estimated risk of CIN, taking into account the amount of RCF used, is higher in patients with low LVGFI in the MICAD group (6.5 points versus 4 points, p=0.028). Patients with MINOCA with LVGFI >31.2% required a larger volume of PCI (200 ml and 199 ml in patients with LVGFI <31.2%, p=0.041). Patients with CIN in the MINOCA group tended to have higher creatinine (110 and 92 mmol/L, p=0.08). No differences in the main risk factors were found in patients with MICAD who had and had not had acute kidney injury due to contrast-induced nephropathy.

Conclusion. The risk and prevalence of AKI are the same in patients with MINOKA and MICAD. Patients with MICAD needed more RCB. Depending on the LVGFI value, renal function, the occurrence of risk factors for acute kidney injury, and the prevalence of CIN OP did not differ. Patients with MINOCA with CIN had higher pre-procedure creatinine levels.

For a long time, the only method of revascularization in patients with chronic thromboembolic pulmonary hypertension (CTEPH) was pulmonary thromboendarterectomy from the branches of pulmonary artery. Transluminal balloon pulmonary angioplasty (BPA), as an alternative treatment option for inoperable and residual CTEPH, appeared recently, but has already firmly taken its place in the treatment algorithm of CTEPH, and has significantly improved the prognosis in such patients. Active use of BPA in everyday practice served as the reason for the creation of this consensus in order to summarize and systematize modern data on patient selection, technique and goals of endovascular treatment, prevention and treatment of complications. The document additionally covers the issues of visualization of the pulmonary arteries, complex variants of damage and describes an algorithm for the prevention and treatment of pulmonary injury after BPA. The recommendations provided in the consensus are based on the results of national and foreign studies, the experience of experts and are intended for specialists who are part of a multidisciplinary team for the management of patients with CTEPH (cardiologists, endovascular and cardiovascular surgeons), as well as pulmonologists, radiation diagnosticians and physicians.

Among the most dangerous causes of mortality worldwide, coronary artery disease (CAD) remains the leading cause. Despite the fact that atherosclerosis of the coronary arteries is the main cause of the development of coronary artery disease, clinicians are increasingly identifying myocardial ischemia without coronary obstruction. Myocardial ischemia with non-obstructive coronary arteries (INOCA) is characterized by clinical signs of myocardial infarction (MI) with evidence of coronary artery stenosis on angiography of less than 50%. In recent years, significant advances have been made in understanding the pathophysiological changes that underlie this condition, but the predictors of development of this condition remain unclear. And a diagnosis of INOCA remains a difficult task for the clinician to this day. Determining the mechanism of INOCA and excluding other possible causes of elevated cardiac troponin is important for the development of secondary prevention measures aimed at improving the prognosis of patients after acute myocardial infarction (AMI). A history of disease and use of invasive and noninvasive imaging should lead to the identification of possible vasospastic or microvascular causes of INOCA and their differentiation from myocardial injury caused by other diseases. Compared with patients with AMI due to obstructive coronary artery disease (CAD), patients with INOCA are more often women and tend to have fewer traditional cardiovascular disease (CVD) risk factors.

The aim of this article was to review the literature and evaluate the clinical features, ethiology, diagnosis, treatment, and prognosis of INOCA. This review summarizes the current knowledge of INOCA in the areas of epidemiology, pathophysiology and treatment, with an emphasis on modern diagnostic tools for this disease.

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.