Comparative analysis of parametric images in patients with dilated cardiomyopathy and coronary heart disease by radionuclide ventriculography

After equiponderant radionuclide ventriculography the parametric images (phasic and amplitude) of heart function were estimated in 20 patients with dilated cardiomyopathy and in 17 patients with coronary heart disease associated with cardiomegaly. The patients with dilated cardiomyopathy and those with coronary heart disease showed principal differences in local disturbances of the amplitude of movements of left ventricle myocardium walls. While assessing synchronism of myocardial contraction in the patients with dilated cardiomyopathy the presence of the zones of myocardial asynchronism appeared to be a suggestive sign. At the same time the phenomena of asynchronism were not directly connected with impairment of heart conduction and became aggravated as dilatation of the left ventricle progressed, being often coupled with the ECG signs of cicatrical alterations in the myocardium, which came on the phasic images in the form of dyssynergia areas.     

Ig apheresis for the treatment of severe DCM patients

BackgroundAutoantibodies against β1-adrenoreceptor (AR) are considered by many authors to be the most significant in autoimmune process during DCM. Immunoadsorption (IA) of immunoglobulins (Ig apheresis) is a logic approach to remove autoantibodies against β1-AR and other antibodies. The effect of Ig apheresis and the role of anti-β1-AR in DCM are still an issue for discussion.MethodsWe have performed a prospective case–control study in 16 patients with DCM, NYHA Class II–IV congestive heart failure, positive and negative for anti-β1-AR.ResultsWe observed a clinically significant mean change of exercise tolerance compared with controls (6 MWT distance increased from 420 ± 130 m to 550 ± 150 m, p < 0.05). Systolic function improved rapidly by increase in LVEF from 28.6 ± 5.2% to 33.0 ± 10.3%, LV end-systolic and end-diastolic volumes decreased from 166 ± 58 mL to 148 ± 50 mL and from 235 ± 73 mL to 220 ± 73 mL, respectively, whereas in the control group there was no significant change in clinical variables. The improved quality of life and cardiac function in apheresis group as well as negative changes in control group didn't correlate with the presence of anti-β1-AR.ConclusionsIg apheresis for the treatment of DCM patients is associated with the improvement of quality of life and cardiac function regardless of the presence of anti-β1-AR. We suggest that IgG apheresis is a safe and effective method for DCM patients.     

Non-compact left ventricular myocardium: current state of the problem

Non-compaction of the left ventricle or spongy myocardium is a rare congenital cardiomyopathy which is characterized by impaired endomyocardial morphogenesis, hypertrophy of left ventricular myocardium with prominent trabeculation, and deep inter-trabecular recesses. According to WHO classification (1995) this disease belongs to unclassified cardiomyopathies. Main clinical signs of ventricular non-compaction are heart failure, ventricular arrhythmias, systemic and pulmonary embolism. Echocardiography which is a basic method of diagnosis can reveal double layer structure of thickened left ventricular wall and multiple prominent trabeculation with wide inter-trabecular spaces. Predominant localizations of pathological process are region of cardiac apex, inferior and lateral left ventricular walls. Treatment of patients with ventricular non-compaction concentrates on elimination of its main clinical symptoms.     

Current methods of detection of "viable" myocardium

Assessment of viable dis-synergic myocardium has an important prognostic value. There exists a number of methods of investigation allowing to detect hibernating myocardium and thus to predict improvement of regional and global contractile function of the left ventricle after its revascularization. The review presents comparative characteristics of contemporary methods of detection of viable myocardium as well as algorithm of clinical examination of patients with left ventricular dysfunction.     

Postoperative thyroidal insufficiency in patients with polynodous euthyroid goiter

Results of surgical treatment of 150 patients with polinodous euthyroid goiter were studied up. The influence of various factors on course of hypothyrosis in postoperative period was shown.