Aim To identify independent predictors for long-term serious adverse cardiovascular events following percutaneous coronary interventions (PCI) in patients with a combination of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) and to develop a prognostic mathematical model.Materials and methods Design: a prospective cohort study. The study included 254 patients with IHD associated with COPD after PCI (in 119 patients, PCI was performed for acute coronary syndrome and in 135 patients, PCI was elective). Follow-up duration was up to 36 months. Composite endpoint included cardiovascular death, myocardial infarction, stroke or repeated, unscheduled myocardial revascularization. Cox regression with stepwise inclusion of variables was used for identification of predictors for the composite endpoint.Results The following independent predictors of serious adverse cardiovascular events were identified: number of stenoses in major coronary artery branches, ankle-brachial index. glomerular filtration rate, age, distance in 6-min walk test, COPD phenotype with frequent exacerbations (FE), and functional residual capacity (FRC) of lungs. The mathematical model based on the Cox regression for prediction of serious adverse cardiovascular events had a 75% sensitivity and a 81% specificity.Conclusion Incidence of long-term serious adverse cardiovascular events in patients with a combination of IHD and COPD after PCI depends not only on traditional cardiovascular risk factors but also on characteristics of COPD itself, such as the FE phenotype and the FRC indicative of lung hyperinflation. The proposed mathematical model based on the Cox regression can be used for evaluating the odds for adverse cardiovascular events after PCI in patients with a combination of IHD and COPD.

Aim. To assess the influence of concomitant chronic obstructive pulmonary disease (COPD) on the frequency of repeat myocardial revascularization in patients with coronary artery disease (CAD) after percutaneous coronary interventions (PCI), as well as to determine independent predictors of repeat revascularization in patients with concominant COPD. Materials and methods. A prospective cohort study included 646 patients with CAD, of which 254 had concominant COPD. All patients underwent PCI (46.9% for acute coronary syndrome in the main group and 44.9% in the control group. Remaining interventions were elective). The frequency of repeat myocardial revascularization and the time till re-intervention was registered during the follow-up period up to 36 months. Results. COPD increases risk of repeat myocardial revascularization (hazard ratio - HR 1.46; 95% confidence interval - CI 1.03-2.06), repeat PCI (HR 1.62; 95% CI 1.03-2.32) and is accompanied by an earlier onset of re-intervention. An independent predictors of repeat myocardial revascularization in the Cox regression model are: glomerular filtration rate (p=0.001), ankle-brachial index (p=0.004), frequent exacerbations of COPD (p=0.028), total number of coronary artery stenosis (p=0.039) and blood concentration of C-reactive protein (p=0.066). Conclusions. COPD is a significant risk factor of re-intervention after PCI in patients with acute and chronic forms of CAD and leads to its earlier performing. The patients with frequent COPD exacerbations have the highest risk of repeat myocardial revascularization during follow-up.

Coronary artery (CA) anomalies are a group of congenital heart defects  with a diverse clinical performance, from lifelong asymptomatic to severe consequences such as sudden cardiac death. In some cases,  CA anomalies become  an incidental finding during echocardiography.  If there is a suspicion of CA anomaly, a radiographic investigation (computed tomography (CT) angiography or magnetic resonance imaging) should be performed to clarify the anatomy and indications for surgical correction.A case of diagnosing a tubular structure with hyperechoic  walls in mitral valve projection during echocardiography  is presented. The performed CT angiography confirmed the abnormal origin of circumflex artery from the right sinus of Valsalva with its retroaortic course. This echocardiographic  sign is described in the English-language literature as Retroaortic Anomalous Coronary sign (RAC-sign).

This document is a consensus document of Russian Specialists in Heart Failure, Russian Society of Cardiology, Russian Association of Specialists in Ultrasound Diagnostics in Medicine and Russian Society for the Prevention of Noncommunicable Diseases. In the document a definition of focus ultrasound is stated and discussed when it can be used in cardiology practice in Russian Federation.

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