Aim. To evaluate the information value of a complex of clinical and biochemical parameters of myocardial damage in predicting the development of transmural myocardial damage according to magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).Material and methods. The study included patients admitted to the emergency cardiology department with acute coronary syndrome. All patients underwent invasive coronary angiography, laboratory tests, and dynamic determination of cardiac biomarkers. In the interval of 6,1±4 days from admission to the hospital, patients underwent contrast-enhanced cardiac MRI. According to the pattern of delayed contrast enhancement, patients were divided into two groups: with a transmural and subendocardial pattern.Results. The mean age of patients was 62,5±10,5 years, while 27 (71,1%) had ST-segment elevation AMI. Among the risk factors for coronary artery disease, dyslipidemia (89,5%), hypertension (68,4%), and smoking (57,9%) were the most common. Creatine phosphokinase-MB (CPK-MB), serum high-sensitivity cardiac troponin I (cTnI) and C-reactive protein (CRP) values after 24 h were significantly higher in patients with transmural hyperenhancement. Moderate positive relationship was found between the global size of left ventricular (LV) damage according to MRI data and the levels of CPK-MB after 24 h and 4 days, as well as with CRP after 24 h, 4 and 7 days, and cTnI level after 24 h and 4 days. In the group of patients with transmural pattern, the global size of LV damage was significantly higher. Patients of this group were characterized by higher prevalence of microvascular obstruction. In a univariate regression analysis, there were following significant predictors of transmural myocardial damage: CPK-MB after 4 days (p=0,023) and ST segment elevation (p=0,029). Multivariate regression analysis showed that the only independent predictor of transmural myocardial damage was an increase in CPKMB after 4 days (p=0,023).Conclusion. An independent predictor of LV transmural damage in AMI was an elevated level of CPK-MB after 4 days. However, this laboratory marker had unsatisfactory information completeness and predictive quality. In this regard, cardiac MRI in patients with AMI, compared with the standard clinical assessment, can be considered preferable for assessing the depth of myocardial damage, risk stratification, and prognosis.

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Objective:The purpose of this single-centre, prospective, comparative study was to evaluate the pattern and severity of the brain structural changes in patients with resistant hypertension (RH) based on MRI assessments and their changes one year after renal denervation (RDN).Design and method:The study comprised 58 patients with RH, aged 52.1 ± 9.1 years, who underwent RDN. Patients underwent office blood pressure measurements, 24-hour blood pressure monitoring, and brain MRI scanning. Using brain MRI, the cerebrospinal fluid (CSF) system measurements, the presence of periventricular leukoaraiosis and focal changes in the brain white matter were evaluated.Results:Initially, patients with RH had a high incidence of the structural brain alterations: 75% with fine focal brain lesions, 75% with impaired CSF dynamics, 23% with sulcal widening, and 90% with periventricular oedema. After RDN, a significant hypotensive effect was noted. According to brain MRI, the number of patients without impaired CSF dynamics did not change significantly: 25% initially, and 20% a year later (χ2 = 0.63 p = 0.43, and χ2 = 0.72 p = 0.40). The number of patients with grade I impaired CSF dynamics after 6 months significantly increased after 12 months from 50% to 64% (χ2 = 4.00, p = 0.046) due to lowering the number of patients without impaired CSF dynamics and patients with grade II impaired CSF dynamics (χ2 = 1.56, p = 0.21). The number of patients with sulcal widening significantly decreased: from 23% to 8% one year following RDN (χ2 = 40.21 p = 0.000). The incidence of periventricular cerebral oedema did not significantly change one year after the procedure; however, the incidence of fine focal brain lesions significantly decreased (from 75 to 60%, p = 0.02).Conclusions:Thus, it has been revealed that patients with RH are characterised by a high incidence of structural brain alterations based on MRI assessments. A year after bilateral renal denervation, there are significant improvement in intracranial hypertension signs and decrease in the incidence of fine focal brain lesions, without a significant change in the CSF dynamics parameters (Table 1). Figure 1 shows a clinical example of a decrease in the number of fine focal brain lesions after the intervention.

Objective: Patients with resistant hypertension and type 2 diabetes mellitus (DM) accelerate the subclinical brain damage and the age-related brain atrophy, which leads to a more rapid decrease in cognitive functions. Brain MRI can detect expansion of liquor spaces and white matter lesions (PWMLs), which are patterns of brain atrophy. Renal denervation (RDN) is an effective treatment for resistant hypertension (RHTN), but the key question is whether RDN can slow the progression of brain damage. The aim of this study was to evaluate the effect of renal denervation on the MRI- sing of brain damage in patients with RHTN with type 2 DM over a 3-year follow-up. Design and method: The study included 17 diabetic patients with RHTN (mean age 61,3 ± 6.2 years; 9 males, mean 24 hour (systolic/diastolic) blood pressure (BP) 161.3 ± 19.4/82.2 ± 13.5 mmHg, HbA1c 7 ± 1,2%) from single-arm prospective interventional study (NCT02667912 on ClinicalTrial.gov) in whom 1.5T magnetic resonance imaging (MRI) of the brain and 24-hour BP monitoring were performed at baseline and an annually for 3 years follow up. We measured linear dimensions of liquor spaces (subarachnoidal spaces (SAS), lateral ventricles (LV), both III and IV ventricles) and calculated the number of focal white matter lesions. Periventricular white matter lesions (PWMLs) were evaluated semi-quantitatively on a scale of 0 to 4. On average, patients were taking 4.3 ± 1.0 antihypertensive drugs and were instructed not to change their medication regimen for the duration on the study. The mean number of ablations was 13 ± 1.8 (10–16). Results: Three years after RDN, there was a significant decrease in the average 24-hour systolic/diastolic BP by 14.1/8.6 mm Hg (p = 0.03/0.04). The linear dimensions of liquor spaces (SAS, LV, both III and IV ventricles), number of focal white matter lesions, as well as the mean PWMLs score did not change (p > 0.05). Conclusions: This is the first study to demonstrate that RDN can prevent progression of brain damage in diabetic patients with RHTN during 3 years follow-up and therefore has a potentially beneficial effect on the brain.