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Purpose.To determine the possibilities of coronary CT-angiography (CTA) in evaluation of qualitative and qualitative parameters of coronary plaques in comparison with intravascular ultrasound (IVUS).Matherials and methods.37 patients (29 men, 8 women) with symptoms of acute coronary syndrome (ACS) were included in the study. Unstable angina was detected in 24 patients, acute myocardial infarction (AMI) – in 13 patients. Averageage was 58 [44; 65] years. CTA had been performed as the first method of beam diagnostics in all cases if it was not necessary to use the emergency selective coronary angiography (CAG). IVUS was performed in one, two or three coronary arteries of every patient. Total, 60 coronary lesionsin 55 arteries were examined with IVUS. IVUS data was compared with CTA data.Results.Methods well correlated in detection of plaque burden (r = 0.823; p < 0.0001), plaque length (r = 0.932, p < 0.0001), remodeling index(RI) (r = 0.906; p < 0.0001). Sensitivity and specificity of CTA in detection of irregular contour was 96.1% and 88.9% (area under ROC-curve 0.925), positive remodeling – 100% and 97.4% (area under ROC-curve 0.974). CTA and IVUS in evaluation of spotty calcinates was not coincide in 9 plaques, sensitivity and specificity of CTA in detection of 71% and 100% (area under ROC-curve 0.855).Discussion.Comparison of CTA and IVUS was performed in evaluation of plaques features in patients with ACS. This analysis showed high comparability of methods for evaluation of coronary stenosis degree, RI, plaque burden, length and contour. Thus, the characteristics of plaques according to CTA data can be used to stratify the risk of development of ACS.Conclusion.CTA – fast non-invasive method of coronary plaques evaluation. CTA correlates well with IVUS.

Цель исследования. Сравнение особенностей строения атеросклеротических бляшек (АСБ) в коронарных артериях (КА) у больных с острым коронарным синдромом (ОКС) и стабильной стенокардией (СС). По данным компьютерной томографии (КТ). Материал и методы. Исследование выполнено у 125 больных: с ОКС (n = 94) и СС (n = 31). КТ КА с использованием томографа с 64 рядами де- текторов проводилась до стентирования КА. Определялись тип, протяженность, бремя АСБ, индекс ремоделирования (ИР), а также признаки нестабильности АСБ: наличие точечных кальцинатов, положительное ремоделирование артерии, неровность контура, наличие кольцевидного усиления плотности по периферии АСБ и участка низкой рентгеновской плотности <46 HU. Результаты. В группе больных с ОКС (n = 250 АСБ) по сравнению со СС (n = 81 АСБ) достоверно чаще определялись мягкие бляшки и до- стоверно реже — кальцинированные: n = 127 (50,8%) и n = 26 (32,1%), p = 0,0046; n = 24 (9,6%) и n = 25 (30,9%), p = 0,0011. При срав- нении совокупности мягких и комбинированных АСБ группы ОКС (n=226) и СС (n=56) в группе с ОКС значение ИР было значимо выше (1,20 [1,14; 1,32] и 1,13 [1,05; 1,25], p = 0,0008), а неровность контура определялась достоверно чаще (n = 170 (75%) и n = 30 (54%), p = 0,003). Наоборот, протяженность поражения была больше в группе больных с СС (18 [15; 21,7] мм и 13 [9; 20] мм, p < 0,0001). При ОКС симптом-связанные бляшки (ССБ, n = 87) отличались от симптом-несвязанных бляшек (СНБ, n = 139) более частым наличием неровности контура (n = 72, 83% и n = 97, 70%, p = 0,040), более высокими значениями бремени (90,0 [80,0; 99,0]% и 70,0 [60,0; 85,0]%, p = 0,0001) и протяженности (15 [10; 22] мм и 12 [8; 18] мм, p = 0,038). Достоверных различий остальных характеристик в сравниваемых подгруппах АСБ выявлено не было. Заключение. При ОКС достоверно чаще определялись мягкие АСБ, а при СС — кальцинированные, при этом в мягких и комбинированных коронарных АСБ в группе больных с ОКС отмечались достоверно более высокий индекс ремоделирования, меньшая протяженность и более частое выявление неровности контура. У пациентов с ОКС отсутствовали достоверные различия значений большинства КТ характеристик АСБ между ССБ и СНБ, что может быть следствием генерализации процесса дестабилизации бляшек в КА. Aim. To compare the structural features of coronary artery (CA) atherosclerotic plaques (ASP) in patients with stable angina pectoris (SAP) and acute coronary syndrome (ACS) by computed tomography (CT). Material and methods. The study consists of 125 patients: with ACS (n = 94) and SAP (n = 31). CT angiography (Multislice CT 64; 100-120 ml contrast agent) was performed before coronary angiography. We have estimated type, length, burden of ASP, remodeling index (IR), as well as signs of plaque’s vulnerability — the presence of spotty calcifications, positive remodeling of the artery, rough contour, «ring-like” enhancement and area of low X-ray density < 46 HU. Results. In the group of patients with ACS (n = 250 ASP) compared with SAP (n = 81 ASP) frequency of soft plaques was significantly higher and calcified plaques were significantlylower: n = 127 (50,8%) and n = 26 (32,1%), p = 0,0046; n = 24 (9,6%) and n = 25 (30,9%), p = 0,0011. Comparing only soft and combined ASP inthe ACS group (n = 226) and SAP (n =5 6), in the ACS group, the RI was significantly higher (1,20 [1,14; 1,32] and 1,13 [1,05; 1,25], p = 0,0008), and rough contour was determined significantly more often (n = 170 (75%) and n = 30 (54%), p = 0,003). The length of the lesion was greater in the group of patients with SAP (18 [15; 21,7] mm and 13 [9-20] mm, p < 0,0001). In ACS culprit lessions (n = 87) differed from non-culprit lessions (n = 139) in more frequent presence of rough contour (n = 72, 83%, and n = 97, 70%, p = 0,040), higher values of the burden (90,0 [80,0; 99,0]% and 70,0 [60,0; 85,0]%, p = 0,0001) and length (15 [10; 22] mm and 12 [8; 18] mm, p = 0,038). Conclusion. In ACS soft ASP were significantly more often determined, and in SAP – calcified ones. In ACS, compared with SAP, soft and combined coronary ASP had a significantly higher remodeling index, a shorter length and more frequent detection of contour irregularities. In patients with ACS, there were no significant differences in most of CT plaque’s characteristics between culprit and non-culprit lessions, which may be a consequence of the “generalization of the process plaque’s destabilizing”

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Aim. Aim of our study was the assessment of autonomic nervous system (ANS) modulation by assessment of heart rhythm variation (HRV) using Holter monitoring after single second generation cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (AF).Methods. Patients who underwent the CBA for paroxysmal AF were include in this study. At the baseline the Holter monitoring after withdrawal of antiarrhythmic therapy (AAT) with assessment of HRV: SDNN, RMSSD, ln LF, ln LH, LH/HF, mean, minimal and maximal beats per minute (BPM) was perform. Follow-up was based on outpatient clinic visits at 3, 6, and 12 months including Holter monitoring.Results. Among 80 patients underwent CBA, HRV was assessed in 55 patients (65.5% male, age median 61 years, 97.7% of pulmonary vein have been successful isolated). One year after CBA all HRV parameters and the mean, minimal and maximal BPM was significantly different from baseline parameters (p<0.05). In the AF recurrence group ln LF was lower at 3-, 6and 12-month visits (p<0.05) and minimal HR was higher at 3 months (median 58 vs 55.5, p=0.033). Multivariate analysis demonstrated that early recurrence of AF was independent predictor of AF recurrence after CBA (HR 7,44, 95% CI 2,19-25,25, р=0,001).Conclusion. Our study demonstrated that CBA leads to modulation of ANS which persists for at least 12 months. The early recurrence of AF was only predictor of AF recurrence after CBA.