|
authors:
|
Abstract: Introduction: the problem of the shortage of donor organs can be partially solved by expanding the donor selection criteria. The consequence of this is an increase in the risk of transmission of atherosclerotic lesions of the coronary arteries from the donor to the recipient. According to current publications, endovascular correction is the preferred treatment. Assessment of the hemodynamic significance of borderline stenosis of the coronary arteries in recipients, detected at the first coronary angiography in the early postoperative period, remains a topical issue. Case report: article presents case report of results of endovascular correction of donor-associated lesion of coronary arteries in recipient under control of iFr. Conclusion: due to the severity of patient's condition, the use of non-invasive methods for verifying myocardial ischemia is sharply limited, which determines the high importance of endovascular technologies for the physiological assessment of stenosis. References 1. Lee HY, Oh BH. Heart Transplantation in Asia. Circulation Journal. 2017; 81(5): 617-621. https://doi.org/10.1253/circj.CJ-17-0162 2. Yusen RD, Christie JD, Edwards LB, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report. Focus Theme: Age. J Heart Lung Transplant. 2013; 32(10): 965-978. 3. Sakhovsky SA, Izotov DA, Koloskova NN, et al. Angiograficheskaya otsenka ateroskleroticheskogo porazheniya koronarnikh arterii serdechnogo transplantata. Vestnik transplantologii i iskusstvennih organov. 2018; 20(4): 22-29 [In Russ]. https://doi.org/10.15825/1995-1191-2018-4-22-29 4. Chestukhin VV, Ostroumov EN, Tyunyaeva IYu, et al. Bolezn’ koronarnikh arterii peresazhennogo serdtsa. Vozmozhnosti diagnostiki i lecheniya. Ocherki klinicheskoi transplantologii pod redakciei Got’e SV. M. 2009; 88-93 [In Russ]. 5. Darenskii DI, Gramovich VV, Zharova EA, et al. Diagnosticheskaya tsennost izmereniya momental’nogo rezerva krovotoka po sravneniyu s neinvazivnimi metodami viyavleniya ishemii miokarda pri otsenke funktsionalnoi znachimosti pogranichnikh stenozov koronarnikh arterii. Terapevticheskii arkhiv. 2017; 4: 15-21 [In Russ]. 6. Gramovich VV, Zharova EA, Mitroshkin MG, et al. Opredelenie porogovikh znachenii momental’nogo rezerva krovotoka pri otsenke funktsionalnoi znachimosti stenozov koronarnish arterii pogranichnoi stepeni tyazhesti s ispolzovaniem neinvazivnikh metodov verifikatsii ishemii miokarda v kachestve standarta. Evraziiskii kardiologicheskii zhurnal. 2016; 4: 34-41 [In Russ]. 7. Tonino PAL, De Bruyne B, Pijls NHJ, et al. Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention. The New England Journal of Medicine. 2009; 360: 213-224. https://doi.org/10.1056/NEJMoa0807611 8. De Bruyne B, Pijls NH, Kalesan B, et al. FAME 2 Trial Investigators. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367(11): 991-1001. https://doi.org/10.1056/NEJMoa1205361 9. Xaplanteris P, Fournier S, Pijls NHJ, et al. Five-Year Outcomes with PCI Guided by Fractional Flow Reserve. The New England Journal of Medicine. 2018; 379: 250-259. https://doi.org/10.1056/NEJMoa1803538 10. Barbato E, Toth GG, Johnson NP, et al. Prospective natural history study of coronary atherosclerosis using fractional flow reserve. Journal of the American College of Cardiology. 2016; 68(21): 2247-2255. https://doi.org/10.1016/j.jacc.2016.08.055 11. G?tberg M, Christiansen EH, Gudmundsdottir IJ, et al. Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PC. The New England Journal of Medicine. 2017; 376: 1813-23. https://doi.org/10.1056/NEJMoa1616540 12. Andell P, Berntorp K, Christiansen EH, et al. Reclassification of Treatment Strategy With Instantaneous Wave-Free Ratio and В Fractional Flow Reserve: A Substudy From the iFR-SWEDEHEART Trial. JACC: Cardiovascular Interventions. 2018; 11(20): 2084-2094. https://doi.org/10.1016/j.jcin.2018.07.035 13. Davies JE, Sen S, Dehbi HM, et al. Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. The New England Journal of Medicine. 2017; 376: 1824-1834. https://doi.org/10.1056/NEJMoa1700445 14. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. ESC Scientific Document Group; 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2019; 40(2): 87-165.
Abstract: Purpose. Оf the study was to determine abilities of multislice spiral tomography (MSCT) in detection coronary artery disease (CAD) in patients with atypical angina.. Material and methods. Sixty patients (39 men) with atypical chest pain and suspected ischemic heart disease underwent complex diagnostic strategy. Value of MSCT in detection of significant (more than 50%) coronary artery stenoses was assessed by segmental analysis, vascular bed involvement, and patient analysis. Results. Significant CAD in 8% of patients with atypical angina was revealed. In 98,7% (58 of 60 cases) MSCT allowed to specify coronary anatomy. In 53 (88,3%) of patients no significant CAD was found, in 5 cases (8,3%) MSCT confirmed significant coronary artery stenoses. Sensitivity, specificity, positive and negative prognostic value of MSCT were correspondingly 100%, 99,3%, 71,4%, 100% in segmental analysis (n = 295). Vascular territory involvement analysis (n = 91) showed 100% sensitivity, 97,7% specificity, positive prognostic value 71,4% and negative prognostic value 100%. Conclusions. High prognostic value, as well as high sensitivity and specificity of MSCT allow us to include this method into the CAD diagnostic algorithm in patients with atypical chest pain. This method is highly reliable in eliminating of significant CAD and detecting coronary artery stenoses. References 1. Синицын В.Е., Устюжанин Д-В. КТ-ангио-графия коронарных артерий. Кардиология. 2006; 1: 20-25. 2. Терновой С.К., Синицын В.Е., Гагарина Н.В. Неинвазивная диагностика атеросклероза и кальциноза коронарных артерий.М.: Атмосфера. 2003; 144. 3. Hoffman M.H. et al. Noninvasive coronary angiography with multislice computed tomography. JAMA. 2005; 293: 2471-2478. 4. Leber A.W. et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography. A comparative study with quantitative coronary angiography and intravascular ultrasound. J. Am. Coll. Cardiol. 2005; 46: 147-154. 5. Leschka S. et al. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur. Heart. J. 2005; 26: 1482-1487. 6. Mollet N.R. et al. Highresolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation. 2005; 112: 2318 -2323. 7. Raff G.L. et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J. Am. Coll. Cardiol. 2005; 46: 552-557. 8. Kopp A.F. et al. Coronary arteries: retrospectively ECG-gated multi-detector row CT angiography with selective optimization of the image reconstruction window. Radiology. 2001; 221:683-688. 9. Austen W.G. et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad-Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery. Circulation. 1975; 51:5-40. 10. Patel M.R. et al. Low diagnostic yield of elective coronary angiography. N. Engl.J. Med. 2010; 362: 886-895. 11. Leber A.W. et al. Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur. Heart. J. 2007; 28: 2354-2360. 12. Hausleiter J. et al. Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease. Тhe Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial. Eur. Heart. J. 2007; 28: 3034-3041. 13. Goldstein J.A. et al. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J. Am. Coll. Cardiol. 2007; 49: 863-871. 14. Hoffmann U. et al. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease. Patient-versus segment-based analysis. Circulation. 2004; 110: 2638-2643.
