АКТУАЛЬНЫЕ ВОПРОСЫ ДИАГНОСТИКИ ИБС В МАТЕРИАЛАХ РОССИЙСКОГО КОНГРЕССА КАРДИОЛОГОВ (Г. ЕКАТЕРИНБУРГ, 20-23 СЕНТЯБРЯ 2016)

Currently, one of the problems of diagnosis of CHD is a significant percentage of detection of non-obstructive lesions of coronary arteries (CA) for invasive coronary angiography (CAG). In register trials intact CA rate reaches 42%, in the analysis of our clinical data - 37.9%. In the materials of the past of the Russian Cardiology Congress, solutions to this problem were considered from different points of view, both by improving the diagnostic algorithms in primary care, and using high-tech methods of diagnosis. A number of breakout sessions was devoted to the modern possibilities and prospects of development of MSCT-angiography, stress echocardiography in the diagnosis of coronary atherosclerosis; clinical value assessment of left ventricular mechanics (LV) in CHD; modern trends radionuclide diagnosis of CHD; methods of contrast enhancement in radiation pathophysiological assessment of coronary atherosclerosis and myocardial viability; as well as the characteristics of non-invasive diagnosis of stable coronary artery disease in Russia. In addition, in one of the workshops reminded us that in the absence of stenosis of large CA do not forget about the possible presence of a particular form of ischemic heart disease - microvascular angina (MVA). The reports of the current understanding of the pathogenesis and diagnosis of MVA were recorded, especially pain and determination of nociceptive disorders in patients with MVA, new opportunities in drug therapy MVA. Participation in the Congress allowed us to compare our views on ways to reduce the frequency of intact CA detection with the position of the leading Russian experts. This review will help clinicians to better navigate the current state of the real problem.В настоящее время одной из проблем диагностики ИБС является существенный процент выявления необструктивных поражений коронарных артерий (КА) при инвазивной коронароангиографии (КАГ). В регистровых исследованиях частота интактных КА достигает 42%, в анализе данных нашей клиники – 37,9%. В материалах прошедшего Российского конгресса кардиологов пути решения этой проблемы рассматривались с разных точек зрения – как с помощью улучшения диагностических алгоритмов в первичном звене, так и с использованием высокотехнологических методов диагностики. Ряд секционных заседаний был посвящен современным возможностям и перспективам развития МСКТ-ангиографии, стресс-эхокардиографии в диагностике коронарного атеросклероза; клиническому значению оценки механики левого желудочка (ЛЖ) при ИБС; современным трендам радионуклидной диагностики ИБС; методам контрастного усиления в лучевой патофизиологической оценке коронарного атеросклероза и жизнеспособности миокарда; а также особенностям неинвазивной диагностики стабильной ИБС в России. Кроме того, на одном из симпозиумов нам напомнили, что при отсутствии стенозов крупных КА не стоит забывать о возможном наличии особой формы ИБС – микрососудистой стенокардии (МСС). В докладах были отражены современные представления о патогенезе и диагностике МСС, особенности болевого синдрома и определение ноцицептивных нарушений у больных с МСС, новые возможности в медикаментозной терапии МСС. Участие в конгрессе РКО позволило сопоставить наши взгляды на пути снижения частоты выявления интактных КА с позицией ведущих отечественных экспертов по данному вопросу. Представленный обзор поможет практическим врачам лучше ориентироваться в современном состоянии настоящей проблемы

СЛОЖНОСТИ В ДИАГНОСТИКЕ ОБСТРУКТИВНЫХ ПОРАЖЕНИЙ КОРОНАРНЫХ АРТЕРИЙ: РОЛЬ НЕИНВАЗИВНЫХ ТЕСТОВ

High mortality from cardiovascular diseases, especially coronary artery disease (CAD), represents a major economic burden on healthcare systems. The number of diagnostic coronary angiographies (CAG) is increasing in the Russian Federation. However, routine invasive CAG is not able to determine obstructive coronary artery disease in a considerable number of patients. The rate of intact coronary arteries reaches 42% in the major registries and accounts for 37.9% in our Research Institute. Despite all improvements in the diagnostic algorithms focused on suspected coronary artery disease, stated in the recent international and national guidelines, and the availability of advanced non-invasive diagnostic methods, they do not improve accurate CAG diagnosis of obstructive coronary artery disease. Moreover, the available guidelines contain many contradictions. Therefore, an optimal diagnostic algorithm of significant coronary artery lesions is a subject of discussion. The proposed review discusses all discrepancies concerning the assessment of the pretest probability as well as the proposed non-invasive testing. In addition, the preferred use of non-invasive tests with anatomical assessment (i.e. multispiral computed tomography coronary imaging) rather than functional tests with visualization is stated. This review ensures better understanding of diagnostic strategies for stable coronary artery disease used both in researches and in clinical practice.Высокая смертность от сердечно-сосудистых заболеваний и особенно от ишемической болезни сердца (ИБС) является одной из причин больших затрат системы здравоохранения. Тенденцией последних лет в России является увеличение числа диагностических коронароангиографий (КАГ). Однако в реальной клинической практике у значительного числа больных инвазивная КАГ не выявляет обструктивных поражений коронарных артерий (КА). В регистровых исследованиях частота интактных КА достигает 42%, в анализе данных нашей клиники – 37,9%. Возникает парадоксальная ситуация: несмотря на совершенствование диагностических алгоритмов обследования больных с подозрением на ИБС, отраженных в соответствующих международных и национальных рекомендациях, доступность современных неинвазивных методов диагностики, это никак не влияет на частоту выявления обструктивных поражений КА при КАГ. Оптимальный алгоритм выявления значимых поражений КА является предметом оживленных дискуссий, а имеющиеся рекомендации содержат много противоречий. В предлагаемом обзоре подробно рассматриваются разночтения, касающиеся не только оценки предтестовой вероятности, но и предлагаемых неинвазивных тестов. В том числе обсуждается приоритетное использование неинвазивных тестов с анатомической оценкой (то есть мультиспиральной компьютерной томографии коронарных артерий), а не функциональных тестов с визуализацией. Данный обзор будет способствовать лучшему пониманию диагностических стратегий при стабильной ИБС как в научных исследованиях, так и в клинической практике

Умеренная систолическая дисфункция правого желудочка у больных хроническим коронарным синдромом – что ее определяет?

Aim. To assess the incidence of moderate systolic dysfunction in patients with stable coronary artery disease and determine the factors associated with it.Methods. 200 patients with coronary artery disease admitted to the Cardiology Department of the Research Institute for coronary artery bypass grafting were included in the study. Patients were assigned to two groups depending on the presence or absence of right ventricular systolic dysfunction (RVSD). Patients with RVSD (n = 30, 64 [59; 68] years), were assigned in Group 1, whereas patients without it (n = 170, 64 [60; 68] years) were assigned to Group 2.Results. Univariate logistic regression reported the following factors to be associated with RVSD: prior myocardial infarction (p = 0.098), chronic heart failure (p = 0.020), long smoking history (p = 0.003), increased left ventricular end-systolic and enddiastolic volumes (p = 0.005 and p = 0.004), decreased tricuspid annular plane systolic excursion (p <0.001), decreased early mitral flow propagation velocity (p = 0.027) and left ventricular ejection fraction (p = 0.002), significant circumflex artery stenosis (p = 0.075), right coronary artery occlusion (p = 0.073), singlevessel and three-vessel coronary artery disease (p = 0.055 and p = 0.014). Three multivariate models were generated. A decrease in the left ventricular ejection fraction (p = 0.009), three-vessel coronary artery disease (p = 0.055), and early mitral flow propagation velocity (p = 0.072) were considered as independent predictors of RVSD.Conclusion. Moderate RVSD was found in 15% of patients with stable coronary artery disease and preserved left ventricular function. A decrease in the left ventricular ejection fraction, but not damage to individual coronary arteries, the number of affected coronary arteries, the presence and localization of myocardial infarction were among the factors independently associated with right ventricular systolic function.Цель. Оценить частоту выявления умеренной систолической дисфункции у больных стабильной ишемической болезнью сердца (ИБС) и изучить факторы, ассоциированные с ее наличием.Материалы и методы. В исследование включены данные 200 больных ИБС, госпитализированных в кардиологическое отделение НИИ КПССЗ для подготовки к операции коронарного шунтирования. Предоперационное обследование выполнялись в рамках поискового научного исследования №15/2017-2019. Группирующим признаком являлось наличие или отсутствие систолической дисфункции правого желудочка (СДПЖ). Группа I представлена пациентами с СДПЖ (n = 30, 64 [59; 68] лет), группа II – пациентами без СДПЖ (n = 170, 64 [60; 68] лет).Результаты. По результатам однофакторного логистического регрессионного анализа были выделены факторы, ассоциированные с наличием СДПЖ: наличие в анамнезе инфаркта миокарда (р = 0,098), хронической сердечной недостаточности (р = 0,020), увеличение стажа курения (р = 0,003), конечного систолического и диастолического объемов левого желудочка (р = 0,005 и р = 0,004), снижение систолической экскурсии фиброзного кольца трикуспидального клапана (р<0,001), скорости распространения раннего митрального потока (р = 0,027) и фракции выброса левого желудочка (ФВ ЛЖ) (р = 0,002), наличие значимых стенозов огибающей артерии (р = 0,075), окклюзии правой коронарной артерии (КА) (р = 0,073), однососудистого и трехсосудистого поражения КА (р = 0,055 и р = 0,014). Многофакторный анализ представлен тремя моделями, согласно которым, независимыми предикторами наличия СДПЖ являлось снижение ФВ ЛЖ (р = 0,009) и в некоторой степени – трехсосудистое поражение КА (р = 0,055) и снижение скорости распространения раннего митрального потока (р = 0,072).Заключение. Умеренная СДПЖ выявлена у 15% больных стабильной ИБС с сохранённой функцией левого желудочка. Факторами, независимо ассоциированными с наличием СДПЖ, были снижение ФВ ЛЖ, но не поражение отдельных КА, число поражённых КА, наличие и локализация перенесенного инфаркта миокарда

ФАКТОРЫ, АССОЦИИРОВАННЫЕ С НАЛИЧИЕМ ХРОНИЧЕСКОЙ МИТРАЛЬНОЙ РЕГУРГИТАЦИИ У БОЛЬНЫХ СТАБИЛЬНОЙ ИБС

Aim. To study the frequency of mitral regurgitation (MR) detection and the factors associated with its presence in patients with stable coronary heart disease.Methods. 874 patients with coronary artery disease undergoing preoperative assessment before elective surgical repair of coronary artery disease, carotid artery disease, atherosclerotic lesions of abdominal aorta and lower extremity arteries were included in the study. All patients were enrolled into three groups depending on the presence and severity of mitral regurgitation: Group 1 patients without mitral regurgitation (n = 448), Group 2 – patients with grade I mitral regurgitation (n = 378), Group 3 – patients with grade II-IV mitral regurgitation (n = 48).Results. The independent predictors of grade II-IV mitral regurgitation according to the multivariate analysis included prior myocardial infarction (p = 0.044), left ventricular aneurysm (p = 0.004), elevated left ventricular end-systolic volume (p<0.001), an increased risk by the EuroSCORE scale (p = 0.004), female gender, the presence of heart failure and angina pectoris.Conclusion. Mild mitral regurgitation was found in 43.2% of patients with stable coronary artery disease, whereas moderate and severe mitral regurgitation in 5.5% of patients. Independent factors associated with the presence of moderate and severe mitral regurgitation included prior myocardial infarction, left ventricular aneurysm, elevated left ventricular end-systolic volume, the presence of chronic heart failure and angina pectoris, female gender. However, there were no relationships between moderate and severe mitral regurgitation and the localization of coronary stenoses. Цель. Изучить частоту выявления митральной регургитации (МР) и факторы, ассоциированные с ее наличием у больных стабильной ишемической болезнью сердца (ИБС).Материалы и методы. В исследование включены 874 пациента с ИБС, находившихся на обследовании и лечении в клинике НИИ КПССЗ перед проведением плановых оперативных вмешательств на коронарных артериях, каротидном бассейне, брюшной аорте и артериях нижних конечностей. В зависимости от наличия и выраженности МР всех больных разделили на три группы: 1 группа – пациенты без МР (n = 448), 2 группа – с МР I степени (n = 378), 3 группа – с МР II-IV степени (n = 48).Результаты. По результатам многофакторного анализа независимыми предикторами выявления МР II-IV степени оказались: инфаркт миокарда (ИМ) в анамнезе (р = 0,044), аневризма левого желудочка (ЛЖ) (р = 0,004), повышение конечного систолического объема ЛЖ (р<0,001), увеличение риска по шкале EuroSCORE (р = 0,004), а также женский пол, наличие симптомов хронической сердечной недостаточности (ХСН) и стенокардии.Заключение. При обследовании больных стабильной ИБС незначительная ишемическая дисфункция митрального клапана (МК) выявлена в 43,2% случаев, умеренная и выраженная – у 5,5% пациентов. Независимыми факторами, ассоциированными с наличием умеренной и выраженной МР, были наличие ИМ в анамнезе, аневризмы ЛЖ, повышение конечного систолического объема ЛЖ, симптомы ХСН и стенокардии, женский пол, при этом не отмечено связи с локализацией коронарных стенозов

ВЛИЯНИЕ НАЛИЧИЯ МУЛЬТИФОКАЛЬНОГО АТЕРОСКЛЕРОЗА НА КАЧЕСТВО ЖИЗНИ БОЛЬНЫХ C ИБС

Purpose. To study the effect of polyvascular disease (PolyVD) on quality of life (QoL) of coronary artery disease (CAD) patients.Materials and methods. We examined 807 CAD patients (59,0 ± 8,0 years old; 648 men and 159 women), who were examined before planned coronary artery bypass surgery (CABG). The patients were additionally examined for subclinical stenosis of non-coronary arteries to identify the signs of PolyVD (artery stenosis 30% and more were included). The following groups were formed: PolyVD group (n = 336) and non-PolyVD group (n = 473). The groups were compared in terms of quality of life and depression. QoL was analyzed with the help of SF36 questionnaire, depression level – with the help of “Depression scale” questionnaire.Results. In PolyVD group integral indicators of QoL were lower compared to non-PolyVD group both as for physical component (69 (51,5;72,3) and 71,3 (61,3;75,8) points; р = 0,004), and for psychological component (62.8 (48.5, 72.0) and 63.5 (57.0, 72.8) points, p = 0.045) of QoL. In multiple regression analysis the independent effect on physical component of QoL was provided by PolyVD (OR = 0,679; 95%CI 0,477–0,966; р = 0,031) and functional class of CHF (OR = 0,514; 95%CI 0,378–0,698; р < 0,001), on psychological component – functional class of CHF (OR = 0,577; 95%CI 0,425–0,784; р<0,001).Conclusion. CAD patients with PolyVD as compared to patients with discrete lesion of coronary arteries have a higher level of depression and reduce of quality of life both as for certain scales of SF-36 questionnaire and integral indicators of physical and psychological components of QoL. In multivariate analysis the independent factors associated with a reduction in overall physical health were PolyVD presence and CHF severity, associated with a reduction in overall psychological health – only CHF severity.Цель. Изучение влияния наличия мультифокального атеросклероза (МФА) на качество жизни (КЖ) у больных с ИБС.Материалы и методы. Обследовано 807 больных с ИБС (возраст 59,0 ± 8,0 года; 648 мужчин и 159 женщин), обследовавшихся перед плановой операцией коронарного шунтирования (КШ). Пациенты дополнительно были обследованы на предмет выявления у них субклинических стенозов некоронарных артерий для выявления признаков МФА (учитывали стенозы артерий 30 % и более). Сформированы следующие группы: группа с МФА (n = 336) и группа без МФА (n = 473). Группы были сопоставлены по уровню качества жизни и депрессии. КЖ анализировали с помощью опросника SF-36, уровень депрессии – с помощью опросника «Шкала депрессии».Результаты. В группе МФА интегральные показатели КЖ были ниже по сравнению с группой без МФА как по физическому (69 (51,5; 72,3) и 71,3 (61,3; 75,8) балла; р = 0,004), так и психологическому компоненту (62,8 (48,5; 72,0) и 63,5 (57,0; 72,8) балла; р = 0,045) КЖ. При множественном регрессионном анализе независимое влияние на физический компонент КЖ оказывали МФА (ОШ = 0,679; 95 %ДИ 0,477–0,966; р = 0,031) и функциональный класс ХСН (ОШ = 0,514; 95 %ДИ 0,378–0,698; р < 0,001), на психологический компонент – функциональный класс ХСН (ОШ = 0,577; 95 %ДИ 0,425–0,784; р < 0,001).Заключение. У больных с ИБС с наличием МФА по сравнению с пациентами с изолированным поражением коронарных артерий отмечаются более высокий уровень депрессии и снижение качества жизни как по отдельным шкалам опросника SF-36, так и интегральным показателям физического и психологического компонента КЖ. При многофакторном анализе независимыми факторами, связанными со снижением общего физического здоровья, были наличие МФА и выраженность ХСН, со снижением общего психологического здоровья – только выраженность ХСН

Comparative Study of the Results of a Three-year Observation of Cardiologists and Surgeons in Patients with Peripheral Atherosclerosis

Aim. To compare the results of 3-year follow-up of patients with peripheral atherosclerosis (PA) in two patient cohorts: during outpatient monitoring by cardiologists and when observed by surgeons.Material and methods. The first group included 131 patients with PA who sought medical attention in outpatient clinic in 2013-2014 and then were observed by a surgeon. The second group is represented by 454 patients with PA who sought medical attention in outpatient clinic in 2010- 2012 and then underwent observation by a cardiologist as a part of a pilot project. The average follow-up duration in the studied groups was three years. The groups were compared according to the main demographic, anthropometric indicators, the presence of risk factors for atherosclerosis, comorbidity, the prevalence of atherothrombotic events in history, laboratory and instrumental examination data. Additionally, after 3 years of observation the incidence of deaths and amputations was assessed in groups.Results. Patients of the second group were older than these in the first group (p<0.001). Patients of the group 1 compared to the group 2 were more often overweight (p=0.005), suffered from diabetes mellitus (p<0.001), had a disability (p<0.001). Among patients of the group 2 compared with the group 1, the clinical picture of angina pectoris (p=0.001), rhythm disorders (p=0.058) were more often observed, they had a greater number of myocardial infarctions (p<0.001) and myocardial revascularization operations in the history: coronary bypass surgery (p=0.029), percutaneous coronary interventions (p<0.001), and underwent coronary angiography (p<0.001). Patients in group 2 were more likely to receive statins (p<0.001), β-blockers (p<0.001), angiotensin-converting enzyme inhibitors, and calcium channel blockers, angiotensin II receptor blockers, and antiarrhythmics (p<0.001). Pentoxifylline was prescribed more often in the first group (p<0.001). With a three-year observation of PA patients a fatal outcome occurred in 8.2% of cases, amputation – in 1.4%. In the first group, compared with the second one, there were more often observed deaths in general (p=0.023), death from cardiac causes, stroke, disability (p=0.005) and amputations (p=0.003). The risk of adverse outcomes (death and amputations) was increased in the presence of signs of chronic lower limb ischemia of stage III, a history of amputation, more than 70% stenosis and occlusions of lower limb arteries, chronic lung disease, and angina symptoms. The risk of adverse outcomes was decreased in outpatient observation by cardiologist, taking statins, aspirin, and performing exercise therapy.Conclusion. Observation of PA patients by a cardiologist results in more frequent optimal drug therapy (due to the better adherence of cardiologists to clinical recommendations for the treatment of such patients) and improves the prognosis of these patients

COMORBIDITIES IN PATIENTS WITH ISCHEMIC HEART DISEASE: GENDER DIFFERENCES

Background. The problem of comorbidity in ischemic heart disease (IHD) has always been given increased attention, due to the high social significance of cardiovascular diseases. However, often the problem solution involved studying cardiac pathology along with concomitant diseases, such as diabetes mellitus, pulmonary or kidneys pathology, etc., but not a comprehensive approach, which takes into account all available comorbidities. An important issue that should be considered in the shift to the personalized medicine is the presence of gender differences, which varies greatly and depends on different correlations with specific comorbidities.Aim. To study gender differences in comorbidities in patients with IHD.Material and methods. 742 patients with IHD examined in the Research Institute for Complex Issues of Cardiovascular Diseases in 2011 before elective coronary by-pass surgery were included into the study. All the patients were divided into 2 groups depending on the gender: Group 1 – 147 females, Group 2 – 595 males.Results. The obtained results reported that women were commonly older than men and more often had excess body weight (p<0.001). The majority of current smokers were males (p<0.001). During preoperative preparation, the development of myocardial infarction (MI) was observed in 12.9% of women and 7.4% of men (p=0.031), while the history of MI was more often found in male patients (p=0.004). The evaluation of the severity of angina pectoris and chronic heart failure (CHF) revealed that in men the I and II functional classes (FC) of angina (p=0.057 and p=0.007, respectively) and stage I CHF (p<0.001) were prevailed, whereas women had angina FC 3-4 (p=0.005 and p=0.050, respectively) and stage IIa CHF (p<0.001). Women more often than men suffered from hypertension (p=0.01) and atrial fibrillation (p=0.024), while peripheral artery disease prevailed among men (p=0.022). The analysis of comorbidities showed that disorders of carbohydrate metabolism, thyroid disease, bronchial asthma and varicose disease were more common in female patients (p<0.05), whereas chronic hepatitis (p=0.079) and urolithiasis – in males (p=0.028). The comorbidity score did not differ significantly between the study groups  (p>0.05), wherein the average level of comorbidity score prevailed among men (70.4%) and women (66%).Conclusion. Detection of comorbidities in IHD patients based  on gender differences is advisable to improve both  the  immediate results of surgical management and further preventive measures

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY IN DIAGNOSTICS OF OBSTRUCTIVE LESION IN CORONARY ARTERIES

Aim. To evaluate the potential of single photon emission computed tomography (SPECT) in diagnostics of obstructive lesion of coronary arteries (CA).Material and methods. The studied group consisted of 107 patients, admitted for diagnostics and treatment in the SRI CICVD during 2012-2015 with former established diagnosis of coronary heart disease (CHD) or hospitalized to rule it out. For hemodynamically significant stenoses, coronary arteriography (CAG) was applied. Data from CAG was compared with SPECT. As a result, four groups were formed: 1 group — with positive results by SPECT and CAG (SPECT“+”/CAG“+”, n=24); 2 group — with positive SPECT and negative CAG (SPECT“+”/CAG“-”, n=6); 3 group — with negative SPECT and positive CAG (SPECT“-”/CAG“+”, n=36); 4 group — negative both SPECT and CAG (SPECT“-”/CAG“-”, n=41).Results. In assessment of the patients with suspected CHD, positive result of pharmacological stress-test in SPECT was revealed in 28% cases, and hemodynamically significant CA lesion was found in 56% of patients. Myocardial infarction in anamnesis predominated in SPECT“+”/CAG“+” (79,2%), SPECT“+”/CAG“-” (83,3%), SPECT“-”/CAG“+” (55,6%) comparing to SPECT“-”/CAG“-” (39%; р=0,007). Also, in the group SPECT“-”/CAG“-” pre-test probability of CHD was the lowest (58%) comparing to other groups — 80,5%; 80,5% and 77% (р=0,002). Hence ejection fraction of the left ventricle was significantly lower in the group of SPECT“+”/CAG“+” (53%; р=0,011). In this group also subocclusion was found in circumflex (29,2%) and right CA (45,8%), respectively, р=0,033 and р=0,054. With the false negative results of SPECT there was association of male gender, former coronary bypass operation, increased cardiac volume. Sensitivity of SPECT in hemodynamically significant CA stenoses diagnostics was 40%, specificity — 87%.Conclusion. The results of current study are important for further elaboration on the approaches to obstructive CHD diagnostics

STENOSIS IN NONCORONARY AREAS AND LIFE QUALITY IN ISCHEMIC HEART DISEASE

Aim. To study the influence of noncoronary atherosclerotic stenosis on life quality (LQ) in patients with IHD.Material and methods. Totally 804 patients studied with IHD, that were selected into 4 groups according to presence of noncoronary stenosis (30% and more). To the group without noncoronary stenosis 472 patients were included. Stenotic subgroups (multifocal — MFA) consisted of: 1 group (n=73) — coronary arteries (CA) + extracranial arteries (BCA) + lower extremities arteries (LE), 2 group (n=154) — CA + BCA, and 3 group (n=105) — CA + LE. LQ was assessed with SF-36 questionnaire, depression level — with the questionnaire “Depression scale”Results. In MFA groups the level of depression was significantly higher than in patients without MFA (p<0,001), the highest values were found in the group with three pools involved. Also in the MFA group’s values of LQ were significantly lower, than in those without MFA by the scales: general health, physical functioning, physical condition and emotional condition. Integral parameters of the LQ were significantly lower in MFA (p=0,0439 for physical component and p=0,0347 for psychological). By the results of monofactor regression analysis, the negative influence on physical component of LQ had MFA, severity of CHF, and smoking, female gender, diabetes. In multifactor analysis the negative influence was confirmed for MFA (p=0,031) and for functional class of CHF  (p<0,001). Negative influence on the psychological component of LQ by monofactor regression analysis had the severity of CHF, decrease of left ventricle ejection fraction, female gender and diabetes mellitus. In monofactor analysis the only independent factor that negatively influenced general psychological health was functional class of CHF (p<0,001).Conclusion. In 41% of patients there are comorbid subclinical lesions of noncoronary arterial pools. Presence of MFA negatively influences physical and psychological components of life quality in IHD. In multifactor analysis, the independent factors related to general physical health were MFA and CHF severity, related to general psycho health only — just the severity of CHF

THE PREVALENCE OF INTACT CORONARY ARTERIES IN RELATION WITH INDICATIONS FOR SCHEDULED CORONARY ARTERIOGRAPHY

Aim. To evaluate the prevalence and possible reasons for intact coronary arteries (CA) diagnostics in patients with different indications for scheduled coronary arteriography (CAG).Material and methods. The selection studied, consisted of 711 case histories of patients, underwent scheduled CAG at SRI CICVP during 1 April — 31 may 2014. Taken the indications for CAG, 5 groups were selected: 1 — patients with coronary heart disease (CHD) suspicious (n=288), 2 — patients with myocardial infarction (MI) in anamnesis (n=277), 3 — atherosclerosis of peripheral arterial pools (PAP) (n=18), 4 — patients with acquired valve defects (AVD) (n=43), 5 — patients with cardiac rhythm disorders (CRD) (n=85).Results. In intergroup comparison it is marked that men were predominant among patients with MI in anamnesis and having PAP atherosclerosis, but women predominated among AVD patients (p<0,01). The age of groups was comparable (p=0,266). Typical angina clinical picture was more common significantly in suspected CHD group and previous MI (p<0,001). Also, the atypical angina and cardialgia were less common in MI anamnesis group (p=0,003) and p<0,001). Cardialgia was more common in AVD (p<0,001). Mean value of pretest probability of CHD was higher in groups with MI anamnesis and PAP lesion, and lesser — in AVD (p=0,015). Rhythm disorders were more common in AVD patients and those who actually was being investigated for CRD (p<0,001). also, ischemic strokes dominated among PAP and AVD (p=0,019). Analysis of CAG data showed that the absence of coronary lesion with higher prevalence is in groups with AVD and CRD (p<0,001). No significant stenoses of CA were less common in MI anamnesis group and AVD (p=0,004). However, hemodynamically significant stenoses of CA were significantly more common in those after MI and in PAP lesion (p<0,001).Conclusion. Among studied patients, in 32,9% there were no stenoses of CA in planned CAG. Highest number of intact CA was found in preoperation investigation of AVD patients (76,7%) and CRD (67,1%), least — in MI anamnesis (11,6%) and PAP lesion (16,7%). In investigation of suspected CHD, intact CA were found in 37,9% cases