Background/Objectives: The aim of this study is to identify markers and develop a multifactorial model for characterizing extensive scar tissue after revascularization in patients with myocardial infarction (MI). Methods: A total of 123 patients with MI were examined. The patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th–10th days from the onset of the disease. At the first stage, we performed a comparative analysis and built a multifactorial model based on the examination results of 92 (75%) patients enrolled from April 2021 to October 2023. These patients formed the group used for model development, or the “modeling group”. The mass of the scar was calculated, including relative to the left ventricular (LV) myocardium mass (M_scar/LVMM, in %). Results: The first subgroup consisted of 36 (39%) patients with a large scar, denoted as “LS” (M_scar/LVMM > 20%). The second subgroup included 56 (61%) patients with a smaller scar, referred to as “SS” (M_scar/LVMM ≤ 20%). Logistic regression was used to identify independent factors affecting scar tissue size. A multifactorial model was created. This model predicts M_scar/LVMM > 20% on MRI. It uses readily available clinical parameters: high-sensitivity troponin I (HscTn I) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and LV relative wall thickness (RWT). We tested the multifactorial model on the “modeling group” (n = 31). The sensitivity was 63.6% and the specificity was 85.7%. Conclusions: These indicates the feasibility of its application in clinical practice.

Aim. To study the lipid-lowering and pleiotropic effects of statin monotherapy and combination with ezetimibe in patients in the postinfarction period, depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) for 24 weeks. Materials and methods. 114 patients with myocardial infarction were included. Treatment was started with statin monotherapy, with insufficient efficacy, ezetimibe was added. After 24 weeks, the 1st group included 38 people, the 2nd – 76 patients. On 7–10th days and 24 weeks later, the lipid profile, the N-terminal fragment of the precursor of the cerebral natriuretic peptide (NT-proBNP) were determined, speckle-tracking echocardiography, ultrasound examination of the carotid arteries (CA) with RF technology were performed. Results. At week 24, the patients were divided depending on the achievement/non-achievement of the LDL cholesterol target. The highly effective therapy group (HET) included 52 patients, the insufficiently effective therapy group (IET) consisted of 62 people. The ratio of the chances of achieving LDL cholesterol with the addition of ezetimibe to a statin was 3.4 [1.8; 6.6] (p0.001). In the HET group, by the 24th week, NT-proBNP decreased by 59.6% (p=0.045); in the IET group – by 52.2% (p=0.042). According to echocardiography data, after 24 weeks in the HET group, an increase in global constructive work GCW by 9.1% (p=0.036) and the global work index GWI by 8.2% (p=0.041) was revealed without dynamics of indicators in the comparison group. In the study of the CA, the thickness of the intima-media complex in the HET and IET groups regressed by 9.5% and 6.8% respectively (p0.05). Only in the HET group did the common CA stiffness indicators improve. Conclusion. The achievement of LDL cholesterol control on the background of combined lipid-lowering therapy in patients in the postinfarction period is characterized by the most pronounced organoprotective effect.

The aim of this study is to identify markers and develop a multifactorial model for characterizing extensive scar tissue after revascularization in patients with myocardial infarction (MI). 123 patients with MI were examined. The patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, USA) on the 7th-10th days from the onset of the disease. At the first stage, we performed a comparative analysis and built a multifactorial model based on the examination results of 92 (75%) patients enrolled from April 2021 to October 2023. These patients formed the group used for model development, or the “modeling group”. The mass of the scar was calculated, including relative to the left ventricular (LV) myocardium mass (Mscar/LVMM, in %). The first subgroup consisted of 36 (39%) patients with a large scar, denoted as “LS” (Mscar/LVMM >20%). The second subgroup included 56 (61%) patients with a smaller scar, referred to as “SS” (Mscar/LVMM ≤20%). Logistic regression was used to identify independent factors affecting scar tissue size. A multifactorial model was created. This model predicts Mscar/LVMM >20% on MRI. It uses readily available clinical parameters: high-sensitivity troponin I (HscTn I) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and LV relative wall thickness (RWT). We tested the multifactorial model on the “modeling group” (n=31). The sensitivity was 63.6%, and the specificity was 85.7%. This indicates the feasibility of its application in clinical practice.

Objective. To study morphofunctional characteristics of the myocardium in patients with different variants of LV remodeling 24 weeks after myocardial infarction and revascularization. Material and methods. A total of 105 patients with myocardial infarction were included. Primary percutaneous coronary intervention was performed in 67 (63.8%) patients, pharmacoinvasive revascularization in 38 (36.2%) patients. Cardiac magnetic resonance imaging (MRI), speckle tracking echocardiography (EchoCG) were performed on the 7th—10th day and after 24 weeks. Results. Follow-up was completed for 92 (87.6%) patients. According to EchoCG results, patients were divided into groups: 1 — 44 patients with increased end-diastolic volume index (iEDV) >20% and/or end-systolic volume index (iESV) >15% after 24 weeks (pathological remodeling (PR) of the LV); 2 — 27 patients with iEDV <20% in combination with dynamics of iESV from -15% to +15% (slowly progressive remodeling (SR) of the LV); 3 — 21 patients with regression of iESV≥15% (reverse remodeling (RR) of the LV). According to cardiac MRI, scar mass in the PRLV group decreased by 4.8% (p=0.005), SRLV — by 48.2% (p=0.017), RRLV — by 44.4% (p=0.040). The incidence of microvascular obstruction decreased with SRLV by 2.7 times (p=0.006). According to EchoCG after 24 weeks, the RRLV group was characterized by global work efficiency increase by 2.7% (p=0.021), global work index by 28.1% (p<0.001), and global constructive work by 27.3% (p<0.001). These parameters did not change in comparison groups. Conclusion. Cardiac MRI and speckle-tracking EchoCG allow quantitative assessment of morphofunctional picture of postinfarction cardiac sclerosis. Cardiac MRI revealed shrinkage of infarction zones that was most pronounced in the SRLV group. In the RRLV group, speckle-tracking EchoCG revealed favorable increase in myocardial work indicators.

Aim . To study quantitative and morphological parameters of myocardial injury using cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement in patients with acute myocardial infarction and to identify factors associated with scar zone size. Material and methods . The single-centre observational study included 202 patients (91% men) with ST-segment elevation (86%) and non-ST-segment elevation (14%) MI, aged 57 (50; 61) years. Primary percutaneous coronary intervention was performed in 136 patients (67%), and pharmacoinvasive revascularisation was performed in 66 patients (33%). On days 7–10, examination was performed, including echocardiography (Echo) and magnetic resonance imaging (MRI) of the heart with contrast. Based on cardiac MRI results patients were divided into three groups: Group 1 — 43 patients with LV scar burden of 20%. One-factor logistic regression analysis was used to identify variables that help diagnose different scar sizes. Results . Patients in Group 3 were more likely to have type 2 diabetes mellitus compared to Group 2. Non-ST-segment elevation MI was more common in Group 1 compared to Groups 2 and 3 (p1-2,3 <0.05); pathological Q waves were diagnosed in Group 3 12.4 and 1.6 times more often than in Groups 1 and 2, respectively (p1-2,3;2-3 <0.001). It was also noted that Group 1 received thrombolytic therapy more quickly than Group 3 (p=0.032). Echo data revealed a predominance of indexed left ventricular (LV) volume parameters and the LV myocardial mass index in Group 3 compared to Groups 1 and 2, while the ejection fraction (EF) was minimal in Group 3 (p1,2-3 <0.05). MRI results revealed additional differences in the end-systolic volume index and LVEF between Groups 1 and 2. According to cardiac MRI results, the ratio of peri-infarction heterogeneous zone mass to the scar mass in Group 1 was 123.3 (81.3; 182.1) %, in Group 2 — 77.2 (57.8; 112.8) %, in Group 3 — 42.9 (29.4; 56.4) % (p1-2,3;2-3 <0.05). In Group 1, reperfusion injury was detected in only one patient (2.3%), in Group 2 — in 34.9% of cases, and in Group 3 — in 78.9% (p1-2,3;2-3<0.05). According to the regression analysis results, the following general significant indicators were found for the absence of a scar zone or SM/LVMM 20%: high-sensitivity troponin I, N-terminal pro-brain natriuretic peptide; according to EchoCG data — end-systolic volume index, EF, LV myocardial mass index; according to MRI data — indexed volume indicators, EF, indexes of local contractility and global contrast. Conclusion . A small scar burden had no adverse effect on cardiac morphological or functional parameters in patients with acute myocardial infarction who had no detectable scar or only a minimal scar burden (scar mass/left ventricular myocardial mass 20%).