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Background: According to numerous studies, from 30% to 50% of patients with chronic heart failure (CHF) are resistant to cardiac resynchronization therapy (CRT) and cardiac contractility modulation (CCM), despite their careful selection in accordance with current guidelines. It is of interest to study neurohormones characterizing myocardial (NT-proBNP) and fibrosis (sST2) as potential additional markers of CHF patients' “response” to CRT and CCM.Aim: To evaluate the potential to use NT-proBNP and sST2 biomarkers in CHF patients combined with transthoracic echocardiography (Echo) and contrast magnetic resonance imaging (MRI) parameters of the heart to predict a positive response to CRT and CCM devices.Materials and methods: The study included 51 patients (41 men, 10 women) aged 58 ± 12 years (26 to 79 years) with ischemic heart disease post acute myocardial infarction (n = 22) or non-ischemic cardiomyopathy (n = 29), left ventricle (LV) ejection fraction (EF) < 35%, and CHF II–III NYHA functional class despite ≥ 3 months of optimized medical therapy. The patients were assessed by serum biomarkers NT-proBNP and sST2 measurements, transthoracic Echo, and contrast- enhanced cardiac MRI. After the diagnostic assessment, CRT defibrillators (CRT-D) were implanted to 39 patients and CCM to 12 patients. After prospective follow-up of the patients for 18 to 24 months, predictors of the response to each device type were analyzed in univariate, multivariate, and ROC analysis.Results: The response to CRT-D was found in 21 (54%) patients, to CCM in 7 (58%) patients. Multivariate analysis showed the following predictors of the response of patients to CRT-D were: 1) sST2 < 50 ng/mL, 2) NT-proBNP < 3900 pg/mL, 3) < 3 LV segments with fibrosis (by MRI) and 4) anteroposterior dimension of the left atrium < 4.8 cm (by Echo). Any 2 of these 4 characteristics made it possible to predict the response to CRT with an accuracy of 87% (sensitivity 90%, specificity 83%). The predictors of the response to CCM were: 1) sST2 < 30 ng/ml, 2) LV end diastolic diameter < 78 mm (Echo), 3) age < 56 years, 4) body mass index < 27 kg/m2. Any 2 of these 4 characteristics predicted the positive response to CCM with an accuracy of 92% (sensitivity 86%, specificity 100%).Conclusion: The preoperative sST2 level was the only universal marker of the response to either CRT (< 50 ng/mL) or CCM (< 30 ng/mL) devices in CHF patients with reduced LVEF. The results indicate the potential for improved efficacy of these devices with their earlier implantation after the onset of the heart disease, as well as provided that maximal control CHF in these patients has been achieved.

Aim. To identify the features of myocardial scar and fibrosis associated with the occurrence of malignant ventricular tachyarrhythmias (VTs) in high-risk patients with ischemic (ICMP) and non-ischemic cardiomyopathy (NICMP). Materials and methods. This prospective study included 50 patients (41 men, 9 women), age = 60 ± 13 years, 30 patients of them with ICMP and 20 patients with NICMP, who underwent echocardiography (Echo) and contrast magnetic resonance imaging (MRI) of the heart followed by implantation of cardioverter-defibrillators (ICD) or resynchronizing devices with defibrillator (CPTD) to prevent sudden cardiac death. Results. Sustained VTs were reported in 20/30 (67%) patients with ICMP and in 5/20 (25%) patients with NICMP on follow-up [26 (22-37) months]. Successive univariate and ROC-analyses of Echo and MRI-indices between patients with and without recurrence of VTs found different results for ICMP and NICMP patients groups. In ICMP patients the VTs were associated with wide transmural fibrosis on contrast MRI that covered 3 or more segments of left ventricular. These segments were preferably localized in the middle parts of the inferior and inferolateral segments of the left ventricle. The independent predictors of VTs in NICMP patients were non-transmural fibrosis at 4.5% of the left ventricular mass by contrast MRI as well as low left ventricular ejection fraction (less than 26%) by Echo. Conclusion. To determine the indications for implantation of the ICD and CRTD for primary prevention of sudden cardiac death, it is advisable to take into account not only the value of ejection fraction of left ventricular, but also the features of the fibrosis of the left ventricle by contrast MRI of the heart.

We report a case of bundle-branch reentrant ventricular tachycardia as a first and severe manifestation of myotonic dystrophy. Progressive cardiac conduction disturbances and cardiac arrhythmias are well-known features of myotonic dystrophy, although they are commonly found in late stage of disease in patients with established diagnosis. We review clinical manifestations, diagnostics, management, and prognostic value of cardiac involvement in myotonic dystrophy.

Objective This study aimed to assess the level of anti-1-adrenergic receptor autoantibodies in patients with ventricular arrhythmias with no signs of organic heart disease and with presence of cardiovascular pathology in comparison with a group of healthy volunteers. Material and methods The study included 44 patients with ventricular arrhythmias with no signs of organic heart disease ("idiopathic"), 34 patients with diagnosed dilated cardiomyopathy (DCM) of inflammatory origin, 35 patients with coronary heart disease and ventricular arrhythmias, 12patients with coronary heart disease with no ventricular arrhythmias, and 19 healthy volunteers (control group). The level of autoantibodies against the 1-adrenergic receptor was determined by the developed competitive cell-based enzyme-linked immunosorbent assay (ELISA) and by the standard ELISA using peptides corresponding to the second extracellular loop of the 1-adrenergic receptor. Results Elevated level of autoantibodies detected by a competitive cell-based ELISA was observed in 62% of patients with DCM compared to 21% of healthy volunteers (p=0.0006). In patients with "idiopathic" ventricular arrhythmias, the level of 1-adrenergic receptor autoantibodies was lower than in healthy subjects (p=0.003). Coronary heart disease patients with or without ventricular arrhythmias exhibited no differences from the control group. The number of significantly positive signals in peptide-based ELISA did not exceed 10% in any of the groups. No correlation between the data from competitive cell-based ELISA and peptide-based ELISA was found. Conclusions This study demonstrated that competitive cell-based ELISA technique can be applied for detection of 1-adrenergic receptor autoantibodies. The results in DCM patients generally correspond to the expected. Decreased level of autoantibodies in patients with "idiopathic" ventricular arrhythmias indicates that this disease is related to changes in the immune system. Such relation is not observed in the case of coronary heart disease patients.

PURPOSE to assess status of myocardial energy metabolism in patients with different etiology of left ventricular hypertrophy by phosphorus magnetic resonance spectroscopy (MRS) compared with healthy individuals. METHODS The study included 94 people: 30 healthy volunteers (group 1), 35 patients with arterial hypertension and left ventricular hypertrophy (group II), 29 patients with hypertrophic cardiomyopathy (group III). All persons underwent cardiac magnetic resonance imaging (MRI) and MRS on high field MR scanner. Energy metabolism index (ratio of phosphocreatine and adenosine triphosphate concentrations [Pcr/ATP]) was used for evaluation of myocardial energy metabolism. RESULTS Values of Pcr/ATP were 2.11 ± 0.29, 1.65 ± 0.12, and 1.32 ± 0.16 in groups I, II, and III, respectively (p < 0.05). CONCLUSION 31P MRS is an effective tool of detection of disordered energy metabolism in hypertrophic myocardium. Combined use of MRI and MRS can become an effective method of comprehensive study of the heart.