Assessment of Risks and Outcomes of Surgical Intervention in Patients With Ischemic Cardiomyopathy in the Early and Long-term Postoperative Period, Selection of Optimal Surgical and Surgical Treatment

The aim of the study is to develop a new personalized approach to diagnostics and surgical treatment of patients with ischemic cardiomyopathy.

Research Objectives:

1. To assess the prognostic values of scintigraphic indicators of myocardial perfusion, contractility, and metabolism in patients with ischemic cardiomyopathy in regard to the development of cardiac remodeling and adverse cardiovascular events in the mid term after surgery.
2. To assess the prognostic values of parameters of cardiac magnetic resonance imaging (cMRI) allowing to predict the risks of surgical intervention and chronic heart failure progression in patients with ischemic cardiomyopathy.
3. To analyze the relationships between the structural and functional state of the myocardium and the effectiveness of various types of surgery in patients with ischemic cardiomyopathy. The structural and functional state of the myocardium is assessed by the instrumental methods including myocardial scintigraphy, cMRI, stress echocardiography, spiroergometry, and intraoperative fluometry.
4. To identify the myocardial biopsy-based predictors of adverse outcome in patients with ischemic cardiomyopathy in the early and mid term postoperative period in patients with ischemic cardiomyopathy.
5. To study the relationships between tissue and molecular biomarkers, severity of ischemic cardiomyopathy, and the outcomes in patients with ischemic cardiomyopathy in the postoperative period.
6. To introduce new and to optimize existing methods of surgical treatment in patients with ischemic cardiomyopathy.
7. To develop an algorithmic model for assessing the risks and predicting outcomes of surgical intervention in patients with ischemic cardiomyopathy in the postoperative period.

Methods:

1. Clinical status of the patient: collection of complaints, medical history, physical examination, assessment of anthropometric indicators (measurement of body weight, height, BMI), and demographic indicators before and in the control period after surgical treatment.
2. General clinical examination: standard 12-lead ECG, general urine analysis, general blood analysis, blood chemistry, coagulation, chest x-ray, ultrasound of the carotid and femoral arteries.
3. Echocardiography: determination of the type of aneurysm according to Di Donato; measuring the distance between the papillary muscles of the left ventricle; assessing the depth of co-optation of the mitral valve cusps; measuring Vena contracta; measuring the radius of the proximal regurgitation zone, cm; Effective Regurgitant Orifice Area (EROA, cm2); assessing systolic index and sphericity index. Stress echocardiography with dobutamine. Before stress echocardiography on a Vivid E9 ultrasound system (GE, Healthcare), continuous intravenous administration of dobutamine HEXAL, starting from 5 μg/kg/min and increasing its dose every 3 minutes to 10, 15, 20, 30, and 40 μg/kg.
4. Coronarography for assessing the anatomy and condition of the coronary pool using an angiographic unit (Axiom Artis/Innova 2121-IQ (General Electric, USA)).
5. Contrast-enhanced cMRI to assess the following parameters: