Результаты перфузионной однофотонной эмиссионной томографии миокарда и данных коронарографии у пациентов с различной претестовой вероятностью ишемической болезни сердца
Результаты перфузионной однофотонной эмиссионной томографии миокарда и данных коронарографии у пациентов с различной претестовой вероятностью ишемической болезни сердца
Аншелес А.А., Сергиенко И.В., Денисенко-Канкия Е.И., Сергиенко В.Б. Результаты перфузионной однофотонной эмиссионной томографии миокарда и данных коронарографии у пациентов с различной претестовой вероятностью ишемической болезни сердца. Терапевтический архив. 2020; 92 (4): 30–36. DOI: 10.26442/00403660.2020.04.000549
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Изучить взаимосвязь претестовой вероятности (ПТВ) ишемической болезни сердца (ИБС), рассчитанной согласно рекомендациям Европейского общества кардиологов (ESC) 2013 и 2019 гг., с перфузией миокарда левого желудочка по данным однофотонной эмиссионной томографии (ОЭКТ) и результатам инвазивной коронароангиографии (КАГ).
Материал и методы. В исследование включены данные 220 пациентов с предварительным диагнозом ИБС, направленных на инвазивную КАГ. Всем пациентам проведена перфузионная ОЭКТ по протоколу покой + нагрузка в пределах 1 мес до или после КАГ с оценкой стандартных количественных параметров перфузии левого желудочка. Ретроспективно проанализированы клинические данные и рассчитана ПТВ ИБС согласно рекомендациям ESC 2013 и 2019 гг.
Результаты. По данным инвазивной КАГ обструктивное поражение одной или более коронарной артерии (КА) выявлено у
204 (92,7%) пациентов из 220. При ретроспективном анализе с учетом пола, возраста и характера жалоб, согласно рекомендациям ESC 2013 г., ПТВ оценена как низкая (<15%) у 13 (5,9%) пациентов, как промежуточная (15–85%) – у 207 (94,1%) пациентов. По итогам комплексного обследования (ОЭКТ и КАГ) 8 пациентам с низкой ПТВ (61,5%) выполнена реваскуляризация КА. Среди пациентов с промежуточной ПТВ достоверная преходящая ишемия по данным ОЭКТ выявлена у 31 (15,0%), начальная – у 107 (51,7%). По данным КАГ среди пациентов с промежуточной ПТВ обструктивное поражение КА выявлено у 192 (92,7%), из них реваскуляризация КА выполнена 113 (58,8%) пациентам. В соответствии с рекомендациями ESC 2019 г. ПТВ оценена как низкая (<15%) у 117 (53,2%) пациентов, в том числе 5–14% – у 98 (44,5%). По итогам обследования (ОЭКТ и КАГ) 68 (58,1%) из них выполнена реваскуляризация КА.
Заключение. Принципы оценки ПТВ, предложенные ESC, не могут быть применены к пациентам российской популяции с предполагаемой ИБС без существенных поправок. Рекомендации ESC 2013 г. с более высокой ПТВ ИБС для всех категорий пациентов в большей мере отражают российскую популяцию, в то время как рекомендации 2019 г. ошибочно относят пациентов к низкой ПТВ не менее чем в 58% случаев. Данные результаты являются предварительными и будут расширены в последующих исследованиях с более детальным анализом ПТВ ИБС у включенной группы пациентов с предполагаемой ИБС.
Ключевые слова: перфузионная сцинтиграфия миокарда, коронароангиография, претестовая вероятность ишемической болезни сердца.
Material and methods. The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019.
Results. Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (<15%) in 13 patients (5.9%), as intermediate (15–85%) – in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial – at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (<15%) in 117 patients (53.2%), including 5–14% – in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization.
Conclusion. PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.
Keywords: myocardial perfusion scintigraphy, coronary angiography, pretest probability of ischemic heart disease.
Материал и методы. В исследование включены данные 220 пациентов с предварительным диагнозом ИБС, направленных на инвазивную КАГ. Всем пациентам проведена перфузионная ОЭКТ по протоколу покой + нагрузка в пределах 1 мес до или после КАГ с оценкой стандартных количественных параметров перфузии левого желудочка. Ретроспективно проанализированы клинические данные и рассчитана ПТВ ИБС согласно рекомендациям ESC 2013 и 2019 гг.
Результаты. По данным инвазивной КАГ обструктивное поражение одной или более коронарной артерии (КА) выявлено у
204 (92,7%) пациентов из 220. При ретроспективном анализе с учетом пола, возраста и характера жалоб, согласно рекомендациям ESC 2013 г., ПТВ оценена как низкая (<15%) у 13 (5,9%) пациентов, как промежуточная (15–85%) – у 207 (94,1%) пациентов. По итогам комплексного обследования (ОЭКТ и КАГ) 8 пациентам с низкой ПТВ (61,5%) выполнена реваскуляризация КА. Среди пациентов с промежуточной ПТВ достоверная преходящая ишемия по данным ОЭКТ выявлена у 31 (15,0%), начальная – у 107 (51,7%). По данным КАГ среди пациентов с промежуточной ПТВ обструктивное поражение КА выявлено у 192 (92,7%), из них реваскуляризация КА выполнена 113 (58,8%) пациентам. В соответствии с рекомендациями ESC 2019 г. ПТВ оценена как низкая (<15%) у 117 (53,2%) пациентов, в том числе 5–14% – у 98 (44,5%). По итогам обследования (ОЭКТ и КАГ) 68 (58,1%) из них выполнена реваскуляризация КА.
Заключение. Принципы оценки ПТВ, предложенные ESC, не могут быть применены к пациентам российской популяции с предполагаемой ИБС без существенных поправок. Рекомендации ESC 2013 г. с более высокой ПТВ ИБС для всех категорий пациентов в большей мере отражают российскую популяцию, в то время как рекомендации 2019 г. ошибочно относят пациентов к низкой ПТВ не менее чем в 58% случаев. Данные результаты являются предварительными и будут расширены в последующих исследованиях с более детальным анализом ПТВ ИБС у включенной группы пациентов с предполагаемой ИБС.
Ключевые слова: перфузионная сцинтиграфия миокарда, коронароангиография, претестовая вероятность ишемической болезни сердца.
________________________________________________
Material and methods. The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019.
Results. Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (<15%) in 13 patients (5.9%), as intermediate (15–85%) – in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial – at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (<15%) in 117 patients (53.2%), including 5–14% – in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization.
Conclusion. PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.
Keywords: myocardial perfusion scintigraphy, coronary angiography, pretest probability of ischemic heart disease.
Список литературы
1. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019. doi: 10.1093/eurheartj/ehz425
2. Стабильная ишемическая болезнь сердца. Клинические рекомендации. 2016. http://cr.rosminzdrav.ru/#!/recomend/133 (Stable ischemic heart disease. Clinical guidelines. 2016. http://cr.rosminzdrav.ru/#!/
recomend/133 (In Russ))
3. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American
Association for Thoracic Surgery, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-67. doi: 10.1161/CIR.0000000000000095
4. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. doi: 10.1093/eurheartj/eht296
5. Adamson PD, Newby DE, Hill CL, et al. Comparison of International Guidelines for Assessment of Suspected Stable Angina: Insights From the PROMISE and SCOT-HEART. JACC Cardiovasc Imaging. 2018;11(9):1301-10. doi: 10.1016/j.jcmg.2018.06.021
6. Foldyna B, Udelson JE, Karady J, et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019;20(5):574-81. doi: 10.1093/ehjci/jey182
7. Reeh J, Therming CB, Heitmann M, et al. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J. 2019;40(18):1426-35. doi: 10.1093/eurheartj/ehy806
8. Verberne HJ, Acampa W, Anagnostopoulos C, et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging. 2015;42(12):1929-40. doi: 10.1007/s00259-015-3139-x
9. Jespersen L, Abildstrom SZ, Hvelplund A, et al. Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study. PLoS One. 2014;9(4):e93170. doi: 10.1371/journal.pone.0093170
10. Patel MR, Dai D, Hernandez AF, et al. Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J. 2014;167(6):846-52e2. doi: 10.1016/j.ahj.2014.03.001
11. Johnston N, Schenck-Gustafsson K, Lagerqvist B. Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain? Eur Heart J. 2011;32(11):1331-6. doi: 10.1093/eurheartj/ehr009
12. Hannan EL, Samadashvili Z, Cozzens K, et al. Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State. Circ Cardiovasc Interv. 2014;7(1):19-27. doi: 10.1161/
CIRCINTERVENTIONS.113.000741
13. Sato A, Hiroe M, Tamura M, et al. Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging. J Nucl Med. 2008;49(4):564-72. doi:
jnumed.107.042481/10.2967/jnumed.107.042481
14. Gaemperli O, Schepis T, Valenta I, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology. 2008;248(2):414-23. doi: 2482071307/10.1148/radiol.2482071307
15. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283-91. doi: 10.1161/CIRCULATIONAHA. 107.743963
16. Аншелес А.А., Шульгин Д.Н., Соломяный В.В. и др. Сопоставление результатов нагрузочных проб, данных однофотонной эмиссионной компьютерной томографии миокарда и коронарографии у больных ишемической болезнью сердца. Кардиологический вестн. 2012;2:10-6 [Ansheles AA, Shulgin DN, Solomyany VV, et al. Comparison of the results of stress tests, single photon emission computed tomography and coronary angiography in patients with coronary heart disease. Kardiologicheskij vestn. 2012;2:10-6 (In Russ.)].
17. Djaberi R, Roodt J, Schuijf JD, et al. Endothelial dysfunction in diabetic patients with abnormal myocardial perfusion in the absence of epicardial obstructive coronary artery disease. J Nucl Med. 2009;50(12):1980-6. doi: 10.2967/jnumed.109.065193
18. Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. Eur Heart J. 2015;36(45):3182-8. doi: 10.1093/eurheartj/ehv452
19. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49(21):2105-11. doi: 10.1016/j.jacc.2007.01.087
20. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl
J Med. 2009;360(3):213-24. doi: 10.1056/NEJMoa0807611
21. Van Nunen LX, Zimmermann FM, Tonino PA, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet. 2015;386(10006):1853-60. doi: 10.1016/S0140-6736(15)00057-4
22. Ko DT, Guo H, Wijeysundera HC, et al. Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012;60(19):1876-84. doi: 10.1016/j.jacc.2012.06.056
23. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018. doi: 10.1093/eurheartj/ehy394
24. Min JK, Chandrashekhar Y. Atherosclerosis, Stenosis, and Ischemia: One Primary, One Secondary, and One Tertiary. JACC Cardiovasc Imaging. 2018;11(4):531-3. doi: 10.1016/j.jcmg.2017.12.006
25. Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97(6):535-43.
26. Shaw LJ, Hendel R, Borges-Neto S, et al. Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med. 2003;44(2):134-9.
27. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011;32(8):1012-24. doi: 10.1093/eurheartj/ehq500
28. Boiten HJ, van den Berge JC, Valkema R, et al. Ischemia burden on stress SPECT MPI predicts long-term outcomes after revascularization in stable coronary artery disease. J Nucl Cardiol. 2018;25(3):958-66. doi: 10.1007/s12350-016-0735-5
29. Simonsen JA, Mickley H, Johansen A, et al. Outcome of revascularisation in stable coronary artery disease without ischaemia: a Danish registry-based follow-up study. BMJ Open. 2017;7(8):e016169. doi: 10.1136/bmjopen-2017-016169
30. Farzaneh-Far A, Phillips HR, Shaw LK, et al. Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging. 2012;5(7):715-24.
doi: 10.1016/j.jcmg.2012.01.019
31. Kim YH, Ahn JM, Park DW, et al. Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol. 2012;60(3):181-90.
doi: 10.1016/j.jacc.2012.02.061
32. Johnson NP, Gould KL. Fractional Flow Reserve Returns to Its Origins: Quantitative Cardiac Positron Emission Tomography. Circ Cardiovasc Imaging. 2016;9(9). doi: 10.1161/CIRCIMAGING.116.005435
33. Melikian N, De Bondt P, Tonino P, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv. 2010;3(3):307-14. doi: 10.1016/j.jcin.2009.12.010
34. Van de Hoef TP, van Lavieren MA, Damman P, et al. Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity. Circ Cardiovasc Interv. 2014;7(3):301-11. doi: 10.1161/CIRCINTERVENTIONS.113.001049
35. Genders TS, Steyerberg EW, Hunink MG, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012;344:e3485. doi: 10.1136/ BMJ.e3485
2. Stable ischemic heart disease. Clinical guidelines. 2016. http://cr.rosminzdrav.ru/#!/
recomend/133 (In Russ)
3. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American
Association for Thoracic Surgery, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-67. doi: 10.1161/CIR.0000000000000095
4. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. doi: 10.1093/eurheartj/eht296
5. Adamson PD, Newby DE, Hill CL, et al. Comparison of International Guidelines for Assessment of Suspected Stable Angina: Insights From the PROMISE and SCOT-HEART. JACC Cardiovasc Imaging. 2018;11(9):1301-10. doi: 10.1016/j.jcmg.2018.06.021
6. Foldyna B, Udelson JE, Karady J, et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019;20(5):574-81. doi: 10.1093/ehjci/jey182
7. Reeh J, Therming CB, Heitmann M, et al. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J. 2019;40(18):1426-35. doi: 10.1093/eurheartj/ehy806
8. Verberne HJ, Acampa W, Anagnostopoulos C, et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging. 2015;42(12):1929-40. doi: 10.1007/s00259-015-3139-x
9. Jespersen L, Abildstrom SZ, Hvelplund A, et al. Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study. PLoS One. 2014;9(4):e93170. doi: 10.1371/journal.pone.0093170
10. Patel MR, Dai D, Hernandez AF, et al. Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J. 2014;167(6):846-52e2. doi: 10.1016/j.ahj.2014.03.001
11. Johnston N, Schenck-Gustafsson K, Lagerqvist B. Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain? Eur Heart J. 2011;32(11):1331-6. doi: 10.1093/eurheartj/ehr009
12. Hannan EL, Samadashvili Z, Cozzens K, et al. Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State. Circ Cardiovasc Interv. 2014;7(1):19-27. doi: 10.1161/
CIRCINTERVENTIONS.113.000741
13. Sato A, Hiroe M, Tamura M, et al. Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging. J Nucl Med. 2008;49(4):564-72. doi: jnumed.107.042481/10.2967/jnumed.107.042481
14. Gaemperli O, Schepis T, Valenta I, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology. 2008;248(2):414-23. doi: 2482071307/10.1148/radiol.2482071307
15. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283-91. doi: 10.1161/CIRCULATIONAHA. 107.743963
16. Ansheles AA, Shulgin DN, Solomyany VV, et al. Comparison of the results of stress tests, single photon emission computed tomography and coronary angiography in patients with coronary heart disease. Kardiologicheskij vestn. 2012;2:10-6 (In Russ.)
17. Djaberi R, Roodt J, Schuijf JD, et al. Endothelial dysfunction in diabetic patients with abnormal myocardial perfusion in the absence of epicardial obstructive coronary artery disease. J Nucl Med. 2009;50(12):1980-6. doi: 10.2967/jnumed.109.065193
18. Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. Eur Heart J. 2015;36(45):3182-8. doi: 10.1093/eurheartj/ehv452
19. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49(21):2105-11. doi: 10.1016/j.jacc.2007.01.087
20. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl
J Med. 2009;360(3):213-24. doi: 10.1056/NEJMoa0807611
21. Van Nunen LX, Zimmermann FM, Tonino PA, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet. 2015;386(10006):1853-60. doi: 10.1016/S0140-6736(15)00057-4
22. Ko DT, Guo H, Wijeysundera HC, et al. Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012;60(19):1876-84. doi: 10.1016/j.jacc.2012.06.056
23. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018. doi: 10.1093/eurheartj/ehy394
24. Min JK, Chandrashekhar Y. Atherosclerosis, Stenosis, and Ischemia: One Primary, One Secondary, and One Tertiary. JACC Cardiovasc Imaging. 2018;11(4):531-3. doi: 10.1016/j.jcmg.2017.12.006
25. Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97(6):535-43.
26. Shaw LJ, Hendel R, Borges-Neto S, et al. Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med. 2003;44(2):134-9.
27. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011;32(8):1012-24. doi: 10.1093/eurheartj/ehq500
28. Boiten HJ, van den Berge JC, Valkema R, et al. Ischemia burden on stress SPECT MPI predicts long-term outcomes after revascularization in stable coronary artery disease. J Nucl Cardiol. 2018;25(3):958-66. doi: 10.1007/s12350-016-0735-5
29. Simonsen JA, Mickley H, Johansen A, et al. Outcome of revascularisation in stable coronary artery disease without ischaemia: a Danish registry-based follow-up study. BMJ Open. 2017;7(8):e016169. doi: 10.1136/bmjopen-2017-016169
30. Farzaneh-Far A, Phillips HR, Shaw LK, et al. Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging. 2012;5(7):715-24.
doi: 10.1016/j.jcmg.2012.01.019
31. Kim YH, Ahn JM, Park DW, et al. Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol. 2012;60(3):181-90.
doi: 10.1016/j.jacc.2012.02.061
32. Johnson NP, Gould KL. Fractional Flow Reserve Returns to Its Origins: Quantitative Cardiac Positron Emission Tomography. Circ Cardiovasc Imaging. 2016;9(9). doi: 10.1161/CIRCIMAGING.116.005435
33. Melikian N, De Bondt P, Tonino P, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv. 2010;3(3):307-14. doi: 10.1016/j.jcin.2009.12.010
34. Van de Hoef TP, van Lavieren MA, Damman P, et al. Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity. Circ Cardiovasc Interv. 2014;7(3):301-11. doi: 10.1161/CIRCINTERVENTIONS.113.001049
35. Genders TS, Steyerberg EW, Hunink MG, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012;344:e3485. doi: 10.1136/ BMJ.e3485
2. Стабильная ишемическая болезнь сердца. Клинические рекомендации. 2016. http://cr.rosminzdrav.ru/#!/recomend/133 (Stable ischemic heart disease. Clinical guidelines. 2016. http://cr.rosminzdrav.ru/#!/
recomend/133 (In Russ))
3. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American
Association for Thoracic Surgery, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-67. doi: 10.1161/CIR.0000000000000095
4. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. doi: 10.1093/eurheartj/eht296
5. Adamson PD, Newby DE, Hill CL, et al. Comparison of International Guidelines for Assessment of Suspected Stable Angina: Insights From the PROMISE and SCOT-HEART. JACC Cardiovasc Imaging. 2018;11(9):1301-10. doi: 10.1016/j.jcmg.2018.06.021
6. Foldyna B, Udelson JE, Karady J, et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019;20(5):574-81. doi: 10.1093/ehjci/jey182
7. Reeh J, Therming CB, Heitmann M, et al. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J. 2019;40(18):1426-35. doi: 10.1093/eurheartj/ehy806
8. Verberne HJ, Acampa W, Anagnostopoulos C, et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging. 2015;42(12):1929-40. doi: 10.1007/s00259-015-3139-x
9. Jespersen L, Abildstrom SZ, Hvelplund A, et al. Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study. PLoS One. 2014;9(4):e93170. doi: 10.1371/journal.pone.0093170
10. Patel MR, Dai D, Hernandez AF, et al. Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J. 2014;167(6):846-52e2. doi: 10.1016/j.ahj.2014.03.001
11. Johnston N, Schenck-Gustafsson K, Lagerqvist B. Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain? Eur Heart J. 2011;32(11):1331-6. doi: 10.1093/eurheartj/ehr009
12. Hannan EL, Samadashvili Z, Cozzens K, et al. Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State. Circ Cardiovasc Interv. 2014;7(1):19-27. doi: 10.1161/
CIRCINTERVENTIONS.113.000741
13. Sato A, Hiroe M, Tamura M, et al. Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging. J Nucl Med. 2008;49(4):564-72. doi:
jnumed.107.042481/10.2967/jnumed.107.042481
14. Gaemperli O, Schepis T, Valenta I, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology. 2008;248(2):414-23. doi: 2482071307/10.1148/radiol.2482071307
15. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283-91. doi: 10.1161/CIRCULATIONAHA. 107.743963
16. Аншелес А.А., Шульгин Д.Н., Соломяный В.В. и др. Сопоставление результатов нагрузочных проб, данных однофотонной эмиссионной компьютерной томографии миокарда и коронарографии у больных ишемической болезнью сердца. Кардиологический вестн. 2012;2:10-6 [Ansheles AA, Shulgin DN, Solomyany VV, et al. Comparison of the results of stress tests, single photon emission computed tomography and coronary angiography in patients with coronary heart disease. Kardiologicheskij vestn. 2012;2:10-6 (In Russ.)].
17. Djaberi R, Roodt J, Schuijf JD, et al. Endothelial dysfunction in diabetic patients with abnormal myocardial perfusion in the absence of epicardial obstructive coronary artery disease. J Nucl Med. 2009;50(12):1980-6. doi: 10.2967/jnumed.109.065193
18. Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. Eur Heart J. 2015;36(45):3182-8. doi: 10.1093/eurheartj/ehv452
19. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49(21):2105-11. doi: 10.1016/j.jacc.2007.01.087
20. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl
J Med. 2009;360(3):213-24. doi: 10.1056/NEJMoa0807611
21. Van Nunen LX, Zimmermann FM, Tonino PA, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet. 2015;386(10006):1853-60. doi: 10.1016/S0140-6736(15)00057-4
22. Ko DT, Guo H, Wijeysundera HC, et al. Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012;60(19):1876-84. doi: 10.1016/j.jacc.2012.06.056
23. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018. doi: 10.1093/eurheartj/ehy394
24. Min JK, Chandrashekhar Y. Atherosclerosis, Stenosis, and Ischemia: One Primary, One Secondary, and One Tertiary. JACC Cardiovasc Imaging. 2018;11(4):531-3. doi: 10.1016/j.jcmg.2017.12.006
25. Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97(6):535-43.
26. Shaw LJ, Hendel R, Borges-Neto S, et al. Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med. 2003;44(2):134-9.
27. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011;32(8):1012-24. doi: 10.1093/eurheartj/ehq500
28. Boiten HJ, van den Berge JC, Valkema R, et al. Ischemia burden on stress SPECT MPI predicts long-term outcomes after revascularization in stable coronary artery disease. J Nucl Cardiol. 2018;25(3):958-66. doi: 10.1007/s12350-016-0735-5
29. Simonsen JA, Mickley H, Johansen A, et al. Outcome of revascularisation in stable coronary artery disease without ischaemia: a Danish registry-based follow-up study. BMJ Open. 2017;7(8):e016169. doi: 10.1136/bmjopen-2017-016169
30. Farzaneh-Far A, Phillips HR, Shaw LK, et al. Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging. 2012;5(7):715-24.
doi: 10.1016/j.jcmg.2012.01.019
31. Kim YH, Ahn JM, Park DW, et al. Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol. 2012;60(3):181-90.
doi: 10.1016/j.jacc.2012.02.061
32. Johnson NP, Gould KL. Fractional Flow Reserve Returns to Its Origins: Quantitative Cardiac Positron Emission Tomography. Circ Cardiovasc Imaging. 2016;9(9). doi: 10.1161/CIRCIMAGING.116.005435
33. Melikian N, De Bondt P, Tonino P, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv. 2010;3(3):307-14. doi: 10.1016/j.jcin.2009.12.010
34. Van de Hoef TP, van Lavieren MA, Damman P, et al. Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity. Circ Cardiovasc Interv. 2014;7(3):301-11. doi: 10.1161/CIRCINTERVENTIONS.113.001049
35. Genders TS, Steyerberg EW, Hunink MG, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012;344:e3485. doi: 10.1136/ BMJ.e3485
________________________________________________
2. Stable ischemic heart disease. Clinical guidelines. 2016. http://cr.rosminzdrav.ru/#!/
recomend/133 (In Russ)
3. Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American
Association for Thoracic Surgery, Preventive Cardiovascular Nurses
Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-67. doi: 10.1161/CIR.0000000000000095
4. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. doi: 10.1093/eurheartj/eht296
5. Adamson PD, Newby DE, Hill CL, et al. Comparison of International Guidelines for Assessment of Suspected Stable Angina: Insights From the PROMISE and SCOT-HEART. JACC Cardiovasc Imaging. 2018;11(9):1301-10. doi: 10.1016/j.jcmg.2018.06.021
6. Foldyna B, Udelson JE, Karady J, et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019;20(5):574-81. doi: 10.1093/ehjci/jey182
7. Reeh J, Therming CB, Heitmann M, et al. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J. 2019;40(18):1426-35. doi: 10.1093/eurheartj/ehy806
8. Verberne HJ, Acampa W, Anagnostopoulos C, et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging. 2015;42(12):1929-40. doi: 10.1007/s00259-015-3139-x
9. Jespersen L, Abildstrom SZ, Hvelplund A, et al. Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study. PLoS One. 2014;9(4):e93170. doi: 10.1371/journal.pone.0093170
10. Patel MR, Dai D, Hernandez AF, et al. Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J. 2014;167(6):846-52e2. doi: 10.1016/j.ahj.2014.03.001
11. Johnston N, Schenck-Gustafsson K, Lagerqvist B. Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain? Eur Heart J. 2011;32(11):1331-6. doi: 10.1093/eurheartj/ehr009
12. Hannan EL, Samadashvili Z, Cozzens K, et al. Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State. Circ Cardiovasc Interv. 2014;7(1):19-27. doi: 10.1161/
CIRCINTERVENTIONS.113.000741
13. Sato A, Hiroe M, Tamura M, et al. Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging. J Nucl Med. 2008;49(4):564-72. doi: jnumed.107.042481/10.2967/jnumed.107.042481
14. Gaemperli O, Schepis T, Valenta I, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology. 2008;248(2):414-23. doi: 2482071307/10.1148/radiol.2482071307
15. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283-91. doi: 10.1161/CIRCULATIONAHA. 107.743963
16. Ansheles AA, Shulgin DN, Solomyany VV, et al. Comparison of the results of stress tests, single photon emission computed tomography and coronary angiography in patients with coronary heart disease. Kardiologicheskij vestn. 2012;2:10-6 (In Russ.)
17. Djaberi R, Roodt J, Schuijf JD, et al. Endothelial dysfunction in diabetic patients with abnormal myocardial perfusion in the absence of epicardial obstructive coronary artery disease. J Nucl Med. 2009;50(12):1980-6. doi: 10.2967/jnumed.109.065193
18. Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. Eur Heart J. 2015;36(45):3182-8. doi: 10.1093/eurheartj/ehv452
19. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49(21):2105-11. doi: 10.1016/j.jacc.2007.01.087
20. Tonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl
J Med. 2009;360(3):213-24. doi: 10.1056/NEJMoa0807611
21. Van Nunen LX, Zimmermann FM, Tonino PA, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet. 2015;386(10006):1853-60. doi: 10.1016/S0140-6736(15)00057-4
22. Ko DT, Guo H, Wijeysundera HC, et al. Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012;60(19):1876-84. doi: 10.1016/j.jacc.2012.06.056
23. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018. doi: 10.1093/eurheartj/ehy394
24. Min JK, Chandrashekhar Y. Atherosclerosis, Stenosis, and Ischemia: One Primary, One Secondary, and One Tertiary. JACC Cardiovasc Imaging. 2018;11(4):531-3. doi: 10.1016/j.jcmg.2017.12.006
25. Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97(6):535-43.
26. Shaw LJ, Hendel R, Borges-Neto S, et al. Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med. 2003;44(2):134-9.
27. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011;32(8):1012-24. doi: 10.1093/eurheartj/ehq500
28. Boiten HJ, van den Berge JC, Valkema R, et al. Ischemia burden on stress SPECT MPI predicts long-term outcomes after revascularization in stable coronary artery disease. J Nucl Cardiol. 2018;25(3):958-66. doi: 10.1007/s12350-016-0735-5
29. Simonsen JA, Mickley H, Johansen A, et al. Outcome of revascularisation in stable coronary artery disease without ischaemia: a Danish registry-based follow-up study. BMJ Open. 2017;7(8):e016169. doi: 10.1136/bmjopen-2017-016169
30. Farzaneh-Far A, Phillips HR, Shaw LK, et al. Ischemia change in stable coronary artery disease is an independent predictor of death and myocardial infarction. JACC Cardiovasc Imaging. 2012;5(7):715-24.
doi: 10.1016/j.jcmg.2012.01.019
31. Kim YH, Ahn JM, Park DW, et al. Impact of ischemia-guided revascularization with myocardial perfusion imaging for patients with multivessel coronary disease. J Am Coll Cardiol. 2012;60(3):181-90.
doi: 10.1016/j.jacc.2012.02.061
32. Johnson NP, Gould KL. Fractional Flow Reserve Returns to Its Origins: Quantitative Cardiac Positron Emission Tomography. Circ Cardiovasc Imaging. 2016;9(9). doi: 10.1161/CIRCIMAGING.116.005435
33. Melikian N, De Bondt P, Tonino P, et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv. 2010;3(3):307-14. doi: 10.1016/j.jcin.2009.12.010
34. Van de Hoef TP, van Lavieren MA, Damman P, et al. Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity. Circ Cardiovasc Interv. 2014;7(3):301-11. doi: 10.1161/CIRCINTERVENTIONS.113.001049
35. Genders TS, Steyerberg EW, Hunink MG, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012;344:e3485. doi: 10.1136/ BMJ.e3485
Авторы
А.А. Аншелес1, И.В. Сергиенко1, Е.И. Денисенко-Канкия2, В.Б. Сергиенко1
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница №4» Департамента здравоохранения г. Москвы, Москва, Россия
1 National Medical Research Center for Cardiology, Moscow, Russia;
2 City Clinical Hospital №4, Moscow, Russia
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ГБУЗ «Городская клиническая больница №4» Департамента здравоохранения г. Москвы, Москва, Россия
________________________________________________
1 National Medical Research Center for Cardiology, Moscow, Russia;
2 City Clinical Hospital №4, Moscow, Russia
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.