The thesis presents a solution to the important problem of increasing the effectiveness of complex radiological diagnostics of ischemic cardiomyopathy (ICMP), the elaboration of a set of radiological criteria for optimizing patients selection for various treatment methods and assessing their effectiveness, taking into account the main forming factors of ICMP (coronary arteries involvement, left ventricular (LV) remodelling, volume of viable myocardium, functional state of the heart ventricles and the degree of mitral regurgitation). It was established, that in patients with ICMP, an extensive process of geometric remodelling with a significant increase in the end-diastolic, end-systolic LV volumes and the diameter of the left atrium exists. We found the decreased indices of the right ventricular function (TAPSE and STr) in patients with ICMP. The correlation was revealed between TAPSE and left ventricular ESV, MPI and systolic pressure in the pulmonary artery (Kendall tau -0. 40; -0. 42; -0. 48; P <0. 0001 for all), and between the TAPSE and the degree of mitral regurgitation (Kendall tau -0. 20,P = 0. 0040). An excessive LV remodelling, a higher degree of IMR, higher pulmonary artery systolic pressure and right ventricular dysfunction were found to be the predictors of lack of improvement of patient's clinical status and LV function after revascularization. Threshold levels of sonographic parameters, which were predictors of the low efficiency of revascularization, and, accordingly, predictors of the need for additional surgical interventions, have been established. Criteria of the myocardial viability (contrast transmurality extent), which predict the effect of revascularization on myocardial contractility, were established by cardiac MRI with contrast. We found that the sensitivity of the contrast transmurality extent less than 50% of the thickness of the segment in the prediction of the improvement of the myocardial function was 70. 8%, specificity - 84. 9%. Determinants of ischemic MR in patients with different localization of MI were established. In patients with anterior MI apical and posterior papillary muscles (PM) displacement, inferoapical segments akinesia, obstruction of right coronary and circumflex arteries are predictors of ischemic MR. In patients after inferoposterior MI local remodelling parameters - posterior PM tethering and anteroposterior mitral annular dilatation - are the main determinants of ischemic MR. The threshold levels of ultrasound parameters of LV remodelling and deformation of MV have been established, in which the frequency of MR in the remote period after surgery is significantly greater. The multivariant model of independent prognostic factors of ischemic MR recurrence after annuloplasty was elaborated and it included 6 parameters (MV tenting area, MV coaptation height, LV end-diastolic and end-systolic volumes, interpapillary distance and posterior displacement of posterior PM). Our multivariant model of independent predictors allows predicting MR in late period after annuloplasty with an accuracy of 94%.
