Doppler Echocardiographic Methods Research Articles

Hemodynamic Doppler echocardiographic evaluation of permanent His bundle and biventricular pacing after AV nodal ablation.

placing after atrioventricular (AV) nodal ablation for permanent atrial fibrillation (AF) may include cardiac resynchronization therapy (CRT) with either His bundle pacing (HBP) or biventricular pacing (BVP), or conventional single site right ventricular apical pacing (RVAP). To determine the relationship between pacing method and hemodynamic outcome, we used Doppler echocardiographic methods to evaluate left ventricular (LV) hemodynamics after AV nodal ablation and either HBP, BVP, or RVAP.Method20 patients were evaluated > 6 months after AV nodal ablation, 10 each with chronic HBP or BVP, and all with RVAP lead. Doppler echocardiography was used to measure 3 parameters indicative of CRT: 1) LV dP/dt, 2) the LV pre-ejection interval, and 3) myocardial performance index, relative to intra-patient RVAP.ResultsPrimary endpoint of LV dP/dt on average improved by > 17% with both HBP and BVP, compared to RVAP. HBP but not BVP, had improvement across all three parameters.ConclusionHBP provides LV electromechanical synchrony across multiple echo Doppler parameters. Both HBP and BVP were hemodynamically superior to RVAP following AV nodal ablation.

Prognostic value of selected one-, two- and three-dimensional and Doppler echocardiographic methods to assess severity in dogs with myxomatous mitral valve disease

IntroductionAlthough challenging, predicting outcomes in dogs with myxomatous mitral valve disease (MMVD) is of importance to owners and veterinarians. Our aim was to compare the prognostic value of selected one-, two-, and three-dimensional and Doppler echocardiographic methods to predict cardiac-related and all-cause mortality in MMVD dogs. We hypothesize that three-dimensional methods would better predict prognosis than one- and two-dimensional methods. AnimalsOne-hundred thirty-eight privately-owned dogs with MMVD. Materials and methodsCox proportional Hazard analyses and Kaplan–Meier curves were used to investigate the predictive value of 14 variables; left atrial (LA) volume indexed to body weight (BW) measured by real-time three-dimensional echocardiography (RT3DE) and calculated using Simpson's modified method of discs (SMOD) and the area-length method; LA diameter in short-axis and long-axis to aortic in short-axis ratio, effective regurgitant orifice area indexed to body surface area measured in RT3DE en face view and calculated using four-chamber (4Ch) and two-chamber views alone or in combination; percentage increase in left ventricular end-diastolic and systolic internal diameters; fractional shortening; E wave velocity; regurgitant jet area/LA area. ResultsAll 14 variables were significantly predictive of cardiac-related mortality, and 11 were predictive of all-cause mortality. The prognosis was best predicted by LA volume/BW estimated by SMOD or RT3DE, consistently showing the highest predictive value in all analyses. ConclusionsLeft atrial volume calculated by SMOD showed a similar predictive value compared to RT3DE. Performing SMOD from apical 4Ch images should be considered an alternative to RT3DE for echocardiographic examinations where prognostication of disease outcome is sought.

English

BACKGROUND Sickle cell disease is the commonest haemoglobinopathy. Recent advanced therapeutic approaches are enabling the sickle cell patients to survive beyond adulthood. METHODS The study provides important data on cardiovascular abnormalities in sickle cell disorder in Chhattisgarh by employing a non-invasive method of two-dimensional colour Doppler echocardiography. RESULTS The present study suggests that sickle cell disease has association with left ventricular diastolic dysfunction and pulmonary artery hypertension and no association with other echocardiographic findings including left ventricular dimensions and functions. The association is further affected by the presence of moderate to severe anaemia (haemoglobin < 8.9 gm %), higher urea (> 19 mg / dL), creatinine (0.8 mg / dL) and diastolic blood pressures (< 69 mmHg). The age, gender and systolic blood pressures of the subject were not found to impact echocardiographic parameters. CONCLUSIONS The present study suggests that sickle cell disease affects left ventricular diastolic dysfunction and pulmonary artery hypertension but does not affect the other echocardiographic dimensions and functions. The association is further affected by the presence of moderate to severe anaemia, higher urea, creatinine and diastolic blood pressures. The age, gender and systolic blood pressure do not influence echocardiographic parameters. KEY WORDS Adult, Sickle Cell Disease, Echocardiography, Ventricular Function, Anaemia

Angiotensin II blockers improve cardiac coronary flow under hemodynamic pressure overload.

Coronary flow velocity (CFV) is reduced in pathologic cardiac hypertrophy. This functional reduction is linked to adverse cardiac remodeling, hypertension and fibrosis, and angiotensin II (AngII) is a key molecular player. Angiotensin receptor blockers (ARBs) are known to attenuate adverse cardiac remodeling and fibrosis following increased afterload, while the mechanism by which these drugs offer clinical benefits and regulate hemodynamics remains unknown. To establish a direct connection between coronary flow changes and angiotensin-induced hypertension, we used a Doppler echocardiographic method in two distinct disease models. First, we performed serial echocardiography to visualize coronary flow and assess heart function in patients newly diagnosed with hypertension and currently on ARBs or calcium channel blockers (CCBs). CFV improved significantly in the hypertensive patients after 12 weeks of ARB treatment but not in those treated with CCBs. Second, using murine models of pressure overload, including Ang II infusion and aortic banding, we mimicked the clinical conditions of Ang II- and mechanical stress-induced hypertension, respectively. Both Ang II infusion and aortic banding increased the end-systolic pressure-volume relationship and cardiac fibrosis, but interestingly, only Ang II infusion resulted in a significant reduction in CFV and corresponding activation of pressure-sensitive proteins, including connective tissue growth factor, hypoxia-inducible factor 1α and signal transducer and activator of transcription 3. These data support the existence of a molecular and functional link between AngII-induced hemodynamic remodeling and alterations in coronary vasculature, which, in part, can explain the clinical benefit of ARB treatment in hypertensive patients.

Aortic Insufficiency During HeartMate 3 Left Ventricular Assist Device Support

BackgroundAortic insufficiency (AI) is associated with morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs), whereas its impact on the HeartMate 3 LVAD cohorts remains uninvestigated. We aimed to investigate the clinical impact of AI on patients with HeartMate 3 LVADs. Methods and ResultsConsecutive 61 patients (median age 54 years; 67% male) implanted with HeartMate 3 LVAD between 2015 and 2019 were enrolled and underwent echocardiography at 3 months after LVAD implantation. AI severity was quantified by the novel Doppler echocardiographic method obtained at the outflow cannula and the calculated regurgitation fraction of 30% or greater (moderate or greater) was defined as significant. At 3 months after implant, 12 patients (20%) had significant AI. They had a higher incidence of death or heart failure readmissions compared with those without significant AI during a 1-year observational period (70% vs 24%, P = .003) with an adjusted hazard ratio of 2.76 (95% confidence interval 1.03–7.88). ConclusionsIn patients with HeartMate 3 LVAD support, significant AI remains both prevalent and a clinically significant downstream complication.

In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method

Doppler echocardiographic methods, such as the proximal isovelocity surface area (PISA) method, are used to quantify mitral regurgitations (MRs). However, their accuracy and reproducibility are still being discussed, especially in the case of MR of complex geometry. The aim of this study was to evaluate the accuracy of the PISA method depending on the shape and number of regurgitant flows. First, various MR shapes and severities (central, oblong, and multiple-jet MR) were mimicked in a left heart simulator. The effective regurgitant orifice area (EROA) was calculated using the standard and modified PISA methods and was compared to a reference value obtained from an electromagnetic flowmeter. Second, in order to clinically validate the invitro findings, 16 patients were examined with two-dimensional (2D) echocardiography. The results were analyzed by comparing the PISA method and the echocardiographic 2D quantitative volumetric method. Both hemicylindrical and hemiellipsoidal PISA assumptions improved the quantification of the EROA for oblong MR compared with the traditional PISA method (hemispherical PISA assumption: 11±4.6mm2, P<.01; hemicylindrical PISA assumption: 2±0.8mm2, P=.83; hemiellipsoidal PISA assumption: 6±3.7mm2, P=.05). In the case of multiple jets of different sizes, an improved EROA calculation was measured when both jets were considered (single hemispherical PISA assumption: 4.5±0.7mm2, P<.01; double hemispherical PISA assumption: 2±1.1mm2, P=.64). For a correct diagnosis of MR, the PISA geometry must be considered. A measurement of both PISA radius and PISA width is necessary for an accurate quantification of an oblong MR. In the case of a double-jet MR, a measurement of the two radii is recommended.

OPTIMIZATION ATRIOVENTRICULAR DELAY USING ECHO FOR CARDIAC RESYNCHRONIZATION THERAPY PATIENTS

Objective: To determine correlation of echo-doppler optimization of atrioventricular delay in cardiac resynchronization therapy with left ventricular invasive hemodynamics optimization. Methods: Intervention prospective study. Result: In 30 patients(50% female, mean age 63.5 ± 11.8; 70% NYHA III, the rest is NYHA IV with LVEF= 27.1 ± 6.1%, sinus rhythm, QRS wide is 159 ± 17 ms) who underwent CRT. AVsense optimization were determined by invasive LV dP/dtmax, and the Doppler echocardiographic methods evaluated were the velocity–time integral (VTI) of the transmitralflow (EA VTI), the VTI of the LV outflow tractor aorta (LV VTI). The result are 114.8 ± 10 ms; 116.1 ± 8.8 ms and 115.1 ± 10.3 ms, prospectively. The optimal AVsense delay with the EA VTI method was most concordant with LV dP/dtmax (r=0.947), LV VTI was less concordant (r=0.504). The result of AVpace optimization by three methods are 158 ± 15.1 ms; 158.6 ± 13.5 ms and 161.3 ± 12.2 ms, prospectively. The optimal AVpace delay with the EA VTI method was most concordant with LV dP/dtmax(r=0.0907), LV VTI was less concordant (r = 0.646). Conclusions: Comparing with invasive LV dP/dtmax, measurement of the maximal VTI of mitral inflow is more concordant than LV VTI in AVsense and AVpace optimization. If we optimize AVsense and AVpace, for replacing invasive LV dP/dtmax, EA VTI method was better option Key words: CRT, optimization

P343 Evaluation of the age-related reference values of aortic pulse wave velocity in healthy subjects using Doppler echocardiography

Abstract Introduction Aortic pulse wave velocity (aPWV) is a measure of aortic stiffness, which is an indicator of vascular aging and has established independent prognostic role in predicting cardiovascular complications. aPWV can be measured with various non-invasive methods, but with different reference values depending on the technique used. The Doppler echocardiography method is potentially widely accessible and has been recently showed to have high correlation with invasive reference method of aPWV based on intraarterial pressure evaluation. Purpose The aim of the study was to establish reference values of aPWV, measured by Doppler method during a standard echocardiography in healthy subjects. Methods 121 healthy adults, normotensive, non-smoking, without chronic diseases and not taking medication, were included. All the patients were divided into 5 groups due to age criterion (D1-age 21-30 yrs., n = 33; D2-age 31-40 yrs., n= 23; D3-age 41-50 yrs., n = 26; D4-age 51-60 yrs., n = 22; and D5-age 61-70 yrs., n = 17). During a routine echocardiographic examination with a cardiac probe, standard echocardiographic and anthropometric parameters were acquired. Additionally, 10 Doppler waveforms were recorded in the distal aortic arch and then in the left external iliac artery. The transit time was calculated as a difference between time delay of the two points of the Doppler recordings relative to ECG signal. The distance between proximal and distal points was measured over the body surface using a flexible measuring tape. aPWV values were calculated according to the formula: PWV = distance/transit time. Results The mean age of the studied group was 42 ± 13 yrs., BMI 24.5 ± 3.4, SBP 123 ± 10.39 mm Hg, DBP 76.98 ± 6.53 mm Hg, HR 64 ± 10 bpm. aPWV 5.28 ± 1.07; LVEDD 4.6 ± 0.4 cm; LA 3.65 ± 0.33 cm; aorta 3.26 ± 0.38 cm; LVMI 87.12 ± 15.00 g/m2. In the studied subjects, aPWV did not differ according to sex (females, n = 53, aPWV 5.38 ± 1.21 m/s vs. males, n = 68, aPWV 5.21 ± 0.94 m/s, p = 0.37). In the multivariate linear regression analysis only age and SBP were independently associated with aPWV, but none of the echocardiographic parameters studied. Mean aPWV values with 95% confidence interval (95%CI) for each decade of life were recorded as follows: D1-age 21-30, aPWV 4.56 m/s (95%CI 4.41 to 4.72), D2-age 31-40, aPWV 4.65 m/s (95%CI 4.37 to 4.94), D3-age 41-50, aPWV 5.15 m/s (95%CI 4.88 to 5.43), D4-age 51-60, aPWV 5.96 m/s (95%CI 5.54 to 6.38), D5-age 61-70, aPWV 6.88 m/s (95%CI 6.42 to 7.34). Conclusions We report age-related values of aPWV in a healthy population measured by Doppler echocardiography method. This may be helpful in future research exploring the associations between aortic stiffness, cardiac function and cardiovascular prognosis in a large population of patients referred for echocardiography.

Is Doppler echocardiography useful for estimating left ventricular filling pressures in pediatric heart transplant recipients?

LV E/E' ratio obtained using Doppler echocardiography is considered a surrogate for LV filling pressure in adults but has performed poorly in children. We hypothesized that LV E/E' ratio Z-score, adjusted for age, will relate more strongly to LV filling pressures than LV E/E' ratio in pediatric HT recipients. We analyzed 751 echocardiograms performed within 24hours of a heart catheterization in 122 pediatric HT recipients (median age at HT 13years, median 6 studies per patient). The primary end-point was PCWP, assessed both as a continuous and a binary variable. Associations with LV E/E' ratios and z-scores were assessed using generalized estimating equations models. PCWP, LV E/E' ratios (using E' from LV free wall, septum, and their average), and LV E/E' ratio Z-scores, all declined over time after HT. LV E/E' ratios and their Z-scores were significantly associated with PCWP assessed as a continuous variable (P<0.001 for all); however, the relationship was weak (R2 range, 0.083 to 0.121). LV E/E' ratios and their Z-scores were also significantly associated with PCWP as a binary variable (P<0.001 for all) but with only modest ability to discriminate PCWP ≥15mmHg (c-statistic range, 0.660 to 0.695). The association between LV E/E' ratio and PCWP in pediatric HT recipients is modest. Using a LV E/E' ratio Z-score did not result in significantly improved association with PCWP. Current Doppler echocardiographic methods are unreliable for estimating LV filling pressures in pediatric HT recipients.

Improvement of the PISA method in the setting of mitral regurgitation of complex geometry

Doppler echocardiographic methods, such as proximal isovelocity surface area (PISA) are used to quantify mitral regurgitations (MR). However, their accuracy and reproducibility are still discussed, especially in case of MR of complex geometry. The aim of this study was to test in-vitro the accuracy of the PISA method depending on the shape and number of regurgitant flows. Several regurgitant volumes (RV) were produced through various regurgitation severities and shapes in a left heart double activation simulator. Central and oblong MR were performed by suturing the extremity of a bioprosthesis leaflet to the annulus. Multiple jets regurgitation was performed by suturing centrally the two leaflets of an anatomically shaped mitral valve made of hydrogel. A transesophageal echocardiography probe was used to acquire the data. The RV was calculated with the classical PISA method (hemispheric assumption), or by considering the PISA as a hemicylinder or a double hemisphere. It was then compared to a reference value obtained from an electromagnetic flowmeter measurement (accuracy ± 2 ml/min). For a central jet, the hemispheric assumption best estimated the RV (bias − 3.5 ± 14.8 ml, P = 0.10). Oblong MR was underestimated with hemispheric assumption (−18.3 ± 14.9 ml, P < 0.01) whereas hemicylindrical assumption was more accurate (−0.2 ± 5.8 ml, P = 0.85). In case of 2 regurgitant jets, considering only the largest jet led to an important underestimation (−10.9 ± 5.6 ml, P < 0.01), whereas adding the two RV was more accurate (−1.2 ± 8.2 ml, P = 0.50). In case of a single central orifice, the hemispheric assumption correctly quantified the MR. In case of an oblong orifice, the hemicylindrical assumption provided a good quantification with simple measurements. In case of multiple jets of different sizes, it was more accurate to consider both jets for RV calculation.

Methodical, Diagnostic and Prognostic Aspects Using Transmitral Blood Flow Indicators as Markers of Diastolic Dysfunction During the Progression of Chronic Heart Failure

The objective: to evaluate changes in transmitral blood flow indices asmarkers of myocardial diastolic function using Doppler echocardiography with an increase in the severity of chronic heart failure (CHF).Materials and methods. 84 patients with CHF II-III FC were examined. Evaluation of left ventricular (LV) diastolic function was carried out by the Doppler-echocardiography method in pulsed mode on a Toshiba SSH-160A apparatus (Japan) using a 3.5 MHz transducer based on transmitral diastolic blood flow.Results. The analysis showed that if in patients with CHF II FC,LV myocardial hypertrophy dominates in the pathogenesis, then in patients with CHF III FC there is systolic dysfunction. The main pathogenetic factor in the increase in the severity of CHF from II to III FC is diastolic dysfunction.Conclusion. In patients with CHF II FC in an intact left atrium, impaired transmitral diastolic blood flow occurs in the «slow relaxation» mode. Patients with CHF II FC against the background of an increased size of the left atrium, especially in the presence of post-infarction cardiosclerosis and arrhythmias, are diagnosed with a «pseudonormal» type of transmitral blood flow. The majority of patients with CHF III FC are diagnosed with a «restrictive» type of transmitral blood flow.

Nimura lecture: "Three EBMs".

The three EBMs in the title refer to the following concepts: evidence-based medicine, experience-based medicine, and echo-based medicine. Evidence-based medicine: I have carried out the following clinical research using transthoracic Doppler echocardiography: (1) noninvasive pulsed-wave Doppler echocardiographic detection of the direction of shunt flow in patients with atrial septal defect: usefulness of the right parasternal approach (1985), (2) significance of laminar systolic regurgitant flow in patients with tricuspid regurgitation: a combined pulsed-wave, continuous-wave, and two-dimensional echocardiography (1990), (3) obstruction of the inferior vena caval orifice by the giant left atrium in patients with mitral stenosis: a Doppler echocardiographic study from the right parasternal approach (1992), and (4) demonstration of a localized acceleration flow signal in the transmural penetrating coronary artery using transthoracic color and pulsed-wave Doppler echocardiography in patients with hypertrophic cardiomyopathy (1996-2017). Experience-based medicine: Dr. Eugene Braunwald says "The best book of cardiology is the patient itself." I have conducted my modest research activities gleaning hints through day-to-day routine work and sometimes investigating experimentally using the Doppler echocardiographic method. I have also learned from the Japanese Society of Echocardiography that a physician should stand between evidence-based medicine and experience-based medicine. Echo-based medicine: This term is intended to express my personal determination. I believe that echocardiography is the stethoscope of the 21st century. It is a safe, painless, low-cost, and repeatable tool at the bedside. I expect that echocardiography can reduce unnecessary healthcare costs and appropriately select reasonable examinations for patients. I would like to devote the time left in my career to the study of cardiovascular medicine, believing in the power of echocardiography and the Doppler method to provide a link between evidence-based medicine and experience-based medicine.

Left ventricular dysfunction by conventional and tissue Doppler echocardiography in pediatric hemodialysis patients: relation with plasma brain natriuretic peptide levels.

IntroductionTissue Doppler imaging (TDI) is a relatively new echocardiography method in children with chronic kidney disease (CKD). The aims of this study were to evaluate left ventricular (LV) diastolic function in pediatric CKD patients using conventional pulsed-wave Doppler echocardiography (cPWD) and TDI methods and correlate them with BNP levels.Material and methodsThirty children on regular hemodialysis (HD) were included. Left ventricular systolic and diastolic indices and BNP levels were measured immediately before and after HD.ResultsAfter HD, LV and left atrium diameters were significantly decreased (p < 0.001 and p < 0.001, respectively). Transmitral E velocity and E/A ratio decreased (p < 0.001 and p < 0.001, respectively). Also, there were significant decreases in the early diastolic velocity E’ of LV wall, septal wall, and anterior wall (p = 0.001, p = 0.004 and p < 0.001, respectively). Mean E/E’ ratio and ratios of septal and lateral walls were decreased significantly (p = 0.004, p = 0.002 and p = 0.017, respectively). BNP levels decreased significantly during HD when comparing concentrations before and after HD (p < 0.001). BNP strongly correlated with LV diastolic function indices (before HD: mean E/E’ (r = 0.401, p = 0.028), lateral E/E” (r = 0.291, p = 0.025), septal E’(r = –0.398, p = 0.029), lateral wall E’ (r = –0.452, p = 0.012) and mean E’ (r = –0.469, p = 0.009), after HD: mean E/E’ (r = 0.38, p = 0.038) and lateral E/E” (r = 0.474, p = 0.008) and lateral wall E’ (r = –0.270, p = 0.037)).ConclusionsThe cPWD and TDI-derived LV indices are influenced by HD. The diagnostic utility of BNP in the presence of deteriorating renal function may be compromised to some extent.

OPTIMIZATION ATRIOVENTRICULAR DELAY USING ECHOGRAPHY FOR CARDIAC RESYNCHRONIZATION THERAPY PATIENTS

Objective: To determine correlation of echo-doppler optimization of atrioventricular delay in cardiac resynchronization therapy with left ventricular invasive hemodynamics optimization. Methods: Intervention prospective study. Result: In 25 patients (48% female, mean age 6.1±10.6, had diagnosis heart failure NYHA IIIV with LVEF= 26.9±5.7%, sinus rhythm, QRS wide is 170±22.1 ms) who underwent CRT. AVsense optimization were determined by invasive LV dP/dtmax, and the Doppler echocardiographic methods evaluated were the velocity–time integral (VTI) of the transmitralflow (EA VTI), the VTI of the LV outflow tractor aorta (LV VTI). The result are 117.8±15.2ms; 117.2±14.5ms and 120.8 ± 12.8ms, prospectively. The optimal AVsense delay with the EA VTI method was most concordant with LV dP/dtmax(r=0,953), LV VTI was less concordant (r=0.568). The result of AVpace optimization by three methods are 159.6±17.9ms; 159±16.2ms và 165±13.8ms, prospectively. The optimal AVpace delay with the EA VTI method was most concordant with LV dP/dtmax (r=0.964), LV VTI was less concordant (r=0.734). Conclusions: Comparing with invasive LV dP/dtmax, measurement of the maximal VTI of mitral inflow is more concordant than LV VTI in AVsense and AVpace optimization. If we optimize AVsense and AVpace, for replacing invasive LV dP/dtmax, EA VTI method was better option. Key words: Dyssychronization, CRT, optimization, dP/dtmax

A Simple Method for Noninvasive Quantification of Pressure Gradient Across the Pulmonary Valve

Pressure gradient across the pulmonary valve (PVPG) is an important hemodynamic variable used in the management of patients with cardiovascular and pulmonary disease. However, a reliable noninvasive method is unavailable. We hypothesized that a progressive Muller maneuver would elicit the pulmonary valve premature opening (PVPO) in diastole and that this event would be detectable by Doppler echocardiography. The intrathoracic pressure (ITP) decrease during this maneuver equals PVPG, which may be assessed with a custom airway pressure measurement device. A total of 102 subjects were enrolled in the study. At the earliest appearance of PVPO, the ITP decrease was recorded as the PVPG. PVPG was also simultaneously measured and compared by other two methods: right heart catheterization in 43 subjects, and routine Doppler echocardiography (pulmonary regurgitation jet) in the other 59 subjects. The results measured by different approaches were compared using the Bland-Altman analysis. PVPG assessed via PVPO showed strong agreement with PVPG measured by catheterization or routine Doppler echocardiography methods, with Lin concordance correlation coefficients of 0.91 and 0.70, respectively. In conclusion, PVPO provides a new noninvasive method of quantification of PVPG.

FORENSIC MEDICAL ASSESSMENT OF CERVICAL SPINE TRAUMAS WITH THE ACCOUNT OF CHANGES IN CENTRAL HEMODYNAMICS

The article analyzes the up-to-date state and problematic issues of forensic medical diagnosis of cervical spine injuries. It establishes that there are cases when forensic medical experts underestimate the outcomes and consequences of this trauma. It studies the state of the central hemodynamics of the injured with cervical spine traumas. At the same time 107 injured were divided into two groups: with clear and moderate manifestations. The research applied an objective and modern method of Doppler echocardiography. The conducted research has demonstrated significant changes in extraand intracerebral blood flow. The results of the comparative analysis show that forensic medical assessment of cervical spine traumas should take into account the results of Doppler echocardiography. Among these results the most informative are functional changes of the cerebral and spinal arteries. The manifestation of these deviations is determined, primarily, by the severity and time of injuries. The article determines the ways of improving forensic medical examinations of the injured with cervical spine traumas. It demonstrates the criteria significance of changes in bloodflow of cerebral and cervical arteries of the injured while establishing the severity of injuries.

Cardiovascular Involvement in Behçet's Disease

Objectives: This study aims to evaluate left and right ventricular functions at rest by pulsed-wave Doppler and tissue Doppler echocardiography methods in patients with Behcet’s disease (BD) without overt cardiovascular disease, and compare with age and sex matched subjects. Patients and methods: Fifty-four patients with BD (12 males, 42 females; mean age 35±8 years; range 18 to 51 years) without cardiovascular symptoms, and 36 age-matched controls (12 males, 24 females; mean age 33±5 years; range 18 to 47 years) were included. Cardiac functions were evaluated by conventional and tissue Doppler echocardiography. Results: Although conventional indices of left ventricular systolic function were similar in both groups, mitral annular systolic velocity was lower (p<0.001) and myocardial performance index was higher (p<0.001) in patients with BD compared to the controls. As an early diagnostic marker of contractile dysfunction, intra- and interventricular dyssynchrony were more common in patients with BD. In addition, mitral E/A ratio of <1 was more common (p<0.001), isovolumic relaxation time (p=0.032) and mitral deceleration time (p=0.037) were longer in patients with BD compared to the control group. All Doppler parameters of right ventricular function were impaired in patients with BD. Atrial septal aneurysm was more frequent in patients with BD than controls (p=0.007). Conclusion: Right ventricular and left ventricular function is impaired in patients with BD. Clinically silent cardiovascular involvement can be detected early by tissue Doppler echocardiography even in asymptomatic patients with BD.

Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus with or without anticardiolipin antibodies.

The aim of this study was to use transthoracic Doppler echocardiographic (TTE) imaging methods to identify cardiac dysfunction, an indicator of subclinical atherosclerosis in asymptomatic systemic lupus erythematosus (SLE) patients in terms of cardiac effects. This study involved 80 patients: a study group (n = 50) and control group (n = 30). They were categorized into four subgroups: anticardiolipin antibodies (aCL) (+) (n = 14) and aCL (-) (n = 36); systemic lupus erythematosus disease activity index (SLEDAI) ≥ 6 (n = 15) and SLEDAI < 6 (n = 35); disease period ≥ 5 years (n = 21) and disease period < 5 years (n = 29); major organ involvement (+) (n = 19), major organ involvement (-) (n = 31). The ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E') for the study group was found to be higher than the control (p < 0.01). Systolic septal motion velocity (Ssm) was lower in the study group compared with the control (p < 0.01). Left atrium (LA) dimension was greater in the study group than the control (p < 0.01). Ssm was found to be lower in the aCL (+) patients compared with the control and aCL (-) groups (p < 0.01, p < 0.05, respectively). LA dimension was greater in the aCL (+) and (-) groups compared with the control, (p < 0.01, p < 0.05, respectively) and aCL groups compared with each other (p < 0.05). The E/E' ratio for the aCL (+) and (-) groups was found to be greater than the control (p < 0.05). In the study, both the Ssm and the late diastolic septal velocity (sA') was found to be lower in the SLEDAI ≥ 6 group compared with SLEDAI<6 group, (p < 0.001, p < 0.05, respectively). LA dimension was statistically greater in the SLEDAI ≥ 6 group compared with the SLEDAI <6 group (p < 0.001). E' and early diastolic septal velocity (sE') were statistically lower in the disease period >5 years group compared with the disease period <5 years group (p < 0.01, p < 0.05, respectively). Carrying out regular scans with TTE image of SLE patients is important in order to identify early cardiac involvement during monitoring and treatment. Identifying early cardiac involvement in SLE may lead to a reduction in mortality and morbidity rates.

IMPACT OF THE ANTIVIRAL THERAPY ON CARDIAC HEMODYNAMICS IN PATIENTS WITH CHRONIC VIRAL HEPATITIS

Aim. To study the effect of antiviral therapy (AVT) on some cardiac hemodynamic parameters in patients with chronic viral hepatitis (CVH). Material and methods. Segmental systolic and diastolic functions of the ventricles as well as global diastolic function were evaluated in 25 patients with CVH by pulsed tissue Doppler mapping and by the method of Doppler echocardiography, respectively. The blood flow speed and diameter of blood vessels in liver were determined by ultrasound Doppler. Cardiac hemodynamics was examined in all patients before and after AVT with interferon in combination with ribavirin with formation of persistent virological response. Healthy people (n=19) were included into control group. Results. Reduction in atrial and ventricular sizes, decrease in left ventricular mass, improvement of systolic function of both ventricles, as well as diastolic function of the left ventricle were found in patients with CVH after specific treatment. Reduction in hepatic arterial and portal blood flow speed and a total number of heart rhythm disorders were also observed. Therefore AVT in patients with CVH shows a positive impact on cardiac hemodynamics. Medium-strength correlation (r=0.31; p<0.05) was identified between Еm speed at fibrous ring of mitral valve and high viral load. Strong correlation (r=0.81; p<0.05) was also found between portal vein diameter and Sm speed at fibrous ring of tricuspid valve. Conclusion. Patients with CVH that do not receive AVT have worse prognosis and indicators of cardiac hemodynamics in comparison with patients who receive specific AVT.

EFFECT OF ANTIVIRAL THERAPY ON HEART AND LIVER HEMODYNAMICS IN PATIENTS WITH VIRAL CIRRHOSIS

Aim. To study the effect of antiviral therapy on some hemodynamic parameters of the heart and the liver in patients with viral cirrhosis. Material and methods. In 75 patients with chronic viral cirrhosis evaluation of segmental systolic and diastolic function using pulsed tissue Doppler mapping and global diastolic function by the method of Doppler echocardiography was performed. Blood flow in the veins of the liver was determined by means of ultrasonic Dopplerography. 16 patients had previously received antiviral therapy - interferon combined with ribavirin - with the formation of a sustained virologic response (1st group), the remaining 59 (2nd group) had never received antiviral therapy. The control group consisted of 19 healthy individuals. Results. In patients with chronic viral cirrhosis the increase of the left atrium, diastolic and systolic dimensions, sphericity index and left ventricle mass (p&lt;0.001) were revealed. The right ventricle increased in size with the impairment of its diastolic function and the reduction in longitudinal systolic velocity while pulmonary artery and its branches expanded with the increase of flow velocity in it (p&lt;0.001). Dilation of the splenic vein in the 1st (30%) and 2nd groups (46%) was detected as compared with the control group (p&lt;0.001). Standard deviation normal to normal (SDNN) of RR interval durations reflecting general autonomic tone increased in the 1st and 2nd groups and it was 42% and 62% lower, respectively, in comparison with this index in the control group (p&lt;0.001). These disorders prevailed in patients who were not receiving antiviral therapy, moreover, they showed acceleration of blood flow in the hepatic vein and reduction in longitudinal systolic velocity at the fibrous ring of the mitral valve (p&lt;0.001). The correlation between systolic velocity on the fibrous ring of the mitral valve, high viral load and a diameter of splenic vein was revealed. Conclusion. Evidence suggests that patients not treated with antiviral therapy have worse prognosis and hemodynamics of the heart and liver than patients who receive specific treatment.