Intracardiac Hemodynamics Research Articles

Clinical results of cardiac valve repair with bicuspid full-flow mechanical prosthesis 'MedEng-ST'

Prosthetic repair of cardiac valves with artificial mechanical prostheses is ubiquitously performed using prostheses consisting of two cusps (bicuspidal). Several years ago, new bicuspid full-flow prostheses appeared on the market. From the first use they immediately proved reliable, with stable haemodynamic characteristics. At the Interregional Clinical and Diagnostic Centre, bicuspid full-flow mechanical prostheses 'MedEng-ST' have been used since 2017. We carried out a retrospective follow up of 84 patients subjected to prosthetic repair of cardiac valves with full-flow prostheses 'MedEng-ST' in mitral and aortic positions. There were no prosthesis-associated or procedural complications during follow up. Neither were there major complications in the postoperative period. All complications were related to peculiarities of the approach to the heart. We assessed the functional parameters of the heart by standard echocardiography. The obtained findings demonstrated good haemodynamic parameters on the 'MedEng-ST' prostheses, improved intracardiac haemodynamics, which eventually had a beneficial effect on the patients' clinical picture. The transprosthetic gradients had stable parameters with a decrease in time when placing the 'MedEng-ST' prosthesis into the aortic position (p≤0.05). Proceeding from the obtained results, as well as taking into account the absence of thromboembolic events it may be stated that the proposed design of the device is universal for replacement of the aortic and mitral valves of the heart. Based on the obtained findings of the study we recommend to use the 'MedEng'ST' prostheses in clinical practice. Further studies are required for more convincing data and explicit recommendations.

THE EFFECT OF BETA-BLOCKERS ON A COURSE OF CHRONIC HEART FAILURE IN PATIENTS WITH A LOW TRIIODOTHYRONINE SYNDROME

The aim: The aim is to study the effect of β-ABs in patients with LT3 S on the course of HF. Materials and methods: 354 patients with HF on a background of post-infarction cardiosclerosis were included in the 2-yeared follow-up study. LT3 S was diagnosed at 89 (25.1%) patients. The levels of thyroid-stimulating hormone, free T3f and T4f, and reversible T3 were determined. The echocardioscopy was performed. Results: Patients with HF in combination with LT3 S have a heavier functional class by NYHA, greater dilatation of the left heart cavities, less myocardial contractility, a higher frequency of atrial fibrillation and re-hospitalization. The use of β-ABs in patients with HF without LT3 S leads to a likely decrease in hospitalization frequency, while in patients with LT3 S it has an opposite effect. The frequency of rehospitalization increases with an excess of β-ABs dose > 5 mg (equivalent to bisoprolol). At these patients a decrease in serum T3 level and negative dynamics of parameters of intracardiac hemodynamics are observed. Conclusions: The use of β-ABs in patients with LT3 S leads to an increase in re-hospitalization at a dose over 5.0 mg (equivalent to bisoprolol). In these patients there is a decrease in serum T3, an increase in T4 level; and the ejection fraction decrease; and heart cavities size increase.

Three-valve reconstruction with prosthetic repair of the ascending portion of the aorta in elderly patients

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.

Comparative assessment of immediate results of mitral valve repair according to the classical technique with posterior leaflet preservation

We comparatively assessed the results of mitral valve repair according to the classical technique either with complete removal of leaflets or with the preservation of the posterior leaflet and the chordal-papillary apparatus. Depending on the variant of the operation, all patients were divided into two groups. Group One consisted of 23 patients in whom the posterior leaflet with the chordal-papillary apparatus was preserved, and Group Two comprised 23 patients in whom the mitral valve was removed completely. In the immediate postoperative period, Group One patients were found to have a decrease in the left ventricular end-systolic and end-diastolic dimensions and volumes. Similar dynamics was observed in relation to the left-atrial dimension, with a decrease in the pressure gradient across the mitral valve, pulmonary artery systolic pressure, and the degree of systolic shortening of the anterior-posterior size of the left ventricle. Group Two patients also demonstrated positive dynamics in relation to the left ventricular size and volume, the size of the left atrium and the right ventricle. The left-ventricular ejection fraction in the immediate postoperative period decreased averagely from 59.0±9.8% to 56.1±9.4%, accompanied and followed by a decrease in the pressure gradient across the mitral valve and pulmonary artery systolic pressure. The degree of systolic shortening of the anterior-posterior size of the left ventricle remained unchanged postoperatively. A conclusion was drawn that preserving the annulo-papillary continuity after mitral valve repair made it possible to achieve better functional results, normalization of the intracardiac haemodynamics, and improvement of the left-ventricle myocardial contractility. Complete removal of the subvalvular structures resulted in decreased contractility of the left ventricular myocardium.

Ефективність комбінованого препарату L-аргініну та L-карнітину в терапії пацієнтів з гострим інфарктом міокарда

Мета роботи – оцінити ефективність комбінованого препарату L-аргініну та L-карнітину (КПАК) як доповнення до стандартної терапії в пацієнтів з гострим інфарктом міокарда (ГІМ).Матеріали і методи. У дослідження залучено 60 хворих віком у середньому (48,9±19,2) року з верифікованим діагнозом ГІМ, після перкутанного коронарного втручання. Термін спостереження – 6 тиж. Пацієнти були рандомізовані на дві групи. До 1-ї групи увійшло 30 хворих, які, крім стандартної терапії, отримували КПАК (Тіворель, Юрія-Фарм, Україна) у вигляді внутрішньовенної інфузії 100 мл 1 раз на добу, починаючи з 3–7-ї доби ГІМ протягом 10 діб. До 2-ї групи увійшло 30 пацієнтів, у яких застосовували лише стандартну терапію (подвійна антитромбоцитарна терапія, інгібітори ангіотензинперетворювального ферменту, β-адреноблокатори, статини). Усім пацієнтам проводили ехокардіографію з оцінюванням об’ємних показників та фракції викиду за Simpson, велоергометрію, лабораторні тести. Результати та обговорення. Додаткове призначення КПАК до стандартної терапії зумовило зниження рівня глюкози до референтних значень (6,1±2,8) ммоль/л порівняно з (7,2±3,3) ммоль/л (р<0,05) у пацієнтів 2-ї групи, в якій рівень глюкози так і не наблизився до референтного діапазону. Рівень креатиніну у хворих 1-ї групи під час третього дослідження статистично значуще (р<0,005) знизився порівняно з першим дослідженням (з (124,0±20,1) до (103,6±18,1) ммоль/л). У пацієнтів 2-ї групи цей показник становив (121,2±18,1) та (124,8±17,4) ммоль/л при першому та третьому дослідженні відповідно. Середнє значення порогової потужності навантаження в пацієнтів 1-ї групи досягло (107,5±30,9) Вт та було статистично значуще (р<0,05) вищим порівняно з таким у хворих 2-ї групи ((99,4±24,9) Вт). Відношення різниці подвійного добутку до виконаної роботи (∆ПД/А) у відповідь на субмаксимальне фізичне навантаження у 1-й групі на 15–18-ту добу становило 2,8±1,8, а в групі контролю – 2,4±2,2. До 5–6-го тижня у 1-й групі показник ∆ПД/А статистично значуще (р<0,05) знизився, до 2,1±0,6, порівняно з 2,3±1,4 у 2-й групі. Таким чином, толерантність до фізичного навантаження в пацієнтів 1-ї групи через 5–6 тиж стала вищою, ніж при першому дослідженні, що можна розцінити як сприятливу клінічну ознаку. Показники внутрішньосерцевої гемодинаміки протягом періоду спостереження між групами мали різні тенденції. Так, у пацієнтів 1-ї групи до другого дослідження фракція викиду збільшилася до (51,9±5,0) % порівняно з першим дослідженням ((48,9±5,9) %; р=0,189), а в пацієнтів 2-ї групи до другого дослідження цей показник знизився до (45,6±6,2) % порівняно з першим ((48,1±9,2) %; р=0,201). У пацієнтів 1-ї групи до 5-6-го тижня зафікcовано зниження кінцевосистолічного об’єму до (64,0±18,6) мл порівняно з попереднім дослідженням ((69,9±21,3) мл; р=0,192), тоді як у хворих 2-ї групи цей показник фактично залишився без змін. До кінця дослідження різниця цього показника між групами була статистично значущою (р<0,05).Висновки. З огляду на те, що під час ГІМ виснажується депо карнітину та аргініну, їх дефіцит передбачає можливість застосування КПАК у складі комбінованої терапії в пацієнтів з ГІМ. Застосування КПАК у перші 3–15 діб ГІМ при спостереженні протягом 6 тиж продемонструвало кардіопротективні, нефропротективні та гепатопротективні властивості препарату. Позитивна динаміка рівня глюкози крові та значущі відмінності між групами свідчать про сприятливий вплив КПАК на вуглеводний обмін.

Features of central hemodynamics in patients with community - acquired pneumonia depending on the course of the disease and cardiovascular comorbidity

The study of intracardiac hemodynamics and blood flow in the pulmonary circuit in patients with community - acquired pneumonia, depending on the presence of concomitant pathology of the cardiovascular system and the severity of the pathological process. In 43 patients with community - acquired pneumonia (22 men, 21 women, mean age 67±17 years), the functional state of pulmonary - cardiac hemodynamics was assessed by echodoplerography. All subjects were divided into 2 groups: 1st group - 25 patients with community - acquired pneumonia (mean age 49±18 years) without concomitant pathology of the cardiovascular system and 2nd group - 18 patients with community - acquired pneumonia (mean age 70.1±11 years) with concomitant cardiovascular disease. The main ultrasound parameters did not differ from the normal values in patients from the 1st group. In patients from the 2nd group there was a significant deterioration of several pulmonary - cardiac hemodynamics parameters, decrease of left ventricular ejection fraction, significant myocardial hypertrophy of the left ventricle and left atrium size increase. Regarding the right heart chambers it was revealed dilatation of the right ventricle, increasing of the estimated systolic pressure in the right ventricle, deterioration of right ventricle myocardial diastolic function, increase of the: RV/LV size ratio, LV eccentricity index, RV myocardium thickness, diameter of the pulmonary artery, velocity of pulmonary regurgitation and the area right atrium size. In addition, the amplitude of systolic displacement of the tricuspid valve ring and the intensity of inspiratory collapse of the inferior vena cava decreased. Correlation analysis of clinical and laboratory parameters, which are markers of endogenous intoxication, oxygen saturation of arterial blood (SpO2), separately for two groups of patients with community - acquired pneumonia, showed a reliable correlation with a number of informative and used in the practice echocardiography parameters of pulmonary cardiac hemodynamics, characterizing systolic (systolic movement amplitude of the tricuspid valve ring - TAPSE), as well as diastolic function (E/A of the right ventricle) of the heart. The relationship between the severity of pulmonary - cardiac hemodynamics disturbances in patients with community - acquired pneumonia, having comorbid pathology, contributing to the deterioration of pulmonary - cardiac hemodynamics and more severe course of the disease with markers of the inflammatory process and oxygen saturation of arterial blood decrease is revealed.

EVALUATION OF INDICATORS OF ENDOTHELIAL DYSFUNCTION AND INTRACARDIAC HEMODYNAMICS OF THE LEFT VENTRICLE IN PATIENTS WITH CHRONIC PULMONARY HEART BRONCHOPULMONARY GENESIS OF COMORBIDITY WITH ESSENTIAL ARTERIAL HYPERTENSION

Introduction: Chronic obstructive pulmonary disease (COPD) is the main cause of progression chronic pulmonary heart (CPH), it is a serious worldwide problem. The combination of COPD with essential arterial hypertension (EAH) ranges from 4 to 27.7% with increasing age. The aim: To evaluate endothelium function changes by the level of metabolites of nitric oxide, endothelin-1(ET-1), values of ultrasonic diagnosis of the humeral artery (HA), intracardial hemodynamics of the left ventricle in patients with CPH in combination with EAH. Materials and methods: The research is involved 175 patients. Indicators of endothelial function by the level of nitric oxide metabolites, ET - 1, ultrasound intracardiac hemodynamics of the left ventricle of the heart were studied. Results: The patients with CPH in combination with EAH in compensation stage have reduced level of nitric oxide in comparison with patients with CPH without EAH and healthy. To a large extent, reducing of nitric oxide level in decompensation stage indicates about contribution of combined pathology and requires ED correction. On the contrary increased concentration of ET-1 in decompensation stage indicate about combined pathology and demands correction of endothelial cell function. Conclusions: Thus, patients with CPH in combination with EAH are characterized by more pronounced changes in endothelial dysfunction toward an increase in the level of vasoconstrictor factors, a decreasing of vasodilators, which is confirmed by ultrasound diagnosis of HA and reflected in the peculiarities of the intracardiac hemodynamic state.

Состояние внутрисердечной и централь- ной гемодинамики у пациентов с недостаточностью митрального клапана при хирургической коррекции с кардиопротекцией путем электрической фибрилляции и интермиттирующих пережатий аорты

Состояние внутрисердечной и централь- ной гемодинамики у пациентов с недостаточностью митрального клапана при хирургической коррекции с кардиопротекцией путем электрической фибрилляции и интермиттирующих пережатий аорты

Restrictive cardiomyopathy: difficulties desminopathy diagnostics

The article provides a brief overview of the problems of diagnostics and etiological verification of restrictive cardiomyopathy (RCMP). Multiple causes lead to the restrictive phenotype of intracardiac hemodynamics and diastolic dysfunction of the heart: infiltrative (amyloidosis, sarcoidosis, elastoma, metabolic syndrome, tumor metastasis to the myocardium); endomyocardial (tropical endomyocardial fibrosis, hypereosinophilic syndrome, carcinoid, radiation damage); accumulation diseases (hemochromatosis, Pompe and Gaucher diseases, Fabry disease). RKMP is also characteristic for desminopathy — so-called desmin storage disease. This is a disease caused by mutations in the desmin gene (DES) that determine the development of cardiomyopathy or myofibrillar myopathy, and in some cases cause a combined phenotype of the disease. Desmin belongs to the group of intermediate filaments that maintain the structural and functional integrity of myofibrils. Mutations in DES lead to disruption of the assembly of filaments and a change in the myofibrillar cell lattice, which contributes to an increased vulnerability of myocytes to mechanical stress. The article presents a clinical case of familial desminopathy associated with a new missense R118P mutation of DES gene, characterized by dominant cardiac RCMP phenotype and subclinical manifestations of myofibrillar myopathy.

NEW METHODS FOR PREDICTING OUTCOMES AND COMPLICATIONS IN PATIENTS WITH ATRIAL FIBRILLATION

Aim:assessment of the capabilities of “machine learning” methods in predicting remote outcomes in patients with non-valvular atrial fibrillation (AF).Methods.From 2015 to 2016 234 patients with non-valvular AF were included in the study (median age 72 (65; 79) years; 50.0% men). During the median follow-up of 2.9 (2.7; 3.2) years 42 patients died, 9 patients had non-fatal acute cerebral circulatory disorders and 3 patients had non-fatal myocardial infarction (MI). These events in 52 subjects (22.2% from all patients included) were combined into a combined endpoint (death and a nonfatal cardiovascular accident at the stage of remote observation). The first 184 patients comprised a “training” group. The next 50 patients formed the “test” group. The following methods of «machine learning» were used in the analysis: classification trees, linear discriminant analysis, the k-nearest neighbor method, support vectors method, neural network.Results.Long-term outcomes were influenced by age, known traditional risk factors for cardiovascular diseases, the presence of these diseases, changes in intracardiac hemodynamics and heart chambers as evaluated by echocardiography, the presence of concomitant anemia, advanced stages of chronic kidney disease, and the administration of drugs associated with a more severe cardiovascular disease progression (amiodarone, digoxin). The best prognosis was created using the model of linear discriminant analysis, the complex neural network model, and the support vector machine.Conclusion.Modern methods aimed at prognosis estimation seem to be of great potential for cardiology. These methods include big data analysis and machine learning technologies. The methods require further evaluation and con firmation, and in the future they may allow correcting cardiovascular risks, using data from real clinical practice and evidence-based medicine at the same time.

THE ASSOCIATION BETWEEN INTRACARDIAC HEMODYNAMICS AND LUNG FUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Study objective. To assess the association between intracardiac hemodynamics and airway obstruction with pulmonary hyperinflation in patients with chronic obstructive pulmonary disease.Materials and methods. Ninety-six patients with chronic obstructive pulmonary disease, aged 40 to 75 years, without concomitant cardiovascular disease, were examined and divided into 4 groups according to the severity of the disease. The patients underwent general clinical examination, spirometry, 24-hour pulse oximetry and echocardiography with assessment of linear and volumetric parameters, as well as diastolic function of left and right ventricles.Results. Linear and volumetric parameters of the left ventricle, LV myocardial mass and geometry in the examined patients with chronic obstructive pulmonary disease matched threshold values. The progression of the severity of chronic obstructive pulmonary disease was accompanied by decrease of the end-diastolic size of the left ventricle, ratio of peak early to late diastolic filling velocity for the left ventricle (E/A) without significant changes in the left ventricle isovolumetric relaxation time (IVRT). Moderate correlations of the inspiratory capacity with the end-diastolic size of the left ventricle (r=0.612; p=0.001) and the left ventricle E/A (r=0.464; p=0.001); forced expiratory volume in 1 second (FEV1) with the left ventricle E/A (r=0.600; p=0.011) were established. As a result of the logistic regression performed, the predictor value of the inspiratory capacity was confirmed (Wald χ2 — 5.795; р=0.024). Impairment of left ventricular diastolic function of grade I was revealed in 12 (31.6 %) patients in group 2, in 7 (24.1 %) patients in group 3, and in 9 (56.2 %) patients in group 4.Conclusion. Airway obstruction severity and pulmonary hyperinflation progression in patients with chronic obstructive pulmonary disease and without concomitant cardiovascular disease is associated with a decrease of left ventricular size and diastolic filling, contributes to the development of the left ventricular diastolic dysfunction, predominantly due to the decrease in filling velocity parameters.

A pipeline for image based intracardiac CFD modeling and application to the evaluation of the PISA method

Mitral regurgitation is one of the most prevalent valvular heart disease. Proper evaluation of its severity is necessary to choose appropriate treatment. The PISA method, based on Color Doppler echocardiography, is widely used in the clinical setting to estimate various relevant quantities related to the severity of the disease. In this paper, the use of a pipeline to quickly generate image-based numerical simulation of intracardiac hemodynamics is investigated. The pipeline capabilities are evaluated on a database of twelve volunteers. Full pre-processing is achieved completely automatically in 55 min, on average, with small registration errors compared to the image spatial resolution. This pipeline is then used to study the intracardiac hemodynamics in the presence of diseased mitral valve. A strong variability among the simulated cases, mainly due to the valve geometry and regurgitation specifics, is found. The results from those numerical simulations are used to assess the potential limitations of the PISA method with respect to different MR types. While the PISA method provides reasonable estimates in the case of a simple circular regurgitation, it is shown that unsatisfying estimates are obtained in the case of non-circular leakage. Moreover, it is shown that the choice of high aliasing velocities can lead to difficulties in quantifying MR.

Changes of endothelial function and intracardiac hemodynamics during implantation of different types of pacemakers

Aim. To determine the dynamics of endothelial function and intracardiac hemodynamics during implantation of different types of pacemakers. Material and methods. The study involved 61 patients, 29 of them were implanted with single-chamber pacemaker (the first group), 32 — two-chamber pacemaker (second group) with sick sinus syndrome (SSS), as well as patients with 2-3 degrees AV conduction disorder. Test with endothelium-dependent vasodilation of the brachial artery was performed using the standard technique and the velocity parameters of blood flow were determined. Parameters of intracardiac hemodynamics and left atrial (LA) function were determined. These studies were conducted in patients initially upon admission to the hospital and 2 months later implantation of pacemaker. Results. Endothelium-dependent vasodilation significantly deteriorated in patients with single-chamber pacemaker which initially was 6,1 [2,74;9,815]% and in 2 months decreased to 5,4 [2,37;7,55]% (p=0,05). There was a tendency to deterioration of left ventricular (LV) contractile function accompanied by a decrease in ejection fraction (EF) to 55,04 [49,04;68,72]%, and decrease emptying fraction of LA to 37,36 [31,67;52,85]%. There was a tendency to increase the volume index of LA which indicates an increasing overload of the volume and pressure of LA. There was a significant increase in the degree of endothelium-dependent vasodilation in patients of the second group initially compiling a 3,25 [2,15;6,61]% and then reaches 6,15 [2,75;8,97]% 2 months after surgery (p <0,04). There was no overload in the volume and pressure of LA and improved indirect signs of LV compliance parameters (growth of end-systolic dimension and volume) and decreased LV EF to 53,23 [44,1;69,95]%. In patients in the first group there was a tendency to increase peripheral resistance to 1227 [1065;1318] dyne x cm -5 x sec, accompanied by a significant decrease in blood flow rate. In the second group there was a tendency to reduce peripheral resistance to 1215 [1136;1391] dyne x cm -5 x sec and a significant increase in blood flow rate. There was a significant correlation between the systole LA dimension and total peripheral resistance in patients with VVI stimulation (r=0,78, p=0,0022), which indicates an increase in total peripheral resistance with a change in blood flow from LA to LV and a decrease in cardiac output. Conclusion. Endothelial function deteriorates with single-chamber stimulation and improves with two-chamber stimulation. These changes are based on shear stress and nitric oxide endothelium secretion the changes of which depend on the characteristics of central and peripheral hemodynamics.

THE LEFT VENTRICLE DIASTOLIC FUNCTION IN PATIENTS WITH HYPERTENSION UNDER THE USE OF DIFFERENT DRUG GROUPS

The objective: To assess the prevalence of diastolic dysfunction in patients with hypertension and preserved left ventricular ejection fraction under pharmacological correction (monotherapy) with angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and β-blockers. Materials and methods: 82 patients (58 women and 24 men) with stage 2 hypertension were examined. The diastolic function was assessed via echocardiography in accordance with the European Association of Cardiovascular Imaging guidelines (2017). Echocardiography was performed before the onset of the treatment and 6 months after its onset. The treatment onset was considered to start after a 2-week period of elimination of previously used pharmacological substance and 2 weeks of assessing tolerability, dose and regimen adjustment. Results: For all selected drugs, target values of blood pressure were achieved, and no adverse effects were identified. The average values of the left atrial volume index before and after the treatment course did not show significant differences. In the majority of the examined patients, this parameter did not exceed the threshold value of 34 ml/m2 . Values exceeding the specified threshold were observed in Group 1 in 4 patients, in Group 2 in 3 patients and in Group 3 in 8 patients. According to the Tissue Doppler echocardiography results on the velocity of myocardial motion at the early diastolic filling, which was measured at the level of the lateral segments of mitral valve and the interventricular septum, positive, but unreliable changes were observed in the Groups of bisoprolol and valsartan, and no changes — in the Group of perindopril. According to the traditional criteria, diastolic dysfunction was observed in 80 % of patients, while according to the criteria of the European Association of Cardiovascular Imaging (2017) — in 21 % of patients. Conclusion: The same efficacy of all three drugs is observed in terms of achieving target blood pressure values. The most pronounced effect on the morphometric parameters of the left atrium and intracardiac hemodynamics is shown in the Groups of bisoprolol and valsartan.

ОСОБЛИВОСТІ СТРУКТУРНО-ФУНКЦІОНАЛЬНОГО СТАНУ СЕРЦЯ У ПАЦІЄНТІВ НА РІЗНИХ СТАДІЯХ ЦЕРЕБРАЛЬНОГО АТЕРОСКЛЕРОЗУ

Cerebrovascular diseases is one of the most important causes of morbidity and mortality in the adult population. Objective: to conduct a comparative analysis of the morpho-functional changes of the heart, intracardiac and systemic hemodynamics in elderly patients with cerebral atherosclerosis (CA) of 1–3 degree. Materials and methods: 229 patients with cerebral atherosclerosis of 2–3 degree took part in a comprehensive study. The patients were divided into 4 groups: Group 1 – patients with ischemic stroke (IS) in the right hemisphere (RH), Group 2 ­– with IS in the left hemisphere (LH), Group 3 – with cerebral atherosclerosis of 1–2 degree (no IS – comparison group) and Group 4 – a general group of patients who have IS. Design: simple, prospective, non-randomized, with the consistent inclusion of patients. Results and discussion: The compared groups differed statistically significantly by the LA diameter index (ILA), the LV diastolic index (LVIDd), the LV systolic index (LVIDs) and the wall thickness of the left ventricle (LV). Thus, the highest ILA value was observed in patients with CA (1.1 times more than in patients with IS), the highest values of LVIDd and LVIDs – in the group of patients with left-hemispheric localization of IS (1.14 and 1.18 times more, accordingly, than in patients with CA without IS). The minimal thickness of the interventricular septum (IVS) and the posterior wall of the LV was in the group of patients with CA (1.18 and 1.17 times less, respectively, compared with the group of patients with AI, without taking into account the hemispheric localization of IS). Interhemispheric differences were observed only in the assessment of LVIDd, LVIDs, and the thickness of the IVS. So, in patients with left hemispheric localization of IF LVIDd, it was 1.09 times greater, and LVIDs was 1.16 times greater than in patients with right hemispheric IF, while the IVS was 1.15 times thicker in the IS ​​group with the right hemisphere than with left hemispheric localization of IF. In the compared groups, we also observed statistically significant differences in the assessment of the parameters of systemic and intracardiac hemodynamics. So, in patients with CA, the index of the end-diastolic volume (iEDV) was 1.14 times higher and the index of the end-systolic volume (iESV) was 1.09 times less than in patients with IS, while in patients with left-hemispheric localization of IS the lowest ejection fraction and iEDV were observed compared with the group of patients with CA (1.02 and 1.15 times, respectively). Interhemispheric differences were recorded only in terms of the magnitude of the stroke index (SI). Thus, patients with IS in LН SI was 1.2 times more than in patients with IS in RH. In the group of patients with CA and IS, non-dilatational eccentric and concentric hypertrophy of LV (LVH) was most common (37.4 % and 48.1 %–26.0 % and 61.6 %, respectively), but type III was 1.44 times more common in patients with CA, and type V – 1.28 times more often in patients with IS. Eccentric dilated LVH was most often observed in patients with IS – 2.2 times more often than in patients with CA, and concentric dilated LVH was more common in patients with CA – 1.8 times more often than in patients with IS. Interhemispheric differences were observed only in relation to types III and V LVH. Thus, in patients with right hemispheric localization of IF, concentric non-dilated LVH was 1.66 times more common, and in patients with left-hemispheric IF localization – 4.4 times eccentric non-dilated LVH. Conclusions: in patients with CA of 1–3 degree, there were statistically significant differences in the morpho-functional changes in the heart, intracardiac and systemic hemodynamics and LV geometry, and some of these differences were hemispheric.

Myocardial biomechanics, intracardiac hemodynamics and endothelial function in patients before and after various types of pacemakers implantation

This review presents 31 sources from 1995 to 2019. Atrioventricular blockades (AVB) 2-3 degrees occupy a special place among the causes of death from cardiovascular disease. The above AVB lead to a significant slowing of the heart rate and predispose to the development and progression of heart failure (HF) and the occurrence of acute hypoxia of the brain and attacks Morgagni-Adams-Stokes. The main method of treatment of hemodynamically significant AB-conduction disorders is electrocardiostimulation (ES), which is the basic method of treatment. A single chamber pacemaker is the most often implanted with using isolated ventricular stimulation in clinical practice in the Russian Federation. Implantation of a dual chamber pacemaker is less frequent. This type of stimulation allows to maintain atrioventricular synchronization constantly. Stimulation of the apex of the right ventricle leads to a decrease in left ventricle (LV) function and structural changes that are a consequence of the occurrence of electric and mechanical dyssynchrony of the myocardium. There is a large number of works devoted to the comparison of different methods of ES leading to the conclusion that a powerful alternative to the stimulation of the apex of the right ventricle can be a dual ventricular stimulation. It is noted that implantation of single-and dual-chamber pacemaker with fixation of the electrode in the region of the right ventricle apex leads to the fact that both modes of stimulation can not cancel the electrical and anatomical remodeling of the myocardium of left atrium and LV. It may be necessary to use a more physiological site of stimulation with using optimal AB-delay to minimize the frequency of ventricular stimulation. Endothelium plays an important and independent role in the development of cardiovascular diseases. The effect of AB conduction impairment on endothelial function (EF) has not been described to date. There were few studies which are discussed the influence of constant pacemaker on endothelial function in patients with AVB 2-3 degrees in recent years. It should be noted that the studies were conducted on a small sample of patients and had a different design.

Состояние внутрисердечной и центральной гемодинамики у пациентов с недостаточностью митрального клапана при хирургической коррекции с применением кристаллоидной кардиоплегии в периоперационном периоде

Состояние внутрисердечной и центральной гемодинамики у пациентов с недостаточностью митрального клапана при хирургической коррекции с применением кристаллоидной кардиоплегии в периоперационном периоде

CAPABILITIES AND LIMITATIONS OF SPECKLE TRACKING STRESS ECHOCARDIOGRAPHY

Stress echocardiography is a technique that allows to evaluate myocardial contractility and intracardiac hemodynamics under conditions of physical exercise or reaction to a pharmacological drug. Evaluation of systolic function of the left ventricle plays an important role in establishing the prognosis and choosing a treatment strategy for various cardiovascular diseases. Speckle tracking technique is one of the most promising methods for determining values of left ventricular deformation, due to which not only visual, but also quantitative assessment of left ventricular myocardial contractility is possible at rest and during stress tests. In this review, we analyzed the possibility of using speckle tracking stress echocardiography with physical exercise or with the pharmacological drug, in order to diagnose various diseases, such as ischemic heart disease, valvular heart disease, diabetes mellitus, and microvascular damage. Along with this, differences between the values of the longitudinal systolic deformation depending on age were considered. We also compared diagnostic values of the data of speckle-tracking stress echocardiography and coronary angiography and values of the data of speckle-tracking stress echocardiography and computed tomography of the coronary arteries.

CAPABILITIES AND LIMITATIONS OF SPECKLE TRACKING STRESS ECHOCARDIOGRAPHY

Stress echocardiography is a technique that allows to evaluate myocardial contractility and intracardiac hemodynamics under conditions of physical exercise or reaction to a pharmacological drug. Evaluation of systolic function of the left ventricle plays an important role in establishing the prognosis and choosing a treatment strategy for various cardiovascular diseases. Speckle tracking technique is one of the most promising methods for determining values of left ventricular deformation, due to which not only visual, but also quantitative assessment of left ventricular myocardial contractility is possible at rest and during stress tests. In this review, we analyzed the possibility of using speckle tracking stress echocardiography with physical exercise or with the pharmacological drug, in order to diagnose various diseases, such as ischemic heart disease, valvular heart disease, diabetes mellitus, and microvascular damage. Along with this, differences between the values of the longitudinal systolic deformation depending on age were considered. We also compared diagnostic values of the data of speckle-tracking stress echocardiography and coronary angiography and values of the data of speckle-tracking stress echocardiography and computed tomography of the coronary arteries.

An impact of cardiovascular comorbidity on course and prognosis of chronic obstructive pulmonary disease

Comorbidity of chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) is currently important and not fully investigated. The aim of this study was to analyze clinical signs, lung function, the central and the intracardiac hemodynamics, and predictors of outcome in patients with comorbidity of COPD and CVD. Methods. The study involved 118 patients with stage 3 to 4 COPD (GOLD, 2016) including 111 men and 7 women. The mean age was 59.5 ± 0.63 years, the smoking history was 23.1 ± 0.93 pack-years, and body mass index (BMI) was 27.2 ± 9.06 kg/m2. The patients were allocated into one of three groups: COPD group (n = 37), COPD + coronary heart disease (CHD) group (stable angina functional class (FC) II to III, n = 45), and COPD + hypertension (H) group, n = 36). Results. Patients with COPD and CVD were older, had higher smoking history and higher BMI. Clinical signs of COPD were more prominent and the lung function was lower in COPD patients with CVD comorbidity. Cardiac remodeling and right and left ventricular diastolic dysfunction were more severe in the groups with comorbidity. The 3-year survival in the groups with comorbidity clearly tended to be lower. Age, smoking history, the heart beat rate, the systolic blood pressure, the distance in 6-minute walking test, and the serum C-reactive protein and fibrinogen levels were independent predictors of mortality in both COPD + CHD and COPD + H groups. Conclusion. The comorbidity of COPD + CHD and COPD + H is characterized by more severe clinical signs and symptoms of COPD, and decreased physical tolerance. Hypoxemia, heart remodeling, left and right ventricular diastolic dysfunction, and higher mortality risk were seen in both groups with comorbidity.