Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction.

AIM: To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain. MATERIAL AND METHODS: Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode. RESULTS: During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample. CONCLUSION: Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.

[Left ventricular dysfunction in patients following high-dose chemotherapy and autologous hematopoietic stem cell transplantation].

AIM: To evaluate the dynamics of LV global longitudinal strain (GLS) and other EchoCG parameters after high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell transplantation (aHSCT). MATERIAL AND METHODS: The risk of LV dysfunction in patients after HDCT followed by aHSCT has not been sufficiently studied. This study included 74 patients with hemoblastosis aged 20 to 65 years who had undergone HDCT followed by aHSCT. All patients had a history of antitumor treatment. EchoCG with assessment of LV GLS and measurements of troponin T and N-terminal pro-brain natriuretic peptide (NT-proBNP) were performed for all patients before and after the treatment. RESULTS: A decrease in GLS by 15 % or more from the baseline was detected in 6 (8.1 %) patients. The decrease in GLS was associated with increased NT-proBNP >125 pg / ml at baseline (odds ratio, 8.667; 95 % confidence interval, 1.419-52.942; p=0.022). CONCLUSION: The decrease in LV GLS in patients after aHSCT was associated with increased NT-proBNP before the intervention.

[Remote Monitoring of the QT Interval During Polychemotherapy].

Aim      To evaluate the incidence of prolonged corrected QT interval (QTc) by remote single-channel electrocardiogram (ECG) monitoring in primary oncological patients with elective polychemotherapy (PCT).Material and methods  This study included 49 oncological patients with elective PCT. A single-channel portable CardioQVARK electrocardiograph was used to record single-channel, one-lead ECG between the first and second courses of PCT.Results Analysis of QTc interval detected a prolonged QTc interval >500 msec in 8.2 % of cases, prolonged QTc >480 msec in 18.3 % f cases, and prolonged QTc interval >60 msec compared to baseline in 12.2 % of cases.Conclusion      Remote recording of single-channel ECG using a portable electrocardiograph is an effective method for recording and detecting various forms of heart rhythm disorders.

[Exhaled Breath Analysis in Diagnostics of Cardiovascular Diseases].

Exhaled breath analysis is a novel tool for diagnostics of different diseases. Taking into account the secretory function of the lungs, the composition of exhaled breath is different in physiological and pathological conditions. In this review we consider of some substances which content vary in cardiovascular diseases - pentane, isoprene, carbon monoxide and trimethylamine. Modern technologies allow to move the analysis of exhaled breath from research laboratories into clinical practice. Thus, a new tool for real time of screening various cardiovascular diseases has appeared in the arsenal of physicians.

Functional Diagnostic Methods in Cardiac Prognosis in Major Abdominal Surgery in Patients with Heart Disease or Over 65 Years Old.

PURPOSE OF THE STUDY: Evaluation of the value of the results of the use of cardiac functional examination methods for the stratification of the risk of developing cardiovascular complications in planned abdominal surgical interventions in patients over 65 years of age or with cardiac pathology. MATERIALS AND METHODS: The study included 179 patients over 65 years of age or with a history of heart disease who underwent elective abdominal surgery. The median age was 70 years. During the operation and for 30 days after it, cardiac complications were recorded: severe (myocardial infarction, stroke, death from cardiovascular disease), others (strokes of exertional angina, ischemic dynamics of the ST segment on the electrocardiogram - ECG - rest, paroxysmal fibrillation / flutter atrial). All patients underwent basic examination - examination, anamnesis, ECG, blood test, assessment of respiratory function, ECG monitoring. Additionally, echocardiography (EchoCG) and ergospirometry (ESM) were performed. RESULTS: In 30 (16.8 %) patients, various MTRs were detected: 6 (3.4 %) of fatal myocardial infarctions, 2 (1.1 %) of fatal strokes; 3 (1.7 %) cases of sudden cardiac death, angina attacks were recorded in 4 (2.2 %) patients, 7 (3.9 %) had ischemic ECG dynamics, 11 (6.1 %) had fibrillation episodes or atrial flutter. Chronic obstructive pulmonary disease, intervention on the colon, blood hemoglobin level <100 g / l, serum creatinine >103 µmol / l, presence of any pathological changes in the resting ECG were associated with the development of SSO; according to EchoCG - VTI (linear velocity integral) in the outflow tract of the left ventricle (LV) <21.5 cm, volume of the left atrium> 57 ml, global LV myocardial deformity is less than 18 %, increase in heart rate (HR) at the 1st minute load test> 27 %, peak oxygen consumption at ESM <15.8 ml / kg / min. The optimal plan for preoperative examination in men is to perform a basic model, and for women it is advisable to combine a basic examination with an ESM or an assessment of the degree of myocardial deformity using the speckle-tracking method for EchoCG. CONCLUSION: The risk of perioperative MTS during planned abdominal operations in patients older than 65 years or with a history of heart disease is relatively high - 16.8 %. When assessing the risk associated with the operation, it is advisable to additionally conduct echocardiography with VTI assessment in the LV outflow tract and myocardial deformity indicators, as well as ESM with the determination of HR increase in the 1st minute of the test and peak oxygen consumption.

[Proton Transfer Reaction Mass Spectrometry of Exhaled Breath in Diagnostics of Heart Failure].

BACKGROUND: Exhaled breath analysis is one of directions in the search for novel biomarkers of chronic heart failure (CHF). According.

[Predictive value of cardiopulmonary exercise testing in various categories of patients with chronic heart value].

AIM: To specify the prognostic value of parameters of cardiopulmonary exercise testing (CPET) in patients with chronic heart value (CHF) on optimal medical treatment depending on gender, age, left ventricular ejection fraction (LVEF), cardiac rhythm and achievement of target respiratory exchange ratio (RER) > or = 1.0. MATERIALS AND METHODS: 111 patients (83 male, mean age 60.6 +/- 12.8 years) with CHF NYHA class I-III on optimal treatment were included in the study. One third had preserved EF, 27.9%--permanent atrial fibrillation (AFib). Average followup was 19.4 +/- 9.6 months. Prognostic value of CPET indices and Heart Failure Survival Score (HFSS) for cardiovascular mortality (CVM) and combined endpoint including CVM or CHF hospitalization were evaluated using logistic regression analysis. RESULTS: CVM amounted 14.4%, combined endpoint was observed in 46.8% of patients. HFSS had the highest predictive value for CVM (in all subgroups of patients) and for combined endpoint (except patients with AFib). In men, patients younger than 65 years, with reduced LVEF and with Afib CVM was also related to ventilatory indices (VE/VCO2, ventilatory class and PetCO2 peak), and combined endpoint was related to VO2peak and its derivativatives. Only HFSS and VE/VCO2 had prognostic value for CVM in patients with AFib. Ventilatory parameters were associated with combined endpoint in all subgroups except Afib. Blood pressure response and heart rate recovery had prognostic significance only in patients with sinus rhythm. Target RER > or = 1.0 was achieved only in 40.5% patients. In patients with RER < 1.0 significant relationship between VO2 peak and combined endpoint was observed. CONCLUSIONS; Heart Failure Survival Score, VE/VCO2, ventilatory class and PetCO peak are the strongest predictors of cardiovascular mortality and heart failure hospitalizations in all subgroups of patients with CHF. CPET has the highest significance for men, age < 65 years, patients with LVEF < 45% and sinus rhythm. In these subgroups VO2 peak and Weber class have predictive value for decompensation of CHF whether RER > or = 1.0 or not. Blood pressure response and heart rate recovery have prognostic significance only in patients with sinus rhythm.

[Pathology diagnostics by human breath analyze].

Modern medicine experiences deficit of inexpensive rapid screening technologies despite progress in the development of diagnostic methods for various diseases. A promising approach is the analysis of exhaled air known to contain thousands of volatile organic substances whose composition differs considerably in health and disease. We isolated certain compounds that may be used as biomarkers of cardiovascular pathology (nitric oxide, carbon monoxide, pentane, isoprene, acetone). There is a variety of methods for the detection of substances in the exhaled air; such as gas spectrography, mass spectrometry, etc. However, ion mobility spectrometry appears the most suitable technique for the purpose of screening studies due to its high speed and sensitivity, small size of the apparatus, and possibility to measure trace amounts of the substances of interest. Possibilities to diagnose lung cancer based on exhaled air composition are considered.

[The place of multispiral computed tomography in diagnostics of ischemic heart disease.]. / Mesto mul'tispiral'noi komp'iuternoi tomografii v diagnostike ishemicheskoi bolezni serdtsa.

Multispiral computed tomography (CT) of the heart with detection of coronary artery calcification as well as clinical examination, stress tests, single photon emission computer tomography at rest and during stress, and/or stress echocardiography were used in the study of 56 patients with and 26 without ischemic heart disease (mean age 58+/-1 and 55+/-1.5 years, respectively). In 44 patients multispiral CT was performed with intravenous contrast injection and 27 patients were subjected to coronary angiography. Specificity, sensitivity of multispiral CT for detection of hemodynamically significant (>50%) stenoses compared with angiography and for diagnosis of structural changes of the myocardium were 92, 90%, and 89, 91%, respectively. Calcium index was significantly higher in patients with than without ischemic heart disease (253+/-28 and 3+/-1.5 U, respectively) and could be a significant diagnostic criterion of ischemic heart disease.