An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension.

AIM: To study the relationship between changes in left atrial volume (LAV) during exercise and the result of a diastolic stress test (DST) in patients with arterial hypertension (AH). MATERIAL AND METHODS: The study included 219 patients with AH without ischemic heart disease and atrial fibrillation. During the DST performed before and after exercise, the ratio of transmitral flow velocity to mitral annular velocity (E/e'), the left atrial global longitudinal strain in the reservoir phase (reservoir strain), and LAV were determined. The criterion for a positive DST was an increase in E/e' ≥15. RESULTS: A positive result of DST was observed in 90 (41.1%) patients. Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e' increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. The AUC for changes in LAV as an indicator of a positive DST was 0.987 while the AUC for the resting left atrial reservoir strain was 0.938. An increase in LAV >1 ml, as an indicator of a positive DST has a sensitivity of 96.9% and a specificity of 95.1%. CONCLUSION: In AH patients, changes in left ventricular filling pressure are associated with a unidirectional change in LAV. An increase in LAV during exercise by more than 1 ml can serve as a criterion for a positive DST result. This assessment was consistent with the assessment of the DST result by the E/e' criterion >15 in 94.5% of cases.

Features of Left Atrial Appendage Thrombosis in Patients With Persistent Nonvalvular Atrial Fibrillation After COVID-19.

Aim      To evaluate the incidence and characteristic features of left atrial appendage (LAA) thrombosis in patients with persistent nonvalvular atrial fibrillation (AF) after COVID-19.Material and methods  Transesophageal echocardiography (TEE) was performed for 469 patients (57.4 % males; mean age, 64.0 [58.0; 70.0] years) with persistent nonvalvular AF before scheduled sinus rhythm restoration. In 131 of these patients (27.9 %), the most recent episode of arrhythmia developed during the coronavirus infection. The time from the onset of COVID-19 to TEE was 145 [62; 303] days. All patients received an adequate anticoagulant therapy, in most cases, with direct oral anticoagulants for at least 3 weeks preceding the study.Results A LAA thrombus was detected in 20 (5.9 %) patients who have had no coronavirus infection and in 19 (14.5 %) patients after COVID-19 (р=0.0045). 18 of 19 (94.7 %) thrombi found in patients who have had COVID-19 were mural whereas only 5 (25.0 %) of such thrombi were found in patients who have had no COVID-19 (p<0.0001). In the absence of LAA thrombus, the LAA emptying velocity was 32.0 [25.0; 40.0] cm/sec whereas in the presence of a mural thrombus, it was 25.0 [20.0; 32.3] cm/sec, and in the presence of a typical thrombus, it was 17.0 [13.5; 20.0] cm/sec (р<0.0001). A Kaplan-Meier analysis showed that the median time of mural thrombus dissolution was 35.0 (95 % confidence interval (CI), 24.0-55.0) days and for a typical thrombus, this time was 69.0 (95 % CI, 41.0-180.0) days (р=0.0018).Conclusion      Patients with persistent AF who have had COVID-19 had LAA thrombosis 2,5 times more frequently and, in most cases, the thrombus was mural. Mural thrombi, in contrast to typical, are not associated with a pronounced decrease in LAA emptying velocity and dissolve twice as fast as typical thrombi with an adequate anticoagulant treatment.

Left Atrial Strain as a Predictor of Diastolic Stress Test Results in Patients With Arterial Hypertension.

Aim      To study a possibility of using the left atrial strain (LAS) for predicting results of the noninvasive diastolic stress test (DST) in patients with arterial hypertension (AH).Material and methods  The study included 98 patients previously diagnosed with AH. As a part of evaluation for complaints of dyspnea, palpitation or pain in the area of the heart, DST and transthoracic echocardiography were performed. Echocardiography included measurements of LAS in the reservoir phase, left atrial volume index (LAVI), pulmonary artery systolic pressure (PASP), and ratio of early filling transmitral flow velocity to mitral annular velocity (Е / е').Results The DST was negative in 52 patients (group 1) and positive in 46 patients (group 2). Group 2 had greater values of mean Е / е' (11.0 [9.4; 12.6] vs 9.0 [7.9; 11.1], р=0.0003); LAVI (33.8 [29.0; 40.0] ml /m2 vs 28.0 ml /m2 [25.0; 32.9], р=0.0001); and PASP (29.0 mm Hg [28.0; 30.0] vs 26.0 mm Hg [25.0; 28.0], р<0.0001 were greater, but LAS values were lower (19.0 % [18.0; 21.0] vs 24.0 % [22.0; 28.0], р<0.0001. The predictive capability of LAS with respect of heart failure was higher than of other echocardiographic parameters. The area under the ROC curve (AUC) for the reservoir strain was 0.922 (95 % confidence interval, CI, 0.851-0.967), which was significantly greater than for Е / е': 0.713 (0.613-0.800); the LAVI was 0.724 (0.624-0.809); and the PASP was 0.764 (0.668-0.844). A LAS value in the reservoir phase less than 22 % predicts a positive result of DST with a probability of 88.9 % (76.5-95.2 %). Higher values of the strain allow expecting a negative DST result with a probability of 88.7 % (77.4-94.7 %).Conclusion      If the DST cannot be performed for a noninvasive diagnosis of heart failure with preserved ejection fraction, a positive result of this test can be predicted by a decrease of LAS in the reservoir phase to 21 % or lower. The diagnostic accuracy of this criterion is 88.8 % (81.0-93.6 %).

The left atrial appendage thrombosis of in patients with persistent atrial fibrillation after the novel coronavirus infection.

Aim      To evaluate the incidence and features of left atrial appendage (LAA) thrombosis in patients with persistent atrial fibrillation (AF) after novel coronavirus infection (COVID-19).Material and methods  Percutaneous echocardiography (pcEchoCG) was performed for 128 patients with persistent AF prepared for cardioversion, 36 (28.1 %) of whom had had COVID-19. In 3 (8.3 %) patients, the lung lesion area was 50-75 %; in 31 (86.1 %) patients, 25-50 %; in 1 (2.8 %) patient, less than 25 %. One patient had no lung lesion. Median time from the onset of COVID-19 to the patient enrollment in the study was 76.5 days. At the time of enrollment, the polymerase chain reaction test for SARS-CoV-2 was negative in all patients.Results Patients after COVID-19 and those who had not had COVID-19 were comparable by age (62.5±9.2 and 62.4±9.1 years, respectively; р=0.956), gender (men 52.8 and 59.8 %, respectively; р=0.471), and risk of stroke (score 2.19±1.28 and score 1.95±1.35, respectively; р=0.350). Duration of the last arrhythmia episode was longer for patients after COVID-19 than for the comparison group (76.5 and 45.0 days, respectively; р=0.011). All patients received oral anticoagulants. 55.6 % of COVID-19 patients received rivaroxaban, whereas 62.0% of patients who had not had COVID-19 were treated with apixaban. Median duration of the anticoagulant treatment was longer for COVID-19 patients than for the comparison group (61.5 and 32.0 days; р=0.051). LAA thrombus was detected in 7 (19.4 %) patients after COVID-19 and in 6 (6.5 %) patients of the comparison group (р=0.030). In COVID-19 patients, the thrombus adhered to LAA wall over the entire thrombus length whereas in patients who had not have COVID-19, the thrombus had a free part that formed a sharp angle with LAA walls. In the presence of LAA thrombus, the LAA blood flow velocity was considerably higher for COVID-19 patients than for the comparison group (31.0±8.9 and 18.8±4.9 cm/sec, respectively; p=0.010). At the follow-up examination performed at 24.0 days on the average, the thrombus was found to be dissolved in 80 and 50% of patients after and without COVID-19, respectively (р=0.343).Conclusion      In patients with persistent AF after the novel coronavirus infection, LAA thrombosis was detected more frequently than in patients who had never had COVID-19; it was characterized by mural localization and was not associated with a decrease in LAA blood flow velocity.

[Diagnostic difficulties of isolated right ventricular myocardial infarction].

The article describes a case of isolated right ventricular myocardial infarction induced by proximal occlusion of the right coronary artery in a patient with the left type of heart blood supply. A specific feature of the case was detection of the McConnell's sign, which is considered characteristic of pulmonary artery thromboembolism.

Risk of Cardiovascular Complications in Patients with Persistent Atrial Fibrillation after Dissolution of a Thrombus in the Left Atrial Appendage.

Aim      To compare the incidence of cardiovascular complications (CVC) in patients with persistent atrial fibrillation (AF) following thrombus dissolution in the left atrial appendage (LAA) and in patients with persistent AF without preceding LAA thrombosis.Material and methods  The main group included 43 patients who had been diagnosed with LAA thrombosis on the first examination, transesophageal echocardiography, and who showed dissolution of the thrombus on a repeated study performed after 7.1+2.0 weeks of the anticoagulant treatment. The control group consisted of 123 patients with a risk score >0 for men without LAA thrombosis and score >1 for women without LAA thrombosis according to the CHA2DS2­VASc scale. The patients were followed up for 47.3±17.9 months. The following unfavorable outcomes were recorded: all-cause mortality, ischemic stroke or systemic thromboembolism, hemorrhagic stroke or severe bleeding, and myocardial infarction (MI).Results Unfavorable clinical outcomes were observed in 39.5 % of patients in the main group and in 3.3 % of patients in the control group (p<0.001). Furthermore, the incidence of ischemic stroke (relative risk (RR), 12.9; 95 % confidence interval (CI), 2.89-57.2), and MI (RR, 5.72; 95 % CI, 1.09-30.1) was higher in the main group. However, the number of MI cases in both groups and the number of stroke cases in the control group increased during the entire follow-up period, while the number of stroke cases rapidly increased only during the first year of follow-up.Conclusion      In patients with persistent AF, the risk of CVC after LAA thrombus dissolution remains significantly higher than in patients with AF without LAA thrombosis.

[Clinical and angiopulmonographic association in pulmonary embolism].

AIM: To detect the effect of the feature of the pulmonary vascular obstruction on the clinical manifestations of pulmonary embolism (PE). MATERIALS AND METHODS: The 127 patients with PE were included in this study. PE verified with multidetector computed tomography with pulmonary angiography. Among them were 57 patients with high-risk PE, and 39 patients with intermediate-risk PE and 31 patients with low-risk PE. The pulmonary artery obstruction index and the obstruction level were determined. RESULTS: The mean values of the pulmonary artery obstruction index in high and intermediate risk patients were 42.5%, and in low risk patients 12.5% (p0.001). The trunk or main branches obstruction was in 80.7% of high-risk PE patients, the main or lobar branches obstruction in 92.3% of intermediate-risk patients and lobar or segmental branches obstruction in 93.5% of low-risk patients. Pulmonary infarction was detected in 89.2% of patients with the segmental branches obstruction and with another level of obstruction in 28.0% of patients only (p0.001). CONCLUSION: The hemodynamic disorder in pulmonary embolism associate with the pulmonary artery obstruction index of more than 30%. The development of obstructive shock is associated with the pulmonary artery trunk obstruction, and the development of pulmonary infarction associated with the segmental branches obstruction.

Right Ventricular Longitudinal Strain in Acute Pulmonary Embolism and Right Ventricular Myocardial Infarction in Patients with McConnell's Sign.

Aim      To study the right ventricular (RV) myocardial longitudinal systolic strain in patient with RV myocardial infarction (MI), and pulmonary embolism (PE) with and without McConnell' phenomenon.Material and methods  This study included 53 patients with PE (mean age, 59.0±15.1 years; men, 58.5 %) and 30 patients with RVMI (mean age, 61.8±10.9 years; men, 90 %). Longitudinal strain of basal, medial and apical segments of the RV free wall (RVFW) and the interventricular septum (IVS) was determined in the mode of two-dimensional speckle tracking. Ratio of the IVS apical strain to the RVFW strain (apical ratio) was calculated. Systolic excursion of the RVFW apical segment (apical excursion) was measured in the anatomical M-mode from the apical four-chamber view.Results The McConnell's sign was observed in 23 (43.4 %) of 53 patients with PE and in 16 (53.3 %) of 30 patients with RVMI (p>0.05). Irrespective of the cause for the RV damage, patients with the McConnell's sign had higher values of the apical ratio (1.69±0.50 vs. 0.95±0.22; p<0.001; cutoff point, 1.18) and apical excursion (7.9±1.7 vs. 2.6±1.4 mm; p<0.001; cutoff point, 5.0 mm). Apical excursion closely correlated with the value of apical ratio (r=0.65; p<0.001) but not with the RVFW apical segment strain (r= -0.07; p>0.05).Conclusion      Incidence of the McConnell's sign was similar in patients with PE and RVMI. McConnell's sign is based on a passive systolic shift of the RVFW apical segment, which develops during contraction of the IVS apical segment. The greater the ratio of IVS apical segment to RBFW global strain the greater the amplitude of this shift. With the ratio value of 1.18 or more, the systolic shift of RVFW apical segment was >5 mm, which was visually perceived as the McConnell's sign.

[On the Causes of Angina Pectoris in Patients With Pulmonary Embolism].

Objective Compare the distance between the pulmonary artery (PA) and the left coronary artery (LCA) using pulmonary angiography and the rate of detection of the signs of left ventricular myocardial ischemiain the first electrocardiogram (ECG) in pulmonary embolism (PE) patients with or without angina to detect possible causes of angina pectoris.Material and Methods Measurement of the minimum distance between the PA and LCA in multislice spiral computed tomography and analysis of the first ECG were performed in 55 PE patients. 15 (27.3%) patients had angina pectoris at the onset of the disease.Results Angina pectoris was observed in 14 (93.3%) of 15 patients with the distance between the PA andLCA less than 4.3 mm, and in one (2.5%) of 40 patients with the distance between these vessels equalto or exceeding the specified value (p<0.001). In the first ECG, the ST elevation in the aVR lead wasdetected in 10 (66.7%) patients with angina pectoris, and only in 3 (7.5%) patients without anginapectoris (p<0.001).Conclusions The findings suggest that angina pectoris in acute pulmonary embolism may be caused by compression of the LCA by the dilated PA.

[Results of a multicenter study on the efficacy of cortexin in treatment of cognitive dysfunction in children]. / Rezul'taty mul'titsentrovogo issledovaniia éffektivnosti primeneniia korteksina pri kognitivnykh disfunktsiiakh u detei.

AIM: To study the efficacy and tolerability of cortexin in the treatment of cognitive dysfunction in children. MATERIAL AND METHODS: The study included 635 patients, aged 3-7 years. Patients were divided into 4 clinical groups: group 1 (269 children with attention deficit hyperactivity disorder (ADHD)), group 2 (215 children with speech delay), group 3 (82 patients with the consequences of a perinatal lesion of the central nervous system), group 4 (69 patients with asthenic/neurotic syndrome). Attention, visual memory and thinking were assessed before and after treatment. Standard treatment of cortexin, including 10 intramuscular injections, was used. RESULTS AND CONCLUSION: The reliable effect of cortexin on cognitive impairment was shown. The best response to treatment was observed in patients with ADHD, aged 3-4 years, in particular on the tests measuring thinking. The tolerability of cortexin was good. It has been concluded that cortexin is an effective drug for treatment of children with ADHD, speech delay and consequences of a perinatal lesion of the central nervous system.

[THE INFLUENCE OF ANAESTHESIA ON PERIOPERATIVE VALUES OF AMINOTERMINAL FRAGMENT OF THE BRAIN NATRIURETIC PEPTIDE PRECUSSOR IN PATIENT WITH POSTINFARCTION CARDIOSCLEROSIS UNDERGOING NONCARDIAC SURGERY].

BACKGROUND: The importance of postoperative values of cardiac damage biomarkers studying (such as troponine and NTproBNP) is stressed by recommendations of the European Society of Cardiology and the European Society of Anaesthesiologists (2014). AIM OF THE STUDY: the effects of general and spinal anaesthesia on perioperative dynamics of NTproBNP in patients with postinfarction cardiosclerosis in the surgical treatment of benign prostatic hyperplasia. MATERIALS AND METHODS: 67 men aged 60 to 75 years were included in a prospective, randomized study. Patients were undergone elective open surgery for prostatic hyperplasia. All patients had a history of myocardial infarction. Depending on the type of anaesthesia the patients were divided into 2 groups: The first group (35) was operated under spinal anaesthesia (SA). The second group (32) was operated under general anaesthesia (GA). The volume infusion was 2700 ± 250 ml in the first group and 1600 ± 250 ml in the second group during perioperative period. Determining the level of NTproBNP in the venous blood plasma realized four times: 1 hour before surgery, at once at the end of surgery, 12 and 24 hour after surgery. RESULTS: The first group patients was registered an increase the values of NTproBNP in plasma 2 times from 628.6 ± 107.4 pg/mol to 1204.1 ± 141.9 pg/mol 12 hour after the operation (P < 0.01). After 24 hours the level of NTproBNP in blood plasma of the first group patients was reduced by 28%, but, however, exceeding the values in the second group is more than 1.7 times (P < 0.05). CONCLUSION: The extra volume of the infusion during the spinal anaesthesia in the early postoperative period after the elimination of the sympathetic blockade to leads volume overload in patients with accompanying cardiac pathology.

[Congenital parotid gland fistula in the children: diagnostics and surgical treatment].

The objective of the present study was to improve diagnostics and surgical treatment of congenital parotid gland fistulae. It involved 86 children presenting with this defect at the age varying from 4 months to 17 years who were admitted to the Department of Otorhinolaryngology of the Morozovskaya City Children's Clinical Hospital during the period from 2010 till 2014. It was shown that parotid fistula suppuration is an absolute indication for the surgical treatment of such children regardless of their age. The proposed diaphanoscopic technique was shown to produce good results and can be recommended for both diagnostics an intraoperative visualization of the fistulous passage.

[Local anesthesia in the children undergoing the fibroendoscopic study of the nasal cavity, nasopharynx, and larynx: are topical anesthetics needed?].

This prospective randomized study with double blind control was designed to evaluate the effectiveness of various anesthetic techniques employed prior to fibroendoscopy of the nose, nasopharynx, and larynx of the children. The study included 160 children at the age varying from 3 to 14 (mean 7.4±2.96) years randomly allocated to four statistically comparable groups matched for age and sex. The following preparations were used to treat the children prior to fibroendoscopy: physiological solution (group 1), a 0.05% xylometazoline solution (group 2), a 10% lidocaine solution (group 3), and a mixture of 0.05% xylometazoline and 10% lidocaine solutions (group 4). The evaluation of the tolerance to the pretreatment of the nasal cavity with lidocaine and lidocaine plus xylometazoline (groups 3 and 4) showed that it was significantly (p<0.05) worse than in groups 1 and 2. The subjective tolerance to fibroendoscopy as reported by the patients was on the average similar in the children of all four groups (p>0.05). The doctors found the tolerance of fibroendoscopy to be the worst following pretreatment with the physiological solution (group 1) and the best after pretreatment with a mixture of lidocaine and xylometazoline (group 4) (p=0.03). The children comprising groups 2 and 3 were not significantly different in terms of the tolerance to fibroendoscopy (p>0.05). It is concluded that the pretreatment of the nasal cavity of the children with a 10% lidocaine solution before fibroendoscopy has no advantage over the pretreatment with a 0.05% xylometazoline solution; at the same time, insuflation of lidocaine as an anesthetic induces more pronounced negative emotions compared with the application of 0.05% xylometazoline.

Epidemiology, clinical history and microbiology of peritonsillar abscess.

The purpose of this investigation was to explore the epidemiology, clinical history and microbiology of peritonsillar abscess (PTA). A retrospective review of PTA cases treated at the Department of Otolaryngology, Regional Specialist Hospital in Radom, Poland between 1st October 2003 and 30th September 2013 was undertaken. A total of 111 PTA patients were admitted. The study population consisted of 57.7 % males and 42.3 % females, with an average age of 31.0 (range 5-78) years. Smokers comprised 22.0 % of the study group. The seasonal variation of PTA was statistically insignificant (p = 0.45). Recurrent tonsillitis occurred in 35.5 % of patients. In comparison with the rest of the study population, patients with a history of recurrent pharyngotonsillitis had higher incidence of previous PTA episodes [odds ratio (OR) 17.8, 95 % confidence interval (CI) 2.1-148.7, p = 0.001]. Also, they were more frequently treated with antibiotics prior to hospitalisation (OR 4.6, 95 % CI 2.0-10.9, p = 0.0005) and had significantly longer hospital stay (p = 0.03). Bacterial cultures of abscess aspirates were performed in 40.5 % of patients. Monomicrobial growth was detected in 77.8 % of aerobic cultures. Streptococcus pyogenes, growing most frequently in monoculture, was found in 28.9 % of aerobic cultures. PTA patients with and without recurrent pharyngotonsillitis differed with regard to clinical history and course of disease. The percentage of smokers among PTA patients was lower than that described in the literature. Monomicrobial growth predominated in PTA aspirate cultures. S. pyogenes proved to be the most frequent pathogen.

[Foreign bodies (disk batteries) in the nose].

This paper reports the results of analysis of the treatment of 8 children after the removal a disk battery from the nasal cavity. It was shown that the restoration of all the structures of the nasal cavity is possible if the foreign body remains in it during a short (up to 5 hours) time. The longer presence of such a body in the nasal cavity gives rise to post-traumatic defects, in the first place septal perforations and injuries to the inferior turbinated bone. In such cases, the foreign body must be immediately removed from the nasal cavity, and the child should be placed under thorough medical observation taking into consideration the long process of rejection of necrotic tissues and healing of the resulting defects.

[Microbiocenosis and activity of the inflammatory process in the colon of the patients with chronic cardiac failure].

The aim of this work was to study colonic microbiocenosis, endotoxin level, intensity of systemic inflammation and the state of matrix metalloproteinase (MMP) system and MMP tissue inhibitors (TIMP) in 75 patients with post-infarction cardiosclerosis at different stages of chronic cardiac failure (CCF). The patients were examined by clinical, echocardiographic and laboratory methods including bacteriological analysis of feces and measurement of amino-terminal brain natriuruetic peptide, endotoxin, TNF-alpha, MMP-9, and TIMP-4. The progress of CCF was shown to be associated with increasing colonic dysbiosis, endotoxin and TNF-alpha levels, disbalance in the MMO and TIMP systems.

[Gustatory sensitivity threshold to table salt and efficacy of the treatment of newly diagnosed patients with antihypertensive therapy].

Gustatory sensitivity threshold to table salt (GST) and extracellular fluid volume (EFV) were determined in 128 patients with arterial hypertension (mean age 54.1+-0.5 yr; 79 men) before and 3 month after antihypertensive therapy. Those with the initially high GST (sensing salt in its 0.32% solution) had AP 161+-2/97+-1 mm Hg, myocardial mass 235.1+-13.2 g and left ventricular diastolic size 4.91+-0.07 compared with 151 +- 1/93+-1, 203.5+-7.8 and 4.71+-0.05 respectively in patients with low GST. The treatment resulted in a decrease of AP and EFV by 14-19 and 12% respectively in all the patients. In those with high GST it decreased after intake of indapamide by 49% vs 24 % in the absence of therapy. In patients with initially low GST it decreased (by 37%) only after intake of diuretics. It is concluded that changes of GST reflect activation of mechanisms leading to a stable drop of AP.

[Immune mechanisms in pathogenesis of chronic heart failure].

In the review the new information about a participation of immune mechanisms in a pathogenesis of a chronic heart failure (CHF) is presented. Significance of a bacterial endotoxin, as inductor of activation of immune system at CHF, and factors of a system inflammation in a pathogenesis of the disease, breaking balance of matrix metalloproteinases and tissue inhibitors of metalloproteinases system, leading to change of structure of an extracellular matrix of a myocardium, are discussed.