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1.
Kardiologiia ; 61(3): 71-76, 2021 Mar 30.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33849422

RESUMO

Aim    To develop a new, modified protocol for transesophageal atrial electric stimulation (TEAES), which would significantly enhance the diagnostic value of stress echocardiography and reduce the duration of the test in patients with ischemic heart disease (IHD).Material and methods    This study included 101 patients (80 men and 21 women aged 55±9 years) with suspected or documented diagnosis of IHD who were divided into two homogenous groups. Group 1 (51 patients) underwent stress echocardiography (stress-EchoCG) according to a standard protocol (SP) for TEAES and group 2 (50 patients), underwent stress-EchoCG according to a modified protocol (MP). In addition to stress-EchoCG with TEAES, selective coronary angiography was performed for all patients. The development of the new method for evaluating occult coronary insufficiency was based on comparison of SP and MP for TEAES with stress-EchoCG with data of coronary angiography.Results    In both groups, significant differences in values of systolic and diastolic blood pressure were absent. However, the values of achieved heart rate were significantly different: 141±11 (TEAES SP) and 155±10 (TEAES MP) bpm (p=0.01). There was also a difference in the duration of the TEAES protocols: 15±3 and 5±2 min, respectively (p=0.006). The use of the modified TEAES protocol for detecting transient disorders of left ventricular myocardial local contractility increased the sensitivity, specificity and accuracy of the test from 76 %, 87 %, and 80 % to 83 %, 92 %, and 86 %, respectively. The most significant differences were found in the area supplied by the circumflex artery: the SP and MP sensitivities were 63 % and 75 %, respectively (p<0.05) and the SP and MP accuracies were 81 % and 90 %, respectively (p<0.05).Conclusion    Evaluation of occult coronary insufficiency by stress-EchoCG with the TEAES MP as compared to the TEAES SP provides a gentler procedure regimen for the patient due to a shorter duration of the test and at the same time improves the diagnostic significance of this method in IHD patients.


Assuntos
Doença das Coronárias , Isquemia Miocárdica , Angiografia Coronária , Ecocardiografia sob Estresse , Teste de Esforço , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Sensibilidade e Especificidade
2.
Kardiologiia ; 60(12): 48-63, 2021 Jan 19.
Artigo em Russo | MEDLINE | ID: mdl-33522468

RESUMO

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.


Assuntos
Pesquisa Biomédica , Cardiologia , Insuficiência Cardíaca , Consenso , Ecocardiografia , Ecocardiografia sob Estresse , Teste de Esforço , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Federação Russa , Volume Sistólico , Função Ventricular Esquerda , Carga de Trabalho
3.
Ter Arkh ; 92(9): 24-29, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33346427

RESUMO

AIM: To perform comparative analysis of right ventricular (RV) structure and function in patients with various cardiovascular diseases using modern echocardiographic technologies in comparison with magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study included 85 patients. Group 1 consisted of 32 patients with idiopathic pulmonary hypertension (IPH) (mean age 35.910.2 years). Group 2 included 27 patients with arterial hypertension (AH) grade 3 (mean age 58.612.3 years). Group 3 consisted of 26 patients with chronic heart failure (CHF) (mean age 56.115.3 years). Control group included 28 healthy volunteers (mean age 38.710.9 years). The main method was transthoracic echocardiography (TTE) using modern technologies, such as three-dimensional echocardiography (3DE), tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). In some patients and healthy volunteers 3DE data were compared with MRI data. RESULTS: Patients with IPH and CHF had minimal RV ejection fraction (EF) both according to 3DE and MRI. Correlation analysis revealed close correlation between RV volumes and EF according to 3DE and MRI. Minimal values of systolic indicator STV according to TDI were observed in patients with CHF. In all groups, including control group, the highest values of STV were obtained at the level of the basal segments and the lowest values at the level of apical segments. STE revealed the same pattern as TDI. According to STE minimal RV strain was observed in IPH and CHF groups and significantly differed not only from control group, but also from AH group. CONCLUSION: The lowest values of RV EF and strain were observed in IPH and CHF groups. There were no significant differences in these indicators between the groups, that dictates the need for thorough assessment of RV structure and function not only in patients with precapillary, but also with postcapillary pulmonary hypertension. The results of the study confirm good comparability of 3DE and MRI in assessing RV volumes and EF.


Assuntos
Doenças Cardiovasculares , Disfunção Ventricular Direita , Adulto , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita
4.
Ter Arkh ; 92(4): 45-50, 2020 May 19.
Artigo em Russo | MEDLINE | ID: mdl-32598697

RESUMO

AIM: To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses. MATERIALS AND METHODS: Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (5075%) and 33 over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed. RESULTS: Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (5075%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.


Assuntos
Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Isquemia Miocárdica , Angiografia Coronária , Ecocardiografia , Ecocardiografia sob Estresse , Humanos , Sensibilidade e Especificidade
5.
Kardiologiia ; 60(3): 137-141, 2020 Mar 18.
Artigo em Russo | MEDLINE | ID: mdl-32375626

RESUMO

LEOPARD syndrome with multiple lentigines (cardiomyopathic lentiginosis) is a rare, genetically predetermined disease with autosomal dominant inheritance. Prevalence of this syndrome is unknown. One of pathognomonic clinical manifestations of this syndrome is the presence of multiple lentiginous pigment spots all over the body. The most common cardiac manifestation (approximately 80%) is myocardial hypertrophy. We presented a rare clinical case of detecting LEOPARD syndrome with multiple lentigines in a 32-year old female patient with major manifestations evident as pronounces morpho-functional alterations, myocardial hypertrophy, and heart rhythm disorders.


Assuntos
Síndrome LEOPARD , Adulto , Feminino , Coração , Humanos
6.
Kardiologiia ; 60(3): 155-160, 2020 Jan 20.
Artigo em Russo | MEDLINE | ID: mdl-32375630

RESUMO

Transthyretin amyloidosis (ATTR) is a threatening and severe genetic disease characterized by damages to organs and systems caused by a pathological protein transthyretin produced in the liver. Clinical manifestations of this disease vary from injuries of the nervous system to injuries of the cardiovascular system. Prognosis for ATTR-amyloidosis remains unfavorable. The absence of pathognomonic symptoms complicates diagnostics of this disease, which tends to simulate other conditions. At present, medicines exist, which are pathogenetic in the treatment of ATTR-amyloidosis. The article describes a clinical case of ATTR-amyloidosis with primary heart injury complicated with functional class III chronic heart failure during the tafamidis treatment.


Assuntos
Neuropatias Amiloides Familiares , Benzoxazóis/uso terapêutico , Neuropatias Amiloides Familiares/tratamento farmacológico , Humanos , Pré-Albumina
7.
Kardiologiia ; 60(2): 54-60, 2020 Mar 05.
Artigo em Russo | MEDLINE | ID: mdl-32345199

RESUMO

Objective Identify the diagnostic markers of the severe MV changes in patients with ischemic mitral regurgitation (IMR) and suggest a modification of the echocardiography (EchoCG) algorithm.Materials and Methods A two-stage examination of 65 patients with mild (n=22), moderate (n=22), and severe (n=21) IMR was performed using two-dimensional (2D) transthoracic EchoCG with dopplerography, 2D and three-dimensional (3D) transesophageal EchoCG (TEE). 4D MV-Assessment in off-line mode was made in TomTec Imaging Systems GmbH, Germany. Statistical analysis (SAS 9.4) included Student's t-test, Kruskal-Wallis method, Pearson correlation, multivariate regression analysis, and ROC-analysis.Results According to 3D TEE the significant changes in MV annulus, leaflets and tenting are detected. 3D parameters of MV geometry are related to IMR severity, left ventricle (LV) remodeling (global and regional), and they are different in symmetric and asymmetric variants. In symmetric variant MV reconstruction is correlated with LV dilatation and contractility decrease, in asymmetric variant it's correlated with regional remodeling parameters. Severe IMR is characterized by a decrease in MV annulus displacement (27,0±6,6 mm/s versus 32,4±10,8 mm/s in mild IMR; р<0,05), tenting volume fraction (32,5±14,8% versus 56,2±16,8% in mild IMR; p<0,05), and annulus area fraction (4,7±2,7% versus 6,6±4,5% in mild IMR; р<0,05). Vena contracta width (VCW), Proximal Isovelocity Surface Area (PISA) radius, Effective Regurgitant Orifice Area (EROA), Regurgitant Volume (Rvol), LV end systolic dimension (LV ESD), and central large jet >50% of left atrium (LA) area have a predictive value in the diagnosis of MV geometry severe changes. If thresholds are reached these 2D TTE parameters can be used as indications for the 3D TEE.Conclusion 3D TEE allows for detailed assessment of MV geometry and function depended on IMR severity and variant. To make decision of MV surgery 3D TEE is recommended if the following indicators are presented: (1) VCW ≥0,7 cm; PISA radius ≥1,0 cm; central large jet >50% of LA area; LV ESD ≥4,0 cm; (2) VCW ≥0,6 cm; PISA radius = 0,6-0,99 cm; EROA ≥0,3 cm2; RVol≥45 cm; IMR eccentric jet + IMR elliptical orifice.


Assuntos
Ecocardiografia Tridimensional , Insuficiência da Valva Mitral , Algoritmos , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Humanos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
8.
Ter Arkh ; 92(12): 142-147, 2020 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-33720586

RESUMO

AIM: The study was to assess the deformation properties of the left ventricle (LV) myocardium in patients with breast cancer initially and after anthracycline chemotherapy according to 2D and 3D speckle-tracking echocardiography (STE). MATERIAL AND METHODS: the study included 99 patients with triple negative breast cancer with hypertensionandnormotension. All patients underwent standard transthoracic echocardiography with assessment of systolic function of the LV. To assess the indicator of global longitudinal strain (GLS), as a marker of cardiotoxicity, STE was used in two-and three-dimensional modes. In the three-dimensional STE mode, a new strain parameter, the global area strain (GAS) was evaluated. RESULTS: The study showed that in patients with breast cancer for a more accurate assessment of LV systolic function (ejection fraction) it is advisable to use 3D-echocardiography. A comparative analysis revealed statistically significantly lower values of the GLS according to the three-dimensional mode of STE compared to two-dimensional. The study also evaluated a new strain parameter GAS (%). In patients with breast cancer during ROC analysis with a value of -14.0, the GAS indicator for the development of subclinical cardiotoxicity showed a sensitivity of 81.5% and a specificity of 73.3%. Сonclusion.the advantage of the STE in the three-dimensional mode, in contrast to the two-dimensional mode, is the simultaneous and more accurate assessment of LVEF. The value of the additional parameter of LV deformation the area of deformation requires further study.


Assuntos
Neoplasias da Mama , Disfunção Ventricular Esquerda , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/diagnóstico por imagem , Ecocardiografia , Humanos , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda
9.
Kardiologiia ; 59(10S): 64-72, 2019 Oct 07.
Artigo em Russo | MEDLINE | ID: mdl-31876463

RESUMO

AIM: To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. MATERIALS AND METHODS: We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. RESULTS: Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. CONCLUSION: The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Aminobutiratos , Humanos , Peptídeo Natriurético Encefálico , Neprilisina , Receptores de Angiotensina , Tetrazóis
10.
Kardiologiia ; 59(10): 23-30, 2019 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-31615385

RESUMO

AIM: to compare diagnostic accuracy of exercise treadmill testing and stress echocardiography in the diagnosis of stable coronary artery disease (CAD) in patients aged >70 years. MATERIALS AND METHODS: The study included 390 patients aged >70 years with suspected stable ischemic heart disease, who underwent elective coronary artery angiography (CAG). Exercise treadmill testing (ETT) according to the modified Bruce protocol was carried out in 189 patients (48 %), bicycle stress echocardiography - in 179 patients (46 %). Initially we determined the prevalence of angiographically significant CAD according to the gender and chest pain character, and identified persons in whom stress testing was appropriate. After that diagnostic accuracy of both tests was evaluated in patients with atypical angina and non-anginal chest pain. RESULTS: Among 72 patients with atypical angina and non-anginal pain who underwent ETT and had unequivocal results, 38 (53 %) had obstructive CAD. ETT for detection of obstructive CAD had sensitivity 79 %, specificity 82 %, positive likelihood ratio (LR+) 4.4, and negative likelihood ratio (LR-) 0.3. Positive result increased probability of obstructive CAD from 53 % to 83 %, negative result reduced probability of obstructive CAD to 25 %. Among 111 patients with atypical angina and non-anginal pain who underwent stress echocardiography and had unequivocal results, 69 (62 %) had obstructive CAD. Sensitivity, specificity, LR+, and LR- of stress echocardiography were equal to 89 %, 95 %, 17.8, and 0.1, respectively. Positive result increased probability of obstructive CAD from 62 % to 95 %, negative result reduced probability of obstructive CAD to 16 %. CONCLUSION: bicycle stress echocardiography was found to be more accurate than ETT to rule in or rule out obstructive CAD in patients aged ≥ 70 years with atypical angina and non-anginal pain.


Assuntos
Doença da Artéria Coronariana , Ecocardiografia sob Estresse , Idoso , Angina Pectoris , Angiografia Coronária , Teste de Esforço , Humanos
11.
Angiol Sosud Khir ; 25(3): 54-61, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31503247

RESUMO

Analysed herein are the data of scientific literature over several last years concerning the use of contrast-enhanced ultrasonography (CEUS) of the abdominal portion of the aorta. Based on the results of Russian and foreign studies, the authors analyse feasibility of using CEUS in various pathological conditions of the aorta, as well as sensitivity, specificity, and prognostic value of the method. Also discussed are advantages and limitations of CEUS compared with other imaging techniques. This is followed by determining appropriate approaches to using the methodology of CEUS in examination of patients after endoprosthetic repair of abdominal aortic aneurysms. Finally, described is own experience of using CEUS in examination of a patient with chronic renal insufficiency after aortic endoprosthetic repair.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Meios de Contraste , Humanos , Estudos Prospectivos , Federação Russa , Tomografia Computadorizada por Raios X , Ultrassonografia
12.
Ter Arkh ; 91(3): 11-16, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31094452

RESUMO

AIM: The aim of the work is to compare vectorcardiographic (VCG) variables - spatial QRS-T angle and electrocardiographic ventricular gradient (VG) with echocardiography (EchoCG) data in patients with idiopathic pulmonary hypertension (IPH) and chronic thromboembolic pulmonary hypertension (CTEPH). MATERIALS AND METHODS: In 40 patients with IPH and 40 patients with CTEPH at the age of 45±12 years, systolic pulmonary artery pressure (SPAP); the sizes of heart chambers, parameters of RV systolic and diastolic function were evaluated with EchoCG. The QRS-T and VG angles were calculated on the VCG, derived from 12-lead digital ECG. RESULTS: In all patients SPAP was greater than 40 mm Hg (mean 83±18 mm Hg), EchoCG data indicated hypertrophy and dilatation of RV, its systolic and diastolic function; dilatation of the right atrium (RA). Prognostically unfavorable changes in EchoCG were observed: the presence of pericardial effusion in 35 (44%) patients, RA area greater than 26 cm2 in 18 (23%) patients; TAPSE less than 1.5 cm in 37 (46%) patients. EchoCG and VCG variables had statistically significant differences in patients with III-IV functional class in comparison with I-II functional class. Statistically significant moderate correlations between VCG and EchoCG variables were revealed. VCG variables allowed to separate patient groups with the presence and absence of prognostically unfavorable changes in EchoCG with sensitivity from 54 to 78% and specificity from 66 to 87%. CONCLUSION: In patients with IPH and CTEPH, changes of QRS-T angle and VG correlate with SPAP, the size of RV and RA, parameters of RV systolic and diastolic function. The possibility of the use of QRS-T angle and VG for the detection of patients with prognostically unfavorable echocardiographic changes in the general group of patients with IPH and CTEPH has been shown.


Assuntos
Ecocardiografia , Hipertensão Pulmonar , Adulto , Doença Crônica , Eletrocardiografia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Sístole
13.
Kardiologiia ; 59(4S): 21-32, 2019 May 24.
Artigo em Russo | MEDLINE | ID: mdl-31131757

RESUMO

PURPOSE: To assess and to compare the ventricular myocardium activation patern obtained by non-invasive epi- and endocardial mapping (NIEEM), as well as electrocardiographic (ECG) variants of lef bundle branch block (LBBB) and to estimate the value of these data for the success of cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: Te study included 23 patients (mean age 59,6±9,9 years) with LBBB, QRS duration ≥ 130 ms, lef ventricular ejection fraction (LVEF) ≤ 35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of LBBB ECG-criteria, proposed by Strauss D.G. et. al, patients were divided into 2 groups: 1group - strict LBBB, proposed by Strauss D.G. et. al. (n=14) and 2 group - other ECG morphologies of LBBB (n=9). NIEEM by the Amycard 01C system with an analysis of epi- and endocardial ventricular electrical activation was performed in all patients and 5 healthy volunteers (mean age 29±1,0years). Response to CRT was estimated by echo and was defned as decrease in lef ventricular (LV) end-systolic volume by > 15% afer 6 months of follow-up. RESULTS: LBBB ECG-criteria, proposed by Strauss D.G. et. al, was detected in 14 patients (61% of all included). According to the results of NIEEM, these patients had more pronounced ventricular electrical uncoupling (VEU) (р=0,002). Most ofen the line of block was detected in the anteroseptal or posterolateral region of the LV. Te zone of late LV activation, which is the most optimal position for the LV pacing electrode, was located in the basal and middle segments of the lateral and posterior walls. Afer 6 months of CRT 15 patients (65%) were included in the "response" group, the remaining 8 patients (35%) formed the "non-response" group according to echo criteria. In the "response" group the morphology of the QRS complex more frequently met the criteria, proposed by Strauss D.G. et al, than other ECG variants of LBBB (12 vs. 3 respectively, p = 0.023). Initially, VEU was more pronounced in the "response" group (VEU 55 [51, 64] ms in the "response" group vs 22 [8, 38] ms in the "non-response" group).Сonclusions. LBBB ECG criteria, proposed by Strauss D.G., identify patients with delayed transseptal interventricular conduction due to complete LBBB, what is a good target for CPT. Identifcation of individual ventricular activation properties may help to reveal responders to CRT in patients with LBBB.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Idoso , Bloqueio de Ramo , Eletrocardiografia , Humanos , Pessoa de Meia-Idade , Miocárdio , Resultado do Tratamento
14.
Kardiologiia ; 59(5): 92-96, 2019 May 25.
Artigo em Russo | MEDLINE | ID: mdl-31131774

RESUMO

Radiofrequency ablation is the "gold standard" in atrial fibrillation treatment. The frequency of complications is about 3.5-3.9 %. The symptomatic pulmonary vein stenosis is one of the most severe complications. In this report we present a clinical case of stenosis of all four pulmonary veins after redo catheter ablation of atrial fibrillation in 61year-old patient, and discussion of possible causes, specific features of diagnosis, and possible approaches to treatment of this complication.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Constrição Patológica , Humanos , Complicações Pós-Operatórias , Ablação por Radiofrequência/efeitos adversos , Resultado do Tratamento
15.
Ter Arkh ; 90(12): 76-83, 2018 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-30701837

RESUMO

AIM: To assess the value of the complex analysis of electrocardiographic (ECG) variants and echocardiographic (echo) manifestation of left bundle branch block (LBBB) in predicting the success of cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: The study included 39 patients (mean age 61.49±9.0 years) on sinus rhythm with LBBB, QRS duration ≥130 ms, left ventricular ejection fraction (LVEF) ≤35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of ECG-criteria, proposed by D.G. Strauss et al., patients were divided into 2 groups: 1 group - strict LBBB, proposed by D.G. Strauss et al. (n=29) and 2 group - other patients (n=10). In addition to standard echocardiography, global longitudinal 2-dimensional strain (GLS) and LBBB contraction pattern have been performed initially and in 6 months after implantation. Response to CRT was defined as decrease in LV end-systolic volume by >15% after 6 months of follow-up. RESULTS: Typical LBBB echo contraction pattern was detected in 25 patients (64% of all included). These patients had more pronounced longitudinal dissynchrony and a more expressed global longitudinal strain before CPT-D implantation (p<0.05). 27 patients (69% of all included) were included in the "response" group, the remaining 12 patients (31% of all included) - the "non-response" group. In the "response" group the morphology of the QRS complex was significantly more likely to meet the criteria, proposed by D.G. Strauss et al., than other variants (23 vs. 6, respectively, p=0.02), and the echo contraction pattern of this patients more often corresponded to "typical" LBBB (24 vs. 1, p=0.001). All patients, who had the ECG criteria, proposed by D.G. Strauss et al., and echo "typical" LBBB contraction pattern, responded on CPT. Moreover, the proportion of these patients in the "response" group was rather high - 81.5% (22 of 27 patients). CONCLUSION: ECG criteria LBBB, proposed by D.G. Strauss et al., identify patients with delayed transseptal interventricular conduction due to complete LBBB, what is a good target for CPT. Evaluation of the echo contraction pattern based on the definition of longitudinal myocardial deformation by means of a two-dimensional strand technology allows predicting the success of CPT in patients with LBBB. Patients with «typical¼ LBBB contraction pattern show more pronounced global longitudinal strain and larger longitudinal dissynchrony compared with other patients, and it explains their better response to CPT. Complex analysis of strict LBBB ECG criteria and echo contraction pattern are promising parameters in predicting beneficial response to CRT in patients with HF.


Assuntos
Bloqueio de Ramo , Terapia de Ressincronização Cardíaca , Eletrocardiografia , Insuficiência Cardíaca , Idoso , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Ecocardiografia , Humanos , Pessoa de Meia-Idade , Volume Sistólico , Resultado do Tratamento
16.
Kardiologiia ; 57(10): 80-86, 2017 Oct.
Artigo em Russo | MEDLINE | ID: mdl-29276933

RESUMO

We present in this article 2 cases of successful pharmacological restoration of sinus rhythm by a new class III antiarrhythmic drug refralon in patients with obesity and persistent atrial fibrillation. In both cases, the effective use of refralon was preceded by repeated ineffective attempts of electrical cardioversion. In the article we discuss the role of obesity as the factor leading to a substantial increase of transthoracic electrical resistance, and thus significantly reducing the probability of sinus rhythm restoration by means of electrical cardioversion. The clinical examples described in this article clearly show that the use of refralon may represent a unique clinical alternative to electrical cardioversion for sinus rhythm restoration in patients with persistent atrial fibrillation, and in some cases where the success of electrical cardioversion is obviously questionable, like in patients with severe obesity, the use of refralon seems preferable.


Assuntos
Fibrilação Atrial , Cardioversão Elétrica , Antiarrítmicos , Humanos , Obesidade
17.
Kardiologiia ; 55(6): 109-11, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26625528

RESUMO

Catheter radiofrequency ablation of focal atrial fibrillation was successfully performed in a patient after closure of interventricular septal defect with a xeno-pericardial patch and plastic of tricuspid valve. The case demonstrates feasibility of carrying out such interventions under intracardiac echocardiographic guidance in patients with disturbed anatomy and complicated access to the left atrium.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ablação por Cateter/métodos , Comunicação Interatrial/complicações , Pericárdio/transplante , Veias Pulmonares/cirurgia , Adulto , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interatrial/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Veias Pulmonares/inervação
18.
Kardiologiia ; 55(1): 64-9, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26050495

RESUMO

The article contains review of possibilities of the method of intracardiac echocardiography (ICE) in clinical electrophysiology, delineation of indications to its use, and perspectives of development of this technology. Characteristics of technical variants of the method and special features of their application are also given. Technique of performance of interventions under ICE control is described in detail. Foreign experience of ICE use is summarized, and own experience is presented.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Ecocardiografia/métodos , Ultrassonografia de Intervenção/métodos , Cateterismo Cardíaco/métodos , Humanos
19.
Kardiologiia ; 55(1): 82-7, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26050498

RESUMO

Surgical aortic valve replacement is the standard therapy for severe aortic valve stenosis, however one third of patients are rejected because of high surgical risk. Under medical treatment alone these patients have a very poor prognosis with a high mortality rate. We present a case of 70-year-old male patient with degenerative symptomatic critical aortic stenosis and chronic lymphocytic leukemia. Due to recurrence of leukemia, the patient was denied conventional open heart surgery. Within few months of palliative chemotherapy decompensated aortic stenosis with severe congestive heart failure developed. Such therapeutic alternative as transcatheter aortic valve implantation (TAVI) emerged as a lifesaving procedure for the patient that allowed performing full-dose chemotherapy later. We provide a comprehensive review of current indications and contraindications for TAVI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Insuficiência Cardíaca/complicações , Leucemia Linfocítica Crônica de Células B/complicações , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Seguimentos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Masculino , Índice de Gravidade de Doença
20.
Kardiologiia ; 55(6): 109-111, 2015 Jun.
Artigo em Russo | MEDLINE | ID: mdl-28294786

RESUMO

Catheter radiofrequency ablation of focal atrial fibrillation was successfully performed in a patient after closure of interventricular septal defect with a xeno-pericardial patch and plastic of tricuspid valve. The case demonstrates feasibility of carrying out such interventions under intracardiac echocardiographic guidance in patients with disturbed anatomy and complicated access to the left atrium.

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