THE ROLE OF LEFT VENTRICULAR HYPERTROPHY, RS1801253 AND RS1801252 ALLELIC POLYMORPHISMS OF ADRB1 IN ASSESSING THE RISK OF SUDDEN CARDIAC DEATH IN PATIENTS WITH ARTERIAL HYPERTENSION.

OBJECTIVE: The aim: To study the association of left ventricular hypertrophy (LVH) and polymorphisms rs1801253 and rs1801252 of the ADRB1 gene with the risk of sudden cardiac death (SCD). PATIENTS AND METHODS: Materials and methods: The study included 179 patients which underwent clinical investigation, echocardiography, elektrokardiography. The examined were divided into groups with a low (110 people) and high risk (69 people) of SCD. The distribution of allelic polymorphisms was investigated with polymerase chain reaction (PCR). RESULTS: Results: All patients of group with high-risk cardiovascular mortality showed a decrease in heart rate variability (RV) due to an increase in sympathetic activity (p=0.013). Also, in the group of patients with LVH, predictors of sudden cardiac death and arrhythmogenic substrate, were observed. The variability of the allele C1165G rs1801253 of the ADRB1 gene was associated with an increased risk (2.55-fold increase) of SCD and LVH. Also, the associations of polymorphic locus A145G (rs1801252) of the ADRB1 gene proved the presence of a permanent difference for the "risky" allele A in patients with a high risk of SCD. CONCLUSION: Conclusions: It was set the probable association of alleles rs1801253 (C1165G) and rs1801252 (A145G) ADRB1 at the patients with a high risk of SCD compared to the control group.

ASSOCIATION OF LEFT ATRIAL SPONTANEOUS ECHO CONTRAST WITH CLINICAL AND HEMODYNAMIC CHARACTERISTICS OF PATIENTS WITH LONG-TERM EPISODES OF PERSISTENT ATRIAL FIBRILLATION.

OBJECTIVE: The aim: To identify clinical and hemodynamic factors, associated with left atrial spontaneous echo contrast (LASEC) (LASEC in general, and the dense LASEC), in non-valvular persistent atrial fibrillation (AF) patients with the duration of AF episode ≥90 days. PATIENTS AND METHODS: Materials and methods: The cross-sectional study consecutively enrolled 115 persistent AF patients with the duration of its episode ≥90 days (82 (71,3 %) males; mean age 59 ± 11 years). Transthoracic (TEE) and transesophageal echocardiography (TEE) were performed. LASEC (by TEE) was observed in 79 (68,7 %) patients. The dense (moder¬ate-to-severe) LASEC was detected in 23 (20,0 %) cases. RESULTS: Results: Heart failure (HF) stage C (OR 2,09 (95 % CI 1,24-3,53); p=0,006), lower TEE-derived left atrial appendage (LAA) flow velocity (FV) (OR 0,94 (95 % CI 0,91-0,98); p=0,003), and the presence of TTE-derived pulmonary hypertension (PH), appeared to be strongly associated with LASEC (AUC for logistic regression model: 0,83 [95 % СI 0,75- 0,89]). The presence of diabetes mellitus type 2 (DM) (OR 2,34 (95 % CI 1,13-4,86); p=0,027), along with lower LAA FV (OR 0,83 (95 % CI 0,76-0,91); p<0,001), were strongly associated with dense LASEC (AUC: 0,89 [95 % CI 0,82-0,94]). CONCLUSION: Conclusions: The TEE-derived LASEC in patients with long term episodes (≥90 days) of persistent AF was strongly associated with HF stage C and TTE-derived PH, and with lower TEE-derived LAA FV. The presence of DM, in addition to lower LAA FV, was related to dense LASEC.

CLINICAL CASES OF LIFE-THREATENING ARRHYTHMIAS: LONG AND SHORT QT SYNDROMES.

OBJECTIVE: The aim: To present clinical cases of sudden cardiac death in patients with prolonged and shortened QT interval. PATIENTS AND METHODS: Materials and methods: The study includes description of two different clinical cases with prolonged and shortened QT interval after sudden cardiac death. Verification of the diagnosis was performed using the criteria recommended by the European Society of Cardiology (ESC) and European Heart Rhythm Association (EHRA). RESULTS: Clinical case: Two clinical cases of syncopе with life-threatening arrhythmias, confirmed by electrocardiographic and clinical diagnostic criteria, indicating a change in the dispersion of the QT interval, are presented. The first case represents a patient with intermittent syncope. The patient had previously had attacks of sudden palpitations with fainting. The patient came after another episode of syncope. Further follow-up revealed clinical and electrocardiographic signs of ventricular tachycardia paroxysm. Than the prolongation of the QT interval is set. In this clinical case, verification of QT prolongation syndrome was established in the elderly. Another clinical case is associated with QT syndrome, which remains difficult to diagnose. Such cases have been described relatively recently. The clinical picture of the syndrome of short QT interval in the presented clinical case was characterized by the appearance of syncopal states. The patient showed changes in the adjusted QT interval <320 ms. The causes of syncope in a patient with a short QT interval were paroxysms of atrial fibrillation (AF) or ventricular arrhythmias. At the same time the anatomical structure of a myocardium remains normal and unchanged. The hereditary nature of the disease in the patient has been proven. CONCLUSION: Conclusions: Timely diagnosis of prolongation (LQTS) or shortening (SQTS) of the QT interval after ECG and Holter monitoring allows you to identify a group of patients with an increased risk of developing ventricular arrhythmias, syncope and sudden cardiac death. Implantation of a cardioverter-defibrillator is an effective and safe method of preventing sudden cardiac death in patients with long and short QT syndromes.