Тематичний Архів | Category Archives: Functional diagnostics

E.G. Nesukay, I.I. Giresh Evaluation of the right ventricular function in patients with arterial hypertension using speckle-tracking echocardiography

The aim – to study structural and functional state of the right ventricle in patients with essential hypertension and different levels of left ventricular hypertrophy (LVH) on the basis of longitudinal right ventricular myocardium strain assessment.

Material and methods. The study involved 64 patients with arterial hypertension, average age (55.7±1.1) years. The first group consisted of 17 patients without LVH, the second group included 17 patients with mild LVH, the third group included 15 patients with moderate LVH, and the fourth group consisted of 15 patients with severe LVH. Additionally, patients with LVH were distributed according to the dilatation of the left atrium (LA) into group A – 21 patients without dilatation of the LA, and group B – 26 patients with dilated LA. In all patients we performed echocardiography and speckle tracking echocardiography with analysis of longitudinal global systolic strain of the right ventricular (RV LGSS), and its rate (RV LGSSR) and early diastolic strain rate (SR) of LV (EDSRLV). We calculated E/EDSR ratio for the assessment of LV filling pressure.

Results. Decrease of RV contractile function that was characterized by RV LGSS and RV LGSSR was observed even in patients with mild hypertrophy, being more prominent along with increase of the hypertrophy level. Average RV LGSS in group 2 was 16.8±0.4 % which appeared less compared to group 1 (19.7±0.9 %). RV LGSSR in group 2 (0.82±0.03 s–1) and group 3 (0.83±0.03 s–1) indices were less compared to group 1 (1.02±0.06 s–1). In patients with dilated LA we found decreased contractile function of RV compared to the patients without LA dilatation. RV LGSS and RV LGSSR in group B were less compared to group A.

Conclusion. Impaired RV contractility can be explained by the fact that LA dilation in arterial hypertension occurs due to diastolic dysfunction progression which in turn, influences the RV contractile function. In group with severe LVH we detected direct correlation between indicators of RV deformation and EDSRLV, as also inverse correlation between RV LGSS and E/EDSRLV, confirming influence of LV diastolic function on RV contractility.

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О.A. MyshakivskyyPredictors of the deterioration of left ventricular systolic function after surgical intervention in severe primary mitral insufficiency: one-center prospective study

The aim – to verify whether the proposed new echocardiographic parameter of left ventricular (LV) systolic function – so-called effective LV ejection fraction – may become a predictor of occurrence of LV dysfunction in patients with severe primary mitral regurgitation (MR) after mitral valve surgery.

Material and methods. We performed prospective, one-center study and analysed the results of surgical treatment of 72 patients with severe primary MR (mitral valve replacement or repair) in the cardiac surgery department from October 2013 to February 2016. Transthoracic echocardiography was used to evaluate different parameters of LV systolic function, including the new parameter – effective LV ejection fraction. The measurement of parameters was performed three times: before the surgery, during the 1st week and during the 3rd month after surgery. 

Results. Three patients died after the surgery. By applying the diagnostic coefficients (method of Wild – Hubler – Henkin) we determined the threshold point for effective LV ejection fraction, discriminating patients with deterioration of LV systolic function after surgery. We showed that the optimal threshold level was 30 % and the lower level was associated with sensitivity 80 %, specificity 94.4 %, odds ratio 68.0 (95 % confidence interval 10.6–261.7) for prognosis of ejection fraction reduction after surgery.

Conclusion. The parameter of effective LV ejection fraction may be used in patients with severe primary MR in order to predict the risk of LV ejection fraction deterioration after corrective surgery. This parameter might also be helpful for dynamic evaluation of these patients and to determine the terms of corrective mitral valve surgery before occurrence of irreversible LV dysfunction.

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I.I. Giresh Evaluation of gender features of systolic and diastolic function in patients with essential hypertension using speckle tracking echocardiography

The aim – to investigate the peculiarities of longitudinal deformation, contractile, reservoir and conduit function of left atrium in patients with essential hypertension depending on gender by means of specle tracking echocardiography

Material and methods. The study involved 92 patients with essential hypertension. We formed groups of patients: 1A group – 14 females, without LV hypertrophy (LVH), 1B group – 10 males, without LV hypertrophy, 2A group – 16 females, with mild LVH, 2B group – 14 males, with mild LVH, 3A group – 13 females, with moderate LVH, 3B group – 8 males, with moderate LVH, 4A group – 6 females, with severe LVH, 4B group – 11 males, with severe LVH. In all patients we performed echocardiography (Echo) and speckle tracking Echo with analysis of longitudinal global systolic strain (LGSS), its rate, early diastolic strain rate (EDSR) and late of LV, early diastolic strain rate (EDSRLA) and late of left atrium (LA), LA systolic deformation (LASD). We calculated E/EDSR ratio for the assessment of LV filliig pressure.

Results. Decrease of LV contractile function in males with mild or without LVH using LGSS was found. Diastolic function evaluation in males revealed reliably lower EDSR and higher LV filling pressure and was obtained using E/EDSR index in mild LVH group compared to females. In males without, with mild or moderate LVH decrease of reservoir LA function using LASD index was found. Also, in males with mild LVH decrease of LA conduit function using EDSRLA was revealed compared to females. All received results are possibly caused by higher LV filling pressure.

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V.I. Tseluyko, S.M. Sukhova, K.Yu. Kinoshenko, L.M. Yakovleva Usage of 2D speckle tracking echocardiography in the diagnosis of right ventricular dysfunction in patients with acute pulmonary embolism

The aim – to study the diagnostic value of 2D speckle tracking echocardiography (2D STE) to assess functional condition of the right ventricle (RV) in patients with acute pulmonary embolism (PE).

Material and methods. One hundred and four patients were examined, average age was 62.9±13.5 years, consecutively hospitalized with acute PE determined according to ESC 2014 recommendations. All patients were examined by transthoracic echocardiography and multislice computed tomography pulmonary angiography (CTPA).

Results. Examined patients with PE were divided into two groups depending on presence of at least one echo sign of RV dysfunction: group I included 75 (72.2 %) patients with RV dysfunction; group II included 29 (27.8 %) patients without RV dysfunction. According to the 2D STE, reduction of the longitudinal strain was detected in all studied segments of group I and in four out of six segments of the group II compared to the control group. The degree of the global longitudinal strain of RV free wall was the worst in group I (5.1±7.9 % vs 23.2±7.1 % in the control group and 10.0±8.9 % in group II). The indicators of the radial velocity in basal and middle segments in patients with RV dysfunction were significantly higher in group I than in the control group (Р<0.001). Contrary, in the middle and apical RV segments these indicators were significantly lower in group I than in the control group (P<0.001). Segmental ejection fraction (SEF) of all RV segments was significantly lower in group I (Р<0.001). The descent of the SEF was recorded only in the apical and middle RV segments in group II compared to the control group (Р<0.001). Conclusions. RV dysfunction signs are not evident in patients with acute PE examined by standard echocardiography. Nevertheless, changes of right ventricular contractility in these patients may bedetected by 2D STE indicators.

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E.G. Nesukay, Y.Y. Hiresh Left heart geometry changes in patients with essential hypertension and different heart rate

The aim – to investigate longitudinal deformation, left atrial contractile, reservoir and conduit function in patients with essential hypertension and different heart rate (HR) by means of speckle tracking echocardiography.

Material and methods. The study involved 56 patients with essential hypertension (women – 63 %). We formed groups of patients: group 1A – 13 patients with HR < 70/min, without LV hypertrophy (LVH), 2A – 16 patients with HR < 70/min, with moderate LVH; 1B group – 12 patients with HR ≥ 70/min without LVH; 2B – 15 patients with HR ≥ 70/min and moderate LVH. In all patients we performed echocardiography (Echo) and speckle tracking Echo with analysis of longitudinal global systolic strain (LGSS), and its rate (LGSSR), early (EDSR) and late diastolic strain rate (SR) of LV, early and late diastolic SR of left atrium (LA), LA systolic deformation. Results. We found decreased longitudinal deformation in patients in both groups with HR < 70/min. We also found significantly smaller values of LGSS in groups with moderate LV hypertrophy compared to the respective groups without hypertrophy. Analysis of diastolic function showed significantly smaller value of EDSR in groups with HF < 70/min. Decreased reservoir and contractile function of left atrium in groups with low HF was found. Conclusions. Decreased contractile function of left atrium in groups with HR < 70/min may be caused by elevated left ventricular filling pressure shown by E/EDSR changes.

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D.D. Dyachuk, A.М. Kravchenko, L.S. Fainzilberg, S.S. Stanislavska, Z.A. Korchinska, K.B. Orikhovska, V.S. Pasko, K.O. Mikhaliev. Screening of myocardial ischemia myocardium by the assessment of repolarization phase

The aim – to evaluate the screening value for phasegraphy device for ischemia diagnosis.

Material and methods. We screened 590 people in scope of planned yearly screening. Phasegraphy was performed in all subjects. This study was performed using special sensor determining the symmetry of the T-wave (βТ parameter) at single-channel ECG.

Results. We demonstrated that diagnostic test based on measurement of the symmetry of the single-channel ECG T-wave in the phase space, was an effective diagnostic tool for identification of subjects with suspected coronary artery disease. In vast majority of patients with coronary heart disease the value of T-wave symmetry βТ significantly exceeded the βТ value in patients without clinical evidence of ischemic changes of the myocardium.

Conclusion. Due to the simplicity of methodology, its low cost, the small amount of time (3–5 minutes) for examination and high diagnostic value, phasegraphy might be recommended for use in primary health care institutions to assess the level of functional state of the cardiovascular system at population screening.

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E.G. Nesukay, Y.Y. Hiresh. Evaluation of left heart function in patients with different types of left ventricular hypertrophy by speckle-tracking echocardiography

The aim – to assess the structural and functional state of the left heart in patients with essential hypertension (EH) with different types of left ventricular hypertrophy (LVH).

Material and methods. The study involved 80 patients with essential hypertension (women – 59 %), average age 57.2±1.03 years. According to the type of LVH patients were divided into four groups. The 1st group consisted of 20 patients without LVH, the 2nd – 25 pts with mild LVH, the 3rd – 20 pts with moderate LVH, and the 4th – 15 pts with severe LVH. In all patients we performed echocardiography (Echo) and speckle-tracking Echo with analysis of longitudinal global systolic strain (LGSS), circumferential global systolic strain (CGSS) and their rates (LGSSR and CGSSR respectively), early and late diastolic strain rate (SR) of LV, early and late diastolic SR of left atrium (LA), LA systolic deformation.

Results and conclusion. In patients with different degrees of LVH we observed the following changes: in the second group with mild LVH a decrease of LGSS and early diastolic LV SR was found and these changes were more expressed in groups with moderate and severe LVH. Moderate LVH was characterized also by the significant decrease of LGSSR and CGSSR. In patients with severe LVH we recorded the lowest values of LGSS, CGSS and CGSSR, compared to those in other groups. Changes of reservoir and conduit LA function were found in hypertensive patients even without LVH, these changes became more pronounced with more severe LVH. In patients with severe LVH we observed also impairment of LA contractile function.

Conclusions. Application of speckle-tracking echocardiography in hypertension pts with LVH and preserved EF allows to reveal changes of longitudinal function, diastolic dysfunction, increase of LV filling pressure already at stage of mild LVH. These changes were most significant in group of severe LVH. Changes of reservoir and conduit LA function increased along with more severe LVH. Contractile LA dysfunction was marked only in group with severe LVH.

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V.S. Tanasichuk, S.V. Fedkіv, T.M. Babkinа, N.V. Tanasichuk-Gazhieva. Role of modern methods of cardiovascular imaging in the assessment of left ventricular remodeling in chronic forms of the ischemic heart disease

This paper presents results of the comprehensive study of 86 patients with chronic ischemic heart disease using cardiovascular imaging techniques. The precision and specificity of multidetector computer tomography and magnetic resonance imaging in the diagnosis of myocardial infarction were determined. Interrelation between depth of myocardial injury, global and regional left ventricular function was studied. Comparability of the results received by means of multidetector computed tomography and echocardiography or magnetic resonance imaging for evaluation of left ventricular remodeling was observed.

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V.M. Kovalenko, E.G. Nesukay, E.Yu. Titov, N.S. Polenova, O.O. Danylenko. Optimization of the diagnosis of heart failure with preserved left ventricular ejection fraction in patients with essential hypertension using speckle-tracking echocardiography

The aim – to study strain and strain rate of left ventricular (LV) and left atrium (LA) at rest and during exercise and establish early markers and mechanisms of heart failure (HF) with preserved ejection fraction (EF) in patients with essential hypertension (EH).

Material and methods. The study involved 30 patients with EH (men – 60 %) aged (55.5±2.8) years. Patients with EH and HF with preserved LVEF (15 patients) constituted group 1. The group 2 included 15 patients with EH and without HF. All patients were studied by means of echocardiography, stress echocardiography and speckle tracking echocardiography, as well as measuring NT-proBNP levels.

Results. Patients of group 1 had significantly higher LV mass index (at 22.5 %), LA volume index (at 29.2 %), level of NT-proBNP (2.3 times) and LV filling pressure, compared to group 2. Group 1 showed also significant decrease of mean longitudinal and circumferential LV systolic strain (22.7 and 26.9 % respectively), indices of LV and LA diastolic strain as well as LA conduit, reservoir and contractile function. The factors associated with HF with preserved LVEF in patients of group 1 were established: the value of LA systolic strain < 27.5 %, value of LV global systolic longitudinal strain < 10 % and early LV diastolic strain rate < 0.47 c–1. During exercise there was no increase in LV longitudinal systolic and diastolic strain, no improvement of the reservoir and conduit LA function in group 1. This was accompanied by increasing LV filling pressure and appearance of dyspnea, compared to patients of group 2. Conclusions. Patients with hypertension and HF with preserved LVEF have more pronounced impairment of LV and LA strain compared to patients with EH without HF. Echocardiographic parameters associated with HF with preserved LVEF in patients with EH were identified. We found link between reduced exercise tolerance and LV/LA strain abnormalities in patients with EH and HF with preserved LVEF.

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N.D. Oryshchyn.Assessment of the myocardial viability by magnetic resonance imaging for prediction of functional recovery after revascularization in patients with ischemic cardiomyopathy

The aim – to assess the prognostic value of MRI-derived segmental late hyperenhancement extent as a predictor of the functional recovery of myocardial segments after revascularization in patients with ischemic cardiomyopathy.

Material and methods. We enrolled 40 patients with heart failure due to the systolic dysfunction and performed cardiac MRI with late gadolinium enhancement. Segmental extent of hyperenhancement was calculated in all patients. Revascularization was performed in 12 patients. We assessed segmental contractility before and 3–6 month after revascularization and compared the degree of functional improvement of the segment with different extent of hyperenhancement.

Results. Segments with low extent of hyperenhancement (1–25 %) improved systolic function in 70 %, segments with extent of hyperenhancement up to 50 % – in 50 %, segments with hyperenhancement 75 % and more – in 2.7 %. Based on echocardiographic segmental functional recovery 3–6 months after revascularization, we calculated the prognostic value of the late hyperenhancement extent that might be used to distinguish between viable and nonviable segments. The sensitivity of the segmental late hyperenhancement extent in prediction of segmental functional recovery was 70.8 %, the specificity – 84.9 % with cut-off 50 %.

Conclusions. Likelihood of the systolic function improvement in segments with low extent of late hyperenhancement (0–50 %) is high. Segments with high extent of late hyperenhancement (> 75 %) could be considered as non-viable. Cardiac MRI with late gadolinium enhancement is a sensitive and specific method of prediction of functional recovery after revascularization.

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