The aim – 1) to evaluate the possibilities of ultrasound fetal heart examination in the detection and differential diagnosis of bradyarrhythmias; 2) to study the influence of arrhythmias on fetal hemodynamics; 3) to examine the role of fetal echocardiography in the management of prenatally diagnosed bradyarrhythmias for determining the optimal pregnancy and delivery tactics.
Material and methods. The analysis of echocardiographic examinations of the fetal heart from April 1996 to July 2016 has been performed. During this period 2073 pregnant women were examined and 213 cases of fetal heart arrhythmias were detected. Ultrasound examination of the fetal heart was conducted according to the general protocol. The anatomy of the fetal heart was assessed based on segmental analysis. Rhythm of the fetal heart was determined by simultaneous recording of mechanical events (contractions of the atria and ventricles), which are the consequence of electrical activity, with estimation of the ratio between them, as well as the measured time intervals of the cardiac cycle with calculation of their ratio. For this purpose, various ultrasound techniques (M-method, color, pulse-wave and tissue Doppler) have been used.
Results. During the study period 45 cases of fetal bradyarrhythmias were detected, (2.2 % of the number of all patients examined and 21.1 % of all arrhythmias). They included 20 cases (44.5 %) of periodic bradycardia of different duration, 9 cases (20 %) of sustained sinus bradycardia, 9 cases (20 %) of complete atrioventricular block, 5 cases (11 %) of blocked atrial bigeminy and 2 cases (4.5 %) of 2nd degree atrioventricular block. Persistent fetal bradycardia requires a complete echocardiographic examination to exclude structural pathology and assess possible hemodynamic complications. Bradyarrhythmias with a frequency of ventricular contractions of more than 60 bpm are well tolerated by the fetuses due to various adaptive mechanisms. Permanent forms of arrhythmia with a frequency less than 55 bpm, as usual, lead to serious hemodynamic comromise even in the absence of fetal congenital heart defects.
Conclusions. Ultrasound fetal heart examination provides not only the identification and reliable differential diagnosis of various types of fetal bradyarrhythmia, but also an assessment of its hemodynamic consequences and prenatal period monitoring of the fetal condition. This makes possible to choose the tactics of pregnancy management, determine the frequency of follow-up examinations, plan the time, place and route of delivery. The majority of fetal bradyarrhythmias are non-threatening rhythm disorders.
The aim – to elaborate and to validate the combined non-invasive method to reveal the obstructive сoronary artery disease (CAD) presence using its clinical pretest probability value in conjunction with tissue Doppler data of local systolic wall motion.
Material and methods. 81 pts with typical anginal and atypical chest pain and known absence of structural myocardial diseases as well as history of myocardial infarction and coronary revascularization, 64 % men, age 56.2±9.9 yrs old were examined. All patients were divided into investigational (teaching) and checking group (49 and 32 patients, accordingly) comparable by age, gender and main comorbidities rates. The index of coronary obstruction (INCO) was expressed in conventional units and was calculated as the ratio of CAD pretest probability to mean systolic wall motion velocity of 12 myocardial segments by tissue Doppler imaging.
Results. Invasive angiography identified obstructive lesions of coronary arteries in 37 patients, including 23 patients (47 %) of the investigational group and 14 (44 %) in checking group. The investigational group patients’ INCO composed 7.8±3.8 conv units with bimodal distribution of the parameter and cut-off point at 8 conv units which corresponds to 80 % sensitivity and 91 % specificity, AUC in ROC analysis 0,965. Comparable diagnostic properties of INCO at 8 conv units were confirmed during the further analysis in checking group with 85 % sensitivity and 95 % specificity, AUC 0.971.
Conclusions. New complex non-invasive diagnostic method including INCO calculation based on CAD pretest probability and local systolic wall motion velocities evaluation by tissue Doppler was proposed. High INCO sensitivity and specificity at value – 8 conv units to determine obstructive lesions in coronary arteries were shown. INCO calculation may be widely used at the first step of non-invasive diagnosis in suspected CAD, as well as for determination of the further strategy in patients after coronary revascularization.
The aim – to study heart structure and function according to the results of MR and ultrasound imaging, heart rate variability parameters, immune status indices in patients with myocarditis and to detect prognostic markers of unfavorable myocarditis clinical course.
Material and methods. Fifty two patients with clinically suspected acute diffuse myocarditis, sinus rhythm and heart failure with reduced LV ejection fraction (LV EF ≤ 40 %), among them 30 men and 22 women were examined. They were divided into two groups: 1st group – 27 patients with recovery of left ventricular ejection fraction (> 40 %) in 12 months, 2nd group – 25 patients without restoration of myocardial contractile function (LV EF ≤ 40 %). Within the 1st month after disease onset and after 12 months magnetic resonance imaging (MRI) of the heart, transthoracic echocardiography, Holter ECG monitoring with HRV parameters and examination of the immune status were performed.
Results. Left ventricular ejection after 12 months observation in patients of the 1st group increased by 27.8 % (P<0.01) and averaged 48.7 %, in patients of the 2nd group – by 12.4 % (P>0.05), on average to 38.5 %. Within the 1st month after myocarditis onset, myocardial edema at MRI was detected in 100 % and early contrast accumulation – in 92.3 % of patients (n=48). After 12 months of follow-up, both study groups were comparable by the results of detection of myocardial edema (18.5 and 20 %, respectively), and early contrast accumulation (22.2 and 28 %, respectively). The amount of delayed contrast accumulation zones at 12 months was significantly higher in patients in the second group – 42 (80.7 %) and 45 (86.5 %). The SDNN indicator in the 1st group increased by 18.3 % (P<0.05) for 12 months, while in the 2nd group it increased by 9.6 % (P>0.05). Number of ventricular arrhythmias and episodes of an unstable ventricular tachycardia after 12 months in patients of the 2nd group almost 2 and 2.5 times (P<0.01) respectively, exceeded the similar indicators of the 1st group.
Conclusions. In patients with myocarditis, in which LV EF remained ≤ 40 % after 12 months, significantly greater amount of delayed contrast accumulation and a decrease of HRV parameters were noted, related to more frequent development of ventricular arrhythmias. Patients with myocarditis having sites with delayed MRI accumulation of contrast, had a significantly higher risk of developing episodes of unstable ventricular tachycardia after 12 months of follow-up, according to Fisher’s exact test (F=0.012, OR=6.88).
The aim – to investigate remodeling of left heart chambers in patients with essential hypertension and left ventricular hypertrophy (LVH) under one-year treatment with renin-angiotensin system blockers by means of longitudinal, circular deformation of left ventricle (LV) myocardium and contractile, reservoir and conductive functions of left atrium (LA).
Material and methods. The study involved 64 patients (women – 56 %) with arterial hypertension. Patients were divided into groups. 22 patients receiving angiotensin II receptor blockers (ARB), mean age 57.5±1.6 years, constituted group 1. The 2nd group included 26 patients on angiotensin-converting enzyme inhibitors (ACEI), mean age 59.4±1.4 years. Besides, patients were divided depending on LVH severity: group A was presented by 35 patients with mild and moderate LVH; group B – 13 patients with severe LVH. In all patients we performed echocardiography and speckle tracking echocardiography with analysis of longitudinal global systolic strain (LGSS), circumferential global systolic strain (CGSS) and their rates, early (EDSR) and late LV diastolic strain, LA early and late diastolic SR, LA systolic deformation (LASD).
Results and discussion. Longitudinal contractile LV function improved under treatment. This was supported by LGSS increase by 6 and 5 % in groups 1 and 2, respectively. When diastolic function was analyzed, EDSR was found to be higher by 6 and 4 % in groups 1 and 2, respectively at the end of observation period. Also, LASD was revealed to be higher in groups 1 and 2 by 9 and 8 %, respectively, compared to that before treatment. Thus, treatment with ARBs and ACEIs resulted in improvement of both systolic and diastolic functions of LV and reservoir LA function.
Conclusion. In groups A and B myocardial mass index decreased by 5 and 10 %, respectively. In the group with severe LVH along with longitudinal improvement CGSS reliably increased by 10 % compared to that before treatment.
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.
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.
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.
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.
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.
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.