Search

Aim. To study changes in pulmonary vein ostia strain after radiofrequency (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF) by intracardiac echocardiography.Methods. Patients with paroxysmal AF (n=41) aged 60.1±7.1 years and duration of the disease 7.7±4.8 years were included in the study. Pulmonary vein (PV) isolation was performed with RFA (n=23) and CBA (n=18). All patients underwent transthoracic and intraoperative intracardiac echocardiography. Longitudinal strain of PV ostia was assessed before and after isolation.Results. Groups were comparable in main clinical parameters. Regress of PV ostia strain after RFA and CBA was achieved in all of PV, which corresponded to complete PV isolation. Remarked trend toward a more pronounced regression of PV ostia longitudinal strain after CBA compared with RFA for left superior (10±0.7% and 6.1±0.8% respectively, pConclusion. PV isolation is accompanied by a significant change in their longitudinal strain using intracardiac echocardiography both after CBA and after RFA.

Congenital heart disease occurs in the population with a frequency of 8 per 1000 live births. Information on the incidence of various congenital heart defects in newborns in connection with the widespread introduction of prenatal ultrasound diagnostics and an increase in its accuracy allows for planning pregnancy and management of newborns with critical heart defects. The aim of this study wasto retrospectively study the incidence of various congenital heart defects according to echocardiographic studies among newborns in the framework of the experience of one clinic over the period from 2009 to 2019. In the clinic of the Science Research Institute of Cardiology, echocardiographic studies were performed in 34298 children aged 1 day to 17 years, the average age was 3.68 years, the median 2.0 years. The newborns accounted for 4.6% of them (n = 1607). The results of echocardiographic studies were analyzed in 1607 newborns aged from 1 to 27 days. In 247 (15.3%) of the examined no congenital defects were detected, 1360 newborns had various congenital heart diseases. It was found that the most common anomaly in newborns were interventricular septal defects (37%), more than 60% of all interventricular septal defects were clinically insignificant small muscle defects. It has been shown that the incidence of congenital heart defects in newborns with complex prenatal diagnosis (coarctation of the aorta, double outlet right ventricle) has increased in recent years. A decrease in the incidence of atrioventricular septal defect was observed over the past five years. The possibilities of neonatal cardiac surgery in a particular clinic influenced the structure of the occurrence of individual congenital heart disease due to prenatal pregnancy planning and surgical tactics.

Determining fluid retention in circulatory system currently remains a challenge. The objective of our study was to determine the sensitivity of individual symptoms and signs of chronic heart failure (CHF) and echocardiographic criteria for detecting fluid retention in patients with atrial fibrillation and invasively measured elevated atrial pressure. Methods — We conducted a prospective study of adult patients with a history of cardiovascular disease (coronary artery disease or/and arterial hypertension in combination with atrial fibrillation [AF]) hospitalized for radiofrequency catheter ablation. All patients underwent expert ultrasound examination of the heart using Philips HD 15 and Philips iE33 devices, as well as invasive measurement of pressure in the left and right atria at rest (n=20). Results — The sensitivity of dyspnea in patients with paroxysmal AF and long-standing persistent AF was 44.4% and 90.9%, respectively. The sensitivity of the mean E/e' ratio in patients with paroxysmal AF and long-standing persistent AF was 22.2% and 18.1%, correspondingly. According to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm, only one patient (11.1%) in the group with paroxysmal AF and 54.5% of subjects in the group with a long-standing persistent AF type had two positive criteria. The sensitivity of lower limb edema was 0% in patients with paroxysmal AF and 57.1% in those with long-standing persistent AF. The sensitivity of IVC diameter >22 mm was 80% in patients with paroxysmal AF and 57.1% in the group with long-standing persistent AF. At the same time, the sensitivity of the IVC inspiratory collapse ≤50% was significantly lower in both groups: 60% in patients with paroxysmal AF and 42.9% in subjects with long-standing persistent AF. Conclusion — Clinical symptoms and signs of chronic heart failure (CHF), as well as echocardiographic parameters reflecting an increase in the filling pressure of the heart chambers, are characterized by extremely low sensitivity in a cohort of patients with paroxysmal AF. The use of more stringent criteria for diagnosing congestion in this group of patients leads to a significant underdiagnosis of elevated filling pressure in the left chambers of the heart, which, in turn, increases the likelihood of insufficient prescription of diuretic therapy when it is objectively necessary.

Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

Rationale — Fluid retention is among the most common causes of heart failure decompensation. The goal of our study was to evaluate the sensitivity and specificity of the ultrasound method for evaluating congestive phenomena in both systemic and pulmonary circulatory systems in patients with atrial fibrillation (AF) and chronic heart failure (CHF). Material and Methods — The study included 28 patients with paroxysmal AF, with or without CHF, who were scheduled for radiofrequency pulmonary vein isolation. The maximum and minimum diameters of the right superior pulmonary vein (RSPV) and inferior vena cava (IVC) were measured via echocardiography on expiration. Mean blood pressure in both right and left atria was measured intraoperatively. We calculated the correlations between maximum and minimum diameters of the RSPV and a mean pressure in the left atrium, as well as between IVC on expiration and a mean pressure in the right atrium, and evaluated the sensitivity and specificity of ultrasound diagnostics for evaluating congestive phenomena in both systemic and pulmonary circulation. Results — We established positive correlation between the minimum diameter of RSPV and invasively measured mean left atrial pressure (R=0.65, P

Aim. To evaluate the informational and diagnostic significance of the myocardial Tei index.Patients and methods. The study assessed data of echocardiographic studies of 9,256 patients aged 1 month to 60 years, 1,350 healthy individuals, and 7,906 patients with various cardiovascular diseases with abnormal volume-capacitive characteristics of the heart (congenital heart defects, different types of cardiopathy, and hypertensive disease).Results. The cutting points of the normal values of the indicator were established. Data showed that the Tei index did not reflect changes in the pumping function of the left ventricle and did not depend on the contractility of the left ventricle (LV), but it had direct significant correlation with the left ventricular filling pressure, both in normal and pathological conditions. Correlation was more significant in adult patients.Conclusion. Normal values of the Tei index less than 0.5 were observed in more than 95% of practically healthy individuals of any age. The maximum sensitivity and specificity of the myocardial performance index was found in patients with restrictive and dilated cardiopathy and common atrioventricular connection.

BackgroundFluid retention is one of the most common reasons for the heart failure decompensation. The purpose of the study is to estimate the sensitivity, specificity of the ultrasound method for evaluating congestive phenomena in the systemic and pulmonary circulations in patients with the atrial fibrillation (AF) and chronic heart failure (CHF).MethodsThe study includes 28 patients with the paroxysmal AF with and without CHF, who were planned for the radiofrequency pulmonary veins isolation. The maximum and minimum diameters of the right superior pulmonary vein and inferior vena cava on exhalation were measured echocardiographically. An average pressure in the right and left atria was measured intraoperatively. Сorrelation between the maximum and minimum diameters of the right superior pulmonary vein and an average pressure in the left atria and between inferior vena cava on exhalation and an average pressure in the right atria was calculated. The sensitivity, specificity of ultrasound methods for evaluating congestive phenomena in the systemic and pulmonary circulations was evaluated.ResultsThere was positive correlation between the minimum diameter of right superior pulmonary vein and invasive mean pressure in the left atrium (R=0.65, PConclusionsThe new ultrasound method of congestion diagnostics in the pulmonary circulation by the maximum and/or minimum diameter of the right superior pulmonary vein can be effectively applied in clinical practice in the same way as the well-known technique of congestion diagnostics in the systemic circulation by the diameter of the inferior vena cava in patients with the atrial fibrillation and chronic heart failure.

The aim of the study was to evaluate the influence of risk factors on the development of a combination of atrial fibrillation and sick sinus node syndrome and to determine the relationship of these cardiac arrhythmias to the polymorphism of the CASQ2 gene. The study included 95 patients, mean age 61.1 ± 14.3 years; Of them men - 48 (50.5%), with AF - 38 (40.0%), SSS - 17 (17.9%) and their combination - 40 (42.1%). Patients are divided into 3 groups, depending on the type of heart rhythm disturbance. The analysis of polymorphism rs6684209 of the gene of calsequestrin CASQ2 in all patients by the method of analysis of restriction fragment length polymorphism was performed. The size of the left atrium, ejection fraction, the presence of chronic heart failure (CHF), the presence of dyslipidemia, the increased body mass index (BMI), myocardial hypertrophy of the left ventricle were evaluated as factors influencing the development of the tachy-brady syndrome. It was revealed that all patients in the first group had CHF (y = 4.44, p = 0.03, x = 4.88, p = 0.02), and patients with CHF FC II significantly prevailed. Dyslipidemia in patients with a combination of two types of heart rhythm disturbances is much more common (x = 6.24, p = 0.01) than in patients with only AF. The BMI was significantly different in the first and third groups (t = 2.1, CC = 55, p = 0.03). Analysis of the frequency distribution ofgenotypes of the CASQ2 gene and alleles did not reveal the presence of statistically significant differences between the groups studied. According to the research on the development of a combination of two cardiac arrhythmias of AF and SSS, such factors as CHF, BMI and the presence of dyslipidemia influence. The relationship between the development of the tachy-brady syndrome and the genetic polymorphism of the protein calsequestrin in the sample was not revealed. A population with a heterozygous type of inheritance of a protein called calsequestrin is less prone to developing a dilatation of the left atrium.