Aim. To study the clinical manifestations, incidence of life-threatening complications, and their possible mechanisms and outcomes of left ventricular non-compaction (LVNC) in adults.Material and methods. This study included 125 adult patients with LVNC, 74 men (59.2%) and 51 women (40.8%) aged 46.4±15.1 years. Echocardiography (EchoCG) (n=125), Holter monitoring (n=125), cardiac magnetic resonance imaging (MRI) (n=60), and contrast-enhanced multislice computed tomography (MSCT) of the heart (n=90), and, if indicated, coronary angiography (CAG) (n=33) and myocardial scintigraphy (n=27) were performed. The diagnosis of LVNC was confirmed in 74 cases using two methods, and in 21 cases, using three imaging methods. DNA diagnostics was performed in most patients. For most patients, the level of anticardiac antibodies and the genome of cardiotropic viruses were determined in the blood. Mean left ventricular (LV) ejection fraction (EF) was 38.6±14.0%; LV end-diastolic volume (EDV) was 158.1±67.8 ml; LV end-diastolic dimension (EDD) was 6.1±0.9 cm; and left atrial (LA) volume was 97.1±38.1 ml. The mean follow-up period was 14 months [4.0; 41.0]; from 1 month to 10 years.Results. Death rate was 14.4%; heart transplantation was performed in 5.6% of cases. Nonsustained ventricular tachycardia (VT) was detected in 45.6% of cases and sustained VT in 13.6%. The presence of VT was associated with poor R-wave progression in the precordial ECG leads, low QRS voltage, QRS duration >105 ms, NYHA chronic heart failure functional class (CHF FC) ≥2-3, LV EF <40%; LV EDD >6.1 cm, the presence of myocarditis, and higher death rate. Cardioverter defibrillators, including cardiac resynchronization therapy defibrillators (CRTD), were implanted in 38 patients. Appropriate defibrillator shocks were associated with frequent premature ventricular contractions (PVCs). The incidence of thrombosis and embolism was 22.4%. Their predictors included CHF FC ≥2-3, RV anteroposterior dimension >3.1 cm, LA volume >98 ml, E/A >1.65, LV EDD >6.3 cm, LV EDV >153 ml, LV EF <35%, and myocardial necrosis of unknown origin (in patients without coronary atherosclerosis). The incidence of myocardial necrosis in LVNC was 16.0%. The mechanisms identified, in addition to coronary atherosclerosis, were embolism in unchanged coronary arteries, secondary myocarditis, and the presence of genetically determined thrombophilia.Conclusion. LVNC is associated with a high risk of life-threatening conditions, such as ventricular arrhythmias, thrombosis and embolism, and myocardial necrosis, that are typical complications of LVNC in adults. Reassessing the predictors for the risk of thromboembolic and arrhythmic events, specifying the indications for implantable cardioverter defibrillator and anticoagulants, and actively identifying and treating concomitant myocarditis are essential.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка риска фибрилляции предсердий (ФП) у пациентов с хронической сердечной недостаточностью (ХСН) при помощи Холтеровского мониторирования и дистанционной записи ЭКГ портативным одноканальным аппаратом. МАТЕРИАЛ И МЕТОДЫ В исследовании приняли участие 100 пациентов с ХСН 1—4-го функционального класса по NYHA с синусовым ритмом. Всем пациентам выполнен расширенный протокол эхокардиографии (ЭхоКГ) с определением глобальной деформации миокарда левого предсердия и диастолической дисфункции. Наряду с суточным мониторированием ЭКГ, проводили дополнительное 3-суточное мониторирование, а также дистанционное наблюдение за параметрами ЭКГ средствами телемедицинских технологий (аппарат CardioQVARK). Срок наблюдения составил 1 мес или до выявления эпизода ФП. РЕЗУЛЬТАТЫ В ходе исследования у 20 (20%) пациентов выявлен пароксизм ФП различными способами. При записи ЭКГ по жалобам выявлено 10% пароксизмов ФП. С помощью холтеровского мониторирования ЭКГ в течение 24, 48 и 72 ч выявлены 5, 10 и 20% случаев ФП соответственно. При использовании одноканального аппарата CardioQVARK 1, 2 и 3 раза в сутки пароксизмы ФП выявлены в 5, 55 и 15% случаев соответственно. Это показывает значительное преимущество переносного аппарата для записи ЭКГ по отношению к другим методам контроля синусового ритма у пациентов с ХСН. Также отмечено значимое изменение показателей у пациентов с выявленной ФП. Фракцию выброса левого предсердия (ФВ ЛП) <36% чаще выявляли у пациентов с пароксизмами ФП (отношение шансов (ОШ) 5,3, 95% ДИ 1,8—15,6, p=0,001). Глобальную деформацию миокарда ЛП <9,5% чаще выявляли у пациентов с пароксизмами ФП (ОШ 12,2, 95% ДИ 3,7—40,2, p=0,003). TDI E med <6,5 см/с также чаще выявляли у пациентов с пароксизмами ФП (ОШ 10,2, 95% ДИ 2,2—47,6, p=0,001). ВЫВОД Риск ФП у пациентов с ХСН высокий (до 20%). При ведении пациентов с ХСН целесообразно использование дистанционных методов контроля ЭКГ для раннего выявления пароксизмов ФП и своевременного начала антикоагулянтной терапии. ЭхоКГ у данной группы пациентов целесообразно проводить с оценкой показателей глобальной деформации миокарда ЛП для определения риска ФП.

Objective. To evaluate the alterations of Global longitudinsl strain (GLS) and it’s value for prediction of cardiotoxicity of low to moderate cumulative doses of anthracyclines. Methods. Forty-nine women 50 ± 10 years old with breast cancer, treated with anthracyclines (cumulative dose of 251 ± 60 mg/m2) were enrolled in the study. Echocardiography with GLS measurement was performed at baseline, at the end of anthracycline treatment, then every 3 months during 1 year. Cardiotoxicity was defined as a decline in left ventricular ejection fraction (LVEF) of at least 10 % to ≤ 53 %. Results. There was a significant increase in mean LVESV and LVEDV and decrease of GLS (р < 0,05) but not LVEF at 3 month post anthracycline treatment. Cardiotoxicity was detected in 8 patients (16 %) with moderate baseline risk. Absolute ≥ 4 % reduction of GLS during follow-up, GLS andpercent of it’s reduction from baseline to 3 month post-anthracycline were predictive of cardiotoxicity (AUC = 0,822 and 0,870, respectively). The reduction in GLS of >12,5 % from baseline at 3 month post anthracyclines was predictive of cardiotoxicity with sensitivity of 80 % and specificity of 95 %. Conclusions. GLS and its reduction from baseline has shown predictive value for development of cardiotoxicity in patients with moderate risk treated with low-to moderate cumulative doses of antracyclines. Additional echocardiography with GLS assessment at 3–6 month after completion of anthracycline treatment may be recommended irrespective of cardiotoxicity risk.

ЦЕЛЬ ИССЛЕДОВАНИЯ Описать протокол диастолического стресс-теста у пациентов с ишемической болезнью сердца (ИБС) с указанием временных рамок оценки диастолической функции (ДФ) левого желудочка (ЛЖ), а также определить диагностическую точность диастолического стресс-теста по разработанному протоколу в верификации ИБС. МАТЕРИАЛ И МЕТОДЫ Обследованы 80 пациентов старше 18 лет; 12 из них имели подтвержденные данные о перенесенном инфаркте миокарда со снижением систолической функции ЛЖ; 15 — исходно сниженную ДФ ЛЖ. Средний возраст пациентов составил 56,0±12,2 года. Пациенты с абсолютными противопоказаниями к нагрузочному тестированию входили в группу исключения. Всем пациентам после сбора анамнеза, физикального осмотра, измерения артериального давления и электрокардиографии в покое была выполнена стресс-эхокардиография с использованием тредмил-теста. Оценку ДФ начинали на 10, 20, 40 и 60-й секундах после прекращения нагрузки в течение в среднем 12 с. Всем пациентам была выполнена визуализация коронарных артерий с контрастированием. РЕЗУЛЬТАТЫ Наибольшая диагностическая точность динамики параметров ДФ ЛЖ (сравнение данных ДФ до и после нагрузки) в выявлении значимого поражения коронарного русла выявлена на 10—20-й секунде после нагрузки: чувствительность 81,2% (95% ДИ 65,1—92,5), специфичность 89,3% (95% ДИ 82,0—97,7), прогностическая значимость положительного результата 90,2% (95% ДИ 80,0—95,2), прогностическая значимость отрицательного результата 84,6% (95% ДИ 77,2—93,2), диагностическая точность 86,9% (95% ДИ 80,2—94,2). ВЫВОД Оценку параметров ДФ ЛЖ после достижения пика нагрузки при тредмил-тесте оптимально начинать в течение 40 с после нагрузки. Следует получить необходимые изображения в течение 10—15 с. Анализ параметров ДФ, зарегистрированных с 40—60-й секунды после нагрузки, приводит к снижению чувствительности и специфичности диастолического стресс-теста.

Thromboembolic syndrome, the frequency of which is 8–15%, is the main danger for a patient with atrial fibrillation (AF). The left atrial appendage is the most common source of thromboembolia in atrial fibrillation. The frequency of detection of left atrial appendage thrombus in AF is 15.2% in the absence of anticoagulant therapy and 1–8% in patients using this group of drugs. The reason for the formation of thrombi in this localization during anticoagulant therapy today it is not reliably known. This article describes a clinical case of a 67-year-old patient with persistent AF and left atrial appendage thrombosis, who was hospitalized to determine further management strategies. A left atrial appendage thrombus lasted for a year despite continuous anticoagulant therapy with various oral anticoagulants at doses consistent with clinical guidelines due to the patient's absolute refusal to take warfarin, vitamin K antagonist. In addition, this article discusses the use of Thrombodynamics, a new global coagulation test, in patients with AF, which revealed a plasma hypercoagulable state with underlying persistent thrombosis in this patient on continuous oral anticoagulant treatment. The Thrombodynamics test is a promising procedure for assessing the coagulation system state and may be promising as a method for measuring the effectiveness of any oral anticoagulant. However, it is impossible to draw any definite conclusions on the basis of single observations; large clinical studies with the potential of long-term case follow-up of patients are needed.

Aim. To evaluate the correlation of values of left atrial (LA) strain in patients with atrial fibrillation (AF) who underwent cardioversion (CV) with AF recurrence, hospitalization or death in early and late periods after cardioversion.Material and methods. 85 patients of the University Clinical Hospital No. 1 of Sechenov University were examined: 30 men (35.3 %) and 55 women (64.7 %), the average age was 70 ± 8 years. All patients underwent speckle tracking, the parameters of LA strain and LA stiffness index were determined upon admission to the hospital after CV; after 1, 3, 6 months, a relapse of AF, the fact of hospitalization for cardiovascular reasons, and death were detected.Results. 4 people died during the follow-up, 37 hospitalizations were registered due to a relapse of AF, 7 developed a long-term persistent/permanent form of AF. The predictors associated with the onset of adverse events at the 3rd month were: reduction of the negative peak in the 4-chamber position (risk ratio (HR) 1.26, 95 % confidence interval (CI) 1.05, 1.51; p=0.009), reduction of LA strain in the 4-chamber position (HR 0.85, CI 0.75, 0.96; p=0.007), reduction of positive strain peaks in the 4-chamber (HR 0.44, CI 0.25, 0.77; p<0.001) position. When analyzing the data of the sixth month of observation, the predictors were: reduction of negative strain peak in 4-chamber (HR 1.33, CI 1.05, 1.69, p=0.009) and 2-chamber (HR 1.23, CI 1.01, 1.5; p=0.029) positions, reduction of global longitudinal strain LA (HR 0.83, CI 0.72, 0.95; p=0.004), high left atrial stiffness index (HR 15.3, CI 6.56, 35.9; p<0.001).Conclusion. Evaluation of LA strain parameters during speckle- tracking may be promising in patients with AF after CV, since their decrease correlates well with the risk of adverse events in the long-term periods (3 and 6 months after CV).

Aim. To study the place of NCM in the structure of DCM, its clinical features and influence on prognosis in comparison with other forms of DCM syndrome.Methods. The NCM registry includes 125 patients, mean age 46.4±15.1 years, 74 men and 51 women, median follow-up 14 [4.0; 41.0] months. The DCM registry included 365 patients, mean age 46.4±15.1 years, 253 men and 112 women, median follow-up 14 [5; 43.75] months. The examination included electrocardiography (ECG), ECG Holter monitoring, echocardiography, blood anti-heart antibody level evaluation, and additionally cardiac computed tomography, magnetic resonance imaging, DNA diagnostics (in the MYH7, MYBPC3, TPM1, TNNI3, TNNT2, ACTC1, TAZ, ZASP (LDB3), MYL2, MYL3, DES, LMNA, EMD, TTR gene panel), coronary angiography, right ventricular endomyocardial biopsy.Results. The proportion of patients with DCM phenotype in the NCM registry was 40% (n=49), another 11% (n=15) had NCM diagnosed simultaneously with acute/subacute myocarditis. Lethality in these subgroups was 12.2% and 33.3%, respectively, and was significantly higher than in asymptomatic, ischemic and arrhythmic variants of NCM. In the DCM registry, the proportion of patients with NСM was 21% (n=78), and increased left ventricular (LV) trabecularity was detected in another 18% (n=64). DCM patients with and without NСM did not differ by baseline echocardiographic parameters, heart failure class, and cardiotropic therapy. Pathogenic mutations were detected in 14% of DCM patients with NCM and only 3% of other patients with DCM (p<0.001). Only in patients without NCM the presence of mutations had a significant effect on lethality. The patients with NCM compared with the others DCM patients showed significantly lower increase in EF in early and late period (from 31.0±10.2 to 34.8±11.0 and 37.1±10.9% [р<0.05] vs from 31.8±9.7 to 38.8±11.3 and 42.3±12.4% [р<0.01] respectively), a greater incidence of premature ventricular beats (1568 [105;7000] vs 543.5 [77.75; 3194], p<0.05), appropriate defibrillator shocks and sudden deaths (17.9 vs 5.9%, p<0.001), intracardiac thrombosis (21.8 vs 13.5%, p=0.069) despite a greater frequency of anticoagulants (73.1 vs 57.4%, p<0<05). There were no significant differences in death (19.2 vs 18.5%) and transplantation (7.7 vs 3.8%) between patients with and without NCM. There were no cases of NCM regression.Conclusion. NCM is an independent form of DCM syndrome, which is characterized by higher frequency of pathogenic mutations, arrhythmic events, worse response to cardiotropic therapy, higher frequency of intracardiac thrombosis. The absence of mortality differences can be explained by the higher frequency of preventive interventions in this category of patients with DCM (prescription of anticoagulants, defibrillator implantation, heart transplantation).

The long-lasting efficacy of the diuretic acetazolamide in the therapy of Cheyne–Stokes respiration (CSR) was assessed in the pilot study in patients with chronic heart failure (СHF) and reduced left ventricular ejection fraction (LVEF). A cohort of 21 patients included in the study had stable CHF II to IV functional class (according to NYHA) and CSR. All patients passed standard clinical-laboratory examinations, the arterial blood gas test, and cardiorespiratory monitoring during sleep. The subjects were randomized into two groups. Patients in the intervention group ( n = 10) received a standard medical therapy in combination with a 250-mg dose of acetazolamide once a day while those in the control group ( n = 11) received only a standard therapy. The observational period comprised 12 months. The mean apnea-hypopnea index (AHI) in the intervention group decreased significantly after 3 months from 32 to 13 ( р = 0.005). No significant changes were observed in AHI in the control group. A statistically significant decrease (from 7.43 to 7.39; p = 0.007) in pH was recorded in the acetazolamide group. During further observation, 1 patient (10%) in the acetazolamide group and 4 patients (36.4%) in the control group died (the difference is nonsignificant). Treatment with acetazolamide at a daily dose of 250 mg significantly reduces the severity of CSR in patients with CHF. Acetazolamide may be recommended for the CSR therapy in patients with CHF.

Aim. To study the significance of monitoring high-sensitivity troponin I (hs-cTnI) for predicting anthracycline-induced left ventricular (LV) dysfunction in the treatment of breast cancer in patients with moderate and low risk of cardiotoxicity (CT). Material and methods . The study involved 49 patients with breast cancer aged 50±10 years who underwent neoadjuvant or adjuvant chemotherapy, which included doxorubicin at a course dose of 60 mg/m 2 and an average cumulative dose of 251±60 mg/m 2 . The level of hs-cTnI was determined by an ultrasensitive method before the start of chemotherapy, after each course of anthracyclines and in 18 patients before the administration of anthracyclines. The level of hscTnI >0,017 ng/ml was considered elevated. Echocardiography was performed before the start of chemotherapy, after the end of anthracycline therapy, and every 3 months for 12 months thereafter. CT was defined as a decrease in LV ejection fraction (EF) by ≥10% to <53%. Results . CT risk before chemotherapy was considered low and moderate in 96% of patients. An increase in hs-сTnI was detected ≥1 times in 56,8% of patients: before chemotherapy — in 13,5%, after 1 and 2 courses of anthracycline therapy — in 13,9%, after 3, 4, 5 and 6 courses — in 44%, 62%, 71% and 66% of patients, respectively. The levels of hs-cTnI before and after administration of anthracyclines did not differ significantly. The development of LV dysfunction was observed in 16,3% of patients. There were following prognostic significance of an increase in hs-cTnI at any time of chemotherapy for a decrease in LV EF: sensitivity — 87,5%, specificity — 50%, the positive predictive value — 28%, the negative predictive value — 94,7%. The closest relationship was noted between CT and hs-cTnI value before the start of chemotherapy (β=0,45, p=0,005) and after the 3 rd course of anthracycline therapy (β=0,56, p=0,002). Conclusion. An increase in hs-cTnI level before and during anthracycline thera py in patients with a low risk of cardiotoxicity has a prognostic value in relation to the development of left ventricular dysfunction. Hs-cTnI assessment should be performed before the start of therapy, and then starting from the 3rd course of anthracycline therapy in all patients, regardless of the risk of cardiotoxicity.

The article focuses on ultrasound diagnosis of cardiac tumors (CT). In recent time, the frequency of detecting cardiac neoplasm has been growing. Correct diagnosis at an early stage of the process would allow timely treatment. Before the introduction of two-dimensional echocardiography (EchoCG), life-time diagnosis of CT was very rare. This article describes major echocardiographic criteria for most common benign, malignant, and metastatic CTs. The article is illustrated with original echocardiographic images.

Aim. To evaluate the effectiveness of myocarditis therapy depending on the diagnosis approach (with or without myocardial biopsy).Material and methods. The study included 83 patients ≥18 years old with severe and moderate myocarditis (25 women and 58 men; mean age, 45,7±11,7 years), established by myocardial biopsy (group 1, n=36) or by a non-invasive diagnostic algorithm (group 2, n=47), for which immunosuppressive therapy (IST) was carried out. Inclusion criteria were left ventricular (LV) end-diastolic dimension >5,5 cm and ejection fraction (EF) <50%. An endomyocardial (n=31) or intraoperative (n=5) biopsy with a study of the viral genome and level of anticardiac antibodies were performed. Coronary angiography (29%), cardiac multislice computed tomography (75%), cardiac magnetic resonance imaging (41%), and 99mTc-MIBI scintigraphy (35%) were also carried out. The mean follow-up period was 3 years (36 [12; 65] months). The study was approved by the Intercollegiate Ethics Committee.Results. The groups were completely comparable in age, baseline parameters (class III [2,25; 3] and III [2; 3] heart failure (HF); end-diastolic LV dimension, 6,7±0,7 and 6,4±0,7 cm; EF, 29,9±8,7 and 31,4±9,3%), the extent of cardiac therapy (excluding the administration rate of в-blockers — 94,4 and 78,7%, p<0,05) and 1ST (methylprednisolone in 91,7 and 89,4% of patients at a mean dose of 24 [16; 32] and 20 [15; 32] mg/day, azathioprine in 50,0 and 46,8% of patients at a mean dose of 150 mg/day or mycophenolate mofetil 2,0 g/day in 30,6% in group 1, hydroxychloroquine 0,2 g/day in 27,8 and 23,4%). Biopsy in group 1 revealed active/borderline (61/39%) myocarditis, in 8 patients — viral genome in the myocardium, including parvovirus B19 in 7 of them. Both groups showed a comparable significant increase in EF after 6 months up to 37,6±8,1 and 42,6±11,5% (p<0,001) and after 27 [12; 54] months up to 43,4±9,6 and 45,5±12,3% (p<0,001), as well as a significant decrease in HF class to 2 [1; 2] in both groups. An increase in EF by ≥10% was recorded in 70 and 72% of patients, respectively. The mortality rate was 13,9 and 12,8%. Taking into account the only transplantation in group 2, the death+transplantation endpoints reached 13,9 and 14,9% of patients (without significant differences between the groups).Conclusion. In patients with severe and moderate myocarditis diagnosed with and without myocardial biopsy, the effectiveness of combined therapy, including IST, was comparable. If it is impossible to perform a biopsy, complex non-invasive strategy makes it possible to diagnose myocarditis with different probability rate and conduct an effective IST, the refusal of which mostly is not justified.

Abstract Introduction Noncompact myocardium (NCM) is a cardiomyopathy with various genetic causes and clinical manifestations; its relationship with other forms of dilated cardiomyopathy (DCM) and its impact on prognosis are unclear. Objective To study the place of NCM in the structure of DCM, its clinical features and influence on prognosis in comparison with other forms of DCM syndrome. Methods The NCM registry includes 125 patients, mean age 46.4±15.1 years, 74 men and 51 women, mean follow-up 14 [4.0; 41.0] months. The DCM registry included 365 patients, mean age 46.4±15.1 years, 253 men and 112 women, mean follow-up 14 [5; 43.75] months. The examination included ECG, ECG Holter monitoring, echocardiography, blood anti-heart antibody level evaluation, and additionally cardiac CT, MRI, DNA diagnostics (in the MYH7, MYBPC3, TPM1, TNNI3, TNNT2, ACTC1, TAZ, ZASP (LDB3), MYL2, MYL3, DES, LMNA, EMD, TTR gene panel), coronary angiography, right ventricular endomyocardial biopsy. Results The proportion of patients with DCM phenotype in the NCM registry was 40% (n=49), another 11% (n=15) had DCM syndrome diagnosed simultaneously with acute/subacute myocarditis. Lethality in these subgroups was 12.2% and 33.3%, respectively, and was significantly higher than in asymptomatic, ischemic and arrhythmic variants of DCM. In the DCM registry, the proportion of patients with NCM was 21% (n=78), and increased left ventricular (LV) trabecularity was detected in another 18% (n=64). DCM patients with and without NCM did not differ by baseline echocardiographic parameters, heart failure class, and cardiotropic therapy. Pathogenic mutations were detected in 14% of DCM patients with NCM and only 3% of other patients with DCM (p<0.001). Only in patients without NCM the presence of mutations had a significant effect on lethality. The patients with NCM compared with the others DCM patients showed significantly lower increase in EF in early and late period (from 31.0±10.2 to 34.8±11.0 and 37.1±10.9% vs from 31.8±9.7 to 38.8±11.3 and 42.3±12.4%, p<0.05 vs 05 and <0.01, respectively), a greater incidence of PVBs (1568 [105; 7000] vs 543.5 [77.75; 3194], p<0.05), appropriate defibrillator shocks and sudden deaths (17.9 vs 5.9%, p<0.001), intracardiac thrombosis (21.8 vs 13.5%, p=0.069) despite a greater frequency of anticoagulants (73.1 vs 57.4%, p<0<05). There were no significant differences in death (19.2 vs 18.5%) and transplantation (7.7 vs 3.8%) between patients with and without NCM. There were no cases of NCM regression. Conclusion NCM is an independent form of DCM syndrome, which is characterized by higher frequency of pathogenic mutations, arrhythmic events, worse response to cardiotropic therapy, higher frequency of intracardiac thrombosis. The absence of mortality differences can be explained by the higher frequency of preventive interventions in this category of patients with DCM (prescription of anticoagulants, defibrillator implantation, heart transplantation). Funding Acknowledgement Type of funding sources: None.

ВТОРИЧНОЕ ПОРАЖЕНИЕ ПЕРИКАРДА ПРИ РАКЕ ЯИЧНИКОВБеляевская А.А

The aim of the study – to evaluate the parameters of left atrial myocardial strain in patients with atrial fibrillation who underwent electrical and drug cardioversion. Materials and methods. The study included 118 patients of the University Clinical Hospital No 1 of the First Sechenov Moscow State Medical University. The analysis was carried out in three groups of patients: group 1 (n=54) – patients with atrial fibrillation who underwent electrical cardioversion; group 2 (n=31) – patients with atrial fibrillation who underwent drug cardioversion; group 3 (n=43) – patients without a history of atrial fibrillation. The clinical and anamnestic data of the medical history of each patient, as well as ultrasound indicators were evaluated: global strain of the left atrial, the values of negative peaks as a reflection of the left atrial systole and the values of positive peaks as a reflection of the filling of the left atrium, LASI – the left atrial stiffness index. Results. The analysis showed that left atrial strain in patients with atrial fibrillation were reduced in all analyzed parameters: negative strain peaks (-9.00 vs. -12.6 in the control group, p<0.001), positive strain peaks (12.6 vs. 14.6 in the control group, p<0.001), global left atrial strain (21.5 in the atrial fibrillation group vs. 27.3 in the control group, p<0.001). Left Atrial Stiffness Index (LASI) was significantly higher in patients with a stopped episode of atrial fibrillation (0.50 vs. 0.40, p=0.006). Conclusions. The indicators of left atrial strain were significantly reduced, and the left atrial stiffness index was significantly increased both in the group with electrical cardioversion and in the group with drug-induced cardioversion, compared with patients with similar cardiovascular pathologies, but without a history of atrial fibrillation episodes.

Background. A few cases of combination of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) with left ventricular noncompaction (LVNC) have been described. Aims to study the genetics, diagnostical features and clinical course of the combination of ARVC with LVNC. Methods. 58 patients with ARVC diagnosis (26 men; mean age 39.1 14.2 years; mean follow-up period 21.5 [6; 60] months) and 125 patients with LVNC (74 men; mean age 46.4 15.1 years; mean follow-up period 14 [3; 40] months). All patients underwent electrocardiogram (ECG), echocardiography, 24-h ECG monitoring. Heart MRI was performed in 53 (91.4%) patients with ARVC and 60 (48%) with LVNC, heart CT in 18 (31%) patients with ARVC and 89 (71.2%) with LVNC. For all patients with combination of ARVC and LVNC DNA-diagnostic was performed using both ARVC (PKP2, DSG2, DSP, DSC2, JUP, TMEM43, TGFB3, PLN, LMNA, DES, CTTNA3, EMD, SCN5A, LDB3, CRYAB, FLNC) and LVNC (MYH7, MYBPC3, TAZ, TPM1, LDB3, MYL2, MYL3, ACTC1, TNNT2, TNI3) gene panels. Results. Combination of ARVC and LVNC was found in 9 patients (15.5% of patients form ARVC cohort and 7.2% from LVNC cohort). These patients were distinguished from patients with isolated ARVC or LVNC by aggressive ventricular arrhythmias (frequent premature ventricular beats, sustained ventricular tachycardia, significantly worse antiarrhythmic therapy effect, appropriate shocks of implanted cardioverter-defibrillators (ICD) in all patients with ICD). Patients with combination of ARVC + LVNC were also distinguished from patients with isolated LVNC by the dilatation of RV, low QRS voltage on ECG, presence of AV block, absence of signs of LV hypertrophy on ECG. LV dilatation with reduction of its ejection fraction distinguished patients with mixed cardiomyopathy from patients with isolated ARVC. Potentially pathogenic variants (IVV classes of pathogenicity) and variants of unclear clinical significance (III class of pathogenicity) were found in both desmosomal and non-desmosomal genes in 78% of patients, including 3 (33%) in DSP gene. Conclusions. The combination of ARVC and LVNC can be caused by mutations in both desmosomal and non-desmosomal genes and has typical features: aggressive, resistant ventricular rhythm abnormalities leading to appropriate ICD shocks and a high risk of sudden cardiac death.

Abstract Purpose To study clinical features of endocarditis and its possible mechanisms (infective and nonbacterial) in the long-term period after acute COVID-19. Methods Three patients (two male and one female, age 64, 39 and 46 years) diagnosed with postcovid endocarditis were included in the study. One patient had severe bilateral coronavirus pneumonia; the other two had only fever and weakness. The diagnosis of COVID-19 was confirmed by seroconversion. The time of admission after COVID-19 was from 4 to 7 months. All patients had study for anti-heart antibodies (AHA), EchoCG, Holter ECG, and endomyocardial biopsy (EMB) with PCR for SARS-Cov2 and cardiotropic viruses. The indication for EMB was suspected myocarditis. Blood cultures and procalcitonin levels were tested in one patient due to a prolonged febrile fever. Results Two variants of postcovid endocarditis have been diagnosed. The first variant was detected in two patients by EMB only. This patients had severe lymphocytic and giant cell myocarditis. In addition, EMB showed signs of lymphocytic endocarditis with infiltrates, marked thickening and fibrosis of the endocardium (Fig. 1). Some biopsy specimen were represented by fresh thrombotic masses, infiltrated with neutrophilic leukocytes. No intraventricular thrombus was detected on EchoCG and MRI. The second variant of postcovid endocarditis developed in a patient with bicuspid aortic valve and met the criteria of infectious endocarditis 2015: mobile vegetations on the valve with aortic regurgitation II, splenomegaly, irregular fever up to 39°C for six months, marked increase of CRP, procalcitonin and ferritin, hypochromic anemia, LV EF 25%. Blood culture was negative. After intravenous therapy with antibiotics and immunoglobulin, EMB confirmed the active lymphocytic myocarditis and only slight fibrosis of right ventricular endocardium. The bacteriological study of endocardium was negative. SARS-Cov-2 RNA was detected by PCR in myocardial biopsy specimens of two patients; the biopsy of one patient is in the study now. All patients had significantly elevated antibody titers to various cardiac antigens, but the level of antibodies to endothelial antigens remained completely normal. It is possible to suggest an active deposition of immune complexes in the endothelium. Two surviving patients receive steroid therapy (in case of IE with antibiotics). Conclusions SARS-Cov-2 infection induces the prolonged non-bacterial thromboendocarditis or infective endocarditis. In both cases, autoimmune mechanisms play a significant role, as evidenced by the simultaneous lymphocytic/giant cell myocarditis and high titers of AHA. Long-term persistence of coronavirus in the myocardium can also be considered as an etiological factor of endocarditis. In favor of this hypothesis is the parietal thrombosis in the absence of bacterial infection. Corticosteroids and anticoagulants should be considered for the treatment of postcovid endocarditis. Funding Acknowledgement Type of funding sources: None. Figure 1. The EMB in in postcovid endocarditis